Exam 2 Review: Coronary Artery Disease Flashcards
What are the developmental stages of coronary artery disease? (4)
- fatty streak
- fibrous plaque
- complicated lesion
- collateral circulation
What are the lab values that would correlate to a patient who has atherosclerosis?
LDL and HDL levels (cholesterol levels)
What type of diet does a patient with coronary artery disease need to be on?
Heart healthy diet: low sodium, unsaturated fat, monounsaturated oils
What medication and how much does a patient need to take everyday to decrease the risk for CAD?
Baby aspirin, 20 mg (to prevent stroke and MI)
What are the lipid-lowering drugs used to treat coronary artery disease? (4) when should drug therapy be considered?
- statins
- niacin
- fibric acid derivatives
- bile acid sequestrants
- drug therapy should be considered once diet modifications have been attempted
Statins are damaging to which organ?
Statins (HMG-CoA reductase inhibitors) are damaging to the liver for example Atorvastatin
How do fibric acid derivatives affect cholesterol levels?
increases HDL levels and decreases LDL levels
What should be the main focus for identifying patients with CAD?
Reduction of LDL levels
What type of exercise should gerontologic patients be doing to prevent CAD?
Swimming
Who has a high risk for developing CAD?
A 45-year-old depressed male with a high stressed job
What medication should be taken to treat chronic stable angina?
Nitroglycerin
What is the first line of therapy for chronic stable angina?
short-acting nitrates (sublingual, under the tongue) to relieve pain in about 5 mins and lasts 30-40 mins
What should the patient be taught to do if their s/s are unchanged or worsens after 5 mins of taking nitroglycerin to treat chronic stable angina?
repeat NTG every 5 mins for a max of 3 doses and contact ERS if s/s do not improve
When planning emergent care for a patient with suspected MI, what should the nurse anticipate administering? (4)
- oxygen (tissue ischemia)
- nitroglycerin
- aspirin (antiplatelet)
- morphine (aggravation)
What vitals should be monitored when administering blood pressure medications?
BP and HR
Describe cardiac catheterization as a diagnostic study for coronary artery disease? If a patient is allergic to the dye, what must they be premedicated with?
- Uses radiation and IV contrast to provide images of the coronary circulation and identify the severity of the blockage
- Patient allergic to shellfish and iodine must be premedicated patient with corticosteroids (Benadryl)
What medication is contraindicated with radiation?
Metformin
What diagnostic study requires a catheter with a deflated balloon tip inserted into the coronary artery?
Angioplasty, temporary procedure
What is the most indicative presentation of a STEMI? (ST elevation myocardial infarction)
Initially presents with chest pain and ST-elevations on the 12 lead ECG = priority patient
Clinical manifestations of MI that are subjective to the patient? (3)
- severe chest pain not relieved by rest, position change, nitrate admin
- crushing heavy pressure
- pain radiates to the neck, lower jaw, arms or back
Clinical manifestations of MI? (4)
- SNS activation: cool, clammy skin, diaphoresis
- BP and HR may be initially high, then BP drops because of decreased CO leading to decreased renal perfusion and urine output
- nausea and vomiting
- fever
What is the normal urine output per hour?
30 cc
Describe serum cardiac biomarkers as the diagnostic study for MI? What is the indication sign?
- Troponin: most cardiac specific and sensitive biomarker, indicates how much tissue has been necroses
- indication: troponin levels increased over 6 hrs
What is the emergency treatment for an MI (1-9 steps)
- assess responsiveness, circulation, airway, breathing
- position patient upright and give O2
- obtain baseline vitals
- obtain 12 lead ECG
- Insert 2 IV catheters
- Assess pain and admin pain medication
- admin aspirin for heart-related chest pain unless contraindicated
- admin high dose of statin
- admin antidysrhythmic drugs
What are the drugs used in therapy for MI? (8)
- IV nitroglycerin
- Morphine
- B-adrenergic blockers
- ACE inhibitors
- Angiotensin receptors blockers
- Antidysrhythmic drugs
- Lipid-lowering drugs
- Stool softeners: to prevent strains and vagal stimulation
Nursing diagnosis for MI
Decreased cardiac output related to altered contractility and altered HR and rhythm
Lifestyle modification for a patient with chronic signs and symptoms of coronary artery disease?
Exercise to promote collateral circulation
What is the most common approach to avoid the recurrence of sudden cardiac death?
Use an implantable cardioverter-defibrillator (ICD)
