Chest pain resulting from inadequate blood flow to heart muscle. If flow is not restored, it can lead to further damage.
Most common cause is coronary artery disease (CAD). Other causes include anemia, heart failure, stress/overexertion, and abnormal rhythms.
Restore adequate blood flow to heart muscles as evidenced by decreased chest pain and improved activity tolerance.
Bedside EKG monitoring
(3 or 5 Lead)
Apply a 3- or 5-lead EKG monitor to determine the presence of any arrhythmias.
Most common arrhythmias that cause angina include Atrial Fibrillation with Rapid Ventricular Response (AFib with RVR), Supraventricular Tachycardia (SVT), and Bradycardias.
If initial 12-lead ECG indicates inferior MI, do a right-sided 12-lead ECG.
To rule out the presence of Myocardial Infarction. It takes 5-15 minutes to determine if the chest pain will subside with nitroglycerin. By checking a 12-lead EKG, a possible STEMI can be ruled out immediately. If STEMI is present, patient should be taken to the Cath Lab STAT.
Right sided 12 lead ECG shows the right side of the heart to assess for right ventricular ischemia.
*note – this is only a mnemonic and not the correct order of administration – see rationale for details*
Initial treatment for acute coronary syndrome.
Insert Large Bore IV and draw initial Cardiac Enzymes
IV access is important for administration of medications, possible interventions if angina worsens, and any scans that may be needed to rule out thrombosis.
Cardiac enzymes further serve to rule out Myocardial Infarction and can give an indication to the extent of myocardial damage.
This is important because the higher the blood pressure, the more pressure is on a clot. It isn’t out of the question for someone to have more than one clot, and increased pressure could break free a clot lodge itself somewhere else either in the heart, lungs, brain, or extremity.
It is also possible that the source of the angina is severe hypotension. This should be assessed and monitored and corrected as needed.
Monitor Cardiac Enzymes:
The values of these enzymes are based on your institutional laboratory technique. If they are elevated it indicates that the cardiac muscle is stressed out or injured.
Cluster Care to allow for periods of rest
It is important in initial phases of treatment that patients get adequate rest. Clustering nursing care means doing multiple tasks in a short period of time and allowing longer breaks between interventions. This allows the patient to rest, thus decreasing their myocardial oxygen demands.
Create Your Free Account