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NSG 430 - Critical Care > T5: CAD & Acute Coronary Syndrome > Flashcards

T5: CAD & Acute Coronary Syndrome Flashcards

(65 cards)

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1
Q

Coronary Artery Disease (CAD)

A

disease of the arteries surrounding the heart included in the general category of atherosclerosis.

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2
Q

Atherosclerosis

A

hardening of arteries with a collection of cholesterol-like plaque

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3
Q

what is the major cause of coronary artery disease

A

atherosclerosis

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4
Q

collateral circulation

A

When plaque blocks the normal flow of blood through a coronary artery and the resulting ischemia is chronic, increased collateral circulation develops.

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5
Q

nursing management of coronary artery disease

A

if diet and exercise are ineffective;
-lipid lowering drug therapy (statin, niacin, fibric acid derivatives)
-antiplatelet therapy

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6
Q

Statins Inhibit…

A

cholesterol synthesis, decrease LDL, increase HDL

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7
Q

when given statins monitor

A

for lover damage and myopathy

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8
Q

niacin lowers

A

LDL and triglyceride by inhibiting synthesis-Increases HDL

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9
Q

niacin causes

A

Flushing, pruritus, GI side effects, orthostatic hypotension

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10
Q

Fibric acid derivatives (Lopid) decreases..

A

Decrease triglycerides and increase HDL

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11
Q

fibric acid derivative SE

A

GI SE

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12
Q

ASA, Clopidogrel (Plavix) monitor for

A

bleeding and brusing

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13
Q

clinical manifestations of CAD

A

-angina because of myocardial ischemia and decreased O2 supply

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14
Q

PCI and Stent placement

A

A stent is an expandable meshlike structure designed to keep the vessel open after balloon angioplasty.

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15
Q

When patients first present with chest pain, ST-elevations on the 12-lead ECG are most likely indicative of a

A

STEMI

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16
Q

For patients with chest pain who do not show ST-elevation or ST-T wave changes on the ECG..

A

*distinguish between UA and NSTEMI until serum cardiac biomarkers are measured.

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17
Q

STEMI vs NSTEMI

A

STEMI: Total occlusion of coronary artery, immediate intervention needed
NSTEMI: partial occlusion of coronary artery

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18
Q

action for STEMI

A

no blood flow through the artery so from the ER > cath lab > angioplasty, PCI, thrombolytic therapy
-must be opened with in 90 minutes

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19
Q

clinical manifestations of unstable angina

A

*New in onset
*Occurs at rest
*Increase in frequency, duration, or with less effort
*Pain lasting > 10 minutes
*Needs immediate treatment
*Symptoms in women often under-recognized

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20
Q

Unstable angina (UA)

A

*chest pain that is new in onset, occurs at rest, or occurs with increasing frequency, duration, or with less effort than the patient’s chronic stable angina pattern

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21
Q

MONA

A

Morphine, O2, nitro, aspirin (325mg) ask them to chew it and swallow it
-may add metoprolol to slow down the work load of the heart

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22
Q

clinical manifestations of MI ECG

A

*ST-elevation and non-ST-elevation
*Result of abrupt stoppage of blood flow through a coronary artery, causing irreversible myocardial cell death (necrosis)

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23
Q

myocardial infarction occurs because

A

abrupt stoppage of blood flow through a coronary artery from a thrombus caused by platelet aggregation

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24
Q

action in patients with NSTEMI

A

do not go to cath lab immediately, procedure usually within 12-72 hours

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25
Thrombolytic therapy is not indicated for
*NSTEMI patients.
26
widow maker
left coronary artery
27
ECG Changes Associated With Acute Coronary Syndrome (ACS): ischemia
ST-segment depression and/or T wave inversion
28
ECG Changes Associated With Acute Coronary Syndrome (ACS): injury
ST-segment elevation occurs
29
Absence of serum cardiac markers confirms
no infarction
30
treatment for ACS should be
prompt and effective to help avoid or limit infarction
31
dramatic ST-segment elevation associated with
myocardial injury "tombstone"
32
complications of MI
-dysrhythmias -HF -cardiogenic shock -papillary muscle dysfunction -ventricular aneurysm -pericarditis -Dressler syndrome
33
dysrhythmias can be caused by
ischemia, electrolyte imbalances, or SNS stimulation
34
Cardiogenic shock occurs when
*oxygen and nutrients supplied to the tissues are inadequate because of severe LV failure, papillary muscle rupture, ventricular septal rupture, LV free wall rupture, or right ventricular infarction.
35
Cardiogenic shock requires aggressive management including...
*control of dysrhythmias, intraaortic balloon pump (IABP) therapy, and support of contractility with vasoactive drugs.
36
Papillary muscle rupture
a rare and life-threatening complication. It causes immediate and massive mitral valve regurgitation with no time for the heart to compensate
37
Left ventricular aneurysm
results when the infarcted heart wall is thin and bulges out during contraction
38
A new loud systolic murmur heard in patients with acute MI may signal
*ventricular septal wall rupture.
39
Serum cardiac biomarkers
*proteins released into the blood from necrotic heart muscle after an MI.
40
indicator of MI
troponins
41
negative biomarkers indicate
unstable angina
42
postive biomarkers indicate
NSTEMI
43
coronary angiography is a diagnostic study for patients with
a STEMI, NOT for patients with UA or NSTEMI
44
pharmacologic stress testing is used for patients with
abnormal but nondiagnostic ECG and negative biomarkers
45
The patient with a STEMI must undergo coronary angiography within
90 minutes of presentation or receive thrombolytic therapy within 30 minutes in agencies without PCI capability
46
initial intervention for ACS
-12-lead ECG -Upright position -Oxygen - keep O2 sat > 93% -IV access -MONA -Nitroglycerin (SL) and ASA (chewable) -Morphine -Statin if not taking already
47
monitoring for ACS
-Treat dysrhythmias -Frequent vital sign monitoring -Bed rest/limited activity for 12-24 hours
48
what is recommended for patients with UA and NSTEMI
Dual antiplatelet therapy (aspirin) and heparin (UH or LMWH)
49
Cardiac catheterization with possible PCI is considered for both UA and NSTEMI patients once
the patient is stabilized and angina is controlled or if angina returns or increases in severity
50
Reperfusion therapy
treatment to re-establish perfusion to an organ for patients with STEMI
51
what is the first line therapy for STEMI
Emergent PCI
52
thrombolytic therapy is only for patients with
a STEMI, give IV within 30 minutes of arrival to ED
53
when initiating thrombolytic therapy
-Draw blood and start 2-3 IV sites -Administer according to protocol -Monitor closely for signs of bleeding -Assess for signs of reperfusion *Return of ST segment to baseline best sign *IV heparin to prevent reocclusion
54
Coronary revascularization with CABG surgery is recommended for patients who
*Failed medical management *Presence of left main coronary artery or three-vessel disease
55
arteries used for CABG
*The internal mammary artery (IMA) is most common artery used for bypass graft -radial and saphenous are also used
56
Cardiopulmonary Bypass--CPB
*During CPB, blood is diverted from the patient's heart to a machine where it is oxygenated and returned (via a pump) to the patient. *This allows the surgeon to operate on a quiet, nonbeating, bloodless heart while perfusion to vital organs is maintained.
57
nutritional therapy ACS
-Initially NPO -Progress to *Low salt *Low saturated fat *Low cholesterol
58
clinical manifestations of MI
-Severe chest pain not relieved by rest, position change, or nitrate administration *Heaviness, pressure, tightness, burning, constriction, crushing *Substernal or epigastric *May radiate to neck, lower jaw, arms, back -Palpitations, dyspnea, dizziness, weakness
59
skin assessment for clients w MI
Diaphoresis, ashen, clammy, and/or cool to touch
60
CV manifestions for MI
-Initially, ↑ HR and BP, then ↓ BP (secondary to ↓ in CO) -Crackles -Jugular venous distention *S3 or S4 *New murmur *Ventricular Dysrhythmias-pulse deficit
61
management for MI
*Pain: nitroglycerin, morphine, oxygen *Continuous monitoring *Rest and comfort *Balance rest and activity *Begin cardiac rehabilitation -anxiety reduction
62
The major nursing responsibilities for the care of the patient following PCI involve:
-Monitor for recurrent angina -Frequent VS, including cardiac rhythm -Monitor catheter insertion site for bleeding -Neurovascular assessment -Bed rest per institutional policy
63
CABG: postoperative nursing care
-Assess patient for bleeding at surgical site -Monitor hemodynamic status -Assess fluid status -Replace blood and electrolytes PRN -Restore temperature -Monitor for atrial fibrillation (which is common) -pain management
64
syncope
*lapse in consciousness *loss in postural tone (fainting)
65

NSG 430 - Critical Care (42 decks)

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