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medsurg exam 2
CHD treatments
| Question | Answer |
|---|---|
| basic treatment plans are | Increase supply Decrease demand gold standard: PREVENTION!!!! |
| Primary and Secondary Prevention – Patient Education | Dietary Measures Physical Activities Medications Tobacco Cessation HTN Management DM Management Control Cholesterol Abnormalities |
| lifestyle modifications for prevention of CHD | Exercise Progressive muscle relaxation/breathing techniques Meditation/Yoga Prayer Social support/Family &friends Leisure activities Sleep/Good diet/ taking care of yourself |
| Prevention: Smoking Cessation Medications | Nicotine replacement medications Varenicline (Chantix) Bupropion (Wellbutrin) |
| Nursing Care - Focused Physical Exam should always entail | ABC’s, vital signs, general observation |
| Nursing Care - Focused Physical Exam: neuro | Stroke symptoms, restlessness, lightheaded, anxiety |
| Nursing Care - Focused Physical Exam: cardiac | Chest pain, EKG changes, JVD, murmurs, S3, S4, pulses |
| Nursing Care - Focused Physical Exam: pulmonary | Crackles, resp distress, tachypnea, pulmonary edema |
| Nursing Care - Focused Physical Exam: gastrointestinal | Nausea/vomiting |
| Nursing Care - Focused Physical Exam: genitourinary | Urine output |
| Nursing Care - Focused Physical Exam: skin | Cool, clammy diaphoresis, pale |
| Nursing Care - Focused Physical Exam: psychosocial | Feeling of impending doom, fear, denial |
| you should always evaluate for | adequate perfusion |
| Ischemic cardiac tissue may not contract normally due to | Level of consciousness Adequate urine output Gastrointestinal symptom Skin temperature Capillary refill |
| Acute episode of Cardiac Catheterization with PCI: Increase Supply through an | invasive procedure done to visualize the coronary arteries and fix the diseased area |
| how does a PCI work | Balloon opens vessel Stent holds vessel open Contrast dye is used Same prep and care as for diagnostic cath |
| Treatments - Pharmacologic Therapy Nitrates | decrease demand |
| action of nitrates | Reduces myocardial oxygen consumption which decreases ischemia and pain by acting as a vasodilator (mainly venous) |
| long acting nitrates | Oral preparations: isosorbide mononitrate; isosorbide dinitrate Prevents angina in patients with stable angina |
| short acting nitrates | Given as a spray or sublingual tablet Indicated for acute chest pain |
| sublingual administration | 1 tablet or spray sublingually q 5 min times 3 (check BP before each dose) |
| nitrates can also be given IV which | decreases demand but also increases supply by dilating arteries too |
| nitrates are contraindicated in patients taking | phosphodiasterase inhibitors |
| Treatments - Pharmacologic Therapy Beta-Adrenergic Blockers | decrease demand |
| action of beta/adrenergic blockers | Blocks the effects of the sympathetic nervous system and decreases myocardial contractility and heart rate Prolongs coronary perfusion during diastole |
| beta/adrenergic blockers decrease | the workload of the heart and the mortality after an MI |
| beta/adrenergic blockers types | Metoprolol, atenolol, and about 30 others carvedilol |
| what does carvedilol have | an alpha blocker |
| use beta/adrenergic blockers in caution with | respiratory diseases |
| Treatments - Pharmacologic Therapy Cholesterol Lowering Agents – “Statins” | Increase (or maintain) Supply |
| action of statins | inhibits an enzyme in the liver called HMG-CoA reductase which is needed for cholesterol production |
| statins can | stabilize vulnerable plaques by improving endothelial function, reducing platelet function and inflammation |
| statins cause | the liver to make less cholesterol and actively removes exiting cholesterol from the bloodstream |
| statins reduce | total cholesterol and LDL cholesterol |
| the use of statins require | periodic monitoring of liver enzymes |
| statins can cause | rhabdo |
| for elevated triglycerides, don't use statins, use: | Niacin, Bile acid sequestrants, Fibrates |
| Treatments - Pharmacologic Therapy Anti Platelet Agents | Increase or maintain supply |
| antiplatelets action | inhibit platelet aggregation |
| two examples of antiplatelets | aspirin and clopidogrel |
| aspirin | Given in ER or prior to hospital arrival |
| clopidogrel | Used along with ASA if patient receives a stent |
| Treatments - Pharmacologic Therapy Calcium Channel Blockers | Increase Supply AND Decrease Demand |
| when should you use CCBs | when beta blockers are contraindicated |
| actions of CCBs | Inhibits the influx of calcium prior to electrical impulse Decreases Myocardial O2 demand: Increases O2 supply |
| the inhibition of calcium prior to electrical impulse | Slows HR, lowers BP, relaxes blood vessels Decrease in strength of contraction Prolongs coronary perfusion during diastole |
| CCB examples | Diltiazem, Amlodipine, Nifedipine, Nicardipine |
| Treatment: Coronary Artery Bypass Surgery (CABG) | Increase Supply |
| CABGs are done if | blocked areas seen on the cath cannot be opened with PCI and symptoms cannot be controlled with meds |
| CABGs are generally | very invasive |
| during a CABG | a large artery or vein that can be sacrificed will be removed and will be added to get blood past the blockage(s) |
| complications after a CABG | Atelectasis Other hazards of immobility Wound infection Wound instability Pain – chest and/or leg Low cardiac output syndrome Decreased appetite Depression |
| care after a CABG | OOB, I.S., C+DB OOB, ambulate, pain meds Infection control; observe wound Get out of chair carefully! Encourage pain meds Check lungs, diuretics, I/O, wt May liberalize menu for awhile May need post-d/c support |
Created by:
leh195