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TT2 CAD
TT2 NHCC CAD
| Question | Answer |
|---|---|
| What are the 3 developmental stages of atherosclerosis? | 1. Fatty streak 2. Raised Fibrous Plaque 3. Complicated Lesion |
| Describe a fatty streak | Earliest lesions in atherosclerosis. Lipid filled smooth muscle cells. Usually observed in coronary artery disease by age 15 and involve increasing amount of surace area as the patient ages |
| What is raised fibrous plaque? | begins progressive changes in arterial wall. Appear by age 30 and increase w/age. Chronic injury -elevated BP, high blood cholesterol, heredity, Co2, smoking and immune reactions. Once inner wall has damage, platelets can accumulate and lead to throm |
| What are complicated lesions? | The final stage of atherosclerosis and the most dangerous - they can cause partial or total occlusion |
| What are the 2 factors that collateral circulation (arterial branching) is attributed to? | 1. Inherited predisposition 2. Presence of chronic ischemia |
| What are the myocardial changes with ischemia? | Changes that can lead to an infarct are: 1. ECG changes 2. anaerobic metabolism (due to lack of 02) 3. Lactic Acid 4. Pain to cardiac nerves |
| What are the modifiable risk factors for CAD? | 1. Age 2. Gender - male until age 60 3. Ethinicity 3. Genetic predisposition & family history of heart disease |
| The highest incidence of MI are seen in who? | white middle aged males |
| Modifiable risk factors for CAD are: | elevated serum lipids - hypertension - cigarette smoking - obesity - physical inactivity |
| The CAD risk factors for women are? | Increases with age - birth control pills - living longer - lose protection after menopause |
| What are contributing factors to CAD? | 1. Diabetes melitus 2. Stressful life style (type A personality) 3. Factor X - group of conditions together increase risk |
| What are the physical assesment techniques for evaluating the cardiovascular system? | Vital signs - Inspection - palpitation - percussion - auscultation |
| Auscultation for what? | No bruits |
| Percussion for what? | unable to distinguish right sided border |
| Palpitation for what? | Pulses in neck and extremeties for volume and pressure, equal R & L side - normal bounding, thready or absent. Rigidity - normal pulse feels like a tap-- thrill = vibrate caused by narrowed or bulging vessel. |
| What is a thrill? | vibration during palpitation caused by narrowed or bulging vessel. |
| Inspection for what? | skin color, hair distribution, edema, thrombophelbitis, varicose veins, lesions, capillary filling time, internal/external jugular distension & prominent pulsations = caused by right lateral pressure increase. Thorax symmetric no heaves. |
| Common assessment abnormalites of the pulse are: | Pulse volume (bounding, thready, absent) Thrill, Rigidity, Bruit, Tachycardia, Bradycardia, Arrhythmia, |
| What are common assessment abnormalities of the venous? | Distended neck veins, Pitting edema of lower extremities or sacral area, Thrombophlebitis, + Homans sign |
| What are common assessment abnormalities of the skin? | Unusually warm hands or feet, Cold hand or feet, Central or peripheral cyanosis, Color changes in extremities w/ postural change, stasis ulcers |
| What are common assessment abnormalities of the extremites? | clubbing of nail bed, splinter hemorrhages, abnormal capillary filling time, varicose veins, asymmetry in limb circumference arterial bruit |
| What does the accronym "Old Cart" stand for in a pain assessment? | O – onset –L - location - D - Duration CART= C - character - A - associated symptoms - R -radiation - T - treatment |
| What are 3 major clinical manifestations of CAD? | Angina pectoris, Acute coronary syndrome , Sudden cardiac death |
| acute coronary syndrome includes what three things? | Unstable angina, Cardial infarction , Non –ST and ST segment elevations |
| What are the signs and symptoms of Angina ? | Most common initial manifestation = chest pain or discomfort. Also,Pressure, ache in the chest -- constrictive, squeezing, heavy, choking or suffocating sensation, Severe indigestion or burning, Almost never sharp or stabbing and doesn’t usually chang |
| What are complication of CAD? | Vascular problems, Stroke, Myocardial Infarction (total occlusion), Peripheral Vascular Disease, Renal Failure, Diabetes doubles risk for these problems |
| What is the treatment of Treatment of Stable Angina? | Stop activity Work up Nitrates – meds vasodilate - ↑ perfusion Life style modification |
| What is the treatment for unstable angina? | Hospitalization / work up/ surgery ↑ O2 to myocardium Medication – Beta blockers Channel blockers ASA - preventative |
| What is the definition of Coronary Artery Disease? | A narrowing of the coronary arteries causing a decreased lumen and decreased blood flow through an artery. |
| What happens when there is an injury to the artery? | Results in ↑permeability of endothelia cells, allowing plasma components to enter. An inflammatory reaction occurs. Thrombus formation occurs. Cholesterol, fat, and thrombi develop into a plaque formation. |
| What happens as atherosclerosis progresses? | Luminal narrowing is accompanied by vascular changes which impeded the vessel's ability to dilate. |
| Progressive narroiwn of lumen by plaque enlargement results in what? | ischemic to the myocardium |
| What does transient ischemic cause at the cellular level? | Reversable changes (anaerobic metabolism) If untreated ischemia may lead to tissue injury or necrosis. |
| What is tissue ischemia manifested by? | pain or angina |
| What is ischemic pain called if it is relieved by rest or nitrates? | stable angina |
| Insufficent Oxygen supply in angina is due to what? | stenosis, spasm, thrombosis |
| What are lifestyle modifications needed for CAD? | Blood pressure monitoring, nutrition (DASH Diet), modified activity, and life long follow up |
| What is the purpose of testing cholesterol? | Elevated level risk factor or atherosclerotic heart disease. Norm - , 140-200 varies w/ age/gender |
| What is the purpose of testing triglygerides? | elevations associated w/ cardiovascular disease. Norm 40-190 varies w/ age |
| What is the purpose of an ECG? | Purpose: measures rate and regularity of heartbeat – can detect rhythm of heart, activity of pacemakers, conduction abnormalities, position of heart, size of atra and ventricles, presence of injury, and Hx of MI |
| What is the purpose of a stress test? | Purpose: evaluates effect of exercise tolerance on myocardial function. 3 min stages of elevations in speed. Continual monitoring of vital signs for ECG rhythms for ischemic changes important for Dx of left ventricular function and coronary artery dise |
| What is the purpose of Echocardiogram, stress echocardiogram? | Purpose: Records sounds waves bounced off of heart, direction and flow of blood thru heart – becomes audio and graphic data that measures valvular abnormalities, congenital cardiac defects, wall motion, and cardiac function. Combine w/ stress – take imag |
| What is the purpose of Nuclear imaging? | Purpose: IV injection of radioactive isotopes. Supplies info about myocardial contractility, myocardial perfusion, and acute cell injury. |
| What is the purpose of a MRI, MRA? | Purpose: obtains info about cardiac tissue integrity, aneurysms, ejection fractions, cardia output, and patency of proximal coronary arteries. Provides images in multiple planes w/ uniformly good resolution. Can’t be used w/ implanted metal. |
| What is the purpose of Cardiac catheterization / angiography? | Purpose: Info about O2 saturation and pressure readings w/in chambers. Contrast medium assists in examining structure and motion of heart. |
| What postion should a patient be in for an Echocardiogram, stress echocardiogram? | Place patient in a supine position of left side facing equipment. |
| What is the purpose of a Holter monitor? | Recording of ECG rhythm for 24-48 hrs correlating rhythm changes w/ symptoms recorded in diary. Normal activity encouraged. Recorder stores, prints info to analyze for rhythm disturbance |
| What test has restrictions on bathing and showering during testing? | the Holter monitor |
| What are 6 nursing cares that need to be done if present during an anginal attack? | 1) Administration of O2 2.) Determination of VS 3) ECG 4) Prompt pain relief first with a nitrate followed by a narcotic analgesic if needed 5) Auscultation of heart sounds 6) Comfortable positioning of patient |
| Where should the catheter be inserted for right side angiogram? | vein |
| Where should the catheter be inserted for left side angiogram? | artery |
Created by:
2007Nurse
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