Programme: Post Basic CCN Year 1 Semester 2

Topic: STEMI

A 63 years old man with known case of NSTE-ACS usually due to artheroschlerosis
admitted to ER with chest pain of 3 hours duration. ECG indicates anterior ST elevation.
He was given Aspirin in ER.

Cardiac enzymes reveal a peak in CPK of 1800 and CK –MB fraction of 15%.

He was eventually transferred out of CCU.

He develops sudden severe shortness of breath. BP 100/70 Pulse 126 and regular.

a) What is the pathophysiology of NSTE – ACS ?

b) How do you consider that the patient is having anteroseptal infarction in 12 leads
ECG.
c) State the importance in Serum Markers in diagnosing STEMI
d) How do you manage a patient on thrombolytic therapy?
Programme: Post Basic CCN Year 1 Semester 2

Topic: Heart Failure

A 70 year old gentleman was admitted to your unit, with complain of fatique, shortness
of breath, and edema of lower limbs. His hemodynamic status is as follow:

BP 186/100 mmHg, pulse 110, Respiration rate 32, arterial pressure 42/22 CVP 17

a) Define Right Heart Failure and Left Heart Failure

b) State the medication that you will anticipate from the doctor to prescribe to treat
this patient.

c) Explain the action and adverse effects of these 2 types of drugs.

d) What is your nursing intervention with the patient, based on the preceding data
above.
Programme: Post Basic CCN Year 1 Semester 2

Topic: CABG

A 45 year old gentleman is transferred to your unit following Coronary Artery

Bypass Graft (CABG). During taking over the nursing report, patient was alert and
orientated and was then extubated without difficulties. An hour later, he seemed
lethargic, the chest tube drainage was 500 ml in the last one hour.

ABG taken, the result showed:

PH 7.37

HCO3 24

Fio 2 0.4

Sa O2 0.96

Based on the lab finding, patient may develope…..

a) Explain the pathophysiology of the above condition

b) Based on the preceding data, what condition would this patient exhibit

c) How would you manage this patient in ICU?

d) Explain the medication and the action of drugs used for this patient.
Programme: Post Basic CCN Year 1 Semester 2

Topic: Acute Coronary Syndrome (ACS)

Madam A 59 year old female complained of chest pain 2 hours ago, upon resting her
pain subsides. She came to see the doctor for treatment. ECG was then done on her
which showed ST inversion in the inferior leads. Her BP 130/80mmHg, PR 90 Resp.
26.

She was then admitted in CCU under your care.

a) Explain in detail what is ST inversion in the inferior leads means

b) Describe the terminology NSTE-ACS?

c) The risk factors of ACS may include ..

d) How do you manage Madam A in your unit.

Programme: Post Basic CCN Year 1 Semester 2

Topic: Cardiac Catheterization/ Angioplasty

A 65 year old pensioner accompanied by his son, arrived in ER with complaint of

retrosternal pain which radiates to the left arm. While talking to him, suddenly he
complained of severe shortness of breath. BP lowish 80/50 mmHg, pulse 120, rr
34.

He was attended immediately by the doctor and pushed to Cardiac Catheterization

laboratory for emergency Angiogram.

a) Describe what is percutaneous transluminal coronary balloon angioplasty (PTCA)

and stents.

b) Explain how do you manage your patient during pre and post cardiac
catheterization.

c) After PTCA, can your patient go into fluid volume deficit ? Yes/No
Explain clearly.