Acute Coronary Syndrome for Certified Emergency Nursing (CEN)
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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)
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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.
- ✓Full lesson outlines
- ✓NCLEX simulator (SIMCLEX)
- ✓6,500+ practice questions
- ✓2,000+ lesson videos
- ✓300+ cheatsheets
200% NCLEX Pass Guarantee.
No Contract. Cancel Anytime.
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