NUR 240 ch 23 CAD Flashcards
Atherosclerosis
the abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and lumen
coronary atherosclerosis
blockages and narrowing of the coronary vessel reduce blood flow to the myocardium
what causes the symptoms in atherosclerosis
myocardial ischemia (tissue death, no blood flow)
symptoms of atherosclerosis
angina pectoris, pain that radiated to jaw or left arm, shortness of breath
atypical in women- epigastric pain, low back pain
modifiable and nonmodifiable risk factors for CAD
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
LDL levels
100-129
HDL levels
above 40
how can we prevent CAD
control cholesterol level
dietary (reduce sodium, mediterranean diet)
physical activity
medications
smoking cessation
HTN management
control diabetes
Cholesterol medications (first line for CAD)
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)
atorvastatin (lipitor)
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)
types of angina
typical (stable) angina
unstable angina
typical angina
predictable and consistent pain that occurs on exertion and is relieved by rest and/or nitroglycerin
unstable angina
symptoms increase in frequency and severity; may not be relieved with rest or nitroglycerin
clinical manifestations of angina pectoris
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
angina pectoris in older adults
dyspnea is often the presenting symptom
silent CAD
object of medical management of angina pectoris
decrease oxygen demand of the myocardium and to increase the oxygen supply
Nitroglycerin
a potent vasodilator that improves blood flow to the heart muscle and relieves pain
beta blockers
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
beta blockers balance what
balance the myocardial oxygen needs and the amount of oxygen available
calcium channel blockers
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
oxygen therapy administration in angina pectoris
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
Acute coronary syndrome
is an emergent situation characterized by an acute onset of myocardial ischemia that results in myocardial death
how often can someone take nitroglycerin
1 nitro every 5 mins up to 3 times
can you chew a sublingual or subbuccal nitroglycerin tablet
no!!
want it to be dissolved so it gets into the circulatory system, not the digestive system
how do you store nitroglycerin
do not put in direct sunlight or heat, it will decrease the potency
antiplatelet drugs reduce
blood viscosity
anticoagulant drugs reduce
fibrin
severe heat and cold weather can trigger angina pectoris
dehydration and hypovolemia should be considered
when giving nitro, monitor blood pressure because
nitro dilates blood vessels.
dilation of veins causes venous blood pooling, less blood returns to the heart which decreases preload
what is the first priority/intervention for a patient with MI
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)
assessing angina (interview questions)
“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?”
goals for a patient with angina pectoris
immediate and appropriate treatment of angina
prevention of angina
reduction of anxiety
nursing intervention to treat angina
patient is to stop all activities and sit or rest in bed
semi-fowlers position- reduces work on the heart
important patient education on angina
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
ECG indicator for MI
elevation in the ST segment in two contiguous leads
purpose of SCDs
increases venous blood return
venous stasis
pooling of blood peripherally (mostly in the hands, legs, and feet)
invasive coronary artery procedures
percutaneous transluminal coronary angioplasty
coronary artery stent
coronary artery bypass graft (CABG)
echocardiogram
used to evaluate ventricular function
may be used to assist in diagnosing an MI
what lab values may indicate an MI
cardiac enzymes and biomarkers including troponin, creatine kinase (CK), and myoglobin
troponin
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
arteriosclerosis
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
