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Acute Coronary Syndrome for Certified Emergency Nursing (CEN)

Acute Coronary Syndrome for Certified Emergency Nursing (CEN)

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Study Tools For Acute Coronary Syndrome for Certified Emergency Nursing (CEN)

Acute Coronary Syndromes (Image)
Angina (Cheatsheet)
Angina Pectoris (Image)
Unstable Angina (Picmonic)
Stable Angina (Picmonic)
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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.
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My Study Plan

Concepts Covered:

  • Concepts of Pharmacology
  • Test Taking Strategies
  • Prefixes
  • Suffixes
  • Bipolar Disorders
  • Immunological Disorders
  • Medication Administration
  • Learning Pharmacology
  • Dosage Calculations
  • Noninfectious Respiratory Disorder
  • Anxiety Disorders
  • Substance Abuse Disorders
  • Emergency Care of the Cardiac Patient
  • Cardiac Disorders
  • Vascular Disorders
  • Acute & Chronic Renal Disorders
  • Neurologic and Cognitive Disorders
  • Depressive Disorders
  • Disorders of Pancreas
  • Female Reproductive Disorders
  • Liver & Gallbladder Disorders
  • Integumentary Disorders
  • Pregnancy Risks
  • Upper GI Disorders
  • Urinary System
  • Central Nervous System Disorders – Brain
  • Cardiovascular Disorders
  • Microbiology
  • Infectious Respiratory Disorder
  • Shock
  • Male Reproductive Disorders
  • Labor Complications
  • Sexually Transmitted Infections
  • Respiratory Disorders
  • EENT Disorders
  • Urinary Disorders
  • Personality Disorders
  • Psychotic Disorders
  • Nervous System
  • Peripheral Nervous System Disorders
  • Gastrointestinal Disorders
  • Neurological
  • Lower GI Disorders
  • Hematologic Disorders
  • Disorders of the Thyroid & Parathyroid Glands
  • Postpartum Complications
  • Prenatal Concepts
  • Newborn Care
  • Intraoperative Nursing
  • Postoperative Nursing
  • Disorders of the Adrenal Gland
  • Disorders of the Posterior Pituitary Gland
  • Terminology
  • Psychological Disorders
  • Prioritization
  • Communication
  • Documentation and Communication
  • Legal and Ethical Issues

Study Plan Lessons

Pharmacology Course Introduction
12 Points to Answering Pharmacology Questions
54 Common Medication Prefixes and Suffixes
Therapeutic Drug Levels (Digoxin, Lithium, Theophylline, Phenytoin)
Essential NCLEX Meds by Class
6 Rights of Medication Administration
Pharmacodynamics
Pharmacokinetics
The SOCK Method – Overview
The SOCK Method – S
The SOCK Method – O
The SOCK Method – C
The SOCK Method – K
Basics of Calculations
Dimensional Analysis Nursing (Dosage Calculations/Med Math)
Oral Medications
Injectable Medications
IV Infusions (Solutions)
Complex Calculations (Dosage Calculations/Med Math)
Disease Specific Medications
Antianxiety Meds
Benzodiazepines
Alprazolam (Xanax) Nursing Considerations
Lorazepam (Ativan) Nursing Considerations
Midazolam (Versed) Nursing Considerations
Diazepam (Valium) Nursing Considerations
Buspirone (Buspar) Nursing Considerations
Amiodarone (Pacerone) Nursing Considerations
Adenosine (Adenocard) Nursing Considerations
Procainamide (Pronestyl) Nursing Considerations
Clopidogrel (Plavix) Nursing Considerations
Warfarin (Coumadin) Nursing Considerations
Enoxaparin (Lovenox) Nursing Considerations
Heparin (Hep-Lock) Nursing Considerations
Alteplase (tPA, Activase) Nursing Considerations
Streptokinase (Streptase) Nursing Considerations
Carbamazepine (Tegretol) Nursing Considerations
Divalproex (Depakote) Nursing Considerations
Gabapentin (Neurontin) Nursing Considerations
Lamotrigine (Lamictal) Nursing Considerations
Levetiracetam (Keppra) Nursing Considerations
Phenytoin (Dilantin) Nursing Considerations
Antidepressants
Bupropion (Wellbutrin) Nursing Considerations
MAOIs
Selegiline (Eldepyrl) Nursing Considerations
SSRIs
Escitalopram (Lexapro) Nursing Considerations
Fluoxetine (Prozac) Nursing Considerations
Paroxetine (Paxil) Nursing Considerations
Sertraline (Zoloft) Nursing Considerations
TCAs
Glipizide (Glucotrol) Nursing Considerations
Metformin (Glucophage) Nursing Considerations
Insulin
Insulin – Rapid Acting (Novolog, Humalog) Nursing Considerations
Insulin – Short Acting (Regular) Nursing Considerations
Insulin – Intermediate Acting (NPH) Nursing Considerations
Insulin – Mixtures (70/30)
Insulin – Long Acting (Lantus) Nursing Considerations
Histamine 1 Receptor Blockers
Diphenhydramine (Benadryl) Nursing Considerations
Promethazine (Phenergan) Nursing Considerations
Histamine 2 Receptor Blockers
Cimetidine (Tagamet) Nursing Considerations
Famotidine (Pepcid) Nursing Considerations
Ranitidine (Zantac) Nursing Considerations
Renin Angiotensin Aldosterone System
Atenolol (Tenormin) Nursing Considerations
Metoprolol (Toprol XL) Nursing Considerations
Propranolol (Inderal) Nursing Considerations
ACE (angiotensin-converting enzyme) Inhibitors
Captopril (Capoten) Nursing Considerations
Enalapril (Vasotec) Nursing Considerations
Lisinopril (Prinivil) Nursing Considerations
Angiotensin Receptor Blockers
Losartan (Cozaar) Nursing Considerations
Calcium Channel Blockers
Amlodipine (Norvasc) Nursing Considerations
Diltiazem (Cardizem) Nursing Considerations
Nifedipine (Procardia) Nursing Considerations
Verapamil (Calan) Nursing Considerations
Cardiac Glycosides
Digoxin (Lanoxin) Nursing Considerations
Gentamicin (Garamycin) Nursing Considerations
Metronidazole (Flagyl) Nursing Considerations
Nystatin (Mycostatin) Nursing Considerations
Isoniazid (Niazid) Nursing Considerations
Rifampin (Rifadin) Nursing Considerations
Acyclovir (Zovirax) Nursing Considerations
Meropenem (Merrem) Nursing Considerations
Ciprofloxacin (Cipro) Nursing Considerations
Levofloxacin (Levaquin) Nursing Considerations
Vancomycin (Vancocin) Nursing Considerations
Clindamycin (Cleocin) Nursing Considerations
Erythromycin (Erythrocin) Nursing Considerations
Azithromycin (Zithromax) Nursing Considerations
Anti-Infective – Penicillins and Cephalosporins
Amoxicillin (Amoxil) Nursing Considerations
Ampicillin (Omnipen) Nursing Considerations
Cefaclor (Ceclor) Nursing Considerations
Cefdinir (Omnicef) Nursing Considerations
Cephalexin (Keflex) Nursing Considerations
Trimethoprim-Sulfamethoxazole (Bactrim) Nursing Considerations
Tetracycline (Panmycin) Nursing Considerations
Atypical Antipsychotics
Chlorpromazine (Thorazine) Nursing Considerations
Antipsychotics
Haloperidol (Haldol) Nursing Considerations
Quetiapine (Seroquel) Nursing Considerations
Olanzapine (Zyprexa) Nursing Considerations
Autonomic Nervous System (ANS)
Methylphenidate (Concerta) Nursing Considerations
Sympathomimetics (Alpha (Clonodine) & Beta (Albuterol) Agonists)
Dobutamine (Dobutrex) Nursing Considerations
Dopamine (Inotropin) Nursing Considerations
Carbidopa-Levodopa (Sinemet) Nursing Considerations
Parasympathomimetics (Cholinergics) Nursing Considerations
Neostigmine (Prostigmin) Nursing Considerations
Parasympatholytics (Anticholinergics) Nursing Considerations
Atropine (Atropen) Nursing Considerations
Benztropine (Cogentin) Nursing Considerations
Diphenoxylate-Atropine (Lomotil) Nursing Considerations
Guaifenesin (Mucinex) Nursing Considerations
Albuterol (Ventolin) Nursing Considerations
Montelukast (Singulair) Nursing Considerations
Salmeterol (Serevent) Nursing Considerations
Diuretics (Loop, Potassium Sparing, Thiazide, Furosemide/Lasix)
Furosemide (Lasix) Nursing Considerations
Hydrochlorothiazide (Hydrodiuril) Nursing Considerations
Spironolactone (Aldactone) Nursing Considerations
Mannitol (Osmitrol) Nursing Considerations
Bisacodyl (Dulcolax) Nursing Considerations
Bismuth Subsalicylate (Pepto-Bismol) Nursing Considerations
Lactulose (Generlac) Nursing Considerations
Loperamide (Imodium) Nursing Considerations
Metoclopramide (Reglan) Nursing Considerations
Ondansetron (Zofran) Nursing Considerations
Pancrelipase (Pancreaze) Nursing Considerations
Sucralfate (Carafate) Nursing Considerations
Proton Pump Inhibitors
Omeprazole (Prilosec) Nursing Considerations
Pantoprazole (Protonix) Nursing Considerations
Epoetin Alfa
Epoetin (Epogen) Nursing Considerations
Glucagon (GlucaGen) Nursing Considerations
Iodine Nursing Considerations
Levothyroxine (Synthroid)
Propylthiouracil (PTU) Nursing Considerations
Cyclosporine (Sandimmune) Nursing Considerations
HMG-CoA Reductase Inhibitors (Statins)
Atorvastatin (Lipitor) Nursing Considerations
Magnesium Sulfate
Magnesium Sulfate in Pregnancy
Magnesium Sulfate (MgSO4) Nursing Considerations
Calcium Acetate (PhosLo) Nursing Considerations
Calcium Carbonate (Tums) Nursing Considerations
Ferrous Sulfate (Iron) Nursing Considerations
Alendronate (Fosamax) Nursing Considerations
Mood Stabilizers
Lithium (Lithonate) Nursing Considerations
Acetaminophen (Tylenol) Nursing Considerations
Phenazopyridine (Pyridium) Nursing Considerations
NSAIDs
ASA (Aspirin) Nursing Considerations
Celecoxib (Celebrex) Nursing Considerations
Ibuprofen (Motrin) Nursing Considerations
Indomethacin (Indocin) Nursing Considerations
Ketorolac (Toradol) Nursing Considerations
Naproxen (Aleve) Nursing Considerations
Tocolytics
Terbutaline (Brethine) Nursing Considerations
Uterine Stimulants (Oxytocin, Pitocin) Nursing Considerations
Meds for Postpartum Hemorrhage (PPH)
Methylergonovine (Methergine) Nursing Considerations
Oxytocin (Pitocin) Nursing Considerations
Prostaglandins in Pregnancy
Rh Immune Globulin in Pregnancy
Lung Surfactant for Newborns
Eye Prophylaxis for Newborn
Phytonadione (Vitamin K) for Newborn
Hepatitis B Vaccine for Newborns
Opioid Analgesics in Pregnancy
Butorphanol (Stadol) Nursing Considerations
Codeine (Paveral) Nursing Considerations
Fentanyl (Duragesic) Nursing Considerations
Hydrocodone-Acetaminophen (Vicodin, Lortab) Nursing Considerations
Hydromorphone (Dilaudid) Nursing Considerations
Meperidine (Demerol) Nursing Considerations
Methadone (Methadose) Nursing Considerations
Morphine (MS Contin) Nursing Considerations
Nalbuphine (Nubain) Nursing Considerations
Oxycodone (OxyContin) Nursing Considerations
Sedatives-Hypnotics
Phenobarbital (Luminal) Nursing Considerations
Pentobarbital (Nembutal) Nursing Considerations
Propofol (Diprivan) Nursing Considerations
Lidocaine (Xylocaine) Nursing Considerations
Corticosteroids
Betamethasone and Dexamethasone in Pregnancy
Cortisone (Cortone) Nursing Considerations
Dexamethasone (Decadron) Nursing Considerations
Fluticasone (Flonase) Nursing Considerations
Methylprednisolone (Solu-Medrol) Nursing Considerations
Hydralazine
Hydralazine (Apresoline) Nursing Considerations
Nitro Compounds
Nitroglycerin (Nitrostat) Nursing Considerations
Nitroprusside (Nitropress) Nursing Considerations
Vasopressin
Epinephrine (EpiPen) Nursing Considerations
Norepinephrine (Levophed) Nursing Considerations
Vasopressin (Pitressin) Nursing Considerations
Pharmacology Terminology
Psychiatry Terminology
Psychological Disorders
Prioritizing Assessments
How to Take Nursing Report
Introduction to the Electronic Medical Record (EMR)
Confidence in Communication
Acute Coronary Syndrome for Certified Emergency Nursing (CEN)
X-Ray (Xray)