Overview
Acute Coronary Syndrome (ACS) is an umbrella term covering three life threatening presentations of abrupt coronary artery occlusion or near occlusion: unstable angina (UA), non...
Acute Coronary Syndrome (ACS) is an umbrella term covering three life-threatening presentations of abrupt coronary artery occlusion or near-occlusion: unstable angina (UA), non-ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI). The critical distinction lies in whether myocardial necrosis has occurred (elevated troponin = MI) and whether complete occlusion is present (ST elevation = STEMI requiring emergent reperfusion within 90 minutes door-to-balloon). Missing STEMI on a 12-lead ECG or delaying reperfusion by even 30 minutes meaningfully increases infarct size and 30-day mortality. Top 3 nursing priorities: 1. Obtain a 12-lead ECG within 10 minutes of symptom onset and transmit to cardiology immediately if ST elevation ≥1 mm in two contiguous leads is identified 2. Establish large-bore IV access (×2), administer aspirin 162–325 mg chewed (unless allergy confirmed), apply continuous cardiac monitoring, and place on supplemental O₂ only if SpO₂ <90% 3. Prepare for emergent percutaneous coronary intervention (PCI) or fibrinolytic therapy based on facility protocol and time-to-balloon feasibility Common NCLEX trap: Supplemental oxygen is NOT routinely given to all ACS patients — giving O₂ when SpO₂ ≥90% can increase oxidative...
