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N465A: Med-Surg > HTN, CAD, Acute Coronary Syndrome and Nursing Management > Flashcards

HTN, CAD, Acute Coronary Syndrome and Nursing Management Flashcards

1
Q

What is the most severe consequence of HTN?

A

End organ failure.

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2
Q

What medications are used for HTN?

A

ACE Inhibitors and Beta Blockers (used if lifestyle modification such as exercise do not work)

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3
Q

What are some patient education points you would provide for Thiazide Type Diuretics?

A
  1. Tell your patient to take medication early each day to prevent nighttime urination.
  2. Suggest taking it with food to minimize gastrointestinal irritation.
  3. Teach to change position slowly, such as when
    rising after lying down. (NCLEX loves this)** (ORTHOSTATIC HYPOTENSION)
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4
Q

What are Beta Blockers? Why are they used?

A
  1. They help coronary vessels dilate (SAVES LIVES)
  2. Lower HR, lower B/P; Reduces infarct size, dysrhythmias, C/P, cardiac arrest, and mortality.
  3. Do not give is bradycardic: HR <60 and SBP <90.
  4. Taper off, do not abruptly stop.
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5
Q

List the modifiable risk factors for CAD and MI

A
  1. Hyperlipidemia
  2. High blood pressure
  3. Alcohol intake
  4. Physical inactivity
  5. Diabetes-glucose control
  6. Smoking/Stress
  7. Obesity
  8. Diet (more controversy…)
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6
Q

List the non-modifiable risk factors for CAD and MI

A
  1. Gender & Age
  2. Men over 45 years age
  3. Women over age 60
  4. Family Hx / Genetics
  5. Post-menopausal women
  6. Ethnicity
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7
Q

Which populations may present the clinical manifestations of coronary artery disease differently?

A

Women and people with diabetes

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8
Q

What are symptoms women with CAD may experience?

A
  1. Women’s most common heart attack symptom ischest pain
  2. But women more likely than men to experience other noncardiac symptoms
  3. SOB, N/V, GI upset, heartburn, general malaise, back/jaw pain.
    ‘I thought I had the flu’
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9
Q

Why would delay to be seen by a provider occur in women with CAD?

A

Even thoughheart diseaseis the No. 1 killer of women in the United States, women often chalk up the symptoms to less life-threatening conditions like acid reflux, the flu or normal aging

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10
Q

True or false: Angina is ALWAYS indicative of MI

A

False

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11
Q

What is the medication for angina? What is the goal?

A

Nitroglycerine; to be pain free

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12
Q

What is a myocardial infarction?

A

When the metabolic demand of the heart exceeds its oxygen supply, myocardial ischemia or infarction (MI) may occur

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13
Q

How is MI diagnosed?

A

12 lead EKG (look at trends and changes).

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14
Q

What is specificity?

A

ability of a test to identify a patient who does not have a disease (few false positive tests)

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15
Q

What is sensitivity?

A

ability of test to identify a patient with a disease (few false positive results)

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16
Q

What blood tests are the most reliable cardiac biomarkers to diagnose a MI?

A

Troponin & CKMB are more reliable measures.
Troponin has highest specificity and shows up after ischemic cardiac events.

17
Q

What is a normal Troponin level?

A

between 0 and 0.04 ng/mL

18
Q

What is a 12 lead EKG used for?

A

12 lead EKG identifies location of heart injury/infarct/myocardial damage

19
Q

What is a STEMI?

A

ST-segment elevation usually indicates a total blockage of the involved coronary artery and that the heart muscle is currently dying. (myocardial infarction)

20
Q

What is a NSTEMI?

A

Non-STEMI heart attacks usually involve an artery with partial blockage, which usually does not cause as much heart muscle damage. (often injury or start of ischemia)

21
Q

What is the main goal of MI treatment?

A

Reperfuse – must meet O2 to myocardial muscle and cells.
TREAT UNDERLYING PROBLEM. IF PLAQUE BLOCKING IN CORONARY ARTERY, REMOVE PLAQUE OR OPEN THE VESSEL DIAMETER
IF NOT ENOUGH BLOOD VOLUME, GIVE BLOOD TRANSFUSIONS

22
Q

What is the order for acute MI nursing management?

A
  1. O2
  2. Nitroglycerine –> Morphine
  3. Aspirin (anti-platelet, which helps with reperfusion); ECASA
  4. EKG
  5. Labs
23
Q

Why does aspirin save lives?

A

Prevents platelet formation and blood clot formation, and if given within 24 hours of anginal onse –> death decreases death by 23%.

24
Q

What is Plavix (Clopidorgel)? What are some precautions to be mindful of?

A

– given after a STENT to prevent from clotting off
-75mg daily for 6 month to a year with stent
-Bleeding precautions**

25
Q

List the medications used to reduce blood clotting (anticoagulants)

A
  1. Lovenox- low molecular weight heparin (Enoxaparin)-method is injections
  2. Heparin- prevents the development of NEW clots in arteries. Heparin measured by PTT/aPTT/antiXa levels
  3. Coumadin (Warfarin)-coumadin monitored by INR. If patient on coumadin needs frequent INR/PT/PTT lab draws
  4. NoACs- Eliquis, Xarelto (not monitored by INR)** will NOT need monthly INR/PT/PTT labs*
26
Q

What are the precautions and nursing considerations for Heparin drip?

A
  1. Bleeding Precautions**
  2. 2 RN verification!!! Mandatory
  3. Fall Precautions!!!!
  4. Adverse Effects:
    -Heparin induced Thrombocytopenia
27
Q

What is thrombocytopenia?

A

a condition in which the platelets (also called thrombocytes) are low in number, which can result in bleeding problems.

28
Q

What are bleeding precautions for patients on blood thinners?

A

RANDI:
1. Razor electric
2. Aspirin – NOI
3. Needles - small gauge
4. Decrease needle sticks
5. Injury – protect from

29
Q

What to observe for in patients on bleeding precautions?

A

Hematuria
Melena
Nosebleeds
Gingival bleeding
Bruising

30
Q

When would you implement bleeding precautions?

A
  1. Using anticoagulants
  2. Liver disease present
  3. Platelets below 150,000
  4. Hemophilia present
  5. Using thrombolytic meds
31
Q

List bleeding precautions not listed in RANDI

A
  1. Do not blow your nose too hard or scratch the inside of your nose
  2. Do not walk barefoot (slip resistant)***
  3. Be careful not to fall or bump into objects
  4. Do not push too hard when having bowel movements.
  5. Do not use enemas/tampons
  6. Apply firm pressure to any area of abrasions/scrapes/bleeding for at least 5 minutes.*****
32
Q

What is thrombolytic therapy?

A

-Dissolve blood clots in a procedure termed thrombolysis.
-limit the damage caused by the blockage or occlusion of a blood vessel
-Examples: tPA, Activase, Retavase
Must be given within first 90 minutes of active MI

33
Q

Would you administer thrombolytic therapy to a high risk patient?

A

It is not ideal; contraindicated in unstable angina and NSTEMI d/t higher risk of bleeding; Cardiac catherization lab preferred.

34
Q

What is a cardiac catheterization lab?

A
  1. Department in hospital with diagnostic imaging equipment used to visualize the arteries and chambers of the heart – procedures dealing with coronary arteries
  2. Can be diagnostic and/or therapeutic (angioplasty, stent placement, thrombus removal_
35
Q

What medication would you hold three days before planned PCI or cardiac catheterization?

A

Metformin (due to the possibility of causing lactic acidosis and acute nephropathy); however, if emergency and pt took Metformin this morning, we still go.

36
Q

Nursing responsibilities to prep for cath lab

A

-Hold Metformin
-Check BUN/Creatinine (renal function)*
-If going for stent, give Plavix
-Ensure consent is signed**
-Code Status*
-Fill out preop checklist
-Check allergies (iodine, shellfish)**
-Keep NPO

37
Q

Nursing responsibilities post cath lab procedure

A

-Check incision site
-Check pulses
-Check vitals per protocol (usually Q15minx4, Q30x2, Q1 hr x 2)
-Maintain bedrest if femoral access
-Educate patient
-Monitor heart rhythm via telemetry

38
Q

What are some complications from angioplasty and stent replacement?

A
  1. Restenosis
  2. Blood clots (form within stents)
  3. Arterial bleed (during or post procedure)
  4. Coronary artery tear requiring CABG
  5. Contrast induced nephrotoxicity
  6. CVA.
  7. Irregular heartbeats
39
Q

Why is a CVA a potential complication from angioplasty and stent replacement?

A

During angioplasty, a piece of fatty plaque can break loose, travel to the brain Blood thinners used during the procedure to reduce the risk.

N465A: Med-Surg (5 decks)

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