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NUR 240 > NUR 240 ch 23 CAD > Flashcards

NUR 240 ch 23 CAD Flashcards

1
Q

Atherosclerosis

A

the abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and lumen

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2
Q

coronary atherosclerosis

A

blockages and narrowing of the coronary vessel reduce blood flow to the myocardium

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3
Q

what causes the symptoms in atherosclerosis

A

myocardial ischemia (tissue death, no blood flow)

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4
Q

symptoms of atherosclerosis

A

angina pectoris, pain that radiated to jaw or left arm, shortness of breath

atypical in women- epigastric pain, low back pain

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5
Q

modifiable and nonmodifiable risk factors for CAD

A

nonmodifiable:
- family history of CAD
- increasing age
- gender (men develop earlier than women)
- race (higher among African Americans)
- history of premature menopause
- primary hypercholesterolemia

modifiable:
- hyperlipidemia
- tobacco use
- HTN
- diabetes
- metabolic syndrome (elevated LDL, low HDL)
- obesity
- physical inactivity
- chronic inflammatory disease
- chronic kidney disease

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6
Q

LDL levels

A

100-129

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7
Q

HDL levels

A

above 40

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8
Q

how can we prevent CAD

A

control cholesterol level
dietary (reduce sodium, mediterranean diet)
physical activity
medications
smoking cessation
HTN management
control diabetes

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9
Q

Cholesterol medications (first line for CAD)

A

lipid lowering agents:
3-Hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) (or statins)
nicotinic acids
fibric acids (fibrates)
bile acid sequestrates (resins)
cholesterol absorption inhibitors
omega-3 acid-ethyl (esters)

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10
Q

atorvastatin (lipitor)

A

used to lower bad cholesterol and reduce the risk of stroke, heart attack, and other heart and blood vessel problems

monitor liver enzymes (medication is hepatotoxic and processed through the liver)

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11
Q

types of angina

A

typical (stable) angina
unstable angina

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12
Q

typical angina

A

predictable and consistent pain that occurs on exertion and is relieved by rest and/or nitroglycerin

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13
Q

unstable angina

A

symptoms increase in frequency and severity; may not be relieved with rest or nitroglycerin

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14
Q

clinical manifestations of angina pectoris

A

pain or discomfort is poorly localized and may radiate to the neck, jaw, shoulders, and inner aspects of the upper arms, usually the left arm. tightness or a heavy choking or strangling sensation
weakness or numbness in the arms, wrists, and hands, as well as shortness of breath, pallor, diaphoresis, dizziness or lightheadedness, and nausea and vomiting

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15
Q

angina pectoris in older adults

A

dyspnea is often the presenting symptom

silent CAD

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16
Q

object of medical management of angina pectoris

A

decrease oxygen demand of the myocardium and to increase the oxygen supply

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17
Q

Nitroglycerin

A

a potent vasodilator that improves blood flow to the heart muscle and relieves pain

18
Q

beta blockers

A

reduce myocardial oxygen consumption by blocking beta-adrenergic sympathetic stimulation to the heart
result= reduction in HR, slowed conduction of impulses through the conduction system, decreased blood pressure, reduced myocardial contractility

19
Q

beta blockers balance what

A

balance the myocardial oxygen needs and the amount of oxygen available

20
Q

calcium channel blockers

A

decrease sinoatrial node automaticity and atrioventricular node conduction, resulting in slower heart rate and a decrease in myocardial contraction strength

= decrease workload of the heart

21
Q

oxygen therapy administration in angina pectoris

A

increased the amount of oxygen delivered to the myocardium and to decrease pain

assess the rate and rhythm of respirations, color of skin and mucous membranes, and pulse ox

22
Q

Acute coronary syndrome

A

is an emergent situation characterized by an acute onset of myocardial ischemia that results in myocardial death

23
Q

how often can someone take nitroglycerin

A

1 nitro every 5 mins up to 3 times

24
Q

can you chew a sublingual or subbuccal nitroglycerin tablet

A

no!!
want it to be dissolved so it gets into the circulatory system, not the digestive system

25
Q

how do you store nitroglycerin

A

do not put in direct sunlight or heat, it will decrease the potency

26
Q

antiplatelet drugs reduce

A

blood viscosity

27
Q

anticoagulant drugs reduce

A

fibrin

28
Q

severe heat and cold weather can trigger angina pectoris

A

dehydration and hypovolemia should be considered

29
Q

when giving nitro, monitor blood pressure because

A

nitro dilates blood vessels.
dilation of veins causes venous blood pooling, less blood returns to the heart which decreases preload

30
Q

what is the first priority/intervention for a patient with MI

A

MONA
M- morphine (relaxation of the vessels, reduces anxiety, pain relief
O- oxygen
N- nitroglycerin
A- aspirin (325mg, reduces viscosity, reduces size of myocardial tissue death)

31
Q

assessing angina (interview questions)

A

“Where is the pain (or prodromal symptoms)? Can you point to it?”

*“Can you feel the pain anywhere else?”

*“How would you describe the pain?”

*“Is it like the pain you had before?”

*“Can you rate the pain on a 0–10 scale, with 10 being the most pain?”

*“When did the pain begin?”

*“How long does it last?”

*“What brings on the pain?”

*“What helps the pain go away?”

*“Do you have any other symptoms with the pain?”

32
Q

goals for a patient with angina pectoris

A

immediate and appropriate treatment of angina
prevention of angina
reduction of anxiety

33
Q

nursing intervention to treat angina

A

patient is to stop all activities and sit or rest in bed

semi-fowlers position- reduces work on the heart

34
Q

important patient education on angina

A

Avoid over-the-counter medications that may increase HR or BP before consulting with health care provider

stop tobacco (increases HR and BP)

diet low in fat and high in fiber

35
Q

ECG indicator for MI

A

elevation in the ST segment in two contiguous leads

36
Q

purpose of SCDs

A

increases venous blood return

37
Q

venous stasis

A

pooling of blood peripherally (mostly in the hands, legs, and feet)

38
Q

invasive coronary artery procedures

A

percutaneous transluminal coronary angioplasty
coronary artery stent
coronary artery bypass graft (CABG)

39
Q

echocardiogram

A

used to evaluate ventricular function

may be used to assist in diagnosing an MI

40
Q

what lab values may indicate an MI

A

cardiac enzymes and biomarkers including troponin, creatine kinase (CK), and myoglobin

41
Q

troponin

A

is a protein found in myocardial cells, it regulates the myocardial contractile process

trop levels may be high within a few hours to up to 2 weeks after acute MI

trop levels may rise with sepsis, heart failure, and respiratory failure

42
Q

arteriosclerosis

A

hardening of the arteries
expect to see with age
causes a higher blood pressure bc the more narrow to arteries the harder the blood has to work

NUR 240 (18 decks)

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