Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
H&C CV - CAD
H&C CV - CAD NUR 235
| Question | Answer |
|---|---|
| What is the leading cause of death for adults regardless of sex, race or ethnicity ? | Cardiovascular disease |
| What is the most prevalent type of CV disease in adults ? | CAD |
| what is an abnormal acculumation of lipid, fatty substances and fibrous tissue in the lining of the arterial blood veseel walls ? | atherosclerosis |
| You are educating a family member who wants to know what atherosclerosis does to the body, what do you say ? | It reduces blood flow to your heart by narrowing coronary vessels or blocking them |
| True or False. Atheroscloerosis alters the structure and biochemical properties of the arterial walls. | True, this is an inflammatory response |
| How might injury to the endothelium occur ? | smoking, tobacco use, hypertension, hyperlipidemia |
| What does inflammation attract ? | inflammatory cells such as macrophages |
| What do macrophages do in the setting of atherosclerosis ? | they become foam cells by ingesting the lipids |
| _______ oxidizes which fuels progression of atherosclerosis | LDL |
| What is the fibrous cap called that is filled with lipid and inflammatory infiltrates | atheromas |
| How does atherosclerosis cause a MI ? | plaque ruptures, attracts platelets, which causes a thrombus formation, thrombus obstructs blood flow |
| A deprived heart muscle causes what clinical manifestion secondary to ischemia ? | angina pectoris |
| Significant myocardial damage causes what with regards to cardiac output ? | reduced cardiac output |
| True or False unstable angina, MIs, or sudden cardiac death events are always symptomatic | false p. 637 |
| Which of these symptoms may be present during a cardiac event? epigastric distress, pain that radiates to the jaw or left arm shortness of breath | all of them p 637 |
| LDL is a risk factor for CAD. What therapy is used to treat LDL elevations ? | cholesterol lowering therapy |
| The _________________ is a tool that calcualates risk for having a cardiac event within the next _________ years | Framingham Risk Calculator , 10 |
| A patient who is 17 years old has an elevated LDL. A student is eductating the patient regarding risk factors and calculating his cardiovascular risk using Framingham. What would you say to this student regarding these actions ? | Framingham is not appropriate for a 17 year old. |
| Framingham uses what facgtors for calcuations ? | age, sex, total cholesterol, HDL, smoking status, systolic blood pressure, and need for antihypertensive medication. p 638 |
| list the modifiable reisk factors for CAD (there are 9) | hyperlipidemia, tobacco use, HTN, DM, metabolic syndrome, excess weight, physical inactivity, chronic inflammaotry conditions and chronic kidney disease |
| Male Patient Profile: waist 38", triglycerides 160 , HDL 32, Blood pressure 128/70, fasting glucose 98 Do they have metabolic syndrome | no they do not have 3 risk factors, they only have 2 |
| Female patient provile : waist 34", triglycerides 180, Blood pressure 150/70, fasting glucose 105 Does she have metabolic syndrome ? | yes she has the required 3 risk factors |
| What is primary vs secondary prevention for CAD ? | primary prevents occurence, secondary prevents progression |
| Your patient had an MI 1 month ago. Their LDL is now low. They state that they are not taking their cholesterol medication because their LDL is now lower than it ever has been. What would you tell this patient ? | you would tell them that LDL is usually low after a serious cardiac event and that they should continue to take their medication unless their provider has told them otherwise p. 639 |
| What is the acceptable level of LDL on a fastin Lipid panel ? | less than 100 |
| What is the acceptable level of HDL on a fasting lipid panel ? | greater than 40 in males and 50 for females |
| What is the acceptable level of triglycerides ? | less than 150 mg/dl |
| what is the goal number for total cholesterol ? | less than 200 |
| What cholesterol is the target for therapy ? | LDL |
| What can elevate triglycerides ? | may be genetic in origin, it also can be caused by excess weight, physical inactivity, excessive alcohol intake, high-carbohydrate diets, diabetes, kidney disease, and certain medications, such as oral contraceptives and corticosteroids. |
| What diet is recommended to lower LDL ? | Mediterranean or AHA's diet |
| People needing to lower LDL and BP should avoid intake of two specific things. What are they | sweets and sugar sweetened beverages |
| What lifestyle modification is the focus of management for elevated triglycerides ? | weight reduction and increased physical activity p. 640 |
| What is the exercise goal for adults ? | 150 minutes per week |
| What education should you provide regarding muscular training for a patient with CAD ? | msucle train 2 or more days each week working on all muscle groups |
| How should a CAD patient measure safe cardiovascular activity ? | they should be able to talk comfortably while doing it, otherwise it is too strenuous |
| Medications have a ____________effect when combined with diet and exercise ? | synergistic p. 640 |
| List the drug classes used for lowering lipids | statins, fibric acids (fibrates), bile sequestrants, cholesterol absoprtion inhibitors, PCSK9 |
| Why is smoking a concern with CAD ? | because nicotinic adic in tobacco triggers reslease of catecholamines which raises heart rate and BP ; it increases oxidation of LDL; increases carbon monixode levels and decreases oxygen to the heart |
| HMG-CoA's have a suffix of ______________ | "statin" |
| Fibric acids have what 3 letters in the middle of their name ? | "fibr" |
| bile sequestrants have what letters / sound at the begining of them ? | Chole, Cole (think bile, gallbladder, chole) |
| PCSK9 agents have what suffix ? | "umab" |
| Your patient has a blood pressure of 150/90 and an LDL of 22. They are asking why you are talking about their blood pressure and heart disease when their LDL is normal. What do you tell them ? | as your blood pressure increases so does yoru risk for CV disease |
| What does longstanding blood pressure do to vessel walls ? | increase stiffness |
| How does DM foster thrombus formation ? | fosters dyslipidemia, increases platelet aggregation (clumping), and alters red blood cell function p 642 |
| Who experiences CV events earlier in life ? | men p. 642 |
| hormone replacement therapy increases or decreases risk for CV disease? | increases |
| Why does eating a big meal cause angina ? | blood flow is increased to mesenteric area , reducing blood supply for the heart muscle |
| Why does stress cause angina ? | causes release of catecholamines which incrases blood pressure, heart rate and myocardial work load p. 643 |
| Why does cold exposure increase risk for angina ? | vasoconstriction which elevates blood pressure with increased oxygen demand |
| what is the main characteristic of angina ? | it subsides with administration of nitroglycerin and/or rest |
| ______ is predicatable angina and consistent pain that occurs on exertion , relieved by rest | stable p. 643 |
| ______ angina has symptoms that increase in frequency and severity, may not be relieved with nitro or rest | unstable |
| _____ angina is severe incapacitating chest pain | intractable or refractory |
| ______ angina is pain at rest with reversible ST segment elevation thought to be caused by vasospasm | variant (prinzmetal) |
| __________ __________ (2 words) is objecgtive evidence of ischmia but the patient reports no pain | silent ischemia |
| True or False : The older adult with angina may exhibit a typical pain profile because of the increased pain transmission that can occur with aging. | FALSE !!!! The older adult with angina may NOT exhibit a typical pain profile because of the DIMINISHED pain transmission that can occur with aging. |
| Main medical management of angina is to do what ? | decrease oxygen demand |
| what is the mechanism of nitroglycerin ? | it is a vasodilator , reduces oxygen consumption by myocardium |
| What does a beta blocker do for angina ? | reduces oxygen demand |
| What does amlodipine or diltiazem do for angina ? | treats vasospasms |
| What is platelet aggregation ? | platelet clumping |
| What 4 drugs are antiplatelet medications used for angina ? | clopidogrel, prasugrel, ticagrelor |
| What are the routes for nitroglycerin? | SL, PO, TOP, IV |
| when shoud chest pain reduce after taking nitro ? | within 3 mintues p. 644 |
| Your patient does not like the taste of the nitroglycerin dissolving tablet and states they swallow it instead. What do you teach ? | it will not be effective if swallowed |
| Your patient is going on a cruise and has a waterproof pill bottle to keep her pills in when she goes off of the ship to go on excursions on shore. She takes nitroglycerin. What do you tell her? | it is volatile inactivated by heat, moisture, air, light, time and therefore should be stored securely in its original container (e.g., capped dark glass bottle in a cool place); tablets should never be removed and carried in an unapproved container |
| how often should nitroglycerin replaced? | every 3 to 6 months p. 644 |
| Your patient calls the office after taking 3 nitro pills with relief of pain from an 8/10 now to a 5/10, what do you tell them ? | call 9-1-1, chest pain unrelieved after 3 doses needs medical attention immedidately p. 644 |
| Your patient states that after taking nitro they got flushed and they feel they had an allergic reaction. What do you tell them. | possible side effects of nitroglycerin, include flushing, throbbing headache, hypotension, and tachycardia. |
| Your male patient has been prescribed sildenafil and and is having chest pain. What do you ask him ? | did you take the sildenafil today and if so how long ago ? |
| You are in Walmart and someone stops and says they are having chest pain. They have baby aspirin in their purse, 81 mg chewable, how many should they be advised to take ? | at least 2 (162 to 325mg range) |
| What drug class may be required to prevent GI complications from aspirin ? | H2 blockers or PPIs |
| Heparin therapy is considered therapeutic when the PTT is ___ to _____times normal PTT value | 2 , 2.5 |
| Your patient is taking enoxaparin what do you tell them regarding bleeding complication identification? | signs and symptoms of external and internal bleeding, such as low blood pressure, increased heart rate p. 645 |
| What drug is a known cause for MI ? (street drug) | cocaine |
| Angina and MI have similar presentations, what is the distinguishing symptom ? | Angina chest pain goes away with rest, MI chest pain is regardless of resting |
| What heart sounds may be present with MI ? | S3, S4, and new onset murmur |
| MI can cause heart failure ? What assessment finding in the neck region is indicative of heart failure ? | JVD |
| A person having an MI , may show what on an ECG ? | ST-segment and T-wave changes |
| What respiratory symptoms may be present with an MI ? | Shortness of breath, dyspnea, tachypnea, and crackles if MI has caused pulmonary congestion. Pulmonary edema may be present. |
| What GI symptoms may be present with an MI ? | nausea, vomiting, indigestion p. 648 |
| If a patient is in cardiogenic shock secondary to an MI what urinary symptom may be present ? | Decreased urinary output may indicate cardiogenic shock |
| How might the skin of a person who is having an MI present as ? | Cool, clammy, diaphoretic, and pale appearance |
| Why do Q waves change in an MI ? | Q waves develop within 1 to 3 days because there is no depolarization current conducted from necrotic tissue |
| What is troponin ? | a protein found in mycoardial cells |
| What troponins are specific to cardiac muscle ? | Troponin I and T |
| What CK level is sepcific to cardiac muscle ? | CK-MB |
| Which is diagnostic of an MI elevated Troponin T or CK-MB ? | Troponin T p. 649 |
| What action is immediate of a patient is supected having an MI ? | adminsiter oxygen |
| Why is morphine the drug of choice for chest pain? | Morphine is the drug of choice to reduce pain and anxiety. It also reduces preload and afterload, decreasing the work of the heart. |
| Why is a PCI the plan for a patient with an MI ? | it opens the occluded coronary artery and promotes reperfusion |
| What are the indications for tPa ? | Chest pain lasting more than 20 minutes, unrelieved by nitroglycerin •ST-segment elevation in at least two leads that face the same area of the heart•Less than 12 hours from onset of pain |
| What are absolute contraindications for tPa ? | known bleeding, bleeding disorder, hx of hemorrhagic stroke, recent major surgery/trauma, uncontrolled HTN, pregnancy |
| Your patient is planned for tPa. You have orders for an oxgyen, IV, labs, and ECG. When do you obtain labs ? | when you start the IV p. 650 |
| Why is cardiac rehab important ? | to limit the effects and progression of atherosclerosis, provide education, target risk reduction, group support |
Created by:
Kelly Quijano
Popular Nursing sets