CHD - medsurg2 Flashcards
what is responsible for almost all cases of CHD
atherosclerosis (hardening of the arteries)
non modifiable risk factors for CHD
1) age (older)
2) gender (male)
3) family hx (esp if cases are seen in young pt)
what are the 4 most established modifiable reasons fro CHD + how to correct
1) elevated lipids -> diet & meds & regular labs
2) HTN -> meds & treat co morbids
3) tobacco use -> stop
4) physical inactivity -> increase PA
other modifiable risk factors for CHD
-obesity (apple is worse than pear)
-DM
-depression/stress
what meds & diet would a pt be on for elevated lipids
statins & low fat
what meds & diet would a pt be on for htn
antiHTN (ace, arbs, BB, CBB, diuretics) & DASH diet
does switching from cigarettes to a lower nicotine/filtered cigarette affect risk of CHD
no -> does not affect risk
physical activity recommendation / teach
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)
diet teaching for obese pt
-restrict sat fats, sweets & cholesterol
-avoid fad diets
-increase PA
angina
chest pain d/t temporary loss of O2 to the heart muscles
characteristics of chronic stable angina
-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
how to dx stable angina
-thorough physical exam & hx
-EKG
-stress test or drug induced
-echo &/or TEE
what drugs are used to medically induce a stress test
vasodilators or drug w/ positive inotropic/chronotropic effectd (inc contractility of heart & inc heart rate)
when dx stable angina, a stress test can help determine if
low/intermediate/ high risk -> low & intermediate can be managed w/o interventions, high risk pt will need a cardiac cath + PCI or CABG
what is the goal of collaborative care for stable angina
decrease O2 demand on the heart and increase O2 supply
+lower risk factors
what drugs can help lower risk factors of stable angina
-antiplatelet (ASA, 75-325 mg daily)
-lipid lowering agents
medications to relieve stable angina
-beta blockers
-CCB (w/ BBs)
-nitrates (SL 1st line, can take prophylactically before known problem activity)
-ranolazine
what is the benefit of beta blockers w/ stable angina
only class proven to prevent re infarction & to improve survival for MI patients
if pt w/ chest pain takes a nitrate and it hasn’t improved in 5 mins, patient should
call 911 immediately and then take a chewable 325mg ASA
if pt has a new onset, teach take ASA immediately
chewable 325mg ASA gives what benefit
anti platelet benefits within 1hr and lasts several days
if a pt is in the hospital and needs to be given a rapid acting nitrate, what do you do first
take vitals (BP)
dose for tridil (IV nitrate)
5mcg/min
nursing considerations for nitrate administration
-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
pt teaching for SL nitrate (nitrostat)
-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
side effects of nitrostat
bounding HA, dizziness & flushing
but still take
if pt w/ stable angina has low BP but is having chest pain, what can be given instead of nitrate
IV morphine
characteristics of unstable angina
-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
angina S/s in women
-fatigue
-SOA
-indigestion
-anxiety
+pain in shoulder, trouble sleeping, anxiety, sweating, back pain
when comparing angina pain to MI pain, characteristics of angina would include
-precipitated by exertion/stress
-relieved by rest/ntg
-lasting <15 mins
