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Nurs 230 Final > CAD/ACS > Flashcards

CAD/ACS Flashcards

1
Q

CAD

A

Atherosclerosis of coronary arteries
“Hardening of the arteries”

Due to damage to vessel

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2
Q

Risk factors of CAD
Non modifiable

A

Age: 55+ women 45+ men
FH

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3
Q

Risk factors of CAD
Modifiable risks

A

Tabacco use
Sedentary lifestyle
stress
HTN
High cholesterol: total:200+ LDL:130+ triglycerides 150+
Obesity

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4
Q

Cholesterol

A

Total cholesterol normal: <200

HDL:
Females: >50+
Males: >40+

LDL: <100

Triglycerides: <150

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5
Q

Dietary interventions for hyperlipidemia
LDL

A

activity
Avoid trans/saturated fats and cholesterol in foods

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6
Q

Dietary interventions for hyperlipidemia
Increase HDL

A

Physical activity
Healthy fats
Modify ETOH intake
Smoking cessation
Weight loss

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7
Q

Dietary interventions for hyperlipidemia
Lower triglycerides

A

Control blood sugar (if DM)

Avoid excessive ETOH and refined sugars

Physical activity

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8
Q

Tx for hyperlipidemia: drug therapy

A

On these meds for lifetime

Types:
Statins (lower LDL raise HDL)
Niacin
Fibrates
Bile acid sequestrants
PCSK9 inhibitors

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9
Q

Statins

A

First line tx (best chance of reducing risk)

Lower LDL and triglycerides
Small increase in HDL

AE:
-Muscle aches
-Rhabdomylosis (DARK URINE, muscle pain, high CK) STOP STATIN
-Increase in AST/ALT

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10
Q

Niacin

A

B vit
Lower LDL and triglycerides
Increases HDLs

AE: flushin, pruritus

Taken if statin doesnt help enough
(For cholesterol)

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11
Q

Fibric acid derivates (gemfibrozil)
And
Bile acid sequestrants (cholestyramine)

A

Both work in the gut

Also given if statin doesnt help enough

(For cholesterol)

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12
Q

PCSK inhibitors (evolocumab)
And
Ezetimibe

A

Just know their also for cholesterol

Added to statins

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13
Q

Angina

A

Chest pain from myocardial ischemia
(Increase o2 demand or decrease o2 supply)

Blockage causes symptoms

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14
Q

Precipitating factors of angina

A

Physical exertion
Temp
Emotions
Consuming heavy meal
Tabacco
Sex
Stimulants

(Any thing to increase demand of O2)

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15
Q

Chronic stable angina

A

Episodic pain

Pattern: provoked by stress and activity

Improves with rwst or NTG

No longer than 15 mins

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16
Q

Unstable angina

A

New or change pattern

Occurs at rest
Does not imporve with NTG or rest

Emergency!

17
Q

Prinzmetals angina

A

Caused by coronary vasospasm

Comorbid with migraines, raynauds, heavy smoking

18
Q

Diagnostic studies for CAD

A

12 lead ECG

Labs: cardiac enzymes

Stress test: see if activity causes symptoms

Cardiac catheterization

19
Q

Cardiac enzymes

A

Markers of injury

CK total: nonspecific, any muscle injury

Specific:
CKMB: ⬆️ 4-8 hours, peals 12-24 hours
Troponin: ⬆️ 3-4 hours peaks 4-24 hours

Get 3 sets of cardiac enzymes 3-6 hours apart

20
Q

Cardiac catheterization
Gold standard
PCI
Complications

A

Gold standard to localized CAD for pt with worsening angina symptoms

PCI (percutaneous coronary intervention) can be done if a block is found
(stent placement)

Complication’s: infection, poke hole in heart, bleeding

21
Q

Cardiac cath nursing care
Pre and post procedure

A

Pre procedure:
Allergy: shell fish (contrast dye)
Lab studies: bleeding, kidney function

Post procedure:
Monitor: bleeding, dysrhythmia, chest pain

22
Q

Nitroglycerin (short acting nitrate)
Why important
MOA
Route
Other use
Cause

A

First line for acute angina

MOA: vasodilations
Route: SL 1 tab every 5 mins, mac 3 then call EMS
Spray can be on or under tongue

Used Prophlactically in stable angina before activity

HA common (Tylenol), watch BP

23
Q

Topical NTG

A

Nitro ointment (nitro-paste)
Ordered by inch
Wear gloves

Transdermal patch
Apply over non-hairy area, occlusive dressing

24
Q

Long acting nitrates

A

Used to reduce frequency
Tx for prinzmetals angina
Orthostatic hypotension

Ex: isosorbide

25
Q

Antiplatelet therapy
Med and dose
Why given
Risk
Use
What else we can give if not tolerant

A

Low dose ASA (81mg) daily

Decrease platelet to prevent clots

Bleeding risk
Used for primary prevention

Or can give clopidogrel (plavix) if ASa intolerant

26
Q

MI/ACS

A

Prolonged ischemia

Non-ST elevation (NSTEMI):
Not as much of a emergency

ST-segment-elevation MI (STEMI): emergency right now
Need pci within 90 mins

27
Q

ACS clinical manifestations: MI

A

Severe chest pain not relieved by rest , NTG:
Heaviness, pressure, crushing

Radiate (jaw,neck,shoulder)
Diaphoresis
Tachycardia
Palor
Low grade fever, N/V

28
Q

ACS clinical manifestations: MI

As it progresses

A

Low BP

LOC

weak pulse, oliguria

29
Q

MI diagnositic studies
Test
Gold standard to localize the lesion

A

ECG: show ST elevation

Cardiac biomarkers: increased CKMB, Troponin

Gold standard to localize the lesion: cardiac catheterization

30
Q

MI: intitial management
Goal
MONA

A

Goal: decrease O2 demand/increase O2 supply
Semi fowler
Bed rest
Cardiac monitoring

MONA: morphine, oxygen, nitroglycerin, ASA

Asses pain/VS

Plan for cardiac catheterization

31
Q

MI med management

A

Antiplatelet therapay (ASA, clopidogrel)

Anticoagulation (Heparin/LMWH)

Cardiac cath/PCI
May require CABG

Rural hospital may use thrombolytic meds to break up clot due to lack of resources

32
Q

CABG
Coronary artery bypass graft

A

Placement of arterial or venous grafts to bypass coronary blockage

Usually: internal mammary, saphenous, or radial artery

Requires STERNOTOMY

33
Q

CABG postop care

A

Assess: bleeding, fluid status, dysrhymthmias

Sternotomy site and harvest site would care

Pain management

Prevent VTE

Resp tx: splinting, IS

34
Q

Post MI nursing management

A

Cardiac monitoring
VS
Labs/ECG
Bedrest 12-24 hours
Heparin drip
Pain tx
Oxygen

35
Q

MI complications

A

Dysrhythmias

HF: pulmonary congestion, dyspnea, edema

Cardiogenic shock: decompensated
Increased HR
Decreased BP

New murmur is emergency post-op
Will need surgery

36
Q

Discharge teaching

A

Lifestyle mods

Cardiac rehab

Likely to have another

Nurs 230 Final (6 decks)

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