ACUTE CORONARY SYNDROME (ACS) Acute coronary syndrome is a medical condition that causes rapid and diminished blood

circulation toward the heart. The most common symptom prompting diagnosis of ACS is chest pain, often radiating of the left arm or angle of the jaw, pressure-like in character, and associated with nausea and sweating. Acute coronary syndrome usually occurs as a result of one of three problems: ST elevation myocardial infarction (30%), non ST elevation myocardial infarction (25%), or unstable angina (38%).

Pathophysiology

There is accumulation of plaques in the arteries

Precipitating Factors:
-Increased blood pressure -Increased blood cholesterol -Smoking -Sedentary Lifestyle

Blood vessels splits or comes apart

Predisposing Factors: Development of thrombus will occur -Family history of heart disease -Age (older than 45 for men and older than 55 for women)

There will be partial blockage in the blood vessels

Arterial blood flow will be reduced Anxiety

The sympathetic nervous system will be stimulated

Indigestion

Sudden chest pain Increased respiratory rate Nausea Shortness of breath

Sign and Symptoms 1. Chest pain characterize by burning feeling, heaviness or tightness and persists for more than a few minutes or longer 2. Pain somewhere else in the body, like the left upper arm or jaw, this could be a referred pain 3. Nausea and vomiting 4. Difficulty of breathing 5. Sudden and heavy sweating Other unusual symptoms are the following: 1. Pain the abdominal area 2. Pain akin to a heartburn 3. Moist skin 4. Dizziness or fainting 5. Unusual exhaustion 6. Restlessness or nervousness Medications: 1. Aspirin Indicated to decrease blood coagulation Keep blood circulation inside the narrowed heart arteries 2. Thrombolytics Also known as clot busters Indicated to help dissolve a blood clot that is obstructing the blood circulation to your heart The earlier you take a thrombolytic medication following a heart attack, the better the likelihood you will stay alive and decrease the injury to your heart 3. Nitroglycerin Momentarily broadens narrowed arteries, enhancing blood circulation to and from your heart. 4. Beta blockers Indicated to relax your heart muscle, slow your heart beat and lower your blood pressure, which lessens the demand on your heart It can increase blood circulation through your heart, relieving chest pain and the risk for injury to your heart 5. Angiotensin-converting enzyme (ACE) inhibitors and Angiotensin receptor blockers (ARBs). They let blood to flow from your heart more simply They decrease blood pressure and may stop a second heart attack 6. Calcium channel blockers Indicated to relax the heart and allow more blood to flow to and from the heart 7. Cholesterol-lowering drugs Indicated to decrease your cholesterol levels, leading to less plaque deposits 8. Clopidogrel Indicated to help avoid blood clots from developing May cause bleeding Surgery: a) Angioplasty and stenting In this surgical procedure, your physician will place a catheter into the obstructed or narrowed area of your blood vessel. A wire with a deflated balloon is entered through the catheter to the area of stenosis. The balloon is then inflated, constricting the plaques against the lining of your

artery. A stent (medical tube) is typically left behind in the artery to hold the artery wide open. Angioplasty may also be performed using laser technology. b) Coronary bypass surgery This surgical procedure develops a substitute path for blood to go around an obstructed coronary artery.

Nursing Diagnosis: Acute pain related to myocardial tissue damage from inadequate blood supply

Nursing Intervention -Relieve pain -Advise to perform deep breathing exercise -Assess fluid volume -Administer oxygen as ordered -Assess vital signs -Change position frequently -Decrease anxiety

CEREBROVASCULAR ACCIDENT (Stroke) Cerebrovascular accident or stroke (also called brain attack) results from sudden interruption of blood supply to the brain, which precipitates neurologic dysfunction lasting longer than 24 hours. Stroke are either ischemic, caused by partial or complete occlusions of a cerebral blood vessel by cerebral thrombosis or embolism or hemorrhage (leakage of blood from a vessel causes compression of brain tissue and spasm of adjacent vessels). Hemorrhage may occur outside the dura (extradural), beneath the dura mater (subdural), in the subarachnoid space (subarachnoid), or within the brain substance itself (intracerebral). Pathophysiology Hardening of arteries (atherosclerosis)

Blood clot is formed in inner chamber of the heart

When it circulates in the blood stream, artery in the brain may be blocked

Blood flow in that certain area of the brain may impede

Aphasia

Apraxia Muscle weakness Dysarthria

Numbness Decreased reflexes

Ataxia

Sign and symptoms Symptoms of a stroke depend on the area of the brain affected. The most common symptom is weakness or paralysis of one side of the body with partial or complete loss of voluntary movement or sensation in a leg or arm. There can be speech problems and weak face muscles, causing drooling. Numbness or tingling is very common. A stroke involving the base of the brain can affect balance, vision, swallowing, breathing and even unconsciousness.

Medications
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Anticoagulant medicine: Treatment for an ischemic stroke includes anticoagulant medicines which are also called blood thinners. This medicine group keeps clots from forming in the blood. Antiplatelet aggregating medicine: These medicines interact with platelets to prevent blood clots from forming. Platelets are a type of blood cell that join to form clots. Thrombolytic medicine: This medicine group is used in a stroke caused by a clot in a blood vessel. Thrombolytics break apart clots and restore blood flow.

Surgical Management In most cases, surgery is not used to treat a stroke, because brain tissue is destroyed quickly when the blood flow is blocked to an area of the brain. Exceptions include: Surgery to repair a ruptured aneurysm that has caused bleeding into the brain. - Carotid endarterectomy: Usually performed after a TIA to reduce the risk for stroke Procedure removes tissue that blocks the flow of blood inside of the arteries May prevent further strokes due to carotid artery disease - Carotid artery stent: Placement of a mesh-like stent into the artery to open it up May reduce risk of stroke due to carotid artery disease Nursing Diagnosis: Impaired physical mobility related to loss of balance and coordination

Nursing interventions: 1. Maintain a patent airway to promote adequate oxygenation 2. Administer oxygen therapy with possible intubation and mechanical ventilation to ensure adequate tissue perfusion 3. Maintain bed rest to minimize metabolic requirements 4. Provide I.V. fluids to support blood pressure and maintain volume

5. Administer dexamethasone as ordered to reduce cerebral edema 6. Administer anticoagulants and antiplatelet drugs as ordered for thrombotic conditions after hemorrhage has been ruled out 7. Assess the patients neurologic status; observe for CVA progression and level of consciousness (LOC) change as evidenced by decreasing numerical score on the GLASGOW COMA SCALE. 8. Correct cardiovascular abnormalities, such as atrial fibrillation, that may be contributing factors 9. Begin bedside range-of-motion exercise to preserve mobility and prevent deformities 10. Teach the patient to identify risk factors and necessary life-style modifications, such as diet, stress reduction, and smoking cessation