Acute coronary syndrome Minimally invasive direct coronary artery bypass (MIDCAB) For patients with disease of left anterior descending or right coronary artery Does not involve

Interprofessional care Acute Coronary Syndrome Initial interventions 12-lead ECG Upright position Oxygen – keep O2 sat > 93% IV access Nitroglycerin (SL) and ASA (chewable)

Nursing management Nursing Assessment Subjective Data Important Health Information Past health history: Known duration and past workup of high BP; cardiovascular, cerebrovascular, renal, or thyroid

Hypertension in older persons BP goal for people > 60 is < 150/90 Preferred antihypertensive drugs Thiazide diuretic Calcium channel blockers ACE inhibitors or ARBs

Nursing diagnoses Ineffective health management related to lack of knowledge of pathology, complications, and management of hypertension Anxiety related to complexity of management regimen Sexual

Resistant hypertension Failure to reach goal BP in patients taking full doses of an appropriate 3-drug therapy regimen that includes a diuretic. Reasons include Improper

Angiotensin Inhibitors Angiotensin-Converting Enzyme Inhibitors Benazepril (Lotensin) Captopril Enalapril (Vasotec) Fosinopril Lisinopril (Zestril) Moexipril (Univasc) Perindopril (Aceon) Quinapril (Accupril) Ramipril (Altace) Trandolapril (Mavik) Inhibit ACE,

Adrenergic Inhibitors Central-Acting α-Adrenergic Agonist Clonidine (Catapres) Clonidine patch (Catapres-TTS) Reduce sympathetic outflow from CNS. Reduce peripheral sympathetic tone, produces vasodilation, and decreases SVR and

Drug Examples Mechanism of Actions Nursing considerations Diuretics Thiazide and Related Diuretics Chlorothiazide (Diuril) Chlorthalidone Hydrochlorothiazide Indapamide Metolazone (Zaroxolyn) Inhibit NaCl reabsorption in the distal

Lifestyle modifications Weight reduction Weight loss of 22 lb (10 kg ) may decrease SBP by approx. 5 to 20 mm Hg Calorie restriction and

Diagnostic studies Diagnostic assessment History and physical examination, including an ophthalmic examination Routine urinalysis Basic metabolic panel (serum glucose, sodium, potassium, chloride, carbon dioxide, BUN,

Complications Target organ diseases occur most frequently in Heart Hypertensive heart disease Coronary Artery disease Hypertension disrupts the coronary artery endothelium This results in a