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Med surg 2 > management of coronary artery alterations > Flashcards

management of coronary artery alterations Flashcards

1
Q

what is a widow maker

A

a block in the coronary artery

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2
Q

where is the left anterior descending coronary arteries

A

anterior and lateral wall of the left ventricle

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3
Q

where is the circumflex coronary artery

A

posterior and lateral wall of the left ventricle

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4
Q

where is the right coronary artery

A

SA node and AV node

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5
Q

where there is a block in the right coronary artery what happens

A

it blocks out the SA node and the AV node

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6
Q

what is atherosclerosis

A

begins as soft deposits of fat that harden with age over time hardening the arteries

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7
Q

what plays a major role in development if atherosclerosis

A

endothelial injury and inflammation

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8
Q

why would someone with atherlerscorosis be on antiplatelets

A

because if that build up of fat explodes all the platelets will go to close it and they pile on eachother blocking blood flow

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9
Q

what are some non-modifiable risks associated with coronary artery disease

A

over 65 years old, male, women if obese, African Americans, family history (1st degree), genetic predisposition

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10
Q

what are some major modifiable risks for coronary artery disease

A

HDL, LDL, Cholesterol (>200), triglycerides (>150), hypertension, smoking, low physical activity, obese (BMI>30), drug use, pernicious anemia

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11
Q

what levels do you want for HDL

A

high >60

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12
Q

what does HDL do

A

carry lipids away from arteries

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13
Q

what levels do you want for LDL

A

low levels <160

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14
Q

what does LDL do

A

carries lipids to arteries

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15
Q

what is an LDL goal for someone who is high risk

A

<70

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16
Q

what is a DM A1c goal for coronary artery disease

A

<7%

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17
Q

what are some ss of metabolic syndrome: insulin resistance disorders

A

central obesity, hypertension, abnormal serum lipids, elevated fasting BG

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18
Q

what are some contributing factors for coronary artery disease

A

DM, metabolic syndrome, psychological status, homocysteine level (pernicious anemia), substance abuse

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19
Q

what drug can lower lipids

A

atrovastain - inhibit cholesterol synthesis decreasing LDL and increasing HDL

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20
Q

what should you monitor for atrovastain

A

liver damage and myopathy

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21
Q

what nutrition therapy for coronary artery disease

A

decrease saturated fats, cholesterol, red meat, egg yols, whole milk increase complex carbs, fiber, omega 3 fatty acids

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22
Q

what is an antiplatelet therapy used for people over 50

A

asprin

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23
Q

how long are most CAD asymptomatic

A

years

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24
Q

what causes symptom angina

A

ischemia

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25
Q

what is ischemia

A

demand for myocardial oxygen exceeds what the coronary arteries can supple

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26
Q

what is stable angina

A

when resting it stops

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27
Q

what is unstable angina

A

not relieved at rest

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28
Q

what could be some reasons for unstable angina

A

acute coronary syndrome (myocardial infarction) which would be a Nstemi (non ST elevation myocardial infarction or a STEMI (ST elevation myocardial infarction)

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29
Q

what are some interventions for angina stable and unstable

A

percutaneous coronary intervention or coronary artery bypass graft

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30
Q

what is collateral cirulation

A

blockage in the arteries creates tiny branches around the artery to bypass the blockage - increase with chronic ischemia

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31
Q

what are some ss of stable chronic angina

A

predictable, relieved with rest, rarely requires aggressive treatment

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32
Q

what are some ss of unstable angina

A

new onset, not relieved with rest, pre-infarction

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33
Q

how is angina usually described

A

pressure, heaviness, or discomfort in chest

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34
Q

what is a medication that may be used with stable angina

A

nitroglycerin - 1st line

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35
Q

how does nitroglycerin work

A

dilates peripheral and coronary blood vessels

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36
Q

how do you take nitroglycerin

A

sublingually or nasal spray

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37
Q

if after taking nitroglycerin and there is no relief what should you do

A

call EMS

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38
Q

if some relief after taking nitroglycerin what should you do

A

take every 5 minutes for max of 3 does

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39
Q

can you take nitroglycerin if before angina happens

A

yes

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40
Q

what are some long acting nitrates

A

lsordill, limdur, nitroglycerin ointment, transdermal controlled release nitroglycerin

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41
Q

is ranolazine a 1st line drug

A

NO

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42
Q

why would you use ranolazine

A

if other treatments arent working

43
Q

what is the main side effect for nitrates and how can you relieve it

A

headaches take Tylenol and keep taking the med

44
Q

what is the main complication for nitrates and what are the interventions for that

A

orthostatic hypotension monitor BP after initial dose advise patient to change positions slowly

45
Q

what can you not take with nitrates and why

A

erectile dysfunction meds like viagra it can cause severe hypotension

46
Q

what is the teaching for storage of nitroglycerin

A

keep away from light and heat, once opened its only good for 6 months

47
Q

how should a patient take nitroglycerin

A

place under the tongue pill or spray

48
Q

can you take sublingual nitroglycerin with long acting nitroglycerin

A

yes if angina develops while on long acting

49
Q

how is nitropaste dosed

A

by the inch

50
Q

where is nitropaste placed

A

upper body or arm, over flat muscular area that is free of hair and scars

51
Q

can you build a nitropaste tolerance

A

yes so you need to have 10-14 hours in between putting it on

52
Q

what is the stable angina comobidity treatmennt

A

ACE (lisinopril) ARBs (losartan), betablocker

53
Q

what are some acute interventions you can do for chronic stable angina

A

upright position, supplemental o2, assess vs, ECG, access lungs, nitroglycerin, check troponin lab values (usually negative)

54
Q

where is S2 heard

A

second intercostal aortic valve closing

55
Q

what is happening when S1 is heard

A

tricuspid valve closing

56
Q

what is an embolus

A

moving clot

57
Q

how does unstable angina happen

A

deterioration of a plaque blockage, rupture, platelets go to fix it cause a thrombus (non moving clot) which stops blood flow causing irreversible myocardial cell death

58
Q

what would a chest xray show you for CAD

A

cardiac enlargement, aortic calcifications, and pulmonary congestion (to rule out aortic distension)

59
Q

what would be seen on a 12 lead ECG for CAD

A

changes from baseline and ST elevation

60
Q

what is the normal troponin 1 levels 0-0.04

A

0-0.04

61
Q

what is normal high-sensitivity troponin level

A

<14

62
Q

what does a coronary computed tomography angiography detect

A

calcified and non calcified plaques in the artery in CT scan with IV contrast

63
Q

What are some diagnostic tests for CAD

A

chest x ray, ECG, Labs (toponin), echocardiogram, exercise stress test, thallium scans,

64
Q

what is a cardiac cauterization

A

looks at coronary arteries in cath lab with IV contrast

65
Q

when someone is experiencing a STEMI when should you get them to cath lab

A

within 90 minutes

66
Q

how could you open arteries with a cardiac cathertization

A

with more dye you can place a percutaneous coronary intervention or a balloon or stent to keep it open

67
Q

can some with IV contrast allergy get a cardia cath

A

yes premeditate with corticosteriods

68
Q

if someone has renal damage and going to go to cath lab what should you do

A

pre hydrate and post hydrate because the dye can hurt the kidneys (check creatine levels before)

69
Q

what is the treatment of choice for a STEMI

A

Emergent PCI

70
Q

what is the goal for placement of emergent percutaneous coronary intervention (PCI)

A

90 minutes from door to cath lab

71
Q

what is a emergent percutaneous coronary intervention (PCI)

A

balloon angioplasty + stent

72
Q

what are the 2 different stents used for emergent percutaneous coronary intervention (PCI)

A

bare metal stent (BMS) or drug-eluting stent (DES)

73
Q

what is required for a bare metal stent (BMS)

A

1month to a year of dual antiplatelet therapy

74
Q

what is required for drug-eluting stent

A

minimum of 12 months of dual antiplatelet therapy

75
Q

what is dual antiplatelet therapy

A

ASA + clopidogrel (plavix)

76
Q

if someone cant take clopidogrel (plavix) what can be replaced

A

ticagrelor or prasugrel

77
Q

what is the nursing management for coronary revascularization

A

monitor for reccurent angina, monitor VS/cardiac rhythm/dysrhythmias/ catheter insertion site/ neurovascular assessment (peripheral pulses), bed rest per policy

78
Q

what is thrombolytic therapy and why would it be used

A

only for patients with a STEMI who cant get to cath lab give 30 mins after arrival

79
Q

what is the nursing management for thrombolytic therapy

A

draw blood and start 2-3 IV sites, do invasive procedures first, monitor for signs of bleeding, monitor neurological status,

80
Q

what is the best sign for thrombolytic therapy

A

ST returning to baseline

81
Q

how can you prevent reocculsion for thrombolytic therapy

A

heparin

82
Q

acute coronary syndrome ss

A

initially increase in HR and BP then drop in BP, crackles, jugular vein distension, new murmur, diaphoresis, nv, fever (up to 100 in first 24-48 hours)

83
Q

why would someone with unstable angina be given a stool softner

A

dont want them to bare down

84
Q

why would someone get a coronary surgical revascularization with coronary artery bypass grafting

A

failed medical management, multivessel disease, not a candidate for PCI (blockages too long or difficult to access), multiple comorbidities

85
Q

what is required for coronary surgical revascularization with coronary artery bypass grafting

A

sternotomy and cardiopulmonary bypass

86
Q

what is coronary surgical revascularization with coronary artery bypass grafting

A

taking arteries and veins to graft new ones

87
Q

what kind of management is done for coronary surgical revascularization with coronary artery bypass grafting

A

pulmonary artery cath, intraarterial line, pleural/mediastinal chest tubes, ECG, mech vent, urinary cath, NG tube

88
Q

what are some complications for coronary surgical revascularization with coronary artery bypass grafting

A

bleeding and anemia from damage to RBCs, fluid and electrolyte imbalances, hypothermia (because the blood is cooled as it passes through bypass machine), infection

89
Q

what should you monitor for coronary surgical revascularization with coronary artery bypass grafting

A

hemodynamic status, fluid status, restore temp, monitor for a fib (very common so restart beta blockers ASAP)

90
Q

what is the teaching involved after a acute coronary syndrome/MI for physical activity

A

monitor HR, low stress level before discharge, isotonic preferred over isometric

91
Q

what is isotonic activity

A

walking, jogging, swimming, bicycling

92
Q

what is a isometric

A

lifting, carrying, or pushing heavy stuff

93
Q

what is the teaching involved after a acute coronary syndrome/MI for sexual activity

A

can typically resume after 7-10 days or when they can walk up 2 flights of stairs without pain

94
Q

what is the most common complication of a acute coronary syndrome/MI

A

dysrhythmias

95
Q

what is the most common cause of death in pre hospitalization period for a acute coronary syndrome/MI

A

VT and VF

96
Q

why would hear failure occur for acute coronary syndrome/MI

A

pumping power of the heart has diminished because of scar tissue formation

97
Q

what is cardiogenic shock

A

when the heart is not working effectively leaving the body poorly perfused -high death rate

98
Q

what is acute pericarditis

A

inflammation of the pericardium

99
Q

what is the ss of acute pericarditis

A

mild to severe chest pain made worse with inspiration, coughing, movement of upper body relieved by sitting in a forward position

100
Q

what is the treatment for acute pericarditis

A

aspirin or colchicine (anti-inflammatory)

101
Q

what is the ss of ventricular wall rupture and papillary muscle rupture

A

new loud systolic murmur, HF and cardiogenic shock will ensue, rare and life threatening

102
Q

what is left ventricular aneurysm

A

the myocardial wall becomes thinned and bulges out during a contraction

103
Q

what is recommended for patients with left ventricular aneurysm

A

anticoagulation if not contraindicated to prevent thrombi

Med surg 2 (12 decks)

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