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z_MEDSURGE: FINAL REVIEW > CAD and Acute Coronary Syndromes > Flashcards

CAD and Acute Coronary Syndromes Flashcards

1
Q

What is Coronary Heart Disease?

A
  • CAD occurs if plaque builds up in the coronary arteries reducing blood flow to the tissues of the heart
  • This can lead progressively to ischemia, angina, and infarction of cardiac tissues
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2
Q

What is Acute Coronary Disease (ACD)?

A

It is a type of ischemic heart disease that has progressed to unstable angina and MI

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3
Q

What is Angina Pectoris?

A

General term for angina – chest pain

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4
Q

What are the characteristics of Stable Angina?

A
  • Occurs usually during physical exertion
  • Episodes of predictable pain tend to be alike
  • Usually lasts a short time (5 minutes or less)
  • Is relieved by rest or medicine (nitro)
  • May feel like chest pain that spreads to the arms, back, or other areas
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5
Q

Outside of physical exertion, what are some other triggers of Stable Angina?

A
  • Emotional stress
  • Excessive hot or cold temperatures
  • Heavy meals
  • Smoking
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6
Q

How does nitroglycerin relive angina?

A
  • relaxes the coronary arteries and other blood vessels,
  • reducing the amount of blood that returns to the heart and
  • easing the heart’s workload
  • By relaxing the coronary arteries, it increases the heart’s blood supply
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7
Q

What are the key points to remember about nitro administration?

A
  • Sublingual to dissolve
  • Take every 5mins for 3x’s if not effective, call 911
  • Takes 5mins to fully absorb, so don’t spit, rinse or drink while taking
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8
Q

What is Unstable Angina?

A
  • Unexpected, unpredictable chest pain
  • Can occur while resting (typically) or active
  • Should be treated as an emergency!
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9
Q

What are the s/s of Unstable Angina?

A
  • Often occurs at rest, sleeping, or with little physical exertion
  • May last longer than stable angina
  • Rest or medicine usually do not help relieve it
  • May get progressively worse and lead to MI
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10
Q

Explain the conservative and aggressive treatment for Unstable Angina.

A
  • Conservative
    • Lovenox (low dose anticoag)
  • Aggressive
    • Cardiac catheterization
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11
Q

What are the two types of MI?

A
  1. ST- elevation (STEMI)
  2. Non ST-elevation (NSTEMI)
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12
Q

What is indicated by a STEMI MI?

A

the artery supplying an area of the heart muscle is completely blocked

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13
Q

What is indicated by a NSTEMI MI?

A
  • the artery is only partly blocked, so only part of the heart muscle supplied by the affected artery is affected
  • (NSTEMI can also include unstable angina)
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14
Q

What provides the definitive dx for MI?

A

EKG

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15
Q

S/S of MI?

A
  • Severe angina/heavy pressure feeling – can last from minutes to hours
  • Diaphoresis, nausea, feel faint
  • SOB
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16
Q

If a client is having chest pain, what may indicate that it is not angina?

A
  • The pain fluctuates w/ breathing.
  • This would indicate pleuritic pain from breathing, not angina
  • Angina is not affected by breathing
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17
Q

True or False

It is possible to have a normal ECG even if you have had an MI

A

True

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18
Q

Besides an EKG, what else would we test for positive MI indication?

A

Troponin and CK levels

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19
Q

What are the key points to remember regarding the levels of Troponin?

A
  • Definitive test for MI
  • Not normally in blood, Released during MI
  • Level of troponin increases w/in 4-6hrs after onset of chest pain
  • Peaks at 10-24hrs
  • Returns to normal level over 10-14days
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20
Q

What are the 3 types of Creatine Kinase (CK)?

A
  • mm (found in skeletal muscle)
  • MB (found in cardiac muscle) and
  • BB (found in brain tissue)
21
Q

What are the key points to remember regarding levels of CKMB?

A
  • After cardiac injury, CK and the isoenzyme MB are released into the blood stream at a predictable rate.
  • Within a 4 to 6 hour window (post injury) the CKMB level rises above normal and within 24 to 36 hours this level elevates to approximately 5 to 15 times normal
  • Within 2 to 3 days the CKMB returns to normal.
  • Definitive test for MI
22
Q

Why do we send for Troponin levels before CKMB?

A

Trop labs have a faster turnaround

23
Q

What is the progression of MI treatment?

A

O2 ➝ Aspirin ➝ Nitro ➝ Morphine

24
Q

Why does giving Beta blockers and ACE inhibitors help w/ MI?

A

They help decrease afterload thus the heart doesn’t have to work so hard to get blood to the system

25
Q

How do morphine and nitro help w/ MI?

A

They are potent vasodilators which allow more blood to flow, decreasing O2 demand

26
Q

True or False

Heparin (anticoags) are given to break clots up.

A

False

They are given to PREVENT clotting

27
Q

What is the potential danger of nitro use?

A

hypotension

28
Q

What is the nursing responsibility regarding admin of nitro?

A
  • Check blood pressure and pulse before each administration of NTG–blood pressure can drop precipitously after a single dose.
  • Hold dose if systolic BP < 90 or more than 30 below baseline.
  • How is pt responding/tolerating to medication
  • Document
  • Acetaminophen is generally given PO for relief of headache secondary to NTG therapy
    • NOT PROPHYLACTICALLY
29
Q

What is PTCA – Percutaneous transmural coronary angioplasty?

A

revascularization procedure that is used to increase the diameter of an artery that has been stenosed due to coronary artery disease

30
Q

What is required prior to PCTA?

A
  • PTCA - is invasive, needs consent.
  • Signed by Pt, Physician, and RN who witnessed consent
31
Q

What are our Nursing responsibilities during PTCA?

A
  • Monitoring vitals, I/O’s?
  • Watch urine OP for signs of blood (Foley catheter needs to be in place to do so)
  • Look for any visual signs of bleeding. (IV, skin penetration sites, nose bleeds etc)
  • Watching for any signs of embolism
  • Observing for pt tolerance of procedure
32
Q

What are Nursing Responsibilities for f/u care of PTCA?

A
  • Check site for bleeding
  • Check for movement
  • Check for perfusion
  • Check erythema at penetration sites
  • Check for inflammatory responses (normal and abnormal)
33
Q

ACE inhibitors and Calcium channel blockers help…

A

relax vessels and manage vasoconstriction

34
Q

What is the purpose of administering fibrinolytics for thrombolytic therapy?

A

To dissolve thrombi and restore myocardial blood flow

35
Q

What are the Contraindications to Thrombolytic Therapy?

A
  • Previous intracranial hemorrhage.
  • Known structural cerebral vascular lesion.
  • Ischemic stroke within 3 months
  • Face or and head trauma within 3 months
  • Recent internal bleeding
  • Current use of anticoagulants
36
Q

What is PTT?

A

Partial thromboplastin time (PTT) test measures the time it takes for a blood clot to form.

37
Q

What is PT?

A

Prothrombin time (PT) is a blood test that measures the time it takes for the liquid portion (plasma) of your blood to clot

38
Q

What is INR?

A

The international normalized ratio (INR) is a calculation based on results of a PT and is used to monitor individuals who are being treated with the blood-thinning medication

39
Q

What is monitored for use of Heparin, PT, PTT, or INR?

A

PTT

40
Q

What is monitored for use of Warfarin/Coumadin, PT, PTT, or INR?

A

PT and INR

41
Q

What are the dangers for clotting times that are too short or too long?

A
  • Too short = quick clotting = @risk for clots; stroke, DVT, PE, etc
  • Too long = slow clotting = @risk for bleeding out
42
Q

What methods of administration are used for Heparin?

A

IV or SubQ ONLY

43
Q

True or False

PTs are sent home w/ a prescription for Heparin.

A
  • FALSE
  • If needed, they are sent home w/ a script for PO WARFARIN/COUMADIN or Lovenox
44
Q

True or False

Lovenox requires a PTT test.

A
  • False
  • Lovenox reqs no blood work for script
45
Q

What is to be kept in mind it a PT is on Heparin while in the hospital and will be given a script for Warfarin/Coumadin when discharged?

A

Start Warfarin prior to discharge to give it time to work and then cut off heparin when PT sent home.

46
Q

What is an Atherectomy?

A

procedure to remove plaque from an artery (blood vessel).

47
Q

What is a Rheolytic thrombectomy?

A

a minimally invasive procedure to break up blood clots.

48
Q

What is the PT education at discharge for a PT that had a MI?

A

Self monitor for

  • Chest pain
    • Types and actions
  • Nitro
    • How to take and physical position when doing so
  • HCP
    • When to contact
  • ED
    • When to hit the emergency dept
  • Appropriate edu on specific meds

z_MEDSURGE: FINAL REVIEW (15 decks)

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