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Stack #38874
RRC Maintenance - CAD
| question | answer |
|---|---|
| what is atherosclerosis? | build-up of fatty plaque compose primarily of cholesterol |
| what is preload? | ability of myocardium to stretch/expand as LV fills with blood --> venous return to right side of heart |
| what is afterload? | force against which the LV must pump against in order to move blood against the systemic circulation |
| What factors affect afterload? | mitral/aortic valve stenosis; increased SVR (HTN, increased blood volume) |
| What is contractility? | vigour of each contraction generated by the myocardium regardless of preload/afterload factors |
| What is collateral circulation? | development of new blood vessels that re-route blood around blockage or narrowing of artery |
| What is cardiomyopathy? | compensation that occurs early in heart disease --> hypertrophy develops as heart increases its muscle mass and will eventually outgrow it blood supply resulting in ischemia |
| What is cardiac output? | amount of blood passing through the left ventricle in one minute |
| How atherosclerosis contribute to CAD? | creates nodular plaques in tunica intima which become fibrous over time due to complex interaction between platelets and leukocyte; platelets will adhere to surface and generate thrombi...results in turbulent blood flow resulting in more clot/plaque dev. |
| Stable angina | consistent pattern usually triggered by exercise and nitrates will relieve |
| Unstable angina | duration is increased, unpredictable pattern, can be triggered by nothing, required admission for close monitoring due to increased risk of MI |
| Angina not resolved in 20 mins with 3 treatment of nitro and rest? | Myocardial infarction |
| Classic symptoms of angina | chest discomfort radiating down arm, neck, jaw, shoulders, back; feelings of anxiety/dooml; indigestion/epigastric burning; SOB, diaphoresis, numbness or tingling of arms |
| Female symptoms of angina | pain or discomfort with unusual fatigue or SOB with activity, difficulty performing "easy" activities, heaviness in shoulders, jaw, back, neck, teeth, weakness common |
| diagnostic tests | chest x-ray, EKG, serum troponin to r/o MI |
| risk factors for CAD | male gender, dyslipidemia, family hx, decreased HDL levels, smokers on OCP, HTN, DM, PVD, abdominal obesity, smoking, sedentary lifestyle, stress, increased homocysteine levels |
| How does smoking increase risk of CAD? | vasoconstriction, promotes atherosclerosis and build-up of fatty plaque, causes tachycardia and HTN, results in increased afterload and decreased contractility |
| Rationale for assess client for bleeding post-administration of thrombolytics? | affects coagulation for up to 18 hours therefore client may develop complications r/t bleeding |
| Rationale for O2 administration with angina/suspected MI? | relieves hypoxia, reduces WOB and reduction of cardiac workload |
| State nursing intervention with rationale if BP is stable in an individual with angina/suspected MI? | Raise HOB to decrease preload and increase pulmonary capacity |
| State nursing intervention with rationale if BP is unstable in an individual with angina/suspected MI? | reduces cardiac workload and increases blood flow to vital organs (ie: brain) |
| Why do we have to make sure an IV is started on someone who is coming in with angina/suspected MI? | if patient arrests, a patent IV line is lifeline for medications, once a patient arrest, loss of BP makes it impossible to insert an IV catheter |
| Why is morphine given for angina/suspected MI if nitroglycerin is ineffective? | morphine is a potent vasodilator and will help relieve chest pain |
| Why can an uncoated ASA tablet be given sublingually if an MI is suspected? | because the effect of ASA is required immediately --> helps to decrease further formation of clot |
| What lifestyle changes are necessary for CAD? | weight loss, stop smoking, exercise, reduce stress level, lower fat diet and comply with medication therapy |
| Why is smoking prohibited on oxygen therapy? | oxygen is combustible |
| diet teaching re: CAD | check food labels, increase consumption of complex CHO (fruits/veggies), increase water intake, avoid pre-packaged/processed foods, fats that are solid at room temp should be avoided, low-Na+ diet, if trig increased, avoid ETOH |
| Why is streptokinase only given once? | due to anaphlactic reaction r/t prior exposure, used because it is cheap and works well |
| Why is low-dose ASA given (81mg)? | acts to decrease platelet aggregation preventing further thrombus formation |
| Why is ASA given enteric-coated? | to prevent pin-point hemorrhages in GI tract |
| Why is important to prevent straining in a client with CAD? | straining stimulates the vagus nerve which will decrease HR --> client will fall off of toilet/commode after blacking out from lack of O2 to brain |
| What is the purpose of statins? | decrease LDL levels |
| What is the purpose of fibrates? | increase HDL levels and decrease triglycerides |
| What is important to teach about antihyperlipidemics? | used in addition to diet, weight loss and exercise. Administer at suppertime because fat is consumed most at supper meal and cholesterol is produced at higher concentrations at night |
| Why are diuretics administered for those with CAD? | if heart failure develop from extensive myocardial tissue death |
Created by:
bella83
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