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Nursing of Adults I > Chapter 37: Coronary Artery Disease and Acute Coronary Syndrome > Flashcards

Chapter 37: Coronary Artery Disease and Acute Coronary Syndrome Flashcards

1
Q

What increases C-reactive protein (CRP) levels?

A

systemic inflammation or coronary artery disease

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2
Q

High ____________ and ____________ levels may contribute to atherosclerosis

A

homocysteine, lipoprotein(a)

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3
Q

pathogenesis of atherosclerosis includes which four stages

A

chronic endothelial injury, fatty streak, fibrous plaque, complicated lesion

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4
Q

lipid-filled smooth muscle cells; lipids accumulate and migrate into smooth muscle cells

A

fatty streak

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5
Q

collagen covers fatty streak, vessel lumen is narrowed, blood flow is reduced, fissures can develop

A

fibrous plaque

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6
Q

plaque rupture, thrombus formation, further narrowing or total occlusion of vessel

A

complicated lesion

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7
Q

alternative arterial anastomoses or connections within the coronary circulation

A

collateral circulation

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8
Q

nonmodifiable risk factors for coronary artery disease

A

age, gender, ethnicity, family history, genetics

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9
Q

modifiable risk factors for coronary artery disease

A

high serum lipids, high blood pressure, tobacco use, physical inactivity, obesity, diabetes, metabolic syndrome

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10
Q

Men or women are more likely to die after their first MI

A

women

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11
Q

four major modifiable risk factors for coronary artery disease

A

elevated serum lipids, hypertension, tobacco use, physical inactivity

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12
Q

types of substance use most likely to contribute to coronary artery disease

A

cocaine, methamphetamine

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13
Q

normal total cholesterol levels

A

<200 mg/dL

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14
Q

normal HDL levels

A

males: >45 mg/dL
females: >55 mg/dL

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15
Q

normal LDL levels

A

<130 mg/dL

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16
Q

normal triglyceride levels

A

males: 40-160 mg/dL
females 35-135 mg/dL

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17
Q

statin therapy is recommended for these four patients

A
  1. Patients with known CVD
  2. LDL cholesterol >190 mg/dL
  3. Age 40-75 with diabetes and LDL 70-189 mg/dL
  4. Age 40-75 with LDL 70-189 mg/dL and 10-year risk for CVD at least 7.5%
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18
Q

side effects of statins

A

rash, GI problems, increased liver enzymes, myopathy, rhabdomyolysis* (tea-colored urine, muscle pain)

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19
Q

side effects of niacin

A

flushing, pruritis, GI problems, orthostatic hypotension

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20
Q

gemfibrozil

A

fibric acid derivative

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21
Q

fenofibrate

A

fibric acid derivative

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22
Q

lipid-lowering drug class that interferes with GI and absorption of many different drugs (take _______ before eating or taking other drugs)

A

bile sequestrants, 2 hours

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23
Q

drug that further reduces LDL when used with a statin

A

ezetimibe

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24
Q

drug used with high-risk hyperlipidemia to decrease cholesterol and associated 10-year risk

A

ezetimibe

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25
Q

give this drug ___________ prior to reduce flushing associated with niacin

A

NSAID, 30 minutes

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26
Q

this lipid-lowering drug class increases hyperglycemia and interacts with metformin and antihyperglycemics

A

fibric acid derivatives

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27
Q

drugs in this class have “chole” or “cole” in drug name

A

bile acid sequestrants

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28
Q

angina that occurs intermittently over a long period of time with a similar pattern

A

chronic stable angina

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29
Q

angina that involves chest pain that is new in onset that occurs at rest or with increasing frequency and duration

A

unstable angina

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30
Q

variant and rare form of angina that occurs at rest and not with increased physical demand

A

Prinzmetal’s angina

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31
Q

factors contributing to Prinzmetal’s angina

A

substance use (alcohol, cocaine), caffeine use, medications that cause vasoconstriction, cold weather exposure

32
Q

angina in which chest pain is related to myocardial ischemia from atherosclerosis or spasm of small distal branch vessels in coronary circulation

A

microvascular angina

33
Q

acute care for angina (7 steps)

A
  1. position upright (Fowler’s), apply oxygen
  2. assess vital signs, heart/breath sounds
  3. continuous ECG; 12-lead ECG
  4. pain relief (nitroglycerin, IV opioid if needed)
  5. cardiac biomarkers
  6. chest X-ray
  7. support, reduce anxiety
34
Q

gold standard cardiac biomarker

35
Q

purpose of chest X-ray in patient with angina

A

see if heart is enlarged

36
Q

give this drug for headache caused by nitroglycerin

A

acetaminophen

37
Q

drugs that dilate peripheral and coronary arteries and collateral vessels

A

short-acting nitrates

38
Q

when does SL NTG relieve angina

A

5 minutes after administration

39
Q

how long does SL NTG last

A

30-40 minutes

40
Q

how often can a dose of SL NTG be repeated

A

3 doses every 5 minutes

41
Q

side effects of SL NTG

A

headache, dizziness, flushing, orthostatic hypotension

42
Q

store NTG tablets away from _______ and _______

A

light, heat

43
Q

NTG tablets should be replaced every ________ after the bottle is opened

44
Q

prophylactic use of NTG

A

take tablet/spray 5-10 minutes before activity known to cause angina

45
Q

drug class used for LV dysfunction, elevated BP, or MI

A

beta blockers

46
Q

drug class in which drugs end in “lol”

A

beta blockers

47
Q

drug class that causes vasodilation and decreases contractility

A

calcium channel blockers (CCBs)

48
Q

drug class in which many of its drugs end in “dipine”

A

calcium channel blockers

49
Q

diltiazem

A

calcium channel blocker

50
Q

verapamil

A

calcium channel blocker

51
Q

last-chance drug for control of chronic stable angina

A

ranolazine

52
Q

three drug classes used to treat chronic stable angina

A

beta blockers, calcium channel blockers, sodium current inhibitor

53
Q

diagnostic studies for chronic stable angina (7)

A
  1. 12-lead ECG
  2. Lab studies: cardiac biomarkers, lipid profile, CRP
  3. chest x-ray
  4. echocardiogram
  5. exercise stress test
  6. electron beam computed tomography
  7. coronary computed tomography angiography
54
Q

gold standard test for patients with increasing angina symptoms that can identify and localize CAD

A

cardiac catheterization

55
Q

cardiac catheterization and PCI preprocedure nursing management (5)

A
  1. allergies (contrast dye)
  2. baseline assessment: vital signs, pulse ox, heart/breath sounds, neurovascular
  3. baseline laboratory studies
  4. administer ordered drugs
  5. patient education for preprocedure and postprocedure care
56
Q

cardiac catheterization and PCI postprocedure nursing management

A
  1. compare assessments to preprocedure
  2. assess catheter insertion site for hematoma, bleeding, bruit every 15 minutes for first hour, then agency policy
  3. ECG for dysrhythmia; chest pain or other pain
  4. IV infusion of antianginals
  5. monitor for complications
  6. educate: discharge care and drugs; signs and symptoms to report to HCP
57
Q

three drugs used during PCI

A

unfractionated heparin or low-molecular weight heparin
direct thrombin inhibitor
glycoprotein IIb/IIIa inhibitor

58
Q

drugs used after PCI

A

dual antiplatelet therapy (DAPT): aspirin and ticagrelor or clopidogrel

59
Q

coronary artery bypass graft (CABG) surgery recommended in these four situations

A
  1. medical treatment failed
  2. disease involves left main coronary artery or three vessels
  3. PCI cannot be done
  4. failed PCI or chest pain continues
60
Q

coronary artery bypass graft (CABG) is an option in those who have any of these three conditions

A

diabetes, left ventricular dysfunction (LVD), chronic kidney disease (CKD)

61
Q

two treatment options for STEMI

A

cardiac catheterization (if available at hospital): 90 minutes door to balloon
if cardiac catheterization not available, start thrombolytic therapy

62
Q

treatment for NSTEMI

A

cardiac catheterization within 12-72 hours

63
Q

chest pain from ischemia is prolonged and not immediately reversible

A

acute coronary syndrome (ACS)

64
Q

acute coronary syndrome (ACS) occurs on a spectrum from _____________ to ______________

A

non-ST elevation ACS (UA and NSTEMI)
STEMI

65
Q

diagnostic studies for acute coronary syndrome (ACS)

A

12-lead ECG, serum cardiac biomarkers

66
Q

serum cardiac biomarkers for ACS

A

proteins released after MI
cardiac-specific troponin T (cTNT)
cardiac-specific troponin I (cTNI)

67
Q

serum cardiac biomarkers are _________ for UA and ___________ for NSTEMI

A

negative, positive

68
Q

________________ are better indicators of MI than _________ or ____________ (serum cardiac biomarkers)

A

cardiac-specific troponins, CK-MB, myoglobin

69
Q

partial occlusion of coronary artery indicates _____ or ______

A

UA, NSTEMI

70
Q

total occlusion of coronary artery indicates ________

71
Q

first treatment with confirmed STEMI

A

emergent PCI

72
Q

two types of stents that may be used in emergent PCI

A

bare-metal stent (BMS), drug-eluting stent (DES)

73
Q

with emergent PCI, patients with severe LV dysfunction may require ____________ and/or __________

A

VAD therapy, inotropes

74
Q

five advantages of PCI (vs. CABG)

A
  1. faster reperfusion to limit infarction size
  2. performed with IV sedation and local anesthesia
  3. ambulatory shortly after procedure
  4. shorter length of stay
  5. faster return to work
75
Q

complications of PCI (6)

A
  1. dissection or rupture of coronary artery
  2. abrupt artery closure
  3. acute stent thrombosis
  4. failure to cross blockage with balloon or stent
  5. extended infarction
  6. in-stent restenosis
76
Q

acute care for ACS after admitted to ICU/telemetry unit

A
  1. monitor VS and pulse oximetry
  2. continuous ECG
  3. serial 12-lead ECGs
  4. serial cardiac biomarkers
  5. bed rest/limit activity
77
Q

how long should an ACS patient be on bed rest and limit activity for when admitted to ICU/telemetry unit

A

12-24 hours (then increase gradually)

Nursing of Adults I (21 decks)

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