a patient comes in and shows signs of early atherosclerosis what would you anticipate the doctor to do?
advise prevention measures such as diet and exercise and prescribe cholesterol-lowering drugs to lower LDL's
a patient is diagnosed with advance stage atherosclerosis what would you anticipate the doctor to do
advise a healthy diet, exercise, prescription for cholesterol-lowering drug, and anti-platelet therapy
why would a pt w/ advance atherosclerosis need to be on anti-platelet therapy?
because there is a complicated lesion and when it ruptures and is exposed to the blood you'll need anti-platelets to help there not be a clot formation so there is no blockage of an artery and blood can still flow through
what is the purpose of cholesterol lowering drug therapy?
prevent fat deposits from getting worse
example of anti-platelet medications are
example of a medication that lowers cholesterol
what are other recommendations to prevent CAD?
get and maintain healthy weight, reduce sodium and fat intake, increase fruits and veggies, exercise, quit smoking, and limit alcohol intake
a type of chest pain, pressure, or discomfort is termed as
angina is chest pain related to
myocardial tissue ischemia
what are the two types of angina
lack of oxygen to the tissue is termed as
death of the tissue is termed as
angina is caused by
increased demand of oxygen or a decreased supply to the myocardium
how long does it take the myocardium to become hypoxic?
10 seconds of coronary occlusion
referred pain is on the
neck, back, and down left arm
myocardial cells can survive how long in ischemic conditions
Chest pain that occurs intermittently over a long period with the same pattern of onset, duration, and intensity of symptoms is termed as
chronic stable angina
when patients come in with signs and symptoms of chronic stable angina what do doctors prescribe?
go through femoral and snake it up to heart and wedge into coronary artery and shoot dye in and see patency of coronary artery (look for blockages) =angiogram
prolonged angina that is not immediately reversible is termed as
Acute Coronary Syndrome
Acute Coronary Syndrome encompasses
unstable angina, STEMI, and non-STEMI
acute coronary syndrome is associated with
deterioration of a once stable atherosclerotic plaque
what occurs when the deterioration of a once stable atherosclerotic plaque occurs?
Arterial intima is exposed to blood & the inflammatory process is initiated Platelet aggregation, vasoconstriction, and thrombus formation cause occlusion
is unstable angina a medical emergency?
YES! its prolonged ischemia that results in tissue death --> the longer the ischemia the higher chance of infarction
where does ischemia start?
at the most inner myocardial tissue and goes out and spreads
what causes a myocardial infarction?
what does infarction mean
death, necrosis, irreversible, cease in cardiac function
myocardial cells can withstand ischemic conditions for how long before infarction occurs?
after 20 minutes of ischemic conditions what portion of the heart muscle in infarcted?
the innermost portion
how long does it take for the entire thickness of the myocardium to infarct?
what are clinical manifestations of a myocardial infarction?
pain, sympathetic nervous system stimulation, increased HR, increased blood pressure initially, nausea and vomiting, and fever.
how is the sympathetic nervous stimulation occur in men
Diaphoresis, vasoconstriction of peripheral vessels, & cool, clammy skin
how is the sympathetic nervous stimulation occur in females?
how do you diagnose a myocardial infarction?
ECG changes (look at ST segment), cardiac markers, and coronary angiography
what cardiac marker is specific to myocardial infarction
what is the goal when dealing with a acute coronary syndrome/ myocardial infarction
salvage myocardial muscle and function
patient comes into ER and is having an MI what actions do you anticipate being done
give O2, establish IV, give nitro aspirin and IV morphine, treat dysrhythmias, monitor vitals and ECG continuously, prepare patient for catheter or surgical interventions as indicated and fibrinolytic therapy such as TPA/clot busters
what are the acute coronary syndrome ACS acute interventions
1) assess pain and evaluate interventions 2) monitor physiologic status 3) promote rest and comfort 4) alleviate stress and anxiety 5)be understanding of patient emotional and behavioral response to ACS
what are post acute coronary syndrome nursing care?
teach patient s/s of angina, nitroglycerin protocol, to gradually resume physical and sexual activity and do cardiac rehab
when doing a CABG what option has the least amount of complications
what does an "on-pump" do in a by-pass surgery?
it stops heart, infuses solution high in potassium & heparin then reverses it
what does an "Off-pump" do in a by-pass surgery
this cord like thing sits on the heart to hold it still so you DONT have to stop the heart. it is faster and no holes are made in the heart
when a patient is coming out of a by-pass surgery what is given to them immediately?
protamine sulfate so they don't bleed to death (heparin antidote)
what are the benefits of a robotic CABG
smaller incisions, camera inside, arms can move like hands never could, arms can be changed out for tools, and SHORT recovery time and go home in like 3 days
sudden decrease in blood pressure that is so profound it can cause damage to vital organs caused by a heart issue is termed
what is the pathophysiology of cardiogenic shock
-decreased pumping ability leading to decreased oxygen to the tissues -increased pulmonary pressure
what are signs and symptoms of cardiogenic shock
increased central venous pressure
pump failure issues associated with cariogenic shock are
MI, HF, dysrhythmias, cardiomyopathy, and heart valve disease
what is the end result of shock no matter the cause?
decrease oxygen to tissues
sudden drop in blood pressure that is so profound it can cause damage to vital organs caused by diuresis, vomiting, diarrhea, hemorrhage, blood loss, surgery, trauma, postpartum hemorrhage is termed
what is the pathophysiology of hypovolemic shock
decreased circulating volume leading to decreased cardio output leading to decreased oxygen to tissues
what are signs and symptoms of hypovolemic shock
low hemoglobin and hematocrit and decreased central venous pressure
sudden low blood pressure that is so profound it can cause damage to vital organs caused by trauma to T5 or higher is termed
what is the pathophysiology of neurogenic shock
spinal cord is damaged causing loss of sympathetic nervous system response and vasoconstriction / vascular tone which causes vasodilation where blood pulls in the vessels instead of return to heart leading to decreased tissue perfusion and less O2 to tissues
what are signs and symptoms of neurogenic shock
Low blood pressure, poor peripheral perfusion, Pulmonary dysfunction (really high), Poor temperature regulation, Bradycardia, Poor regulation of bladder, GI and musculoskeletal system, loss of reflexes
drop in blood pressure due to severe allergic reaction to an allergen is termed
what is the pathophysiology os Anaphylactic Shock
exposure to an allergen causes an antigen antibody complex to form causing massive vasodilation that increases capillary permeability leading to fluid leaking into interstitial spaces and blood pulling in the periphery
what are signs and symptoms of anaphylactic shock
shortness of breath, edema of airway, wheezing, stridor, rhinitis, angioedema, urticaria, pruritus, and decrease LOC and chest pain
sudden decrease in blood pressure that is so profound it can cause damage to vital organs caused by sepsis, urosepsis is termed
what is the pathophysiology of Septic Shock
chemical mediators cause massive vasodilation that increases capillary permeability that allows fluid to leak into interstitial space and blood pools into the periphery
signs and symptoms of septic shock are
myocardial dysfunction and decreased ejection fraction, respiratory alkalosis then respiratory acidosis, pulmonary HTN, ARDS, low blood pressure, and retiform purpura