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NSG 430 - Critical Care > T5: CAD & Acute Coronary Syndrome > Flashcards

T5: CAD & Acute Coronary Syndrome Flashcards

1
Q

Coronary Artery Disease (CAD)

A

disease of the arteries surrounding the heart included in the general category of atherosclerosis.

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2
Q

Atherosclerosis

A

hardening of arteries with a collection of cholesterol-like plaque

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3
Q

what is the major cause of coronary artery disease

A

atherosclerosis

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4
Q

collateral circulation

A

When plaque blocks the normal flow of blood through a coronary artery and the resulting ischemia is chronic, increased collateral circulation develops.

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5
Q

nursing management of coronary artery disease

A

if diet and exercise are ineffective;
-lipid lowering drug therapy (statin, niacin, fibric acid derivatives)
-antiplatelet therapy

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6
Q

Statins Inhibit…

A

cholesterol synthesis, decrease LDL, increase HDL

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7
Q

when given statins monitor

A

for lover damage and myopathy

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8
Q

niacin lowers

A

LDL and triglyceride by inhibiting synthesis-Increases HDL

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9
Q

niacin causes

A

Flushing, pruritus, GI side effects, orthostatic hypotension

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10
Q

Fibric acid derivatives (Lopid) decreases..

A

Decrease triglycerides and increase HDL

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11
Q

fibric acid derivative SE

A

GI SE

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12
Q

ASA, Clopidogrel (Plavix) monitor for

A

bleeding and brusing

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13
Q

clinical manifestations of CAD

A

-angina because of myocardial ischemia and decreased O2 supply

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14
Q

PCI and Stent placement

A

A stent is an expandable meshlike structure designed to keep the vessel open after balloon angioplasty.

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15
Q

When patients first present with chest pain, ST-elevations on the 12-lead ECG are most likely indicative of a

A

STEMI

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16
Q

For patients with chest pain who do not show ST-elevation or ST-T wave changes on the ECG..

A

*distinguish between UA and NSTEMI until serum cardiac biomarkers are measured.

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17
Q

STEMI vs NSTEMI

A

STEMI: Total occlusion of coronary artery, immediate intervention needed
NSTEMI: partial occlusion of coronary artery

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18
Q

action for STEMI

A

no blood flow through the artery so from the ER > cath lab > angioplasty, PCI, thrombolytic therapy
-must be opened with in 90 minutes

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19
Q

clinical manifestations of unstable angina

A

*New in onset
*Occurs at rest
*Increase in frequency, duration, or with less effort
*Pain lasting > 10 minutes
*Needs immediate treatment
*Symptoms in women often under-recognized

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20
Q

Unstable angina (UA)

A

*chest pain that is new in onset, occurs at rest, or occurs with increasing frequency, duration, or with less effort than the patient’s chronic stable angina pattern

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21
Q

MONA

A

Morphine, O2, nitro, aspirin (325mg) ask them to chew it and swallow it
-may add metoprolol to slow down the work load of the heart

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22
Q

clinical manifestations of MI ECG

A

*ST-elevation and non-ST-elevation
*Result of abrupt stoppage of blood flow through a coronary artery, causing irreversible myocardial cell death (necrosis)

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23
Q

myocardial infarction occurs because

A

abrupt stoppage of blood flow through a coronary artery from a thrombus caused by platelet aggregation

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24
Q

action in patients with NSTEMI

A

do not go to cath lab immediately, procedure usually within 12-72 hours

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25
Q

Thrombolytic therapy is not indicated for

A

*NSTEMI patients.

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26
Q

widow maker

A

left coronary artery

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27
Q

ECG Changes Associated With Acute Coronary Syndrome (ACS): ischemia

A

ST-segment depression and/or T wave inversion

28
Q

ECG Changes Associated With Acute Coronary Syndrome (ACS): injury

A

ST-segment elevation occurs

29
Q

Absence of serum cardiac markers confirms

A

no infarction

30
Q

treatment for ACS should be

A

prompt and effective to help avoid or limit infarction

31
Q

dramatic ST-segment elevation associated with

A

myocardial injury “tombstone”

32
Q

complications of MI

A

-dysrhythmias
-HF
-cardiogenic shock
-papillary muscle dysfunction
-ventricular aneurysm
-pericarditis
-Dressler syndrome

33
Q

dysrhythmias can be caused by

A

ischemia, electrolyte imbalances, or SNS stimulation

34
Q

Cardiogenic shock occurs when

A

*oxygen and nutrients supplied to the tissues are inadequate because of severe LV failure, papillary muscle rupture, ventricular septal rupture, LV free wall rupture, or right ventricular infarction.

35
Q

Cardiogenic shock requires aggressive management including…

A

*control of dysrhythmias, intraaortic balloon pump (IABP) therapy, and support of contractility with vasoactive drugs.

36
Q

Papillary muscle rupture

A

a rare and life-threatening complication. It causes immediate and massive mitral valve regurgitation with no time for the heart to compensate

37
Q

Left ventricular aneurysm

A

results when the infarcted heart wall is thin and bulges out during contraction

38
Q

A new loud systolic murmur heard in patients with acute MI may signal

A

*ventricular septal wall rupture.

39
Q

Serum cardiac biomarkers

A

*proteins released into the blood from necrotic heart muscle after an MI.

40
Q

indicator of MI

A

troponins

41
Q

negative biomarkers indicate

A

unstable angina

42
Q

postive biomarkers indicate

A

NSTEMI

43
Q

coronary angiography is a diagnostic study for patients with

A

a STEMI, NOT for patients with UA or NSTEMI

44
Q

pharmacologic stress testing is used for patients with

A

abnormal but nondiagnostic ECG and negative biomarkers

45
Q

The patient with a STEMI must undergo coronary angiography within

A

90 minutes of presentation or receive thrombolytic therapy within 30 minutes in agencies without PCI capability

46
Q

initial intervention for ACS

A

-12-lead ECG
-Upright position
-Oxygen - keep O2 sat > 93%
-IV access
-MONA
-Nitroglycerin (SL) and ASA (chewable)
-Morphine
-Statin if not taking already

47
Q

monitoring for ACS

A

-Treat dysrhythmias
-Frequent vital sign monitoring
-Bed rest/limited activity for 12-24 hours

48
Q

what is recommended for patients with UA and NSTEMI

A

Dual antiplatelet therapy (aspirin) and heparin (UH or LMWH)

49
Q

Cardiac catheterization with possible PCI is considered for both UA and NSTEMI patients once

A

the patient is stabilized and angina is controlled or if angina returns or increases in severity

50
Q

Reperfusion therapy

A

treatment to re-establish perfusion to an organ for patients with STEMI

51
Q

what is the first line therapy for STEMI

A

Emergent PCI

52
Q

thrombolytic therapy is only for patients with

A

a STEMI, give IV within 30 minutes of arrival to ED

53
Q

when initiating thrombolytic therapy

A

-Draw blood and start 2-3 IV sites
-Administer according to protocol
-Monitor closely for signs of bleeding
-Assess for signs of reperfusion
*Return of ST segment to baseline best sign
*IV heparin to prevent reocclusion

54
Q

Coronary revascularization with CABG surgery is recommended for patients who

A

*Failed medical management
*Presence of left main coronary artery or three-vessel disease

55
Q

arteries used for CABG

A

*The internal mammary artery (IMA) is most common artery used for bypass graft
-radial and saphenous are also used

56
Q

Cardiopulmonary Bypass–CPB

A

*During CPB, blood is diverted from the patient’s heart to a machine where it is oxygenated and returned (via a pump) to the patient.
*This allows the surgeon to operate on a quiet, nonbeating, bloodless heart while perfusion to vital organs is maintained.

57
Q

nutritional therapy ACS

A

-Initially NPO
-Progress to
*Low salt
*Low saturated fat
*Low cholesterol

58
Q

clinical manifestations of MI

A

-Severe chest pain not relieved by rest, position change, or nitrate administration
*Heaviness, pressure, tightness, burning, constriction, crushing
*Substernal or epigastric
*May radiate to neck, lower jaw, arms, back
-Palpitations, dyspnea, dizziness, weakness

59
Q

skin assessment for clients w MI

A

Diaphoresis, ashen, clammy, and/or cool to touch

60
Q

CV manifestions for MI

A

-Initially, ↑ HR and BP, then ↓ BP (secondary to ↓ in CO)
-Crackles
-Jugular venous distention
*S3 or S4
*New murmur
*Ventricular Dysrhythmias-pulse deficit

61
Q

management for MI

A

*Pain: nitroglycerin, morphine, oxygen
*Continuous monitoring
*Rest and comfort
*Balance rest and activity
*Begin cardiac rehabilitation
-anxiety reduction

62
Q

The major nursing responsibilities for the care of the patient following PCI involve:

A

-Monitor for recurrent angina
-Frequent VS, including cardiac rhythm
-Monitor catheter insertion site for bleeding
-Neurovascular assessment
-Bed rest per institutional policy

63
Q

CABG: postoperative nursing care

A

-Assess patient for bleeding at surgical site
-Monitor hemodynamic status
-Assess fluid status
-Replace blood and electrolytes PRN
-Restore temperature
-Monitor for atrial fibrillation (which is common)
-pain management

64
Q

syncope

A

*lapse in consciousness
*loss in postural tone (fainting)

65
Q
A

NSG 430 - Critical Care (42 decks)

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