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medsurg > Exam 2 Review: Coronary Artery Disease > Flashcards

Exam 2 Review: Coronary Artery Disease Flashcards

1
Q

What are the developmental stages of coronary artery disease? (4)

A
  1. fatty streak
  2. fibrous plaque
  3. complicated lesion
  4. collateral circulation
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2
Q

What are the lab values that would correlate to a patient who has atherosclerosis?

A

LDL and HDL levels (cholesterol levels)

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3
Q

What type of diet does a patient with coronary artery disease need to be on?

A

Heart healthy diet: low sodium, unsaturated fat, monounsaturated oils

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4
Q

What medication and how much does a patient need to take everyday to decrease the risk for CAD?

A

Baby aspirin, 20 mg (to prevent stroke and MI)

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5
Q

What are the lipid-lowering drugs used to treat coronary artery disease? (4) when should drug therapy be considered?

A
  • statins
  • niacin
  • fibric acid derivatives
  • bile acid sequestrants
  • drug therapy should be considered once diet modifications have been attempted
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6
Q

Statins are damaging to which organ?

A

Statins (HMG-CoA reductase inhibitors) are damaging to the liver for example Atorvastatin

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7
Q

How do fibric acid derivatives affect cholesterol levels?

A

increases HDL levels and decreases LDL levels

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8
Q

What should be the main focus for identifying patients with CAD?

A

Reduction of LDL levels

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9
Q

What type of exercise should gerontologic patients be doing to prevent CAD?

A

Swimming

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10
Q

Who has a high risk for developing CAD?

A

A 45-year-old depressed male with a high stressed job

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11
Q

What medication should be taken to treat chronic stable angina?

A

Nitroglycerin

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12
Q

What is the first line of therapy for chronic stable angina?

A

short-acting nitrates (sublingual, under the tongue) to relieve pain in about 5 mins and lasts 30-40 mins

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13
Q

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?

A

repeat NTG every 5 mins for a max of 3 doses and contact ERS if s/s do not improve

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14
Q

When planning emergent care for a patient with suspected MI, what should the nurse anticipate administering? (4)

A
  • oxygen (tissue ischemia)
  • nitroglycerin
  • aspirin (antiplatelet)
  • morphine (aggravation)
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15
Q

What vitals should be monitored when administering blood pressure medications?

A

BP and HR

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16
Q

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?

A
  • 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)
17
Q

What medication is contraindicated with radiation?

A

Metformin

18
Q

What diagnostic study requires a catheter with a deflated balloon tip inserted into the coronary artery?

A

Angioplasty, temporary procedure

19
Q

What is the most indicative presentation of a STEMI? (ST elevation myocardial infarction)

A

Initially presents with chest pain and ST-elevations on the 12 lead ECG = priority patient

20
Q

Clinical manifestations of MI that are subjective to the patient? (3)

A
  • severe chest pain not relieved by rest, position change, nitrate admin
  • crushing heavy pressure
  • pain radiates to the neck, lower jaw, arms or back
21
Q

Clinical manifestations of MI? (4)

A
  • 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
22
Q

What is the normal urine output per hour?

A

30 cc

23
Q

Describe serum cardiac biomarkers as the diagnostic study for MI? What is the indication sign?

A
  • Troponin: most cardiac specific and sensitive biomarker, indicates how much tissue has been necroses
  • indication: troponin levels increased over 6 hrs
24
Q

What is the emergency treatment for an MI (1-9 steps)

A
  1. assess responsiveness, circulation, airway, breathing
  2. position patient upright and give O2
  3. obtain baseline vitals
  4. obtain 12 lead ECG
  5. Insert 2 IV catheters
  6. Assess pain and admin pain medication
  7. admin aspirin for heart-related chest pain unless contraindicated
  8. admin high dose of statin
  9. admin antidysrhythmic drugs
25
Q

What are the drugs used in therapy for MI? (8)

A
  • IV nitroglycerin
  • Morphine
  • B-adrenergic blockers
  • ACE inhibitors
  • Angiotensin receptors blockers
  • Antidysrhythmic drugs
  • Lipid-lowering drugs
  • Stool softeners: to prevent strains and vagal stimulation
26
Q

Nursing diagnosis for MI

A

Decreased cardiac output related to altered contractility and altered HR and rhythm

27
Q

Lifestyle modification for a patient with chronic signs and symptoms of coronary artery disease?

A

Exercise to promote collateral circulation

28
Q

What is the most common approach to avoid the recurrence of sudden cardiac death?

A

Use an implantable cardioverter-defibrillator (ICD)

medsurg (16 decks)

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