Heart stuff Flashcards
Angina Pectoris (1 of 2)
Defined as acute chest pain caused by myocardial ischemia
Myocardial ischemia
Condition in which the supply of oxygen to the myocardium does not meet the metabolic demands of the myocardium
Types of angina
Stable
Vasospstic
Types of angina
Silent
Unstable
Angina of effort
Nutritional Therapy of Angina
Large meals should be avoided because they increase the work-load of the heart. Plus, blood is diverted to the digestive system and reduced to the coronary arteries.
Why does BMI matter for angina?
More fat, more load on the heart
Prophylactically
In prevention of
O2 therapy on an acute attack
Can make them feel better even if it’s not objectively doing so
Goals in management of angina
Decrease frequency and intensity of attacks
Increase exercise tolerance
Organic nitrates and angina
Terminate anginal episodes by ___________coronary arteries to _________ O2 needs
Dialate to decrease
Beta adreneergic blocks prevent angina
Reducing Cardiac workload by slowing heart down
Calcium channel blockers
and angina
Prevent angina episodes by either reducing CO (decrease O2 demand) dilating coronary arteries (increase O2 demand) or both
Organic nitrates
Preventing and terminating angina episodes
Relax venous muscle _ reduces preload and decreases O2 demand on myocardium
Relax arterial muscle _ relax spasms and pain can increase oxygen
Can cause reflex tachycardia, HOTN, flushing, and a headache
Nitroglycerin trade names
Nitro-Dur, Minitran, Nitrostat, Trinipatch
Therapeutic effects and uses of nitro
Acute angina
Acute congestive heart failure
Acute pulmonary edema
Acute myocardial infarction
Severe / emergency hypertension
Mech of action for nitro
NO relaxes vascular smooth muscle of arteries (increases O2 supply, decreases afterload and O2 demand) and veins (decreasing preload and O2 demand)
Serious adverse effects of nitro
Anaphylaxis, methemogloineamia
Nursing considerations for clients receiving nitro
Obtain complete health history including allergies and drug history, characteristics of angina, history of cardiac disorders
Assess vital signs and 12 lead ECG
Obtain lab tests including cardiac enzymes, complete blood count (CBC), kidney and liver function tests
Assess if client has taken phosphodiesterase -5 inhibitors (such as sildenafil) within last 24 hours why?
If Assess if client has taken phosphodiesterase -5 inhibitors (such as sildenafil) within last 24 hours why?
VIagra can seriousoly increase risk of storkes and MI
Interventions when administering antiangina med
Assess for pain
Asses that it is reducing pain
Monitor BP/Pulse
Ask about ED drug (Can lead to profound hypotension)
When using vasodialotrs which vs do we monitor
BP and pulse (will drop BP)
Nitro protocol
Pain
1st dose
5min
Pain
2nd dose + 911
5min
Pain
3rd Dose
Nitro glycernin pathces are used for the _____ of angina
Prevention
Why do we remove nitro pathces
Not to OD
Also they can build up a tolerance
To avoid skin irritation
Nitro pathces are always placed
Upper body
Clean dry skin
Not an arms
Shave hairy skin
Initial with date and time
Drugs alternative to nitro fro angina
Beta blockers
Calcium channel blockers
Also applicable for HTN
Attenolol
Therapeutic effects and uses
Stable angina, MI
Hypertension
Mechanism of action
Blocks beta1 receptors in heart causing a reduction in HR, and contractility which decreases CO and blood pressure
O2 demand is decreased, relieving angina
Beta blockers
Block beta receptors in the heart which are sympathetic causing greater parasympathetic response decreaing HR
Beta Blocker
Adverse effects
Adverse effects
Bradycardia, hypotension
Fatigue, weakness
Nausea, vomiting
At high doses, can block beta2 receptors and exacerbate asthma by promoting bronchoconstriction
Metoprolol
Beta1 receptor blocker (selecticve)
Does NOT cause bronchconstriction
decreased HR and contractility which decreases myocardial O2 demand
Treats
Angina, MI
Hypertension
Some dysrhythmias
Some cases of congestive heart failure
Migraines
Adverse effects of metoprolol
HTN
Masks symptoms of hypoglycemia
Cause fatigue
Dizziness
Blurred vision
GI effects
Calcium Channel Blockers used for
Vasospastic angina, stable angina
Hypertension
Atrial dysrhythmias
Calcium channel mech of action
Relax arterial muscle (nifedipine, diltiazem)
Increases O2 supply
Decreases afterload, decreasing O2 demand
Some reduce heart rate and contractility (verapamil, diltiazem)
Decreases O2 demand
Adverse effects of Ca channel blockers
Can exacerbate some dysrythmias
Don’t give to pts with HF - Can INCREASE fluid overload, causing per. edema
Heart block
AV block, beat slowly or skip a beawt
Prototype drub Diltiazem
Therapeutic effects and uses
Stable angina
Atrial dysrhythmias
Hypertension
Mechanism of action
Blocks cardiac calcium channels
Decreases HR and force of contraction, decreasing O2 demand of myocardium
Blocks vascular smooth muscle channels
Increases O2 supply in coronary arteries (vasodilation)
Decreases O2 demand by decreasing afterload (decreased HR anf contraction)
Adverse Effets of Diltiazem
Bradycardia
HOTN (vasodialate)
Flushing, dizziness, headache
Fluid buildup - Periph edema
Symptoms of MI
Treatment foals og MI infarction
Restore blood supply to myocardium
Thrombolytics, organic nitrates
Reduce myocardial oxygen demand
Beta blockers
Control MI‒associated dysrhythmias
Beta blockers, calcium channel blockers
Reduce post-MI mortality
ASA, ACE inhibitors
Manage severe MI pain and anxiety
Analgesics
Most common and serious ad erse efefct of thrombolytics
Bleeding
Reteplase (Retavase)
Used for MI
Mech of action: Functions as a tissue plasminogen activator (tPA) converting plasminogen to plasmin, dissolves clots
Adverse effects: Bleeding
N/V, Fever
Antiplatlet meds examples
ASA chewable, then either ticagrelor or clopidogrel.
Antiplatlets useful for MI
Dramatically reduces mortality in the coming weeks.
Clopidogrel and ticlopidine (ticid) antiplatelet drugs usen in the prevention of MI
Anticoagulants examples
Heparin
Other meds used for MI besides anticoag and platlet
Atropine- for symptomatic bradyarrhythmia’s
Dimenhydrinate : Gravol
Fentanyl?
Lorazepam?
Metoclopramide?
Morphine?
Nitro spray?
Ace inhibs are given when in an MI
Given within 1 – 2 days of onset of MI, following thrombolytic therapy, Captopril and lisinopril have been determined to improve survival.
Improve ventricular remodelling
Nutritional Therapy post stroke
Sit up pt high when they eat
Assessed by SLP
Check for pocketing
TPN
Total parental nutrition
Why would a person recieve parental nutritoin
Colon cancer
Enteral feed for diabetes
Specifically LOW glucose
Indications for tube feed
Severe swallowing difficulties
Little or no appetite for extended periods; malnourished
GI obstructions, some types of fistulas, or impaired motility in the upper GI tract
Intestinal resections
Mentally incapacitated
Coma
Extremely high nutrient requirements
Mechanical ventilation
Complications with tube feed
GI: Diarrhea, nausea and vomiting, cramping, distention, constipation
Mechanical: Tube displacement or obstruction, pulmonary aspiration, mucosal damage
Metabolic: Hyperosmolar dehydration or overhydration; Abnormal Na, K, PO4, mg; Hyperglycemia; rapid weight gain
Medications by tube
Liquid form preferred
Flush before and after meds
Check that medication can be crushed or diluted
Never crush time-released, liquid-filled capsules or enteric coated
Do not mix multiple meds unless compatibility known
If going in jejunum instead of stomach, check effect of medication absorption
May need to stop feed before / after drug – know the protocol for each med with tube feeds
Some tubes have an additional port for medication administration, so you do not have to disconnect reconnect.
Components of TPN
Carbohydrates
Amino Acids
Fats
Electrolytes and Minerals
Vitamins
Trace elements
Two bags
TPN issues
Catheter probs
Blood clots
Electrolyte and fluid imbalances
BG levels
Liver funciton
We allow a certian amount of HTN in CVAs for
48hrs
