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NRSG 200: Med Surg 3 > [Exam 2/Final] Chapter 27: Management of Patients with Coronary Vascular Disorders > Flashcards

[Exam 2/Final] Chapter 27: Management of Patients with Coronary Vascular Disorders Flashcards

1
Q

Atherosclerosis: What is this?

A

The buildup of fat inside of the coronary arteries.

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2
Q

Atherosclerosis: What two main arteries come off of aorta?

A

One feeds right side of heart, and other feeds left side.

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3
Q

Atherosclerosis: What is the main clinical manifestations of this?

A

Angina Pectoris

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4
Q

Atherosclerosis: What is Angina PEctoris??

A

Chest pain result of ischemia due to not enough blood flow getting through.

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5
Q

Atherosclerosis - Risk Factors: What Non-Modifiable Risk Factors are included?/

A

Age, Gender, Race, Family History

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6
Q

Atherosclerosis - Risk Factors: Whaht are some Modifiable Risk Factors?

A

High blood pressure, obesity, high cholesterol, inactivity, smoking, diabetes

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7
Q

Atherosclerosis - Prevention: What dietary measures can be done?

A

Eating heart healthy diet, low cholesterol, low fat, low salt.

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8
Q

Atherosclerosis - Prevention: What physical activity changes can be done?

A

Making sure patients are exercising, getting cardio in.

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9
Q

Atherosclerosis - Prevention: How can meds be preventive?

A

Can control blood pressure, monitoring diabetes.

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10
Q

Atherosclerosis - Prevention: What to do about tobacco?

A

Smoking causes plaque buildup, so its best to get them to stop smoking.

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11
Q

Angina Pectoris: What is stable angina?

A

Very predictable, persistent. .Pain occurs on exertion. Relieved by rest and nitro. Patients are aware of when this chest pain will develop.

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12
Q

Angina Pectoris: What is unstable angina?

A

Start to develop chest pain more often, higher in frequency. Not relieved by nitro or rest.

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13
Q

Angina Pectoris: What is MI Angina?

A

Vessel is completely blocked now.

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14
Q

Angina Pectoris: What is a Intractable or Regractory Angina?

A

Patient is in severe pain and we cannot get the chest pain under control.

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15
Q

Angina Pectoris: what is Variant Angina?

A

Vasospasms, which can be induced by cocaine, or other stimulants like smoking. Even hypertension. Since its spasming, may be some ischemia.

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16
Q

Angina Pectoris: What is Silent Ischemia?

A

Patients having ischemia, but experience no chest pain. May be caught on patients taking stress test.

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17
Q

Angina: What are the CMs?

A

The main one is Chest Pain

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18
Q

Angina: What tests can be performed for Chest Pain?

A
  1. EKG, will look for T Wave Inversion or ST Depression.
  2. Cardiac Markers - Troponin
  3. Stress test, Echocardiogram
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19
Q

Angina: How will ST look if they were having an MI?

A

ST Elevation

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20
Q

Angina: Why is a Troponin level drawn?

A

To rule out that acute coronary syndrome is occuring. Normal Troponin is less than 0.3 and shows if hearts being damaged.

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21
Q

Angina: What will you first do when assessing the patient?

A

Assess them to see if its stable, unstable, or if they’re experiencing acute coronary syndrome

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22
Q

Angina Medication: If they don’t need surgery or cath lab visit, what medications can be given?

A

Nitroglycerin (Vasodilates)

Beta Blockers (decrease myocardiac O2 consumption)

CCB (Slow AV/SA node conduction and vasospasm

Antiplatelet/Anticoagulant

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23
Q

Angina Medication: How do the beta blockers work here?

A

Decrease myocardiac o2 consumption by blocking beta androgenic sitmulation to heart which decreases heart rate which decreases bp.

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24
Q

Angina Medication: Why are antiplatelet and anticoagulants given?

A

Plavix, Aspirin. Given to prevent a thrombus from forming when plaque ruptures, and forms clotting cascade.

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25
Q

Angina Medication: Why is Oxygen given?

A

To help perfuse the heart. Not given if patients have O2 sat in low 90s.

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26
Q

Angina - Assessment: What will we assess?

A

Assess for pain, what caused pain, what relieves it, is it substernal/left arm/ radiating?

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27
Q

Angina - Assessment: What are some nursing diagnoses?

A

RF Decreased CO
Anxious
Deficient Knowledge
Non-Compliance with Meds

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28
Q

Angina - Potential Problems: What could happen

A

Acute coronary syndrome, that leads to MI which leads to HF and cardiac arrest, leading to shock.

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29
Q

Angina - Goals: This will be aimed at what?

A

Preventing the angina and making sure patient understands tx plan.

Reducing anxiety.

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30
Q

Acute Coronary Syndrome (ACS) and MI: What is ACS?

A

Emergent situation characterized by an acute onset of myocardial ischemia

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31
Q

Acute Coronary Syndrome (ACS) and MI: MI may be referred to as STEMI, which is what?

A

ST Elevated MI

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32
Q

Acute Coronary Syndrome (ACS) and MI: What kind of Pain will a MI patient refer to?

A

Sudden onset, substernal, will complain of crushing feeling, tightness, unrelieved by nitro

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33
Q

Acute Coronary Syndrome (ACS) and MI: Pain may radiate where?

A

Back, neck, jaw/tooth, shoulder, arm

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34
Q

Acute Coronary Syndrome (ACS) and MI: What CMs may be seen?

A

Dyspnea, Syncope (DEcreased BP), Nausea, Vomiing, Extreme Weakness, Increased Pulse

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35
Q

Acute Coronary Syndrome (ACS) and MI: What broad treatments may occur?

A

O2, IV, Meds, Monitor

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36
Q

Acute Coronary Syndrome (ACS) and MI: What dietary restrictions may occur

A

Decreased Na, Cholesterol, and Caffeine

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37
Q

Acute Coronary Syndrome (ACS) and MI - Areas of Damage after MI: What happens in the zone of infarction and necrosis?

A

O2 Deprieved, Damage Irreversible, Changes “Q” wave on ECG (Elevated about everything else)

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38
Q

Acute Coronary Syndrome (ACS) and MI - Areas of Damage after MI: What happens in the Zone of Injury?

A

Next to infarction zone. Tissue viable if cirrculation remains adequate. Increasing O2 may save area. ST segment change, and elevation on ECG

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39
Q

Acute Coronary Syndrome (ACS) and MI - Areas of Damage after MI: What happens in the Zone of Ischemia?

A

On the outside. Viability may not be damaged as long as MI doesn’t extend and collateral circulation compensate. Causes T Wave Inversion.

40
Q

Acute Coronary Syndrome (ACS) and MI - Areas of Damage after MI: What are the three areas of damage after a MI?

A

Zone of Infarction and Necrosis

Zone of Injury

Zone of Ischemia

41
Q

Acute Coronary Syndrome (ACS) and MI - Assessment/Diagnostic: What patient history will we get?

A

Have they had MIs in past, what were they doing, how long has it been going on for.

42
Q

Acute Coronary Syndrome (ACS) and MI - Assessment/Diagnostic: What is done after an assessment?

A

12 Lead EKG to see all sides of the heart and Echocardiogram, which evaluates structure and function of heart.

43
Q

Acute Coronary Syndrome (ACS) and MI - Assessment/Diagnostic: Echocardiograms show us what inside the heart?

A

What the left ventricle is doing, what the ejection fraction is (55-65%)

44
Q

Acute Coronary Syndrome (ACS) and MI - Assessment/Diagnostic: What lab tests will be done?

A

Troponin T and I
Creatine Kinase (CKMB)
Myoglobin

45
Q

Acute Coronary Syndrome (ACS) and MI - Assessment/Diagnostic: What is Troponin T and I?

A

Specific for Cardiac Muscle and MI Injury. Increases within hours of onset of ischemia. Stay elevated for weeks

46
Q

Acute Coronary Syndrome (ACS) and MI - Assessment/Diagnostic: What is Creatine Kinase (CKMB)

A

Increases when there is damage to muscle and decreases within 24 hours of impart.

47
Q

Acute Coronary Syndrome (ACS) and MI - Assessment/Diagnostic: What is Myoglobin?

A

Not specific to MI, but shows theres been injury to muscle tissues in the body.

48
Q

Acute Coronary Syndrome (ACS) and MI - Assessment/Diagnostic: How can Troponin be drawn?

A

Can be run on bedside with I-STAT machine and get a base of whats going on within 2 minutes.

49
Q

Acute Coronary Syndrome (ACS) and MI - Treatment of MI: Acronym for treatment?

A

MONA

50
Q

Acute Coronary Syndrome (ACS) and MI - Treatment of MI: What does MONA stand for?

A

M - Morphine
O - Oxygen
N - Nitroglycerin
A - ASA or Plavix (Aspirin)

51
Q

Acute Coronary Syndrome (ACS) and MI - Treatment of MI: What role does morphine play?

A
  1. Decreases pain and anxiety
  2. Decreases preload and afterload
  3. Vasodilates
52
Q

Acute Coronary Syndrome (ACS) and MI - Treatment of MI: Why is Oxygen given?

A

Only given if O2 is below 90%

53
Q

Acute Coronary Syndrome (ACS) and MI - Treatment of MI: Why is Nitroglycerin given?

A

Because it vasodilates. May be given on Nitro drip, or may have Nitro face put on. or Sublingually

54
Q

Acute Coronary Syndrome (ACS) and MI - Treatment of MI: Why is Aspirin or Plavix given?

A

Because of its anti-platelet effect.

55
Q

Acute Coronary Syndrome (ACS) and MI - Treatment of MI: What methods can be done other than medication?

A

Emergent Percutaneous Coronary Intervention

Thrombolytics

Inpatient Mx

Cardiac Rehab

56
Q

Acute Coronary Syndrome (ACS) and MI - Treatment of MI: What is Emergent Percutaneous Coronary Intervention?

A

Known as PCI. Goes to Cath Lab. Placed on table and artery opened up within 60 minutes.

57
Q

Acute Coronary Syndrome (ACS) and MI - Treatment of MI: What is Thrombolytics?

A

Drugs called lytics or clot busters given to dissolve blood clots. Reteplase is the drug. Needs to given within 30 minutes. Can still have risk with plaques.

58
Q

Acute Coronary Syndrome (ACS) and MI - Treatment of MI: Drugs that end with lytics do what?

A

Are clot busters.

59
Q

Acute Coronary Syndrome (ACS) and MI - Treatment of MI: Who should not receive a thrombolytic?

A

When a patient has a bleed. We do not want to break up their clots and cause them to bleed out.

60
Q

Acute Coronary Syndrome (ACS) and MI - Treatment of MI: What meds will the patient now be on after treatment is given?

A

Plavix, Aspirin, Beta-Blocker to take stress off heart, Ace-Inhibitor to decrease BP. (great because they stop ventricles from causing hypertrophy)

61
Q

Acute Coronary Syndrome (ACS) and MI - Treatment of MI: What does cardiac rehab consist of?

A
  1. Inpatient
  2. Outpatient (Hosp or Rehab Fac), including education of diet, exercise.
  3. Long term management
62
Q

Nursing Process for ACS - Assessment: What is done here

A

Signs of MI, when was onset, how long has pain been going on, and anything to help relieve it?

63
Q

Nursing Process for ACS - Nursing Diagnosis?

A

Decreased CO because muscle in left ventricle dying, Decreased Cardiac Tissue Perfusion, RF imbalanced fluid volume. Acute Pain, Anxious.

64
Q

Nursing Process for ACS - Goals: What is done?

A

Correcting problems, and not developing complications like HF, Shock, Cardiac Arrest, Tamponade.

65
Q

Nursing Process for ACS - What Interventions can be done?

A

Monitor patient, monitor hemodynamics stability through VS, pulses, pain.

Give Meds

Assess oxygen

Palpable Pulses

66
Q

Nursing Process for ACS - Goals: What does relief of pain show?

A

That oxygen and blood is reaching the heart and the muscle is not dying.

67
Q

Invasive Coronary Artery Procedures - PCI: How does this procedure work?

A

When through femoral artery and angioplastied a balloon that crushed plaque against vessel wall. Stent then inserted and tissue will form around this.

68
Q

Invasive Coronary Artery Procedures - PCI: What may develop at insertion site?

A

Hematoma.

69
Q

Invasive Coronary Artery Procedures - PCI: What should be monitored after procedure?

A

Bleeding, make sure theres no occlusion distal, cap refill, make sure theres no damage to heart.

70
Q

Invasive Coronary Artery Procedures - PCI: What big complications can occur?

A

Bleeding in the recto-perineal area.

71
Q

Invasive Coronary Artery Procedures - PCI: What nursing intervention is important to do after this?

A

Checking pulses, checking sites

72
Q

Invasive Coronary Artery Procedures - PCI: How will they often be positioned?

A

Flat, with HOB raised maybe 10 degrees at most. Bed rest depends on intervention and cardiologist preference.

73
Q

Invasive Coronary Artery Procedures - PCI: Heart Cath Patient is referred to as what procedure?

A

PCI

74
Q

Invasive Coronary Artery Procedures - Coronary Artery Bypass Grafts: THis is known as what

A

CAbbage, and open heart surgery

75
Q

Invasive Coronary Artery Procedures - Coronary Artery Bypass Grafts: When is this performed?

A

When patient taken to cath lab, but unable to place stent because plaques are unstable, don’t want to cause more damage, have multi-vessel disease with multiple blockages.

76
Q

Invasive Coronary Artery Procedures - Coronary Artery Bypass Grafts: What is this procedure?/

A

Left internal mammary artery taken to bypass the blockage. Can also use vein from leg.

77
Q

Invasive Coronary Artery Procedures - Coronary Artery Bypass Grafts: What must be done to the patients to allow the surgery to happen?

A

Patients must be placed on cardiopulmonary bypass system to take over function of heart. Pumps blood to body. Heart stopped chemically with potassium.

78
Q

Invasive Coronary Artery Procedures - Coronary Artery Bypass Grafts - PreOp: What should be done before nursing wise?

A

Assess patient.
Reduce Fear, Anxiety and educate about what to expect after surgery. May be unable to lift more than a galloon of milk. because they entered through sternum

79
Q

Invasive Coronary Artery Procedures - Coronary Artery Bypass Grafts - PreOp: What are some potential complications of this?

A

Hypovolemia, Persistent bleeding, Cardiac Tamponade (Fluid and clots accumulate in pericardial sac) Fluid overload, hypothermia, hypertension,

80
Q

Invasive Coronary Artery Procedures - Coronary Artery Bypass Grafts - Intraoperative: What is done here?

A

Monitor patients VSs, make sure they are stable and safe.

81
Q

Invasive Coronary Artery Procedures - Coronary Artery Bypass Grafts - Intraoperative: What is inserted during surgery

A

Chest tubes to get rid of air and drain blood. Epicardial wires may be inserted into right atrium and right ventricle as well.

82
Q

Invasive Coronary Artery Procedures - Coronary Artery Bypass Grafts - PostOp: Why is a NG tube inserted?

A

To decompress the stomach

83
Q

Invasive Coronary Artery Procedures - Coronary Artery Bypass Grafts - PostOp: Why is a edotracheal tube inserted?

A

For ventilatory assitance, suctioning, adn use of end-tidal CO2 monitor

84
Q

Invasive Coronary Artery Procedures - Coronary Artery Bypass Grafts - PostOp: Central venous or Swan-Ganz catheter inserted why?

A

Monitoring for central venous pressure, pulmonary artery pressure. Can be used to determine CO

85
Q

Invasive Coronary Artery Procedures - Coronary Artery Bypass Grafts - PostOp: ECG electrodes inserted why

A

for monitoring HR and rhythm

86
Q

Invasive Coronary Artery Procedures - Coronary Artery Bypass Grafts - PostOp: SpO2 monitoring why?

A

For measuring arterial oxygen adn saturation

87
Q

Invasive Coronary Artery Procedures - Coronary Artery Bypass Grafts - PostOp: Inddwelling catheter why?

A

To close drainage system for accurate measurement of urine output

88
Q

Invasive Coronary Artery Procedures - Coronary Artery Bypass Grafts - PostOp: Radial arterial line used why

A

for monitoring of arterial blood pressure and used for blood sampling

89
Q

Invasive Coronary Artery Procedures - Coronary Artery Bypass Grafts - PostOp: Mediastinal and pleural chest tubes attached why

A

to suction drainage and wounding healing montored

90
Q

Invasive Coronary Artery Procedures - Coronary Artery Bypass Grafts - PostOp: EPicardial pacing electrodes were placed why

A

to temporarily pace the heart

91
Q

Invasive Coronary Artery Procedures - Coronary Artery Bypass Grafts - PostOp: What should we assess on body?

A

Skin color and temperature, color of lips, and color and capillary refill of nail beds

92
Q

Invasive Coronary Artery Procedures - Coronary Artery Bypass Grafts - PostOp: What neurological assessments performed?

A 
Level of responsiveness
Hand Grasp
Pupils
Pain
Movement
93
Q

Potential Complications of Cardiac Surgery: What can this include?

A 
Decreased CO
Hypovolemia
Persistent Bleeding (Have to go back after surgery to find it, or get platelets)
Cardiac Tamponade
Fluid Overload
Hypothermia
Hypertension
Cardiac Dysrhythmia
Cardiac Failure
MI
94
Q

Potential Complications of Cardiac Surgery: What is CArdiac Tamponade?

A

Fluid buildup in the pericardial sac

95
Q

Potential Complications of Cardiac Surgery: Example of Assessmenet for patient with Cardiac Tamponade?

A

Heart sounds may sound more distant or muffled. BP may also change and pulse difference may get closer to one another.

NRSG 200: Med Surg 3 (46 decks)

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