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Unit 2 > Perfusion: CAD > Flashcards

Perfusion: CAD Flashcards

1
Q

Unstable angina

A

Once activity stops, the vessels stay constricted, and the pain remains; May last longer that 15 min; may be poorly relieved by rest or nitroglycerin; unfamiliar

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2
Q

Oxygen

A

O2 is trying to get to left ventricle; heart needs more O2

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3
Q

ONAM

A

Oxygen,
Nitrogen,
Aspirin,
Morphine (last pharmacological line)

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4
Q

Nitroglycerin

A

Vasodilates; give 0.4 Q 5 min x3 or relief; watch BP

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5
Q

Aspirin

A

Thins platelets

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6
Q

Morphine

A

Numbs the pt; if pain remains, it is probably a heart attack

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7
Q

Coronary arteries are perfused during

A

Diastole

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8
Q

Coronary Artery Disease

A

Atherometous (plaque) formation in the coronary artery causing blood flow to become blocked; ischemia and infarction may result

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9
Q

Acute coronary syndromes

A

ST-elevation MI (STEMI),
Non-ST-elevation MI (NSTEMI),
Unstable angina

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10
Q

Angina in simple terms

A

Low oxygen to the heart

Heart or chest pain

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11
Q

Ischemia

A

Insufficient oxygen to tissues; does not cause damage; causes pain

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12
Q

Infarction

A

Prolonged insufficient oxygen/blood perfusion; causes damage (Necrosis, cell death)

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13
Q

New-onset angina (unstable)

A

Pt who has his/her first angina symptoms

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14
Q

Variant angina (unstable)

A

Chest pain or discomfort resulting from coronary artery spasm; typically occurs after rest

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15
Q

Pre-infarction angina (unstable)

A

Chest pain or discomfort that occurs in the days or weeks before an MI

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16
Q

Non-ST-elevation (NSTEMI)

A

Has ST and T-wave changes on 12-lead ECG indicating myocardial ischemia; cardiac enzymes elevate over the next 6-12 hrs (may present with normal cardiac enzymes)

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17
Q

ST-elevation MI (STEMI)

A

ST elevation in 2 contiguous leads on a 12-lead ECG indicating myocardial infarction/necrosis; requires immediate treatment

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18
Q

Non-modifiable risk factors for CAD

A

Age, gender, family hx, ethnic background, genetics

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19
Q

Modifiable risk factors for CAD

A

Smoking, obesity, elevated serum lipid levels, limited physical activity, HTN, DM, excessive alcohol use, and stress

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20
Q

Prevention (smoking)

A

Quit; don’t start

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21
Q

Prevention (diet)

A

Sufficient calories (less than 7% from saturated fats, avoid trans fatty acids); limit cholesterol (

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22
Q

Prevention (cholesterol)

A

Have lipids checked regularly; if cholesterol and LDL levels are elevated, follow dr’s advice

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23
Q

Prevention (physical activity)

A

Check with dr before starting exercise program; should be enjoyable, burn 400 cal/session, and sustain HR of 120-150/min; should last 30 min with 10 min warm up and 5 min cool down; exercise 3-5 times weekly or walk daily for 30 min; if unable to walk 30 min, walk any distance you can

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24
Q

Prevention (diabetes)

A

Manage diabetes

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25
Q

Prevention (blood pressure)

A

Have BP checked regularly; if elevated, follow dr’s advice

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26
Q

Prevention (obesity)

A

Avoid severely restrictive or fad diets; restrict intake of saturated fats, simple sugars, and cholesterol-rich foods; increase physical activity

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27
Q

Percutaneous Transluminal Coronary Angioplasty (PTCA or PCI)

A

Balloon tipped catheter is fed up through the coronary artery to the lesion or area of infarct and is inflated which pushes the plaque against the wall of the vessel; may place a stent during this time

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28
Q

Complications of PTCA

A 
Bleeding, 
Artery dissection,
Spasms/pain,
Dysrhythmias,
Vagal reaction,
Hypotension,
Reocclusion,
Renal hypersensitivity
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29
Q

CAD assessment

A 
Pain (characteristics)
Skin (perfusion),
Lungs (crackles?),
Heart tones (distant?),
Musculoskeletal, 
Psychosocial (anxiety, depression, denial?),
Family hx,
Activity tolerance (prior to problem),
Drug use, 
Tobacco use,
Weight loss/gain, 
BP,
Diet,
Labs (troponin is first)
30
Q

CAD education

A

Lifestyle modification, medication regimens, prevention methods

31
Q

CAD collaboration

A

Case management,
Physical therapy,
Occupational therapy,
Cardiac rehab

32
Q

Associated MI symptoms

A 
Nausea,
Vomiting,
Diaphoresis,
Dizziness,
Weakness,
Palpitations, 
SOB
33
Q

Thallium scan

A

Uses radiographic imaging to assess for ischemia or necrotic muscle tissue; may be used with stress test; areas of decreased or absent perfusion indicate ischemia or infarction

34
Q

Contrast-enhanced cardiovascular magnetic response (CMR)

A

Noninvasive approach to detect MI

35
Q

Echocardiography

A

Used to visualize the structures of the heart

36
Q

64-slice Computed Tomography Coronary Angiography (CTCA)

A

Helpful in diagnosing CAD in symptomatic pts identified as having “low- or intermediate-pretest probability” risk for CAD

37
Q

12-lead electrocardiogram

A

The provider can identify the leads in which ECG changes are occurring; identifies the occurrence and location of the ischemia or necrosis

38
Q

18-lead electrocardiogram

A

Can determine if ischemia or infarction has occurred in right ventricle

39
Q

Exercise tolerance test

A

Assesses for ECG changes consistent with ischemia, evaluate medical therapy, identify those who would benefit from invasive therapy; either treadmill or pharmacologic stress-testing agents (dobutamine)

40
Q

Cardiac catheterization

A

Used to determine the extent and exact location of obstruction

41
Q

CAD Priority problems

A

Acute pain,
Inadequate tissue perfusion,
Activity intolerance,
Ineffective coping

42
Q

Pain management

A

Helps increase the oxygen supply and decrease myocardial oxygen demand; morphine

43
Q

Drug therapy: Nitroglycerin

A

Increases collateral blood flow; redistributes blood flow; dilates the coronary artery; decreases oxygen demand

44
Q

Nitroglycerin administration

A

Hold tablet under tongue (drink 5 ml water if need help dissolving); do not administer consecutive dose if BP is 25; administer up to 3 doses with 5 min between each; spray should be under tongue; patch should be below the nipple line

45
Q

Stable angina

A

Vessels constrict during activity, lessening oxygen supply and causing pain, at the end of activity, the vessels return to normal and oxygen supply returns, and pain is gone; reproducible; familiar

45
Q

Drug therapy: morphine sulfate

A

Relieves MI pain, decreases myocardial oxygen demand, relaxes smooth muscle, reduces circulating catecholamines

47
Q

Improving cardiopulmonary tissue perfusion

A

Aspirin therapy, glycoprotein IIb/IIIa inhibitors, beta-adrenergic blocking agents, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARB), calcium channel blockers, thrombolytic therapy, percutaneous transluminal coronary angioplasty PTCA)

48
Q

Drug therapy: aspirin

A

Inhibits platelet aggregation and vasoconstriction, decreasing the likelihood of thrombosis

49
Q

Aspirin administration

A

325 mg baby ASA (4 tabs); effect begins within 1 hr and continues for several days; admin 162-325 mg daily to those with suspected CAD

50
Q

Drug therapy: Glycoprotein IIb/IIIa inhibitors

eptifibatide

A

Target the platelet component of the thrombus; prevents fibrinogen from attaching to the activated platelets at the site of the thrombus; used in acute coronary syndromes, before and during PTCA, and with fibrinolytic agents after MI (thrombolytic is decreased 25-50%)

51
Q

Drug therapy: beta-adrenergic blocking agents

A

Aka beta blockers; decrease the size of infarct, the occurrence of ventricular dysrhythmias, and mortality rates in pts with MI; usually given within the first 1-2 hrs; slows the heart rate and decreases the force of the contraction

52
Q

Beta-adrenergic blocking agents administration

A

Monitor for bradycardia, hypotension, decreased LOC, chest discomfort, lung sounds, hypoglycemia, depression, nightmares, and forgetfulness

53
Q

Drug therapy: ACE inhibitors

A

Given within 48 hrs of MI to prevent ventricular remodeling and the development of heart failure; monitor for decreased urine output, hypotension, cough, serum potassium, creatinine, and BUN

54
Q

Drug therapy: calcium channel blockers (ranolazine)

A

For pts with angina, NOT after MI; promotes vasodilation and myocardial perfusion; monitor for hypotension, peripheral edema, and frequency of angina episodes; often effective in relieving the pain in CSA

55
Q

Morphine Sulfate administration

A

To relieve discomfort that is unresponsive to NTG; 2-10 mg doses IV Q 5-15 min; monitor for resp depression, hypotension, bradycardia, and severe vomiting; monitor VS and heart rhythm frequently

56
Q

Thrombolytic therapy: Fibrolytics (tissue plasminogen activator: t-PA)

A

Dissolves thrombi in the coronary arteries and restores myocardial blood flow; may be delivered during cardiac cath; most effective when given in the first 6 hrs of event; indicated for chest pain longer than 30 minutes and unrelieved with NTG with indications of ischemia and injury

57
Q

PTCA

A

May be used to reopen the clotted artery; works best when it can be performed within 2-3 hrs of onset of symptoms

58
Q

Indications that the clot has been lysed after PTCA

A

Abrupt cessation of pain; sudden onset of ventricular dysrhythmias; resolution of ST-segment depression/elevation or T-wave inversion

59
Q

Maintain the patency of coronary artery after PTCA

A

ASA and heparin; monitor PTT

60
Q

Coronary artery bypass graft surgery (CABG)

A

Occluded artery is bypassed with the pts own venous or arterial blood vessels or synthetic grafts; indicated for those unresponsive to other interventions

61
Q

Pre-op teaching for CABG

A

Familiarize with unit; teach splinting chest incision, cough, deep breathe, and arm and leg exercises; teach that pt should report pain, analgesics will be given for pain, early ambulation is important, ETT will be in place following procedure, and close monitoring with sophisticated equipment is standard

62
Q

CABG anxiety

A

Identify the level; pt may want to define their fears; may benefit from detailed info about procedure; assist pt with coping

63
Q

Cardiopulmonary bypass (CPB)

A

Provides oxygenation, circulation, and hypothermia during induced cardio arrest; blood is diverted from heart to bypass machine; it is heparinized, oxygenated, and returned to the circulation through a cannula placed in the ascending aortic arch or femoral artery; heart is infused with potassium solution

64
Q

Post op for CABG

A

Monitor for dysrhythmias, fluid and electrolyte imbalances, hypotension, hypothermia, hypertension, bleeding, cardiac tamponade, decreased LOC, angina like pain; teach difference between sternotomy pain and anginal pain; monitor for mediastinitis and postpericariotomy syndrome; refer to page 848-849

65
Q

Post CABG complication: bleeding/cardiac tamponade

A

Volume expansion and emergency sternotomy with drainage

66
Q

Management of dysrhythmias post CABG

A

Turn on pacemaker and adjust the settings as prescribed

67
Q

Isosorbide

A

Remove patch before defibrillation; rotate application sites; apply to clean, dry, hairless area; remove after 12-14 hrs each day

68
Q

Prasugrel

A

Thienpyrodine; acute coronary syndrome; report any unusual bleeding or bruising; contraindicated in pt with hx of stroke or >75 yrs; if pt

69
Q

Metoprolol

A

Assess HR (hold if

70
Q

Clopidogrel (Plavix)

A

Take with food; report unusual bleeding/bruising (slows clot formation)

Unit 2 (3 decks)

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