1. Medical-Surgical Nursing: Concepts & Practice
3rd edition
Chapter 20
Care of Patients with Coronary Artery Disease and Cardiac Surgery
Copyright © 2017, Elsevier Inc. All rights reserved.

2. Coronary Artery Disease
Etiology
Cultural considerations
Pathophysiology
Coronary insufficiency
Cardiac reserve and older adults
Signs and symptoms
Acute coronary syndrome
Diagnosis
Treatment
Complementary and alternative therapies

3. Progression of Atherosclerosis
See Figure 20-1 on p. 452.
From Lewis SL, Heitkemper MM, Dirksen SR, et al: Medical-surgical nursing: assessment and management of clinical problems, ed. 8, St. Louis, 2011, Mosby.

4. Signs and Symptoms of Coronary Artery Disease
Chest discomfort, including feeling of tightness, aching, burning
Chest pain (angina pectoris) radiating to the arm, jaw, or back
Dyspnea (shortness of breath)
Palpitations or tachycardia
Nausea and vomiting
See Box 20-1 on p.452.

5. Nursing Management Aspirin to prevent MI
Lower fat and cholesterol in the diet

6. Angina Pectoris Signs and symptoms Diagnosis Treatment
Stable or exertional angina
Variant or vasospastic angina
Unstable angina
Diagnosis
Treatment
Nursing management
There are three types of angina:
Stable or exertional angina: triggered by physical activity or stress and related to atherosclerosis. The goal of therapy is to reduce intensity and frequency of attacks.
Variant or vasospastic angina: caused by coronary artery spasms which restrict the blood flow to the myocardium. The goal of treatment is to reduce the number and severity of attacks.
Unstable angina: usually caused by occlusion of coronary arteries. Angina pain occurs even at rest; may not respond well to drug therapy; may require immediate surgery.

7. Stenosis of the Left Anterior Descending Coronary Artery
See Figure 20-2 on p. 454.
From Chabner DA: The language of medicine, ed. 6, Philadelphia, 2001, Saunders.

8. Acute Myocardial Infarction
Etiology and pathophysiology
Signs and symptoms
Diagnosis
Electrocardiography
Cardiac enzymes
Cardiac catheterization and angiography
Treatment
MONA

11. Tests Performed to Determine Myocardial Infarction
Troponin I (TnI)
Troponin T (TnT)
Creatine phosphokinase
CK-MB  
Myoglobin
See Table 20-2 on p. 458

12. The Joint Commission Core Measures for Myocardial Infarction
Aspirin administered within 24 hours of arrival at the hospital or within 24 hours before arrival
Beta blocker started within 24 hours of arrival
Thrombolytic agent administered within 30 minutes of hospital arrival
Aspirin therapy at discharge
See Box 20-2 on p. 454.

13. The Joint Commission Core Measures for Myocardial Infarction (Cont.)
Beta-blocker therapy continued at discharge
Angiotensin-converting enzyme (ACE) inhibitor therapy at discharge for left ventricular ejection fraction less than 40%
Patients with a history of cigarette use within past year given smoking cessation advice or counseling during hospitalization

14. Treatment Oxygen Sublingual nitroglycerin Morphine sulfate
Thrombolytic agents
Pacemaker
Acute care
Critical care
Intermediate care
Rehabilitation

15. Acute Coronary Syndrome: Nursing Management
Pain relief
Rest
Medications and side effects
Frequent cardiovascular assessment
Weight and intake and output
Vascular access
Activity
Decreasing anxiety
Rehabilitation

16. Signs and Symptoms of Complications after Myocardial Infarction
Dysrhythmia
Heart failure
Cardiogenic shock
Papillary muscle dysfunction
Ventricular aneurysm
Pericarditis
Dressler syndrome
See Table 20-3 on p. 460.

17. Emotional and Behavioral Responses to Acute Myocardial Infarction
Denial
Anger
Anxiety and fear
Dependency
Depression
Realistic acceptance
See Box 20-3 on p. 462.

18. Cardiogenic Shock Signs and symptoms Decreased cardiac output
Confusion; restlessness; diaphoresis; rapid, thready pulse; increased respiratory rate; cold, clammy skin; and diminishing urinary output to less than 20 mL/hr
Decreased cardiac output

19. Intra-aortic Balloon Pump (IABP)
Uses a balloon catheter positioned in the aorta that inflates during diastole and deflates during systole, effectively decreasing the workload of the heart and increasing blood flow through the coronary arteries

20. Surgical and Nonsurgical Treatment Options
Percutaneous transluminal coronary angioplasty (PTCA)
Proton pump inhibitors
Transmyocardial laser revascularization
Cardiac surgery
Coronary artery bypass surgery
Heart transplant

23. Nursing Care of the Patient Having Cardiac Surgery
Preoperative care
Diagnostic tests and examinations
Teaching
Psychological preparation

24. Nursing Care of the Patient Having Cardiac Surgery (Cont.)
Postoperative care
Early postoperative period and critical care
Frequent assessment of respiratory and cardiac status
Care of invasive lines and chest tubes
Wound assessment and care
Fluid and electrolyte balance
Pain management
Assessment of emotional status

25. Cardiac Rehabilitation
Home recovery period
Dressler syndrome
Depression
Preventing infection to the surgical sites and managing wounds
Monitoring for complications

26. Community Care Restore and maintain optimal physiologic function.
Improve psychological outlook.
Maintain ability to work and social well-being.