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Adult Nursing II - Exam 2 > Coronary Artery Disease (Week 1) > Flashcards

Coronary Artery Disease (Week 1) Flashcards

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1
Q

What is the cause of coronary artery disease?

KNOW THIS!!!

A

cholesterol-filled atherosclerosis / plaque build up in the coronary arteries that obstructs blood flow

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2
Q

What are potential causes of chest pain?

A

Cardiac: acute coronary syndrome, aortic dissection, tamponade, takotsubo cardiomyopathy

Pulmonary: PE, pneumothorax

Esophageal: rupture or impaction

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3
Q

What do you need to consider as a nurse when a patient presents with chest pain?

A

History: DVT, DM, HTN, etc.

Risk Factors: CAD, Marfans, hyperlipidemia, HTN, DM, CKD, obesity, etc.

Onset: sudden (MI, PE, pneumo, dissection) vs progressive (pneumonia)

Severity, quality, & radiation

Associated symptoms

Position & effect of activity (including inspiration

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4
Q

How would a patient with an aortic dissection describe their chest pain?

KNOW THIS!!!

A

Tearing pain

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5
Q

How would a patient with a pulmonary embolism describe their chest pain?

KNOW THIS!!!

A
  • Sudden onset
  • Shortness of breath
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6
Q

How would a patient with a pneumothorax describe their chest pain?

KNOW THIS!!!

A

Increased pain (she said tearing…) when taking a deep breath

  • NO breath sounds
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7
Q

What findings can the nurse expect when examining a patient with pneumonia?

KNOW THIS!!!

A
  • Coarse breath sounds
  • Low pulse ox
  • Shortness of breath
  • Cough
  • Fever
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8
Q

Pain Characteristics to Consider

A
  • Acute or Chronic
  • Onset
  • Sleep (does it wake them from sleep)
  • Location
  • Character
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9
Q

Modifiable & Non-Modifiable Risk Factors for Heart Disease

KNOW THIS!!! (IN RED)

A

Unmodifiable
* Age
* Heredity
* Race
* Sex

Modifiable
* Cigarette smoking
* High cholesterol
* Hypertension
* Physical inactivity
* Obesity
* DM

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10
Q

Common symptoms associated with ischemia / cardiac related

A

Crushing or squeezing pain +

  • cold sweats
  • SOB
  • tachycardia
  • N/V
  • choking / difficulty swallowing
  • numbness or discomfort in hand or arms
  • pain that radiates from the chest to the neck, jaw, shoulders, or arms
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11
Q

What characteristics should the nurse assess when a patient presents with chest pain?

A

Type of Pain
* Acute
* Chronic

Onset
* Sudden onset
* Onset with activity - angina
* Onset with trauma - contusion, rib fx, pneumo
* Onset lying down - esophagitis

Sleep
* does pain awaken patient from sleep? (serious)

Location / Character
* Dull
* Sharp
* Stabbing
* Aching
* Pressure / Heavy
* Pins & needles
* Shock
* Throbbing
* Gnawing
* Heavy

Radiation

Exacerbating / Relieving Factors

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12
Q

What signs & symptoms are associated with an MI?

KNOW THIS!!!

A
  • Nausea
  • Vomiting
  • Diaphoresis
  • Shortness of breath
  • Syncope (+)
  • Left arm pain / radiation of pain
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13
Q

What signs & symptoms are associated with a P.E.?

KNOW THIS!!!

A
  • Shortness of breath
  • Apprehension (anxiety)
  • Hemoptysis
  • Increased pain with respirations
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14
Q

What signs & symtoms are associated with pneumonia?

KNOW THIS!!!

A
  • fever
  • cough
  • sputum change
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15
Q

What are potential GI causes / origins of chest pain?

KNOW THESE!!!

A
  • Herpes Zoster: burning, knife life, may restrict movement & respiration (usually in the chest or flank; pain before rash)
  • Costochondritis: inflammation of cartilage that connects ribs to sternum
  • Sickle Cell: extreme pain
  • Marfan Syndrome: connective tissue disorder
  • Peptic Ulcer Disease: may have bloody emesis (hematemesis)
  • Cholecystitis: R sided chest pain w/ radiation to R shoulder & upper back
  • Pancreatitis: excrutiating constant LUQ pain w/ radiation to chest, shoulder & arm (associated with HTN)
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16
Q

What is ST elevation indicative of?

What is ST depression indicative of?

A

ST Elevation = NO O2 or HIGH K+ (hyperkalemia)

ST depression (T-wave inversion) = low O2 (ischemia)

ST is HIGH, heart muscles have DIED

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17
Q

What is a zone of ischemia?

What does it look like on an EKG?

KNOW THIS!!! – highlighted & red

A
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18
Q

What is the zone of injury?

What does it look like on an EKG?

KNOW THIS!!!

A
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19
Q

What is the zone of infarction?

What does it look like on an EKG?

KNOW THIS!!!

A

Area of complete death of cardiac muscle (cannot be regenerated)

Looks like DEEP Q waves (longer than normal, 1/3 or more of the R wave)

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20
Q

What is a transmural infarction?

A

involves all vascular layers of the heart (endocardium, epicardium, myocardium)

STEMI (ST elevated MI)

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21
Q

What symptoms do women commonly present with when having an MI or ACS (acute coronary syndrome)?

**KNOW THIS!!! – red **

A
  • nausea
  • vomiting
  • dyspnea
  • fatigue
  • neck pain
  • abnormal pain location (abdomen, chest, etc.)
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22
Q

Chest Pain Evaluation

KNOW THIS SCALE!!!

A

Onset
Precipitating factors
Quality (stabbing, dull, aching, etc.)
Region / Radiation
Severity-Use scale (scale of 1 - 10)
Timing

Also ask about:

Relieving factors: nitroglycerin, oxygen, position change

Aggrevating factors: exercise, environment

Associated symptoms: n/v, diaphoriesis, dysnpea

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23
Q

What is stable angina?

A

Chest pain that is relieved with rest & taking nitroglycerin

  • substurnal discomfort, pressure, or tightness
  • Can radiate to left arm, back, shoulders, jaw, neck
24
Q

What is unstable angina?

A

Chest pain that does not go away and was previously stable angina

  • may awaken from sleep
  • more intense pain
  • Change in level or frequency of sx requires immediate medical intervention
25
Q

What is variant or prinzmetal angina?

List risk factors & associated symptoms

A

Due to vasoconstriction & spasms of coronary arteries

CYCLICAL – happens at the same time every day

  • Risk Factors: smoking, EtOH use, cocaine use
  • Assoc. Sx:Chest pain & ST elevation
26
Q

What is silent ischemia?

What patient population is most at risk for silent ischemia?

A

Objective EKG evidence wihtout subjective complaint of chest pain

DIABETICS (type 2) with autonomic neuropathy are at high risk

27
Q

Nursing Responsibilities for stable angina

A

Patient Education & Lifestyle Modifications
* smoking
* EtOH
* obesity (diet & exercise)

Educate them on when to call 911 if they have chest pain

28
Q

What diagnostic labs or tests should be done when determining if a patient is having an MI?

KNOW THIS!!!

A

TROPONIN
* EKG
* Cath lab
* Stress test
* Echocardiogram
* Myoglobin - not cardiac specific
* Creatinine kinase - not cardiac specific

29
Q

What labs are drawn to determine if a patient is having an MI? Which labs are and are not cardiac specific?

A

TROPONIN: cardiac specific

Creatinine Kinase (CK-MB): not cardiac specific

Myoglobin: not cardiac specific

30
Q

Explain the conduction system of the heart

A
  • SA Node
  • AV Node
  • Bundle of His
  • R & L Bundle Branches
  • Purkinje Fibers
31
Q

What abnormalities are seen on an EKG when a patient is having an MI?

A

ST elevation

32
Q

What is the J Point (junction) on an EKG?

KNOW THIS!!!

A

The point where the QRS complex & ST segment meet

33
Q

What is a pathological Q-wave on an EKG and what does it represent?

KNOW THIS!!!!

A
  • Q-wave is LOWER than normal
  • Patient has had a prior MI

Greater than 1 small box in duration & deeper than 1/3 of the R wave

34
Q

Where are the 6 pericordial leads placed?

A
  • V1 = 2nd intercostal space R of sternum
  • V2 = 2nd intercostal space L of sternum
  • V3 = halway between V2 & V4
  • V4 = L midclavicular line, 5th intercostal space
  • V5 = L anterior axillary line, 5th intercostal space
  • V6 = L midaxillary line 5th intercostal space
35
Q

What is an Anterior Wall MI?

KNOW THIS!!!

A

Affects LAD artery (L anterior descending)

MOST DANGEROUS because LAD supplies the rest of the body with O2 & blood

36
Q

What is seen on an EKG that would indicate an anterior infarct (anterior wall MI)?

A

ST Elevation in leads V2 - V4

37
Q

What is interventions are taken with a patient who has an anterior wall MI?

KNOW THIS!!!!

A

Pressors

  • giving a patient fluids will put them into fluid overload & pulmonary congestion

Pressors are given because in an anterior MI, the L ventricle isn’t pumping properly

38
Q

What is an anterior infarct (anterior wall MI)? What is seen on an EKG to indicate an anterior infarct? What interventions are taken?

A

improper blood flow to LAD (dangerous because LAD supplies the rest of the body with blood & O2)

ST Elevation in leads V2 - V4

Interventions: Pressors

do not give fluid because this can lead to fluid overload & pulmonary congestion

39
Q

What is a lateral MI? What is seen on an EKG to indicate a lateral MI? What does this type of MI usually accompany?

A

Caused by blockage in L circumflex artery

Changes in leads I, aVL, V5, V6

  • Usually accomanies an anterior or inferior MI
40
Q

40 - 50% of acute MI’s are usually what type of MI?

A

Lateral MI

  • damage to the L circumflex artery
41
Q

What is an anterior MI? What is seen on an EKG to indicate a anterior MI? What complications can this type of MI lead to?

A

Occlusion of R coronary artery

Changes in leads II, III, & AvF

Complications: ventricular failure or BBB (bundle branch block), bradycardia, sinus arrest, PVCs

42
Q

How do the zone of ischemia, zone of injury, & zone of infarction present on an EKG?

KNOW THIS!!!

A

Zone of Ischemia = ST segment depression

Zone of Injury = ST segment elevation (STEMI)

Zone of Infarction = DEEP Q Waves (pathological Q wave due to absence of depolarization)

43
Q

What is the difference in a STEMI and an NSTEMI on an EKG?

KNOW THIS!!!

A

STEMI = ST - elevation

NSTEMI = ST depression & T wave inversion

44
Q

What 4 things should be administered to patients who present with chest pain when there is concern for an MI?

KNOW THIS!!! - HIGHLIGHTED, BOLD, RED

A

Oxygen (4 L / min)
Aspirin (160 mg or 325 mg – CHEW)
Nitroglycerin (sublingual or IV)
Morphine (2-4 mg q5-10 min.)

OANM

45
Q

What is the primary reason for administering morphine to a patient with an MI?

a.) To sedate the patient
b.) To decrease the patient’s pain
c.) To decrease the patient’s anxiety
d.) To decrease oxygen demand on the patient’s heart

A

d.) To decrease oxygen demand on the patient’s heart

PER NIH

  • to decrease HR, BP, & venous return
  • decrease pain
  • reduce myocardial oxygen demand
46
Q

What must be done in under 10 minutes (immediate assessment) when a patient arrives to the ER with chest pain?

KNOW THIS!!! – HIGHLIGHTED, BOLD, RED

A
  • 12-lead EKG
  • IV - 1-2 lines
  • O2
  • Monitor (vital signs, cardiac monitor, etc.)
  • ABCs (Airway, Breathing, Cicrulation)
  • Draw initial labs
  • Chest x-ray
47
Q

What are potential complications of an acute MI?

A
  • Rhythm disturbances
  • Ventricular aneurysm
  • Ventricular septal rupture
  • Papillary muscle rupture (responsible for closing the heart valves; therefore, if muscle ruptures the valves won’t work)
  • Cardiac wall rupture
  • Pericarditis
  • Heart Failure
48
Q

What are the different types of therapy used for myocardial infarctions?

KNOW THIS!!! - BOLD, RED

A

Reperfusion (acute; used in the moment)
* fibrinolytic therapy (like tpa)
* percutaneous coronary intervention (PCI) (CATH LAB)

Adjunctive (usually after an MI)
* beta-blocker
* ACE inhibitor
* glycoprotein IIb/IIIa
* Heparin

49
Q

What are the two different types of reperfusion therapy used for myocardial infarctions?

A
  • fibrinolytic therapy (like TPA)
  • percutaneous coronary intervention (PCI) (Cath Lab)
50
Q

What are the 4 different types of Adjunctive Therapy used for a myocardial infarction?

A
  • Beta-blockers
  • ACE inhibitors
  • Glycoprotein IIb / IIIa inhibitors
  • Heparin
51
Q

When are fibrinolytic therapies used for treatment of an MI?

A
  • onset of symptoms was < 12 hours prior

Class I Intervention when…
* clinical complaints are consistent with ischemic type pain
* ST elevation > or = 1mm in 2 anatomical contiguous leads
* There are no contraindications
* Patient is < 75 years old

52
Q

Nursing management for patients receiving drug therapy for an MI

A
  • Identify the candidates
  • Monitor for signs of bleeding
  • Observe for evidence of reperfusion (either by medications, fibrinolytics, or surgery – ST segment normalization)
  • Patient education
53
Q

Patient Education for patients who have had a myocardial infarction.

A
  • Pathophysiology
  • Angina
  • Use of pain scale & EMS notification
  • Avoid valsalva
  • Risk factor modification
  • Cardiac rehab
  • Medication education
  • Follow up care after d/c
  • Symptoms to report to HC professional
  • Discuss emotional stress, anger, & sex
54
Q

What is therapeutic hypothermia & why is it used?

A

**Cooling the body to 32-34 degrees C **

  • used when cardiac death causes the heart to stop pumping blood throughout the body…it’s shown to improve mortality & neurological function

Return cardiac output initiates cerebral reperfusion injury

55
Q

What is Wolff-Parkinson White Syndrome & what does it look like on an EKG?

KNOW THIS!!!

A

Presence of an abnormal pathway between the atria & ventricles.

ON EKG…
* Short PR interval
* Prolonged QRS with delta wave (slurred, slow rise of initial upstroke of QRS complex)

Ablation is usually done

56
Q

What is Wolff-Parkinson White Syndrome & what does it look like on an EKG?

KNOW THIS!!!

A

Presence of an abnormal pathway between the atria & ventricles.

ON EKG…
* Short PR interval
* Prolonged QRS with delta wave (slurred, slow rise of initial upstroke of QRS complex)

Ablation is usually done

57
Q

What is a Bundle Branch Block?

KNOW THIS!!!!

A

delay or blockage of pathway causing dealyed contraction of a ventricle

Can be a pre-existing condition
** Can be caused by acute coronary syndrome**

  • Wide QRS (> 0.12)!!!!!!
  • Crown on top

Adult Nursing II - Exam 2 (4 decks)

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