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NUR2226 > WK 2: Cardiac Disorders A > Flashcards

WK 2: Cardiac Disorders A Flashcards

1
Q

What are the two types of atherosclerosis?

A

Arteriosclerosis and Atherosclerosis

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2
Q

What is arteriosclerosis?

A

Thickening and hardening of the walls of the arteries

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3
Q

What is atherosclerosis?

A

Occurs when the soft deposits of intra-arterial fat and fibrin along the vessel wall Harden over time

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4
Q

Identify 3 risk factors of atherosclerosis

A

Smoking
Hypertension
Diabetes Mellitus
Increased levels low density lipoprotein cholesterol
Decreased levels of high density lipoprotein cholesterol

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5
Q

Describe the pathophysiology of atherosclerosis

A

Abnormal accumulation of lipid/fatty substance and fibrous tissues, leading to narrowing of the arterial vessel

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6
Q

Identify 3 clinical manifestations of atherosclerosis

A

Chest Pain

Atypical: Nausea, dyspnoea, fatigue, diaphoresis

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7
Q

What is hypertension?

A

Diagnosis of systolic BP at 140mmHg or diastolic BP at 90 mmHg at different times repeatedly

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8
Q

What are the 4 types of hypertension?

A

Primary hypertension
Secondary hypertension
Hypertensive urgencies
Hypertensive emergencies

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9
Q

Define primary hypertension

A

Usually no known cause

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10
Q

Define secondary hypertension

A

Cause can usually be identified

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11
Q

Define hypertensive urgencies

A

Severe BP elevation 180/110 or above

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12
Q

Define hypertensive emergencies

A

Severe BP elevation 220/140 or above

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13
Q

Identify 3 risk factors of hypertension

A

Family history
Advancing age
Smoking
Obesity

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14
Q

Identify 2 potential complications of hypertension

A

Heart attack

Stroke

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15
Q

Describe the pathophysiology of hypertension

A

Complicated combination of genetics and environmental factors that cause neural and hormonal effects e.g. Inflammation = increased BV and PR

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16
Q

Identify 3 clinical manifestations of hypertension

A

Usually asymptomatic -
Fatigue
Frequent headaches
Retinal changes

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17
Q

What is typically involved in the assessment of hypertension?

A

Blood pressure assessment on several occasions at different times, 24 hour BP monitoring, blood tests, ECG

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18
Q

What is angina pectoris?

A

Is the pain or other sensation caused by myocardial ischaemia

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19
Q

Define myocardial ischaemia

A

Occurs when the demand for myocardial oxygen exceeds the supply of oxygen from coronary arteries, causing chest pain

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20
Q

Identify the two types of angina pectoris

A

Stable angina and unstable angina

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21
Q

Define stable angina

A

A brief episode of chest pain that subsides with medication or rest usually associated with physical activity

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22
Q

Define unstable angina

A

Presents as either new onset, occurring at rest or increasing. Results from myocardial ischaemia and does not go away with medication or rest

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23
Q

Identify 3 risk factors of angina pectoris

A

Coronary artery disease
Increasing age
Smoking
Increased cholesterol

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24
Q

Identify 2 complications of angina pectoris

A

AMI
Arrythmia
Death

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25
Q

Describe the pathophysiology of angina pectoris

A

Caused by a reduction of blood flow through the coronary arteries that supply oxygen/nutrients to the myocardium. Either due to a decreased supply or increased demand

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26
Q

What must occur for ischaemia to occur?

A

Arteries must be blocked by 75% for ischaemia to occur

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27
Q

Identify 3 clinical manifestations of angina pectoris

A

Chest pain/discomfort (Stabbing, Crushing, Pressure)
Radiating pain (Arms, Neck, Jaw)
SOB

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28
Q

What is Acute Coronary Syndrome

A

Culmination of atherosclerosis and angina pectoris. Conditions which are caused by a sudden reduction or blockage of blood flow to the heart

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29
Q

What are the two types of ACS?

A

Acute myocardial infarction

Unstable angina

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30
Q

Identify 3 risk factors of acute coronary syndrome

A

Atherosclerosis
Hypertension
Increasing age
Family history

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31
Q

Identify 2 potential complications of ACS

A

Electrical dysfunction

Mechanical dysfunction

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32
Q

Describe the pathophysiology of ACS; Unstable angina

A

Usually reversible myocardial ischaemia, signals that the plaque in the arteries has become complicated and is a strong indicator of an AMI

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33
Q

Describe the pathophysiology of ACS; Acute myocardial infarction

A

Occurs when plaque is disrupted and there is a subsequent clot in the arteries resulting in reduced blood flow and myocyte necrosis. May then progress to the thrombus blocking blood flow

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34
Q

What are the two types of AMI?

A

Subendocardial infarction

Transmural infarction

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35
Q

Describe a subendocardial infarction

A

Occurs when a thrombus blocking coronary blood flow breaks up before distal tissue necrosis. Only involves the myocardium

36
Q

Describe a transmural infarction

A

Occurs when a thrombus permanently blocks blood flow and necrosis extends through the myocardium to the endcaridum and pericardium = cardiac dysfunction

37
Q

How long does it take before myocardial cell death occurs?

A

20 mins of reduced blood flow will lead to myocardial cell death

38
Q

Identify 3 clinical manifestations of an AMI

A

Angina pain, but more intense
Nausea/vomiting
BP drop then increase (sympathetic NS)
Diaphoresis

39
Q

What is coronary heart disease?

A

Is an overarching term for diseases which affect the coronary vessels, e.g. when coronary arteries clog and narrow due to plaque

40
Q

Identify 3 risk facts of CHD

A 
Atherosclerosis 
Hypertension 
High cholesterol 
Obesity 
Smoking
41
Q

Identify 2 potential complications of CHD

A

AMI
Heart failure
Angina

42
Q

Describe the pathophysiology of CHD

A

Disorders which affect the blood flow through the coronary vessels which supply the heart with oxygen and nutrients. Long term, pathological conditions

43
Q

What is metabolic syndrome?

A

A collection of conditions that occur together and increase the risk of DM stroke and heart disease

44
Q

What are the 5 main components of metabolic syndrome?

A
  1. Obesity
  2. Hypertension
  3. Insulin resistance
  4. Elevated blood triglycerides
  5. Low levels if High Density Lipoprotein cholesterol
45
Q

What is troponin?

A

A protein found in cardiac muscle that is released into circulation when there is damage to the myocardium

46
Q

What does a blood test, specifically for troponin levels tell you about the heart?

A

Tells the nurse that there is damage to the myocardium often due to reduced blood flow and therefore needs to be explored for a underlying cause

47
Q

List the 7 cardiac diagnostic tests

A 
ECG 
Echocardiogram 
Exercise stress test 
Chest Xray 
Cardiac catherisation 
Coronary angiogram 
Coronary artery calcium scan
48
Q

What is an ECG?

A

Measures electrical acitivity, rate and regularity of your heartbeat

49
Q

What is an echocardiogram?

A

Uses US to create a picture of your heart. Used to see how blood moves through the heart

50
Q

What is an exercise stress test?

A

Measures your heart rate while you walk on a treadmill. Determines how well your heart works when it has to pump more blood

51
Q

What is cardiac catheterisation?

A

Checks inside of the arteries for blockages by inserting a thin flexible tube through an artery to reach the heart used to measure BP through the heart or collect blood

52
Q

What is a coronary angiogram?

A

Monitors blockage and flow of blood through the coronary arteries. Uses Xray to detect dye injected via cardiac catheterisation

53
Q

What is a coronary artery calcium scan?

A

A CT scan that looks into the coronary arteries for calcium buildup and plaque

54
Q

Identify 3 nursing considerations when caring for cardiac patients

A 
Vital signs
Pain assessment 
Oxygen administration (PRN)
ECG 
Reduce anxiety 
Continuous monitoring
55
Q

Lipid Lowering Agents (Antihyperlipidemic agents)

  • Drug class
  • Indications
  • Mechanism of Action
  • Adverse effects
  • Nursing Consideration
A

SATINS

  • HMG-CoA reductase inhibitor
  • Hypercholestrolaemia, dyslipidaemia
  • Reversibly inhibit HMG-CoA reductase reducing cholesterol synthesis
  • GI upset, dizziness
  • Avoid large amounts of alcohol (increased risk liver impairment)
56
Q

What are 3 examples of lipid lowering agents

A

“SATINS”

  • Atorvastatin
  • Simvastatin
  • Fluvastatin
57
Q

What are the 4 categories of lipid lowering agents

A
  • HMG CoA reductase inhibitors “Satins”
  • Bile acid sequestrants
  • Cholestrol absorption inhibitor
  • Fibrates and vitamin B
58
Q

ACE Inhibitors (Angiotension Converting Enzyme)

  • Drug class
  • Indications
  • Mechanism of Action
  • Adverse effects
  • Nursing Consideration
A
  • ACE inhibitor
  • HTN, HF, AMI, prevent CVD events in high risk patients
  • Prevents the conversion of Angiotensin 1 to Angiotensin 2 by inhibiting ACE = Decreased PVR and BP
  • Cough, hypotension, dizziness
  • Avoid dehydration and over sweating
59
Q

What are 3 examples of ACE inhibitors

A

“PRIL”

  • Captopril
  • Enalapril
  • Fosinopril
60
Q

Anti-Anginal Agents

  • Drug class
  • Indications
  • Mechanism of Action
  • Adverse effects
  • Nursing Consideration
A
  • Organic nitrates
  • Manage acute pain/Prevent further attacks
  • Relaxes smooth muscle = vasodilation of peripheral arteries = decreased arterial pressure and CO = decreased oxygen demand, dilates coronary vessels
  • hypotension, fainting (syncope)
  • Warn patient of fainting, don’t touch GTN
61
Q

Calcium channel blockers (DIHYDROPYRIDINES)

  • Drug class
  • Indications
  • Mechanism of Action
  • Adverse effects
  • Nursing Consideration
A
  • Calcium channel blockers (Dihydropyridines primarily act on arterioles)
  • HTN, Angina, dysrhythmias
  • Impedes influx of calcium ions through slow channels of cell membrane during depolarisation of cardiac smooth muscle, dilates coronary and peripheral arteries to increase blood flow
  • Constipation, dizziness
  • Grapefruit juice can inhibit hepatic/intestinal metabolism and lead to toxicity
62
Q

Calcium channel blockers (PHENYLALKYLAMINES)

  • Drug class
  • Indications
  • Mechanism of Action
  • Adverse effects
  • Nursing Consideration
A
  • Calcium channel blockers (Phenylalkylamines act on arterioles and heart)
  • HTN, Angina, dysrhythmias
  • Impedes influx of calcium ions through slow channels of cell membrane during depolarisation of cardiac smooth muscle, dilates coronary and peripheral arteries to increase blood flow
  • Constipation, dizziness
  • Grapefruit juice can inhibit hepatic/intestinal metabolism and lead to toxicity
63
Q

Calcium channel blockers (BENZOTHIAZEPINES)

  • Drug class
  • Indications
  • Mechanism of Action
  • Adverse effects
  • Nursing Consideration
A
  • Calcium channel blockers (Benzothiazepines act on arterioles and heart)
  • HTN, Angina, dysrhythmias
  • Impedes influx of calcium ions through slow channels of cell membrane during depolarisation of cardiac smooth muscle, dilates coronary and peripheral arteries to increase blood flow
  • Constipation, dizziness
  • Grapefruit juice can inhibit hepatic/intestinal metabolism and lead to toxicity
64
Q

What are the three types of calcium channel blockers?

A

Dihydropyridines
Phenylalkylamines
Benzothiazepines

65
Q

What is the main function of Dihydropyridines (Seperates them from the other calcium channel blockers)

A

Primarily acts on the arterioles

66
Q

What is the main function of Phenylalkylamines (Separates them from the other calcium channel blockers)

A

Acts on the arterioles and the heart

E.G. Verapamil

67
Q

What is the main function of Benzothiazepines

A

Acts on the arterioles and the heart

E.G. Diltiazem

68
Q

Beta Blockers (Beta adrenergic antagonists)

  • Drug class
  • Indications
  • Mechanism of Action
  • Adverse effects
  • Nursing Consideration
A
  • Beta blockers
  • Angina, HTN, Dysrhytmias, AMI, HF
  • Inhibits beta adrenoreceptors = Reduced HR, force of contraction and CO, inhibits renin release from kidneys
  • Bradycardia, hypotension, fatigue
  • Do not stop medication abruptly
69
Q

What are 3 examples of beta blockers

A

Atenolol
Metoprolol
Propanolol
Bisoprolol

70
Q

What are the three types of diuretics?

A

Thiazide diuretics
Loop diuretics
Potassium sparing diuretics

71
Q

Thiazide diuretics

  • Drug class
  • Indications
  • Mechanism of Action
  • Adverse effects
  • Nursing Consideration
A
  • Thiazide diuretics
  • HF, oedema with HF, HTN, renal impairment
  • Increases excretion of sodium/chloride/water in distal tubule
  • hypokalaemia, dehydration, hypovolaemia
  • Daily weights to measure FB
72
Q

What is an example of a thiazide diuretic?

A

Hydrochlorothiazide

73
Q

Loop diuretics

  • Drug class
  • Indications
  • Mechanism of Action
  • Adverse effects
  • Nursing Consideration
A
  • Loop diuretics
  • HF, oedema with HF, HTN, renal impairment
  • Blocks absorption of sodium, chloride and water from filtered fluid in the kidney
  • hypokalaemia, dehydration, hypovolaemia
  • Fluid, electrolyte, acid base balances considered
74
Q

Potassium sparing diuretics

  • Drug class
  • Indications
  • Mechanism of Action
  • Adverse effects
  • Nursing Consideration
A
  • Potassium sparing diuretics
  • HF, oedema with HF, HTN, renal impairment
  • Increases excretion of sodium in distal tubule and conserves potassium
  • Hearing loss, dehydration, hypovolaemia
  • Fluid, acid base balances
75
Q

What is an example of a loop diuretic?

A

Furosemide

76
Q

What is an example of a potassium sparing diuretic?

A

Spironolactone

77
Q

Inotropic Agents

  • Drug class
  • Indications
  • Mechanism of Action
  • Adverse effects
  • Nursing Consideration
A
  • Cardiac glycoside
  • HF, AF, Paoxysmal atrial tachycardia
  • increases CO by inhibiting sodium potassium pump exchange, slows conduction rate through AV node to decrease HR
  • Anorexia, bradycardia
  • Aware of S&S of digoxin toxicity
78
Q

What is an example of a inotropic agent?

A

Digoxin (PO)

Lanoxin (CC environment)

79
Q

Angiotensin receptor blockers

  • Drug class
  • Indications
  • Mechanism of Action
  • Adverse effects
  • Nursing Consideration
A
  • Angiotensin II receptor antagonists
  • HTN
  • Block the angiotensin II receptors to increase renal blood flow and maintain GFR
  • Hypotension, dizziness
  • Consider patients fluid/electrolyte balance
80
Q

What are 3 examples of angiotensin receptor blockers ?

A

“SARTAN”
Irbesartan
Candesartan
Losartan

81
Q

What is antithrombin?

A

Antithrombin is a protein that inactivates thrombin and factor Xa (clotting factors) leading to a reduction in the production of fibrin and clotting is supressed

82
Q

What are the three classes of Heparin?

A

Unfractionated heparin
Low molecular weight Heaprin (LWMH)
Fonaparinux

83
Q

Heparin

  • Drug class
  • Indications
  • Mechanism of Action
  • Adverse effects
  • Nursing Consideration
A
  • Anticoagulants
  • Prophylaxis/Treatment DVT/PE, Clotting in cardiac curve ry
  • Decreases the clotting ability of blood
  • Haemorrhage, local irritation,
  • rotate injection site
84
Q

What is the additional indication for LMWH heparin?

A

Used with other therapies for treatment of unstable angina, MI an STEMI

85
Q

Warfarin

  • Drug class
  • Indications
  • Mechanism of Action
  • Adverse effects
  • Nursing Consideration
A
  • Anticoagulant
  • Long term prophylaxis of thrombosis, prevention of thrombosis in AF patients
  • Supresses coagulation by decreasing production of clotting factors, interferes with vitamin k dependent synthesis of prothrombin
  • Haemorrhage, red or brown urine
  • Pressure to venepuncture to prevent bleeding
86
Q

Aspirin

  • Drug class
  • Indications
  • Mechanism of Action
  • Adverse effects
  • Nursing Consideration
A
  • Acetylsalycyclic acid
  • Ischaemic stroke, AMI or previous AMI, inflammation associated pain
  • Supresses platelet aggregation by causing irreversible inhibition of cycloxegenase
  • GI irritation, increased risk of GI bleeding
  • Elderly are at more risk of adverse effects

NUR2226 (8 decks)

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