1. Chapter 28 Management of Patients With Coronary Vascular Disorders

2. Treatment (MONA)
Treatment seeks to decrease myocardial oxygen demand and increase oxygen supply
Medications (Morphine, Oxygen, Nitro., Aspirin)
Reduce and control risk factors
Reperfusion therapy may also be done

3. Medications*** Nitroglycerin Beta-adrenergic blocking agents
Calcium channel blocking agents
Antiplatelet and anticoagulant medications
Aspirin
Clopidogrel and ticlopidine
Heparin
Glycoprotein IIB/IIIa agents

4. Collaborative Problems
Acute pulmonary edema
Heart failure
Cardiogenic shock
Dysrhythmias and cardiac arrest
Myocardial infarction

5. Treatment of Angina Pain
Treatment of angina pain is a priority nursing concern.
Patient is to stop all activity and sit or rest in bed.
Assess the patient while performing other necessary interventions. Assessment includes VS, and observation for respiratory distress, and assessment of pain. In the hospital setting, the ECG is assessed or obtained.
Administer oxygen.
Administer medications as ordered or by protocol, usually NTG.

6. Anxiety Use a calm manner Stress-reduction techniques Patient teaching
Addressing patient spiritual needs may assist in allaying anxieties
Address both patient and family needs

7. Chapter 28 Management of Patients With Coronary Vascular Disorders Self-Review

8. Myocardial Infarction
An area of the myocardium is permanently destroyed. Usually caused by reduced blood flow in a coronary artery due to rupture of an atherosclerotic plaque and subsequent occlusion of the artery by a thrombus.
In unstable angina, the plaque ruptures but the artery is not completely occluded. Unstable angina and acute myocardial infarction are considered the same process but at different point on the continuum.
The term acute coronary syndrome includes unstable angina and myocardial infarction.

9. Effects of Ischemia, Injury, and Infarction on ECG

10. Clinical Manifestations and Diagnosis
Chest pain, other symptoms
ECG
Laboratory tests—biomarkers
CK-MB
Myoglobin
Troponin T or I

11. Treatment of Acute MI
Obtain diagnostic tests including ECG within 10 minutes of admission to the ED
Oxygen
Aspirin, nitroglycerin, morphine, beta-blockers
Angiotensin-converting enzyme inhibitor within 24 hours
Evaluate for percutaneous coronary intervention or thrombolytic therapy
As indicated; IV heparin or LMWH, clopidogrel or ticlopidine, glycoprotein IIb/IIIa inhibitor
Bed rest

12. Nursing Process: The Care of the Patient with ACS—Assessment
A vital component of nursing care!
Assess all symptoms carefully and compare to previous and baseline data to detect any changes or complications.
Monitor ECG.

13. Collaborative Problems
Acute pulmonary edema
Heart failure
Cardiogenic shock
Dysrhythmias and cardiac arrest
Pericardial effusion and cardiac tamponade

14. Percutaneous Coronary Intervention

15. Coronary Artery Bypass Grafts

16. Greater and lesser saphenous veins are commonly used for bypass graft procedures.

17. Cardiopulmonary Bypass System

18. Postoperative Care of the Cardiac Surgical Patient