Chapter 28: Coronary Heart Disease

Question 1

Beta Blocker Assessments

Answer 1

treat angina, MI, hypertension, heart failure, and dysrhythmias.

Decrease cardiac workload by slowing heart rate, decreasing blood pressure, and reducing contractility.

When beta-adrenergic blockers are started early in patients without signs of heart failure with acute MI (primarily STEMI), they reduce infarction size and early mortality.

long-term use, these drugs lower the risk of death.

Cardioselectivity- not interfering with bronchodilation or peripheral vasodilation
noncardioselective- decreasing peripheral and coronary vascular resistance.

Do not stop taking the drug abruptly because this can cause rebound
tachycardia.

Move slowly from a sitting to a standing position to avoid orthostatic
hypotension.

Be aware of possible adverse effects, including dizziness, wheezing, and low
heart rate.

Question 2

Difference between angina and MI

Answer 2

anginal pain is usually described as substernal chest pain of a constricting, squeezing, or suffocating nature. Pain may radiate to the jaw, neck, or shoulder; down the left or both arms; or to the back. unstable angina often occurs hours or days before acute MI

Myocardial infarction may be “silent,” and go undetected, or it could be a catastrophic event leading to hemodynamic deterioration and sudden death

Question 3

Nitroglycerin (routes of admission)

Answer 3

IV, SL TRANSLINGUAL SPRAY, PO TOPICAL OINTMENT, TOPICAL TRANSDERMAL DISK

Question 4

Nitroglycerin (Contraindications)

Answer 4

hypersensitivity reactions, severe anemia, hypotension, and hypovolemia

Question 5

Nitroglycerin (patient teaching)

Answer 5

sublingual nitroglycerin tablets, keep them in the original container; carry them so that they are always within reach but not where they are exposed to body heat; and replace them approximately every 6 months because they become ineffective

Temporary headache and dizziness may occur with nitrate antianginal drugs, especially sublingual nitroglycerin. If the headache is severe, you may take aspirin or acetaminophen with the nitrate drug. Do not reduce drug dosage or take the drug less often to avoid headaches; loss of effectiveness may occur. Keep family members or support people informed about the location of
nitro

Avoid over-the-counter decongestants, cold remedies, and diet pills, which stimulate the heart and constrict blood vessels and thus may cause angina. Drugs and alcohol dilate blood vessels, and an excessive reduction in blood pressure, avoid drugs and alcohol

Avoid concurrent intake of grapefruit juice

Question 6

Nitroglycerin (Assessments)

Answer 6

assess for relief of acute chest pain as well as a modest decrease in blood pressure

Question 7

Nitroglycerin (indication)

Answer 7

acute relief of an attack or acute prophylaxis of angina pectoris due to coronary artery disease

Question 8

Beta-blockers for angina

Answer 8

Cardioselectivity is diminished at higher doses, where it inhibits beta2 receptors in the bronchial and vascular musculature. Noncardiac adverse effects include bronchospasm, especially in patients with chronic obstructive pulmonary disease (COPD)

Question 9

Atenolol nursing assessments and nursing interventions

Answer 9

Report a heart rate of fewer than 55 beats/min to your healthcare provider and withhold medication as instructed. beta-adrenergic blockers mask symptoms of low blood sugar., check bg often

Take atenolol at the same time each day and avoid drinking large amounts of orange juice. Do not stop taking the drug abruptly because this can cause rebound tachycardia, and taper, and limit physical activity to a minimum during this period.

Move slowly from a sitting to a standing position to avoid orthostatic hypotension.