Test three Flashcards

Question

Characteristics of chronic angina pain

Answer 1

usually substernal, but can radiate doesn't change with position or breathing lasts 5-15 mins subsides when precipitating factor resolves

Answer 2

12-lead ECG Echo --> patient lies on left side Exercise test (no caffeine 24 hrs b4; no smoking or exercise b4; stop if chest pain, wild VS change, or ECG change) Nuclear cardiology - IV dipyridamole to mimic exercise, then inject isotope and do imaging --> observe for SOB, dizziness, nasea Labs - troponin, CK-MB, lipids, CRP

Answer 3

SA nitrates -dilate blood vessels (SL NGT can be used prophylactically) Aspirin - inhibits cyclooxygenase to prevent clot formation LA nitrates - reduces frequency of angina ACE inhibitors - for those at high risk for cardiac event; can also reverse ventricular remodeling BBs - for MI, LV dysfunction, or HTN --> decrease myocardial O2 demand CCB - if can't use BBs

Answer 4

-radiation and dye to view coronary arteries -take baseline creatinine first to monitor renal func -premedicate with corticosteroids if allergic to dye -hydrate if CKD -NPO 6-12 hrs PCI -balloon angioplasty -don't do if 3 vessel CAD and/or significant left main coronary artery disease

Answer 5

prolonged ischemia from decline of once stable atherosclerotic plaque partial block = UA or NSTEMI full block = STEMI

Answer 6

UA -new in onset -occurs at rest -worsens MI - Severe and persistent - doesn't get better with nitrate or rest -heaviness, pressure, burning, crushing, tightness -20+ mins -might have epigastric pain that antacids won't help

Answer 7

-SL NTG and chewable aspirin -morphine if they get to hospital w/o having these things Start to consider coronary angiography and PCI -ECG --> if STEMI, PCI w/in 90 mins -thrombolytic if no cath lab (w/in 30 mins of arrival)

Answer 8

first, cardiac catheterization to locate blockages, see collateral circulation, and evaluate LV function Put BMS or DES into blocked artery If bad LV function, possibly IABP and/or inotrope **very few need CABG

Answer 9

-for ppl with chest pain less than 12 or 24 hrs and STEMI -GET BASELINE LABS and start 2-3 IV lines -meds can be given in one IV bolus or over 30-90 mins -serum cardiac biomarkers rapidly rise 3 hrs after -start heparin bc risk of re-clotting *Now you can move them to PCI facility *complications = bleeding --> apply pressure or ice

Answer 10

-intracranial hemorrhage ever -known structural/vascular abnormality -intracranial neoplasm -stroke in past 3 months -recent head or facial trauma -recent intracranial or intraspinal surgery -severe uncontrolled htn -active bleeding -suspected aortic dissection

Answer 11

CABG -requires sternotomy and CPB -for left coronary artery, 3-vessel disease, DM, CKD, LV dysfunc MIDCAB --> no sternotomy or CPB -IMA is sutured to left anterior descending or right coronary artery OFCAB -sternotomy, but no CPB -done on beating heart -less blood loss, renal dysfunc, postop afib, and neuro issues Transmyocardial laser revascularization -for ppl with advanced CAD who aren't candidates for traditional CABG -laser makes channels in heart to let blood flow to ischemic areas

Answer 12

IV nitroglycerin aspirin BBs anticoagulants (LMWH or UH) glycoprotein IIb/IIIa inhibitors if PCI anticipated ACE-i sometimes; CCBs if issues w/ BBs

Answer 13

1. Pain assessment using PQRST 2. position patient upright and give O2 NO MATTER WHAT 3. Establish IV line 4. give NG, MORPHINE, and O2 for chest pein 5. maintain ECG monitoring (PVC and Vfib after MI are common) 6. assess vitals frequently along with I and O **look for heart failure: dyspnea, tachycardia, pulmonary congestion, distended neck veins

Answer 14

1. hospitalization -msy or may not be able to ambulate --> depends on severity -start with sitting up, ROM, self care, then work on walking -focus on pain, anxiety, dysrhythmias 2. Early recovery -2-12 weeks in outpatient place -increase activity -teach ab risk factor reduction 3. Late recovery - physical activity program -therapeutic lifestyle changes -some med supervision