Nu230 - Coronary Artery Disease Ii

Front 1

What is the difference between cardioversion and defibrillation?

Back 1

Cardioversion is an elective procedure where the shock is timed with the EKG to fall on the QRS.

-Defibrillation can be used in emergency situations and has a higher energy jolt.

Front 2

What must be said prior to administering the shock?

Back 2

ALL CLEAR!!

Front 3

What is the most common type of cardiovascular disease?

Back 3

CAD

Front 4

What specific problem is encompassed under CAD?

Back 4

atherosclerosis

Front 5

What is atherosclerosis?

Back 5

an abnormal accumulation of lipid and fibrous tissue in the vessel wall

Front 6

What occurs distal to an occluded vessel?

Back 6

hypoxia

Front 7

What is an atheroma?

Back 7

a plaque: blockage that narrows the vessel wall and decreases blood flow to the myocardium

Front 8

What forms when an atheroma ruptures?

Back 8

a clot

Front 9

What occurs in the heart when insufficient O2 occurs in an area?

Back 9

Tissue dies: Myocardial Infarction

Front 10

What are the non-modifiable risk factors of CAD?

Back 10

1. Family Hx
2. Gender
3. Increasing age
4. Race

Front 11

What race is most at risk for CAD?

Back 11

African Americans

Front 12

What is the relationship with gender and CAD?

Back 12

For pre-menopausal women and younger, they are less likely to get CAD than men

-After the age of 55, women are just as likely as men to get CAD

Front 13

What are the modifiable risk factors for CAD?

Back 13

1. High cholesterol level
2. Cigarette smoking
3. HTN
4. DM
5. Lack of physical activity
6. obesity
7. stress
8. homocystin levels (can advocate taking Vit B or folate)

Front 14

What is the most common type of angina?

Back 14

Classic or Stable angina

Front 15

What is classical angina? What is it usually related to?

Back 15

-Substernal pain lasting < 10mins

-Usually related to activity

Front 16

What are the 4 types of Angina?

Back 16

1. Classical
2. Unstable
3. Prinzmetal or Variant
4. Nocturnal

Front 17

What is unstable angina?

Back 17

-Unpredictable
-have pain with little or no activity
-

Front 18

which type of angina can be caused by drinking cold water?

Back 18

Prinzmetal or Variant angina

Front 19

What is the least common angina?

Back 19

Nocturnal

Front 20

What drug is used most often to treat angina?

Back 20

Nitroglycerine

Front 21

What can precipitate anginal pain?

Back 21

1. physical exertion
2. exposure to the cold
3. eating a heavy meal
4. stress and emotional factors
5. stimulants

Front 22

What are the subjective symptoms of angina?

Back 22

1. Pain
2. apprehension
3. tightness or choking sensation
4. weakness, fatigue
5. numbness in the arms

Front 23

What are the objective signs that an anginal attack is occuring?

Back 23

1. Ceases movement
2. Fowlers
3. Take nitroglycerin
4. EKG: Ischemia: ST depression

Front 24

What lab value is the gold standard for angina?

Back 24

Troponin

Front 25

Define angina.

Back 25

Chest pain lasting < 10 mins, usually radiates to the neck or left arm and is alleviate by rest and/or Nitroglycerine

Front 26

What are the instructions for nitroglycerin?

Back 26

Take one at the first onset of pain. Wait 5 mins, if the pain does not go away, take another and call 911

Front 27

What are the nursing interventions for angina?

Back 27

1. Rest
2. O2
3. Nitroglycerine

Front 28

What must a nurse do when handling nitroglycerin?

Back 28

Wear gloves

Front 29

What is the number 1 most common adverse effect of nitroglycerine?

Back 29

headache

Front 30

What are the systemic effects of nitroglycerin?

Back 30

1. Dilates veins: venous pulling, less venous return, less preload
2. Dilates arteries: drops BP, afterload and work on the heart
3. Vasodilates CORONARY arteries sending more O2 to myocardium

Front 31

How often should BP be taken once giving nitroglycerine?

Back 31

every 2-3 mins

Front 32

How fast does sublingual nitroglycerine work?

Back 32

< 3 mins

Front 33

What must a pt do that wears a nitroglycerine patch?>

Back 33

Take it off at bedtime to allow medication free periods. Keeps it therapeutic

Front 34

What is a normal PTT?

Back 34

25-38

Front 35

What educational factors should be discussed with pts with angina?

Back 35

1. Stop smoking
2. Lose weight
3. Exercise
4. Dietary: high fiber and veggies, low fat, take meds and alcohol moderately
5. reduce stress
6. get psychological support

Front 36

What are the etiologies for a Myocardial Infarction?

Back 36

1. Reduced blood flow
2. Complete arterial occlusion
3. Reduced cardiac blood flow

Front 37

What are examples of conditions that lead to reduced blood flow and subsequent MI?

Back 37

Atheroma

Vasospasm

Front 38

What is the difference between ischemia and infarct?

Back 38

Ischemia: decrease of O2 but tissue is still viable. Blood flow can be reinstated

-Infarct: the tissue begins to die

Front 39

What possible things cause a complete arterial occlusion?

Back 39

Thrombi or emboli

Front 40

What MI complication is the # 1 most common cause of death?

Back 40

Dysrhythmias from conduction disturbances

Front 41

What are the subjective assessments of a MI?

Back 41

1. Pain
2. Anxiety and feeling of impending doom
3. N/V

Front 42

How long after the onset of chest pain can damage be reversed following an MI?

Back 42

6 hours

Front 43

Describe the Pain of a MI?

Back 43

-Heavy
-Pressure
-Weight on the chest
-Levine sign (fist on the chest to show pain)
-Up the neck, down the shoulder
-Not relieved by nitroglycerine

Front 44

What are the objective assessment findings for an MI?

Back 44

1. Pulse changes: brady to tachy to irregular
2. Diaphoretic
3. Pale
4. low grade temp
5. Increase WBC over the next few days
5. ST segment elevation
6. Increase CK-MB and Troponin
7. Signs of shock

Front 45

What are the possible nursing diagnoses for MI?

Back 45

1. Alteration in CO: decreased r/t L vent MI
2. Alteration in comfort: pain
3. Fear
4. FVE r/t CHF 2nd to MI
5. Potential for alteration in bowel elimination
6. Potential for alteration in tissue perfusion
7. Knowledge deficit
8. Disturbance in self-concept

Front 46

What are the contraindications for thrombolytics?

Back 46

1. Major surgery within the last 6 weeks
2. Gave birth in the last 6 weeks
3. Active bleeding

Front 47

What is the hallmark drug to manage paint post MI?

Back 47

Morphine

Front 48

What is valsalva and which pts should be instructed to avoid it?

Back 48

Holding breath/expiration with pressure, usually when moving positions. Like bearing down

MI pts should avoid it

Front 49

What are the nursing interventions for and MI?

Back 49

1. O2
2. Relieve pain
3. Continuous Heart monitor
4. V/S
5. Bedrest
6. IV-KVO
7. avoid valsalva
8. administer sedatives
9. antiarrhythmics
10. Thrombolytics

Front 50

What is the purpose of thrombolytics? What are some common ones?

Back 50

Lyses the clot

-Urokinase, Retavase, Activase

Front 51

What is the time frame for the use of thrombolytics?

Back 51

< 30 mins from time the pt comes in the ER.

Front 52

What is the average time frame for healing post MI?>

Back 52

6-8 weeks

Front 53

What aspects are part of the convalescence post MI?

Back 53

1. REst
2. Diet
3. No SMOKING
4. Pace activity
5. Meds: ACEI's, BBlocker, ASAs, Statins
6. Emotional support
7. Patient Ed

Front 54

What are the SxS that a pt should return to the hospital if he or she experiences them post MI?

Back 54

-SOB
-Syncope
-swelling of the extremities

Front 55

When does rehab begin following a MI?

Back 55

Begins on admission!