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Med Surg 1 > Coronary Vascular Disorders (Online Lecture)/Coronary Vascular Disorders Acute Coronary Syndrome > Flashcards

Coronary Vascular Disorders (Online Lecture)/Coronary Vascular Disorders Acute Coronary Syndrome Flashcards

1
Q

acute ischemic heart disease
what is it

A

lack of adequate blood flow to the heart and results in inadequate oxygen supply to meet demands this results in supply-demand mismatch

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2
Q

diagnoses under acute coronary syndrome (5)

A

chronic (unstable) angina
unstable angina
Prinzmetals (Variant) angina
Non ST segment elevation MI (NSTEMI)
ST segment elevation MI (STEMI)

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3
Q

chronic stable angina
definition

A

angina that has not increased in frequency or severity over time

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4
Q

how is chronic stable angina relieved

A

with rest and sublingual nitroglycerine

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5
Q

what exacerbates chronic stable angina pain

A

exertion, cold, stress, emotion

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6
Q

people with chronic stable angina usually have a diagnosis of

A

hypetension
high cholesterol
CAD
atherosclerosis

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7
Q

is chronic stable angina predictable or not

A

yes it is predictable

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8
Q

unstable angina
definition

A

angina that is changed in frequency, severity, or duration or occurs with less exertion or rest

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9
Q

unstable angina
new or old onset

A

new onset

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10
Q

unstable angina
duration of pain

A

more than 20 minutes

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11
Q

unstable angina
how will this present in someone who has chronic stable angina

A

changed frequency
more severe
lasting longer
occurring with less exertion
could occur at rest

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12
Q

is unstable angina relieved with nitroglycerine or rest

A

no

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13
Q

is unstable angina something to go to the ER

A

yes, immediate medical attention

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14
Q

prinzemetal (variant) angina
definition

A

resting angina caused by coronary artery spasm

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15
Q

when does prinzemetal (variant) angina occur

A

always at rest
normally at night (12am-8am)

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16
Q

prinzmetal (variant) angina is associated with

A

acute MI
arrhythmias
sudden cardiac death

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17
Q

NSTEMI
defintion

A

intermittently occlusive thrombus that may cause myocardial necrosis of the inner most layer of the myocardium

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18
Q

NSTEMI and STEMI present the same as

A

unstable angina

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19
Q

how do we differentiate between NSTEMI AND STEMI

A

12 lead EKG
Cardiac biomarkers

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20
Q

if someone is diagnosed with a NSTEMI how long do we have to take them to cath

A

24 hours, longer than a STEMI

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21
Q

STEMI
definition

A

occlusive thrombus

thrombus occluding a coronary vessel for a prolonged period of time
reduced blood flow results in myocardial ischemia, injury, and necrosis with damage extending through all myocardial layers

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22
Q

if someone is diagnosed with a STEMI how long do we have to take them to cath

A

90 mins critical

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23
Q

clinical manifestations
males

A

shortness of breath
nasuea
anxiety
pressure
radiation of pain
prodromal symptoms (general malaise)

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24
Q

PQRST method
P

A

Provoke
- what provokes the pain or what precipitates the pain

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25
Q

PQRST method
Q

A

Quality
- what is the quality of the pain

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26
Q

PQRST method
R

A

Radiation
- does the pain radiate to locations other than the chest

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27
Q

PQRST method
S

A

Severity
- what is the severity of pain (scale 1-10)

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28
Q

PQRST method
T

A

Timing
- what is the time of onset of this episode of pain

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29
Q

why is timing of discomfit critial

A

chronic vs unstable angina

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30
Q

what else is important to ask

A

associated symptoms
effect of exertion and rest
effect of nitrates

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31
Q

who are 3 groups of people who present atypical

A

women
diabetics
elderly

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32
Q

women presents

A

tired
lack of energy
shortness of breath
more likely to deny pain

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33
Q

diabetic presents

A

silent ischemia (don’t experience pain in same regard)

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34
Q

elderly presents

A

weakness
dysnpnea
confusion
shortness of breath

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35
Q

areas where pain can radiate

A

back
area between shoulder blades
upper abdomen
elbows
ears

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36
Q

nursing diagnoses

A

risk for decreased cardiac perfusion

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37
Q

nursing interventions
priority nursing concern

A

treatment of angina pain

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38
Q

nursing interventions
stop all _________ and sit or rest in _____________

A

activity
bed

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39
Q

nursing interventions
assessment

A

VS
respiratory distress
assessment of pain

*ECG

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40
Q

nursing interventions
administer

A

oxygen
- maintain over 90%

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41
Q

nursing interventions
administer __________ as ordered

A

medications

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42
Q

nursing interventions
ultimate goal

A

reperfusion (cath lab)

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43
Q

nursing interventions
postion for

A

comfort

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44
Q

nursing interventions
administer nitroglycerine
- what does it do

A

vasodilator
- reduces blood flow and reduces myocardial oxygen consumption
- reduces preload
- causes venous pooling in LE

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45
Q

nursing interventions
administer morphine
- why

A

pain

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46
Q

nursing interventions
administer heparin

A

prevent new clot

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47
Q

nursing interventions
- quite and calm environment

A

decrease stress and anxiety

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48
Q

nursing interventions
administer aspirin
- what is it and what does it do

A

antiplatlet
- decrease platelet aggregation

when there is an occlusion an inflammatory response is to increase platelet migration

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49
Q

nursing interventions
administer beta blockers
- why

A

reduce myocardial oxygen consumption/demand by reducing heart rate and contractility

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50
Q

nursing interventions
administer calcium channel blockers
- why

A

reduce myocardial oxygen consumption/demand through decrease heart rate and strength of contraction

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51
Q

health teaching
- smoking

A

smoke cessation

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52
Q

health teaching
- diet

A

low fat/sodium

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53
Q

health teaching
- activity

A

physical and sexual

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54
Q

health teaching
- blood pressure and glucose

A

make sure it is under control

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55
Q

health teaching
- self monitoring

A

educate on the sign and symptoms and when seeking medical assistance is needed

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56
Q

why might these patients have crackles

A

left ventricle is failing
- unable to push blood out

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57
Q

if someone has fear of impending doom, what do you do

A

believe them

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58
Q

what is the priority from urgent to least urgent

A

STEMI
NSTEMI
unstable angina
noncardiac

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59
Q

acute coronary syndrome encompasses what 3 issues

A

STEMI
NSTEMI
unstable angina

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60
Q

why do we always rule out possible cardio before anything else

A

this will kill you the quickest

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61
Q

12 lead EKG how fast

A

10 mins upon admission

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62
Q

what are the 3 cardiac biomarkers

A

troponin
CK
CK-MB

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63
Q

what are some other labs we might want

A

BMP
CBC
PTT/INR (clotting and if they have to go to cath lab)

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64
Q

ST elevation must be seen in how many leads

A

2 or more leads

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65
Q

STEMI
- classification

A

ST changes
elevated cardiac biomarkers

66
Q

STEMI needs to go to the cath lab in what time

A

90 mins

67
Q

T wave inversion means

A

Ischemia

68
Q

do we normally ever see T wave inversion presentation

A

no
this is an early sign and patient is normally not presenting to the ER at this point

69
Q

ST elevation means

A

injury
- acute injury is happening

70
Q

Q wave formation means

A

Infarct

71
Q

persistent Q wave means

A

they had an MI before

72
Q

NSTEMI
- classificiation

A

no ST elevation
elevated cardiac biomarkers

73
Q

NSTEMI time to cath lab

A

24 hours

74
Q

unstable angina
- classification

A

No ST elevation
no elevated cardiac biomarkers

75
Q

instead of ST elevation in NSTEMI, what might you see

A

ST segment depression

76
Q

inversion of what wave might also indicate a NSTEMI

A

T wave inversion

77
Q

what is the most sensitive cardiac marker

A

troponin

78
Q

troponin tells you

A

injury to myocytes, not just death

79
Q

troponin levels rise

A

4-6 hours after onset of ischemic symptoms

80
Q

troponin levels peak at

A

18-24 hours after an MI

81
Q

troponin levels will return to normal

A

in 2 weeks

82
Q

CK MB (creatine kinase)
sensitive for what

A

cardiac tissue but not as sensitive in early MI

83
Q

CK MB (creatine kinase)
levels rise

A

4-8

84
Q

CK MB (creatine kinase)
peaks

A

12-24

85
Q

CK MB (creatine kinase)
returns to normal

A

24-48

86
Q

myoglobin
sensitive to what

A

muscle damage, not cardiac specific though

87
Q

myoglobin
elevates

A

1-3 hours
(very quick)

88
Q

myoglobin
peaks

A

12 hours after infarct

89
Q

myoglobin
returns

A

18-24 hours

90
Q

additional diagnosis

A

chest X ray
- rule out others
echocardiography
- view ventricles
stress test
- out patient

91
Q

primary therapeutic goals
optimize….

A

blood flow to the myocardium to reduce the amount of myocardial necrosis

92
Q

restoration and maintence of blood flow to myocardium is important to improve

A

patient outcomes

93
Q

2 interventions we can do to optimize blood flow

A

pharm
mechanical

94
Q

since MONA is not in the correct order, what is the correct order

A

AONM

95
Q

AONM
- A stands for

A

aspirin

96
Q

AONM
- O stands for

A

oxygen

97
Q

AONM
- N stands for

A

nitroglycerine

98
Q

AONM
- M stands for

A

morphine

99
Q

aspirin
- action

A

antiplatelet

100
Q

aspirin
- dose

A

160-325mg

101
Q

when do we want to administer aspirin

A

as soon as possible

102
Q

aspirin is standard therapy for

A

all patients with new pain suggestive of AMI

103
Q

oxygen is given if saturation is less than

A

94%

104
Q

if saturation is less than 94% what L do we start at

A

4L/min

105
Q

what is nitroglycerins action

A

venodilator

106
Q

what does a venodilator do

A

cause venous pooling
which leads to

less blood returning to heart
which leads to

reducing myocardial oxygen consumption and demand
which leads to

reduction in preload
dilates coronary artery
which leads to

collateral flow (all other arteries are open)

107
Q

oral nitroglycerine side effects

A

orthostatic hypotension
hypotension
right sided MI = extreme hypotension

108
Q

what do we assess before and after giving nitroglycerine

A

BP & HR
VS
pain

109
Q

what is the maximum nitroglycerin does

A

3 mins

110
Q

what is the time frame in between doses

A

5 mins

111
Q

what other forms can nitroglcycerine be given

A

IV

112
Q

IV nitro side effects

A

severe headache
dizziness
light headedness
orthostatic hypotension

113
Q

if the patient is on nitro IV what is going to be on continuous

A

ECG

114
Q

what is the key point with IV nitro

A

do not stop abruptly
we must taper

115
Q

what to assess before and after giving morphine

A

respirations
BP
sedation/LOC
pain

116
Q

morphine does

A

1-5mg every 5-30 mins

117
Q

antiplatelet therapies (3)

A

aspirin
ADP-receptor inhibitors
glycoprotein IIb/IIIa inhibitors

118
Q

patients who are on anti platelet are at risk for

A

bleeding and fall

119
Q

ADP-receptor inhibitors
action

A

decrease platelet aggregation

120
Q

ADP-receptor inhibitors
can it be used with aspirin

A

yes

121
Q

ADP-receptor inhibitors
- drugs (2)

A

Plavix (clopidogrel)
Effient (Prasugrel)

122
Q

ADP-receptor inhibitors
risk

A

bleeding

123
Q

glycoprotein IIb/IIIa inhibitors
- drugs (2)

A

eptitibatide (intergrilin)
abciximab (repro)

124
Q

glycoprotein IIb/IIIa inhibitors
- action

A

potent inhibitors of platelet aggregation

125
Q

glycoprotein IIb/IIIa inhibitors
- indications

A

NSTEMI
unstable angina
ACS undergoing cath lab procedure

126
Q

anti ischemia therapies
4 classes

A

beta blocekrs
ACEI
ARBS
calcium channel blockers

127
Q

beta blockers
- ending

A

olol

128
Q

beta blockers
- reduce (4)

A

HR
BP
myocardial oxygen demand
myocardial work load

129
Q

beta blockers
- contraindications

A

heart failure
low CO
increased risk of cariogenic shock

130
Q

beta blockers
- drug examples (3)

A

metropolol
propranolol
atenolol

131
Q

calcium channel blockers
- action

A

vasodialtion
prevent ischemia

132
Q

calcium channel blocekers
- drugs (2)

A

verapamil
diltiazem

133
Q

ACEI
- action (3)

A

decrease BP
lower peripheral vascular resistance
decrease O2 demand

134
Q

ACEI drugs

A

enalapril
captopril

135
Q

ACEI
- what should we monitor for

A

orthostatic hypotension
syncope
serum potassium levels
renal function studies

136
Q

ACEI
- side effects (2)

A

dry nagging cough
angioedema

137
Q

what is the major anticoagulation drug that you will encounter in the hospital

A

heparin

138
Q

heparin
- class

A

antithrombin
- prevents formation of thrombi

139
Q

reversal for heparin

A

protamine sulfate

140
Q

heparin
- contraindications/cautions

A

active bleeding
following recent surgery
recent bleed
severe hypertension

141
Q

drugs that decrease the activity of coagulation systems with anti platelet therapy

A

aspirin
clopidogrel

142
Q

drugs increase ventricular filling time and decrease heart rate

A

beta blockers

143
Q

drugs that decrease preload

A

nitrates
diuretics
morphine

144
Q

drugs that decrease afterload

A

ACEI
hydralazine (?)

145
Q

drugs that decrease myocardial oxygen consumption

A

beta blockers

146
Q

2 ways we can destroy the clot

A

cath lab
fibrinolytic therapy

147
Q

what is the gold standard
-cath lab or fibrinolytic therapy

A

cath lab

148
Q

cath lab/PCI uses dye, what do we assess for

A

allergies
kidney function (BUN, CR before and after)

149
Q

STEMI door to balloon

A

90 mins

150
Q

fibrinolytic therapy door to drug

A

30 mins

151
Q

why might fibrinolytic therapy be used over PCI

A

rural setting that has no cath lab

152
Q

major risks of fibrinolytic therapy

A

hemorrhage
stroke
allergy

153
Q

what can be done on a STEMI
- PCI
- fibrinolytic

A

both

154
Q

what can be done on a NSTEMI
- PCI
- fibrinolytic

A

fibrinolytic is not recomended

155
Q

NSTEMI PCI time frame

A

24 hours

156
Q

MI teaching

A

recognize and take action for recurrent symptoms
lifestyle changes
- stop smoking
- reduce stress
- decrease caffeine
- modify intake of calories, sodium, fat

157
Q

ischemia is what wave

A

inverted T wave

158
Q

injury is what wave

A

elevated ST wave

159
Q

infarction is what wave

A

Q wave

160
Q
A

Med Surg 1 (47 decks)

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