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22 Cards in this Set
- Front
- Back
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what is coronary artery disease (CAD)? |
CAD is an imbalance between the demand of myocardial perfusion and the supply of oxygenated blood by the coronary arteries. *MEANING BECAUSE THERE IS LESS BLOOD BEING SUPPLIED TO THE HEART VIA CORONARY ARTERIES, THE HEART IS UNABLE TO PUMP OUT ENOUGH BLOOD SUPPLY DEMANDED BY THE BODY. |
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what is the cause of CAD? |
CAD is caused by plaque build up in the arteries. *WHEN PLAQUE STARTS TO BUILD UP THE BODY STABLIZIES IT WHICH CREATES A PARTIAL OBSTRUCTION. HOWEVER IF THE PLAQUE THEN RUPTURES IT BECOMES A FULL BLOWN BLOCKAGE. THIS PREVENTS BLOOD FLOW THROUGH THE CORONARY ARTERIES CAUSING MYOCARDIAL DAMAGE. THUS LEADING TO THE HEART BEING UNABLE TO ADEQUATELY PUMP ENOUGH BLOOD SUPPLY TO THE BODY. |
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CAD is can lead to what?. |
CAD can lead to either chronic stable angina or acute coronary syndrome. acute coronary syndrome is broken into unstable angina and myocardial infarction. myocardial infarction is broken into ST Elevation MI (STEMI) and Non-ST Elevation MI (NSTEMI) |
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what is chronic stable angina? |
chronic stable angina is chest pain occurring intermittently over a long period of time with the same pattern, onset, duration, and intensity. THIS IS RELIEVED WITH REST! *THE PAIN RADIATES UP THE JAW AND NECK AND DOWN THE LEFT ARM* *ELDERLY PATIENTS MAY NOT BE ABLE TO IDENTIFY CHEST PAIN. DIABETICS MAY NOT BE ABLE TO FEEL CHEST PAIN. MEN 45-65 MAY NOT ACKNOWLEDGE THE CHEST PAIN AND LET IT SWIPE UNDER THE RUG. chronic stable angina can be caused by: physical exertion (majority of blood flow to extermities) exposure to cold (vasoconstriction of coronary arteries) heavy meals(majority of blood flow to GI ssytem) stress/emotions (vasoconstriction of coronary arteries) *THE ABOVE CAUSES FOR LESS BLOOD FLOW THROUGH THE CORONARY ARTERIES. |
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how to assess for angina? |
P - percipitating pain. THIS IS ASKING WHERE THE PAIN IS AND WHAT WAS DONE BEFORE THE PAIN BEGAN ex. pt states "i feel pain in my chest and started while I was shoveling snow." Q - quality and quantity of the pain. THIS IS ASKING TO DESCRIBE THE PAIN. ex. pt states "my chest pain feels like pressure against my chest it is on and off." R - radiation of pain and relief. THIS IS ASKING DOES THE PAIN RADIATE ANYWHERE AND WHAT IS DONE TO RELIEVE THE PAIN? ex. pt states "my chest pain has spread to my neck and left arm. however i felt better once i sat down to rest." S - severity of pain and symptoms. THIS IS ASKING HOW BAD IS THE PAIN AND WHAT ELSE ARE YOU FEELING. ex. pt states "the pain is horrible it is an 8/10 on the pain scale. i've also started to sweat a lot and my head hurts a lot. T - timing. THIS IS ASKING HOW LONG HAS THE PAIN BEEN THERE. ex. pt states "the pain has lasted for over an hour now." |
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what are nursing diagnosis for angina? |
acute pain altered tissue perfusion risk for activity intolerance |
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what is the treatment for chest pain? |
GIVE: nitrates: nitroglycerin is given to vasodilate the coronary artery so that more blood can perfuse to the heart muscle enabling the heart to pump adequate blood flow to the body. THIS IS GIVEN SUBLINGUALLY ONE PILL EVERY 5 MINUTES (MAXIMUM 3 PILLS IN 15 MINUTES) OR IV. *ASSESS FOR BLOOD PRESSURE AND HEADACHES. oxygen: due to the coronary arteries being partial blocked less oxygenated blood is being supplied to the heart hence oxygen is needed to provide the heart with proper nutrients. 2-3L OF OXYGEN VIA NASAL CANNULA CAN BE ADJUSTED BASED ON INDIVIDUAL NEED. ASSESS USING THE O2 SAT, BREATHING RATE, AND WORK OF BREATHING (DYSPNEA OR EUPNEA) aspirin: this is an antiplatelet which is used to prevent the formation of blood clots that can lead to an MI. THIS IS CHEWED SO IT CAN WORK FASTER. PLAVIX CAN ALSO BE GIVEN. beta-blockers: this reduced heart rate which reduces the demand on the heart to supply blood to the other. doing this gives the heart time to be nourished. LOPRESSOR (METOPROLOL) IS THE BETA-BLOCKER OF CHOICE. |
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what are the diagnostic test taken when a patient is experiencing chest pain? |
12 lead EKG: used to isolate the affected area of the heart. Labs: CBC - assessing the H&H to determine the oxygen carrying capacity. a drop in hemoglobin will increase the need for oxygen because decreased hemoglobin concentration causes for a decrease in oxygen supply to the body including the heart which causes angina. CHEST PAIN IS CAUSED BY A DECREASE OF OXYGEN TO THE HEART THUS THE HEART IS UNABLE TO PUMP EFFICIENT AMOUNTS OF BLOOD HENCE CAUSING A DECREASE OF HEMOGLOBIN TO THE BODY THUS INCREASING THE BODY'S DEMAND FOR OXYGEN THEREFORE CAUSING CHEST PAIN. assess for increased WBCs which can indicate healing process after an MI. assess for platelet count because aspirin can cause thrombocytopenia. chemistry: assessing for sodium, potassium, and magnesium. ESPECIALLY THE POTASSIUM WHICH CAN CAUSE ISCHEMIA cardiac enzymes: used to determine if this a heart problem (i.e. MI) due to an increase in enzymes such as troponin in the blood. THIS IS DRAWN EVERY 4, 8 OR 12 HOURS TO DETERMINE ANY PROGRESSION FROM CHEST PAIN TO MI. cogulation studies: if patient is to receive heparin how long it takes to clot blood (cogulation testing) is needed before. thyroid function: an increase in thyroid hormone increases metabolic rate. lipoprotein panel: this used to assess cholesterol, LDL, HDL, triglyceride levels. HbA1c: used to determine for diabetics |
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what should be evaluated after treatment of a stable angina? |
relief of pain avoid complications that can cause progression into MI follows a self-care plan: diet, exercise, and taking medications follow-up: exercise stress test |
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what is a exercise stress test? what are other methods that can be done if a patient cannot do a exercise stress test? |
exercise stress test is used to mimick chest pain by exerting stress to the heart via exercise i.e. running on a treadmill or biking. the goal heart rate is 80-90% maximum of patient's age. SO IF A PATIENT HAS A BLOCKAGE THE EXERTION OF STRESS TO THE HEART WILL CAUSE CHEST PAIN AND THE EKG WILL SPOT WHERE IT IS. EKGs ARE CONTINUOUSLY ASSESSED FOR ANY CHANGES I.E. ST ELEVATION ASSESSING FOR CHEST PAIN ASSESSING VITAL SIGNS FOR ANY CHANGES ASSESSING FOR SHORTNESS OF BREATH OTHER TEST: nuclear stress test: mimickes chest pain by using medications (dobutamine, adenosine etc). CT scan: assess for calcified plaque in the coronary arteries (if greater than 10 pt has coronary heart disease). Echocardiogram: used to assess for heart size and ejection fraction. Cardiac catherization: used to assess for blockages and if any used to treat by placing a stent. |
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what is unstable angina? |
unstable angina can be a sudden chest pain that occurs at rest or increase in severity and frequency. THIS IS DUE TO INCREASED BLOCKAGE IN THE CORONARY ARTERY. LESS BLOOD IS BEING SUPPLIED TO THE HEART CAN CAUSE DAMAGE TO THE HEART MUSCLE (MI). symptoms: diaphoresis dyspnea anxiety as pain worsens |
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what is the major difference between stable and unstable angina? |
unstable angina does NOT go away with rest or treatment. stable angina does go away with rest and/or treatment. |
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what is myocardial infarction? |
myocardial infarction is irreversible necrosis of the heart muscle due to prolonged ischemia (inadequate blood supply to the heart). the damaged heart muscle looses their ability to contract as well as releases cardiac enzymes into the blood. HENCE THE HEART IS NOT PUMPING OUT ENOUGH BLOOD SO THERE IS BLOOD LEFT OVER IN THE HEART |
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what to assess in a patient who has an MI? |
Airway Breathing Circulation: IS THE PATIENT AIRWAYS BLOCKED? ARE THEY BREATHING? ARE THE CIRCULATING ADEQUATELY. safety: MI will cause light-headness and anxiety which can cause patients may fall so he/she must be protected. PQRST: TO ASSESS THEIR CHEST PAIN vital signs: HR, RR, O2 STAT, BREATH SOUNDS, BP, TEMP, PAIN cardiovascular: palpitations (bounding pulse) tachycardia, JVD, irregular heart rate, bradycardia, hypo/hypertension, S3 and S4 heart sounds, murmur. respiratory: tachypnea, SOB, crackles GI: nausea and vomiting GU: decreased urinary output due to heart not pumping enough blood out the amount of floods excreted is decreased. skin: cool, clammy, diaphoresis, pale due to the anxiety neurologic: lightheadness, anxious psychological: feelings of impending doom feeling like they are going to die.
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what is the treatment plan for patients having an MI? |
Morphine: used for masking the chest pain and vasodilate the arteries. Oxygen: to supply adequate oxygen to the body. GIVE FIRST Nitrate: to vasodilate coronary arteries. ASSESS BP AND CHEST PAIN BEFORE EACH SUBLINGUAL DOSE OR ASSESS THE CHEST PAIN AND BP BEFORE AND DURING IV INFUSION. Aspirin: to prevent additional blood clot formation. beta-blockers: Lopressor (metoprolol). GIVEN IV. continuous monitoring: to assess for any changes. USING EKG OR 12 LEAD EKG. 2-3 IV peripheral fluids |
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what changes will show on an EKG/ECG for a patient with an MI? |
T wave inversion: when the T wave is depressed (flipped upside down) thus a negative deflection indicates ischemia. ST elevation: indicate injury to the heart muscles. Q wave: a huge negative deflection or a widened Q wave indicates infarction. |
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what are the 2 types of MI? |
Non-ST elevation MI (NSTEMI): is MI where the ST segments depression (below baseline) indicating partial MI (damage of the myocardium only). THERE IS NO Q WAVE AND THERE IS AN INCREASE IN TROPONIN AND CPK-MB IN THE BLOOD. ST-elevation MI (STEMI): is an MI where the ST segment is elevated thus indicating a full blown MI (necrosis extending from the myocardium to the endocardium). THERE IS Q WAVE DEVELOPMENT AND AN INCREASE IN TROPONIN AND CPK-MB ENZYMES IN THE BLOOD. |
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what are surgical treatments for MI? |
percutaneous coronary intervention (PCI): is a type of cardiac catherization where a cath goes from the femoral, brachial, or radial artery and assess for any blockages using a contrast dye to view for blockages in the heart. IF THERE IS A BLOCKAGE A STENT WILL BE PUT IN SO CORONARY ARTERIES CAN BE OPEN AND BLOOD CAN BE PERFUSED. |
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what is fibrinolytic therapy? |
fibrinolytic therapy is used if a PCI is unavailable. THIS IS USED TO BREAKUP ANY PRESENT CLOTS IN THE CORONARY ARTERIES THAT IS/ARE CAUSING THE MI. THIS CANNOT BE USED ON PATIENTS WITH ACTIVE BLEEDING OR CEREBRAL ANEURYSM ETC. ANYTHING WHERE A CLOT WAS FORMED TO PATCH UP AN AREA OF THE BODY LIKE THE BRAIN AFTER A STROKE OR HEMORRHAGE. |
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what is CABG? |
Coronary Arterial Bypass Graft surgery: is a surgery where a blood vessel is taken from another part of the body i.e. the saphenous vein is attached to a major artery in the heart where there is blockage i.e. coronary artery to provide blood supply to that region of the heart that is not being supplied of blood. THIS IS USED WHEN EVERYTHING ELSE HAS FAILED I.E. PCI OR WHEN THE ARE MULTIPLE BLOCKAGES. |
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what to do after a patient has had a CABG? |
continuous monitoring of EKG to assess for dsyrhythmias monitor ventilation and if not ventilated teach patient how to deep breath and use the incentive spirometry to prevent aspiration pneumonia. assess vital signs assess wound site. |
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what are some discharge plans after a CABG? |
discharge plans include: teaching patient the importance of taking their medications. cardiac rehab risk factor modification. immediately report chest pain bleeding |
