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


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