Page 141 - Critical Care Nursing Demystified

126 CRITICAL CARE NURSING DeMYSTIFIED

Monitor for worsening of angina intensity or duration, which can indicate
unstable angina or ACS.
Have the patient rest to avoid further increase in demand on the heart and
decreased oxygen need.
Administer and monitor oxygen saturation to ensure an adequate amount of
oxygen to the heart muscle
Administer nitroglycerin sublingually or intranasally to help dilate coronary
arteries and pool blood peripherally away from the heart.
Educate patients about nitrates to help decrease preload and O demand on
2
the heart.
Teach patients that daily acetylsalicylic acid (ASA) is needed to prevent
platelets from adhering and causing a clot in the coronary arteries.

Acute Coronary Syndrome (ACS)
What Went Wrong?
ACS is an all-encompassing syndrome that includes angina, ST segment eleva-
tion myocardial infarction (MI), and acute MI. Angina was described previously Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
in this chapter.
The plaques narrowing the coronary arteries rupture causing a progressive
to complete block of blood flow to the coronary artery, which can lead to an
acute MI.
The three main events that characterize ACS include ST segment elevation
MI, unstable angina, and myocardial infarction. Table 3–13 summarizes the
difference between these three coronary events.

TABLE 3–13 Acute Coronary Syndromes (ACSs)
ST segment Sometimes called a non-Q wave MI. The ST segment of the
elevation myo- ECG in certain leads that look at the left ventricle is elevated.
cardial infarction Cardiac enzymes are also elevated.
Unstable angina Angina that increases in either frequency or duration. This is
a clear message that an MI can occur unless intervention
is swift.
MI (Q wave) Death of myocardial tissue within three muscular coats
called a transmural MI (endo-, myo-, and epicardium). This
leaves a permanent “electrical scar” on a 12-lead ECG called
a “Q” wave, thus the name.