Chapter 28

Management of Patients With

Coronary Vascular Disorders

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Treatment (MONA)

• Treatment seeks to decrease myocardial oxygen demand

and increase oxygen supply
• Medications (Morphine, Oxygen, Nitro., Aspirin)
• Reduce and control risk factors
• Reperfusion therapy may also be done

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Medications***

• Nitroglycerin
• Beta-adrenergic blocking agents
• Calcium channel blocking agents
• Antiplatelet and anticoagulant medications
• Aspirin
• Clopidogrel and ticlopidine
• Heparin
• Glycoprotein IIB/IIIa agents
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Collaborative Problems

• Acute pulmonary edema

• Heart failure
• Cardiogenic shock
• Dysrhythmias and cardiac arrest
• Myocardial infarction

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Treatment of Angina Pain

• Treatment of angina pain is a priority nursing concern.

• Patient is to stop all activity and sit or rest in bed.
• Assess the patient while performing other necessary
interventions. Assessment includes VS, and observation
for respiratory distress, and assessment of pain. In the
hospital setting, the ECG is assessed or obtained.
• Administer oxygen.
• Administer medications as ordered or by protocol, usually
NTG.

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Anxiety

• Use a calm manner

• Stress-reduction techniques
• Patient teaching
• Addressing patient spiritual needs may assist in allaying
anxieties
• Address both patient and family needs

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 Chapter 28

Management of Patients With

Coronary Vascular Disorders

Self-Review

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Myocardial Infarction

• An area of the myocardium is permanently destroyed.

Usually caused by reduced blood flow in a coronary
artery due to rupture of an atherosclerotic plaque and
subsequent occlusion of the artery by a thrombus.
• In unstable angina, the plaque ruptures but the artery is
not completely occluded. Unstable angina and acute
myocardial infarction are considered the same process
but at different point on the continuum.
• The term acute coronary syndrome includes unstable
angina and myocardial infarction.

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Effects of Ischemia, Injury, and Infarction
on ECG

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Clinical Manifestations and Diagnosis

• Chest pain, other symptoms

• ECG
• Laboratory tests—biomarkers
– CK-MB
– Myoglobin
– Troponin T or I

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Treatment of Acute MI
• Obtain diagnostic tests including ECG within 10 minutes
of admission to the ED
• Oxygen
• Aspirin, nitroglycerin, morphine, beta-blockers
• Angiotensin-converting enzyme inhibitor within 24 hours
• Evaluate for percutaneous coronary intervention or
thrombolytic therapy
• As indicated; IV heparin or LMWH, clopidogrel or
ticlopidine, glycoprotein IIb/IIIa inhibitor
• Bed rest
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Nursing Process: The Care of the Patient
with ACS—Assessment

• A vital component of nursing care!

• Assess all symptoms carefully and compare to previous
and baseline data to detect any changes or
complications.
• Monitor ECG.

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Collaborative Problems

• Acute pulmonary edema

• Heart failure
• Cardiogenic shock
• Dysrhythmias and cardiac arrest
• Pericardial effusion and cardiac tamponade

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Percutaneous Coronary Intervention

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Coronary Artery Bypass Grafts

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Greater and lesser saphenous veins are
commonly used for bypass graft
procedures.

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Cardiopulmonary Bypass System

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Postoperative Care of the Cardiac Surgical
Patient

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