Exam 2 study guide Flashcards
what are the common signs and symptoms of myocardial infarction
Signs (objective)
pallor, hypertension, cardiac rhythm changes, vomiting, fever and diaphoresis
-pallor
-erratic behavior
-hypotention
-vomiting
-fever
-diaphoresis
symptoms (subjective)
heavy pressure or squeezing pressure in the chest, pain radiating to left arm and jaw, anxiety, nausea and dyspnea
why do elderly present different symptoms with MI
Arterial stiffening
Increased blood pressure
decreased maximal heart rate
Increased recovery time from activity
*Even with lower doses of medications, the older adult should be observed for signs and symptoms of toxicity
why are women frequently misdiagnosed with MI
classic symptoms are far less common; most frequently early symptoms are:
- unusual fatigue
- sleep disturbances
- shortness of breath
- weakness
- Indigestion
- Anxiety
*acute chest pain is not present and commonly misdiagnosed as indigestion, gallblader disease, depression, or anxiety
what is stable angina
Stable angina (exertional angina) occurs with exercise or emotional stress and is relieved by rest or nitroglycerin (Nitrostat).
what is unstable angina
occurs at lower levels of activity or at rest, is less predictable, and is often a precursor of myocardial infarction. (preinfarction angina)
-it increases in occurrence, severity, and duration over time.
what is prinzmetals angina
-is prolonged and severe and occurs at the same time each day, most often at rest.
Variant angina (Prinzmetal's angina) is due to a coronary artery spasm, often occurring during periods of rest. -Generally it is treated with calcium-channel-blocking agents
approx how many years would it take to decrease a smokers risk for coronary artery disease compared to that of a non-smoker
“If you quit now, your risk of cardiovascular disease will decrease to that of a nonsmoker in 3 to 4 years.”
what are the dietary recommendations for a patient with coronary artery disease (CAD)
Tuna fish, tofu, and walnuts are all rich in omega-3 fatty acids, which have been shown to reduce the risks associated with CAD when consumed regularly
-The use of polyunsaturated oils is recommended to control hypercholesterolemia.
- Should avoid foods high in saturated fat and cholesterol such as eggs, whole milk, and red meat.
- These foods contribute to increases in low-density lipoproteins.
what are the common nursing assessments for a patient with complaints of chest pain
- assess original pain and location, duration, radiation, and onset of new symptoms
- administer prescribed analgesic
- bed rest
- administer oxygen
- provide calm environment
*focus on achievement of 5 pt outcomes: comfort promote tissue perfusion encourage activity and rest reduce activity and promote feelings of well being promote pt education
why is oxygen administered to patient complaining of angina pectoris
-how many liters is given via nasal cannula
The pain of angina pectoris occurs because of a decreased oxygen supply to heart cells.
Supplemental oxygen will help to meet the added demands on the heart muscle.
oxygen via nasal cannula at 2 L/min for 24-48 hrs or longer
what is the most common diagnostic tool to determine the location of MI
ECG
what is the common electrocardiogram (ECG) change seen in relation to myocardial infarction
ECG - will show pathogenic Q waves (necrosis), ST increase (myocardial infarction), T wave inversion (ischemia)
- A women experiencing an MI is far less likely than a man to have concurrent ST-increase, resulting in misdiagnosis and failure to receive correct treatment.
what is the difference between troponin and CK-MB in regards to MI
Troponin is a sensitive cardiac marker that is NOT influenced by skeletal muscle trauma or renal failure
why may a patient be prescribed nitroglycerin
Nitroglycerin used to prevent coronary artery vasospasm and reduces preload and afterload, decreasing myocardial oxygen demand
what is the method of action for nitroglycerin
dilate blood vessels by reducing coronary artery spasm, increase coronary artery blood supply and decrease oxygen demands
nitroglycerin patient teaching
- taught to take nitroglycerin before any activity that previously caused the pain and to take the medication at the first sign of chest discomfort.
- take 1 nitroglycerin tablet sublingual up to 3 tablets 5 minutes apart
- always carry medication
- store in a dark bottle and keep dry
- replace every 6 months or before exp date
nitroglycerin side effects that should be provided with this medication
- May cause headache as a common side effect
- Encourage patient to sit and lie down slowly
- burning sensation on the tongue-indicates activation
- throbbing sensation in head and flushing may occur
nitroglycerin-when should a patient call 911 after taking this medication
call 911 after the third tablet, if pain does not subside.
what discharge teaching should be given to a patient receiving a transdermal nitroglycerin patch
avoid drugs to treat erectile dysfunction.
transdermal nitroglycerin patch common side effects
Dizziness or light-headedness; headache; irritation at site of patch.
transdermal nitroglycerin patch how should it be applied
- Apply the patch to a hairless area and rotate sites
- Apply a new patch each morning and remove at bedtime to prevent development of tolerance
- Apply the patch at the same time every day.
- Wash your hands thoroughly before and after applying the patch.
why are thrombolytic agents used for MI
- thrombolytics salvage heart muscle by minimizing infarct size and maximizing heart function
- they lyse the clot thus allowing perfusion of the heart muscle
thrombolytic agents- when should this medication be administered
therapy starts within 30 to 60 minutes of symptom onset
* before administration obtain thorough history
DO NOT USE IF : active internal bleed
suspected aortic dissecting aneurysm
recent head trauma
hx of hemorrhagic stroke w/in year
surgery w/in past 10 days
thrombolytic agents- side effects of this medication
Remind the client of the risk for bruising and bleeding while on this medication.
which laboratory blood test is specific for MI damage
Triponin 1- a sensitive cardiac marker; increased levels indicate that an MI has occured; normal value 0.04-0.4
how does the nurse prepare the patient going for an exercise stress test
- The client should wear loose, comfortable clothing for the procedure.
- Lead placement is enhanced if the client wears a shirt that buttons in the front.
- The client should receive nothing by mouth after bedtime or for a minimum of 2 hours before the test.
- The client should wear rubber-soled, supportive shoes, such as athletic training shoes.
- The client should avoid smoking, alcohol, and caffeine on the day of the test.
- Inadequate or incorrect preparation can interfere with the test, with the potential for a false-positive result.
exercise stress test-patient teaching (clothing and diet )
The client should wear loose, comfortable clothing for the procedure.
- nothing by mouth after bedtime or for a minimum of 2 hours before the test.
- wear rubber-soled, supportive shoes, such as athletic training shoes.
- avoid smoking, alcohol, and caffeine on the day of the test.
what is cardiac catheterization used for
invasive procedure used to visualize the hearts chambers, valves, great vessels, and coronary arteries
-this procedure aids in diagnosis, prevention, of progression of cardiac conditions and accurate evaluation and treatment of the critically ill patient.
