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Exam 2- Coronary Vascular Disorders Flashcards

1
Q

Leading cause of death in the US for men and women of all racial and ethnic groups

A

Cardiovascular disease

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2
Q

The abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and lumen

A

Atherosclerosis

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3
Q

What happens in coronary atherosclerosis?

A

Blockages and narrowing of the coronary vessels which reduces blood flow to the myocardium

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4
Q

Most prevalent cardiovascular disease in adults

A

Coronary Artery Disease (CAD)

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5
Q

Most common clinical manifestation of atherosclerosis

A

Angina pectoris (chest pain)

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6
Q

Symptoms of atherosclerosis are caused by…

A

Myocardial ischemia

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7
Q

Symptoms and complications of atherosclerosis are related to…

A

Location and degree of vessel obstruction

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8
Q

Difference between ischemia and infarction

A

Ischemia is not enough blood flow, infarction is when you start to have cell death and tissue loss and scarring

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9
Q

Modifiable risk factors for CAD

A

Cholesterol abnormalities
Tobacco use
HTN
Obesity
Physical inactivity

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10
Q

Nonmodifiable risk factors for CAD

A

Family history
Age
Race
Gender (men > women)

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11
Q

Tool used to estimate risk for having a cardiac event within the next 10 years

A

Framingham risk calculator

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12
Q

Risk factor for CAD: Metabolic Syndrome

A

Enlarged waist circumference
Elevated triglycerides
Reduced HDL
Hypertension

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13
Q

Measurement of elevated triglycerides

A

Greater than or equal to 175 mg/dL

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14
Q

Measurement of reduced HDL levels

A

Less than 40 mg/dL in males
Less than 50 mg/dL in females

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15
Q

What is hs-CRP?

A

High sensitivity C-reactive protein
- an inflammatory marker

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16
Q

Prevention of CAD (7)

A

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

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17
Q

When should you administer atorvastatin and why?

A

In the evening, because statins are processed by the liver and can cause muscle aches

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18
Q

What do you do before taking cholesterol medications?

A

Try to manage diet alone

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19
Q

Cholesterol medications can reduce…

A

CAD mortality

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20
Q

Most commonly prescribed cholesterol medications

A

Statins

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21
Q

Common adverse effect for statins

A

Myalgia

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22
Q

What do we monitor when taking statins?

A

Liver function tests

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23
Q

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?

A

AST and ALT
Atorvastatin (Lipitor) is an HMG-CoA reductase inhibitor and is hepatotoxic, so liver enzymes should be monitored.

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24
Q

Angina pectoris

A

A syndrome characterized by episodes or paroxysmal pain or pressure in the anterior chest caused by insufficient coronary blood flow

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25
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
26
Stable angina
Predictable and consistent pain that occurs on exertion and is relieved by rest and/or nitroglycerin
27
Unstable angina
Symptoms increase in frequency and severity; may not be relieved with rest or nitroglycerin
28
Angina may be described as...
Tightness, choking, or a heavy sensation May also experience dyspnea, dizziness, nausea, and vomiting
29
Where is angina frequently felt?
Retrosternal.. may radiate to neck, jaw, shoulders, back, or arms (usually left)
30
Gerontologic considerations for Angina
- Teach older adults to recognize their "chest pain-like" symptoms - Pharmacologic stress testing; cardiac catheterization - Medications should be used cautiously
31
Why do we have gerontologic considerations for angina?
There is diminished pain transition that occurs with aging which may affect presentation symptoms
32
What does treatment for angina pectoris do?
Seeks to decrease myocardial oxygen demand and increase oxygen supply
33
Treatment for angina pectoris
- Medications - Oxygen - Reduce and control risk factors - Reperfusion therapy (Cardiac cath)
34
Medications for angina
MONA Nitroglycerin Beta-adrenergic blocking agents Antiplatelet & anticoagulant meds Heparin IV
35
MONA
Morphine Oxygen Nitro Aspirin
36
Nitroglycerin
Vasodilator, so it opens the vessels
37
Beta-adrenergic blocking agents
Decreases HR and stroke volume (how hard it is pumping)
38
Antiplatelet & anticoagulant meds
Aspirin- inhibits platelet aggregation, making them less sticky so they cannot stick together, less likely to clog Clopidogrel Ticlopidine
39
Heparin IV
Thins the blood enough to allow blood to go through, but doesn't just burst the clot
40
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
41
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
42
OLDCARTS
Onset Location Duration Characteristics Aggravating factors Relieving factors Timing Severity
43
Collaborative problems of pt with angina pectoris
- ACS, MI, or both - Arrhythmias & cardiac arrest - HF - Cardiogenic shock
44
Nursing interventions for patient with angina pectoris
- Continuing care - Treat angina - Reduce anxiety - Prevent pain - Educate pt about self-care
45
Top priority nursing intervention for angina pectoris
Treat angina
46
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
47
Assessment for treating angina includes...
VS Observation for respiratory distress Assessment of pain In hospital setting, ECG also obtained
48
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
49
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
50
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
51
Key diagnostic indicator for MI in patient with ACS experiencing ECHG changes
Elevation in the ST segment in two continuous leads
52
Lab studies to look at for patient with ACS
Cardiac enzymes Troponin Creatine kinase-MB (CK-MB) Myoglobin (less used) BNP BMP CBC Coags
53
Collaborative problems of patients with ACS
Acute pulmonary edema HF Cardiogenic shock Arrhythmias & cardiac arrest Pericardial effusion and cardiac tamponade
54
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
55
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
56
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
57
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
58
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
59
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
60
Name the coronary syndrome... I cause you intermittent chest pain with exertion and am easily relieved with a wee bit of Nitro
Stable angina

Med Surg 1 (13 decks)

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