CAD: Chronic stable angina

Question 1

What is the most common type of CV disease?

Answer 1

CAD

Question 2

CAD includes what?

Answer 2

Chronic stable angina and acute coronary syndrome

Question 3

Chronic stable angina patho

Intermittent decreased blood flow to the myocardium leads to ischemia or necrosis? What does it lead to?

Answer 3

Ischemia

Ischemia can lead to temp/pain pressure in chest

Question 4

Chronic stable angina patho

What brings the pain on?

Answer 4

Low O2 usually due to exertion

Question 5

Chronic stable angina patho

What relieves the pain?

Answer 5

Rest and/or nitroglycerin SL

Question 6

Chronic stable angina tx: Nitroglycerine

How is it given?

Answer 6

SL

Question 7

Chronic stable angina tx: Nitroglycerine

What does it cause?

Answer 7

Venous and arterial dilation —dilation causes decrease in preload and after load

Question 8

Chronic stable angina tx: Nitroglycerine

Dilates and causes decrease in preload and after load. It also causes dilation of ____ which will increase blood flow to actual heart muscle (myocardium)

Answer 8

Cornary arteries

Question 9

Chronic stable angina tx: Nitroglycerine

How often to take?

Answer 9

Take 1 every 5 min for 3 doses

Question 10

Chronic stable angina tx: Nitroglycerine

Ok to swallow?

Answer 10

No

Question 11

Chronic stable angina tx: Nitroglycerine

How to store

Answer 11

Dark, glass bottle
Dry
Cool

Question 12

Chronic stable angina tx: Nitroglycerine

How it feels when its in mouth

Answer 12

May or may not burn or fizz

Question 13

Chronic stable angina tx: Nitroglycerine

T/F: HA is to happen

Answer 13

T

Question 14

Chronic stable angina tx: Nitroglycerine

Call doc for HA?

Answer 14

NO..this is expected to happen, nothing life-threatening. don’t need to call doc

Question 15

Chronic stable angina tx: Nitroglycerine

How often to renew?

Answer 15

Every 3-5 months

Question 16

Chronic stable angina tx: Nitroglycerine

What if it is spray–how often to renew?

Answer 16

Every 2 years

Question 17

Chronic stable angina tx: Nitroglycerine

After giving this, what should BP do?

Answer 17

Decrease

Question 18

Never leave who?

Answer 18

An unstable client

Question 19

Take one NTG SL, after 5 min if chest pain/discomfort is unimproved or worsened, do what?

Answer 19

Activate emergency response

Question 20

Chronic stable angina tx: BB

What do BB do to BP, P and myocardial contractility?

Answer 20

Decrease

Question 21

Chronic stable angina tx: BB

What does this do to workload of heart?

Answer 21

Decrease

Question 22

Chronic stable angina tx: BB

BB block beta cells. These are the receptors sites for what?

Answer 22

Catecholamines (epi and norepi)

Question 23

Chronic stable angina tx: BB

Decreased contractility so ___ to CO?

Answer 23

Decrease

Question 24

Chronic stable angina tx: BB

Decrease or increase workload of heart?

Answer 24

Decrease

Question 25

Chronic stable angina tx: CCB

Examples?

Answer 25

Nifedipine
Amlodipine
Verapamil
Diltiazem

Question 26

Chronic stable angina tx: CCB

What do these do to BP?

Answer 26

Decrease

Question 27

Chronic stable angina tx: CCB

These cause vasodilation of the ____

Answer 27

Arterial system (after load)

Question 28

Chronic stable angina tx: CCB

Dilate what?

Answer 28

Coronary arteries

Question 29

Chronic stable angina tx: CCB

2 benefits?

Answer 29

Decrease after load

Increase oxygen to muscle

Question 30

Chronic stable angina tx: Acetylsalicyclic acid

What is this drug?

Answer 30

Aspirin –anti platelet

Question 31

Chronic stable angina tx: Acetylsalicyclic acid

How is dose determined?

Answer 31

By doc (81-325 mg)

Question 32

Chronic stable angina: Education/teaching

Rest how often?
Avoid what? (3)
When to exercise after eating?
How to dress?

Answer 32

Rest frequently

Avoid overeating, excess caffeine/drug that increase HR, and isometric exercises (lifting weights)

Wait 2 hours after eating to exercise

Dress warmly in cold weather (any temp. extreme can precipitate an attack)

Question 33

Chronic stable angina: Education/teaching

When to take nitro?
Stop what?
Lose what?
Reduce what?

Answer 33

Take nitro prophylactically

Stop smoking

Lose weight

Reduce stress

Question 34

Cardiac cauterization–Pre procedure

Ask about what?

Answer 34

If they are allergic to shellfish or iodine

Question 35

Cardiac cauterization–Pre procedure

What do we want to check because dye is excreted here?

Answer 35

Check kid function bc dye is excreted through kidneys

Question 36

Cardiac cauterization–Pre procedure

What may be ordered pre procedure if they have kidney problems and why?

Answer 36

Acetyclysteine – helps protect the kidneys

Question 37

Cardiac cauterization–Pre procedure

What does it feel like when dye is injected?

Answer 37

Hot shot

Question 38

Cardiac cauterization–Pre procedure

T/F: Palpitations normal

Answer 38

T

Question 39

Cardiac cauterization–Post procedure

Monitor what?
Watch what?
Assess what?

Answer 39

Monitor VS

Watch puncture site for bleeding/hematoma formation

Assess extremity distal to puncture site (5Ps)

Question 40

Cardiac cauterization–Post procedure

What are 5Ps?

Answer 40

Pulselessness
Pallor
Pain
Paresthesia
Paralysis

Question 41

Cardiac cauterization–Post procedure

Position after?

Answer 41

Bed rest
Flat
Extremity straight for 4-6 hr

Question 42

Cardiac cauterization–Post procedure

Major complication ?

Answer 42

Bleeding

Question 43

Cardiac cauterization–Post procedure

Report what ASAP?

Answer 43

Pain (could be arterial occlusion; bleeding)

Question 44

Cardiac cauterization–Post procedure

What if client is on metformin?

Answer 44

Hold the med for 48 hours post procedure!

Worried about kidneys!