Exam 1 - Cardiac disease & rehab

Question 1

cardiovascular disease

Answer 1

conditions that involve the heart or blood vessels

CAD: angina, MI
HF

Question 2

atherosclerosis
meds

risk factors

TLC

Answer 2

plaque build up which causes arteries to narrow
statin (decrease cholesterol)

modifiable: elevated serum lipids, HTN, smoking, physical inactivity, DM, obesity
nonmodifiable: age, gender, race, fam hx, genetic predisposition

TLC:
diet (decrease cholesterol, sat. fat, no trans fat; increase soluble fiber, plant stanols, sterols)
weight control
exercise
smoking cessation

Question 3

normal values

cholesterol
LDL
HDL

BMI
Na
K

Answer 3

cholesterol <40 mg/dL (F)

BMI 18.5-24.9
Na 135-145
K 3.5-5

Question 4

statin

atorvastatin (Lipitor)
simvastatin (Zocor)

action
effect
adverse
contraindication
nsg implication

Answer 4

atherosclerosis

action: decrease cholesterol production
effect: decrease LDL
adverse: myopathy -> rhabdomyolosis; hepatotoxity
contraindication: pregnancy category X

nsg implication: initial 2 wks, max 4-6 wks; monitor LFT, CPK (muscle breakdown); assess ℅ weakness, muscle aches; follow up appts

Question 5

angina

meds

Answer 5

heart’s oxygen level does not meet heart’s needs (cardiac ischemia)

antianginal drugs
controller drugs: beta blockers, calcium channel blocks, long acting nitrates
rescue drugs: SL, IV nitrates

Question 6

nitrates

nitroglycerin

action
effect
contraindication
adverse

Answer 6

angina

action: vasodilator (reduces venous return and preload) -> decrease heart’s workload

effect: decrease cardiac oxygen demand, increase cardiac oxygen supply
indication: stable, unstable, vasospastic angina

contraindication: hypoTN, ED drugs
adverse: headache, orthostatic hypoTN, reflex tachycardia (heart compensating)

Question 7

beta-blockers

propranolol
metoprolol
“-olol”

action
effect
indication
contraindication
adverse
nsg implication
pt ed

Answer 7

angina

action: blocks beta receptors
effect: decreases HR, contractility -> decreases myocardial oxygen demand
indication: stable angina
contraindication: bradyc, AV block, asthma
adverse: dizziness, bradyc, heart block, bronchoconstriction, constipation, masked s/s of hypoglycemia

nsg implication: assess VS (if HR <60, hold notify MD), contraindication

pt ed: change positions slowly, avoid time in hot tub saunas (vasodilation), monitor glucose, do not stop abruptly (rebound angina)

Question 8

calcium channel blocks (CCB)

diltiazem (Cardizem)
verapamil (Calan)
“-dipine”

action
effect
indication
adverse
nsg implication
pt ed

Answer 8

angina

action: prevents calcium into cell
effect: less contraction (dilation of peripheral, coronary arteries), decreases after load, decreases heart’s workload and myocardial oxygen demand
indication: stable, variant angina
adverse: constipation, hypoTN, dizziness, peripheral edema

nsg implication: monitor VS

pt ed: change positions slowly, increase fluid and fiber to prevent constipation

Question 9

MI

meds
diagnostic
tx

Answer 9

sustained heart ischemia -> heart necrosis

MONA

diagnostic: H&P, 12 lead ECG (STEMI), serum cardiac markers (cardiac enzymes, troponin levels), coronary angioplasty
tx: coronary revascularization (PCI percutaneous coronary intervention: balloon angioplasty, stent)

CABG (last resort, check 2 sites sternum and leg)

Question 10

HF

cause

Answer 10

heart unable to meet body’s needs

cause: chronic HTN, MI
valve deficiency, AFib/flutter, heart aging, DM

s/s: left: pulmonary edema ….