Chapter 19/20 Flashcards
what is coronary artery disease
progressive disease leading to narrowing or blockage of the coronary arteries
what is the major factor of coronary artery disease? explain
atherosclerosis - thickening and loss of elasticity of the arteries
s/s of coronary artery disease?
- chest discomfort, tightness, aching, and burning
- chest pain radiating to arm, jaw, or back
- palpitations of tachycardia
- cold, clammy skin
- nausea and vomiting
- fatigue (in women)
- dyspnea, weakness
nursing management/ teachings for coronary artery disease?
- aspirin to prevent MI
- lower fat and cholesterol in diet
- exercise
what is angina pectoris?
chest pain from coronary vessels becoming narrower, decreasing blood supply to the myocardium
- most common symptom of CAD
s/s of angina in men and women?
men- chest discomfort described as pressure or heaviness or squeezing
- pain located in the midchest area and may radiate to the neck, jaw, or arm
women- shortness of breath, nausea/vomiting, abdominal pain, chest pain described at sharp
nursing interventions for angina pectoris?
- asses and record px severity, location, type, and duration of pain
- check bp after giving nitroglycerin, especially after first dose
- explain med and tx regimen
- review dietary restrictions with px
- stress the need to stop smoking
what is an acute myocardial infarction?
area of necrosis in tissue causing an obstruction to the flow of blood to an area for a prolonged period of time
s/s of acute myocardial infarction?
- sudden sever pain in chest (usually described as tightness, pressure, squeezing, or crushing not relieved by nitrates or rest
- dyspnea, nausea, vomiting, wheezing
- cool clammy skin
what are some lab/diagnostic tests for myocardial infarction
- ECG/EKG
- chest x-ray
- cardiac catheterization
-serial troponins - blood studies: CBC, ESR, LDH, CK-MD
medical treatment of acute myocardial infarctions
MONA- morphine, oxygen, nitrglycerin, aspirin
- iv acess, large bore
heparin- administered as continuous weight-based drip, monitor therapy by PTT
- fibrinolytic therapy- CLOT BUSTER (for STEM)
- stent placement or CABG
nursing interventions for acute myocardial infarction?
- administer analgesics as ordered
- allow periods of uninterrupted rest
- provide a clear liquid diet until nausea subsides
- provide stool softener to prevent straining
- assist with ROM exercises
- provide emotional support, and help reduce stress/anxiety
what are some common emotional and behavioral responses to acute myocardial infarctions
- denial, anger, fear, and anxiety
- dependency, depression, realistic acceptance
what is heart failure?
the left or right ventricle or both fail as pumps
- usually left side of heart fails first, right side fails as result of left side failure
- CONGESTION AND INCREASED PRESSURE
- most common causes are CAD and uncontrolled HTN
s/s of left-sided heart failure
- anxiety
- tachycardia, dyspnea, pallor
- cough, adventitious lung sounds
s/s of right-sided heart failure?
- JVD
- abdominal engorement
-dependent edema - fatigue, weight gain
goals of treatment for heart failure
- reduce demand for oxygen and workload of the heart
- strengthen hearts pumping action
- relieve venous congestion in the lungs
- minimize sodium and water retention in the tissues
heart failure treatment
- loop diuretics (lasix, HCTZ)
-cardiac glycosides/digoxin increases pumping strength
classic symptoms of digitalis toxicity
- yellow- green halos around lights, nausea, diarrhea, and confusion
-physiologic changes resulting from age, electrolyte imbalances (hypokalemia, hypercalcemia)
-renal impairment, metabolic disturbances - certain heart conditions can predispose a px to digitalis toxicity
