CP 34 Coronary Artery Disease and Acute Coronary Syndrome
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Created by:
Clittzen on November 22, 2011
Subjects:
Classes:
Nursing 232, UNLV_Nursing, Yavapai College 2nd Year Second Semester
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70 terms
Terms | Definitions |
|---|---|
 What is Coronary Artery Disease (CAD)? | A type of blood vessel disorder included in the general category of athersclorsis. |
| What is Atherosclerosis characterized by? | Deposists of cholesterol and lipids within the intimal wall of an artery. |
| When CAD becomes symptomatic, what does the generally mean? | The disease process is usually well advanced. |
| What is Collateral Circulation? | Arterial Anastomoses or connections. |
| What is Collateral Circulation growth and extent attributed to? | Inherited predisposition to develop new blood vessels and the presence of chronic ischemia. |
| What are nonmodifiable risk factors for CAD? | Age, gender, ethnicity, family history and genetic inheritance. |
| What are modifiable risk factors for CAD? | Elevated serum lipids, elevated BP, tobacco use, physical inactivity, obesity, DM, metabolic syndrome, psychologic states, and homocysteine level. |
| What is one of the most firmly established risk factors for CAD? | Elevated serum lipid levels. |
| What are High Density Lipoproteins (HDLs)? | Carry lipids away from arteries and to the liver for metabolism. High levels are desirable. |
| How do you increase HDL levels? | Physical activity, moderate alcohol consumption and estrogen administration. |
| What does an Elevated Low Density Lipoprotein Level correlate with? | Increased incidence of atheroslcerosis and CAD> |
| What are recommended changes for the patient with CAD? | A regular physical activity program, a diet that limits saturated fats and cholesterol and emphasizes complex carbohydrates (e.g., whole grain, fruit, vegetables)> |
| How often is a complete lipid profile recommended for the patient with CAD or at risk for? | Every 5 years beginning at age 20. |
| What serum cholesterol level puts a person at risk for CAD? | Greater than 200 mg/dL. |
| If the levels of cholesterol remain elevated despite modifiable changes, what is considered? | Drug therapy with statins. Niacin, fibric acid derivatives, bile acid sequestrants and other agents may be used. |
| What drug is recommended for people at risk for CAD? | Antiplatelet therapy with low dose aspirin. |
| What can people take if they are Aspirin intolerant and at risk for CAD? | clopidogrel (Plavix). |
| What is Chronic Stable Angina? | Refers to chest pain that occurs intermittently over a long period with the same pattern of onset, duration, and intensity of symptoms. |
| What is Angina rarely? | Sharp or stabbing, and usually does not change with position or breathing. |
| How long does Anginal pain usually last? | A few minute and commonly subsides when the precipitating factor is relieved. Pain at rest is unusual. |
| What is the treatment of chronic stable angina? | Aimed at decreasing oxygen demand, and or increasing oxygen supply and reducing CAD risk factors. |
| What is the first line therapy for treatment of angina? | Nitrates. |
| How do Nitrates act? | Dilate peripheral blood vessels, coronary arteries and collateral vessels. |
| What other medications are used in the treatment of chronic stable angina? | Beta blockers. |
| How do beta blockers act? | Decrease myocardial contractility, heart rate, systemic vascular resistance, and blood pressure which reduce myocardial oxygen demand. |
| What is the diagnostic testing for a patient with a history of CAD? | CXRAY, 12-lead ECG, lipid profile, echocardiography, exercise stress testing, and coronary angiography. |
| What is Prinzmetals Angina? | A rare form of angina that occurs at rest, usually in respose to spasm of a major coronary artery. |
| What does the patient experience when spasms occur in Prinzmetals Angina? | Angina and transient ST segment elevation. |
| What may precipitate coronary artery spasms? | Smoking and tobacco use. |
| When else may prinzmetals angina be seen? | In a patient with history of migrane headaches and Raynauds Phenomenon. |
| What may relieve pain for the patient with Prinzmetals Angina? | Exercise or it may disappear spontaneously. |
| What medications are used for Prinzemtals Angina? | Calcium channel blockers and or nitrates to control the angina. |
| What is Acute Coronary Syndrome? | Develops when ischemia is prolonged and not immediately reversible. Encompases a spectrum of unstable angina, non-st-segment-elevation myocardial infaction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). |
| What is Unstable Angina? | Chest pain that is new in onset, occurs at rest, or has worsening pattern. Unpredictable and represents an emergency. |
| Why does a Myocardial Infarction occur? | As a result of sustained ischemia, causing irreversible myocardial cell death. Contractile functions of the heart stops in the infarcted area(s). |
| How long does an acute MI evolve over? | A period up to 12 hours. |
| How are infarctions described? | Based on the location of damage. |
| What is the hallmark of an MI? | Severe, immobilizing chest pain that is not relieved by rest, position change, or nitrate administration. |
| How is pain usually described for a patient with an MI? | Heaviness, pressure, tightness, burning, constriction or crushing. |
| What are complications after an MI? | Dysrhythmias are the most common, heart failure, cardiogenic shock, papillary muscle dysfunction or rupture, ventricular aneurysm, and pericarditis. |
| What is the primary diagnostic study to determine whether the person has a UA or an MI? | ECG and serum cardiac markers. |
| What is necessary for a patient with ACS? | Rapid diagnosis and treatment. |
| What is recommended for a patient with STEMI or NSTEMI with positive cardiac markers? | Reperfusion therapy. This can include emergency PCI or fibrinolytic *thrombolytic) therapy). |
| What is cardiac catherterization used for? | To locate and assess blockage and implement treatment modalities if needed. |
| What is Fibrinolytic Therapies aim? | To stop infarction process by dissolving the thrombus int he coronary artery to reperfuse the mycocardium. |
| When is coronary revascularization with coronary artery bypass graft (CABG) surgery recommended? | For patients who fail medical management, have left main coronary artery or three vessel disease, are not candidates for PCI, have failed PCI with ongoing chest pain or have diabetes. |
| What is initial management of the patient with chest pain in regards to drug therapy? | Aspirin, IV nitroglycerin, systemic anticoagulation, morphine sulfate for pain unrelieved by nitroglycerin and oxygen. |
| When may IV antiplatelet agents be used for Chest Pain? | If PCI is anticipated. |
| Why are Stool softeneres given with Chest Pain? | Facilitate and promote the comfort of bowel evacuation. |
| What nursing measures should be instituted for a patient experiencing angina? | Administer supplemental oxygen and position the patient in upright position unless contraindicated, determine vital signs, obtain a 12 lead ECG, provide prompt pain relief first with a nitrate followed by an opiod analgesic if needed, and auscultate heart sounds. |
| What should teaching for a patient with angina include? | Information regarding ACD, managing angina, risk factor reduction and medication. |
| What does initial treatment of a patient with ACS include? | Pain assessment and relief, physiologic monitoring, promote of rest and comfort, alleviation of stress and anxiety, and understanding of the patients emotional and behavioral reactions. |
| What medications should be provided to reduce or eliminate chest pain? | Nitroglycerin, morphine sulfate and supplemental oxygen. |
| What should be monitored on a patient with ACS? | Continuous ECG monitoring, frequent VS, I & O, and physical assessment. Heart and lung sounds and inspect for evidence of early heart failure. |
| How may a patient with an uncomplicated MI rest for? | In a chair within 8 - 12 hours after the event. |
| What is important nursing implementation about anxiety with a patient following ACS? | Identify the source of anxiety, assist the patient in reducing it, and provide appropriate patient teaching. |
| What is it important to provide for the patient after ACS? | Adequate rest periods free from interruption. |
| What are comfort measures that can promote rest? | Frequent oral care, adequate warmth, a quiet atmosphere, use of relaxation therapy, and assurance that personnel are nearby and responsive to the needs. |
| After a PCI what are the major nursing responsibilities? | Monitoring for signs of recurrent angina, frequent assessment of VS, including HR and rhythm, evaluation of the groin for signs of bleeding and maintenance of bed rest per policy. |
| How long after having a CABG surgery is a patient in ICU? | First 24 - 36 hours, with ongoing ECG and hemodynamic monitoring. |
| After transfer from ICU, what is the focus for a CABG surgical patient for postoperative care? | Monitoring for dysrhythmias, providing wound care, managing pain and preventing complications. |
| What is the key to cardiac rehabilitation programs for the patient? | Maintaining contact. |
| What are the six areas for cardiac rehabilitations focus? | Physiologic, psychologic, mental, spiritual, economic and vocational. |
| How long does post-MI depression usually last? | 1 - 4 months. |
| What should patients know about erectile dysfunction and drugs? | Nitrates should not be used with drugs for erectile dysfunction. |
| How long till it is safe to resume sexual activity after an uncomplicated MI? | 7 - 10 days. |
| What is Sudden Cardiac Death? | An unexpected death from cardiac causes producing an abrupt loss of cardiac output and cerebral blood flow. Usually occurs within an hour of onset of symptoms. |
| What are majority of cases of SCD caused by? | Ventricular dysrhythmias, and may have been accomplished by an acute MI. |
| What are risk factors for SCD? | Ventricular dysfunction, ventricular dysrhythmias following MI, males, african american, family hx of athersclerosis, tobacco use, DM, hyperthcolesterolemia, hypertension and cardiomyopathy. |
| What is the most common appraoch to preventing a recurrent of SCD? | Implantable cardioverter defibrillator (ICD) with drug therapy. |
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