Acute Coronary Syndrome for Certified Emergency Nursing (CEN)
Included In This Lesson
Study Tools For Acute Coronary Syndrome for Certified Emergency Nursing (CEN)
Outline
Acute Coronary Syndrome
Definition/Etiology:
Acute Coronary Syndrome
Chest pain caused by decreased oxygen supply to the heart (myocardial ischemia)
Acronyms:
ACS – acute coronary syndrome
AMI – acute myocardial infarction = heart attack
N-STEMI – non-ST elevation myocardial infarction
STEMI – ST elevation myocardial infarction
SOB – shortness of breath
MONA – morphine, oxygen, nitroglycerin, aspirin
Pathophysiology:
Acute Coronary Syndrome
(How, why)
Word Play:
Acute coronary syndrome (ACS) – think coronary artery
Coronary artery – blood supply of heart muscle
Syndrome = symptoms
Four stages:
SUNS
Short, Unrelieved, Not okay, Severe
Stable angina, Unstable angina, N-STEMI, STEMI
Highway – on the way to an important test
Stable angina – cone in the middle of the road
Unstable angina – lane closure
N-STEMI – accident intermittent closure
STEMI – highway closed (bypass – see alternate route)
Clinical Presentation:
Stable angina – chest pain upon exertion, short lived, relieved by rest or meds
Unstable angina – chest pain occurs at any time, unrelieved by rest or meds, negative troponin, maybe ST depression
ST depression = ischemia (not enough oxygen)
N-STEMI – AMI ischemic chest pain, intermittent coronary occlusion/blockage, no ST elevation (maybe ST depression), positive troponin, admission pt not okay
STEMI – AMI, obstructed coronary artery with thrombosis, ST elevation, positive troponin, immediate intervention = severe and life threatening
AMI
Chest pain or discomfort (burning, crushing, tightness, pressure, and aching)
Radiation – arm, neck, jawline, back, or shoulder
Other – nausea/vomiting, “indigestion,” SOB, diaphoresis, dizziness, syncope, palpitations, tachycardia, bradycardia
Collaborative Management:
- 12-lead ECG
- Treat chest discomfort
- Continuous monitoring
- Cardiac enzymes – troponin, CK-MB
- Chest x-ray and labs
- Pharm management – MONA
- STEMI
- Reperfusion! Reperfusion! Reperfusion!
- Gold standard – PCI <90 minutes
- Fibrinolytics – “who’ya gunna call; clot busters”
- Post – beta-blockers, ace inhibitors, ARB if no ACE inhibitors
Evaluation | Patient Monitoring | Education:
Keep on monitor. Frequent BPs. Enough IVs in case of arrest? Watch out for changes (EKG, LOC, etc.). SAFETY – even in ER.
Linchpins: (Key Points)
Decreased oxygen supply
SUNS
Short, Unrelieved, Not okay, Severe
Stable angina, Unstable angina, N-STEMI, STEMI
Highway – on the way to an important test
Stable angina – cone in the middle of the road
Unstable angina – lane closure
N-STEMI – accident intermittent closure
STEMI – highway closed (bypass – see alternate route)
Transcript
For more great CEN prep, got to the link below to purchase the “Emergency Nursing Examination Review” book by Dr. Laura Gasparis Vonfrolio RN, PHD
https://greatnurses.com/
References:
- Nelson, N. (2017). Cardiovascular Emergencies. In CEN
- Online Review. Emergency Nurses Association.
Study Guide pre LPN-RN
Concepts Covered:
- Cardiac Disorders
- Cardiovascular
- Emergency Care of the Cardiac Patient
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Lower GI Disorders
- Central Nervous System Disorders – Brain
- Neurological
- Noninfectious Respiratory Disorder
- Respiratory
- Hematologic Disorders
- Delegation
- Perioperative Nursing Roles
- Acute & Chronic Renal Disorders
- Respiratory Emergencies
- Disorders of the Adrenal Gland
- Documentation and Communication
- Preoperative Nursing
- Legal and Ethical Issues
- Immunological Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Medication Administration
- Vascular Disorders
- Renal Disorders
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Gastrointestinal Disorders
- Newborn Complications
- Peripheral Nervous System Disorders
- Studying
- Integumentary Disorders
- Communication
- Microbiology
- Emergency Care of the Trauma Patient
- Urinary Disorders
- Integumentary Disorders
- Musculoskeletal Disorders
- Circulatory System
- EENT Disorders
- Postoperative Nursing
- Neurological Emergencies
- Disorders of Thermoregulation
- Neurological Trauma
- Basics of NCLEX
- Fundamentals of Emergency Nursing
- Integumentary Important Points
- Multisystem
- Test Taking Strategies
- Tissues and Glands
- Urinary System
- Emergency Care of the Neurological Patient
- Neurologic and Cognitive Disorders
- Central Nervous System Disorders – Spinal Cord
- Renal and Urinary Disorders
- Nervous System
- Respiratory Disorders
- Respiratory System
- Infectious Disease Disorders
- EENT Disorders
- Emergency Care of the Respiratory Patient
- Health & Stress
- Skeletal System
- Endocrine System
- Hematologic System
- Digestive System
- Reproductive System
- Endocrine and Metabolic Disorders
- Muscular System
- Sensory System
- Basics of Human Biology
- Adult
- Anxiety Disorders
- Depressive Disorders
- Dosage Calculations
- Understanding Society
- Concepts of Pharmacology
- Newborn Care
- Adulthood Growth and Development
- Pregnancy Risks
- Postpartum Complications
- Substance Abuse Disorders
- Bipolar Disorders
- Learning Pharmacology
- Psychotic Disorders
- Prenatal Concepts
- Prefixes
- Suffixes
- Fetal Development
- Terminology
- Proteins
- Statistics
- Med Term Basic
- Med Term Whole
- Labor Complications
- Labor and Delivery
- Postpartum Care
- Hematologic Disorders
- Cardiovascular Disorders
- Musculoskeletal Disorders
- Oncologic Disorders
- Eating Disorders
- Personality Disorders
- Trauma-Stress Disorders
- Developmental Considerations
- Concepts of Mental Health
- Psychological Emergencies
- Somatoform Disorders
- Prioritization
- Factors Influencing Community Health
- Community Health Overview