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Acute Coronary Syndrome
Acute coronary syndrome (ACS) is a term that refers to the clinical symptoms of myocardial ischemia, unstable angina, and myocardial infarction (Overbaugh, 2009). It is one of the leading causes of death with more than 135,000 fatalities in Britain alone in the year 2000 (Jones, 2003). Chest pain (angina) remains the predominant symptom of ACS and can either be unstable or stable. In addition, ACS presents uncharacteristic symptoms such as indigestion, nausea, backache, and fatigue in women, which can slow down diagnosis and medication. Troponin T is the ideal and reliable cardiac biomarker in the diagnosis of ACS.
Pathophysiology of Acute Coronary Syndrome
The disruption of an arteriosclerotic plaque in the coronary artery fuels the accumulation of platelets and the establishment of a thrombus. These events initiate the beginning of ACS. Current statistics propose that the bursting of a volatile susceptible plaque alongside its related inflammatory alterations is largely accountable for the diminished blood flow, which consequently produces ischemia (Davies, 2000). Oxygen and energy (ATP) are essential for the continuation of contractility and electrical stability required in normal transmission (Overbaugh, 2009). When oxygen is unavailable glycogen is degraded anaerobically in the myocardial cells leading to the production of inadequate ATP. Consequently, the sodium-potassium and calcium pump malfunction. Hydrogen and lactate ions accumulate bringing about acidosis. Cell death or infarction then starts if interventions to reverse the situation are not initiated.
Nursing and Medical Management of Acute Coronary Syndrome
Effective management of ACS entails making the correct diagnosis and availing the required interventions in a timely manner (O’Connor et al., 2010). It is imperative that nurses grasp the idea of preload and afterload to comprehend the pharmacologic management of ACS. A rise in preload elevates strain on the heart and increases the risk of heart failure. Drugs such as morphine, nitroglycerin, and beta-blockers reduce preload, whereas inhibitors of angiotensin-converting enzyme (ACE) reduce afterload.
ACS management is made easy by the creation of the mnemonic MONA (morphine sulphate, oxygen, nitroglycerin, and aspirin) to help nurses recall the required medication. Aspirin is administered immediately after the symptoms manifest since it prevents the constriction of blood vessels and the agglutination of platelets. Oxygen is the second regimen given “at 2 to 4 L/min by nasal cannula” (Overbaugh, 2009, p.48). Sufficient oxygen minimizes pain resulting from myocardial ischemia. 0.3 or 0.4 mg of nitroglycerin tablets given sublingually at intervals of five minutes trim down myocardial requirement for oxygen by reducing the preload and afterload. Nurses ought to monitor the drop in blood pressure and the intensity of pain. When all other attempts to manage pain fail, morphine sulphate is the ultimate choice and is administered intravenously at a dosage of 2 to 4 mg at intervals of 15 minutes. Reperfusion therapy (PCIs and fibrinolytic drug treatment) can be performed to reinstate blood flow to ischemic myocardial tissue thereby precluding additional hurdles, and its efficacy depends on distinct time frames. PCI is an insidious process where placing a catheter in the femoral artery removes obstructions and re-establishes the flow of blood. Fibrinolytic therapy, on the other hand, uses ‘clot-busting’ remedies that dissipate the existing thrombi. In all these steps, constant observation of cardiac rhythm aids the speedy identification and treatment of all forms of cardiac arrest.
Application of Information to Professional Nursing Practice
This paper equips nurses with knowledge on the management of ACS patients. It clearly explains the recently restructured practice procedures that assist in providing uniform treatment to all patients portraying indicators of ACS. It also provides accurate indications and contraindications of the various drugs in the management of different stages of ACS. This information ensures that nurses give the best possible care to ACS patients and minimizes cases of death due to negligence. It also places nurses in a better position to steer early treatment decisions (Tierney et al., 2013). Finally, it reduces the extent of myocardial necrosis in patients with acute myocardial infarction thus safeguarding the left ventricular function, avoiding heart failure and reducing other cardiovascular complications (O’Connor et al., 2010).
Davies, M. J. (2000). The pathophysiology of acute coronary syndromes. Heart, 2000 (83), 361-366.
Jones, I. (2003). Acute coronary syndromes: Identification and patient care. Nursing Times.
O’Connor, R. E., Brady, W., Brooks, S. C., Diercks, D., Egan, J., Ghaemmaghami, C., Menon, V., O’Neil, J. B., Travers, A. H., & Yannopoulos, D. (2010). Part 10: Acute coronary syndromes 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 122(suppl 3), S787–S817.
Overbaugh, K. J. (2009). Acute coronary syndrome: Even nurses outside the ED should recognize its signs and symptoms. AJN, 109(5), 42-52.
Tierney, S., Cook, G., Mamas, M., Fath-Ordoubadi, F., Iles-Smith, H., Deaton, C. (2013). Nurses’ role in the acute management of patients with non-ST-segment elevation acute coronary syndromes: An integrative review. European Journal of Cardiovascular Nursing, 12(3), 293-301.