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Med surg 2 > coronary alterations management Focus > Flashcards

coronary alterations management Focus Flashcards

1
Q

where is the left anterior descending coronary arteries

A

anterior and lateral wall of LV

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2
Q

where is the circumflex artery

A

posterior and lateral wall of LV

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3
Q

where is the Right coronary artery

A

SA and AV node

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4
Q

what helps in development of atherosclerosis

A

Endothelial injury and inflammation

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5
Q

what are some non modifiable risks for CAD

A

over 65, male, obese women, african amercian, 1st degree family history, genetics

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6
Q

what are some modifiable risks for CAD

A

HDL, LDL, cholesterol over 200, triglycerides over 150, hypertension, smoking, decreased physical activity, obese BMI over 30, drug use, pernicious anemia

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7
Q

what defines metabolic syndrome - insulin resistance

A

central obesity, hypertension, abnormal serum lipids, elevated fasting BG

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8
Q

what could be some contributing factors to CAD

A

DM, metabolic syndrome, psychological status, homocysteine level (pernicious anemia), substance abuse

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9
Q

what does the med atrovastain do

A

decreases lipids by inhibiting cholesterol synthesis= increasing HDL and decreasing LDL

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10
Q

what should you monitor for atrovastain

A

liver damage and myopathy

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11
Q

what changes should be made for the diet for CAD

A

decrease saturated fats, cholesterol, red meat, egg yolks, and whole milk
increase complex carbs, fiber, omega 3 fatty acids

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12
Q

what is ischemia cause

A

angina

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13
Q

what is ischemia

A

the demand for myocardial oxygen exceeds what the coronary arteries can give

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14
Q

what could be some cause of unstable angina

A

acute coronary syndrome (MI),

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15
Q

what are the 2 options for acute coronary syndrome (MI) and what are there differences

A

NSTEMI (no ST elevation )
STEMI (ST elevation)

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16
Q

what are the 2 procedures you can do for angina stable or unstable

A

Percutaneous coronary intervention or coronary artery bypass graft

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17
Q

how does nitroglycerin work

A

Dilates the peripheral and coronary blood vessels

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18
Q

what are some long acting nitrates

A

lsordill, limdur, nitroglycerin ointment, transdermal controlled release nitrglycerin

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19
Q

what is the main complication for nitrates and what is the intervention for that

A

orthostatic hypotension - monitor BP after initial dose, advise patient to change positions slowly

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20
Q

what med should not be taken with nitrates and why

A

erectile dysfunction (viagra) because it can cause severe hypotension

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21
Q

what are the meds used for stable angina

A

ACE (lisinopril), ARBs (losartan), beta blockers

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22
Q

what are some interventions for stable angina

A

upright position, supplemental O2, VS, ECG, assess lungs, nitroglycerin, tropnin lap values

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23
Q

what are troponin lap values normally for stable angina

A

negative

24
Q

what is unstable angina

A

deterioration of plaque blockage, which then ruptures, platelets go to fix it causing a bigger blockage and stops blood flow = irreversible myocardial cell death

25
Q

what does a chest X ray show for CAD

A

heart enlargement, aortic calcifications, pulmonary congestion

26
Q

what would a chest X ray rule out

A

aortic distension

27
Q

what are you looking at on an 12 lead ECG for CAD

A

changes in baseline and ST elevation

28
Q

what is normal troponin

A

0 - 0.04

29
Q

what is normal high sensitivity troponin

A

less then 14

30
Q

what does a coronary computed tomography angiography do

A

detects calcified/ non calcified plaques in the artery

31
Q

what diagnostic test could you do for CAD

A

chest xray, ECG, labs (troponin), echocardiogram, exercise stress test, thallium scans

32
Q

what should you do if someone has IV contrast allergy but needs to go to cath lab

A

pre-medicate with corticosteroids and still go to cath lab and use contrast

33
Q

what is the treatment of choice for STEMI

A

emergent percutaneous coronary intervention

34
Q

what are the 2 different stents for percutaneous coronary intervention and whats the difference

A

Bare metal (1mt-1yr dual anti-platelet therapy), drug-eluting stent (minimum of one year of anti-platelet therapy)

35
Q

what does dual anti-platelet consist of

A

Aspirin + clopidogrel (plavix)

36
Q

what are some alternatives for plavix

A

ticagrelor or prasugrel

37
Q

what is the management after coronary revascularization

A

monitor for recurrent angina, VS, cardiac rhythmic/dysrhythmia, insertion site, neurovascular assessment (peripheral pulses), bed rest per policy

38
Q

who gets thrombolytic therapy

A

STEMI who cant get to the lab so give within 30minutes of arrival

39
Q

what interventions do you need to do for thrombolytic therapy

A

draw blood from 2-3 IV sites, do invasive procedures first, monitor for bleeding, neuro status,

40
Q

what is the best sign after thrombolytic therapy

A

ST returning to baseline

41
Q

how do you prevent reocclusion for thrombolytic therapy

A

heparin

42
Q

what are the ss of acute thrombolytic syndrome

A

increased HR and BP first then a drop in BP, crackles, jugular vein distention, new murmur, diaphoresis, nv, fever (100 degrees in first 24-48 hours)

43
Q

why would someone need coronary surgical revascularization with coronary artery bypass grafting

A

failed medical management, multivessel disease, non a candidate for percutaneous coronary intervention (because blockage too long or difficult to access), multiple comorbidities

44
Q

what is part of the process for coronary surgical revascularization with coronary artery bypass grafting

A

sternotomy and cardiopulmonary bypass

45
Q

what are some complications of coronary surgical revascularization with coronary artery bypass grafting

A

bleeding (anemia from RBC damage), fluid and electrolyte imbalances, hypothermia (bc blood is cooled when gone through bypass machine), infection

46
Q

what should you monitor for coronary surgical revascularization with coronary artery bypass grafting

A

hemodynamic status, fluid status, monitor for afib (very common so restart beta blockers ASAP)

47
Q

what is the most common complication of acute coronary artery syndrome (MI)

A

Dysrhythmias

48
Q

what is the most common cause of death prehospitalisation

A

VT and VF

49
Q

how does HF happening because of acute coronary artery syndrome (MI)

A

pumping power of the heart is diminished because of scaring

50
Q

what is cardiogenic shock

A

heart is not working effectively leaving the body poorly perfused

51
Q

what are the ss of acute pericarditis

A

mild-severe chest pain made worse with inspiration/coughing/movement of upper chest, relieved when sitting forward

52
Q

what are the 2 med used for acute pericarditis

A

aspirin or colchicine

53
Q

what will happen next if someone has ventricular wall rupture and papillary muscle rupture

A

new loud systolic murmur, HF, and cardiogenic shock will ensue

54
Q

what is left ventricular aneurysm

A

myocardial wall becomes thinned and bulges out during contraction

55
Q

what is usually recommended for someone who has LV aneurysm

A

anticoagulants unless contraindicated

Med surg 2 (12 decks)

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