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Nursing 4 Exam 1 > CAD > Flashcards

CAD Flashcards

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0
Q

What is the main cause of CAD.

A

Atherosclerotic plaque

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1
Q

What is CAD.?

A

Impaired blood flow to the myocardium

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2
Q

Is CAD a normal part of aging?

A

Yes, it begins at 15

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3
Q

What is the final stage of the process of CAD?

A

The formation of atheromas, which are complex lesions if lipids, fibrous tissue, collagen, calcium, cellular debris, and capillaries.

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4
Q

What can happen to atheromas?

A

The calcified lesions can rupture or ulcer are and stimulate a thrombosis.

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5
Q

What are the modifiable risk factors for CAD?

A 
Increased serum lipid levels
HTN
Cigarette smoking 
Obesity 
DM
stress
Physical activity
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6
Q

What are the unmodifiable risk factors for CAD?

A

Age
Gender
Ethnicity
Genetics

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7
Q

How can we decrease HTN?

A 
Regular BP check ups (every 3 months)
Adequate BP medications 
Decrease salt intake 
Stop smoking 
Control and reduce weight (regular exercise)
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8
Q

How can we decrease elevated serum lipid levels?

A

Check them every 90 days (start treatment when LDL is at 190)

Decrease total fat intake (decrease animal fat)
Maintain ideal body weight
Exercise programs
Increase complex carbs and veggies

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9
Q

What is the main way to reduce a stressful lifestyle?

A

REST AND SLEEP

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10
Q

How often a week should you exercise?

A

3-4 times a week?

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11
Q

What is stable angina?

A

Most common and predictable form of angina. Occurs with predictable amount of activity and is common manifestation if CAD.

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12
Q

What is prinzmetal angina?

A

Typical angina that occur unrelated to activity and often at night. It is caused by coronary artery spasm with or without an atherosclerotic lesion.

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13
Q

What is unstable angina?

A

Occurs with increasing frequency, severity, and duration. Pain in unpredictable and occurs with decreasing levels of activity or stress and may occur at rest.m

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14
Q

What is ACS?

A

Coronary blood flow is acutely reduced but not fully occluded.

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15
Q

What do most people with ACS have?

A

Stenosis of one or more coronary arteries.

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16
Q

What is the underlying cause of ACS?

A

Rupture or eroded plaque

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17
Q

What happens when the ACS plaque ruptures?

A

The exposed lipid core of the plaque stimulates platelet aggregation and the extrinsic clotting pathway. Thrombin is generated and fibrin is deposited, forming a clot that severely obstructs blood flow.m

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18
Q

What causes angina?

A

Lactic acid released from the ischemic cells stimulate he pain receptors.

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19
Q

How do stable lesions occlude?

A

They gradually occlude the vessel lumen

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20
Q

How do unstable lesions occlude?

A

Prone to rupture and thrombus formation

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21
Q

What do stable lesions cause?

A

Angina

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22
Q

What do unstable lesions cause?

A

ACS

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23
Q

When does an MI occur?

A

When blood flow to a portion of cardiac muscle is completely blocked. (Irreversible)

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24
Q

How long is the time frame for ischemia to get fixed before irreversible hypodermic damage occurs?

A

20 minutes

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25
Q

What does pain feel like with ACS?

A

Chest pain, usually subs thermal or epigastric. Radiates to the neck, left shoulder or arm. May occur at rest and normally lasts loner than 10-20 minutes

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26
Q

What are CM of ACS?

A

Dyspnea, diaphoresis, pallor, and cool clammy skin. Tachycardia and HTN.

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27
Q

How is an MI distinguished?

A

It’s duration and continuous nature.

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28
Q

What is the onset of pain with MI.?

A

Sudden and usually not associated with activity.

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29
Q

What medications lower cholesterol?

A

Statins, bile acid sequestrants, nicotinic acid, and fibrates.

30
Q

What is the first line drug to treat cholesterol?

A

Statins. They lower LDL and increase HDL

31
Q

What is a major side effect is statins?

A

They may cause myopathy, all clients are instructed to report muscle weakness and brown urine.

32
Q

What tests should be done during statin use?

A

Liver function tests, these drugs may increase liver enzymes.

33
Q

What are drugs used to treat angina?

A

Nitrates, BB, and CCB

34
Q

What do nitrates do?

A

They treat acute anginal attacks and prevent angina.

35
Q

What is the drug of choice to treat acute angina?

A

Sublingual nitroglycerin.

36
Q

What is the primary problem willing term nitroglycerin?

A

They can develop tolerance. (Pt. should do a nitrate free period of 8-10 hours a day, usually at night)

37
Q

What is a common side effect of nitrates?

A

Headache.

38
Q

What is the first line drug to treat stable angina?

A

Beta blockers (olol)

39
Q

What is the action of BB?

A

They block cardiac stimulating effects of NE and epi, decreasing myocardial demand.

40
Q

Who should never take a BB?

A

Asthma or COPD patients. Use cautiously in HF. And do not use to treat prinzmetal angina because it will make it worse.

41
Q

What do CCB do?

A

Reduce myocardial oxygen demand and increase myocardial blood and oxygen supply.

42
Q

What drugs are used to treat MI’s?

A

Fibrinolytics, antidysrhytmics, and analgesics.

43
Q

What dosage of aspirin is given in an emergency situation for an MI?

A

160-325 mg and it should be chewed!

44
Q

What analgesic is given sublingually during an MI?

A

Nitroglycerin 0.4 mg tablet every 5 min

Follow up with IV nitro for first 24-48 hrs

45
Q

What does nitro do?

A

It is pain relief and it decreases myocardial oxygen demand and may increase the oxygen supply to the myocardium.

46
Q

What is a side effect of nitro?

A

Reflex tachycardia or hypotension.

47
Q

What medication should you ask the patient if they have taken in the past 24 hours before giving nitro?

A

Viagra

48
Q

What is the next drug of choice for MI pain relief?

A

Morphine sulfate. Initial IV of 4-8 mg followed up by 2-4mg every 5 minutes.

49
Q

What are Fibrinolytics?

A

Drugs that dissolve or break up clots

50
Q

How soon should a fibrinolytic be given?

A

Within the first6 hours of the MI

51
Q

What is a major side effect of Fibrinolytics?

A

Bleeding!

52
Q

What is streptokinase?

A

Fibrinolytic.

53
Q

What is the major side effect of streptokinase?

A

Anaphylaxis

54
Q

What do ACEI do for patients with MI?

A

Reduce ventricular remodeling after an MI. REDUCING THE RISK for HF

55
Q

What do anti platelet medications do?

A

Improves vessel opening with fibrinolytic activity so that lower doses will have to be used.

56
Q

What are the interventions to treat CAD?

A

Risk factor management and prevention!

57
Q

What is treatment for stable angina?

A

Rest or nitro

58
Q

What is treatment for prinzmetal angina!

A

CCB

59
Q

What are important assessment questions to ask patient with CAD?

A 
P-what are precipitating factors?
Q- qualit of pain or discomfort
R- where does it radiate?
S- severity if pain (0-10)
T- when did pain begin?
60
Q

What should we monitor or tell patients w take nicotinic acid?

A

It will cause flushing sensation and may increase BS,!!

61
Q

What is the WORST complication of angina?

A

MI

62
Q

What two antidysrhytmics do we give?

A

Atropine for bradycardia

Verapamil for Afib

63
Q

What is the surgical treatment for CAD?

A

Per cutaneous coronary revasularization

Stent placement occurs with this.

64
Q

What is a coronary artery bypass graft?

A

Surgery for CAD, using a section of a vein or an artery to create a connection, or bypass between the aorta and coronary artery. This allows blood to perfume to the ischemic portion of the heart.

65
Q

What is the initial treatment for an MI?

A 
M: morphine
O: oxygen
N:nitroglycerin
A:aspirin
B: beta blockers
66
Q

What does the C-reactive protein indicate?

A

Elevated levels may be predictors of CAD

67
Q

What does an ABI indicate?

A

An ABI of less than 0.9 indicates the presences of PAD

68
Q

What does an ECG indicate?

A

ST segment greater than 3 mm is considered positive for CAD

69
Q

What does CK level indicate?

A

It correlates with the size of the infarction. Appears within 4-6 hrs of AMI.

70
Q

What does CK-MB indicate?

A

Greater than 5% is an indicator of MI. DOes not normally rise with any other reason than an MI.

71
Q

What does a CBC indicate?

A

It looks at WBC count to check for inflammation,

72
Q

What does an ECCHO indicate?

A

Cardiac wall motion and left ventricular function

Nursing 4 Exam 1 (5 decks)

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