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NURSADN6 Med Surg > Week 6 Management of Patients with CAD Ch23 > Flashcards

Week 6 Management of Patients with CAD Ch23 Flashcards

1
Q

Abnormal accumulation of the lipid deposits and fibrous tissue within arterial walls and lumen

A

Atherosclerosis

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2
Q

In _____________________ ___________________ blockages and narrowing of the coronary vessels reduce blood flow to the myocardium

A

Coronary Atherosclerosis

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3
Q

Leading cause of death in the United States for all men and women of all racial and ethnic groups

A

Cardiovascular Disease

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4
Q

Most prevalent cardiovascular disease in adults

A

CAD

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5
Q

Pathophysiology of Atherosclerosis

A
  • Endothelium, intima, media, adventitia
    Injury response
  • Monocyte emigration
  • Smooth muscle proliferation
  • Fatty streak and lymphocyte
  • Fibrofatty atheroma, collagen, lipid debris
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6
Q

Clinical manifestations of CAD include

A

Symptoms are caused by MI
Angina pectoris most common
other symptoms include: epigastric distress, pain that radiates to jaw or left arm, SOB, atypical symptoms in women
MI
HF
Sudden Cardiac Death

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7
Q

Non modifiable risk factors of CAD

A

Family History
Increasing age
Gender
Ethnicity
Hx premature menopause before 40
Primary hypercholesterolemia genetically elevated LDL

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8
Q

Name modifiable risk factors of CAD

A

Hyperlipidemia
Tobacco use
HTN
Diabetes
Metabolic Syndrome
Obesity
Physical Inactivity
CKD stage

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9
Q

How to prevent CAD?

A

Control Diabetes
Control cholesterol
Dietary measures
Physical activity
Medications
Cessation of tobacco use
Manage HTN

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10
Q

What are some cholesterol medications

A

-HMG-CoA or statins
- Nicotinic Acids
- Fibric Acids
Resins—Bile acid sequestrants
- Cholesterol absorption inhibitors
- Omega 3 acid ethyl esters

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11
Q

When ischemia is prolonged and not immediately reversible which what develops

A

ACS
- Either be partial or complete blockage

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12
Q

ACS encompasses what?

A
  1. Unstable Angina
  2. NSTEMI
  3. STEMI
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13
Q

What is the relationship between CAD, Chronic Stable Angina, and ACS

A

CAD—- Chronic stable angina —–Acute coronary syndrome

Acute coronary syndrome is broken up to two things

  1. Unstable angina
  2. NSTEMI

or 1. STEMI

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14
Q

Decreased blood flow in a coronary artery

A

Unstable Angina

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15
Q

Plaque ruptures and the clot completely occludes the artery

Ischemia and necrosis of tissue

A

MI

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16
Q

Other causes of MI include

A

Vasospasm
Rapid HR
Decreased O2 supply

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17
Q

Anything that can cause a profound imbalance between myocardia O2 supply and demand

A

MI

2 types of MI- NSTEMI or STEMI

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18
Q

Syndrome characterized by episodes or paroxysmal pain or pressure in the anterior chest caused by insufficient coronary blood flow

A

Angina Pectoris

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19
Q

Name the types of angina

A

Stable
Unstable
Intractable/ refractory
Variant (Prinzmetal)
Silent

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20
Q

Name Angina Precipitating Factors

A

Exertion
Temperature
Emotional Changes

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21
Q

Exercise or other physical exertion increases the HR and decreases the duration of diastole, which interferes with circulation to the coronary arteries

A

Exertion

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22
Q

Extremes increase the heart’s workload. Cold results in Vaso restriction, limiting the coronary blood flow. Heat causes peripheral vessels to dilate and blood to pool in the skin, again limiting coronary blood flow

A

Temperature

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23
Q

Strong emotions, such as anger or fear, stimulate the sympathetic nervous system and increase the pulse and the heart’s workload

A

Emotional Changes

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24
Q

This angina occurs when your heart is working harder and needs more oxygen that can be delivered through the narrowed arteries

Pain goes away when you rest or take nitroglycerin usually < 15 minutes

May continue without much change for years

Treatment and control

A

Stable Angina

Nitro SL
Extended Release Nitro
CC plus, BB

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25
Q

New in onset
Occurs at rest and longer than 15 min
Has worsening pattern may indicate deterioration of plaques

A

Unstable Angina

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26
Q

What angina is unpredictable and represents a medical emergency can lead to MI

A

Unstable Angina

Dx- No ECG changes or elevation of enzymes

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27
Q

Identified based on EKG, non ST segment elevation but still positive cardiac markers

A

NSTEMI

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28
Q

Management of UA/ NSTEMI for high risk

A

Coronary Arteriography - high risk strategy

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29
Q

Not high risk for UA and NSTEMI

A

Clopidogrel
Statin
ACEI
Outpatient Rx

30
Q

Negative Stress tests from UA or NSTEMI

A

Consider alternative diagnosis

31
Q

What is the nursing assessment for angina?

A

-Tightness, choking, or heavy sensation
- Frequently retrosternal and may radiate to neck, jaw, shoulders, back or arms
- Anxiety comes with pain
- Dyspnea, SOB, dizziness, nausea, vomiting
- The pain of typical angina subsides with rest or NTG
- Unstable angina

32
Q

This is characterized by increased frequency and severity and is not relieved by rest or NTG. Requires medical intervention

A

Unstable Angina

33
Q

Name Gerontologic considerations for CAD etc

A

Diminished pain transition that occurs with aging may affect presentation of symptoms
Silent CAD
Teach older adults to recognize their chest like pain ie weakness
- Pharm stress testing: cardiac cath
- Meds used cautiously

34
Q

Tx of Angina/ CAD etc include

A

Tx to decrease myocardial oxygen and increase oxygen supply
Medications
Oxygen
Reduce and control risk factors
Reperfusion therapy may also be done

35
Q

Medications for Angina/ CAD etc

A

Nitroglycerin
Beta adrenergic blocking agents
Calcium channel blockers
Antiplatelet and anticoag meds
- Aspirin
- Clopidogrel and ticlopidine
- Heparin
Glycoprotein IIB/ IIIa agents - Intergrilin and Reopro

36
Q

Nitrates do what?

A

Small does dilate veins
Higher doses dilate arteries

37
Q

Lo dose of nitrate

A

Affects veins/ venous pooling decreases pre load- low doses decreases CO and BP

37
Q

High doses of nitrates

A

Affects arteries
Decrease BP and afterload and decrease myocardial O2 damages

Route: SL, IV, patch, spray

37
Q

Blocks beta adrenergic sympathetic stimulation to the heart

A

Beta antagonist
Decrease
-HR- neg dromotrope
-BP
- Force of contractility- neg. inotrope
Caution in pulmonary diseases asthma

37
Q

Calcium Channel Blockers have negative what?

A

Inotropic effects

38
Q

Calcium Channel Blockers decrease what?

A

SA and AV node= Decrease HR and strength of contraction
Cardiac workload
BP by relaxing the vessels

In return increase
- Coronary artery perfusion
myocardial O2 supply by dilating arterioles

Decreases myocardial O2 demands by decreasing ABP and workload of LV

38
Q

What labs do you look for heparin?

A

PTT

therapeutic levels are 2-2.5 x> normal

Anti factor Xa 0.11-0.4

38
Q

Use LMWH for

A

Unstable angina and NSTEMI
PTT
Bleeding precautions: IM or restrictive BP cuffs

38
Q

Acute angina dose for ASA is

A

160mg- 325 mg load

Maintenance is 81mg-325mg prophylactic

Coupled with H2 Blockers or PPI for GI upset

38
Q

Name calcium channel blocker

A

Amlodipine
Diltiazem

Used when BB are ineffective and can prevent or tx venospasms

38
Q

What does ASA do?

A

Decrease platelet aggregation, reduces incidence of MI and death from CAD

38
Q

Prevents formation of new clots

A

Heparin

38
Q

Nursing Assessment for pt with Angina includes

A

Healt history
Symptoms and activities especially those that precede and precipitate attacks
Risk factors, lifestyle, and health promotion activities
Pt and family knowledge
Dx

38
Q

Diagnoses for Angina Pectoris patients include

A

Risk for decreased cardiac tissue perfusion
Anxiety related to cardiac symptoms and possible death
Deficient knowledge about the underlying disease and methods for avoiding complications
Noncompliance, ineffective management of therapy regimen

38
Q

Interventions for patient with angina

A

MONA
Reduce anxiety
Prevent pain
Educate patients about self care
Continuing care

38
Q

Blocks platelet activation and efficacy is achieved over days

A

Clopidogrel

38
Q

HIT risk is

A

Heparin for 3 months or UFH 5-15 days period

38
Q

Patient has Angina what do you do?

A

Stop all activity and rest

Assess pt with VS, resp. distress, and assessment of pain. ECG

Administer medications as ordered by protocol usually NTG. Reassess pain and administer NTG up to 3 doses

2L O2 by nc

38
Q

Nursing goals for patient with Angina Pectoris

A

Immediate and appropriate tx of angina (relief of pain/ sx)
Prevention of angina
Reduction of anxiety
Awareness of disease process
Understanding of care and adherence to program
Absence of complications

38
Q

Nursing Intervention in preventing pain includes

A

Identify the level of pain from activities
Plan accordingly
Alternate
Educate

38
Q

Collaborative problems include

A

ACS, MI, or both
Dysrhythmias and cardiac arrest
Heart Failure
Cardiogenic Shock

38
Q

Nursing intervention for patient teaching

A

Balance activity with rest
Follow prescribed exercise regimen
Avoid extreme temperatures
Use resources for emotional support
Avoid OTC medications
Stop using tobacco
Diet low in fat and high in fiber

39
Q

Nursing interventions to reduce anxiety include

A

Use a calm manner

Stress reduction techniques
Patient teaching
Address spiritual needs
Address both family and patient

39
Q

Nursing Intervention for patient teaching continued

A

Carry NTG all times
Follow up with provider
Report increases of s/s to provider
Maintain normal BP and blood glucose levels

40
Q

ACS and MI

A

Emergent situation

Characterized by an acute onset of myocardial ischemia that results in myocardial death if definitive interventions do not occur promptly

Terms used Coronary occlusion, heart attack, and MI. MI preferred

41
Q

Result of sustained ischemia greater than 20 min, causing irreversible myocardial cell death (necrosis)

A

MI

Necrosis of entire MI takes about 4-6 hours

42
Q

Reperfusion is less than 20min and is

A

Salvaged

43
Q

Reperfusion is 2-4 hr and is

A

Partial salvage

44
Q

Permanent occlusion is

A

Complete infarct

45
Q

What is the pain like in MI?

A

Total occlusion
–anaerobic metabolism and lactic acid accumulation
—severe, immobilizing chest pain not relieved by rest, position change, or nitrate administration

46
Q

Presenting symptoms of MI include

A

Pain or discomfort to the right or left sided chest with radiation to the shoulder, neck jaw or back as well as tightness around the chest

47
Q

Atypical symptoms of MI include

A

Dyspnea
Nausea
Vertigo
Diaphoresis
Fatigue

48
Q

Gender disparity women MI includes

A

Ear pain, back pain, neck pain, upper abd. pain
More easily missed in women
Increase chance in post menopausal women

49
Q

What is silent ischemia?

A

Up to 80% of patients with MI are asymptomatic

Associated with DM and HTN

Confirmed by ECG changes

50
Q
A

NURSADN6 Med Surg (9 decks)

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