Acute coronary syndrome : Nursing management

Nursing management

• Nursing Assessment:
  • Subjective Data
    • Health history
      • CAD/chest pain/angina/ MI
      • Valve disease
      • Heart failure/cardiomyopathy,
      • Hypertension, diabetes, anemia, lung disease, hyperlipidemia
    • Drugs
      • Use of anti-platelets or anticoagulants
      • Nitrates
      • Angiotensin-converting enzyme inhibitors
      • β-blockers
      • Calcium channel blockers
      • Antihypertensive drugs
      • Lipid-lowering drugs
      • Over-the-counter drugs (e.g., vitamin and herbal supplements)
    • History of present illness
      • Description of events related to current illness
    • Health perception–health management:
      • Family history of heart disease.
      • Sedentary lifestyle
      • Tobacco use
      • Exposure to environmental smoke
    • Nutritional-metabolic
      • Indigestion/heartburn; nausea/vomiting
    • Elimination
      • Urinary urgency or frequency
      • Straining at stool
    • Activity-exercise
      • Palpitations, dyspnea, dizziness, weakness
    • Cognitive-perceptual
      • Substernal chest pain or pressure (squeezing, constricting, aching, sharp, tingling)
      • Possible radiation to jaw, neck, shoulders, back, or arms
    • Cognitive-stress tolerance
      • Stress, depression, anger, anxiety
  • Objective Data
    • Anxious, fearful, restless, distressed
    • Integumentary effects
      • Cool, clammy, pale skin
    • Cardiovascular
      • Tachycardia or bradycardia
      • Pulsus alternans
      • Pulse deficit
      • Dysrhythmias 
      • S₃, S₄, increased or decreased BP, murmur
    • Possible diagnostic findings
      • Positive serum cardiac biomarkers
      • Increased serum lipids;
        • Increased WBC count.
      • Positive exercise or pharmacologic stress test and thallium scans.
      • Pathologic Q wave, ST segment elevation, and/or T wave abnormalities on ECG.
      • Cardiac enlargement, calcifications, or pulmonary congestion on chest x-ray.
      • Abnormal wall motion with stress echocardiogram.
      • Positive coronary angiography