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NURSADN6 Med Surg > Week 6 Management of Patients with CAD Ch23 > Flashcards

Week 6 Management of Patients with CAD Ch23 Flashcards

1
Q

Abnormal accumulation of the lipid deposits and fibrous tissue within arterial walls and lumen

A

Atherosclerosis

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2
Q

In _____________________ ___________________ blockages and narrowing of the coronary vessels reduce blood flow to the myocardium

A

Coronary Atherosclerosis

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3
Q

Leading cause of death in the United States for all men and women of all racial and ethnic groups

A

Cardiovascular Disease

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4
Q

Most prevalent cardiovascular disease in adults

A

CAD

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5
Q

Pathophysiology of Atherosclerosis

A
  • Endothelium, intima, media, adventitia
    Injury response
  • Monocyte emigration
  • Smooth muscle proliferation
  • Fatty streak and lymphocyte
  • Fibrofatty atheroma, collagen, lipid debris
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6
Q

Clinical manifestations of CAD include

A

Symptoms are caused by MI
Angina pectoris most common
other symptoms include: epigastric distress, pain that radiates to jaw or left arm, SOB, atypical symptoms in women
MI
HF
Sudden Cardiac Death

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7
Q

Non modifiable risk factors of CAD

A

Family History
Increasing age
Gender
Ethnicity
Hx premature menopause before 40
Primary hypercholesterolemia genetically elevated LDL

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8
Q

Name modifiable risk factors of CAD

A

Hyperlipidemia
Tobacco use
HTN
Diabetes
Metabolic Syndrome
Obesity
Physical Inactivity
CKD stage

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9
Q

How to prevent CAD?

A

Control Diabetes
Control cholesterol
Dietary measures
Physical activity
Medications
Cessation of tobacco use
Manage HTN

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10
Q

What are some cholesterol medications

A

-HMG-CoA or statins
- Nicotinic Acids
- Fibric Acids
Resins—Bile acid sequestrants
- Cholesterol absorption inhibitors
- Omega 3 acid ethyl esters

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11
Q

When ischemia is prolonged and not immediately reversible which what develops

A

ACS
- Either be partial or complete blockage

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12
Q

ACS encompasses what?

A
  1. Unstable Angina
  2. NSTEMI
  3. STEMI
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13
Q

What is the relationship between CAD, Chronic Stable Angina, and ACS

A

CAD—- Chronic stable angina —–Acute coronary syndrome

Acute coronary syndrome is broken up to two things

  1. Unstable angina
  2. NSTEMI

or 1. STEMI

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14
Q

Decreased blood flow in a coronary artery

A

Unstable Angina

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15
Q

Plaque ruptures and the clot completely occludes the artery

Ischemia and necrosis of tissue

A

MI

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16
Q

Other causes of MI include

A

Vasospasm
Rapid HR
Decreased O2 supply

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17
Q

Anything that can cause a profound imbalance between myocardia O2 supply and demand

A

MI

2 types of MI- NSTEMI or STEMI

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18
Q

Syndrome characterized by episodes or paroxysmal pain or pressure in the anterior chest caused by insufficient coronary blood flow

A

Angina Pectoris

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19
Q

Name the types of angina

A

Stable
Unstable
Intractable/ refractory
Variant (Prinzmetal)
Silent

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20
Q

Name Angina Precipitating Factors

A

Exertion
Temperature
Emotional Changes

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21
Q

Exercise or other physical exertion increases the HR and decreases the duration of diastole, which interferes with circulation to the coronary arteries

A

Exertion

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22
Q

Extremes increase the heart’s workload. Cold results in Vaso restriction, limiting the coronary blood flow. Heat causes peripheral vessels to dilate and blood to pool in the skin, again limiting coronary blood flow

A

Temperature

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23
Q

Strong emotions, such as anger or fear, stimulate the sympathetic nervous system and increase the pulse and the heart’s workload

A

Emotional Changes

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24
Q

This angina occurs when your heart is working harder and needs more oxygen that can be delivered through the narrowed arteries

Pain goes away when you rest or take nitroglycerin usually < 15 minutes

May continue without much change for years

Treatment and control

A

Stable Angina

Nitro SL
Extended Release Nitro
CC plus, BB

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25
New in onset Occurs at rest and longer than 15 min Has worsening pattern may indicate deterioration of plaques
Unstable Angina
26
What angina is unpredictable and represents a medical emergency can lead to MI
Unstable Angina Dx- No ECG changes or elevation of enzymes
27
Identified based on EKG, non ST segment elevation but still positive cardiac markers
NSTEMI
28
Management of UA/ NSTEMI for high risk
Coronary Arteriography - high risk strategy
29
Not high risk for UA and NSTEMI
Clopidogrel Statin ACEI Outpatient Rx
30
Negative Stress tests from UA or NSTEMI
Consider alternative diagnosis
31
What is the nursing assessment for angina?
-Tightness, choking, or heavy sensation - Frequently retrosternal and may radiate to neck, jaw, shoulders, back or arms - Anxiety comes with pain - Dyspnea, SOB, dizziness, nausea, vomiting - The pain of typical angina subsides with rest or NTG - Unstable angina
32
This is characterized by increased frequency and severity and is not relieved by rest or NTG. Requires medical intervention
Unstable Angina
33
Name Gerontologic considerations for CAD etc
Diminished pain transition that occurs with aging may affect presentation of symptoms Silent CAD Teach older adults to recognize their chest like pain ie weakness - Pharm stress testing: cardiac cath - Meds used cautiously
34
Tx of Angina/ CAD etc include
Tx to decrease myocardial oxygen and increase oxygen supply Medications Oxygen Reduce and control risk factors Reperfusion therapy may also be done
35
Medications for Angina/ CAD etc
Nitroglycerin Beta adrenergic blocking agents Calcium channel blockers Antiplatelet and anticoag meds - Aspirin - Clopidogrel and ticlopidine - Heparin Glycoprotein IIB/ IIIa agents - Intergrilin and Reopro
36
Nitrates do what?
Small does dilate veins Higher doses dilate arteries
37
Lo dose of nitrate
Affects veins/ venous pooling decreases pre load- low doses decreases CO and BP
37
High doses of nitrates
Affects arteries Decrease BP and afterload and decrease myocardial O2 damages Route: SL, IV, patch, spray
37
Blocks beta adrenergic sympathetic stimulation to the heart
Beta antagonist Decrease -HR- neg dromotrope -BP - Force of contractility- neg. inotrope Caution in pulmonary diseases asthma
37
Calcium Channel Blockers have negative what?
Inotropic effects
38
Calcium Channel Blockers decrease what?
SA and AV node= Decrease HR and strength of contraction Cardiac workload BP by relaxing the vessels In return increase - Coronary artery perfusion myocardial O2 supply by dilating arterioles Decreases myocardial O2 demands by decreasing ABP and workload of LV
38
What labs do you look for heparin?
PTT therapeutic levels are 2-2.5 x> normal Anti factor Xa 0.11-0.4
38
Use LMWH for
Unstable angina and NSTEMI PTT Bleeding precautions: IM or restrictive BP cuffs
38
Acute angina dose for ASA is
160mg- 325 mg load Maintenance is 81mg-325mg prophylactic Coupled with H2 Blockers or PPI for GI upset
38
Name calcium channel blocker
Amlodipine Diltiazem Used when BB are ineffective and can prevent or tx venospasms
38
What does ASA do?
Decrease platelet aggregation, reduces incidence of MI and death from CAD
38
Prevents formation of new clots
Heparin
38
Nursing Assessment for pt with Angina includes
Healt history Symptoms and activities especially those that precede and precipitate attacks Risk factors, lifestyle, and health promotion activities Pt and family knowledge Dx
38
Diagnoses for Angina Pectoris patients include
Risk for decreased cardiac tissue perfusion Anxiety related to cardiac symptoms and possible death Deficient knowledge about the underlying disease and methods for avoiding complications Noncompliance, ineffective management of therapy regimen
38
Interventions for patient with angina
MONA Reduce anxiety Prevent pain Educate patients about self care Continuing care
38
Blocks platelet activation and efficacy is achieved over days
Clopidogrel
38
HIT risk is
Heparin for 3 months or UFH 5-15 days period
38
Patient has Angina what do you do?
Stop all activity and rest Assess pt with VS, resp. distress, and assessment of pain. ECG Administer medications as ordered by protocol usually NTG. Reassess pain and administer NTG up to 3 doses 2L O2 by nc
38
Nursing goals for patient with Angina Pectoris
Immediate and appropriate tx of angina (relief of pain/ sx) Prevention of angina Reduction of anxiety Awareness of disease process Understanding of care and adherence to program Absence of complications
38
Nursing Intervention in preventing pain includes
Identify the level of pain from activities Plan accordingly Alternate Educate
38
Collaborative problems include
ACS, MI, or both Dysrhythmias and cardiac arrest Heart Failure Cardiogenic Shock
38
Nursing intervention for patient teaching
Balance activity with rest Follow prescribed exercise regimen Avoid extreme temperatures Use resources for emotional support Avoid OTC medications Stop using tobacco Diet low in fat and high in fiber
39
Nursing interventions to reduce anxiety include
Use a calm manner Stress reduction techniques Patient teaching Address spiritual needs Address both family and patient
39
Nursing Intervention for patient teaching continued
Carry NTG all times Follow up with provider Report increases of s/s to provider Maintain normal BP and blood glucose levels
40
ACS and MI
Emergent situation Characterized by an acute onset of myocardial ischemia that results in myocardial death if definitive interventions do not occur promptly Terms used Coronary occlusion, heart attack, and MI. MI preferred
41
Result of sustained ischemia greater than 20 min, causing irreversible myocardial cell death (necrosis)
MI Necrosis of entire MI takes about 4-6 hours
42
Reperfusion is less than 20min and is
Salvaged
43
Reperfusion is 2-4 hr and is
Partial salvage
44
Permanent occlusion is
Complete infarct
45
What is the pain like in MI?
Total occlusion --anaerobic metabolism and lactic acid accumulation ---severe, immobilizing chest pain not relieved by rest, position change, or nitrate administration
46
Presenting symptoms of MI include
Pain or discomfort to the right or left sided chest with radiation to the shoulder, neck jaw or back as well as tightness around the chest
47
Atypical symptoms of MI include
Dyspnea Nausea Vertigo Diaphoresis Fatigue
48
Gender disparity women MI includes
Ear pain, back pain, neck pain, upper abd. pain More easily missed in women Increase chance in post menopausal women
49
What is silent ischemia?
Up to 80% of patients with MI are asymptomatic Associated with DM and HTN Confirmed by ECG changes
50

NURSADN6 Med Surg (9 decks)

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