So you’ve never heard of acute coronary syndrome? But what about heart attack, or angina? As a health care workers or even a common people should understand it so that this disease can be prevented. For nurses, better acute coronary syndrome nursing care depends on how we understand the disease. Acute coronary syndrome involve fat level in human body, especially inside coronary artery.
Myocardial infarction acute, include ST-segment elevation (STEMI), non ST-segment elevation (NSTEMI), and unstable angina nowadays are known as part of clinical disease called acute coronary syndrome (ACS).
Rupture or erosion plaque –an unstable substance with high fat level-starts all of these syndromes. The rupture causes adhesion of blood fragment, fibrin clotting form, and trombone activation.
If those condition cannot be handled soon, the mortality level will be high and almost half of sudden death before hospitalization or hours after MI attack. The prognosis is better if the patient see the doctors soon.
Please read Here is The Easiest Acute Coronary Syndrome Definition for detail
Causes of Acute Coronary Syndrome (ACS)
The most common causes of ACS are only two causes:
Even if the causes of ACS are only two causes, there are many risk factors contributes of it:
- High level of homosistein, C-reactive protein, and fibrinogen
- Excessive alc*h*l cosumtion
- Family history of heart disease
- Fast foods
- Menopause status
- Sedentary life style
Sign and Symptoms
Sign and symptoms of acute coronary disease is unique. Conditions like angina and myocard infarct (MI) as follow:
- Burning pain or pressing in sub sternal chest or precordial that spread to left arm or scapula, neck, and lower jaw pain, include hard to breath
- Chest pain occurs after excercise, emotional, cold, or too much consuming.
- Pressing pain, burning pain, uncomfortable feeling in chest, and the pain is right in the middle of the chest and cannot relieve for more than 15 minutes.
- Chest pain that spread onto shoulder, neck, arm, or jaw
- Excessive sweat
- Shallow respiration
- Anxious and sometime hallucinating
Diagnosis examination is important to ensure the disease. Many disease have similarities with ACS, wrong diagnosis means wrong implementation in acute coronary syndrome nursing care.
- Electrocardiogram helps determine which artery that has problem
- Heart enzyme level show the leak like CK-MB, troponin T and I, include protein myoglobin.
- Laboratory test show white blood cell in high level, red blood cell sediment in high level, and also increasing electrolyte.
- Echocardiogram show the problem in heart muscles like ventricle movement, muscle rupture, etc.
- Echocardiogram transesofageal show the movement problem in heart muscle, it indicates ischemia.
- Chest X-ray shows left side of cardiac failure, cardiomegaly, or other no cardiac cause like dyspnea and chest pain
- Scan nuclear images that use thallium 201 or technetium 99m for infarct area identification
- Cardiac catheter to know artery coroner problem, ventricle function and volume pressure in heart.
Treatment for Acute Coronary Syndrome
- Oxygen supplemental is used to increase the oxygen supply into heart
- Nitroglycerine for chest pain killer
- Morphine for chest pain killer
- Aspirin for blood clot aggregation
- Low cholesterol, natrium, and fat food and high fiber food
For patient with unstable angina and NSTEMI:
- Beta adrenergic inhibitor to decrease the heart overload and increase the oxygen supply
- Heparin and glycoprotein inhibitor IIa/IIb for minimizing thrombocyte aggregation and coronary occlusion
- Nitroglycerine intravenous to dilate coronary artery and reduce chest pain
- Percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft(CABG) for obstruction lesion
- Antilipimic to decrease cholesterol level or triglyceride
For patient with STEMI, the first treatments are like treatment for NSTEMI and also:
- Thrombolytic therapy (except if there is a contraindication) in 12 hours after the chest pain attack for minimizing necrothic.
- Intravenous heparin to clear the plaque in coronary artery
- Glycoprotein IIa/Iib inhibitor to minimize trombocyte aggregation
- Angiotensin converting enzyme (ACE) to decrease afterload and preload and prevent recurrence. This medicine can be taken in 6 hours after admission or the patient’s condition is stable)
- PTCA, stent, CABG to dilate artery.
Acute Coronary Syndrome Nursing Care
Now focus on our point, acute coronary syndrome nursing care! For better nursing care, we provide these nursing care guides. Please implement them for acute coronary syndrome patients.
- Monitor the cardiac status continously and monitor it with electro cardiogram (ECG) to detect heart ryhtm changes. Put the result close to patient periodicly
- Monitor and note blood pressure, temperature, heart sound, and respiration
- Ask patient to inform chest pain that he / she feel
- Use 12 lead ECG during chest pain attack
- Find and note the chest pain location
- Give analgesic and other medication like prescribed
- Monitor the patient blood pressure after nitroglycerine schedule, especially in first schedule
- Monitor the patient’s intake and output of body fluid
- Monitor the patient’s respiration status like cough, tachypnea, and edema that indicate the left side cardiac failure
- If patient did PTCA, do angioplasty care. Give patient right schedule to rest and activity on bed and immobilized the patient’s lower extremity. Monitor the bleeding and pulse on foot.
- Give the patient emotional support and help him/her to handle stress and anxiety.
- Start cardiac rehabilitation
- Explain the patient about right diet like low cholesterol diet, low natrium diet, low fat diet, and high fiber diet. Provide the right diet for patient. Collaborate with dietitian so that the family understand what to do.
- Suggest the patient to avoid unhealthy lifestyle
- Explain the patient about the regulation of heart treatment, side effect of medication, and suggest them to report the bad reaction to.
- Suggest the patient to decrease body weight program
- Suggest the patient to start healthy relationship progressively.
Acute coronary syndrome nursing care is easy to do. We can use nursing intervention guidelines above or refer to NANDA nursing intervention.