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NURS 3512 - Class 1-6 > Week 3 - Coronary Artery Disease > Flashcards

Week 3 - Coronary Artery Disease Flashcards

1
Q

what is CAD

A
  • type of blood vessel disorders included in the general category of atherosclerosis
    = blockage of blood flow to heart muscle
  • causing reduced flow of O2 and nutrients to the myocardium
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2
Q

what is the major cause of CAD`

A
  • atherosclerosis
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3
Q

what type of disease is CAD

A
  • progressive –> takes years to develop
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4
Q

what causes atherosclerosis

A
  • complex interactions between the components of the blood and elements hat form the vascular wall
  • inflammation and endothelial injury play big role
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5
Q

what can cause damage to the endothelial lining (5)

A
  • tobacco use
  • hyperlipidemia
  • HTN
  • DM
  • infection
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6
Q

what is a nonspecific marker of inflammation? how is this impacted during CAD

A

CRP

- increased in pts with CAD

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7
Q

what are 2 categories of risk factors for CAD

A
  1. modifiable

2 nonmodifiable

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8
Q

what are examples of modificable factors of CAD (9)

A
  • elevated serum lipid lvls (cholestrol, triglyceride, LDL)
  • HTN
  • tobacco & substance use
  • physical inactivity
  • obesity
  • DM
  • metabolic syndrome
  • psychological states (depression, stress, anger)
  • elevated homocysteine lvl
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9
Q

what are examples of nonmodifable factors of CAD (5)

A
  • age
  • sex (men > women until 65 years of age)
  • ethnicity (more common in white)
  • genetic predisposition
  • FHx of heart disease
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10
Q

what is homocysteine

A
  • produced by the breakdown of an amino acid found in dietary protein
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11
Q

what is imp to prevent, modify, or slow down the progression of CAD

A
  • appropriate management of risk factors in CAD
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12
Q

describe health promotion r/t CAD

A
  • individuals w risk factors should be encouraged to make changes in their lifestyle tp reduce the risk of heart disease
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13
Q

what can be done to reduce the risk factor HTN for CAD (6)

A
  • regular BP checkups
  • take prescribed BP meds
  • reduce salt
  • stop/never smoking
  • control or reduce weight
  • exercise regularly
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14
Q

what can be done to reduce the risk factor elevated serum lipids for CAD (5)

A
  • reduce total fat intake
  • reduce animal (sat) fat intake
  • adjust caloric intake to maintain ideal body weight
  • exercise
  • increase amt of vegetable proteins and complex carbs in diet
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15
Q

what can be done to reduce the risk factor of smoking for CAD (4)

A
  • enroll in programs to stop
  • change daily routines associated w smoking to reduce desire to smoke
  • substitute other activities for smoking
  • ask family members for support to quit
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16
Q

what can be done to reduce the risk factor of physical inactivity for CAD (3)

A
  • develop & maintain routine for physical activity
  • exercise 3-4 x/week
  • increase actviites to a lvl compatible w physical fitness
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17
Q

what can be done to reduce the risk factor of a stressful lifestyle for CAD (8)

A
  • increase awareness of behaviors detrimental to health
  • alter pattern that cause stress & rushing (ex. get up 30 min earlier)
  • set realistic goals for self
  • reassess priorities in view of health needs
  • learn effective coping strategies
  • avoid excessive & prolonged stress
  • meditate 20min /day
  • plan time for sleep and rest
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18
Q

what can be done to reduce the risk factor of obesity for CAD (5)

A
  • change eating patterns and habits
  • reduce caloric intake
  • exercise regularly to increase calorie expenditure
  • avoid fad and crash diets
  • avoid large, heavy meals
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19
Q

what can be done to reduce the risk factor of DM for CAD (4)

A
  • follow recommended diet
  • reduce weight
  • control diet
  • monitor BG regularly
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20
Q

what nutritional therapy is used for CAD (6)

A
  • decrease sat fat, most fats from monounsat fats
  • reduce/eliminate alcohol
  • omega 3 FA
  • high fibre
  • decrease cholestrol
  • increase complex carbs
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21
Q

what are examples of complex carbs (3)

A
  • whole grains
  • fruit
  • veggies
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22
Q

what are main sources of sat fats (3)

A
  • red meats
  • eggs
  • whole milk
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23
Q

what is a good source of omega3 fatty acids

A
  • fatty fish 2x/week
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24
Q

what is included in treatment of CAD (4)

A
  • treat HTN & DM
  • lifestyle changes (diet, exercise, no tobacco)
  • primary care: yearly appt for physical and diagnostic tests
  • meds
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25
Q

what kind of meds are used in treatment of CAD (2)

A
  • drugs that restrict lipoprotein production

- antiplatelet therapy

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26
Q

what does treatment of high cholestrol begin w (6)

A
  • smoking cessation
  • dietary caloric restriction
  • decreased dietary fat
  • decreased cholestrol intake
  • increased phys. activity
  • stress management
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27
Q

at what point are meds used to lower cholestrol

A
  • cholestrol lvls reassessed 6 mo. after diet therapy

- if remain elevated, then drug therapy may be started

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28
Q

what are the most widely used drugs to lower lipids

A

statins

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29
Q

what do statins do

A
  • inhibit synthesis of cholestrol
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30
Q

what are s/e of statins (3)

A
  • liver damage
  • myopathy
  • rhabdomyolysis
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31
Q

what should be monitored for a pt on statins (3)

A
  • liver enzymes
  • creatinine kinase
  • jaundice
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32
Q

what can CAD lead to ?

A
  • if atherosclerosis ruptures –> blood clot can form = blockage of coronary artery = MI
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33
Q

describe symptoms of CAD (3)

A
  • often asymptomatic for years
  • may develop chronic but stable chest pain
  • if the demand for myocardial O2 exceeds the ability of the coronary arteries to supply the heart w O2, get myocardial ischemia = angina
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34
Q

what is angina

A
  • chest pain

- the clinical manifestation of reversible myocardial ischemia

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35
Q

what can lead to myocardial ischemia

A
  • increased demand for O2

- decreased supply of O2

36
Q

what is the primary reason for insufficient blood flow

A
  • narrow of the coronary arteries r/t atherosclerosis
37
Q

how long does it take for the myocardium to become hypoxix

A
  • 10 seconds
38
Q

with total occlusion of the coronary arteries, how long does it take for contractility of the heart to stop

A
  • several minutes
39
Q

what does chronic, stable chest pain refer to

A
  • chest pain that occurs intermittently over a long period of time with the same pattern of onset & intensity of symptoms
40
Q

what does chronic stable angina feel like (6)

A
  • pressure/ache in chest
  • constrictive
  • squeezing
  • heavy
  • choking
  • suffocating sensation

NOT a sharp or stabbing pain

41
Q

how does angina change w position or breathing

A
  • it doesnt
42
Q

what other symptoms might be experienced w chronic stable angina (2)

A
  • indigestion

- burning sensation in epigastric region

43
Q

where might angina radiate to (5)

A
  • neck
  • jaw
  • shoulders
  • arms
  • between shoulder bladers
44
Q

describe onset of chronic stable angina (3)

A
  • brief (3-5 min)
  • subsides when precipiating factor is relieved
  • pain rare at rest
45
Q

what can decreased O2 supply (11)

A
  • anemia
  • hypoxemia
  • pneumonia
  • asthma
  • COPD
  • low blood vol
  • coronary artery spasm
  • coronary artery thrombosis
  • dysrhythmias
  • HF
  • valve disorders
46
Q

what can caused increased O2 demand or consumption (10)

A
  • anxiety
  • cocaine use
  • HTN
  • hyperthermia
  • hyperthyroidism
  • physical exertion
  • aortic stenosis
  • cardiomyopathy
  • dysrthytmias
  • tachycardia
47
Q

what does an ECG usually reveal during chronic stable angina

A
  • transient ST segment depression = indicative of ischemia

= NSTEMI

48
Q

what is important in assessment of angina (6)

A
  • Onset
  • Precipitating factor
  • Quality of pain
  • Radiation of pain
  • Severity of pain
  • Timing
49
Q

how is chronic stable angina controlled on an outpt basis

A
  • with meds
50
Q

describe med regime for a pt with chronic stable angina

A
  • bc episodes of chronic stable angina are predictable, meds can be timed to provide peak effects during the time of day when angina is likely
51
Q

what is the treatment of chronic stable angina aimed at (3)

A
  • decreasing O2 demand
  • increasing O2 supplu
  • or both
52
Q

what is used to treat chronic stable angina (8)

A
  • O2
  • reduce CAD risk factors
  • antiplatelet and cholestrol-lowering meds
  • short-acting nitrate therapy *first line tx)
  • long-acting nitrates
  • beta blockers
  • calcium channel blockers
  • ACE-I
53
Q

what is drug therapy for chronic stable angina aimed at

A
  • prevent MI/death

- reduce Sx

54
Q

how do nitrates produce their principal effects

A
  • dilate peripheral blood vessels

- dilate coronary arteries and collateral veins

55
Q

what does dilating peripheral blood vessels cause

A
  • decreased SVR
  • venous pooling
  • decreased venous blood return to heart
    = reduced cardiac workload = myocardial demand decreased
56
Q

what does dilating coronary arteries and collateral vessels cause

A
  • increased blood flow to ischemic area of heart
57
Q

what is a type of short-acting nitrate used for treatment of chronic stable angina

A
  • nitroglycerin
58
Q

how can nitro be adminstered (2)

A
  • sublingual

- translingual spray

59
Q

how quickly does nitro relieve angina? how long is its duration

A
  • in 3 min

- duration = 30-60 min

60
Q

what is the recommended dosage of nitro

A
  • 1 tablet sublingual

- or 1 metered spray

61
Q

describe how nitro is taken

A
  • take 1 dose (should last 30-60 min)
  • if symptoms unchanged or worse after 5 min, take another dose
  • if still not changed, take 3rd dose and call 911

no more than 3 doses in one episode

62
Q

what is important pt education regarding nitro (6)

A
  • place under tongue and let dissolve
  • spray under tongue
  • should cause a tingling sensation
  • store in dark glass bottle to protect from degradation
  • s/e: increased HR, headache, dizzy, flushing
  • caution against quickly standing d/t orthostatic hypotension
  • new supply every 6 mo. (lose potency once open)
  • take tylenol w nitrate for HA
  • nitrate holiday
63
Q

what are long acting nitrates used for

A
  • used to reduce incidence of anginal attacks
64
Q

what is the predominant s/e of nitrates

A
  • headache r/t dilation of cerebral blood vessels
65
Q

what is a nitrate holiday? what is the importance of this?

A
  • pts can become tolerate to nitro-induced vasodilation

- pts should schedule an 8-hr nitrate free period (usually at night) to avoid

66
Q

what are the preferrred drugs for management of chronic stable angina

A
  • beta blockers
67
Q

what is an example of a beta blockers used for management of chronic stable angina

A
  • metaprolol
68
Q

what effect do beta blockers have for management of chronic stable angina

A
  • decrease in myocardial contractility
  • decreased HR, SVR, BP
    = reduced myocardial O2 demand
69
Q

what are some s/e of beta blockers (7)

A
  • bradycardia
  • hypotension
  • wheezing
  • GI complaints
  • weight gain
  • depression
  • sexual dysfnxn
70
Q

who should beta blockers be avoided in (2)

A

pts with

  • asthma
  • diabetes (mask signs of hypoglycemia)
71
Q

when are calcium channel blockers used

A
  • if use of beta blockers are contraindicated, poorly tolerated, or not controlling anginal symptoms
72
Q

what is an example of a calcium channel blocker

A
  • amlopdipine
73
Q

what do calcium channel blockers do (4)

A
  • systemic vasodilation w decreased SVR
  • decreased myocardial contractility
  • coronary vasodilation
  • cause sm. muscle relaxation and vasodilation of coronary and systemic arteries = increased blood flow
74
Q

what med do calcium channel blockers impact? how?

A
  • potentiate the action of digoxin by increasing serum digoxin lvls
  • monitor serum digoxin lvls during first week of therapy
75
Q

what should you teach pts on calcium channel blockers and digoxin

A
  • S&S of digoxin toxicity
76
Q

who are ACE-I useful for in treatment of chronic stable angina (3)

A
  • pts with DM, significant CAD, previous history of MI
77
Q

what is used to diagnose CAD (10)

A
  • history
  • physical exam
  • chest xray
  • 12-lead ECG
  • lipid profile
  • echo
  • holyer monitoring
  • exercise stress testing
  • coronary angiography
  • pharmacological nuclear imaging
78
Q

what are the major elements of tx of chronic stable angina (6)

A 
Antiplatelet, antianginal, ACE-I
Beta blockers, BP
Cig smoking, cholestrol
Diet, diabetes
Education, exercise
Flu vaccine
79
Q

what should you teach a pt with chronic stable angina (6)

A
  • identify and avoid precipiating factors of angina
  • decrease modifiable risk factors
  • low sodium, low sat fat diet
  • maintain ideal body weight
  • regular exercise (brisk walk on flat surface at least 30 min/day, 5x/week)
  • proper use of nitro
80
Q

if a nurse is present during an anginal attack, what measures should they institute? (6)

A
  • O2
  • VS
  • 12-lead ECG
  • prompt pain relief (nitro then morphine if necessary)
  • auscultate heart sounds
  • comfortable positioning for pt
81
Q

describe pain assessment during an anginal attack

A
  • OPQRST

- ask to rate pain before and after treatment

82
Q

what is silent ischemia

A
  • ishcemia that occurs without subjective symptoms
83
Q

what type of pts have an increased incidence of silent ischemia

A
  • pts w diabetes d/t neuropathy
84
Q

what is nocturnal angina

A
  • angina that occurs only at night , but not necessarily when the pt is in the recumbent position or asleep
85
Q

what is angina decubitus

A
  • chest pain that occurs only when laying down

- relived by standing or sitting

86
Q

what is prinzmeal’s angina

A
  • angina at rest that usually occurs in response to spasms of a major coronary artery
87
Q

what is important teaching for a pt on beta blockers

A
  • do not stop arubtly, can cause severe angina

- do not miss doses

NURS 3512 - Class 1-6 (47 decks)

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