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Complex Care > Angina > Flashcards

Angina Flashcards

1
Q

In angina, the endothelial lining of the arteries react to what 2 conditions?

A

Hypertension and hyperlipidemia

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2
Q

What circulatory system is under highest pressure?

A

Arterial

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3
Q

What is collateral circulation?

A
  • develops to compensate for low output states such as chronic heart disease; heart failure
  • Provide an “ alternate route” for blood and oxygen to myocardial tissues when arteries become occluded / narrowed
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4
Q

Modifiable risk factors of CAD

A

CHOPSS2

Cholesterol
Hypertension
Obesity
Physical Inactivity
Smoking
Stress
Type 2 Diabetes

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5
Q

Non-modifiable risk factors for CAD

A

FAGGED

Family
Age
Genetic predisposition
Gender (men>women until 65)
Ethnicity
Diabetes type 1

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6
Q

Describe the pain on presentation of angina

A

burning, pressure, elephant sitting on chest, radiates to left arm, hand, jaw, shoulder, women may state it feels like indigestion, does not change with position

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7
Q

Besides pain, what symptoms does somebody with angina present with?

A

Diaphoretic, SOB, light headedness, N/V, sense of doom

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8
Q

What causes the chest pain associated with CAD/angina?

A

ischemia to myocardium; imbalance between oxygen supply vs myocardial demand

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9
Q

Define stable angina

A

Chest pain after exertion that resolves with rest or nitroglycerin after 5 minutes

The course is familiar and unchanged

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10
Q

Define unstable angina

A

New onset, different type of pain, does not resolve with medication

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11
Q

Define vasospastic angina

A

pain at rest with no exertion

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12
Q

For syndromes suggestive of myocardial ischemia, what is the hospital preparation?

A
  1. Aspirin
  2. Oxygen
  3. ECG
  4. (activation of cath lab)
  5. Morphine
  6. Consider nitro
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13
Q

Describe the pain assessment of a patient who is probably experiencing cardiac chest pain:

A

Provoked: provoked by exercise? relieved with rest?

Quality: pressure, fullness, burning, tightness

Radiation: left arm, hand, jaw, shoulder, unchanged with position

Severity: same as usual anginal attacks?

What medications have been given? Have they worked for you?

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14
Q

Describe the assessment of a patient suspected of having cardiac chest pain:

A
  1. Pain assessment
  2. Objective
    a) vitals
    b) focussed cardiopulmonary
    > auscultation of heart/lung
    > skin color (poor perfusion)
    > edema, cap refill, pulses
    > weight, JVD, signs of HF
    > decreased functional ability
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15
Q

What are serum cardiac markers?

A

proteins released into blood when there is necrosis of damage to myocardium

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16
Q

What are CK proteins

A

non specific indicator of skeletal muscle, heart or brain damage or degeneration

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17
Q

What are CK-MB

A

a heart muscle enzyme that is released into the bloodstream when the heart muscle is damaged or injured

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18
Q

What is troponin

A

a type of protein found in the muscles of your heart. Troponin isn’t normally found in the blood

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19
Q

Why is cardiac blood work timed and what is the rate of occurence?

A

to indicate continuing/resolving myocardial damage

Q4-6h x 3

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20
Q

What test is the easiest and most indicative of cardiac ischemia/injuries?

A

ECG

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21
Q

What does an ECG identify?

A

QRS or ST segment abnormalities

22
Q

What does the ST segment represent and what would changes to it mean?

A

represents the period when the heart’s ventricles are contracting and pumping blood.

Changes in the ST segment can indicate heart problems, such as myocardial infarction (heart attack) or ischemia (lack of blood flow to the heart muscle).

23
Q

4 Priorities/Cues for patient with cardiac chest pain

A
  1. acute chest pain due to imbalance between myocardial oxygen supply v demand
  2. decreased myocardial tissue perfusion d/t decreased coronary artery blood flow
  3. potential for dysrhythmias due to ischemia and ventricular irritability
  4. Potential for heart failure due to left ventricular dysfunction
24
Q

Describe the 6 points of rapid assessment/triage of a patient with cardiac chest pain

A
  1. Rule out MI with 12 lead ECG
  2. Aspirin
  3. O2
  4. Initiate IV
  5. Nitroglycerin
  6. Morphine

(consider plavix)

25
Q

Describe the ECG monitoring of a cardiac chest pain patient beginning at triage

A

ECG within 10min of patient reporting chest pain or admission, then continuous monitoring

or serial ECGs Q6H

25
Q

Why is aspirin the first medication given on triage for cardiac chest pain patient and how much?

A

reduces thrombus formation

162-325mg chewed

26
Q

How much oxygen is given to a cardiac chest pain patient on admission

A

3-4L/min if sats <90 or SOB

27
Q

What is important to remember about the IV initiation for cardiac chest pain patient?

A

20 gauge or up to allow rapid administration of medications if necessary

28
Q

Describe the nitroglycerin administration for a cardiac patient on triage including desired effect, common side effects, and key assessments

A

SL then IV if 3 doses weren’t enough

Powerful coronary artery vasodialtor

Hypotension, headache

Vitals and if they have taken at home

29
Q

If a patient’s BP is under 100, can you still give nitro?

A

Yes, but bolus before continuation

30
Q

What is the purpose of IV morphine for cardiac chest pain patients?

A

If nitro not effective and pain persists

Pain reduction and vasodilator properties

31
Q

Describe 6 med classes for pharmaceutical management of cardiac chest pain/angina

A
  1. beta blocker
  2. ace inhibitor
  3. vasodilator (nitro)
  4. anticoagulants
  5. calcium channel blocker s
  6. antiplatelets
32
Q

What is the most common diagnostic test for cardiac chest pain?

A

Exercise stress test: combines exercise and continuous ECG monitoring to evaluate myocardial tissue perfusion

33
Q

Purpose of beta blockers for angina

A
  • Slow heart rate
  • decrease force of cardiac contraction
  • increasing myocardial perfusion - reducing the force of myocardial contraction

Block sympathetic response

34
Q

Purpose of ace-i for angina

A

lowers your blood pressure and improves blood flow to your heart muscle

vasodilation and decreased BP

35
Q

Purpose of CCB for angina

A

dilate coronary arteries and decrease BP

36
Q

What interventions can be done if an angina patient isn’t a candidate for thrombolytic therapy?

A
  1. cardiac catheterization
  2. percutaneous coronary intervention
  3. CABG
37
Q

Nursing care involved with thrombolytic therapy

A
  1. monitor for bleeds
  2. monitor vitals for hemodynamic instability
  3. monitor for reperfusion arrhythmias or reocclusion
38
Q

What is the goal of diet education for a patient with angina?

A

Lower LDL cholesterol
- fat < 30%
- increase omega 3 FA

39
Q

How does smoking increase risk for angina?

A

Increased blood carbon monoxide levels cause decreased hemoglobin, which increases the myocardial workload

Nicotine raises HR/BP due to stimulation of NE and causes platelet adhesion

40
Q

Side effects of beta blockers

A

bradycardia, fatigue, weakness, hypotension

41
Q

Side effects of statins

A

rash, GI upset, hypersensitivity

42
Q

Side effects of ace-i

A

hypotension, proteinuria, cough, angioedema

43
Q

Side effects of CCB

A

edema, constipation

44
Q

Side effects of aspirin

A

dyspepsia, heartburn, bleeding

45
Q

Onset of nitro

A

1-3 min

46
Q

Side effects of nitro

A

hypotension, tachycardia, dizziness, headache

47
Q

Side effects of morphine

A

hypotension, constipation, confusion, sedation, respiratory depression

48
Q

Monitoring of morphine

A
  • RR, HR, BP, sedation, pain before
    5 min and 15 min post infusion
49
Q

Describe SL administration of nitro

A

1 tablet placed under the tongue or between the cheek and gum at the first sign of an angina attack. 1 tablet may be used every 5 minutes as needed, for up to 15 minutes. Do not take more than 3 tablets in 15 minutes.

Complex Care (9 decks)

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