Cardiovascular Disorders

Question 1

General Treatment Measures for Cardiac Disorders

Answer 1

Dietary Modifications
- Decrease total fat intake
- General weight reduction
- Reduce salt intake
Regular Exercise Program
- Increases high-density lipoprotein levels 
- Lowers serum lipid levels
- Reduces stress levels
Cessation of Smoking
- Decreases risk of coronary disease

Question 2

Atherosclerosis

Answer 2

Diagnostic Tests
- Serum lipid levels
Treatment
- Weight loss
- Increase exercise
- Lower total serum cholesterol and LDL levels by dietary modification
- Reduce sodium intake
- Control hypertension
- Cessation of smoking
- Antilipidemic drugs
- Surgical intervention, such as coronary artery bypass grafting

Question 3

Hypertension

Answer 3

Increased BP increases risk of:
- Stroke
- Ischemic cardiomyopathy
- CAD
Decreasing the BP by 5 mm/hg can reduce 
- Stroke by 34%
- ICM by 21%

Question 4

Treatment

Answer 4

Lifestyle Modifications
- Diet: Low Na+ DASH diet (rich in nuts, whole grains, fruits and vegetables), might require low fat as well
- Physical exercise/ stress reduction/ weight loss
- Restrict cigarette smoking, alcohol intake
Medication
- Biggest issue is side effects
- What meds given based on underlying diagnosis and comorbid conditions
- 1st line diuretics: Thiazides (no comorbid conditions)
- 2nd line ACE Is, ARB, Beta blockers, CCBs

Question 5

Hypertension

Answer 5

Angiotensin-Converting Enzyme inhibitors/ Angiotensin II Receptor Blockers
Beta Blockers
CCBs
Diuretics

Question 6

ACE Inhibitors/ ARBs

Answer 6

Used with pts with DM - helps to protect kidneys
ACEI - Inhibits enzyme in the body from making angiotensin II (vasoconstricts and increases BP)
- Ramipril (Altace), Enalapril (Vasotec), Captopril (Capoten), Benazopril (Lotensin)
ARB - block angiotensin II
- Candesarten (Atacand), Losartan (Cozaar)
Side Effects ACEI
- Angioedema - tongue and neck swell
- Cough 30% of the time - switch to ARB
- Inc K+, decrease Na+, increase CRS - can cause renal failure

Question 7

Beta Blockers

Answer 7

Young Caucasian people with BP issues
Block effects of epinephrine (adrenaline)
- Carvedilol
- Metoprolol
- Atenolol
Side Effects
- Known response decrease HR, decrease BP
- Can increase lipids and cholesterol, increase depression, increase asthma and bronchospasm, increase K+

Question 8

CCB

Answer 8

Works well for African American, elderly population
Affects movement of calcium into cells of heart and blood vessels, increase blood and oxygen, reducing workload
Vascular smooth muscle relaxation
Side Effects
- Dihydropyridine - nifedipine, amlodopine (only one that doesn’t cause HR to go up), cause peripheral vasodilation, HR goes up
- Edema, constipation, heart failure
- Non-Dihydropyridine - Diltiazem, Verapamil, cause reduction in inotrope - reduces contractility of heart, decreased HR

Question 9

Diuretics

Answer 9

African American and elderly do well with diuretics
Thiazides
- Used as first line of treatment for individuals without other comorbid conditions (DM, HF, Hx of MI)
- Ascending limb
- Decrease K+, Na+, increase CRS
- Increase Ca+ (decrease amount excreted in urine), uric acid, lipids, glucose
Lassie
- Loop
- Decrease Ca+ (increase amount excreted in urine), K=, Na+
- Increase CRS

Question 10

HTN Nursing Care

Answer 10

Ineffective health maintenance r/t noncompliance with prescribed treatment

• Teaching re medications, Na+ intake
• Lifestyle changes
• Weight loss strategies

Question 11

Evaluation

Answer 11

Response to treatment - decrease BP

Teaching that still might be required - based on client responses to assessment

Question 12

CAD

Answer 12

Treatment
- Main focus of CAD treatment is to lower LDL
Diet
- Low fat, low cholesterol to decrease lipid levels and promote weight loss
- Less than 7% saturated fats of total daily calories
- Cholesterol 25-35% of total calories

Question 13

CAD: Medications

Answer 13

Therapy to lower total cholesterol and LDL levels
Statins and diet first choice
- Atorvastatin, Fluvastatin, Simvastatin
- Inhibit cholesterol synthesis in liver
- Lower LDL levels, some increase HDL
- Side effects: Headache and GI effects
- Myalgias (muscle aches)
- Skin rashes
- Liver function tests (LFTs) and muscle enzymes monitored for toxic effects

Question 14

CAD

Answer 14

If combination of statins and diet not effective to lower cholesterol and LDL levels
Nicotinic Acid - Niacin
- Lower LDL and raise HDL
- Flushing, hot flashes and pruritus common side effects
Bile Acid Sequestrants - Cholestyamine, Colestipol
- Bind with bile acids and cholesterol in intestine, excrete in feces
- GI side effects: constipation, gas, abdominal cramping

Question 15

Medications

Answer 15

ACE Is
Beta Blockers
CCBs
Diuretics
Will depend on comorbid conditions and extent of disease

Question 16

Surgical Interventions

Answer 16

Angioplasty - minor opening of skin on arm or groin
- Reopening narrowed or blocked arteries
- Also known as Percutaneous Transluminal Coronary Angioplasty (PTCA) - angioplasty with stent
Coronary Artery Bypass Graft - major surgery
- Vein or artery is bypassed to provide blood to ischemic portion of the heart
- Internal mammary artery in chest and saphenous vein from leg used as grafts
- Heart is stopped during procedure - placed on cardiopulmonary bypass pump - maintains blood to organs

Question 17

Teaching

Answer 17

Smoking Cessation
Healthy weight
Exercise
Reduce Stress
Control of comorbid conditions - DM, HTN, lipid levels

Question 18

Angina

Answer 18

Goal of treatment is to prevent, and decrease the number of anginal attacks a patient has

Question 19

Angina

Answer 19

Acute Anginal Attacks
- Nitroglycerin - sublingual act within 1-2 min.
Prevention of Angina
- Long acting nitroglycerin PO/ transdermal
- Used to prevent angina, not for acute attacks
- Reduce frequency and severity of angina attacks
- Headaches, nausea, dizziness, hypotension common side effects
- Low dose aspirin - thins blood reduces clots

Question 20

Beta Blockers/ CCBs

Answer 20

Beta Blockers
- Slow heart rate, decrease workload, block SNS stimulation (which causes vasoconstriction), prevent angina
- Metoprolol
- Propanolol
- Atenolol
CCB
- Reduce cardiac workload, increase blood flow to myocardium, control angina
- Anti-anginal effect from vasodilation, decreasing oxygen demand, decrease HR and contractility

Question 21

Teaching

Answer 21

Use of Nitroglycerin SL
- Pain take NTG 1 every 5 minutes x3
- Rest, call 911 if no effect after 3rd
- NTG storage
Medications and side effects
Importance of decreasing angina attacks d/t increase risk of MI
Pre and post-op teaching regarding CABG

Question 22

Angina - Nursing Care

Answer 22

Ineffective tissue perfusion r/t coronary spasm or blockage and decreased oxygenation

• NTG at bedside
• Oxygen
• Rest between activities
• Manage risk factors
• Exercise
• Smoking cessation (slide 30)

Question 23

Angina - Nursing Care

Answer 23

Risk for ineffective Therapeutic Regimen management r/t knowledge deficit of medications and when to use them

• Angina teaching
• Medication teaching
• Cardiac rehabilitation programs - in hospital Coronary Artery Ambulation Day 1-5, outpatient cardiac rehabilitation

Question 24

Evaluation of Treatment

Answer 24

Response to treatment - decreased angina attacks with very few side effects from meds
Teaching that still might be required - based on clients response to assessments

Question 25

Myocardial Infarction: Treatment

Answer 25

Reduce cardiac demand
Oxygen therapy
Analgesics - MONA
Anticoagulants
- Heparin in hospital
- Coumadin/ Plavix
Thrombolytic agents may be used
- Time to needle

Question 26

MONA

Answer 26

Morphine
Oxygen
Nitroglycerin
Aspirin
Morphine is the drug of choice for the heart in pain
Oxygen needed as there is a lack of oxygen causing the ischemia
Nitroglycerin vasodilator the arteries increasing blood flow
Aspirin used as anti platelet - thins blood less work