CAD/MI/PE Flashcards
(98 cards)
1
Q
What is atherosclerosis?
A
Hardening of arteries w/ plaque build up
2
Q
What is the primary component of atherosclerosis? And the other components?
A
Cholesterol; calcium and fat
3
Q
What is the desired cholesterol level?
A
Less than 200mg/dl
4
Q
What is the desired HDL?
A
Greater than 35mg/dl
5
Q
What is the desired LDL if pt is a high risk cardiovascular pt? And moderate risk?
A
Less than 70m/dl; less than 100mg/dl
6
Q
What is High Density Lipoprotein (HDL)?
A
Good cholesterol; goes back to liver for removal from body
7
Q
What is Low Density Lipoprotein (LDL)?
A
Bad cholesterol; remains in blood stream
8
Q
What is the desired triglyceride levels?
A
Less than 150mg/dl
9
Q
What are triglycerides?
A
Fat found in serum/body
10
Q
Age, gender, race, menopause/pre-menopause are what?
A
Nonmodifiable risk factors
11
Q
Smoking, diet, uncontrolled diabetes/HTN, overweight/obesity?
A
Modifiable risk factors
12
Q
What are the s/s of CAD in the geriatric population?
A
SOB, fatigue, syncope, confusion
13
Q
What are the triad of symptoms that appear in women w/ CAD?
A
Abd pain, fatigue, SOB
14
Q
Chest pain is more often what in women? And in men?
A
Angina; MI
15
Q
Men manifest CAD earlier than women and have a higher incidence of what? but CAD causes more what in women?
A
Left ventricular hypertrophy; death
16
Q
Pts who have diabetes may not always present w/ chest pain known as a silent MI; what are the atypical s/s they present w/?
A
Confusion, N/V, fatigue dyspnea
17
Q
What is the goal of treatment?
A
Slow or decrease progression of CAD
18
Q
Nursing action should be directed to what?
A
Prevention and reduction of risk factors: smoking, diet, weight, med info, adhering to health maintenance/med regimen
19
Q
What are “life’s simple 7?”
A
Don't smoke Maintain a healthy weight Engage in regular physical activity Eat a healthy diet Manage BP Take charge of cholesterol Keep blood sugar @ healthy level
20
Q
What is the TLC diet?
A
Therapeutic
Lifestyle
Changing diet
21
Q
What are the recommended percentages of saturated fat, fat, and cholesterol intake per day?
A
Less than 10%, 30%, and 300mg/dl
22
Q
What decreases LDL and where can you find it?
A
Monounsaturated fats; canola, vegetable, peanut oil
23
Q
Where is cholesterol mainly found?
A
Animal products
24
Q
What is angina?
A
Imbalance b/t myocardial supply and demand causing chest pain
25
Atherosclerosis, artery spasm, increased in O2 demand, clogged artery, not enough blood to heart are all causes of what?
Angina
26
How to describe the more normal angina?
Chest pressure that comes on w/ exertion (ex. exercise) and goes away w/ rest or meds (Vasodilator or nitroglycerin)
27
What is stable angina (angina pectoris)?
Chronic angina that's precipitated by a predictable amount of activity/stress and goes away w/ med management/rest
28
What is unstable angina?
Angina w/ ischemia (cell death) or acute coronary syndrome; chest pain last longer (15min+), have frequent attacks and can't be relieved w/ nitroglycerins/rest
29
When considering angina how long does it take for cell necrosis to occur?
30min
30
What is an MI?
Heart muscles start to die bc blood perfusion is cut off by cell death (heart attack)
31
Thrombosis, rupture of plaque, occlusion of vessels, vasospasm and trauma are all causes of what?
MI
32
When considering the stages of infarction how long does it take for ischemia to occur?
20min
33
When considering the stages of infarction how long does it take for injury and necrosis to occur?
1-6hrs
34
When considering the stages of infarction how long does it take for granulation tissues form to occur?
8-10days
35
When considering the stages of infarction how long does it take for scar tissue to continue to form causing for a risk of myocardial rupture to occur?
2wks
36
When considering the stages of infarction how long does it take for the heart to recover as much as possible to occur?
6-12wks
37
What is heart remodeling?
When heart decreases in function
38
What are the 3 factors considered for the size of the infarct?
Extent of occluded blood supply
Amount of collateral circulation
Oxygen demands o the myocardium
39
What is this: Collateral vessels connecting smaller arteries in coronary system dilate to maintain blood flow to cardiac muscle, causing new arteries to form?
Collateral circulation in MI
40
What is the left ventricle of the heart known as?
Workhorse of the heart; has highest O2 demands
41
What is so essential about getting an EKG/ECG done?
Can see all electrical activity in the heart w/ the 12 leads
42
EKG, cardiac labs, stress tests, cardiac catheterization, echocardiogram are all what?
Diagnostic tests
43
An echocardiogram allows you to see what?
Structure of the heart
44
What are the 3 diff meds that are given before a stress test to mimic the effects of exercise?
Persantine, Thallium and Dobutamine
45
ST segment depression and T wave inversion represents an EKG change caused by what?
Ischemia
46
What does the P wave represent?
Atrial depolarization (contraction)
47
What does the S wave represent?
Ventricular depolarization
48
What does the T wave represent?
Ventricular repolarization
49
What does the QRS complex represent?
Ventricular depolarization (contraction)
50
ST segment elevation represents an EKG change caused by what?
Injury- occlusive thrombus
51
What is a STEMI?
ST elevation MI
52
How does a pt w/ a STEMI present?
Sudden onset of chest pain w/ a present Q wave on EKG
53
What is a NSTEMI?
Non STEMI; narrowing of artery, non occlusive thrombus
54
What does a Q wave represent?
Infarction; dead zone of myocardium, MI has extended through all 3 layers of heart
55
When will a Q wave appear on an EKG?
8-12hrs post MI (nonreversible)
56
What cardiac lab is non-specific bc it shows elevation if any muscle in the body is damaged?
Creatine Phosphokinase (total CK/CPK)
57
What 2 cardiac labs are specific to cardiac muscle if they are elevated?
Creatine Phosphokinase Isoenzyme (CPK-MB)
| Troponin levels
58
When will a troponin level become apparent? Peak? and return to normal?
4-6hrs after injury; 8-12hrs; 10-15days
59
What are some manifestations of a MI?
Chest pain, N/V, diaphoresis, sense of impending doom/death, DOE/SOB, cool mottling skin, diminished peripheral pulses, decreased LOC, low grade fever and elevated blood sugar
60
If your s/s last longer than how long what should you do?
20min call 911
61
Relieve chest pain, reduce extent of myocardial damage, maintain cardiovascular stability, decrease cardiac workload, prevent complications, increase O2 supply, decrease myocardial workload are all what?
Goals of MI/ACS treatment
62
Nursing interventions for an acute episode?
Asses pt and their pain frequently
MONA
Monitor EKG/cardiac labs
63
What does MONA stand for?
Morphine for pain/anxiety (IV push)
Oxygen via nasal cannula b/t 2-5L/min
Nitroglycerin for angina (sublingual while laying/sitting)
Aspirin to decrease clumping
64
Nitroglycerin is a vasodilator that can cause what?
Hypotension
65
What does PQRST stand for when assessing pain?
Precipitating events? (exercise, sex, sleep, etc)
Quality of pain? (sharp, dull, burning, etc)
Radiation of pain? (Neck, arm, jaw, leg, etc)
Severity of pain (0-10)
Timing of pain? (when did it start)
66
After an acute episode what should be started to aid the pt in living a more normal lifestyle and providing important education?
Cardiac rehab
67
What are some specific intervention post MI?
Initial bed rest for 6-12hrs (relax heart)
Semi fowlers position (comfort/tissue oxygenation)
Calm quiet environ. (anxiety)
Oxygen @ 2-5L/min
Liquid diet for 1st 4-12hrs no caffeine tho (gastric distention, probs w overeating, enhance cardiac diet)
68
Dysrhythmias, pump failure (CHF), cardiogenic shock, infarct extension, structural defects and pericarditis are all what?
Complications of MI
69
After an MI when is the heart tissue the weakest?
4-7days
70
Name this MI complication: Progressive increase in the amount of myocardial necrosis w/in the infarct zone of the original MI; muscle is stretched/thin, impairment of blood flow happens w/in hours-days after MI?
Infarct extension
71
Name this complication of MI: scar tissue formation?
Structural defects
72
Name this complication of MI: inflammation of the pericardium of the heart and is treated w/ aspirin/NSAIDs?
Pericarditis
73
Name this MI complication: premature ventricular contractions, ventricular tachycardia, ventricular fibrillation and/or Afib and atrial flutter?
Dysrhythmias
74
Name this MI complication: contractility is impaired causing problems w/ filling the heart and may lead to death bc of changes in heart that take place from the damage?
Heart failure
75
What are some s/s of left sided heart failure from the increase in pulmonary pressure rate?
Crackles, wheezes, frothy sputum, dyspnea
76
What are some s/s of right sided heart failure?
Neck vein distention, peripheral edema
77
Name this MI complication: impaired tissue perfusion due to pump failure, heart can't pump blood to meet needs of any vital organs?
Cariogenic shock
78
What are some s/s of cardiogenic shock?
Decrease in LOC, systolic BP less than 90, tachycardia, weak pulses, pal/cool skin, decrease urinary output, increase dysrhythmias (s/s of dying)
79
Nursing implications for heart failure?
Left: pulse ox, O2, frequent assessment, meds
Right: Elevate legs, check for pulses, frequent assessments, meds
80
What are some nursing implications for cardiogenic shock?
ABCs
Revascularize the heart
Fluid Bolus
Antirhythmias
81
What is coronary artery disease (CAD)?
Narrowing of small blood vessels that feed the heart
82
Nursing interventions pre-procedure?
```
Assess (shellfish allergy/peripheral pulses)
NPO 6-8hrs
Ht/Wt
Labs
Patent IV access
```
83
Nursing interventions post-procedure?
```
Frequent assessment
Extremity positioning
Bed rest 2-6hrs
HOB less than 30degree angle
Monitor site
```
84
Complications post-procedure?
```
Clot formation
Trauma
BLEEDING
Re-occlusion
Pain
```
85
Statin drugs are used for what? and what can they cause?
Stabilize cholesterol; pain in muscle and liver failure
86
Important teaching for Statins?
No grapefruit/grapefruit juice
Monitor liver enzyme levels and creatine phosphokinase
Assess for muscle pain/tenderness
Monitor for digoxin toxicity if taking Digoxin
87
Classic s/s of a pulmonary embolism? More common s/s?
Chest pain, hemoptysis, dyspnea, Crackles.
| Anxiety, tachypnea/tachycardia, SOB, low grade fever
88
Nursing interventions for a pulmonary embolism?
Oxygen
Analgesics
Anxiety reduction-calm environ., anti-anxiety med
Pt education on prevention: ambulation, ROM, anticoagulants, bleeding precautions
89
What two anticoagulation meds are admin to prevent a PE?
Heparin, Coumadin
90
What should you monitor for heparin? and for coumadin?
PTT, aPTT; INR
91
What is an antidote given for Heparin? and Coumadin?
Protamine sulfate; Vitamin K
92
D-Dimer and a lung scan are what?
Most common diagnostic tests for PE
93
Thrombolytic therapy?
Lyse thrombus via IV, need 2 IV sites, frequently assess VS/pulses/infusion site during admin
Post-infusion frequent neuro/site checks and VS, bed rest 6-8hrs monitor labs, assess for systemic bleeding
94
What meds are used for angina and what's important to know about them?
Nitrates (vasodilator); monitor BP/HA, give while laying down/sitting
95
'olol' meds are used for what? What is important to know about them?
Beta-blockers for HTN/dysrhythmias; Monitor BP/HR, change positions slowly, not for asthmatics/COPD'rs bc of bronchospasm
96
'pril' meds are used for what? and what's important to know about them?
ACE inhibitors-HTN/CHF; assess for dry cough/angioedema, monitor labs/electrolytes, use w/ caution in asthmatics
97
'sartan' meds are used for what? and what is important to know about them?
ARB's-HTN; monitor labs especially K and BP, don't use w/ ACE bc of hyperkalemia
98
Diltiazem (Cardizem) and Amlodipine (Norvasc) are what type of meds? and what is important to know about them?
Calcium channel blockers-for angina; Monitor BP/HR/EKG, assess for constipation, edema and increase in heart failure
