Coronary Artery Disease (CAD)/Acute Myocardial Infarction(AMI) - EXAM 4 Flashcards
HDL: good or bad
Good. Want high HDL. Carries lipids away from arteries to the liver. Increases with exercise. Associated with lower risk for CAD.
LDL: good or bad?
Bad. Contains the most cholesterol. High levels correlate with CAD. Sticks to artery walls.
How do you decrease serum cholesterol levels?
- Achieve normal weight
- Diet that is low in fat, high in fiber, high in monounsaturated fat, plant sterol or stanol esters
- Management of Diabetes
- Control of BP
- Quit smoking
- Alcohol in moderation
- Medications
How do you increase serum HDL levels?
- Exercise for 30 minutes or more (aerobic) at least 5 times per week
- Quit smoking
- Achieve normal triglyceride level of less than 150 if elevated
- Diet low in fat, high in monounsaturated fat, high in whole grains, fruits, vegetables
What medications can be taken to decrease serum cholesterol levels?
- Bile acid sequestering agents (cholestyramine)
- Satins (Lipitor)
- Fibrates (gemfibrozil)
- Nicotinic Acid (Niacin)
atorvastatin (Lipitor)
Classification: Antilipemic agent
Mechanism of Action: Blocks synthesis of cholesterol and reduces LDL and triglyceride production. Increases HDL plasma levels
Use: Adjunct to diet therapy for decreasing LDL, cholesterol, triglycerides
Side/Adverse Effects: Mild GI disturbance, elevated liver enzymes, may increase digoxin levels
Nursing Implications:
- Do not take if liver disease
- Monitor liver function test
- Monitor digoxin toxicity
- Minimize alcohol intake
- Report any neuromuscular changes
- Teach patient importance of compliance
- Cholesterol med usually taken in the evening because the liver does the most work at night
aspirin (ASA, ECASA)
Classification: antiplatelet
Mechanism of Action: Inhibits platelet aggregation and inflammation
Use: Suspected AMI = 4 81mg chewable tablets or 1 325mg tablet to be chewed. Administer ASAP. Used also to prevent recurrences of MI, prophylaxis in unstable angina. 81mg or 325mg
Side/Adverse Effects: Gastric upset, GI bleeding, anaphylaxis
Nursing Implications: give with meal or full glass of liquid
morphine sulfate
Classification: narcotic analgesic
Mechanism of Action: binds endogeous opiod receptors. Reduces pre and afterload due to vasodilation
Use: pain of AMI, relieves dyspnea in HF/pulmonary edema, decrease anxiety
Side/Adverse Effects: resp.depression, orthostatic hypotension, constipation
Nursing Implications: Avoid valsalva post AMI, CNS depressant safety issues, monitor VS especially respiration and LOC
isosorbide mononitrate (Imdur)
Classification: nitrate vasodilator
Mechanism of Action: vasodilation (relax SM), decrease afterload, decrease venous return to the heart d/t venous pooling, decrease preload, decrease myocardial O2 consumption
Side/Adverse Effects: HA, syncope, flushing, hypotension, orthostatic changes, tachycardia
Nursing Implications: changes positions slowly, given PO, assess for angina/pain, monitor VS, do not break or crush
nitroglycerin
Classification: nitrate vasodilator, IV, SL (tab/spray), PO, transdermal spray
Mechanism of Action: Potent vasodilator - relaxes vascular smooth muscle, both arterial and venous. Promotes peripheral pooling of blood, decreases venous return, decrease SVR, decrease pre and afterload, HTN, angina, MI/CHF, decrease cardiac workload
Side/Adverse Effects: HA, Decrease BP, Palpitations, Syncope
Nursing Implications: CHECK SBP BEFORE GIVING THIS MED
IV: To manage HTN crisis, monitor for change in VS/LOC and relief of symptoms. May be used for angina unrelieved from NTG X 3 and morphine.
SL: Assess for signs of HA. Tingling sensation under the tongue, is normal with SL use. Store SL tabs in original bottle, sealed. Dose = 1 tab or 1 spray for angina. If symptoms unchanged after 5 minutes, call 911. May repeat SL q5minutes X 3 doses.
Transdermal: Avoid any bony prominences and an overly hairy location, rotate sites
- Hold if SBP: less 90mmHg
- Slowly change position
- Contraindicated within 24 hours of erectile dysfunction meds
- May relieve pain in 3 minutes
What is the troponin lab test?
Proteins are released following an acute MI, highly specific biochemical markers for cardiac damage.
What are the nursing considerations for troponin?
Simple blood test with normal = 0.03ng/mL. Patients will have levels drawn q8hours X3. Activity level significantly reduced until there are 2 negative troponin levels, meaning AMI is ruled out.
What is angina?
Chest pain is the clinical manifestation of reversible myocardial ischemia.
What is Prinzmetal’s Angina?
Often occurs at rest, usually in response to spasm of a major coronary artery.
What is stable angina?
This refers to chest pain that occurs intermittently over a long period of time with the same, perdictable pattern of onset, duration, and intensity of symptoms
What is an acute myocardial infarction (AMI)?
Occurs because of sustained cardiac ischemia causing irreversible myocardial cell death
What is an acute coronary syndrome (ACS)?
Cardiac ischemia is prolonged and not immediately reversible. Associated with the deterioration of a once stable atherosclerotic plaque.
Why does pain happen with AMI?
Severe, immobilizing ischemic chest pain not relieved by rest, position change or nitrate. Usually persists more than 20 minutes