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Advanced MedSurg > Ch 33 CAD, ACS, MI (Exam 2) > Flashcards

Ch 33 CAD, ACS, MI (Exam 2) Flashcards

1
Q

What is the main cause of coronary artery disease?

A

Atherosclerosis

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2
Q

What does atherosclerosis lead to?

A

Endothelial injury/inflammation

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3
Q

Causes of endothelial injury? (5)

A
  • hypertension
  • smoking
  • infection
  • diabetes
  • hyperlipidemia (high serum lipids)
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4
Q

Diagnostics for coronary artery disease? (2)

A
  • cardiac markers (high troponin)

- echocardiogram

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5
Q

What are the 4 steps of pathophysiology of CAD?

A
  1. chronic endothelial injury
  2. fatty streak and lipid core formation
  3. fibrous plaque covers the lipid core (reduces blood flow, fissures/scars develop)
  4. complicated lesion: plaque ruptures and thrombus forms (causing narrowing/total occlusion)
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6
Q

Complicated lesions lead to thrombus formation due to which mechanism?

A

Platelet accumulation

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7
Q

Prevention of thrombus formation (3)

A
  • avoid vessel injury (smoking cessation, lifestyle changes, exercise)
  • control platelet aggregation (daily antiplatelet therapy like aspirin)
  • control lipid levels (statins, niacin) if diet/exercise is ineffective
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8
Q

The formulation of thrombus is deterred by?

A

Daily administration of baby aspirin

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9
Q

What are the non-modifiable risk factors of coronary artery disease (4)

A
  • age (>60)
  • gender (women tend to live longer)
  • ethnicity
  • genetics, family hx
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10
Q

Major modifiable risk factors of coronary artery disease (3)

A
  • hyperlipidemia (cholesterol >200)
  • hypertension (>140/90)
  • smoking cessation
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11
Q

How does smoking lead to coronary artery disease? (3)

A
  • increases catecholamines (epinephrine) which leads to vasoconstriction and increased HR
  • increases LDL levels, decreases HDL
  • directly injures the epithelium
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12
Q

Contributing modifiable risk factors (3)

A
  • metabolic syndrome (ABD GERD, prediabetes)
  • psychological states: stress/increased epinephrine, anger, depression
  • substance abuse: cocaine increases cardiac demand for oxygen
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13
Q

Ways to increased HDL (good lipids) (5)

A
  • exercise
  • eat healthy fats
  • lose weight
  • moderate alcohol intake
  • quitting smoking
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14
Q

Your patient has been identified as being at high risk for MI. Which lifestyle modification would have the most benefit to the patient?

A

Quit smoking

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15
Q

After teaching about ways to decrease risk factors for CAD, the nurse recognizes that further instruction is needed when the patient says:

A

“I would like to add weight lifting to my exercise program” (strain is contraindicated)

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16
Q

Nitroglycerin treatment for stable vs unstable angina

A
  • unstable: not effective (unstable angina creates life-long changes on ECG)
  • stable: relieved by nitroglycerin (ECG may return to normal)
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17
Q

Describe unstable angina (2)

A
  • chest pain that is new in onset and occurs at rest

- unpredictable and must be treated immediately

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18
Q

What are the effects of nitroglycerin? (3)

A
  • causes vasodilation
  • side effects: severe headaches
  • patient teaching: take with tylenol to relieve headache
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19
Q

Which actions by nitroglycerin help to reduce or eliminate chest pain? (2)

A
  • lowers preload and work of heart

- dilates coronary arteries to increase blood supply to the myocardium

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20
Q

PQRST (to assess for myocardial infarction)

A

P: precipitating events (arguing, exercise)

Q: quality of pain (pressure, dull, ache, tight)

R: region (location) and radiation

S: severity of pain (0-10)

T: time (when did it begin?)

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21
Q

Nutritional therapy (2)

A
  • low sodium diet (prevent fluid retention)

- for CAD: limit saturated fats and cholesterol and more complex carbs (whole grains, fruits, vegetables) and fiber

22
Q

What is a myocardial infarction?

A

abrupt stoppage of blood flow through the coronary artery, causing irreversible cell death

23
Q

S/S of unstable angina

A

severe chest pain that is NOT relieved by rest/position change or nitroglycerin administration

24
Q

S/S of stable angina (2)

A
  • pain during activity/exercise but SUBSIDES AT REST

- pain is described as heavy, pressured, tight/constricted, burning, crushing (“elephant on chest”)

25
Q

What are complications of MI? (2)

A
  • infarction of papillary muscle/rupture

- acute pericarditis

26
Q

Diagnostics for myocardial infarction (stemi vs nstemi)

A
  • STEMI: coronary angiography

- NSTEMI: high troponin levels (contraindicated to do coronary angiography)

27
Q

You patient reports experiencing chest pain during sex that subsides at rest. He is probably experiencing?

A

Stable angina

28
Q

Your patient’s heart is getting less oxygen due to narrowing/blockage of the coronary artery. What symptom will the patient most likely present?

A

Chest pain or pressure

29
Q

A complication of infarction of papillary muscle from MI can be determined by?

A

Heart sounds (murmur)

30
Q

Treatment for acute angina

A

short-acting nitrates are the first-line therapy

31
Q

Describe chronic stable angina (4)

A
  • chest pain that occurs over a long period
  • patient may deny pain at first
  • anginal pain lasts only a few mins and subsides when the precipitating factor is relieved
  • pain at rest is UNUSUAL
32
Q

Medication teatment for chronic stable angina

A

focused on decreasing oxygen demand or increasing oxygen supply
(medications: nitrates, ACE inhibitors, beta-blockers, calcium channel blockers)

33
Q

Describe Prinzmetal’s angina, a type of chronic stable angina (4)

A
  • rare form of angina that occurs AT REST in response to a spasm of a major coronary artery
  • may be seen in patients with a hx of migraine headaches and Raynaud’s phenomenon
  • precipitating factors: smoking, alcohol, amphetamines, cocaine use
  • pain may be relieved by moderate exercise or spontaneously
34
Q

Treatment for Prinzmetal’s angina

A

calcium channel blockers and/or nitrates (to decrease afterload)

35
Q

What is the goal of interprofessional care for chronic stable angina?

A

decrease O2 demand or increase O2 supply

36
Q

Function of short-acting nitrates

A

decreases preload and afterload

37
Q

Nitroglycerin

  • route
  • adminsitration
  • interventions
A
  • sublingually or by spray (faster)
  • if no relief in 5 mins, call EMS; if some relief after 5 mins, repeat every 3 mins for a max of 3 doses
  • sit patient down to relax them, elevate HOB to improve airway and decrease O2 demand
38
Q

function of long-acting nitrates

A

reduces angina incidence

39
Q

ACE inhibitors and angiotensin blocker functions

A

reduces oxygen demand by lowering HR, afterload, and BP (especially useful after an MI)

40
Q

Purpose of induced hypothermia

A

might prevent hypoxic brain damage during cardiac arrest

41
Q

What can be delegated to UAP during MI care? (6)

A
  • empty urinary catheter
  • use of incentive spirometer and deep breathing exercises
  • observe patient and report to nurse
  • monitor SCDs for DVT prevention
  • drain fluid
  • apply water soluble protectant to nares and lips
42
Q

Delegation to LVN (4)

A
  • give medications
  • take vitals
  • basic skills (applying oxygen and inserting urinary catheter)
  • cannot do initial patient teaching (can reinforce)
43
Q

What is acute coronary syndrome

A

Deterioration of plaque, leading to rupture and platelet aggregation, which leads to thrombus formation

44
Q

Initial interventions for ACS (5)

A
  • 12-lead ECG
  • upright position: stop movement, provide comfort, resting position
  • create IV access
  • administer statin
  • MONA requires doctor’s order except oxygen
45
Q

MONA for ACS stands for?

A

M: morphine
O: oxygen (o2 sat > 92%)
N: nitroglycerin (SL)
A: aspirin (chewable)

46
Q

Therapy for NSTEMI

A

Reperfusion therapy

47
Q

Emergency PCI (percutaneous coronary intervention) stent is indicated for?

  • goal
  • consists of
A
  • indicated for: confirmed STEMI
  • goal: get patient to cardiac cath lab within 90 mins of presentation
  • consists of balloon angioplasty and stents
48
Q

Thrombolytic therapy is only indicated for patients with?

  • give IV within ______
  • contraindications (3)
A
  • indicated for patients with STEMI
  • given IV within 30 mins of arrival with presenting STEMI
  • assess contraindications: recent surgeries, peptic ulcer disease, recent bleeds
49
Q

Coronary revascularization with coronary artery bypass graft (CABG) is recommended for? When is it provided? Post op care includes? (6)

A
  • patients who fail medication management
  • provided in the ICU for the first 24-36 hours (ongoing monitoring of ECG and hemodynamic status)
  • post-op care focuses on monitoring for dysrhythmias, providing wound care, managing pain, preventing DVTs/bleeding, atelectasis, pneumonia
50
Q

Drug therapy for acute coronary syndrome?

A
  • dual antiplatelet (aspirin) therapy should be continued for 1 year after an MI
  • stool softeners to avoid straining
51
Q

Sudden cardiac death (2)

A
  • abrupt disruption in cardiac function, leading to loss of CO and cerebral blood flow
  • most commonly caused by: ventricular dysrhythmias (vfib and vtach)

Advanced MedSurg (11 decks)

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