Ch 33 CAD, ACS, MI (Exam 2)

Question 1

What is the main cause of coronary artery disease?

Answer 1

Atherosclerosis

Question 2

What does atherosclerosis lead to?

Answer 2

Endothelial injury/inflammation

Question 3

Causes of endothelial injury? (5)

Answer 3

• hypertension
• smoking
• infection
• diabetes
• hyperlipidemia (high serum lipids)

Question 4

Diagnostics for coronary artery disease? (2)

Answer 4

• cardiac markers (high troponin)

- echocardiogram

Question 5

What are the 4 steps of pathophysiology of CAD?

Answer 5

1. chronic endothelial injury
2. fatty streak and lipid core formation
3. fibrous plaque covers the lipid core (reduces blood flow, fissures/scars develop)
4. complicated lesion: plaque ruptures and thrombus forms (causing narrowing/total occlusion)

Question 6

Complicated lesions lead to thrombus formation due to which mechanism?

Answer 6

Platelet accumulation

Question 7

Prevention of thrombus formation (3)

Answer 7

• avoid vessel injury (smoking cessation, lifestyle changes, exercise)
• control platelet aggregation (daily antiplatelet therapy like aspirin)
• control lipid levels (statins, niacin) if diet/exercise is ineffective

Question 8

The formulation of thrombus is deterred by?

Answer 8

Daily administration of baby aspirin

Question 9

What are the non-modifiable risk factors of coronary artery disease (4)

Answer 9

• age (>60)
• gender (women tend to live longer)
• ethnicity
• genetics, family hx

Question 10

Major modifiable risk factors of coronary artery disease (3)

Answer 10

• hyperlipidemia (cholesterol >200)
• hypertension (>140/90)
• smoking cessation

Question 11

How does smoking lead to coronary artery disease? (3)

Answer 11

• increases catecholamines (epinephrine) which leads to vasoconstriction and increased HR
• increases LDL levels, decreases HDL
• directly injures the epithelium

Question 12

Contributing modifiable risk factors (3)

Answer 12

• metabolic syndrome (ABD GERD, prediabetes)
• psychological states: stress/increased epinephrine, anger, depression
• substance abuse: cocaine increases cardiac demand for oxygen

Question 13

Ways to increased HDL (good lipids) (5)

Answer 13

• exercise
• eat healthy fats
• lose weight
• moderate alcohol intake
• quitting smoking

Question 14

Your patient has been identified as being at high risk for MI. Which lifestyle modification would have the most benefit to the patient?

Answer 14

Quit smoking

Question 15

After teaching about ways to decrease risk factors for CAD, the nurse recognizes that further instruction is needed when the patient says:

Answer 15

“I would like to add weight lifting to my exercise program” (strain is contraindicated)

Question 16

Nitroglycerin treatment for stable vs unstable angina

Answer 16

• unstable: not effective (unstable angina creates life-long changes on ECG)
• stable: relieved by nitroglycerin (ECG may return to normal)

Question 17

Describe unstable angina (2)

Answer 17

• chest pain that is new in onset and occurs at rest

- unpredictable and must be treated immediately

Question 18

What are the effects of nitroglycerin? (3)

Answer 18

• causes vasodilation
• side effects: severe headaches
• patient teaching: take with tylenol to relieve headache

Question 19

Which actions by nitroglycerin help to reduce or eliminate chest pain? (2)

Answer 19

• lowers preload and work of heart

- dilates coronary arteries to increase blood supply to the myocardium

Question 20

PQRST (to assess for myocardial infarction)

Answer 20

P: precipitating events (arguing, exercise)

Q: quality of pain (pressure, dull, ache, tight)

R: region (location) and radiation

S: severity of pain (0-10)

T: time (when did it begin?)

Question 21

Nutritional therapy (2)

Answer 21

• low sodium diet (prevent fluid retention)

- for CAD: limit saturated fats and cholesterol and more complex carbs (whole grains, fruits, vegetables) and fiber

Question 22

What is a myocardial infarction?

Answer 22

abrupt stoppage of blood flow through the coronary artery, causing irreversible cell death

Question 23

S/S of unstable angina

Answer 23

severe chest pain that is NOT relieved by rest/position change or nitroglycerin administration

Question 24

S/S of stable angina (2)

Answer 24

• pain during activity/exercise but SUBSIDES AT REST

- pain is described as heavy, pressured, tight/constricted, burning, crushing (“elephant on chest”)

Question 25

What are complications of MI? (2)

Answer 25

- infarction of papillary muscle/rupture | - acute pericarditis

Question 26

Diagnostics for myocardial infarction (stemi vs nstemi)

Answer 26

- STEMI: coronary angiography | - NSTEMI: high troponin levels (contraindicated to do coronary angiography)

Question 27

You patient reports experiencing chest pain during sex that subsides at rest. He is probably experiencing?

Answer 27

Stable angina

Question 28

Your patient's heart is getting less oxygen due to narrowing/blockage of the coronary artery. What symptom will the patient most likely present?

Answer 28

Chest pain or pressure

Question 29

A complication of infarction of papillary muscle from MI can be determined by?

Answer 29

Heart sounds (murmur)

Question 30

Treatment for acute angina

Answer 30

short-acting nitrates are the first-line therapy

Question 31

Describe chronic stable angina (4)

Answer 31

- chest pain that occurs over a long period - patient may deny pain at first - anginal pain lasts only a few mins and subsides when the precipitating factor is relieved - pain at rest is UNUSUAL

Question 32

Medication teatment for chronic stable angina

Answer 32

focused on decreasing oxygen demand or increasing oxygen supply (medications: nitrates, ACE inhibitors, beta-blockers, calcium channel blockers)

Question 33

Describe Prinzmetal's angina, a type of chronic stable angina (4)

Answer 33

- rare form of angina that occurs AT REST in response to a spasm of a major coronary artery - may be seen in patients with a hx of migraine headaches and Raynaud's phenomenon - precipitating factors: smoking, alcohol, amphetamines, cocaine use - pain may be relieved by moderate exercise or spontaneously

Question 34

Treatment for Prinzmetal's angina

Answer 34

calcium channel blockers and/or nitrates (to decrease afterload)

Question 35

What is the goal of interprofessional care for chronic stable angina?

Answer 35

decrease O2 demand or increase O2 supply

Question 36

Function of short-acting nitrates

Answer 36

decreases preload and afterload

Question 37

Nitroglycerin - route - adminsitration - interventions

Answer 37

- sublingually or by spray (faster) - if no relief in 5 mins, call EMS; if some relief after 5 mins, repeat every 3 mins for a max of 3 doses - sit patient down to relax them, elevate HOB to improve airway and decrease O2 demand

Question 38

function of long-acting nitrates

Answer 38

reduces angina incidence

Question 39

ACE inhibitors and angiotensin blocker functions

Answer 39

reduces oxygen demand by lowering HR, afterload, and BP (especially useful after an MI)

Question 40

Purpose of induced hypothermia

Answer 40

might prevent hypoxic brain damage during cardiac arrest

Question 41

What can be delegated to UAP during MI care? (6)

Answer 41

- empty urinary catheter - use of incentive spirometer and deep breathing exercises - observe patient and report to nurse - monitor SCDs for DVT prevention - drain fluid - apply water soluble protectant to nares and lips

Question 42

Delegation to LVN (4)

Answer 42

- give medications - take vitals - basic skills (applying oxygen and inserting urinary catheter) - cannot do initial patient teaching (can reinforce)

Question 43

What is acute coronary syndrome

Answer 43

Deterioration of plaque, leading to rupture and platelet aggregation, which leads to thrombus formation

Question 44

Initial interventions for ACS (5)

Answer 44

- 12-lead ECG - upright position: stop movement, provide comfort, resting position - create IV access - administer statin - MONA **requires doctor's order except oxygen**

Question 45

MONA for ACS stands for?

Answer 45

M: morphine O: oxygen (o2 sat > 92%) N: nitroglycerin (SL) A: aspirin (chewable)

Question 46

Therapy for NSTEMI

Answer 46

Reperfusion therapy

Question 47

Emergency PCI (percutaneous coronary intervention) stent is indicated for? - goal - consists of

Answer 47

- indicated for: confirmed STEMI - goal: get patient to cardiac cath lab within 90 mins of presentation - consists of balloon angioplasty and stents

Question 48

Thrombolytic therapy is only indicated for patients with? - give IV within ______ - contraindications (3)

Answer 48

- indicated for patients with STEMI - given IV within 30 mins of arrival with presenting STEMI - assess contraindications: recent surgeries, peptic ulcer disease, recent bleeds

Question 49

Coronary revascularization with coronary artery bypass graft (CABG) is recommended for? When is it provided? Post op care includes? (6)

Answer 49

- patients who fail medication management - provided in the ICU for the first 24-36 hours (ongoing monitoring of ECG and hemodynamic status) - post-op care focuses on monitoring for dysrhythmias, providing wound care, managing pain, preventing DVTs/bleeding, atelectasis, pneumonia

Question 50

Drug therapy for acute coronary syndrome?

Answer 50

- dual antiplatelet (aspirin) therapy should be continued for 1 year after an MI - stool softeners to avoid straining

Question 51

Sudden cardiac death (2)

Answer 51

- abrupt disruption in cardiac function, leading to loss of CO and cerebral blood flow - most commonly caused by: ventricular dysrhythmias (vfib and vtach)