Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

NURS362 - Practice of Nursing III > Week 12: Coronary Vascular Disorders, Atherosclerosis, Angina, MI > Flashcards

Week 12: Coronary Vascular Disorders, Atherosclerosis, Angina, MI Flashcards

1
Q

Flow of Blood from Heart to Body

A

IVC/SVC –> RA –> Tricuspid –> RV –> Pulmonary Valve –> Lungs –> LA –> Mitral Valve –> LV –> Aortic Valve –> Aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Main Coronary Arteries

A

RCA - Right Coronary Artery

Left Main Coronary Artery (LCA)

a. Left Circumflex Artery (LCx)
b. LAD - left anterior descending coronary artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

LAD

A

Left Anterior Descending Artery

Called the Widowmaker

Supplies so much blood to the left side of the heart that an acute change can cause death quickly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

RCA

A

Right Coronary Artery

Can cause a lot of heart rate issues, so a patient with a low 50s HR would not necessarily mean anything bad it may mean they have bradycardic symptoms from RCA problems (d/t inactivity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Leading Cause of US Death is

A

Heart Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

CAD

A

Coronary Artery Disease

Buildup of plaque in coronary arteries - plaque buildup in the walls of coronary arteries

Blocks flow and is often unnoticed until the blockage is more than 70%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What makes up the plaque in CAD

A

Usually lipids, other fatty substances, fibrous material

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What % of blockage of coronary arteries does it take to lead to symptoms being seen?

A

70% minimum usually

Could be 90-100% because of collateral circulation though

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does CAD differ in Men compared to Women

A

CAD manifests 10-15 years sooner

Initial cardiac event is more often an MI than angina

Higher incidence of LVH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does CAD differ in Women compared to Men

A

CAD causes more death in women

Initial cardiac event more likely to be angina than MI

Complain of palpitations more frequently than men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

LVH

A

Left ventricular hypertrophy

thicker musculature and hypertrophy of the heart causing it to get bigger and it tries to pump more blood - but it keeps getting bigger and lessens how efficient it is

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Non Modifiable Risk Factors for CAD

A

Age

Gender

Ethnicity

Genetics and Family Hx - high risk for CAD and MI if in nuclear family

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the gender disparity with CAD

A

men > women until age 60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the ethnicity disparity of CAD

A

AA > Caucasian

South Asian High - Japanese Low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Modifiable risk factors for CAD

A

serum lipids

HTN

tobacco

physical inactivity

obesity - waist circumference and BMI

also watch persons with DM, fasting BS > 100, psychological states

elements of metabolic syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the 3 most common risk factors for CAD that 9/10 patients have

A

HTN

Hyperlipidemia

Obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Nursing Management of CAD Risk Factors

A

Health promotion - ID high risk people through risk screening and work on modifiable factors with lifestyle changes

Physical activity

nutritional therapy - lower LDL cholesterol

cholesterol lowering drug therapy

anti platelet therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

FITT Formula of Physical Activity to counteract CAD

A

FITT Formula = Frequency, Intensity, Type, Time

Moderate exercise 30 min/day on 5 or more days/week - brisk walking, hikin, biking, swimming

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does following the FITT Formula lead to

A

Contributes to weight reduction, 10% drop in SBP, diabetics - better blood glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Nutrition education for CAD emphasizes what things

A

Decrease Sat Fat, Cholesterol, Red meat, eggs, whole milk products, alcohol, simple sugars

Increase Complex Carbs (whole grain, fruit, vegis) and Omega 3 FA

Fat intake 30% of calories - good oils (olive, canola)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What should be done if a patient with CAD has elevated serum triglycerides

A

alcohol intake and simple sugars should be reduced or eliminated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Where to get Omega 3 Fatty Acids

A

Eating fatty fish 2x a week - salmon and tuna

tofu, soybean, canola, walnuts, flaxseed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Angina

A

chest pain or pressure resulting from myocardial ischemia (reflects imbalance between cardiac oxygen demand and supply)

Directly related to myocardial ischemia - but not all chest pain is this (could be eating too much, gas, or somatic pain)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Types of Angina

A

Stable

Unstable

Intractable or Refractory

Variant (Prinzmetal’s Angina)

Silent Ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Stable Angina
predictable, manageable episodes of chest pain Relieved with rest and/or nitroglycerin occurs with exercise
26
Unstable Angina
unpredictable occurs when resting or with minimal activity or at varying levels occurs with increasing frequency, duration, and severity needs further workup and tx comes and goes randomly
27
Interventions for Stable Angina Acute Episodes
stop all ativity and sit or rest in bed Assess patient - VS including O2 sat, resp distress, assess pain, pain, diaphoresis?, sudden LOC change Administer supp. O2 12 lead EKG pain assessment and relief - nitrate then opioid auscultate heart sounds
28
Unstable Angina has a high risk for...
Myocardial infarction
29
Prinzmetal;s Angina
occurs at night in clusters from artery spasms
30
Refractory Angina
Reoccurs despite treatment
31
Silent Angina
No s/s no chest pain but myocardial ischemia is occurring! Tests pick up ischemia affecting heart and perfusion
32
Acute Coronary Syndrome (ACS)
Prolonged ischemia that causes DAMAGE to the heart! An umbrella term for damage to the heart from ischemia
33
3 categories of ACS
unstable angina STEMI NSTEMI
34
STEMI
ACS Complete occlusion of coronary vessel(s) ST elevation on EKG
35
NSTEMI
ACS partial occlusion of coronary vessel(s) No ST Elevation, but other EKG changes are possible
36
In what ways are STEMI and NSTEMI similar
similar clinical manifestations (c/p, SOB, DOE) similar diagnostic study cahnges (CK, troponin)
37
The big differece between STEMI and NSTEMI
STEMI has ST Elevation while NSTEMI does not but can have other EKG changes
38
Creatinine Kinase (CK)
non specific marker for ischemia and inflammation elevation does NOT necessarily mean something cardiac is occurring, but may signift inflammation or ischemia occurring somewhere else too
39
What is teh gold standard diagnostic lab for cardiac studies
Troponin
40
Troponin
elevation in this substance can indicate dx of MI gold standard marker for cardiac
41
A 53 year old male presents to the ED with complaints of 4/10 chest pain, which was previously 7/10. His vital signs are stable. What of these is the first action that the nurse should perform? A. Start nitroglycerin drip B. Obtain an EKG C. Notify Physician D. Obtain Height and Weight of Patient
B. Obtain an EKG
42
What is an EKG a good pic of
A good 3D pic in a 2D format of the blood vessels and such
43
What EKG change likely indicates an MI
ST Elevation They are probably also going through chest pain, SOB, or maybe just a little of it but this EKG change is still occurring *Intervene and let physician know ASAP
44
Clinical Signs of an MI
chest pain - not relieved by rest or position changes heaviness, pressure, tightening radiation to neck, jaw, arm, back irregular heart beat SOB skin - clammy, cool, ashen, diaphoretic BP and HR elevated initially but later may drop crackles in lungs extra heart sounds NV Fever (100.4-102.2F) Elderly or DM pts may not have severe or any chest pain R Side Problem - jugular vein distention *Presentation depends on gender too*
45
What is the gender differences for MIs
MI PRESENTATION MAY BE DIFFERENT IN WOMEN!!! ``` >severe SOB > pain in abdomen > NV >Profound weakness/fatigue >anxiety and feeling "unwell" >Sweating ```
46
How Does the non specific CK marker move after an MI
rises 12 hours after MI and peaks at 24 hours, but returns to normal in 2-3 days
47
Troponin (T or I) is a ...
myocardial muscle protein released after myocardial injury and raises faster than CK-MB
48
What are the levels of Troponin to know
<0.4 = normal 0.4-1.49 = ischemia >1.49 = Acute MI
49
M.O.N.A.
Nursing interventions of ACS and MI: Morphine (for pain) Oxygen (2-4 L) Nitroglycerin (dilate venous system) Aspirin (prevent clot)
50
Nursing Interventions for MI and ACS
Pain relief VS/EKG Monitoring (PVCs and PACs) Check K, Mg levels (want above 4 and below 2 respectively) BLS/ACLS protocol
51
Emergent Percutaneous Coronary Intervention
Cardiac Catheterization Goal to open affect artery within 90 minutes of pain onset and 60 minutes of arrival to ED A balloon is inserted to open or a stent
52
Fibrinolytic Therapy
tPa or streptokinase Used with STEMIs but the gold standard is cardiac catheter Aims to stop infarction process by dissolving the thrombus in the coronary artery (ASA/Plavix)
53
Indications to Use Fibrinolytic Therapy
Chest Pain > 20 minute duration that is unrelieved by nitroglycerin ST segment elevation in at least 2 leads that view the same part of the heart Less than 6 hours from symptom onset
54
Contraindications of Fibrinolytic Therapy
active bleeding, hx of bleeding hx of hemorrhagic stroke, intracranial vessel malformation uncontrolled HTN pregnancy GI bleed recent trauma, CPR, or surgery
55
What is important to be aware of following fibrinolytic therapy
Reperfusion Injury - Myocardial Stunning/Arrhythmia
56
Myocardial Stunning
Arrhythmias from ischemic heart areas being irritated after reperfusion
57
Nursing INterventions for Fibrinolytic Therapy
Watch for s/s of bleeding frequent VS LOC change bruising bleeding from mouth, nose, rectum, urine be aware of increased bleeding times with any invasive procedure (IV insertion, bleed tests)
58
What is the EBP on aspiring/beta blockers and MI care
These two are preferred and should be given on arrival to the ER or within 24 hours of admission and Rx on discharge
59
EBP states that PCI (Cardiac Cath) should occur when?
Within 60 minutes of arrival for MIs with ST elevation
60
What does EBP say on MI care and ACEI/ARB Drugs
Rx on discharge for LVSD (left ventricular systolic dysfunction) as it lowers the EF <40%
61
EBP shows that patients undergoing MI care should undergo what counseling
smoking cessation
62
What is the best EBP to do after someone refuses MI Care and you cannot follow protocol
Any rational (contraindication) for not following the protocol for MI care msut be clearly documented in the patients progress notes
63
Surgical and non Surgical Therapies for ACS
LHC (L Heart Catheterization) - Carc Cath Gold Standard PCI - Percutaneous Coronary interventions (LHC is a type of this as is RHC) CABG - coronary artery bypass graph
64
Stent Placement
occurs with an angiogram a mesh screen is place across a lesioned vessel and opened up with a balloon and keeps the vessel dilated and oepn
65
What nursing care aspects are done post-PCI
bed rest watch for bleeding watch for chest pain and VS changes anticoagulation tx note lyte levels and potential PACs that are normal post reperfusion do not get them out of bed just yet
66
PCI Complications
Coronary Dissection Complete Occlusion MI
67
What % of PCIs restenose in 3-6 months post procedure
25-35% *at max may last 5-10 years before needing to address again*
68
Coronary Dissection
rare post PCI complication catheter punctures a coronary vessel medical emergency
69
What needs to be done if theres a complete occlusion again post PCI
the stent cannot make the vessel patent alone so cardiac surgery with a more invasive approach must be done
70
CABG
coronary artery bypass grafts surgical treatment for CAD that is done after trying to open with PCI balloon and stents priorly and it did not work diagnosis is done by a cardiac cath, LHC is determined diagnostic for CABG and PCI wont work
71
How big are the lesions/occlusions to do a CABG at minimum
70% but often its 90-100% before this is done
72
CPB - Cardiopulmonary Bypass
Machine - the heart outside the body takes the heart blod oxygenates it, and returns it via another catheter at a rate similar to that which teh heart pumps The heart/lungs are stopped during invasive surgery and this takes over
73
What stops the heart to let the CPB take over
A high level of potassium
74
Complications of Longer Use of CPB
coagulopathy (have to give with anticoagulants) pneumonia prolonged mechanical ventilation prolonged ICU stay increased risk of mortality "pump head"
75
Why can pneumonia occur from CPB
laying in one position between 4-8 hours and while on a ventilator also some procedures have an ET tube further down than the carina in the right lung while the left lung is completely decompressed
76
Pump Head
patients with excess of 3,4,5 hours in bypass surgeyr have higher incidence of ICU delirium They are confused, agitated, and need monitoring for a while to get back to previous neurological function
77
Cardioplesia
Potassium amount that stops the heart
78
Off Pump CABG
No CPB used, surgery is done with heart still beating Less 'Complete" revascularization fewer complications than on pump
79
What is the big restriction on off pump CABG
it can only be done on certain vessels it cannot replace the left circumflex before of where it is in positioning but something on the front of the heart could be replaced like this
80
What are some benefits of off pump CABG compared to CABG
less bleeding shorter ICU stay less time on mechanical ventilation
81
Post-Op Care of the Cardiac Surgical Patient involves..
maintain MAP goal Manage resp status, ventilator settings Maintain chest tube patency Monitor urine output Replace Lytes monitor renal fxn, fluid status assess rhythm changes assess neurological status treat pain incentive spirometer early mobility - work with PT and OT - important for lungs, bowels, and such
82
What are some less invasive surgical interventions for cardiac
MIDCABG - minimally invasive direct coronary bypass surgery Robotic CABG
83
MIDCABG
minimally invasive direct coronary bypass surgery instead of 4-5 incisions midline for open heart surgery - only a 1-2 inch incision in the rib side is done it is for vessels easier to access and only 1-2 vessels rather than 3-4 of them
84
Robotic CABG
Use of Davinci Machines Instead of 4-8 hours only takes 1-3 hours Less complications and patients do so well they may even be off unit in 1-2 days
85
Education topics for Post Cardiac Event Discharge
Physical Activity (How to take pulse rate, static v isotonic activities, cardiac rehab program referral) Avoid heavy things and exercise immediately post op for at least a week Self concept teaching 3-4 days of torture for 10+ years of QOL Diet No Smoking When to call doctor S/s of common complications of angina, MI, postprocedural Most have better QOL post procedureally than prior to event
86
A patient presents to teh ED with 5/10 chest pain... HR 122 BP 124/62 Temp 36.8 C SpO2 98% Why could the nurse anticipate any of the following? a. the patients life is in danger immeidately prepare for cath lab transfer b. nothing; pt is stable and can be sent home c. the patient needs to be admitted to the telemetry floor for closer monitoring d. the patient needs open heart surgery
WITH MORE INFO: A. if ST elevation, EKG in multiple Leads ST elevation, diaphoresis, 5/10 CP from nitro while its usually 9/10 then this could be right B. eating too much, gas, exercise, etc could cause this C. Troponin of 7, CP before, Troponin elevated but stable VS - does not have to be an emergency necessarily right now D. Not something ascertained in the ED - but is done after A if it failed
87
A 60 year-old male client comes into the emergency department with a complaint of crushing 10/10 substernal chest pain that radiates to is left arm and shoulder. The admitting diagnosis is acute myocardial infarction (AMI). Immediate admission orders include: Oxygen @4L/min via nasal cannula, blood work, 12 lead EKG, chest radiograph, and 2 mg morphine sulfate given IV. The nurse should first: 1. administer the morphine 2. obtain the 12 lead EKG 3. obtain the blood work 4. order the chest x-ray
1.Administer Morphine
88
A client had driven himself to the emergency department. He is 50 years old, has a history of hypertension, and informs the nurse that his father died from a heart attack at age 60. The client is presently complaining of indigestion. The nurse connects him to the EKG monitor and begins administering oxygen at 2L/min via nasal cannula. The nurse’s next action would be: A. call the physician B. start an IV line C. obtain a 12 lead EKG D. draw blood for lab studies
B. start an IV line Fmaily hx, pt first, might be complaining of indigestion or an MI - have IV ready just incase
89
When monitoring a client who is receiving tissue plasminogen activator (t-Pa), the nurse understands that it is important to monitor vital signs and have resuscitation equipment available because reperfusion of the cardiac muscle can result in which of the following? A. Cardiac Arrhythmias B. hypotension C. seizure D. HTN E. Hyperthermia
A. Cardiac Arrhythmias

NURS362 - Practice of Nursing III (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions