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medsurg exam 2
CHD symptoms and diagnosis
| Question | Answer |
|---|---|
| angina pectoris | chest pain resulting from reduced coronary blood flow |
| temporary angina pectoris means | it is an imbalance that can be reversed with rest or meds |
| patho of angina pectoris | Oxygen demand is greater than the oxygen supply |
| during angina pectoris, what happens | Cells metabolize anaerobically which causes anaerobic metabolism which causes lactic acid production |
| angina pectoris is a result of | decreased oxygen delivery to myocardial cells which causes ischemia and chest pain |
| types of angina pectoris | Stable angina Unstable angina Variant angina – Prinzmetal’s angina - vasospasm Microvascular angina Refractory angina Cocaine induced angina |
| stable angina means you know | the cause and treatment |
| Microvascular angina | Same symptoms, but larger vessels are OK Problem occurring in the smaller vessels |
| refractory angina | symptoms recur even after treatment |
| cocaine induced angina | vasoconstriction |
| questions to ask about chest pain | where is it, what does it feel like, radiate or existing anywhere else, pain scale, when did it start, ever had it before, associated symptoms |
| manifestations of angina | chest pain, arm pain, possible pain in jaw, neck and scapula, indigestion |
| chest pain from angina | substernal, retrosternal experience tightness, pressure, burning, squeezing, dull aching |
| arm pain from angina | unilateral, bilateral |
| associated symptoms of angina | Shortness of breath Diaphoresis Dizziness Pale, cool skin Nausea/vomiting Impending feeling of doom |
| asymptomatic aka silent ischemia occurs in | elderly, women |
| most common type of angina | stable angina |
| stable angina duration | usually short |
| when does stable angina occur | in a pattern such as exercise or stress |
| stable angina is | predictable and resolves when oxygen demand subsides or supply is increased |
| timeline of stable angina | exercise or stress leads to chest pain or SOB which can be treated with rest, nitroglycerin or other meds which relieves the chest pain |
| unstable angina and acute coronary syndrome can occur | at rest |
| unstable angina and acute coronary syndrome can have | no identifiable precipitating factors |
| unstable angina and acute coronary syndrome duration | long |
| unstable angina and acute coronary syndrome has | unpredictable patterns |
| what does not help relieve the pain during unstable angina and acute coronary syndrome | rest or medication |
| unstable angina and acute coronary syndrome requires | immediate intervention |
| unstable angina and acute coronary syndrome may be | an MI and means the pt should go to hospital for tests! |
| during variant angina - prinzmetal's angina, there are many atypical presentations but | 90% of pts identify some amount of pain |
| who does variant angina - prinzmetal's angina affect most | Women Elderly Diabetics Heart transplant recipients |
| common symptoms with variant angina - prinzmetal's angina | Shortness of Breath Back pain Overwhelming fatigue Weakness Nausea Loss of appetite |
| diagnosis of CHD can be done through | History (pain, lifestyle, etc.) 12-lead EKG Chest X Ray Cardiac biomarker - troponin level Echocardiogram Stress test Cardiac catheterization/angiography |
| 12 Lead Electrocardiogram ECG reveals what about ischemia | ST wave depression T wave inversion |
| stress test types | Exercise Stress Test (usually done on a treadmill) Adenosine stress test Thallium/Technetium Stress Test |
| Exercise Stress Test (usually done on a treadmill) | Individuals walk on treadmill Increase exercise intensity looking for ischemia |
| Adenosine stress test | Adenosine is used if the patient cannot walk on treadmill Stresses the heart like exercise Take images before and after administration of adenosine |
| Thallium/Technetium Stress Test | Radioisotope that accumulates in myocardial cells 2-3 hours after scan and can differentiate between healthy, ischemic, or infarcted tissue |
| what should you hold when stress testing | Hold beta blockers before exercise stress testing |
| Echocardiogram (TTE) is essentially a | cardiac ultrasound |
| Echocardiogram (TTE) is a | non-invasive test that can be done at bedside |
| Echocardiogram (TTE) makes you able to | assess myocardial function, estimate ejection fraction |
| Echocardiogram (TTE) allows for assessment of | valve function! |
| Transesophageal Echocardiography (TEE) is | more invasive and requires conscious sedation |
| patient prep for cardiac catherization | 12 L EKG Bloodwork C/D/P, electrolytes, coagulation studies NPO Pre-medicate Renal insufficiency - hydration Dye allergy – pre-medicate Diabetic patients – reduced dose of insulin Anticoagulation – should be addressed |
| post procedure nursing care for cardiac catherization | Monitor for dysrhythmias, CP, neuro changes HOB no higher than 30 deg Frequent VS checks q15 min x’s 4, q30 min x’s 4 and every hour x’s 4 Assess distal pulses with each VS check Assess for bleeding or hematoma with each VS check Monitor I/O |
| Cardiac Catherization Contraindications | Uncontrolled ventricular dysrhythmias Uncorrected hypokalemia/hyperkalemia Digitalis toxicity Decompensated heart failure Severe renal insufficiency Stroke within the last month Active GI bleeding Severe uncontrolled hypertension |
| Cardiac Catherization - Complications | Hematoma Vascular complications Embolism Hypersensitivity to contrast dye Dysrhythmias Bleeding Stroke Contrast induced nephropathy |
Created by:
leh195