CAD

What are some MI causes & consequences

- Acute heart failure - Arrhythmias /dysrhythmias - Sudden death - Often from Vtach or "L main" dx (major vessel breaks off) - Indigestion - Hoarseness - Hiccups

How would you test for ACS/MI?

- Blood tests: routine for rule out MI aneurysm - Troponin test (gold standard) - 2nd choice: CPK-released more slowly than troponin

The most common finding in individuals at risk for sudden cardiac death is: A. Aortic valve disease B. Mitral valve disease C. Left ventricular dysfunction D. Atherosclerotic heart disease

C. Left ventricular dysfunction

What are guidelines of the DASH diet?

Low in saturated fat, cholesterol Focus on fresh fruits / veggies Rich in whole grains, fish poultry, beans, seeds and nuts Few sweets, red meat

What is the primary goal of the DASH diet?

Lower Blood Pressure

What is the Blood Pressure Goal for the patient with CAD? Diabetics?

140/90 Average 130/80 Diabetics

What are some precipitating factors for angina

- Stress (physical or emotional) - Cold: Blood vessels constrict - Activity: Increasing O2 demand - Meal (Heavy): Ingestion of even a modest meal increases heart rate and stroke volume, raising cardiac output by around 30% in patients with angina

What are common s/sxs of Angina pain?

- Varies in severity (as well as type) - Over chest area and or radiating (to where) - Weakness especially in women - Often a feeling of apprehension, a sense of doom

How are some ways to cope / prepare with treating an angina attack?

- Carry nitro at all times & know when to use - Take nitro at first sign of discomfort - Take nitro prophylactically for certain activities such as sexual activity or running

How does Nitroglycerin help?

- Coronary vasodilation - Leading to increased O2 & circulation while also decreasing systemic & peripheral vascular resistance & work load

How would you treat Angina?

- Decrease oxygen demands by giving O2 - Encouraging rest - Increase oxygen supply to myocardium (heart cells)

What are some modifiable factors for CAD?

- Diabetes (2-4x risk) lifestyle changes; meds; a1c goal <7% - Metabolic syndrome: cluster of risk factors likely r/t insulin resistance - Obesity r/t waist size; HTN; abnormal lipids; elevated fasting BS - Psychological state (type A vs. B) - Stressful lifestyle (depression, chronic stress of caregiving, or of poverty) - Homocysteine (r/t dietary protein breakdown, early CAD, pernicious anemia) - Substance abuse & use of ephedrine containing compounds (cocaine)

What are objective signs of ACS/MI?

- EKG interpretation and changes - Inverted T wave - Elevated ST segment - Significant Q wave - May "see" loss of R wave - ST elevation-significant infarct - ST decreased -ischemia

What are some common medications used to treat CAD?

- Fibric acid derivatives (Questran) - Antiplatelet-plavix - Niacin - not common, flush-take aspirin 1 hr prior, for increased triglycerides - Bile Acid Sequestrants - Antihypertensives: BB, CCB, ACE, ARB, nitrates, diuretics - Statins - Cholesterol absorption inhibitor-zeita-only works when eating - antidysrhythmics-Digoxin

What are some causes of Angina?

- Insufficient coronary blood flow - Inadequate oxygen supply to the myocardial muscle - Pneumonia can lead to angina

What are some education points for the patient taking Nitroglycerin?

- Keep in original bottle, cool spot near patient - Renew and reorder shortly before date expires - Take one at 1st sign,Repeat q5min x total of 3 tabs (3 tabs over 10 minutes) - Depending on client response, Call 911

What are some ways you can prevent Angina?

- Moderation in activity -what causes it & minimize it - Avoid emotional stress - Avoid overeating -small frequent meals - Stop smoking - Avoid cold weather -scarf over mouth

What are physiological causes of an MI?

- Occlusion of coronary blood vessel (AEB STEMI) or - Narrowing of coronary blood vessel to critical point of partial obstruction (AEB UA or NSTEMI) - STEMI-ST on EKG elevated in myocardial ischemia - NTEMI-no EKG change

Name some treatments for ACS / MI

- Oxygen -best drug for heart - Bed rest (varies w/ pt & extent of MI) - Diet changes -healthy, DASH - Thrombolytic therapy-risk of bleeding - Cardiac cath -identify other blockages - PTCA/stent (balloon) - Possible CABG

What are surgical treatments for MI?

- Pacemakers &/or AICD (temporary or permenant) - Angioplasty (PTCA, stent) - Revascularization (CABG) - Balloon assist devices (IABP) - LVAD - Heart transplantation

What are the therapeutic ranges of digoxin?

0.5 - 2.0

Which of the following individuals would the nurse identify as having the highest risk for CAD? A. 45-year-old depressed male with a high-stress job B. 60-year-old male with below normal homocysteine levels C. 54-year-old female vegetarian with elevated high-density lipoprotein (HDL) levels D. 62-year-old female who has a sedentary lifestyle and body mass index (BMI) of 23 kg/m

A - Studies demonstrate that depression and stressful states can contribute to the development of CAD.

The community health nurse is planning health promotion teaching targeted at preventing coronary artery disease (CAD). Which of the following ethnic groups would the nurse select as the highest priority for this intervention? A. White male B. Hispanic male C. African American male D. Native American female

A - The incidence of CAD and myocardial infarction (MI) is highest among white, middle-aged men.

A nurse is admitting a client who has a suspected myocardial infarction (MI) and a history of angina. Which of the following findings will help the nurse distinguish angina from an MI? A. Angina can be relieved with rest and nitroglycerin. B. The pain of an MI resolves in less than 15 min. C. The type of activity that causes an MI can be identified. D. Angina can occur for longer than 30 min.

A. Angina can be relieved by rest and nitroglycerin.

A patient is admitted to the CCU with a diagnosis of unstable angina. Which of the following medications would the nurse expect the patient to receive (SELECT ALL THAT APPLY): A. Antiplatelet therapy B. Fibrinolytic therapy C. Beta Blockers D. Prophylactic Antibiotics E. IV Nitroglycerin

A. Antiplatelet therapy C. Beta Blockers E. IV Nitroglycerin

A nurse is caring for a client and reviewing a new prescription for an afterload-reducing medication. The nurse should recognize that this medication is administered for which of the following types of shock? A. Cardiogenic B. Obstructive C. Hypovolemic D. Distributive

A. Reducing afterload will allow the heart to pump more effectively, which is needed for the client who has cardiogenic shock.

What is Percutaneous transluminal coronary angioplasty?

A catheter is used to open the offending artery. PTCA opens blocked coronary arteries r/t CAD, restoring blood flow to the heart tissue without open-heart surgery.

When providing nutritional counseling for patients at risk for CAD, which of the following foods would the nurse encourage patients to include in their diet (select all that apply)? A. Tofu B. Walnuts C. Tuna fish D. Whole milk E. Orange juice

A, B, C - Tuna fish, tofu, and walnuts are all rich in omega-3 fatty acids, which have been shown to reduce the risks associated with CAD when consumed regularly

Which of the following nursing responsibilities are priorities when caring for a patient returning from a cardiac catheterization (select all that apply) A. Monitoring vital signs and ECG B. Checking the catheter insertion site and distal pulses C. Assisting the patient to ambulate to the bathroom to void D. Informing the patient that he will be sleeping from the general anesthesia E. Instructing the patient about the risks of the radioactive isotope injection

A, D

A nurse is caring for a client in a clinic who asks the nurse why her provider prescribed 1 aspirin per day. Which of the following is an appropriate response by the nurse? A. "Aspirin reduces the formation of blood clots that could cause a heart attack." B. "Aspirin relieves the pain due to myocardial ischemia." C. "Aspirin dissolves clots that are forming in your coronary arteries." D. "Aspirin relieves headaches that are caused by other medications."

A. Aspirin decreases platelet aggregation that can cause a myocardial infarction.

When assessing a patient, you note a pulse deficit of 23 beats. This finding may be caused by: A. Dysrhythmia B. Heart Murmur C. Gallop Rhythyms D. Pericardial Friction Rub

A. Dysrhythmia

After teaching about ways to decrease risk factors for CAD, the nurse recognizes that additional instruction is needed when the patient says... A. I would like to add weight lifting to my exercise program B. I can only keep my blood pressure normal with medication C. I can change my diet to decrease my intake of saturated fats D. I will change my lifestyle to reduce activities that increase my stress

A. I would like to add weight lifting to my exercise program

When planning emergent care for a patient with a suspected MI, the nurse will anticipate administration of A. Oxygen, nitroglycerin, aspirin, and morphine. B. Oxygen, furosemide (Lasix), nitroglycerin, and meperidine. C. Aspirin, nitroprusside (Nipride), dopamine (Intropin), and oxygen. D. Nitroglycerin, lorazepam (Ativan), oxygen, and warfarin (Coumadin).

A.- The American Heart Association's guidelines for emergency care of the patient with chest pain include the administration of oxygen, nitroglycerin, aspirin, and morphine. These interventions serve to relieve chest pain, improve oxygenation, decrease myocardial workload, and prevent further platelet aggregation.

What are consequences of decreased oxygen supply, as evidenced by hypoxia in CAD client?

Angina, MI

How do you tell the difference between MI and Angina?

Angina: - precipitated by exertion or stress - Relieved by rest or Nitro - Symptoms last < 15 mins - Not associated w/nausea, epigastric pain, distress, dyspnea, anxiety, diaphoresis Think *A-symptomatic MI: - Can occur without cause - Relieved only by opioids - Symptoms last >30 mintutes - Associated w/nausea, epigastric pain, distress, anxiety, diaphoresis *Think "My NEADD"

How do Antidysrythmics work to treat MI?

Antidysrhythmics - increase force of contraction in order to decrease the heart rate.

The nurse is providing teaching to a patient recovering from an MI. Discussion regarding resumption of sexual activity should be A. Delegated to the primary care provider. B. Discussed along with other physical activities. C. Avoided because it is embarrassing to the patient. D. Accomplished by providing the patient with written material.

B

In teaching a patient about CAD, the nurse explains that the changes that occur in this disorder include which of the following? (select all that apply): A. Diffuse involvement of plaque formation in coronary veins B. Abnormal levels of cholesterol, particularly low-density lipoproteins C. Accumulation of lipid and fibrous tissue withing the coronary arteries D. Development of angina due to decreased blood supply to the heart muscle E. Chronic vasoconstriction of coronary arteries leading to permanent vasospasm

B, C, D

In teaching the patient of CAD, changes that occur in this disorder include (SELECT ALL THAT APPLY): A. diffuse involvement of plaque formation in the coronary arteries B. abnormal levels of cholesterol, particularly LDL C. accumulation of lipid and fibrous tissue within the coronary arteries D. development of angina due to decreased blood supply to the heart muscle E. chronic vasoconstriction of coronary arteries leading to permanent vasospasms

B, C, D

When collecting subjective data related to the cardiovascular system, which of the following should be obtained from the patient (select all that apply): A. Annual Income B. Smoking History C. Religious Preference D. Number of Pillows used to sleep E. Blood for basic laboratory studies

B, C, D

The nurse would assess a patient with complaints of chest pain for which of the following clinical manifestations associated with a myocardial infarction (MI) (select all that apply)? A. Flushing B. Ashen skin C. Diaphoresis D. Nausea and vomiting E. S3 or S4 heart sounds

B, C, D, E

After teaching a patient with chronic stable angina about nitroglycerin, the nurse recognizes the need for further teaching when the patient states, A. "I will replace my nitroglycerin supply every 6 months." B. "I can take up to five tablets every 3 minutes for relief of my chest pain." C. "I will take acetaminophen (Tylenol) to treat the headache caused by nitroglycerin." D. "I will take the nitroglycerin 10 minutes before planned activity that usually causes chest pain."

B. - The recommended dose of nitroglycerin is one tablet taken sublingually (SL) or one metered spray for symptoms of angina. If symptoms are unchanged or worse after 5 minutes, the patient should be instructed to activate the emergency medical services (EMS) system.

A nurse in a cardiac unit is assisting with the admission of a client who is to undergo hemodynamic monitoring. Which of the following actions should the nurse anticipate performing? A. Administer large volumes of IV fluids. B. Assist with insertion of pulmonary artery catheter. C. Obtain Doppler pulses of the extremities. D. Gather supplies for insertion of a peripheral IV catheter.

B. A pulmonary artery catheter and pressure-monitoring system are inserted for hemodynamic monitoring of a client.

The nurse is caring for a patient who is two days post-MI. The patient reports that she is experiencing chest pain. She states "It hurts when I take a deep breath." Which of the following actions would be a priority? A. Notify the physician STAT & obtain a 12-lead ECG B. Obtain vitals & auscultate for pericardial friction rub C. Apply high-flow oxygen by face mask and auscultate breath sounds D. Medicate the patient with PRN analgesic and reevaluate in 30 minutes

B. Obtain vitals & auscultate for pericardial friction rub

A nurse in the emergency department is completing an assessment of a client who is in shock. Which of the following findings should the nurse expect? (Select all that apply.) A. Heart rate 60/min B. Seizure activity C. Respiratory rate 42/min D. Increased urine output E. Weak, thready pulse

B. Seizure activity may be present in a client who is in shock. C. Tachypnea is an expected finding in a client who is in shock. E. A weak, thready pulse is an expected finding in a client who is in shock.

The nurse is examining the ECG of a patient who has just been admitted with a suspected MI. Which of the following ECG changes is most indicative of prolonged or complete coronary occlusion? A. Sinus tachycardia B. Pathologic Q wave C. Fibrillatory P waves D. Prolonged PR interval

B. The presence of a pathologic Q wave, as often accompanies STEMI, is indicative of complete coronary occlusion.

A nurse is planning care for a client who has septic shock. Which of the following is the priority action for the nurse to take? A. Maintaining adequate fluid volume with IV infusions B. Administering antibiotic therapy C. Monitoring hemodynamic status D. Administering vasopressor medication

B. Using the safety and risk reduction framework, administration of antibiotics is the priority action by the nurse. Eliminating endotoxins and mediators from bacteria will reduce the vasodilation that is occurring.

A hospitalized patient with a history of chronic stable angina tells the nurse that she is having chest pain. The nurse bases his actions on the knowledge that ischemia: A. Will always progress to MI B. Will be relieved by rest, nitroglycerin, or both C. Indicates that irreversible myocardial damage is occuring D. Is frequently associated with vomiting and extreme fatigue

B. Will be relieved by rest, nitroglycerin, or both

How do Beta blockers work to treat MI?

Beta Blockers decrease heart rate, contactility, and conduction

How do Ace Inhibitors work to treat MI?

Blocks production of Angiotensin II, causing vasodilation and excretion of sodium and water. (the -pril's)

When assessing the cardiovascular system of a 79 year old patient, you might expect to find... A. Narrowed pulse pressure B. Diminished carotid artery pulses C. Difficulty in isolating the apical pulse D. An increased heart rate in response to stress

C - Difficulty in isolating the apical pulse

Postoperative care of a patient undergoing coronary artery bypass graft (CABG) surgery includes monitoring for which of the following common complications? A. Dehydration B. Paralytic ileus C. Atrial dysrhythmias D. Acute respiratory distress syndrome

C - Postoperative dysrhythmias, specifically atrial dysrhythmias, are common in the first 3 days following CABG surgery.

A nurse is presenting a community education program on recommended lifestyle changes to prevent angina and myocardial infarction. Which of the following changes should the nurse recommend be made first? A. Diet modification B. Relaxation exercises C. Smoking cessation D. Taking omega-3 capsules

C. According to the airway, breathing, and circulation (ABC) priority-setting framework, adequate oxygenation is the priority. Nicotine causes vasoconstriction, elevates blood pressure, and narrows coronary arteries. Therefore, smoking cessation should be the first recommended lifestyle change.

A patient is recovering from an uncomplicated MI. Which of the following rehabilitation guidelines is priority to include in the teaching plan? A. Refrain from sexual activity for a minimum of 3 weeks B. Plan a diet program that aims for a 1 - 2 lb weight loss per week C. Begin an exercise program that aims for at least five 30-minute sessions per week D. Consider the use of erectile agents and prophylactic NTG before engaging in sexual activity.

C. Begin an exercise program that aims for at least five 30-minute sessions per week

A nurse in the emergency department is caring for a client who has an allergic reaction to a bee sting. The client is experiencing wheezing and swelling of the tongue. Which of the following medications should the nurse expect to administer first? A. Methylprednisolone (Solu-Medrol) IV bolus B. Diphenhydramine (Benadryl) subcutaneously C. Epinephrine (Adrenaline) IV D. Albuterol (Proventil) inhaler

C. CORRECT: Using the airway-breathing-circulation (ABC) priority-setting framework, epinephrine is administered first. It is a rapid-acting medication that promotes effective oxygenation and is used to treat anaphylactic shock.

A nurse on a cardiac unit is reviewing the laboratory findings of a client who has a diagnosis of myocardial infarction (MI) and reports that his dyspnea began 2 weeks ago. Which of the following cardiac enzymes would confirm the infarction occurred 14 days ago? A. CK-MB B. Troponin I C. Troponin T D. Myoglobin

C. The Troponin T level will still be evident 14 to 21 days following an MI. (Troponin I levels are no longer evident after 7 days.)

If no angina relief is felt, or grows worse after first dose, instruct pt to do what?

Call 911

If sx significantly better but pain still there do what?

Call 911

When evaluating a patient's knowledge regarding a low-sodium, low-fat cardiac diet, the nurse recognizes additional teaching is needed when the patient selects which of the following food choices? A. Baked flounder B. Angel food cake C. Baked potato with margarine D. Canned chicken noodle soup

D

For which of the following is percutaneous coronary intervention (PCI) most clearly indicated? A. Chronic stable angina B. Left-sided heart failure C. Coronary artery disease D. Acute myocardial infarction

D - PCI is indicated to restore coronary perfusion in cases of myocardial infarction.

A patient was admitted to the emergency department 24 hours earlier with complaints of chest pain that were subsequently attributed to ST-segment-elevation myocardial infarction (STEMI). Which of the following complications of MI should the nurse anticipate? A. Unstable angina B. Cardiac tamponade C. Sudden cardiac death D. Cardiac dysrhythmias

D - The most common complication after MI is dysrhythmias, which are present in 80% of patients.

A nurse is instructing a client who has angina about a new prescription for metoprolol tartrate (Lopressor). Which of the following statements by the client indicates understanding of the teaching? A. "I should place the tablet under my tongue." B. "I should have my clotting time checked weekly." C. "I will report any ringing in my ears." D. "I will call my doctor if my pulse rate is less than 60."

D. The client is advised to notify the provider if bradycardia (pulse rate less than 60) occurs.

How to dx and tx ACS/MI

Diagnose by: - 12 lead EKG, labs, echo, ETT (DST), cardiac cath, Rxs Treat with: - Thrombolytics, stent, CABG, intra aortic balloon pump, LVAD

What lab values should the nurse observe in the patient with cardiogenic shock?

Electrolytes and O2

What does FITT stand for?

Frequency, Intensity, Type & Time

What is a common side effect of nitro?

Light headedness HA

How can you prevent CAD?

Maintain a healthy weight Quit smoking Monitor BP / Cholesterol

How does Morphine work to treat MI?

Morphine- Only prescription that can treat MI pain.

What medications are used to treat MI?

Nitroglycerin Antidysrhythmics Morphine Beta blockers Ace inhibitors

How does Nitroglycerin work to treat MI?

Nitroglycerin is a vaso-dilator, it decreases angina

OPQRST is a common assessment for Angina. What does it stand for?

Onset Precipitating Factors Quality of Pain Radiation of Pain Severity of Pain Timing of Pain

How is Ischemia represented on an EKG?

ST Depression

How is MI represented on an EKG?

ST Elevation

What 3 things can relieve stable angina?

Rest, nitro (keep in brown light sensitive bottle, and oxygen.

What are the different kinds of angina?

Stable, Unstable, Variant (Prinzmetals), and Microvascular

What are some factors of Stable Angina?

Stable: chronic stable chest pain; plaque= 75% obstruction - People live with it, do not feel until 75% obstructed - Same pattern, predictable, resting should relieve chest pain - Rest take 3 SL nitro q5 min of not relieved call 911 - Defined as: predictable pattern, develops & goes away.

What is the "gold standard" test for the patient with ACS/MI?

Troponin

What are some s/sx of Cardiogenic Shock?

Weakness Dizziness Nausea Sweating Rales (early often leads to acute pulmonary edema)