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NURS 347 EXAM 3 > Coronary Artery Disease > Flashcards

Coronary Artery Disease Flashcards

1
Q

What’s the most common cardiovascular disease?

A

Coronary artery disease

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2
Q

CAD can either be what? (2)

A

Asymptotic
Or
Chronic stable angina ( chest pain )

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3
Q

What are the two acute coronary syndrome ?
These are more serious conditions of CAD

A

Unstable angina ( UA )
Myocardial infarction ( MI )

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4
Q

Cad has a profound effect on perfusion
Which means what?

A

Perfusion depends on the hearts ability to generate enough cardiac output to distribute blood to all body tissues

So when it has an effect on perfusion in the body, it decreases cardiac output and perfusion

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5
Q

What’s the major cause of CAD?

A

Atherosclerosis

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6
Q

What does atherosclerosis mean
What type of dis order is it? (2)

A

Soft deposits of fat that harden with age
(Hardening of arteries)

Blood vessel disorder

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7
Q

What are the fatty deposits that form in coronary arteries called?
When these fatty deposits form, this is what classifies the name for CAD

A

Atheromas

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8
Q

Atheromas are characterized how?

A

By lipid deposits within intima of artery

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9
Q

What is another major role that causes Atheromas? (2)

And why is it this cause?

A

Endothelial injury & inflammation

Because the blood vessel is lined with endothelial cells that protect the blood vessel but when it gets injury it’s open to many plaque to enter

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10
Q

How does the inflammation come into play when creating atherosclerosis for CAD?

A

C-reactive protein (CRP) comes from the liver and will rise when detecting systemic inflammation
Such as rheumatoid arthritis & inflammatory bowel disease

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11
Q

In the textbook it mentions how high LDL ( low density lipoprotein) and homocysteine also play a role in increasing CAD, how so? (3)

A

Damaging the inner lining of blood vessels

Plaque build up

Changing the clotting mechanism

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12
Q

Chronic endothelial injury plays a major role in causing atherosclerosis and opening up the 3 stage development of CAD, how so ?

A

It’s opening up the endothelium lining that protects the blood vessel and allows plaque and gunk to come in and cause distruption

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13
Q

What are some things that can cause this chronic endothelial injury? (7) think of like what can cause the actual INJURY, don’t confuse with the anagram!! )

A

Hypertension
Tobacco use
Hyperlipidemia
Hyperhomocysteinemia
Diabetes
Infections
Toxins

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14
Q

What are the 3 stages of development of atherosclerosis?

A

Fatty streak
Fibrous plaque
Complicated lesion

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15
Q

What is fatty streak stage 1 development of CAD & at what age?

A

Lipids infiltrate smooth muscle inside vessel
Usually develop in the teen years

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16
Q

What is fibrous plaque in stage 2 of development of CAD & at what age? (5)

A

Fatty streaks enlarge and become covered by collagen
Vessels lumen is narrowed
Blood flow is reduced
Fissures can develop

Begin at 30s

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17
Q

What is complicated lesion for stage 3 of CAD?

A

Chronic inflammation causes plaque to be unstable, increasing risk for ulceration/rupture. Platelets adhere to the lesion, creating a thrombus ( blood clot )

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18
Q

Coronary artery disease etiology & pathophysiology

Normally some arterial connections called ____ existing within the coronary circulation?
Theses are also known to be what?

A

Collateral circulation
Backup blood vessels

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19
Q

Two factors that contribute to the growth and extent of collateral circulation are? (2/define the terminology)

A

Inherited predisposition to develop new blood cells ( angiogenesis )

Presence of chronic ischemia
( poor blood flow )

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20
Q

What does collateral circulation have the greater change to develop?

A

Slow developing blockages

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21
Q

While during these slow developing blockages that increase collateral circulation, they will allow what to the heart?? But not during what? (2)

A

Blood and oxygen to heart

But not during increased workload like exercise

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22
Q

When you have a rapid onset of CAD or coronary spans ; the collateral circulation doesn’t have Time to develop, however two things can happen?

A

Severe ischemia ( bad blood flow )
Infarction

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23
Q

Visualize the image from the textbook of the collateral circulation
What is the first one
What is the second one
What is the third one

A
  1. Open
  2. Partial blockage with collateral circulation
  3. Complete blockage artery with collateral circulation bypassing
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24
Q

What are some nonmodifiable risk factors for CAD? (5)

A

Age
Gender
Genetics
Ethnicity
Family history

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25
Q

What are the 7 major modifiable risk factors for CAD?

A

High serum lipids
Hypertension
Tobacco
Physical inactivity
Obesity
Diabetes
Metabolic syndrome

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26
Q

What’s the anagram that can help me remember those 7 modifiable risk?

A

High
Hype
To
Physical
Obese
Diary
Meta !!

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27
Q

The increase risk for CAD with high serum lipids are associated with? (4)

A

Total Cholesterol greater than 200
HDL less than 40
LDL greater than 130
Fasting triglycerides greater than 150

28
Q

HDL vs LDL explain
And what they function as

A

HDL is happy cholesterol helps to prevent lipid accumulation in aterties

LDL is bad cholesterol
Increases atherosclerosis ( harden of arteries )

29
Q

Triglycerides are the most common type of what in the blood?

A

Fat

30
Q

How does hypertension work in increasing the risk for CAD?
( think about the vascular endothelial in the Bp) (4)

A

The shear stress of an elevated blood pressure causes endothelial injury

And with atherosclerosis, it causes narrowing, thicken, and decrease elasticity of vessels

And remember from how hypertension the endothelial cells are disrupted because of all of the pressure that’s needed to pump blood through the vessel because of how skinny the vessels become, so that’s why it effects CAD

Not to mention that all this workload can cause left ventricular hypertrophy & decrease stroke volume

31
Q

How does tobacco use-even second hand effect CAD? (2)

A

Nicotine in tobacco caused catecholamines ( epinephrine & norepinephrine ) increased heart workload ; like blood pressure

Increase LDLs

32
Q

How does physical inactivity effect CAD?
And what’s recommended?

A

Lack of exercise

To do 30-60mins brisk walking 5 days a week

33
Q

How does obesity effect CAD.
BMI??
What’s the waist circumference size for men & women?
What type of body shape will we see with CAD? (4)

A

Overweight >30
Men >40
Women>35
Apple figure ( fat in abdomen)

34
Q

How does diabetes effect risk factors for CAD? (2)

A

Increased endothelial dysfunction
Altered lipid metabolism & increasing cholesterol & trigs

35
Q

How does metabolic syndrome effect CAD? (3)

A

Insulin resistance
Abnormal serum lipids
High fasting blood glucose

36
Q

What are 3 more contributing risk factors for CAD?

A

Psychological states
Substance use
CRP,LIPOPROTEINS,HOMOCYSYENINE

37
Q

How does psychological state effect CAD?
( don’t overthink it, it’s literal psychology 3)

A

Depression
Anxiety
Stress

38
Q

How does substance use effect CAD?

A

Cocaine and merhamphetamine result in coronary artery spans causing chest pain & MI

39
Q

How does CRP, LIPOPROTEIN, HOMOCYSTEINE LEVEL effect CAD? (3)

A
  1. Dmg endothelium
  2. Promote plaque buildup
  3. Enhance clotting
40
Q

What are the 6 health promotion strategies for CAD?
We’re gonna identify what?
Precent what?
Encourage what??

A

Identifying high risk patients
Preventing control modifiable risk
Encourage life style changes
Education
Clarify personal values
Set realistic goals

41
Q

What type of physical activity program should we implement for our CAD patients?
Whats the formula name and stand for

A

FITT
frequency
Intensity
Type
Time

42
Q

We want how long to be there physical activity ? And it helps with what 3 things?

A

30mins most days plus weight training 2 days

Weight reduction
Reduction of systolic BP
Increase HDL

43
Q

What nutritional therapy will we implement on CAD patients? (4)
2 decrease
2 increase

A

Decrease saturated fats & cholesterol
Decrease red meat, egg yolk, whole milk
Increase complex carbohydrates & fibers
Increase omega 3 fatty acids

44
Q

When your patient has elevated triglycerides we want to reduce or stop the consumption of what& manage what?

A

ETOH
Blood glucose

45
Q

What type of medication are we going to give to CAD?

A

Lipid lowering medication

46
Q

Lipid lowering medication drug therapy is what?

A

Life long

47
Q

We always want to teach patients when taking lipid lowering medication about rational goals(1) and side effects(2), what are some of them?

A

Goals
Lowering LDL

Side effects
Muscle pain & GI disturbances

48
Q

We want our patient to following a concurrent diet when taking lipid lowering medication, not to mention we want to encourage 2 other things as well?

A

Weight loss and increase physical activity

49
Q

We also want to reassess after how many weeks of taking lipid lowering medication for what?

A

6 weeks
If the medication isn’t working to alternate

50
Q

When do we want to start giving out lipid lowering drug therapy?

A

When there total cholesterol remains greater than 200 in spite of diet and exercise

51
Q

What are the 6 lipid lowering drug therapy medications we can give to patients with CAD?

A

Statins
Niacin
Fibric acid derivatives (lopid)
Bile acid sequestranrs
Ezerimibe (zetia)
Antiplatelet therapy

52
Q

What’s an anagram that can help me remember the medications of lipid lowering drug therapy for CAD?

A

Stop
Nick
Filling
Bile
Ez
Anti

53
Q

What is statins function?
Helps decrease what?(2)
Increase what(1)

A

Inhibit cholesterol synthesis in the liver and
Decrease CRP&LDL
increase HDL

54
Q

We want to monitor stations why?

A

Because of liver damange and myopathy leading to rhabdomyolysis ( break down of skeletal muscle )

55
Q

What is niacin function?
Increases what?

A

Lowers LDL and Trigs by inhibiting synthesis
HDL increase

56
Q

What are some things we want to monitor for niacin ? (4)

A

Flushing
Itching ( pruritus )
GI side effects
Orthostatic hypotension

57
Q

What are fibric acid derivaties function?
Decrease?
Increase?
Nothing to?

A

Decrease triglycerides and increasing HDL

Does nothing to LDL

58
Q

What are important things to monitor for fibric acid derivaties ?

A

Gi side effects
Increase bleeding with warfain & effects of anti hyperglycemia drugs ( repaglinide )

59
Q

What is bile acid sequestrsnts?
What is the side effect?

A

Increase conversion of cholesterol to bile acids

Binds with other drugs

60
Q

What is eztimibie (Zetia)?

A

Decrease absorption of dietary and biliary cholesterol

61
Q

What is antiplatelet therapy ?
Side effects?
Medication

A

Preventing clots
GI bleed or stroke

Clopidigrel (plavix)

62
Q

GERONTOLOGIC CONSIDERSATIONS CAD
THEY HAVE AN INCREASE WHAT?

A

MORTAILITY & INCIDENCE

63
Q

What are strategies to help reduce risk in elderly for CAD? (2)

A

No Smoking
Physical activity

64
Q

What do we want to treat in elderly for CAD?(2)

A

Hypertension
Increased lipids

65
Q

Elderly patients are more willing to change when having what two things?

A

Being hospitalized or having chest pain

NURS 347 EXAM 3 (9 decks)

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