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Nursing 2 Exam 3 > Unit 13 CAD > Flashcards

Unit 13 CAD Flashcards

1
Q

What are the 3 main coronary arteries?

A

Left anterior descending (LAD)
Circumflex (Circ; Cx)
Right (RCA)

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2
Q

Where do the left anterior descending and circumflex artery supply blood too?

A

Mostly the left side of the heart and the body

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3
Q

Where does the right coronary artery (RCA) supply blood too?

A

Back of the heart

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4
Q

What is angiogenesis in what situation could this take place?

A

creation of new blood vessels,

angiogenesis to compensate for chronic ischemia

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5
Q

What is the pacemaker of the heart?

A

SA node

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6
Q

What is Atherosclerosis?

A

progressive hardening of the arteries

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7
Q

When do the coronary arteries get perfused?

A

during diastole

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8
Q

What are fatty streaks?

A

fat deposits in the lining of the arteries, not a good thing but a natural process

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9
Q

What is a plaque atheroma lesion

A

Blockage within the artery

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10
Q

What are the major modifiable risk factors, contributing, and non-modifiable risk factors for CAD?

A

Elevated serum lipids
HTN
Tobacco use
physical inactivity

Diabetes
Stress
Elevated homocysteine 
substance abuse
metabolic syndrome

Age
Gender
Ethnicity
Genetic predisposition

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11
Q

What are a women’s most common symptoms of CAD/Heart Disease

A

fatigue

flu like symptoms

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12
Q

What is Homocysteine (Hcy) and what is it associated with?

A

Homocysteine is an amino-acid, by-product of protein catabolism, and is associated with an increase risk of CVD

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13
Q

What is C-Reactive Protein (CRP), what does it indicate, and what can it predict?

A

C-Reactive Protein (CRP) is a protein made by the liver and indicates acute inflammation,
-it is a predictive of increased risk for cardiac events in patients with UA and MI

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14
Q

What are the types of serum lipids?

A

Triglycerides (storage)
Cholesterol
Phospholipids

-they circulate as lipoproteins

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15
Q

What are the 2 lipoproteins we focus on and which is “good” and which is “bad”?

A

Low-density lipoproteins (LDLs)
-mostly cholesterol

High-density lipoproteins (HDLs)
-mostly protein

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16
Q

What are the preferred lipid profile levels?

A

Total cholesterol < 200

Triglycerides < 150

LDL < 100
-we want these low

HDL > 60
-we want these high

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17
Q

What kind of physical activity should someone do for CAD risk reduction?

A

10,000 steps

30 min a day

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18
Q

Name the HMG-CoA reductase inhibitors, a side effect, and who shouldn’t use them?

A

HMG-CoA reductase inhibitors (Statins)
 atorvastatin
 simvastatin

Most widely used

Side effects: Leg pain,

PT’s with liver failure should not be given statins

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19
Q

Name the Nicotinic acid derivative and what it should be taken with plus a side effect.

A

-niacin

flushing may occur and should be taken with an NSAID or Aspirin

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20
Q

Name the Fibric acid derivative and what is it most effective for?

A
  • fenofibrate

- most effective for lowering triglycerides and increasing HDL

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21
Q

What do the HMG-CoA reductase inhibitors, Nicotinic acid derivative, and Fibric acid derivative medications essentially do?

A

they restrict lipoprotein production

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22
Q

What does the medication cholestyramine do and what can it interfere with?

A

decreases absorption and can interfere with other medications so administer it separately

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23
Q

What medication is usually given with a statin in combination therapy?

24
Q

Name and describe another lipid regulating medication used when PTs aren’t responding to other therapies.

A

oemga-3 acid ethyl ester

  • can increase live enzymes
  • can interfere with anticoagulants and increase bleeding time
  • adjunct to diet in PT’s with very high cholesterol > 500
25
What are diagnostic tests for CAD?
``` Chest X-ray Electrocardiogram Echocardiogram Nuclear scans Cardiac CT scan Blood tests - Lipid profile - Cardiac markers Cardiac catheterization ```
26
Describe aspects of Electrocardiogram (ECG or EKG) and what it shows.
- Shows electrical activity of the heart using 12 leads - Lead corresponds to location within the heart - Helps diagnose injury - Can change over time - Holter monitoring - Exercise stress test
27
If a PT has ischemia what will show on the EKG?
ST segment depression and T wave inversion
28
What is general the purpose of a stress test and what are ways it can be performed?
-to test how your heart responds to "work" can be performed treadmill, hand bicycle, and even medication while at rest
29
Describe an echocardiogram.
>uses sound waves to evaluate cardiac structures - shape - size - motion >measures ejection fraction >can also be performed as stress echocardiogram >can be done Transthoracic or Transesophageal (can see mitral valve disease)
30
What are the purpose of radionuclide scans and what happens with the PTs urine?
- Evaluate coronary artery perfusion - Detect areas of myocardial ischemia - Assess left ventricle function PTs urine radioactive for 24 hrs
31
Describe Cardiac Computed Tomography (Cat scan)
```  Done with or without contrast  Shows anatomy, coronary circulation, great vessels  Coronary CT angiography  Calcium-score screening scan -Increased coronary calcium is predictive of future cardiac events ```
32
What are the 4 serum cardiac markers? Describe each.
Creatine kinase (CK) non-specific >CK-MB is specific to heart tissue - Released with myocardial injury  Troponin - Biomarker of choice for diagnosis of heart damage - Detectable within 4 – 6 hours after injury - Detectable for 10 – 14 days - Level should be less than 0.1  Myoglobin -Non-specific and short duration  Natriuretic Peptide (BNP) - For diagnosis of heart failure
33
What is angina?
pain caused by myocardial ischemia (reversible)
34
When does ischemia occur?
When myocardial oxygen demand is greater than myocardial oxygen supply
35
What is angina/ischemia primally caused by and what is usual percentage of obstruction before it occurs?
atherosclerosis >= 75%
36
What is Prinzmetal's (variant) Angina?
- rare, occurs at rest (supply ischemia) - may occur with or without CAD - controlled with calcium channel blockers and/or nitrates
37
What is silent ischemia?
- ischemia without subjective symptoms - EKG changes will be seen - managed the same as angina with symptoms - same risk as angina with symptoms
38
Describe stable angina.
Transient Predictable Same pattern of onset, duration (5-15 min), & intensity Relieved when cause is stopped or removed Unusual at rest *Demand problem
39
How to assess for angina?
subjective data: ``` history risk factors symptoms pain O,P,Q,R,S,T ``` physical data: signs of adequate perfusion extra heart sounds adventitious lung sounds
40
What is the goal for stable angina management?
Balance myocardial oxygen supply and demand
41
How is stable angina managed?
``` >Lifestyle modifications >Risk factor reduction -lipid-lowering agents >Pharmacological therapy -Nitrates -Beta-blockers -Calcium channel blockers -Anti-platelets >Diagnostic and/or perfusion procedures ```
42
Describe nitrates, name the two types, and provide information on the use of them.
Nitrates are vasodilators (both decreasing venous return and increasing arterial oxygen supply) that relieve angina. The short acting is sublingual nitroglycerin (NTG) - must be kept brown bottle - check expiration date - up to 3x taken within 5 min. periods - check for contraindication like Erectile Dys. Rx The long acting are: NTG ointment/patch Isosorbide dinitrate
43
Describe beta-blockers use for CAD/what they do.
They decrease myocardial oxygen demand - negative inotrope (decreases work of heart) - negative chronotrope
44
Describe calcium channel blockers use for CAD/what they do.
Decrease oxygen demand and increase oxygen supply - negative inotrope - negative chronotrope - vasodilator - used to treat vasospasm
45
What is the purpose of anti-platelet therapy?
to inhibit platelet aggregation/thrombus
46
Name the 3 anti-platelet medications and describe each.
aspirin -inhibits production of thrombus clopidogrel - interacts with PPIs - Needs to be activated by an enzyme * Plavix test shows if PT has enzyme* prasugrel -newer medication more effective than clopidogrel
47
What is coronary angiography (cardiac catheterization)?
-Invasive procedure -Femoral or radial insertion site >if inserted radially allan test needs to be performed to assess for adequate perfusion - Uses fluoroscopy and contrast media to visualize vessels, valves, chambers * Gold standard for diagnosis of CAD*
48
What are two types of precautionary coronary interventions?
Balloon angioplasty Stent placement
49
What are the immediate post procedure priorities?
``` >Promote safety and comfort -Bedrest With femoral insertion -keep PT supine -affected leg straight -HOB <30 degrees -Pain management ``` -Meet basic needs be creative helping PT eat and toileting -Assess for prodecural complications
50
What are the bleeding complications from cardiac catheterization? How often would you check vitals?
Retroperitoneal bleed (flank and back bleeding, PT might have back pain) Puncture site bleeding Psuedoaneurysm (hematoma outside blood vessel) Checking Neuro every VS check Q4 (frequently)
51
What are two other post procedure complications having to do with lower extremities and the kidneys and what are interventions for each?
Lower limp ischemia -check pulse with doppler Acute renal failure do to receiving dye - assess I&Os (check PT is voiding) - check BUN/creatinine - provide IV fluids - oral fluids - antioxidants
52
What is restenosis of a blood vessel and what will be frequently done to check for this complication?
Dissection, thrombus, or spasm of the coronary artery Frequent cardiac assessment - telemetry - EKG - Instruct PT to report symptoms immediately
53
What can be assessed if PT has restenosis?
- Anxious - Chest pain present - Diaphoretic, cool - SOB, hypoxic - Extra heart sounds, dysrhythmias - Adventitious long sounds - VS unstable
54
What are the discharge priorities?
*Education prior to discharge* - Medications - Lifestyle modifications - Cardiac rehabilitation
55
Describe ezetimibe.
Decrease cholesterol absorption

Nursing 2 Exam 3 (5 decks)

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