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NUR 200-Exam 3 > CAD/MI/PE > Flashcards

CAD/MI/PE Flashcards

1
Q

What is atherosclerosis?

A

Hardening of arteries w/ plaque build up

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2
Q

What is the primary component of atherosclerosis? And the other components?

A

Cholesterol; calcium and fat

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3
Q

What is the desired cholesterol level?

A

Less than 200mg/dl

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4
Q

What is the desired HDL?

A

Greater than 35mg/dl

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5
Q

What is the desired LDL if pt is a high risk cardiovascular pt? And moderate risk?

A

Less than 70m/dl; less than 100mg/dl

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6
Q

What is High Density Lipoprotein (HDL)?

A

Good cholesterol; goes back to liver for removal from body

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7
Q

What is Low Density Lipoprotein (LDL)?

A

Bad cholesterol; remains in blood stream

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8
Q

What is the desired triglyceride levels?

A

Less than 150mg/dl

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9
Q

What are triglycerides?

A

Fat found in serum/body

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10
Q

Age, gender, race, menopause/pre-menopause are what?

A

Nonmodifiable risk factors

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11
Q

Smoking, diet, uncontrolled diabetes/HTN, overweight/obesity?

A

Modifiable risk factors

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12
Q

What are the s/s of CAD in the geriatric population?

A

SOB, fatigue, syncope, confusion

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13
Q

What are the triad of symptoms that appear in women w/ CAD?

A

Abd pain, fatigue, SOB

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14
Q

Chest pain is more often what in women? And in men?

A

Angina; MI

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15
Q

Men manifest CAD earlier than women and have a higher incidence of what? but CAD causes more what in women?

A

Left ventricular hypertrophy; death

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16
Q

Pts who have diabetes may not always present w/ chest pain known as a silent MI; what are the atypical s/s they present w/?

A

Confusion, N/V, fatigue dyspnea

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17
Q

What is the goal of treatment?

A

Slow or decrease progression of CAD

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18
Q

Nursing action should be directed to what?

A

Prevention and reduction of risk factors: smoking, diet, weight, med info, adhering to health maintenance/med regimen

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19
Q

What are “life’s simple 7?”

A 
Don't smoke
Maintain a healthy weight
Engage in regular physical activity
Eat a healthy diet
Manage BP
Take charge of cholesterol
Keep blood sugar @ healthy level
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20
Q

What is the TLC diet?

A

Therapeutic
Lifestyle
Changing diet

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21
Q

What are the recommended percentages of saturated fat, fat, and cholesterol intake per day?

A

Less than 10%, 30%, and 300mg/dl

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22
Q

What decreases LDL and where can you find it?

A

Monounsaturated fats; canola, vegetable, peanut oil

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23
Q

Where is cholesterol mainly found?

A

Animal products

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24
Q

What is angina?

A

Imbalance b/t myocardial supply and demand causing chest pain

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25
Q

Atherosclerosis, artery spasm, increased in O2 demand, clogged artery, not enough blood to heart are all causes of what?

A

Angina

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26
Q

How to describe the more normal angina?

A

Chest pressure that comes on w/ exertion (ex. exercise) and goes away w/ rest or meds (Vasodilator or nitroglycerin)

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27
Q

What is stable angina (angina pectoris)?

A

Chronic angina that’s precipitated by a predictable amount of activity/stress and goes away w/ med management/rest

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28
Q

What is unstable angina?

A

Angina w/ ischemia (cell death) or acute coronary syndrome; chest pain last longer (15min+), have frequent attacks and can’t be relieved w/ nitroglycerins/rest

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29
Q

When considering angina how long does it take for cell necrosis to occur?

A

30min

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30
Q

What is an MI?

A

Heart muscles start to die bc blood perfusion is cut off by cell death (heart attack)

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31
Q

Thrombosis, rupture of plaque, occlusion of vessels, vasospasm and trauma are all causes of what?

A

MI

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32
Q

When considering the stages of infarction how long does it take for ischemia to occur?

A

20min

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33
Q

When considering the stages of infarction how long does it take for injury and necrosis to occur?

A

1-6hrs

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34
Q

When considering the stages of infarction how long does it take for granulation tissues form to occur?

A

8-10days

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35
Q

When considering the stages of infarction how long does it take for scar tissue to continue to form causing for a risk of myocardial rupture to occur?

A

2wks

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36
Q

When considering the stages of infarction how long does it take for the heart to recover as much as possible to occur?

A

6-12wks

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37
Q

What is heart remodeling?

A

When heart decreases in function

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38
Q

What are the 3 factors considered for the size of the infarct?

A

Extent of occluded blood supply
Amount of collateral circulation
Oxygen demands o the myocardium

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39
Q

What is this: Collateral vessels connecting smaller arteries in coronary system dilate to maintain blood flow to cardiac muscle, causing new arteries to form?

A

Collateral circulation in MI

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40
Q

What is the left ventricle of the heart known as?

A

Workhorse of the heart; has highest O2 demands

41
Q

What is so essential about getting an EKG/ECG done?

A

Can see all electrical activity in the heart w/ the 12 leads

42
Q

EKG, cardiac labs, stress tests, cardiac catheterization, echocardiogram are all what?

A

Diagnostic tests

43
Q

An echocardiogram allows you to see what?

A

Structure of the heart

44
Q

What are the 3 diff meds that are given before a stress test to mimic the effects of exercise?

A

Persantine, Thallium and Dobutamine

45
Q

ST segment depression and T wave inversion represents an EKG change caused by what?

46
Q

What does the P wave represent?

A

Atrial depolarization (contraction)

47
Q

What does the S wave represent?

A

Ventricular depolarization

48
Q

What does the T wave represent?

A

Ventricular repolarization

49
Q

What does the QRS complex represent?

A

Ventricular depolarization (contraction)

50
Q

ST segment elevation represents an EKG change caused by what?

A

Injury- occlusive thrombus

51
Q

What is a STEMI?

A

ST elevation MI

52
Q

How does a pt w/ a STEMI present?

A

Sudden onset of chest pain w/ a present Q wave on EKG

53
Q

What is a NSTEMI?

A

Non STEMI; narrowing of artery, non occlusive thrombus

54
Q

What does a Q wave represent?

A

Infarction; dead zone of myocardium, MI has extended through all 3 layers of heart

55
Q

When will a Q wave appear on an EKG?

A

8-12hrs post MI (nonreversible)

56
Q

What cardiac lab is non-specific bc it shows elevation if any muscle in the body is damaged?

A

Creatine Phosphokinase (total CK/CPK)

57
Q

What 2 cardiac labs are specific to cardiac muscle if they are elevated?

A

Creatine Phosphokinase Isoenzyme (CPK-MB)

Troponin levels

58
Q

When will a troponin level become apparent? Peak? and return to normal?

A

4-6hrs after injury; 8-12hrs; 10-15days

59
Q

What are some manifestations of a MI?

A

Chest pain, N/V, diaphoresis, sense of impending doom/death, DOE/SOB, cool mottling skin, diminished peripheral pulses, decreased LOC, low grade fever and elevated blood sugar

60
Q

If your s/s last longer than how long what should you do?

A

20min call 911

61
Q

Relieve chest pain, reduce extent of myocardial damage, maintain cardiovascular stability, decrease cardiac workload, prevent complications, increase O2 supply, decrease myocardial workload are all what?

A

Goals of MI/ACS treatment

62
Q

Nursing interventions for an acute episode?

A

Asses pt and their pain frequently
MONA
Monitor EKG/cardiac labs

63
Q

What does MONA stand for?

A

Morphine for pain/anxiety (IV push)
Oxygen via nasal cannula b/t 2-5L/min
Nitroglycerin for angina (sublingual while laying/sitting)
Aspirin to decrease clumping

64
Q

Nitroglycerin is a vasodilator that can cause what?

A

Hypotension

65
Q

What does PQRST stand for when assessing pain?

A

Precipitating events? (exercise, sex, sleep, etc)
Quality of pain? (sharp, dull, burning, etc)
Radiation of pain? (Neck, arm, jaw, leg, etc)
Severity of pain (0-10)
Timing of pain? (when did it start)

66
Q

After an acute episode what should be started to aid the pt in living a more normal lifestyle and providing important education?

A

Cardiac rehab

67
Q

What are some specific intervention post MI?

A

Initial bed rest for 6-12hrs (relax heart)
Semi fowlers position (comfort/tissue oxygenation)
Calm quiet environ. (anxiety)
Oxygen @ 2-5L/min
Liquid diet for 1st 4-12hrs no caffeine tho (gastric distention, probs w overeating, enhance cardiac diet)

68
Q

Dysrhythmias, pump failure (CHF), cardiogenic shock, infarct extension, structural defects and pericarditis are all what?

A

Complications of MI

69
Q

After an MI when is the heart tissue the weakest?

70
Q

Name this MI complication: Progressive increase in the amount of myocardial necrosis w/in the infarct zone of the original MI; muscle is stretched/thin, impairment of blood flow happens w/in hours-days after MI?

A

Infarct extension

71
Q

Name this complication of MI: scar tissue formation?

A

Structural defects

72
Q

Name this complication of MI: inflammation of the pericardium of the heart and is treated w/ aspirin/NSAIDs?

A

Pericarditis

73
Q

Name this MI complication: premature ventricular contractions, ventricular tachycardia, ventricular fibrillation and/or Afib and atrial flutter?

A

Dysrhythmias

74
Q

Name this MI complication: contractility is impaired causing problems w/ filling the heart and may lead to death bc of changes in heart that take place from the damage?

A

Heart failure

75
Q

What are some s/s of left sided heart failure from the increase in pulmonary pressure rate?

A

Crackles, wheezes, frothy sputum, dyspnea

76
Q

What are some s/s of right sided heart failure?

A

Neck vein distention, peripheral edema

77
Q

Name this MI complication: impaired tissue perfusion due to pump failure, heart can’t pump blood to meet needs of any vital organs?

A

Cariogenic shock

78
Q

What are some s/s of cardiogenic shock?

A

Decrease in LOC, systolic BP less than 90, tachycardia, weak pulses, pal/cool skin, decrease urinary output, increase dysrhythmias (s/s of dying)

79
Q

Nursing implications for heart failure?

A

Left: pulse ox, O2, frequent assessment, meds
Right: Elevate legs, check for pulses, frequent assessments, meds

80
Q

What are some nursing implications for cardiogenic shock?

A

ABCs
Revascularize the heart
Fluid Bolus
Antirhythmias

81
Q

What is coronary artery disease (CAD)?

A

Narrowing of small blood vessels that feed the heart

82
Q

Nursing interventions pre-procedure?

A 
Assess (shellfish allergy/peripheral pulses)
NPO 6-8hrs
Ht/Wt
Labs
Patent IV access
83
Q

Nursing interventions post-procedure?

A 
Frequent assessment
Extremity positioning
Bed rest 2-6hrs
HOB less than 30degree angle
Monitor site
84
Q

Complications post-procedure?

A 
Clot formation
Trauma
BLEEDING
Re-occlusion
Pain
85
Q

Statin drugs are used for what? and what can they cause?

A

Stabilize cholesterol; pain in muscle and liver failure

86
Q

Important teaching for Statins?

A

No grapefruit/grapefruit juice
Monitor liver enzyme levels and creatine phosphokinase
Assess for muscle pain/tenderness
Monitor for digoxin toxicity if taking Digoxin

87
Q

Classic s/s of a pulmonary embolism? More common s/s?

A

Chest pain, hemoptysis, dyspnea, Crackles.

Anxiety, tachypnea/tachycardia, SOB, low grade fever

88
Q

Nursing interventions for a pulmonary embolism?

A

Oxygen
Analgesics
Anxiety reduction-calm environ., anti-anxiety med
Pt education on prevention: ambulation, ROM, anticoagulants, bleeding precautions

89
Q

What two anticoagulation meds are admin to prevent a PE?

A

Heparin, Coumadin

90
Q

What should you monitor for heparin? and for coumadin?

A

PTT, aPTT; INR

91
Q

What is an antidote given for Heparin? and Coumadin?

A

Protamine sulfate; Vitamin K

92
Q

D-Dimer and a lung scan are what?

A

Most common diagnostic tests for PE

93
Q

Thrombolytic therapy?

A

Lyse thrombus via IV, need 2 IV sites, frequently assess VS/pulses/infusion site during admin
Post-infusion frequent neuro/site checks and VS, bed rest 6-8hrs monitor labs, assess for systemic bleeding

94
Q

What meds are used for angina and what’s important to know about them?

A

Nitrates (vasodilator); monitor BP/HA, give while laying down/sitting

95
Q

‘olol’ meds are used for what? What is important to know about them?

A

Beta-blockers for HTN/dysrhythmias; Monitor BP/HR, change positions slowly, not for asthmatics/COPD’rs bc of bronchospasm

96
Q

‘pril’ meds are used for what? and what’s important to know about them?

A

ACE inhibitors-HTN/CHF; assess for dry cough/angioedema, monitor labs/electrolytes, use w/ caution in asthmatics

97
Q

‘sartan’ meds are used for what? and what is important to know about them?

A

ARB’s-HTN; monitor labs especially K and BP, don’t use w/ ACE bc of hyperkalemia

98
Q

Diltiazem (Cardizem) and Amlodipine (Norvasc) are what type of meds? and what is important to know about them?

A

Calcium channel blockers-for angina; Monitor BP/HR/EKG, assess for constipation, edema and increase in heart failure

NUR 200-Exam 3 (6 decks)

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