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NSG 320 - MED SURG > Topic 4: CAD, Chronic Stable Angina, HTN > Flashcards

Topic 4: CAD, Chronic Stable Angina, HTN Flashcards

1
Q

perfusion

A

The supply of oxygen to and removal of wastes from the cells and tissues of the body as a result of the flow of blood through the capillaries.

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2
Q

oxygenation

A

The process of delivering oxygen to the blood by diffusion from the alveoli following inhalation into the lungs.

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3
Q

coronary artery disease

A

atherosclerosis of the coronary arteries that reduces the blood supply to the heart muscle

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4
Q

Stages of Atherosclerosis

A
  1. Endothelial injury
  2. Fatty streak
  3. Fibrous plaque
  4. Complicated lesion (thrombus formation)
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5
Q

collateral circulation

A

circulation formed by smaller blood vessels branching off from or near larger, occluded blood vessels

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6
Q

Nonmodifiable risk factors for CAD

A

Age
Gender
Ethnicity
Family history
Genetic predisposition

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7
Q

Modifiable risk factors for CAD

A

Smoking, HTN, DM, obesity, diet, activity level, hyperlipidemia

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8
Q

angina

A

chest pain; caused by either an increased demand for oxygen or a decreased supply of oxygen.

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9
Q

chronic stable angina

A

*Intermittent chest pain that occurs over a long period with same pattern of onset, duration, and intensity of symptoms

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10
Q

chronic stable angina EKG

A

*ST segment depression and/or T-wave inversion

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11
Q

how do patients oftern describe chronic stable angina as

A

pressure, heaviness, or discomfort in the chest. squeezing, heavy, tight, or suffocating sensation

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12
Q

what is chronic stable angina often provoked by

A

*physical exertion, stress, or emotional upset

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13
Q

chonic stable

A

*with exercise or when stress happens, relieved with rest or nitroglycerin

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14
Q

Prinzmetal’s Angina (variant angina)

A

*occurs anytime, including at rest - caused by coronary artery spasms

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15
Q

Microvascular angina

A

*distal coronary arteries, ADLs, more common in women

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16
Q

unstable angina

A

*rupture of plaque, with exercise or rest, increases with severity/frequency/duration over time, not relieved with rest/nitro, lasts longer than 10 min

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17
Q

If Angina is not treated promptly, it can progress into a

A

myocardial infarction

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18
Q

what are the common locations and patternd of angina and MI

A

-most substernal, may radiate to other locations, including the jaw, neck, shoulders, and/or arms.
-complain of indigestion or a burning sensation in the epigastric region.
-between the shoulder blades.

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19
Q

what will the client complain of with angina and MI

A

-Squeezing in the chest
-Pressure, an elephant sitting on the chest
-Pain from chest radiating to jaw, neck, left arm
-Anxiety, sense of impending doom
-Nausea, vomiting
-Dizziness
-Pale, cool, & clammy skin, diaphoresis
-Tachycardia, palpitations
-Tachypnea & shortness of breath
-Decreasing LOC

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20
Q

lab tests for MI/angina

A

Myoglobin
CK-MB
Troponins
Lipids
CBC, BMP, CRP
ECG

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21
Q

coagulation labs

A

(PT/INR, aPTT) - the amount of time it takes for different parts of the clotting system to form a clot.

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22
Q

cardiac enzymes labs

A

(CK-MBs, Troponins, BNP) - enzyme(s) excreted by the heart when it’s in distress

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23
Q

lipid panel

A

(Cholesterol, Triglycerides, HDL, LDL) - measures the different types of fat that float around in our blood

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24
Q

digoxin level labs

A

this measures the amount of a medication, Digoxin, that is in the blood to determine if the amount is too high or too low

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25
Q

D-dimer labs

A

this measures fragments of fibrin that are left over after a clot has formed

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26
Q

CRP labs

A

C Reactive Protein tells us about inflammation in general

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27
Q

What medication affects the aPTT lab value?

A

heparin

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28
Q

What is the antidote to heparin?

A

protamine sulfate

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29
Q

What medication affects the PT/INR lab value?

A

warfarin

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30
Q

What is the antidote to warfarin?

A

Vitamin K

31
Q

diagnostic test for MI/anigna

A

Chest x-ray
12-lead ECG
Laboratory studies
Echocardiogram
Exercise stress test

32
Q

ONA-M (MI)

A

*Oxygenation
*Nitroglycerin tablets sublingual (0.4mg Q15 SL Q5min X 3 doses)
*Aspirin 81mg up to 325mg
*Morphine

33
Q

acute interventions for MI

A

vitals Q5min, PQRST for pain assessment, LOC, O2 administration, IV access, energy conservation, anxiety management, cardiac monitor, ECGs, blood work, urine output

34
Q

A, B, C, D, E, F Chronic Management Interventions:

A

-smoking cessation,
-HTN control
-lower cholesterol/triglycerides if elevated
-diet low in saturated fat and salt
-regular physical activity

35
Q

drug therapy for CAD/angina

A

*Antiplatelets
*Nitrates
*ACE inhibitors, ARBS, Beta-Blockers, Calcium Channel blockers
*Lipid-lowering drugs

36
Q

coronary revascularization

A

*Percutaneous coronary intervention (PCI)
*Coronary artery bypass graft surgery (CABG)

37
Q

Percutaneous coronary intervention (PCI)

A

balloon-tipped catheter is inserted into a coronary artery to open the artery; stents are put in place

38
Q

how do you prepare someone for a PCI?

A

*Client is NPO
*Premedication
*Consent for the procedure
*Nursing assessment

39
Q

what does the nurse do after a PCI?

A

*Vital signs
*Surgical site assessment
*Bedrest and movement

40
Q

complications from PCI

A

-bleeding from the catheter insertion site
-an infection
-an allergic reaction
-damage to the artery from inserting the catheter
damage to the kidneys
-irregular heartbeat

41
Q

client teaching after PCI

A

Tell your doctor if you have any of the following:
-Fever or chills
-Increased pain, redness, swelling, bleeding, or other drainage from the insertion site
-Coolness, numbness or tingling, or other changes in the affected arm or leg
-Chest pain or pressure, nausea or vomiting, profuse sweating, dizziness, or fainting

42
Q

normal BP

A

<120/<80

43
Q

elevated BP

A

120-129/<80

44
Q

HTN stage 1

A

130-139/80-89

45
Q

HTN stage 2

A

> 140/>90

46
Q

hypertension

A

BP is greater than 140/90 mmHg

47
Q

primary HTN

A

no known cause

48
Q

Secondary HTN

A

cause is often identified & treatable

49
Q

Hypertension Clinical Manifestations

A
  • Frequently asymptomatic until it becomes severe and target organ disease has occurred
  • Fatigue, reduced activity tolerance
  • Dizziness
  • Palpitations, angina
  • Dyspnea
50
Q

what are some nursing interventions for HTN

A

-Lifestyle Modifications
-Weight Reduction
-DASH Eating Plan
-Dietary Sodium Reduction
-Moderation of Alcohol Intake
-Physical Activity
-Avoiding Tobacco Products

51
Q

*Nursing Management for Primary Hypertension

A

*Health Promotion
*Screening Programs
*Cardiovascular Risk Factor Modification
*Ambulatory Care
*Home BP Monitoring
*Client Adherence

52
Q

Hypertensive crisis symptoms

A

severe headaches, · Sudden rise in BP associate, N/V, seizures, confusion, coma, dyspnea, anxiety, and nosebleeds

53
Q

what are the interventions of a hypertensive crisis?

A

REQUIRE HOSPITILIZATION and administration of an IV antihypertensive as well as intensive monitoring

54
Q

diagnostic assesment for HTN

A

· Hx and physical examination, including an ophthalmic examination
· Fasting blood glucose
· Routine urinalysis
· Basic metabolic panel with eGFR
· CBC
· Serum lipid profile (total lipids, triglycerides, HDL and LDL cholesterol, total to HDL cholesterol ratio)
· Serum uric acid, calcium and magnesium
12-lead ECG

55
Q

nursing management for HTN

A

· Periodic BP monitoring
· Nutritional therapy
· Regular, moderate physical activity
· Tobacco cessation
· Moderation of alcohol intake
· Stress management techniques
· Antihypertensive drugs

56
Q

nutritional therapy for HTN

A

o DASH diet
o Restrict salt and sodium
o Restrict cholesterol and saturated fats
o Maintain adequate intake of potassium and calcium
o Weight management

57
Q

when teaching BP monitoring at home, when shoould the nurse instruct the client to take their BP

A

monitor first thing in the morning and before bed

58
Q

white coat hypertension

A

· some patients have elevated BP readings in clinical settings

59
Q

DASH eating plan

A

Fruits, vegetables, fat-free or low-fat milk, whole grains, fish, poultry, beans, seeds, and nuts

60
Q

in patients with HTN what shoud sodium be restricted to?

A

2300mg/day or less

61
Q

what are foods high in sodium that should be avoided

A

o Bread products
o Lunch meat and cured meats
o Pizza
o Soup (canned products)
o Sandwiches
o Poultry

62
Q

why should clients be taught to read labels of packages

A

food labels as well as OTC medications can contain sodium

63
Q

physical activity and HTN

A

· Perform moderate intensity aerobic physically active for at least 30 minutes most days with a goal of at least 150 minutes per week

64
Q

what is the most common side effect of antihypertensive drugs and what needs to be taught about it

A

· ORTHOSTATIC HYPOTENSION
o Patient may feel dizzy and faint when sitting up so tell them to rise slowly to avoid falls

65
Q

what are some things to teach a client about the side effects of diuretics

A

Diuretics cause dry mouth and frequent voiding
o Sugarless gum or hard candy can help with dry mouth
o Taking diuretics in the morning may limit voiding during the night and preserve sleep
May need to supplement potassium, or avoid depending on the type of diuretic

66
Q

assessment for CAD

A

· Identifying high risk persons (smoking, obese/overweight, high cholesterol, sedentary lifestyle, poor diet, diabetes, family Hx)
· PQRST Assessment of Angina
· Assess lipid panels

67
Q

Precipitating factors to angina

A

o Physical exertion
o Temperature extremes
o Strong emotions
o Consumption if a heavy meal
o Tobacco use and environmental tobacco exposure
o Sexual activity
o Stimulants
o Circadian rhythm patterns

68
Q

clinical manifestaions of CAD

A

· Usually asymptomatic in the early stage
· Chest pain with activity “HEAVINESS” (stable angina)
· Can progress to unstable angina: pain at rest
Lethargic/tired/run down

69
Q

Blood tests: lipoprotein profile for CAD

A

o LDL (>130 mg/dL)
o HDL (<40mg/dL)
o Total Cholesterol (>200mg/dL)
o Triglycerides (>150 mg/dL)

70
Q

what is the gold standard diagnosic study for CAD

A

cardiac/heart catheterization

71
Q

if something is found during cardiac catheterization, what is done next

A

coronary revascularization with percutaneous coronary intervention may be done
o This is where a deflated balloon tip is inserted into the blocked coronary artery then inflated to compress the plaque against the artery wall, a stent is also usually placed
Also known asballoon angioplasty

72
Q

health promoting behaviros for CAD

A

· Hypertension
· High serum lipids
· Tobacco use
· Physical Inactivity
· Psychologic state
· Obesity
· Diabetes

73
Q

FITT Activity Guidelines (CAD)

A

o Perform mild stretching for 3-5 minutes before and after activity
o Perform physical activity most days of the week
o HR determines the activity intensity; if patient is recovering from an MI their HR should not exceed 20 bpm
o Select regular, rhythmic, repetitive activity that uses large muscles to build up endurance (walking, swimming, rowing, cycling)
Session should be at lease 30 minutes long

NSG 320 - MED SURG (63 decks)

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