Acute Coronary Syndrome Management

Running head: ACS MANAGEMENT
Acute coronary syndrome management
Student Name
Tutor
Date

ACS MANAGEMENT 2
Title of Nursing Practice Standard
Chest pain: Confirmed and Suspected acute ACS management.
Background
An ACS comprises of the medical signs and symptoms or a collection of symptoms and
signs that are led by blockage of the coronary arteries. These clinical symptoms are well matched
with acute myocardial ischemia and consist of non–ST-NSTEMI, unsteady angina (UA) as well
as ST-STEMI (Ranya et al., 2018). An acute coronary syndrome (ACS) is associated with
electrocardiographic abnormalities, chest pain that may involve pressure, tightness or fullness,
dyspnea nausea as well as sweating (Parodi et al., 2016). In many cases, acute coronary
syndrome is caused by obstruction of the coronary artery mostly because of fatty deposits on the
wall or inside these important blood vessels that transports oxygen and nutrients to the heart
muscles (Rashid et al., 2016). A blood clot that inhibits the flow of blood in coronary artery is
formed when these fatty deposits ruptures. When they are not supplied with enough oxygen, the
cells in the heart muscles can die; as a result, the muscle tissues are damaged and this leads to
heart attack or myocardial infarction. Although insufficient oxygen supply to the heart muscles
do not lead to death of the heart muscles cell at all times, it still causes ineffectiveness in the
functions of the heart muscles, which can be temporary or long lasting.
After acute coronary syndrome has occurred, it causes complications such as electrical
dysfunction which include defects in conduction as well as irregular heartbeat. Another problem
that is associated with ACS is myocardial dysfunction such as ventricular aneurysm, heart
failure, pseudoaneurysm, free wall rupture or interventricular septum, cardiogenic shock and
mural thrombus formation. Another dysfunction associated acute coronary syndrome is the

ACS MANAGEMENT 3
valvular dysfunction more specifically mitral regurgitation (Barstow, et al., 2017. It is therefore
necessary to manage acute coronary syndrome using evidenced based practice since is so
dangerous to the victim when it occurs. The environments that one might care for the patient
with acute coronary syndrome is the environment that supports medical quality in the medication
of the victim’s body and promotes both the spiritual needs of the sick as well as their psycho-
social needs (Nicholas, 2016). The environments must also deliver significant sound impact on
the clinical outcomes of the patient as well as staff efficacy.
Current practice
Confirmed and suspected ACS management
Common pharmacological intervention in the supervision of ACS chest pain:
Opioid analgesia
E.g. Morphine Sulphate (or fentanyl)
Administer in titrated doses to control symptoms
[Level IV]
New Suggestion for Practice
Fentanyl is better as compared to morphine sulphate and is effective pharmacological control of
chest pain as a result of acute coronary syndrome. The updated nursing practice standard will
now read:
Common pharmacological intervention in the control of ACS chest pain:
Opioid analgesia [Level IV]

ACS MANAGEMENT 4
E.g. fentanyl
Administer in titrated does to control symptoms but avoid sedation respiratory depression [Level
IV]
Rationale
Morphine is the original opioid on which all beginners are examined. Notwithstanding an
era of opioid study, there is no proof that any opioid that is synthetic is more efficient in regulati
ng pain compared morphine. If it were not for the release of histamine-intermediated
hypertension monitored intraoperatively with greater doses of morphine, it is possible fentanyl
would not have substituted morphine as the most frequently utilized anesthesia opioid in
practice. A crucial information concerning to morphine’s clinical pharmacology is its sluggish
commencement period. The drug’s pKa makes it nearly ionized at physiologic pH. This
characteristic, integrated with its minimum solubility, seemingly accounts or morphine’s
extended latency to topmost effect. This insinuates that morphine is less probable to cause acute
respiratory depression after injection of bolus of normal analgesics doses contrasted with the
more swift acting medicine since the association between partial pressure of carbon dioxide and
ventilation adjusts gradually.
The drug is used to assist in relieving severe to moderate pain. Acute coronary syndrome
is dangerous especially because of the chest pain, which appears in the sternum. Therefore, while
offering a therapy to a victim of acute coronary syndrome, the primary therapy should aim much
on balancing the patient’s condition mostly by reducing the chest pain as well as giving
antithrombotic treatment in order to decrease the myocardial harm and hinder more ischemia
(Abdi et al., 2016). One of the ways that is utilized to fulfil this objective is through efficient