CHD - medsurg2

Question 1

what is responsible for almost all cases of CHD

Answer 1

atherosclerosis (hardening of the arteries)

Question 2

non modifiable risk factors for CHD

Answer 2

1) age (older)
2) gender (male)
3) family hx (esp if cases are seen in young pt)

Question 3

what are the 4 most established modifiable reasons fro CHD + how to correct

Answer 3

1) elevated lipids -> diet & meds & regular labs
2) HTN -> meds & treat co morbids
3) tobacco use -> stop
4) physical inactivity -> increase PA

Question 4

other modifiable risk factors for CHD

Answer 4

-obesity (apple is worse than pear)
-DM
-depression/stress

Question 5

what meds & diet would a pt be on for elevated lipids

Answer 5

statins & low fat

Question 6

what meds & diet would a pt be on for htn

Answer 6

antiHTN (ace, arbs, BB, CBB, diuretics) & DASH diet

Question 7

does switching from cigarettes to a lower nicotine/filtered cigarette affect risk of CHD

Answer 7

no -> does not affect risk

Question 8

physical activity recommendation / teach

Answer 8

talk to doctor before starting
-should be 40 mins long w/ 10 min warm up & 5 min cool down
-moderate exercise 3-4x weekly or walk 30 mins per day (if not possible, do what you can like parking car farther away)

Question 9

diet teaching for obese pt

Answer 9

-restrict sat fats, sweets & cholesterol
-avoid fad diets
-increase PA

Question 10

angina

Answer 10

chest pain d/t temporary loss of O2 to the heart muscles

Question 11

characteristics of chronic stable angina

Answer 11

-occurs w/ exertion that is predictable to pt
-sx remain the same over several months
-only slight limitation in activity
-relived by nitrates or rest
-managed w/ drug therapy
-rarely requires aggressive therapy

Question 12

how to dx stable angina

Answer 12

-thorough physical exam & hx
-EKG
-stress test or drug induced
-echo &/or TEE

Question 13

what drugs are used to medically induce a stress test

Answer 13

vasodilators or drug w/ positive inotropic/chronotropic effectd (inc contractility of heart & inc heart rate)

Question 14

when dx stable angina, a stress test can help determine if

Answer 14

low/intermediate/ high risk -> low & intermediate can be managed w/o interventions, high risk pt will need a cardiac cath + PCI or CABG

Question 15

what is the goal of collaborative care for stable angina

Answer 15

decrease O2 demand on the heart and increase O2 supply
+lower risk factors

Question 16

what drugs can help lower risk factors of stable angina

Answer 16

-antiplatelet (ASA, 75-325 mg daily)
-lipid lowering agents

Question 17

medications to relieve stable angina

Answer 17

-beta blockers
-CCB (w/ BBs)
-nitrates (SL 1st line, can take prophylactically before known problem activity)
-ranolazine

Question 18

what is the benefit of beta blockers w/ stable angina

Answer 18

only class proven to prevent re infarction & to improve survival for MI patients

Question 19

if pt w/ chest pain takes a nitrate and it hasn’t improved in 5 mins, patient should

Answer 19

call 911 immediately and then take a chewable 325mg ASA
if pt has a new onset, teach take ASA immediately

Question 20

chewable 325mg ASA gives what benefit

Answer 20

anti platelet benefits within 1hr and lasts several days

Question 21

if a pt is in the hospital and needs to be given a rapid acting nitrate, what do you do first

Answer 21

take vitals (BP)

Question 22

dose for tridil (IV nitrate)

Answer 22

5mcg/min

Question 23

nursing considerations for nitrate administration

Answer 23

-do not swallow SL or TL
-use gloves to apply & remove patch or ointment bc it will cause you to vasodi and give a horrible headache
-do not discharge defibrillator over patch
-teach to not take w/ erectile dysfunction meds bc drop in BP can be fetal (sildenafil)
-IV form comes in glass bottle -> filter tubing

Question 24

pt teaching for SL nitrate (nitrostat)

Answer 24

-works in <3 mins
-always have accessible
-protect from light
-let dissolve & expected to feel tingling
-contact EMS if one doesn’t resolve pain
-risk for postural hypotension
-can be used prophylactically but tolerance can build
-replace every 6 months

Question 25

side effects of nitrostat

Answer 25

bounding HA, dizziness & flushing
but still take

Question 26

if pt w/ stable angina has low BP but is having chest pain, what can be given instead of nitrate

Answer 26

IV morphine

Question 27

characteristics of unstable angina

Answer 27

-occurs at rest and lasts more than 20 mins
-limited PA
-angina sx increases w/ time, frequency & duration
-not relieved by rest or nitrates
-unpredictable & emergency bc precursor to MI
-no elevation in serum troponin

Question 28

angina S/s in women

Answer 28

-fatigue
-SOA
-indigestion
-anxiety
+pain in shoulder, trouble sleeping, anxiety, sweating, back pain

Question 29

when comparing angina pain to MI pain, characteristics of angina would include

Answer 29

-precipitated by exertion/stress
-relieved by rest/ntg
-lasting <15 mins