Topic 4: CAD, Chronic Stable Angina, HTN Flashcards
perfusion
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.
oxygenation
The process of delivering oxygen to the blood by diffusion from the alveoli following inhalation into the lungs.
coronary artery disease
atherosclerosis of the coronary arteries that reduces the blood supply to the heart muscle
Stages of Atherosclerosis
- Endothelial injury
- Fatty streak
- Fibrous plaque
- Complicated lesion (thrombus formation)
collateral circulation
circulation formed by smaller blood vessels branching off from or near larger, occluded blood vessels
Nonmodifiable risk factors for CAD
Age
Gender
Ethnicity
Family history
Genetic predisposition
Modifiable risk factors for CAD
Smoking, HTN, DM, obesity, diet, activity level, hyperlipidemia
angina
chest pain; caused by either an increased demand for oxygen or a decreased supply of oxygen.
chronic stable angina
*Intermittent chest pain that occurs over a long period with same pattern of onset, duration, and intensity of symptoms
chronic stable angina EKG
*ST segment depression and/or T-wave inversion
how do patients oftern describe chronic stable angina as
pressure, heaviness, or discomfort in the chest. squeezing, heavy, tight, or suffocating sensation
what is chronic stable angina often provoked by
*physical exertion, stress, or emotional upset
chonic stable
*with exercise or when stress happens, relieved with rest or nitroglycerin
Prinzmetal’s Angina (variant angina)
*occurs anytime, including at rest - caused by coronary artery spasms
Microvascular angina
*distal coronary arteries, ADLs, more common in women
unstable angina
*rupture of plaque, with exercise or rest, increases with severity/frequency/duration over time, not relieved with rest/nitro, lasts longer than 10 min
If Angina is not treated promptly, it can progress into a
myocardial infarction
what are the common locations and patternd of angina and MI
-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.
what will the client complain of with angina and MI
-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
lab tests for MI/angina
Myoglobin
CK-MB
Troponins
Lipids
CBC, BMP, CRP
ECG
coagulation labs
(PT/INR, aPTT) - the amount of time it takes for different parts of the clotting system to form a clot.
cardiac enzymes labs
(CK-MBs, Troponins, BNP) - enzyme(s) excreted by the heart when it’s in distress
lipid panel
(Cholesterol, Triglycerides, HDL, LDL) - measures the different types of fat that float around in our blood
digoxin level labs
this measures the amount of a medication, Digoxin, that is in the blood to determine if the amount is too high or too low
D-dimer labs
this measures fragments of fibrin that are left over after a clot has formed
CRP labs
C Reactive Protein tells us about inflammation in general
What medication affects the aPTT lab value?
heparin
What is the antidote to heparin?
protamine sulfate
What medication affects the PT/INR lab value?
warfarin
What is the antidote to warfarin?
Vitamin K
diagnostic test for MI/anigna
Chest x-ray
12-lead ECG
Laboratory studies
Echocardiogram
Exercise stress test
ONA-M (MI)
*Oxygenation
*Nitroglycerin tablets sublingual (0.4mg Q15 SL Q5min X 3 doses)
*Aspirin 81mg up to 325mg
*Morphine
acute interventions for MI
vitals Q5min, PQRST for pain assessment, LOC, O2 administration, IV access, energy conservation, anxiety management, cardiac monitor, ECGs, blood work, urine output
A, B, C, D, E, F Chronic Management Interventions:
-smoking cessation,
-HTN control
-lower cholesterol/triglycerides if elevated
-diet low in saturated fat and salt
-regular physical activity
drug therapy for CAD/angina
*Antiplatelets
*Nitrates
*ACE inhibitors, ARBS, Beta-Blockers, Calcium Channel blockers
*Lipid-lowering drugs
coronary revascularization
*Percutaneous coronary intervention (PCI)
*Coronary artery bypass graft surgery (CABG)
Percutaneous coronary intervention (PCI)
balloon-tipped catheter is inserted into a coronary artery to open the artery; stents are put in place
how do you prepare someone for a PCI?
*Client is NPO
*Premedication
*Consent for the procedure
*Nursing assessment
what does the nurse do after a PCI?
*Vital signs
*Surgical site assessment
*Bedrest and movement
complications from PCI
-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
client teaching after PCI
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
normal BP
<120/<80
elevated BP
120-129/<80
HTN stage 1
130-139/80-89
HTN stage 2
> 140/>90
hypertension
BP is greater than 140/90 mmHg
primary HTN
no known cause
Secondary HTN
cause is often identified & treatable
Hypertension Clinical Manifestations
- Frequently asymptomatic until it becomes severe and target organ disease has occurred
- Fatigue, reduced activity tolerance
- Dizziness
- Palpitations, angina
- Dyspnea
what are some nursing interventions for HTN
-Lifestyle Modifications
-Weight Reduction
-DASH Eating Plan
-Dietary Sodium Reduction
-Moderation of Alcohol Intake
-Physical Activity
-Avoiding Tobacco Products
*Nursing Management for Primary Hypertension
*Health Promotion
*Screening Programs
*Cardiovascular Risk Factor Modification
*Ambulatory Care
*Home BP Monitoring
*Client Adherence
Hypertensive crisis symptoms
severe headaches, · Sudden rise in BP associate, N/V, seizures, confusion, coma, dyspnea, anxiety, and nosebleeds
what are the interventions of a hypertensive crisis?
REQUIRE HOSPITILIZATION and administration of an IV antihypertensive as well as intensive monitoring
diagnostic assesment for HTN
· 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
nursing management for HTN
· Periodic BP monitoring
· Nutritional therapy
· Regular, moderate physical activity
· Tobacco cessation
· Moderation of alcohol intake
· Stress management techniques
· Antihypertensive drugs
nutritional therapy for HTN
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
when teaching BP monitoring at home, when shoould the nurse instruct the client to take their BP
monitor first thing in the morning and before bed
white coat hypertension
· some patients have elevated BP readings in clinical settings
DASH eating plan
Fruits, vegetables, fat-free or low-fat milk, whole grains, fish, poultry, beans, seeds, and nuts
in patients with HTN what shoud sodium be restricted to?
2300mg/day or less
what are foods high in sodium that should be avoided
o Bread products
o Lunch meat and cured meats
o Pizza
o Soup (canned products)
o Sandwiches
o Poultry
why should clients be taught to read labels of packages
food labels as well as OTC medications can contain sodium
physical activity and HTN
· Perform moderate intensity aerobic physically active for at least 30 minutes most days with a goal of at least 150 minutes per week
what is the most common side effect of antihypertensive drugs and what needs to be taught about it
· ORTHOSTATIC HYPOTENSION
o Patient may feel dizzy and faint when sitting up so tell them to rise slowly to avoid falls
what are some things to teach a client about the side effects of diuretics
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
assessment for CAD
· Identifying high risk persons (smoking, obese/overweight, high cholesterol, sedentary lifestyle, poor diet, diabetes, family Hx)
· PQRST Assessment of Angina
· Assess lipid panels
Precipitating factors to angina
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
clinical manifestaions of CAD
· 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
Blood tests: lipoprotein profile for CAD
o LDL (>130 mg/dL)
o HDL (<40mg/dL)
o Total Cholesterol (>200mg/dL)
o Triglycerides (>150 mg/dL)
what is the gold standard diagnosic study for CAD
cardiac/heart catheterization
if something is found during cardiac catheterization, what is done next
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
health promoting behaviros for CAD
· Hypertension
· High serum lipids
· Tobacco use
· Physical Inactivity
· Psychologic state
· Obesity
· Diabetes
FITT Activity Guidelines (CAD)
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
