Medsurg: Cardiovascular: Coronary Heart Disease (Chd)

Front 1

Cause of CHD

Back 1

Imapaired blood flow to the myocardium due to accumulation of atherosclerotic plaque in the coronary arteries.

Front 2

Results of CHD (7)

Back 2

1. asymtomatic
2. angina pectoris
3. MI
4. dysrhythmias
6. heart failure
7. sudden death

Front 3

Highest incident of CHD

Back 3

White male ages 45 and older.
Women after menopause.

Front 4

Non modifiable risk factors for CHD (4)

Back 4

1. Age
2. Gender
3. Race/Ethic background
4. Heredity

Front 5

Modifiable pathologic condition risk factors for CHD (6)

Back 5

1. Hypertension
2. DM
3. Hyperlipidemia
4. Elevated homocystine levels
5. Metabolic syndrome
6. Premature menopause

Front 6

Modifiable lifestyle risk factors for CHD (6)

Back 6

1. Cigarette smoking
2. Obesity
3. Physical Inactivity
4. Diet
5. Oral contraceptives use
6. Hormone Repalcement Therapy use

Front 7

Desirable HDL level

Back 7

above 35 mg/dL

Front 8

Optimal LDL Level

Back 8

< 100 mg/dL

Front 9

Desirable Total Cholesterol, LDL

Back 9

Under 200 mg/dL, 100-129 mg/dL

Front 10

Borderline High Total Cholesterol, LDL

Back 10

200-239 mg/dL, 130-159 mg/dL

Front 11

High Total Cholesterol , LDL

Back 11

> = 240 mg/dL, > = 160 mg/dL or

Front 12

Very High LDL

Back 12

> 190

Front 13

How does smoking promotes CHD? (4)

Back 13

1. Carbon monoxide damages vascular endothelium, promoting cholesterol deposition.
2. Nicotine stimulate catecholamine release, incresing BP, HR, and myocardial oxygen use.
3. Nicotine also constrict arteries, limiting tissue perfusion.
4. Nicotine reduces HDL levels and increases platelet aggregation, increasing the risk of thrombus formation.

Front 14

Define obesity

Back 14

Body weight greater than 30% over odeal body weight.

Front 15

Waist-to-hip ratio that will put you at risk for CHD

Back 15

Greater than 0.8 for women or 0.9 for men

Front 16

Cardiovascular benefits of excercise (3)

Back 16

1. increase availability of oxygen to the heart muscle
2. decrease oxygen demand and cardiac workload
3. increase myocardial function and electrical stability

Front 17

Non-cardiovascular benefits of excercise (5)

Back 17

1. decrease blood pressure
2. decrease blood lipid
3. decrease insulin levels
4. decrease platelet aggregation
5. decrease weight

Front 18

Pathophysiology of Atherosclerosis

Back 18

atheroma --> atherogenic --> atheromas

Front 19

eccentric

Back 19

plaque located in a specific, asymmetric region of the vessel wall

Front 20

concentric

Back 20

plaque involving the entire vessle circumference

Front 21

Pathophysiology of Myocadial Ischemia

Back 21

Oxygen supply inadequate --> switch from aerobi to anaerobic metabolism --> build up of lactic acid --> damage cells --> necrosis and death

Front 22

Categories of CHD

Back 22

1. chronic ischemic heart disease:
a. stable angina
b. vasospastic angina
c. silent myocardial ischemia
2. Acute Coronary Syndromes
a. unstable angina
b. myocardial infarction

Front 23

Factors contributing to myocardial ischemia (3)

Back 23

1. coronary perfusion
2. myocardial workload
3. blood oxygen content

Front 24

Factors contributing to myocardial ischemia: coronary perfusion (4)

Back 24

1. atherosclerosis
2. throbosis
3. vasospasm
4. poor perfusion pressure

Front 25

Factors contributing to myocardial ischemia: myocardial workload (3)

Back 25

1. rapid HR
2. Increase preload, afterload, or contractility
3. Increase metabolic demands

Front 26

Factors contributing to myocardial ischemia: blood oxygen content (3)

Back 26

1. reduced atmospheric oxygen pressure
2. Impaired gas exchange
3. Low RBCs and Hgb content

Front 27

Diagnostic test to assess risk factors for CHD (2)

Back 27

Laboratory testing:
1. Total Serum Cholesterol
2. Lipid Profile

Front 28

Ratio of HDL to Total Cholesterol

Back 28

At least 1:5 with 1:3 being the ideal ratio

Front 29

Total Serum Cholesterol: Patient teaching

Back 29

For most accurate result:
1. dietary cholesterol intake should be consistant for 3 weeks prior to testing
2. Pt. should fast from 10 to 12 hours before sample is drawn.
3. Alcohol intake and many medications can effect results (tell doctor)

Front 30

Diagnostic Tests to Identify subclinical CHD (5)

Back 30

1. C-reactive protein
2. ankle-brachial blood pressure index (ABI)
3. Exercise ECG Testing
4. Electron Beam Computed Tomography (EBCT)
5. Myocardial Perfusion Imaging

Front 31

Possitive Exercise ECG Testing Result if (3)

Back 31

1. depression of the ST segment occurs by greater than 3 mm
2. the client develope chest pain
3. the test is stopped due to excess fatigue, dysrhythmias, or other symptoms before the predicted maximal HR is achieved

Front 32

Risk Factor Management: Smoking

Back 32

1. Prevention
2. Quit to reduce risk by 50%

Front 33

Risk Factor Management: Diet (6)

Back 33

1. Reduce fat and cholesterol intake
2. Increase intake of soluble fiber and insoluble fiber
3. Increase intake of folic acid, B6, and B12
4. Increase intake of antioxident nutrients and foods rich in antioxident
5. Moderate alcohol intake
6. Loose weight through combination of reduce caloric intake and excercise.

Front 34

Risk Factor Management: Exercise

Back 34

30 minutes of moderate intensity physical activity 5 to 6 days each week.

Front 35

Risk Factor Management: Hypertension

Back 35

1. reducing sodium intake
2. incresing calcium intake
3. regular excercise
4. stress management
5. medications

Front 36

Risk Factor Management: Diabetes

Back 36

1. Weight loss
2. reduce fat intake
3. exercise
4. consistant blood glucose management

Front 37

Dietary recommendation for Total fat intake

Back 37

25%-30% of total calories

Front 38

Dietary recommendation for saturated fat

Back 38

<7% of total calories

Front 39

Dietary recommendation for polyunsaturated fat

Back 39

up to 10% of total calories

Front 40

Dietary recommendation for monounsaturated fat

Back 40

up to 20% of total calories

Front 41

Dietary recommendation for cholesterol

Back 41

< 200 mg/day

Front 42

Dietary recommendation for Carbohydrate

Back 42

50%-60% of total calories

Front 43

Dietary recommendation for Dietary Fiber

Back 43

20-30 g/day

Front 44

Dietary recommendation for Protein

Back 44

About 15% of total calories

Front 45

Foods with highest proportions of saturated fat (3)

Back 45

1. Whole milk products
2. Red meat
3. Coconut oil

Front 46

Primary protein sources recommended (3)

Back 46

1. Nonfat dairy products
2. Fish
3. Poultry

Front 47

Example of Food that contains trans fatty acids

Back 47

Solidified vegetable fat (margarine, shortening)

Front 48

Monosaturated fats are found in (3)

Back 48

1. olive oil
2. canola oil
3. peanut oil

Front 49

Omega3 fatty acids are found in (3)

Back 49

1. tuna
2. salmon
3. mackerel

Front 50

Soluble fibers are found in (4)

Back 50

1. oats
2. psyllium
3. pectin-rich fruits
4. beans

Front 51

Insoluble fibers are found in (3)

Back 51

1. whole grain
2. vegetable
3. fruits

Front 52

What is the goal of drugs used to treat hyperlipidemia?

Back 52

Achieve an LDL levels of < 130 mg/dL.

Front 53

What are the classes of drugs used in the treatment of hyperlipidemia? (4)

Back 53

1. Statins
2. Bile Acid Sequestrants
3. Nicotinic Acid
4. Fibric Acid Derivatives

Front 54

Lovastatin

Back 54

Mevacor
Statin

Front 55

Pravastatin

Back 55

Pravachol
Statin

Front 56

Simvastatin

Back 56

Zocor
Statin

Front 57

Fluvastatin

Back 57

Lescol
Statin

Front 58

Atorvastatin

Back 58

Lipitor
Statin

Front 59

Mechanism of Statins

Back 59

Inhibit the enzyme HMG-CoA reductase in the liver, lowering LDL synthesis and serum levels.

Front 60

Side Effects of Statins (2)

Back 60

1. Increase serum liver enzyme levels
2. Myopathy

Front 61

Nursing responsibilities (3)

Back 61

1. Monitor serum cholesterol and liver enzyme levels (liver function test) before and during therapy. Report elevated liver enzyme levels.
2. Assess for muscle pain and tenderness. Monitor CPK level if present.
3. If taking digoxin concurrently, monitor for report digoxin toxicity.

Front 62

Client and family teaching for Statin

Back 62

1. Promptly report:
- muscle pain, tenderness, or weakness
- skin rash or hives, or changes in skin color
- abdominal pain, nausea, or vomiting
- brown urine
2. Do not use these drugs if you are pregnant or plan to become pregnent.
3. Inform your doctor if you are taking any other medications concurrently.

Front 63

Cholestyramine

Back 63

Questran
Bile Acid Sequestrant

Front 64

Colestipol

Back 64

Colestid
Bile Acid Sequestrant

Front 65

Colesevelam

Back 65

Welchol
Bile Acid Sequestrant

Front 66

Mechanism of Bile Acid Sequestrants

Back 66

Lower LDL levels by binding to bile acids in the intestine, reducing its reabsorption and cholesterol production in the liver.

Front 67

When are Bile Acid Sequestrants used? (3)

Back 67

1. Combination therapy regimens
2. Women who are considering pregnancy
3. Young adult

Front 68

What is the primary disadvantage of Bile Acid Sequestrants?

Back 68

Inconvenience of administration due to bulk and gastrointestinal side effects such as constipation.

Front 69

Nursing responsibilities for Bile Acid Sequestrant (3)

Back 69

1. Mix cholestyramine and colestipol powder with 4 to 6 oz of water or juice
2. Administer with meal
3. Store in a tightly closed container

Front 70

Client and family teaching for Bile Acid Sequestrant (3)

Back 70

1. Proptly report
-constipation
-severe gastric distress with nausea and vomiting
-unexplained weight loss
-black or bloody stools
-sudden back pain
2. Drink ample amount of fluid while taking these drugs reduces the problems of caonstipation and bloating
3. Do not omit doses as this may affect the absorption of the drugs you are taking.

Front 71

Nicotinic Acid

Back 71

Niacin (Nicobid, Nicolar, Niaspan, others)

Front 72

General usage of Nicotinic Acid

Back 72

Used in combination therapy (particularly with statin drugs).

Front 73

Nusing responsibilities for Nicotinic Acid (3)

Back 73

1. Give oral preparation with meal and accompanied by cold beverage to minimize GI effects.
2. Administer with caution to client with
-active liver disease
-peptic ulcer disease
-gout
-type 2 diabetes
3. Monitor:
-blood glucose
-uric acid levels
-liver function test during treatment

Front 74

Client and family teaching for Nicotinic Acid

Back 74

1. Flushing of face, neck, and ears may occurs within 2 hours following dose; these effects generally subside as treatment continues. Alcohol use during Nicotinic Acid therapy may worsen this effect.
2. Report weakness or dizziness with changes in posture (lying to sitting; sitting to standing) to your doctor. Change positions slowly to reduce the risk of injury.

Front 75

Gemfibrozil

Back 75

Lopid
Fibric Acid Derivatives

Front 76

Fenofibrate

Back 76

Tricor
Fibric Acid Derivatives

Front 77

Clofibrate

Back 77

Atromid-S
Fibric Acid Derivatives

Front 78

Primary usage of Fibric Acid Derivatives

Back 78

Used to lower a very high triglyceride levels and may be used in combination with statin; they have only a slight to modest effect on LDL.

Front 79

Mechanism of Fibric Acid Derivatives

Back 79

Effect lipid regulation by blocking triglyceride synthesis.

Front 80

Nursing responsibilities for Fibric Acid Derivatives (2)

Back 80

1. Monitor:
-serum LDL and VLDL levels
-electrolytes
-glucose
-liver enzymes
-renal function tests
-CBC during therapy and report abnormal values
2. Up to 2 months of treatment may be required to achieve a therapeutic effect; rebound, with decreasing benefit, may occur in the 2nd or 3rd month of treatment

Front 81

Clent and family teaching for Fibric Acid Derivatives (5)

Back 81

1. Take with meal if the drug causes gastric distress.
2. Promptly report flulike symptoms (fatigue, muscle aching, soreness, or weakness) to your doctor.
3. Do not use this drug if you are pregnent or plan to become pregnent.
4. Use reliable birth control measures while taking this drug.
5. Contact your doctor before stopping this drug and before taking any OTC products.

Front 82

What is the dosage range for prophylactic aspirin therapy?

Back 82

80 to 325 mg/day

Front 83

When is prophylactic aspirin therapy contraindicated?

Back 83

1. Client with sensitivity to aspirin
2. Bleeding disorders
3. Peptic ulcer disease

Front 84

When is ACE-inhibitor prescribed?

Back 84

For high-risk clents, including diabetes with other CHD risk factors.