Cardio dse CAD Flashcards
CAD
Coronary artery dse
race common:
A___
A___
african
american
CAD
gender common:
male
CAD
Age common;
older than 50
CAD
modifiable factor;
High____
high_____
carbohydrates
fat
CAD
modifiable factor:
hyper___
hyperlipidemia
CAD
modifiable factor
Low ____
low estrogen
CAD
modifiable factor; disorder
D___
H____
D____
diabetes mellitus
hypertension
dysrhythmias
types of CAD
fat deposition and fibrous formation
atherosclerosis
types of CAD
hardening of blood vessel
arteriosclerosis
types of CAD
chest pain and chest discomfort
angina
types of CAD
Heart attack
MI
causes of myocardial ischemia
A______
A______
V_______
V_______
Arterioclerosis
atherosclerosis
vasocompression
vasospasm
medication can cause myocardial ischemia/angina?
B
D
E
T
bronchidilator
decongestant
epinephrine
thyroid replacement
example of bronchodilator
aminophylline
theophylline
ecg for ischemia
inverted T wave
nursing disgnosis for myocardial ischemia
altered tissue perfusion
first nursing action for chest pain?
morphine
best nursing position for chest pain
semi fowlers
sign?
clenched fist held over the chest to describe chest pain
levine sign
chest pain relieved by REST and NITROGLYCERIN
angina
chest pain UNRELIEVED by rest and nitroglycerin
MI
chest pain lasting less than 10-15mins
angina
chest pain lasting more than 20mins
MI
chest pain related to arteriosclerosis
stabke angina
chest pain brought by increase physical activities
stabke anginA
chest pain related to atherosclerosis
unstable angina
chest pain also called PREINFARCTION angina
unstable angina
chest pain even at rest/ increased physical activities
unstBle angina
chest pain most likely progress to MI
unstable angina
chest pain also called prinzemetal angina
variant angina
chest pain related to spasm
variant angina
chest pain related to cold temperature
variant angina
an ANGINA that patient is asymptomTic but ecg tracing reveal
INVERTED T WAVE
silent angina
drug induced angina pectoris
LUDWIG angina
types of MI
infarction is in endocardial layer of the heart
subendocardial infarction
types of MI
ecg tracing: ST depresion
subendocardial i farction
types of MI
infarction goes beyond endocardial layer it reaches myocardial to pericardial
Transmural Infrction
types of MI
ecg tracing for transmural i farction
ST elevation
ecg
zone of ischemia:
2 answer
inverted t wave
st depresion
ecg
zone of infarction
pathological Q wave
ecg
zone of injury
ST elevation
diagnostic test for CAD
an ambulatory ecg
holter test
diagnostic test for CAD
how many hours consume when using Holter test
24-48hrs
what to avoid during Holter test? E S S S
electric device
swimming
shower
sweating
diagnostic test for CAD
exammining the heart to check blood supply to the heart muscle with the use of camera. radioactive liquids is injected to blood stream serve as a tracer
thallium scan
or
muga scan
diagnostic test for CAD
used dye to detct blockage in coronary arteries caused by plaque build up
coronary angiography
or
cardiac catheterization
cardiac catheterization
mgt. prior to procedure
void prior to procedure
cardiac catheterization
what to check before and after procedure
peripheral and distal pulses
cardiac catheterization
what laboratory result should check prior to procedure
BUN & CREA
cardiac catheterization
post procedure best position
1st :
2nd :
1st Flat on bed
2nd HOB elevated <20degree
cardiac catheterization
equipment use to avoid bleeding post procedure
sandbag
cardiac enzymes
sensitive to brain injury
CPK BB
cardiac enzymes
sensitive to skeletal muscle injury
CPK MM
cadiac enzymes
sensitive to cardiac muscle injury
CPK MB
cardiac enzymes
sensitive to small infarct and cardiac injury
trop T
cardiac enzymes
sensitive to large infarcts and skeletal muscle injury
TROP I
cardiac muscle
sensitive to skeletal muscle and cardiac muscle injury
MYOGLOBIN
managemnt for CAD
diet: high- high- Low- Low- increase-
high protein high fiber low fat low carbohydrate increase fluid
mgt for CAD
analgesic:
best time to give:
morphine sulfate
before pain become severe
mgt CAD
antidote for morphine:
naloxone/narcan
mgt for CAD Medication: B C S antiplatelet anticoagulant T V A
betarblocker calcium channel blocker stool softener anticuagulant- heparin/warfarin antiplatelet- aspirin thrombolytics vasodilators antilipidemics
Mgt. for CAD
antidote for aspirin
*2 answers
activated charcoal
sodium bicarbonate
Mgt for CAD
antidote for heparin
protamine sulfate
Mgt for CAD
antidote for warfarin
vit k
MGT for CAD
thrombolytic drug:
S
T
A
Streptokinase
TPA
alteplase
MGT for CAD
antidote for thrombolytics
brand/generic
amicar (aminocarproic acid)
mgt for CAD
streptokinase is contraindicated in which dse?
immunocompromised, streptococcal infection
nursing alert: aspirin heparin warfarin ROUTE? aspirin - heparin - warfarin (coumadin) -
enoxaparin -
aspirin -orem
heparin -iv
coumadin -orem
enoxaparin - SUB Q
nursing alert; aspirin heparin warfarin best diagnostic test? aspirin- heparin- warfarin-
aspirin- platelet fxn test
heparin- PTT
warfarin- PT
nrsing alert; aspirin heparin warfarin
PTT normal values-
PTT theraputic values-
PT normal value-
PT theraputic value-
PTT normal 20-36secs
PTT theraputic 60-80secs
PT normal 9-12secs
PT theraputic <30secs
nrsing alert; aspirin heparin warfarin
clotting time normal values
clotting time therraputic value
INR normal value
INR theraputic value
clotting time normal- 5-10mins
clotting time theraputic- 16-20mins
*theraputic level is 2-2.5x higher
INR normal- 2-3
INR theraputic- <4.5
*theraputic level is 2-2.5x higher
Nrsing alert: aspirin
contraindicated in what condition of the patient?
pregnant
nursing alert; aspirin heparin warfarin
may be given to pregnant because cannot cross the placenta
heparin
nursing alert; warfarin
contraindicated in what condition of the patient?
pregnant
nursing alert; aspirin
patient is for surgery or any invasive procedure….
when will you discontinue?
48hrs or 2days prior to surgery
nursing alert; Heparin
patient is for surgery or any invasive procedure….
when will you discontinue?
1 day prior to surgery
nursing alert; warfarin
patient is for surgery or any invasive procedure….
when will you discontinue?
1 week prior to surgery
nursing alert; nitroglycerin tablet
storage;
D-
D-
route of administration-
dry
dark
sublingual
nursing alert: nitroglycerin tablet administration
time interval per tablet-
maximum doses-
how many tablet will you call AP if unrelieved?
5mins interval
3 doses
after 3rd tablet if patient is still unrelieved
nursing alert: nitroglycerin patch
Rule: Do not touch the medicated surface because it causes _______
hypotension
nursing alert: nitroglycerin PATCH administration
Rule: to avoid nitroglycerin tolerance time of administration is important.
Day time nitro is-
night time nitro is-
daytime nitro is on
night time nitro is off
MGT for CAD
Nursing alert
2 vasodilator drug
nitroglycerin tablet
nitroglycerin patch
nursing alert; vasodilator
drug contraindicated when taking nitroglycerin
viagra (sildenafil) cause fatal hypotension
nursing alert: antilipidemics 3 types of drug H- F- B-
HMG-COA reductase inhibitor
fibric acid derivative
bile acid sequestrant
nursing alert; HMG coa reductase inhibitor
known drug-
atorvastatin
nursing alert; Fibric Acid Derivative
known drug- G______ (L_____) generic(brand name)
F_______
gemfibrozil (lopid)
fenofibrate
nursing alert; Bile Acid Sequestrants
known drug- C______ (Q______) generic(brand name)
cholestyramine (questran)
nursing alert: antilipidemics (possible answer) HMG COA reductase inhibitor fibric acid derivative bile acid sequestrant
teratogenic?
HMG
nursing alert: antilipidemics (possible answer) HMG COA reductase inhibitor fibric acid derivative bile acid sequestrant
hepatotoxic?
HMG
nursing alert: antilipidemics (possible answer) HMG COA reductase inhibitor fibric acid derivative bile acid sequestrant
action: decrease LDL and increase increase HDL increasing cholesterol synthesis
HMG
nursing alert: antilipidemics (possible answer) HMG COA reductase inhibitor fibric acid derivative bile acid sequestrant
action: decreases triglycerides
Fibric Acid derivatives
nursing alert: antilipidemics (possible answer) HMG COA reductase inhibitor fibric acid derivative bile acid sequestrant
action: binds with fats and excreted via stool
Bile Acid sequestransts
nursing alert: antilipidemics (possible answer) HMG COA reductase inhibitor fibric acid derivative bile acid sequestrant
side effect: constipation, decrease fat soluble vitamin
(adek) absorption
Bile Acid Sequestrants
nursing alert: antilipidemics (possible answer) HMG COA reductase inhibitor fibric acid derivative bile acid sequestrant
given only at night
HMG COA recductase inhibitor
nursing alert: antilipidemics (possible answer) HMG COA reductase inhibitor fibric acid derivative bile acid sequestrant
it causes cataract
HMG COA recductase inhibitor
nursing alert: antilipidemics (possible answer) HMG COA reductase inhibitor fibric acid derivative bile acid sequestrant
it causes rhabdomyolysis
HMG COA recductase inhibitor
nursing alert: antilipidemics (possible answer) HMG COA reductase inhibitor fibric acid derivative bile acid sequestrant
Hepatotoxic effect
HMG COA recductase inhibitor
Surgical Mgt for CAD:
C-
P-
P-
CABG- coronary artery by pass Grafting
PTCA- percutaneous transluminal coronary angioplasty
Pacemaker Implantation
Surgical Mgt for CAD: CABG, PTCA, Pacemaker
Open heart surgery, to reroute the blood flow
CABG
Surgical Mgt for CAD: CABG, PTCA, Pacemaker
balloon tipped catheter use to open/ dilate obstructed artery
PTCA
Surgical Mgt for CAD: CABG, PTCA, Pacemaker
for SA/AV node malfunctioning
Pacemaker
Surgical Mgt for CAD: CABG
common blood vessel used:
M________ artery
S_________ veins
S_________artery
Mammary artery
saphenous veins
subclavian artery
Surgical Mgt for CAD: PTCA
what medicine used for 3-6mos post PTCA
antiplatelet
Nursing ALert: POST Open Heart Surgery
transporting patient from OR to C-ICU
__RN
__anesth
2 RN
2 anesth
Nursing ALert: POST Open Heart Surgery Prioritization of care: (rank the FF) airway VS Dressing Tubes and Drainage
1 airway
2 VS
3 dressing
4 tubes/drainage
Nursing Alert; Open heart Surgery
Normal cvp:
increase CVP=
decrease CVP=
Normal cvp: 2-8cm H2o or 2-6mmhg
increase CVP= hypervolemia
decrease CVP= hypovolemia
Nursing Alert; Open heart Surgery
Normal urine output:
Normal GFR:
Normal urine output: 30-60ml
Normal GFR: 120ml/minute
Nursing Alert; Open heart Surgery
chest tube drainage normal drainage 24-48hrs:
<100ml/ hr
Nursing Alert; Open heart Surgery
complication: Air embolism
best position:
Head lower than his feet and on LEft side lying
Open heart Surgery: Complication
accumulation of fluid in pericardium causing compression of the heart
cardiac tamponade
Nursing care: Cad
best position
semi fowlers position
Nursing care: Cad
first action
Analgesic
Nursing care: Cad
weeks to resume sexual activity
4-6weeks after attack
or
more than 10 steps of stairs
or 2 flights without chest discomfort
Nursing care: Cad
best time for sex
morning
Nursing care: Cad
Best position for sex
sidelying
Open heart Surgery: Complication: cardiac tamponade H M T D D P
Hypotension tachycardia dyspnea mufflead heart sounds(pericardial friction rub pulsus paradoxus
Open heart Surgery: Complication:
cardiac tamponade
a heart rate or pressure that decrease during inhalation
pulsus paradoxus
Open heart Surgery: Complication:
cardiac tamponade Surgical Mgt:
P
P
pericardiocentesis-fluid
pericardioectomy-part
Open heart Surgery: Complication:
cardiac tamponade Medication
V
O
vasopressor- Levophed-increase BP
Oxygen