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84 Cards in this Set

  • Front
  • Back
Cause of CHD
Imapaired blood flow to the myocardium due to accumulation of atherosclerotic plaque in the coronary arteries.
Results of CHD (7)
1. asymtomatic
2. angina pectoris
3. MI
4. dysrhythmias
6. heart failure
7. sudden death
Highest incident of CHD
White male ages 45 and older.
Women after menopause.
Non modifiable risk factors for CHD (4)
1. Age
2. Gender
3. Race/Ethic background
4. Heredity
Modifiable pathologic condition risk factors for CHD (6)
1. Hypertension
2. DM
3. Hyperlipidemia
4. Elevated homocystine levels
5. Metabolic syndrome
6. Premature menopause
Modifiable lifestyle risk factors for CHD (6)
1. Cigarette smoking
2. Obesity
3. Physical Inactivity
4. Diet
5. Oral contraceptives use
6. Hormone Repalcement Therapy use
Desirable HDL level
above 35 mg/dL
Optimal LDL Level
< 100 mg/dL
Desirable Total Cholesterol, LDL
Under 200 mg/dL, 100-129 mg/dL
Borderline High Total Cholesterol, LDL
200-239 mg/dL, 130-159 mg/dL
High Total Cholesterol , LDL
> = 240 mg/dL, > = 160 mg/dL or
Very High LDL
> 190
How does smoking promotes CHD? (4)
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.
Define obesity
Body weight greater than 30% over odeal body weight.
Waist-to-hip ratio that will put you at risk for CHD
Greater than 0.8 for women or 0.9 for men
Cardiovascular benefits of excercise (3)
1. increase availability of oxygen to the heart muscle
2. decrease oxygen demand and cardiac workload
3. increase myocardial function and electrical stability
Non-cardiovascular benefits of excercise (5)
1. decrease blood pressure
2. decrease blood lipid
3. decrease insulin levels
4. decrease platelet aggregation
5. decrease weight
Pathophysiology of Atherosclerosis
atheroma --> atherogenic --> atheromas
plaque located in a specific, asymmetric region of the vessel wall
plaque involving the entire vessle circumference
Pathophysiology of Myocadial Ischemia
Oxygen supply inadequate --> switch from aerobi to anaerobic metabolism --> build up of lactic acid --> damage cells --> necrosis and death
Categories of CHD
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
Factors contributing to myocardial ischemia (3)
1. coronary perfusion
2. myocardial workload
3. blood oxygen content
Factors contributing to myocardial ischemia: coronary perfusion (4)
1. atherosclerosis
2. throbosis
3. vasospasm
4. poor perfusion pressure
Factors contributing to myocardial ischemia: myocardial workload (3)
1. rapid HR
2. Increase preload, afterload, or contractility
3. Increase metabolic demands
Factors contributing to myocardial ischemia: blood oxygen content (3)
1. reduced atmospheric oxygen pressure
2. Impaired gas exchange
3. Low RBCs and Hgb content
Diagnostic test to assess risk factors for CHD (2)
Laboratory testing:
1. Total Serum Cholesterol
2. Lipid Profile
Ratio of HDL to Total Cholesterol
At least 1:5 with 1:3 being the ideal ratio
Total Serum Cholesterol: Patient teaching
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)
Diagnostic Tests to Identify subclinical CHD (5)
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
Possitive Exercise ECG Testing Result if (3)
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
Risk Factor Management: Smoking
1. Prevention
2. Quit to reduce risk by 50%
Risk Factor Management: Diet (6)
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.
Risk Factor Management: Exercise
30 minutes of moderate intensity physical activity 5 to 6 days each week.
Risk Factor Management: Hypertension
1. reducing sodium intake
2. incresing calcium intake
3. regular excercise
4. stress management
5. medications
Risk Factor Management: Diabetes
1. Weight loss
2. reduce fat intake
3. exercise
4. consistant blood glucose management
Dietary recommendation for Total fat intake
25%-30% of total calories
Dietary recommendation for saturated fat
<7% of total calories
Dietary recommendation for polyunsaturated fat
up to 10% of total calories
Dietary recommendation for monounsaturated fat
up to 20% of total calories
Dietary recommendation for cholesterol
< 200 mg/day
Dietary recommendation for Carbohydrate
50%-60% of total calories
Dietary recommendation for Dietary Fiber
20-30 g/day
Dietary recommendation for Protein
About 15% of total calories
Foods with highest proportions of saturated fat (3)
1. Whole milk products
2. Red meat
3. Coconut oil
Primary protein sources recommended (3)
1. Nonfat dairy products
2. Fish
3. Poultry
Example of Food that contains trans fatty acids
Solidified vegetable fat (margarine, shortening)
Monosaturated fats are found in (3)
1. olive oil
2. canola oil
3. peanut oil
Omega3 fatty acids are found in (3)
1. tuna
2. salmon
3. mackerel
Soluble fibers are found in (4)
1. oats
2. psyllium
3. pectin-rich fruits
4. beans
Insoluble fibers are found in (3)
1. whole grain
2. vegetable
3. fruits
What is the goal of drugs used to treat hyperlipidemia?
Achieve an LDL levels of < 130 mg/dL.
What are the classes of drugs used in the treatment of hyperlipidemia? (4)
1. Statins
2. Bile Acid Sequestrants
3. Nicotinic Acid
4. Fibric Acid Derivatives
Mechanism of Statins
Inhibit the enzyme HMG-CoA reductase in the liver, lowering LDL synthesis and serum levels.
Side Effects of Statins (2)
1. Increase serum liver enzyme levels
2. Myopathy
Nursing responsibilities (3)
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.
Client and family teaching for Statin
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.
Bile Acid Sequestrant
Bile Acid Sequestrant
Bile Acid Sequestrant
Mechanism of Bile Acid Sequestrants
Lower LDL levels by binding to bile acids in the intestine, reducing its reabsorption and cholesterol production in the liver.
When are Bile Acid Sequestrants used? (3)
1. Combination therapy regimens
2. Women who are considering pregnancy
3. Young adult
What is the primary disadvantage of Bile Acid Sequestrants?
Inconvenience of administration due to bulk and gastrointestinal side effects such as constipation.
Nursing responsibilities for Bile Acid Sequestrant (3)
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
Client and family teaching for Bile Acid Sequestrant (3)
1. Proptly report
-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.
Nicotinic Acid
Niacin (Nicobid, Nicolar, Niaspan, others)
General usage of Nicotinic Acid
Used in combination therapy (particularly with statin drugs).
Nusing responsibilities for Nicotinic Acid (3)
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
-type 2 diabetes
3. Monitor:
-blood glucose
-uric acid levels
-liver function test during treatment
Client and family teaching for Nicotinic Acid
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.
Fibric Acid Derivatives
Fibric Acid Derivatives
Fibric Acid Derivatives
Primary usage of Fibric Acid Derivatives
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.
Mechanism of Fibric Acid Derivatives
Effect lipid regulation by blocking triglyceride synthesis.
Nursing responsibilities for Fibric Acid Derivatives (2)
1. Monitor:
-serum LDL and VLDL levels
-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
Clent and family teaching for Fibric Acid Derivatives (5)
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.
What is the dosage range for prophylactic aspirin therapy?
80 to 325 mg/day
When is prophylactic aspirin therapy contraindicated?
1. Client with sensitivity to aspirin
2. Bleeding disorders
3. Peptic ulcer disease
When is ACE-inhibitor prescribed?
For high-risk clents, including diabetes with other CHD risk factors.