Exam 2- Coronary Vascular Disorders Flashcards
Leading cause of death in the US for men and women of all racial and ethnic groups
Cardiovascular disease
The abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and lumen
Atherosclerosis
What happens in coronary atherosclerosis?
Blockages and narrowing of the coronary vessels which reduces blood flow to the myocardium
Most prevalent cardiovascular disease in adults
Coronary Artery Disease (CAD)
Most common clinical manifestation of atherosclerosis
Angina pectoris (chest pain)
Symptoms of atherosclerosis are caused by…
Myocardial ischemia
Symptoms and complications of atherosclerosis are related to…
Location and degree of vessel obstruction
Difference between ischemia and infarction
Ischemia is not enough blood flow, infarction is when you start to have cell death and tissue loss and scarring
Modifiable risk factors for CAD
Cholesterol abnormalities
Tobacco use
HTN
Obesity
Physical inactivity
Nonmodifiable risk factors for CAD
Family history
Age
Race
Gender (men > women)
Tool used to estimate risk for having a cardiac event within the next 10 years
Framingham risk calculator
Risk factor for CAD: Metabolic Syndrome
Enlarged waist circumference
Elevated triglycerides
Reduced HDL
Hypertension
Measurement of elevated triglycerides
Greater than or equal to 175 mg/dL
Measurement of reduced HDL levels
Less than 40 mg/dL in males
Less than 50 mg/dL in females
What is hs-CRP?
High sensitivity C-reactive protein
- an inflammatory marker
Prevention of CAD (7)
Control cholesterol
Dietary measures (DASH, limit salt, monitor fats)
Physical inactivity
Medications (make sure to take them) (atorvastatin usually)
Cessation of tobacco use
Manage HTN
Control diabetes
When should you administer atorvastatin and why?
In the evening, because statins are processed by the liver and can cause muscle aches
What do you do before taking cholesterol medications?
Try to manage diet alone
Cholesterol medications can reduce…
CAD mortality
Most commonly prescribed cholesterol medications
Statins
Common adverse effect for statins
Myalgia
What do we monitor when taking statins?
Liver function tests
The nurse is caring for a patient with hypercholesterolemia who has been prescribed atorvastatin (Lipitor). What serum levels should be monitored in this patient? Why?
AST and ALT
Atorvastatin (Lipitor) is an HMG-CoA reductase inhibitor and is hepatotoxic, so liver enzymes should be monitored.
Angina pectoris
A syndrome characterized by episodes or paroxysmal pain or pressure in the anterior chest caused by insufficient coronary blood flow
What happens in angina pectoris?
Physical exertion or emotional stress increases myocardial oxygen demand, and the coronary vessels are unable to supply sufficient blood flow to meet the oxygen demand
Stable angina
Predictable and consistent pain that occurs on exertion and is relieved by rest and/or nitroglycerin
Unstable angina
Symptoms increase in frequency and severity; may not be relieved with rest or nitroglycerin
Angina may be described as…
Tightness, choking, or a heavy sensation
May also experience dyspnea, dizziness, nausea, and vomiting
Where is angina frequently felt?
Retrosternal.. may radiate to neck, jaw, shoulders, back, or arms (usually left)
Gerontologic considerations for Angina
- Teach older adults to recognize their “chest pain-like” symptoms
- Pharmacologic stress testing; cardiac catheterization
- Medications should be used cautiously
Why do we have gerontologic considerations for angina?
There is diminished pain transition that occurs with aging which may affect presentation symptoms
What does treatment for angina pectoris do?
Seeks to decrease myocardial oxygen demand and increase oxygen supply
Treatment for angina pectoris
- Medications
- Oxygen
- Reduce and control risk factors
- Reperfusion therapy (Cardiac cath)
Medications for angina
MONA
Nitroglycerin
Beta-adrenergic blocking agents
Antiplatelet & anticoagulant meds
Heparin IV
MONA
Morphine
Oxygen
Nitro
Aspirin
Nitroglycerin
Vasodilator, so it opens the vessels
Beta-adrenergic blocking agents
Decreases HR and stroke volume (how hard it is pumping)
Antiplatelet & anticoagulant meds
Aspirin- inhibits platelet aggregation, making them less sticky so they cannot stick together, less likely to clog
Clopidogrel
Ticlopidine
Heparin IV
Thins the blood enough to allow blood to go through, but doesn’t just burst the clot
The nurse is caring for a patient who has severe chest pain after working outside on a hot day and is brought to the ER. The nurse administers nitroglycerin to help alleviate chest pain. Which side effect should concern the nurse the most?
Dry mucous membranes
HR of 88 bpm
BP of 85/68 mmHg
Complaints of headache
BP of 85/68 mmHg
ACS and MI are characterized by…
An acute onset of myocardial ischemia that results in myocardial death (example: MI) if definitive interventions do not occur promptly
OLDCARTS
Onset
Location
Duration
Characteristics
Aggravating factors
Relieving factors
Timing
Severity
Collaborative problems of pt with angina pectoris
- ACS, MI, or both
- Arrhythmias & cardiac arrest
- HF
- Cardiogenic shock
Nursing interventions for patient with angina pectoris
- Continuing care
- Treat angina
- Reduce anxiety
- Prevent pain
- Educate pt about self-care
Top priority nursing intervention for angina pectoris
Treat angina
Nursing intervention: Treat angina
Immediate rest (semi-fowler’s position)
Assess pt while performing other necessary interventions
Administer meds as ordered (usually NTG).. reassess pain and administer up to three doses
Administer 2L oxygen by NC
Assessment for treating angina includes…
VS
Observation for respiratory distress
Assessment of pain
In hospital setting, ECG also obtained
Nursing intervention: preventing pain
- Identify level of activity that causes pt’s prodromal s/s (ex: if you walk 2 miles and that is when pain starts, you need to walk less)
- Plan activities accordingly
- Alternate activities with rest periods
- Educate pt & family
Nursing intervention: Patient teaching
- Balance activity with rest
- Follow prescribed exercise regimen
- Avoid exercise in extreme temps
- Use resources for emotional support (counselor)
- Avoid OTC meds that may increase HR or BP before consulting with HCP
- Stop using tobacco products (nicotine increases HR and BP)
- Diet low in fat and high in fiber
- Med teaching (carry NTG at all times; away from direct light) (phenylephrine)
- Follow up with HCP
- Report increase in s/s to provider
- Maintain normal BP and blood glucose levels
Assessment of pt with ACS
- Chest pain (sudden an continuous, despite rest and medication)
- ECG changes (elevation in ST segment in two continuous leads)
- Lab studies
Key diagnostic indicator for MI in patient with ACS experiencing ECHG changes
Elevation in the ST segment in two continuous leads
Lab studies to look at for patient with ACS
Cardiac enzymes
Troponin
Creatine kinase-MB (CK-MB)
Myoglobin (less used)
BNP
BMP
CBC
Coags
Collaborative problems of patients with ACS
Acute pulmonary edema
HF
Cardiogenic shock
Arrhythmias & cardiac arrest
Pericardial effusion and cardiac tamponade
Planning and goals for patients with ACS
Relief of pain or ischemic s/s (ex: ST segment changes)
Prevention of myocardial damage
Maintenance of effective respiratory function, adequate tissue perfusion
Reduction of anxiety
Adherence to the self-care program
Early recognition of complications
Nursing interventions for patients with ACS
Relieve pain and symptoms of ischemia
Improve respiratory function
Promote adequate tissue perfusion
Reduce anxiety
Monitor and manage potential complications
Educate pt and family
Provide continuing care
Nursing management of patients with ACS
Oxygen/Med therapy
Frequent VS
Physical rest w HOB elevated
Relied of pain helps decreases workload of heart
Monitor I&O and tissue perfusion
Frequent position changes to prevent respiratory complications
Report changes in patient condition
Evaluate interventions
The nurse is caring for a pt after cardiac surgery. Which nursing intervention is appropriate to help prevent complications arising from venous stasis?
A) Encourage crossing of the legs
B) Use pillows in the popliteal space to elevate the knees in bed
C) Discourage exercising
D) Apply sequential pneumatic compression devices as prescribed
D) Apply sequential pneumatic compression devices as prescribed
Invasive coronary artery procedures (4)
- Percutaneous transluminal coronary angioplasty (PTCA)
- Coronary artery stent (keeps the plaque on the sides of the walls to keep it open)
- Coronary artery bypass graft (CABG)
- Cardiac surgery
Nursing management: Patient requiring invasive cardiac intervention (12)
- Assessment of pt
- Reduce fear and anxiety
- Monitor and manage potential complications
- Provide pt education
- Maintain cardiac output
- Promote adequate gas exchange
- Maintain fluid and electrolyte balance
- Minimize sensory-perception imbalance
- Relieve pain
- Maintain adequate tissue perfusion
- Maintain body temp
- Promote health and community-based care
Name the coronary syndrome…
I cause you intermittent chest pain with exertion and am easily relieved with a wee bit of Nitro
Stable angina
