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NURS4036 - complex health > CAD, MI, angina > Flashcards

CAD, MI, angina Flashcards

1
Q

coronary artery disease (CAD)

A
  • chronic endothelial injury d/t hypertension, tobacco use, hyperlipidemia, infections, diabetes
  • fatty streak occurs when lipids accumulate and migrate into smooth muscle cells
  • collagen covers fatty streak causing lumen to narrow
  • plaque can rupture which causes thrombus formation
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2
Q

developmental stages of CAD

A
  • fatty streak
  • fibrous plaque
  • complicated lesion
  • collateral circulation
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3
Q

non-modifiable risk factors of CAD

A
  • age
  • sex
  • ethnicity
  • family history
  • genetics
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4
Q

modifiable risk factors for CAD

A
  • elevated serum lipid levels
  • elevated BP
  • tobacco use
  • physical inactivity
  • obesity
  • diabetes
  • elevated blood glucose
  • psychosocial (stress levels, occupation, etc.)
  • substance use
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5
Q

nursing management for CAD

A
  • health promotion
  • nutritional therapy
  • cholesterol-lowering medication therapy (statins, fibrates)
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6
Q

saturated fats (use sparingly)

A
  • animal fat (bacon, egg, yolk)
  • some oils (coconut, palm)
  • butter
  • cream cheese
  • sour cream
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7
Q

monosaturated fats

A
  • fish oil
  • some oils (canola, peanut, olive)
  • avocado
  • nuts (almonds, peanuts)
  • olives
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8
Q

polysaturated fats (use primarily)

A
  • vegetable oils (corn, soybean, cottonseed, flaxseed)
  • some fish oil
  • some nuts (walnuts)
  • seeds (pumpkin, sunflower)
  • margarine
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9
Q

chronic stable angina

A
  • primary reason is atherosclerosis
  • myocardium becomes hypoxic within 10 seconds
  • with total occlusion, contractility ceases after several minutes
  • anaerobic metabolism begins causing the accumulation of lactic acid which causes cardiac pain
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10
Q

signs of chronic stable angina

A
  • chest pain intermittently over a long period with same pattern of onset, duration, and intensity
  • may be no pain
  • indigestion or burning in epigastric region
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11
Q

short acting nitrates - medications for angina

A
  • nitro
  • relives pain within 3 minutes
  • duration of action is 30-60 minutes
  • if unchanged after 5 minutes patient should call EMS
  • side effects; increased HR, headache, dizziness, orthostatic hypotension
  • teach to not change positions quickly after taking nitro
  • patient should feel a tingling sensation in their mouth when nitro is administered
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12
Q

long acting nitrates - medications for angina

A
  • transdermal controlled-release nitrates
  • reduce incidence of anginal attacks
  • predominant side effect is headaches due to dilation of cerebral blood vessels
  • orthostatic hypotension
  • tolerance to nitrates can develop
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13
Q

dx chronic stable angina

A
  • history
  • physical (heart murmurs, BP, how are they perfusing, edema)
  • ECG, chest radiograph
  • exercise stress test
  • echocardiogram
  • CT, PET
  • coronary angiography
  • labs – lytes, BUN, creatinine, FBG, HbA1C, PTT, aPTT, PT, INR, CBC, lipid profile
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14
Q

acute coronary syndrome

A
  • develop when myocardial ischemia is prolonged
  • NSTEMI, STEMI
  • associated with deterioration of atherosclerotic plaque
  • plaque ruptures exposing intima to blood and stimulating platelet aggregation and local vasoconstriction
  • may partially occluded by a thrombus (NSTEMI) or totally occluded by a thrombus (STEMI)
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15
Q

unstable angina

A
  • chest pain with new onset, occurs at rest or ha worsening pattern
  • unpredictable
  • emergency
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16
Q

MI

A
  • result of sustained ischemia causing irreversible myocardial cell death
  • secondary to thrombus formation
17
Q

MI CM

A
  • pain
  • sympathetic nervous system stimulation
  • cardiovascular manifestations
  • n&v
  • fever
  • complications; dysrhythmias, heart failure, cardiogenic shock
18
Q

dx unstable angina and MI

A
  • ECG
  • serum cardiac markers – troponin, CK
  • coronary angiography
19
Q

management of acute coronary syndrome

A
  • rapid diagnosis to prevent cardiac muscle
  • establish IV
  • sublingual nitro
  • morphine for pain
  • O2 2-4 L/min
  • transfer to CCU
  • monitor vitals
  • bed rest for 12-24 hour
  • anticoagulants/antiplatelet in case of UA or NSTEMI
  • PCI or thrombolytic therapy
20
Q

aspirin and CAD

A
  • prevents platelet activation and reduces incidence of MI and death
  • dose: 160-325mg when diagnosis is made then 81-325 mg QD
  • can be taken if already on NSAIDS
  • may need proton pump inhibitor (omeprazole) prescribed to prevent GI issues
21
Q

heparin

A
  • prevents formation of new clots
  • use with unstable angina to reduce risk of MI
  • bolus IV then continuous infusion: dose based on result of aPTT
  • bleeding precautions
22
Q

coronary surgical revascularization

A
  • coronary artery bypass graft: minimally invasive, off-pump coronary artery
  • trans myocardial laser revascularization

NURS4036 - complex health (10 decks)

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