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NURS 3313 > Coronary Vascular Disease > Flashcards

Coronary Vascular Disease Flashcards

1
Q

Progression of Coronary Artery Disease

A

atherosclerosis -> angina -> ACS -> MI

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2
Q

Risk factors for CAD

A
  • family hx
  • gender (onset earlier in males)
  • age (> 45 m; > 55 f)
  • race (greater risk in African Americans)
  • high cholesterol
  • hyperlipidemia
  • elevated TGs
  • smoking/tobacco use
  • HTN
  • DM
  • obesity
  • physical inactivity
  • metabolic syndrome
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3
Q

stable angina

A

pain associated myocardial ischemia

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4
Q

atherosclerosis

A

abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and lumen

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5
Q

What determines symptoms of atherosclerosis?

A

vessel location and amount of narrowing in the vessel

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6
Q

How often should people with atherosclerosis receive routine follow-up labs?

A

every 6 months

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7
Q

What are the modifiable risk factors of atherosclerosis?

A
  • cholesterol/TG levels
  • tobacco use
  • hypertension
  • DM
  • activity
  • weight
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8
Q

syndrome brought on by an imbalance of oxygen supply to the demand of oxygen need in the myocardium

A

angina pectoris

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9
Q

What are the main causes of angina pectoris?

A
  • atherosclerosis
  • myocardial ischemia
  • any reduction in blood flow to the heart (HOTN)
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10
Q

predictable and consistent pain that occurs on exertion and is relieved by rest and/or nitro

A

stable angina

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11
Q

symptoms increase in frequency and severity; pain not usually relived with rest or nitro

A

unstable angina

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12
Q

objective evidence of ischemia, but pt reports no pain

A

silent ischemia

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13
Q

Common exacerbating factors of stable angina

A
  • exercise
  • extreme cold
  • high stress situation
  • substances (tobacco, caffeine, some illicit drugs)
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14
Q

What is the big deal about unstable angina?

A

it is a health emergency as it is often an indicator of an impending MI

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15
Q

S/S angina pectoris

A
  • pain like indigestion, gripping, pressure, restlessness, anxiety, feeling of impending doom
  • chest/neck/jaw/shoulder pain
  • BP fluctuation, N/V, pallor, tachycardia, vasoconstriction

older adults will vary as will the symptoms vary in men and women

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16
Q

atypical chest pain symptoms in women

A
  • chest pain, discomfort, pressure
  • unusual upper body pain
  • cold sweat
  • lightheadedness
  • nausea
  • fatigue
  • shortness of breath
17
Q

angina pectoris medications

A
  • NTG/Imdur
  • beta-blockers
  • CCBs
  • supplemental oxygen
  • aspirin, plavix, effient, heparin to prevent larger blockage
18
Q

emergent situation caused by the onset of myocardial ischemia

A

acute coronary syndrome

19
Q

occlusion of the coronary artery that leads to ischemia then to necrosis/death of the myocardium

A

myocardial infaraction

20
Q

acute coronary syndrome S/S

A

same as angina, but onset is faster and they are relieved by rest and medication

21
Q

ACS diagnostics

A
  • 12 lead EKG
  • cardiac enzymes/biomarkers
  • echocardiogram
  • stress test
  • cardiac catheterization
22
Q

Left Heart Catheterization

A

radial or femoral artery to insert a catheter, catheter is guided to coronary arteries and contrast is injected

MD can see where vessels are narrowed or blocked

23
Q

How often should vitals be assessed post-cardiac cath?

A

usually q15 minutes for the first hour

24
Q

Post-cardiac cath nursing considerations

A
  • assess vitals, insertion site
  • maintain hydration
  • maintain bedrest for 4-6 hours (per MD order)
25
Q

expected ECG changes with ischemia

A
  • ST segment elevation
  • ST depression
  • T wave inversion
  • Pathologic Q wave
26
Q

pt is symptomatic, but dx are negative for acute ischemia

A

unstable angina

27
Q

pt asymptomatic, but dx shows evidence of cardiac ischemia

A

silent MI

28
Q

abnormal biomarkers, but no ECG changes

A

NSTEMI

29
Q

abnormal biomarkers and ST changes in at least 2 leads

A

STEMI

30
Q

What are the two types of STEMIs?

A

LAD and RCA

31
Q

widow-maker, anterior wall MI

A

LAD occlusion

32
Q

most common, inferior wall MI

A

RCA occlusion

33
Q

goals of care for USA and MI

A
  • reestablish blood flow
  • decrease damage
  • balance supply and demand of oxygen
34
Q

meds for USA and MI

A
  • NTG/Imdur
  • beta-blockers
  • CCBs
  • supplemental oxygen
  • aspirin, plavix, effient, heparin to prevent larger blockage
  • ACE-inhibitors
  • statins
35
Q

Procedures for USA and MI

A
  • PCI (angioplasty and stent placement)
  • Surgery (CABG)
36
Q

USA and MI nursing interventions

A
  • position client safely, implement bedrest
  • administer MONA if indicated
  • call for help from charge nurse
  • page provider asap
  • call for stat EKG per protocol/MD order
  • call for stat labs per protocol/MD order
37
Q

MONA

A
  • morphine (reduction of workload, pain, and anxiety)
  • oxygen (increases oxygen supply)
  • nitroglycerin (increases bloodflow to myocardium)
  • aspirin (prevention of platelet aggregation)
38
Q

How fast does reperfusion need to occur with a STEMI?

A

within 12 hours

39
Q

What is the “door to needle” time from STEMI indication to thrombolytic admin?

A
  • 30 minutes for best outcomes
  • can be within 6-12 if PCI isn’t indicated

NURS 3313 (8 decks)

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