Week 1 part 2Chapter 23: Management of Patients with Coronary Vascular Disorders Flashcards
Coronary Atherosclerosis
Atherosclerosis is the abnormal accumulation of lipid
deposits and fibrous tissue within arterial walls and
lumen
In coronary atherosclerosis, blockages and
narrowing of the coronary vessels reduce blood flow
to the myocardium
Cardiovascular disease is the leading cause of death
in the United States for men and women of all racial
and ethnic groups
Coronary artery disease (CAD) is the most prevalent
cardiovascular disease in adults
Clinical Manifestations of Atherosclerosis
Symptoms are caused by myocardial ischemia
Symptoms and complications are related to the
location and degree of vessel obstruction
Angina pectoris (most common manifestation)
Other symptoms: epigastric distress, pain that
radiates to jaw or left arm, SOB, atypical symptoms
in women
Myocardial infarction
Heart failure
Sudden cardiac death
Risk Factors for Coronary Artery Disease
(CAD)
Refer to Chart 23-1
o Four modifiable risk factors cited as major
(cholesterol abnormalities, tobacco use, HTN,
and diabetes)
Elevated LDL: primary target for cholesterol-
lowering medication
Framingham risk calculator
Metabolic syndrome
hs-CRP (high-sensitivity C-reactive protein)
Prevention of CAD
Control cholesterol
Dietary measures
Physical activity
Medications
Cessation of tobacco use
Manage HTN
Control diabetes
Cholesterol Medications
Six types of lipid-lowering agents: affect the lipid
components somewhat differently (Table 23-1)
o 3-Hydroxy-3-methylglutaryl coenzyme A (HMG-
CoA) (or statins)
o Nicotinic acids
o Fibric acids (or fibrates)
o Bile acid sequestrants (or resins)
o Cholesterol absorption inhibitors
o Omega-3 acid-ethyl esters
Angina Pectoris
A syndrome characterized by episodes or
paroxysmal pain or pressure in the anterior chest
caused by insufficient coronary blood flow
Physical exertion or emotional stress increases
myocardial oxygen demand, and the coronary
vessels are unable to supply sufficient blood flow to
meet the oxygen demand
Types of angina
o Refer to Chart 23-2
Assessment and Findings for Angina
Assessment and Findings for Angina
May be described as tightness, choking, or a heavy
sensation
Frequently retrosternal and may radiate to neck,
jaw, shoulders, back or arms (usually left)
Anxiety frequently accompanies the pain
Other symptoms may occur: dyspnea or shortness
of breath, dizziness, nausea, and vomiting
The pain of typical angina subsides with rest or NTG
Unstable angina is characterized by increased
frequency and severity and is not relieved by rest
and NTG. Requires medical intervention!
Gerontologic Considerations for Angina
Diminished pain transition that occurs with aging
may affect presentation of symptoms
“Silent” CAD
Teach older adults to recognize their “chest pain–
like” symptoms (i.e., weakness)
Pharmacologic stress testing; cardiac catheterization
Medications should be used cautiously!
Treatment of Angina Pectoris
Treatment seeks to decrease myocardial oxygen
demand and increase oxygen supply
Medications
Oxygen
Reduce and control risk factors
Reperfusion therapy may also be done
Medications for Angina
Nitroglycerin
Beta-adrenergic blocking agents
Calcium channel blocking agents
Antiplatelet and anticoagulant medications
Aspirin
Clopidogrel and ticlopidine
Heparin
Glycoprotein IIb/IIIa agents
Acute Coronary Syndrome (ACS) and
Myocardial Infarction (MI)
Emergent situation
Characterized by an acute onset of myocardial
ischemia that results in myocardial death (i.e., MI) if
definitive interventions do not occur promptly
Although the terms coronary occlusion, heart attack,
and MI are used synonymously, the preferred term
is MI
Assessment of the Patient with Angina
Pectoris
Symptoms and activities, especially those that
precede and precipitate attacks (Chart 23-4)
Risk factors, lifestyle, and health promotion
activities
Patient and family knowledge
Adherence to the plan of care
Collaborative Problems of the Patient with
Angina Pectoris
ACS, MI, or both
Arrhythmias and cardiac arrest (see Chapters 22
and 25)
Heart failure (see Chapter 25)
Cardiogenic shock (see Chapter 11)
Planning and Goals for the Patient with
Angina Pectoris
Goals
o Immediate and appropriate treatment of angina
o Prevention of angina
o Reduction of anxiety
o Awareness of the disease process
o Understanding of prescribed care and adherence
to the self-care program
o Absence of complications
Nursing Interventions for the Patient with
Angina Pectoris
Treat angina
Reduce anxiety
Prevent pain
Educate patients about self-care
Continuing care
Nursing Intervention: Treat Angina
Priority
Patient is to stop all activities and sit or rest in bed
(semi-Fowler positioning)
Assess the patient while performing other necessary
interventions. Assessment includes VS, observation
for respiratory distress, and assessment of pain. In
the hospital setting, the ECG is assessed or obtained
Administer medications as ordered or by protocol,
usually NTG. Reassess pain and administer NTG up
to three doses
Administer oxygen 2 L/min by nasal cannula
Nursing Intervention: Reduce Anxiety
Use a calm manner
Stress-reduction techniques
Patient teaching
Addressing patient’s spiritual needs may assist in
allaying anxieties
Address both patient and family needs
Nursing Intervention: Preventing Pain
Identify level of activity that causes patient’s
prodromal S&S
Plan activities accordingly
Alternate activities with rest periods
Educate patient and family
Nursing Intervention: Patient Teaching #1
Balance activity with rest
Follow prescribed exercise regimen
Avoid exercising in extreme temperatures
Use resources for emotional support (counselor)
Avoid over-the-counter medications that may
increase HR or BP before consulting with health care
provider
Stop using tobacco products (nicotine increases HR
and BP)
Diet low in fat and high in fiber
Nursing Intervention: Patient Teaching #2
Medication teaching (carry NTG at all times!)
Follow up with health care provider
Report increase in S&S to provider
Maintain normal BP and blood glucose levels
