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CAD & ACS: MedSurgIII
Medical Surgical Nursing: Lewis, Coronary Artery Disease etc.
56
Nursing
Undergraduate 4
09/04/2011

Additional Nursing Flashcards

 


 

Cards

Term
What is CAD?
Definition
The most common type of cardiovascular disease caused by atherosclerosis  
Term
What are the more serious manifestations of CAD?
Definition
Unstable angina and Myocardial Infarction
Term

What is atherosclerosis?

 

Definition
atherosclerosis is characterized by focal deposit of cholesterol and lipids within the intima of the wall of the artery
Term
What plays a central role in the development of atherosclerosis?
Definition
the genesis of plaque formation, inflammation and endothelial injury
Term
What can cause endothelial injury?
Definition
Tobacco use, hyperlipidemia, hypertension, diabetes, hyperhomocysteinemia and infection (herpes)
Term
What is CRP?
Definition
C-reactive protein is a marker of inflammation that is increased with pt. with CAD
Term

Chronic elevated CRP level have what effect on the patient?

 

Definition
Can trigger a rupture of the plaques and promote oxidation of LDL, cholesterol leading to uptake of macrophages in the endothelial lining
Term
What are the stages of CAD development?
Definition

1) Fatty streak: it is believed that treatment to lower LDL can reverse this stage

2) Fibrous plaque

3)Complicated Lesion

Term

What constitutes a "complicated lesion"

 

Definition
as the fibrous plaque grows, continued inflammation can result in plaque instability,ulceration and rupture. The vessel becomes comproimsed causing platelets to accumulate leading to thrombus. Further platelet aggregation and adhesion enlarges the thrombus leading to a "complicated lesion"
Term
The growth and extent of collateral circulation is attributed to what?
Definition

1) inherited predispostion to develop new blood vessels

2) the presence of ischemia

Term
What are modifiable risk factors for CAD?
Definition

Elevated serum levels-- low HDL and high LDL, cholesterol serum >200

Hypertension

Tobacco use

Physical inactivity

Obesity

Term
How is HTN a modifiable risk factor for CAD?
Definition
The shearing stress that causes endothelial injury, when atherosclerosis is present, there is increased pressure needed to push blood through the narrow lumen. Increased BP can cause injury
Term
How is tobacco a modifiable risk factor?
Definition
Tobacco smoke causes catecholemines to be released, which ^ HR and BP. Also increases platelet adhesion and risk for emboli formation. CO is a byproduct that affects the amount of O2 carried in hemoglobin. Decrease in HMG causes increase cardiac workload
Term
What are the modifiable contributing risk factors?
Definition
Diabetes, Metabolic Syndrome, Stress, Elevated Homocysteine levels
Term
Why does DM cause a increased risk for  CAD?
Definition
DM manifests an increased tendency toward connective tissue degeneration and endothelial dysfunction. Diabetics also have alterations in lipid metabolism and tend to have high cholesterol.
Term
What is metabolic syndrome, what are the risk factors for Met. Syn.?
Definition
It refers to a cluster of risk factors for CAD which is though to be related to insulin resistance. Risk factors are; obesity, HTN, ab. serum levels, elevated fasting blood glucose levels
Term

How does stress become a modifiable contributing risk factor for CAD?

 

Definition
stress causes SNS and it effects on the heart (through release of catecholemines) work load and myocardial oxygen demand.
Term
What is homocysteine?
Definition
^ levels of homocyst. are linked to ^ risk for CAD. Homocyst is a amino acid in dietary protein that contribute athersclerosis by damaging inner lining of vessels and promoting clot build up. 
Term
What are some cholesterol lowering therapy, what are their side effects?
Definition

"statin" drugs

rare side effects include liver damange, rhabdomyolosis and myopathy. Liver enzymes and creatine levels must be monitored

Term

What are some forms of risk management for CAD?

 

Definition

physical activity

nutritional therapy (^EPA & DHA)

cholesterol lowering agents

anti platelet therapy

Term
What causes angina?
Definition
When the demand of myocardial oxygen exceeds the ability of the coronary arteries to supply the heart with oxygen, which lead to myocardial ischemia
Term
what is the primary reason for insufficient blood flow and decrease oxygen delivery to the heart?
Definition

narrowed lumens due to athersclerosis

 

Term
What causes the angina/chest pain during myocardial ischemia?
Definition
myocardial fibers are irritated by a buildup of lactic acid and transmit a pain message through the cardiac nerves and upper thoracic posterior nerve roots
Term

Cardiac cells are viable for how long during ischemic conditons?

 

Definition
20 minutes
Term

What is chronic stable angina?

 

Definition
when chest pain occurs intermittently over a long period of time with the same pattern of onset, duration and intensity of symptoms.
Term

What is silent ischemia?

Nocturnal angina?

Angina Decubitus?

Preinzmetals angina?

Definition

1) angina that occurs in the absence of symptoms

2)occurs during night, despite if person is sleeping or awake

3) occurs when lying down and resolved when standing

4) occurs at rest, response to a spasm, rare form that is seen in pt. with history of migraine or raynaulds

Term
what are some kinds of drug therapy for angina?
Definition

short acting nitrates

long acting nitrates

beta andrenergic blockers

calcium channel blockers

ACE inhibitors

RANOLAZINE

Term
What is the goal for treatment for chronic stable angina?
Definition
aimed at decreasing oxygen demand and or/ increasing oxygen supply
Term
How do short acting nitrates work?
Definition
they dilate peripheral blood vessels, coronary arteries and collateral vessels
Term
When giving nitrates such as nitroglycerin, what are some side effects?
Definition
pt. should be warned about HR increase, pounding headache, dizziness, flushing. Pt. needs to be aware of hypotension when standing
Term
How do Beta Blockers effect the heart?
Definition
decreases myocardial contractility, HR, SVR and BP which reduce the need for oxygen demand
Term
What are the S/E of beta blockers?
Definition
bradycardia, hypotension, wheezing, GI compaints. Pt. may also complain about weight gain, depression and sexual dysfunction
Term
What should you consider when a diabetic pt. is prescribed beta blockers?
Definition
Beta blockers can mimic the symptoms of hypoglycemia
Term
What do calcium channel blockers do?
Definition

1)systemic vasodilation with decreased SVR

2) decreased myocardial contractility

3) coronary vasodilation

Term
How do calcium channel blockers work?
Definition
Block movement of calcium into cells
Term

What type of class of drugs are:

propranolol

metoprolol

cogard

atenolol

Definition
Beta blockers
Term

What type of class of drugs are:

diltiazem

amlodipine

nifedipine

Definition
Calcium channel blockers
Term

What class of drugs are:

lisinopril

captopril

Definition
ACE inhibitors
Term
What is Ranolazine? When is it used?
Definition
It is used to treat chronic angina, based on it anti-anginal and anti-ischemia effects. Ranolazine prolongs QT interval and should only be used as a last result when pt. hasn't responded to any the anti-anginal drugs.
Term
What are the side effects of Ranolazine?
Definition
dizziness, headache, constipation and nausea
Term
What is acute coronary syndrome?
Definition
when ischemia is prolonged and not immediately reversed
Term
What does ACS encompass?
Definition

unstable angina

non ST segment elevation in MI

ST segment elevation in MI

association with deterioration of a once stable plaque

Term
If a unstable plaque grows, creates a thrombus that partially occludes, what would you see on an EKG?
Definition
NSTEMI
Term
If the lesion is unstable, and fully occludes, what would you see on the EKG?
Definition
STEMI
Term
What causes ACS?
Definition
when stable angina becomes unstable angina
Term
Whats the difference between unstable and stable angina?
Definition
when angina changes from stable to unstable, it changes its patter, frequency, and it is easily provoked by little to no exertion.
Term
When does myocardial infarction occur?
Definition
it occurs as a result of sustained ischemia causing irreversible myocardial cell death
Term
How long does it take for the entire thickness of the heart to become necrotic?
Definition
4-6 hours
Term
What are the clinical manifestations of  an MI?
Definition

Pain (severe and immobilizing)

quality of chest pain

SNS activation --> diaphoresis, vasoconstriction of peripheral blood vessels

CV changes

GI changes; nausea & vomiting

Fever due to inflammation causing increased metabolic demand

Term

What are the CV manifestations?

Which are specific to LV dysfunction?

Which are specific to RV dysfunction?

 

Definition

1) elevation of BP and HR initially (due to SNS, then a drop due to decrease cardiac output)

2)decrease in CO= decrease renal perfusion and decrease urine output

3)crackles in lungs indicating LV dysfuntion

4)JVD, hepatic engorgment and peripheral edema indicating RV dysfunction

Term

What are complications of an MI?

 

Definition

1) dysrhythmias

2)heart failure

3)cardiogenic shock

Term
What are the symptoms of HF?
Definition
restlessness, mild dyspnea, agitation, slight tachycardia, crackles, JVD, S3 S4 heart sounds
Term
What drug interventions are taken when a patient presents to the ER with a MI?
Definition

1) IV Nitro -- increase 1 ml increments by titrating till relief

2) morphine sulfate -- can be given with Nitro when chest pain is not relieved

3) ACE inhibitors, anti dysrhytmias, cholesterol lowering agents and stool softners

Term
What are the criteria for CABG?
Definition

failed medical mangment

have left main coronary artery for 3 vessel disease

not a canidate or angioplasty or stent

failed stenting or angioplasty accompanied by chest pain

Term

What are the donor sites for CABG

 

Definition

RIMA

LIMA

R/L saphenous vein

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