Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
22 Cards in this Set
- Front
- Back
|
Coronary Artery Disease
|
Asymptomatic
Chronic Stable Angina -periodic chest pain Acute Coronary Syndrome -Unsable Angina -NSTEMI & STEMI (Myocardial Infarction) |
|
|
Atherosclerosis Formation
|
-endothelial injury
-fatty streak -fibrous plaque -complicated lesion |
|
|
Risks for CAD
|
Non-modifiable risk factors
-Age (>65), Gender, Ethnicity (white), Fam Hx, Genetic Modifiable risk factors - ^ serum chol, HTN, tobacco, inactivity, Obesity, DM |
|
|
Chronic Stable Angina
Process |
-Myocardium Hypoxia ( >10s)
-Anaerobic Metabolism -Lactic Acid produced -Blood flow restored -Cardiac tissue repaired |
|
|
Chronic Stable Angina
(O2 Demand > O2 Supply) |
-75 % of the time due to atherosclerosis
-manifestation of myocardial *ischemia (*reversible) -PREDICTABLE, precipitating factor, done in 5-15 min Types -Silent (female & DM) -Angina Decubitus (laying down) -Prinzmental’s (spasms) |
|
|
Chronic Stable Angina
(Mgmt) |
A
-Antiplatelet/Anticoagulant -Antianginal (nitro dilates coronary artery) -ACE Inhib/ARB (decreases FV by stopping RAAS) B -Beta Blockers (I & II, slows HR, caution w/ non-specifics w/ asthmatics) -Blood Pressure mgmt C -Calcium Channel Blockers -Cigarette smoking (quit) -Cholesterol mgmt D -Diet (v Sat Fat, ^ complex carbs & fiber, ^ omega-3s) -Diabetes mgmt E -Educate & Exercise F -Flu vaccination |
|
|
Acute Coronary Syndrome
|
-Prolonged ischemia = MI
-Rupture of a plaque leads to thrombus formation -Unstable angina, pain is NOT PREDICTABLE |
|
|
Acute Coronary Syndrome
(Mgmt) |
-ABCs, Vitals, O2, PQRST
-12 lead ECG* (5 min*) & tele -obtain cardiac markers (*troponin definitive, myoglobin 1st to elevate) -2 IV caths -Meds: Morphine, O2, Nitro, Aspirin, Beta Blockers -Anticipate CPR, defibrillation or pacing -bedrest & NPO |
|
|
Acute Coronary Syndrome
Meds (Mgmt) |
Morphine
-pain relief, v preload & afterload Oxygen -more O2 to tissue prevents death Nitroglycerin -vasodilator, v preload -monitor for hypotension Aspirin -anti-platelet (chew for fast acting) Beta-Blockers -blocks NS stimulation, v HR, ^ blood to heart tissue |
|
|
Myocardial Infarction (MI)
Process |
-Thrombus Formation
-Myocardial Hypoxia -Ischemia Persists -Cell Death (Infarction) -Non-functioning Tissue |
|
|
Myocardial Infarction (MI)
(Time = Muscle) |
-Location: A or V? L or R?
-Collateral Circulation may develop -arteries will create new capillaries to circumvent plaque buildup (not as effective) |
|
|
Myocardial Infarction (MI)
Phases of Healing |
-Inflammatory response leads to Ventricular remodeling
|
|
|
Myocardial Infarction (MI)
Complications |
-Dysrhythmias (Active MI)
-Heart Failure -Cardiogenic Shock (No CO) -Papillary Muscle Dysfunction (Valve dysfunction) -Sudden Cardiac Death -Acute Pericarditis (Inflammation of heart lining) |
|
|
Acute Coronary Disease
Clinical Manifestations: Pain PQRST |
-Precipitating Events, Quality, Radiation, Severity, Timing
Pain -Severe immobilizing , Not relieved by rest, position or nitro, > 20 minutes Activation of SNS -Clammy, diaphoretic, cool to touch Nausea and Vomiting Fever Atypical Symptoms: Women, Elderly, Diabetics |
|
|
Coronary Artery Disease
ECG Changes |
Ischemia
-ST segment depression -T wave inversion Infarction -ST segment elevated -Pathologic Q wave (exaggerated) |
|
|
Coronary Artery Disease
Diagnosis |
History and Physical
Chest X-ray Electrocardiogram, Echocardiogram C Reactive Protein (inflammation) Lipid Profile (Total Cholesterol & HDL, LDL) Exercise Stress Test Serum Cardiac Markers (triponin) Cardiac Cath (direct view, eval heart function) |
|
|
Serum Cardiac Markers
(proteins released upon cardiac tissue death) |
Myoglobin
-Lacks cardiac specificity, within *2 hours* of MI CK-MB -Quantifies myocardial damage, *4-6 hours* after MI *Troponin* -sensitivity & specificity, trends degree of damage over time, released within *4-6 hours* of MI |
|
|
Cardiac Cath/PCI (stent)
(Mgmt) |
Pre-Procedure
-PT education & consent -iodine sensitivity -NPO 6-18 hrs prior -meds as ordered Post-Procedure -Assess circulation & peripheral pulses -monitor for hematoma & bleeding at puncture site -bedrest 6-8 hrs after, extremity straight |
|
|
Fibrinolytic Therapy
Risks |
Absolute Contraindications
-Active Bleed* -High risk for bleed* Relative Contraindications -Anticoagulants -Pregnancy -Recent surgery or internal bleed -End stage systemic disease -BP > 180/110 mmHg; Prolonged CPR > 10 min |
|
|
Fibrinolytics
(Mgmt) |
Monitor for s/s of systemic bleed
-Vital sign changes* -Mental status changes* -Blood in urine or stool Monitor for reperfusion -ECG Changes -Resolution of chest pain -Reperfusion dysrhythmias Monitor for s/s of reocculsion |
|
|
Coronary Artery Bypass Graft Surgery (CABG)
|
-a vein or artery is grafted from another part of the body to be used as a new coronary artery
|
|
|
General Nursing Management
|
-Knowledge Deficit related to self-health management
-Acute pain related to imbalance of myocardial oxygen supply and demand -Decreased cardiac output related to myocardial injury -Anxiety related to diagnosis, pain and lifestyle changes |
