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N232 > CAD + ACS (M4C) > Flashcards

CAD + ACS (M4C) Flashcards

1
Q

acute coronary syndrome

A
  • group of potentially life threatening disorders resulting from sudden, insufficient blood flow to the heart muscle d/t narrowing or blockage of one or more blood vessels to heart
  • unstable angina to MI
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2
Q

S&S of ACS

A
  • dizziness
  • lightheadedness
  • chest pain
  • upper body discomfort w/ pain
  • numbness in one or both arms, wrist, hand
  • SOB
  • N/V
  • sweating
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3
Q

angina

A
  • typically warning to MI

- vessels narrows and shorter restriction of blood flow

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4
Q

types of angina

A
  • stable
  • unstable
  • refractory
  • variant
  • silent ischemic
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5
Q

stable angina

A
  • chest pain that occurs with activity or stress; relieved by rest
  • stress of heart inc, narrowed vessels become more restricted
  • lack of O2 to heart muscle (cell death) –> pain
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6
Q

unstable angina

A
  • symptoms more frequent and inc in severity
  • not relieved by rest or meds
  • treated w/ nitroglycerin (helps with acute phases of angina)
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7
Q

refractory/intractable angina

A
  • severe, incapacitating angina
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8
Q

variant/vasospastic angina

A
  • anginal pain at rest
  • d/t coronary a. vasospasm
  • ECG shows S-T segment elevation
  • reversible
  • treated w/ nitroglycerin
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9
Q

silent ischemia angina

A
  • info gained by objective data
  • monitor stress tests (ECG changes)
  • not showing S&S (ex. chest pain, tingling)
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10
Q

S&S of MI

A
  • neuro: dizzy, restless, lightheaded, anxiety, pain
  • CV: chest pain, inc/dec/irreg HR
  • resp: SOB, crackles (if HF)
  • GI: N/V, burping, heartburn
  • integ: cool, clammy, diaphoretic
  • psychological: feeling of impending doom or denial that something is wrong
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11
Q

Dx of MI

A
  • cardiac biomarkers: troponin, CK, myoglobin
  • lipid profile
  • ECG
  • angiogram
  • echocardiogram
  • EF
  • CBC
  • renal Fx
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12
Q

troponin

A
  • specific indicator of myocardial tissue damage
  • protein in myocardium
  • regulates myocardial contraction process
  • critical marker of myocardial injury
  • inc in levels of troponin can be detected within 6 hrs (remains elevated for at least 2 wks)
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13
Q

lipid profile

A
  • total cholesterol
  • HDL
  • LDL
  • triglycerides
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14
Q

ejection fraction (EF)

A
  • measurement of % of blood leaving heart each time it contracts
  • normal = 55-75%
  • heart muscle damage d/t injury or disease = dec EF
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15
Q

extent of infarction depends on…

A
  • degree and duration of obstruction
  • collateral circulation
  • atherosclerosis
  • thrombosis
  • coronary a. blood flow reduced at least 75% before symptoms appear
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16
Q

O2 demand > O2 supply when…

A
  • inc workload on heart when there’s fixed supply
  • reduced blood supply to heart
  • reduced O2 carrying capacity of coronary a.
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17
Q

angina/MI nursing care

A
  • thorough pain assessment
  • assess for both chest pain and chest discomfort (heaviness, heart feeling squeezed)
  • goal = inc O2 supply & dec demand on heart
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18
Q

reduce O2 demand by…

A
  • rest
  • nitrates
  • beta blockers
  • Ca+ channel blockers
  • ACE inhibitors/ARBs
19
Q

inc O2 supply by…

A
  • O2 (when indicated)
  • aspirin
  • thrombolytics
  • PCI (stent, CABG)
  • heparins (inc O2 supply by inhibiting clots to form)
  • antiplatelets
  • statins (dec cholesterol levels)
  • Ca+ channel blockers
20
Q

management of ischemia

A
  • dec activity (dec demand on heart)
  • O2 (when indicated)
  • nitrates (do not give more than 3 doses of nitro spray/reassess after every dose)
  • aspirin
  • beta blocker
21
Q

nitrates - action

A
  • relax vascular SM in arteries but particularly veins
  • reduce preload –> reduce cardiac workload
  • ex. nitroglycerine
22
Q

worst ADE of nitrates

A
  • vessels dilate too much and blood pools in periphery –> reducing CO
  • mnfts as headache
  • Tx by filling space w/ isotonic volume
23
Q

nitroglycerine

A
  • SL tabs & spray: for immediate angina attacks
  • transdermal patches: in active HF
  • IV: only in specialty care areas
24
Q

teaching around nitroglycerin

A
  • teach about ADE: dec in BP, dysrhythmias, reflex tachycardia
  • teach about 3 chances for med to work
25
Q

assessments about nitroglycerin

A
  • BP

- pain (repeat pain assessment)

26
Q

aspirin

A
  • anti-inflammatory
  • antiplatelet (inhibits further growth of thrombus)
  • reduces mortality up to 20% for someone w/ MI
  • inc avail O2 supply to heart
  • ex. ASA
27
Q

worst ADE of aspirin

A
  • allergic rxn –> antihistamine/epinephrine
28
Q

beta blockers

A
  • reduce CO by blocking beta receptors
  • dec HR & contractility –> dec workload/demand on heart
    ex. metoprolol, atenolol, propranolol
29
Q

worst ADE of beta blockers

A
  • bradycardia, inadequate CO, bronchospasm
30
Q

Ca+ channel blockers

A
  • inhibits transportation of Ca+ into myocardial and vascular SM cells
  • results in inhibition of excitation-contraction coupling and subsequent contraction
  • reduces cardiac workload & inc O2 supply
  • do not give with grapefruit juice
  • ex. diltiazem, verapamil
31
Q

worst ADE of Ca+ channel blockers

A
  • bradycardia (heart block), inadequate CO, HF
32
Q

ACE inhibitors

A
  • inhibits conversion of angiotensin I to angiotensin II
  • reduces afterload –> reduces cardiac workload
  • ex. ramipril, enalapril
33
Q

worst ADE of ACE inhibitors

A
  • inadequate cardiac output

- cough (angioedema) from action on vasodilator bradykinins

34
Q

fibrinolytics

A
  • “clot busters”
  • used for STEMI if it is within 6 hrs of 1st symptoms and PCI is not avail within 90 mins for 1st medical contact
  • dissolves body’s fresh fibrin clots
  • delivered in critical care areas & close monitoring for bleeding
35
Q

antiplatelets

A
  • inhibits platelet aggregation
  • prolong bleeding time
  • used to prevent MI
  • for pts who have stents
  • assess: platelet count
  • monitor for signs of active bleeding
  • inc avail O2 to heart
  • thienopyridines & glycoprotein IIb/IIIa inhibitors
36
Q

HMG coenzyme A Reductase Inhibitors (Statins)

A
  • inhibit cholesterol production
  • raise HDL lvls and lower triglyceride lvls
  • dec demand on heart
  • inc avail O2 to heart
  • ex. atorvastatin
37
Q

worst ADE of statins

A
  • liver dysfx (freq LFT & monitoring)
  • muscle pain, tenderness and weakness (check CPK)
  • N/V, heartburn, abd cramping & diarrhea, memory loss
38
Q

percutaneous coronary interventions

A
  • used to open up occluded arteries in acute MI
  • promotes reperfusion in areas that have been deprived of O2
  • inc avail O2 to heart
39
Q

coronary artery bypass graft (CABG)

A
  • take vessels to replace blocked vessels with new vessels

- invasive procedure

40
Q

cardiac rehabilitation phase I

A
  • begins w/ Dx of atherosclerosis & ACS symptoms
  • low level activities
  • pt education: S&S, when to contact 911, medication teaching
  • rest-activity balance, follow up appts
41
Q

cardiac rehabilitation phase II

A
  • begins after pt discharged
  • output program
  • ECG monitoring
  • exercise and strength training
  • support w/ Tx of disease
  • lifestyle modifications, risk factor reductions
  • short-term and long-term range goals collaboratively
42
Q

cardiac rehabilitation phase III

A
  • community based
  • focused on maintenance of cardiovascular ability
  • self-directed
  • not supervised
43
Q

cardiac rehabilitation

A
  • 3 phases
  • inc survival
  • reduces recurrent events
  • improves QoL
  • dec workload of heart
  • limit effects & progression of atherosclerosis + return to normal QoL
  • enhance psychosocial status
  • encourage physical activity
  • pt education
  • if can walk 5-1km = can do sexual activities
  • positioning
44
Q

pharmacological interventions for CAD

A
  • O2 therapy
    antianginals:
  • nitrates (nitroglycerine)
  • Ca+ channel blockers (diltiazem, amlodipine)
  • beta blockers (metoprolol)
  • thrombolytics (alteplase)
  • statins (atorvastatin)

N232 (5 decks)

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