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Exam 4 Wk 8 And 9 > CAD/MI > Flashcards

CAD/MI Flashcards

0
Q

Hat are non-modifiable risk factors for CAD?

A 
Age
Gender
Family Hx
Diabetes 1
Ethnicity
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1
Q

Describe the physiology of coronary artery dz.

A 
Coronary risk factors
Get fatty streak formation
CAD- build up of plaque
Plaque rupture- can bleed and cause
Platelet aggregation
Thrombus
If thrombus moves it is an embolism, then goes into lung=PE or brain= stroke
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2
Q

What are the modifiable risks of CAD?

A 
HTN
Elevated lipids
Tobacco and alcohol
Obesity
Diabetes 2
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3
Q

What are the three types of angina?

A

Variant or Prinzmetal’s angina
Chronic stable angina
Unstable angina called Acute Coronary Syndrome

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4
Q

Describe unstable angina (acute coronary syndrome)

A

Chest pain is new in onset, occurs at rest, or has a worsening pattern
Unpredictable
Easily provoked by minimal or no exertion.
WOMEN
-unusual symptoms of fatigue, SOB, indigestion and anxiety.

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5
Q

What is variant or Prinzmetal’s angina?

A

Caused by vasospasm. Not caused by plaque blocking vessels.
Vasodilator and is fine. Probably some cardiac dz but not plaque

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6
Q

What is chronic stable angina?

A

Chest pain that is predictable. Can walk up 1 flight of stairs but know if do 2 will have chest pain. Take a dilator and will be fine.

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7
Q

Acute myocardial infarction is

A

Area of a wall that dies, if chest pain lasts more than 20 minutes.
Irreversible

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8
Q

What are the clinical manifestations of AMI?

A 
Pain- unless fast death
Nausea+ vomiting
Diaphoresis- heart working hard
SOB- low oxygen to heart muscle
Fever - cells go in to clean up dead tissue debris
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9
Q

What is the work up for an AMI?

A 
Hx and Physical exam
12 lead EKG
Labs drawn
Chest X-ray
Coronary angiogram
Echocardiogram
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10
Q

How do you decrease the work load of the heart?

A 
Bed rest with bathroom privileges
Decrease stress
Avoid large meals
Avoid valsalva maneuver 
Medications
Avoid extreme temperature changes
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11
Q

How do you increase oxygen supply to heart

A

Give O2
Aspirin chew -anti platelet
PCI( per cutaneous interventions)/ CABG
Thrombolytics

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12
Q

What do we do for stable angina?

A

Medications- lipid lowering( statins)
- anti platelet
- beta blocker
- nitroglycerin
Teach regarding management of risk factors to reduce plaque and increase blood flow - slow building activity
- coronary angiography for evaluation
“Elective” coronary revascularization considered

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13
Q

What is done for a acute coronary syndrome/ unstable angina/AMI?

A

12 lead EKG
O2
Medication
Emergency coronary revascularization

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14
Q

What is the medication therapy for ACS/unstable angina/AMI?

A 
Lipid lowering agents
Anti platelet 
Nitroglycerin
Morphine sulphate
Beta blockers
Calcium channel blockers
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15
Q

In an acute situation what meds will be given?

A 
Anti platelets
Nitro
Morphine for pain
Beta blockers help prevent another- take for at least 6 wks after
CCB- help protect kidneys
16
Q

What is the classification of atorvastatin ( Lipitor) and how does it work?

A

Decreases lipids

Blocks synthesis of cholesterol…decreases LDL and triglycerides

17
Q

Side effects of Lipitor or statins?

A

GI upset- mess with fat breakdown
Change in LFT’s ( fats are metabolized in liver)
Long term muscle weakness and fatigue, don’t go away once it happens
Can potentiate digoxin-can become digtoxic

18
Q

What are the nursing implications of Statins?

A

Check LFT’s
Check digoxin levels
Liver does most of its work at night so give in evening
Watch alcohol intake

19
Q

What is the classification of aspirin (ASA, ECASA), what does it do?

A

Anti platelet stops aggregation

20
Q

Side effects of aspirin

A

Ulcers, bleeding, GI bleeding

21
Q

Nursing implications with aspirin

A

Take with food or full glass of water

Check for bleeding

22
Q

Classification and action of nitroglycerin

A

Nitrate, fast acting vasodilator, mostly on Coronary arteries as well.
Decreases preload and afterload.
Used with MI, CAD, CHF, angina

23
Q

Side effects of nitro

A

Low blood pressure
HA- will go away with time
Postural hypotension
Increased heart rate

24
Q

Nursing implications for nitro

A

Can give sublingual-HA and tingling of mouth and tongue
Tablets deteriorate in sunlight…keep in brown bottle and dry.
Take one, wait 5 min call 911, then take a second, third in ambulance if it gets there in time.
Hold if BP < 90

25
Q

What are nursing implications for transdermal nitro?

A

Slow release
Don’t put over boney prominence
Rotate sites
Farther away you get from heart, less HA.

26
Q

What do you do if given nitro IV?

A

Watch closely, have on continuous EKG

27
Q

When is nitro contraindicated

A

BP<90

Taken erectile dysfunction meds for 24 hrs

28
Q

Classification and use for isosorbide mono nitrate ( Imdur)?

A

Long acting nitrates
For chronic chest pain,
Vasodilator, decreases afterload, decreases venous return, decreases preload and work load of the heart.
Same thing as nitro but long acting..for chronic

29
Q

Side effects of isosorbide (Imdur)?

A

Increased heart rate- volume going through heart is less so it works harder
HA,
Low BP

30
Q

Nursing implications for isosorbide (Imdur)?

A

Sit up slowly
Long acting so don’t crush
Take pill in morning

31
Q

Classification and use of morphing sulphate

A 
Narcotic,
Blockes receptors causes vasodilation= decreases afterload and work load of heart
#1 choice for pain. Not the first thing you give bcs of CNS depression, RR drops
32
Q

Side effects of morphine sulfate

A

CNS depression constipation

Decrease RR

33
Q

What happens in cath lab?

A

Goes in left femoral artery, sits in aortic arch where coronary artery is, sits in coronary vessels, injects contrast to see blood flow. Do balloon to open vessel and flatten plaque..temporary….painfull when balloon is enflated. Tell them it is tempory

34
Q

How do they do a stent?

A

Put stent over balloon, opens balloon to open cage, then removes ballon. Cage stays open.

35
Q

What is involved with a CABG?

A

Take the left mammary artery and sow it to the top of subclavian artery and put in below the area of the blockage to bypass clot.

36
Q

What are the A,B,C’s of MI?

A

A-angina, give anti platelets
B-blood pressure-give beta blockers
C-stop cigarettes, decrease cholesterol, give CCB
D- check diabetes, change diet, low fat, low sodium
E- education, exercise
F-flu shot

37
Q

What do you do if MI and no cath lab?

A

TPA- clot buster, can’t do anything after…bleeding

Exam 4 Wk 8 And 9 (5 decks)

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