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NP2:Circulation/Cath
Prof.Jordan; Test 3
| Question | Answer |
|---|---|
| Cardiovascular disease (CVD) is | an abnormal condition characterized by disorders of the heart and blood vessels |
| Atherosclerosis is a buildup of | cholesterol, lipids, cellular wastes, calcium, & other substances |
| Endothelium injury | Hyperlipidemia (nondenuding), HTN (denuding), chemical irritants (infections) |
| Stage 1 | fatty streak formation (reversible), collateral circulation formation |
| Stage 2 | prgressive changes (age 30 and continue to increase), chronic endothlial injurey |
| Stage 3 | compicated lesion, rigidity and hardening (Atheromas) |
| Formed plaque | hemmorrhage into the plaque, thrombus formation on the plaques surface, total occlusion; causes MI, stroke |
| Unmodifiable risk factors | age, gender, genetic predisposition, ethnicity |
| Modifiable risk factors | elevated serum lipids and cholesterol, HTN, smoking, physical inactivity, obesity, DM, stress and behavior patterns, elevated cholesterol |
| HTN= | BP > 140 |
| Smoking | 2-6x higher risk to develop CAD, doubles the jeopardy |
| Physical inactivity | decreases HDL's, decreases fibrinolytic activity (increases clot formation), sifles collateral formation |
| obesity | increase risk proportional to degree of obesity, increase LDL's and triglycerides, assoc. with HTN and DM2 |
| Diabetes Mellitus | altered lipid metabolism |
| Stress and behavior patterns | Type "A" personality, activation of sympathatic nervous system |
| Elevated cholesterol | < 200 is desired, 240 is high risk |
| To utilize lipids | must become water soluble, done by combining with proteins |
| Primary prevention | reduce intake of saturated fat and cholesterol, increase physical activity, control weight, smoking cessation, decrease stress or alter behavioral problems, elvaluate dietary patterns |
| Medication therapy goals | increase lipoprotein removal, restrict lipoprotein production, decrease cholesterol absorption |
| HGM CoA Reductase inhibitors (statins) | block the syntesis of cholesterol, increase the removal of LDL's and triglycerides, increase HDL's |
| Statins must be administered at | bedtime |
| nursing interventions for statins is | monitor liver function |
| Statin medications are | Atorvastatin (lipitor), Pravastatin (pravachol), Simvastatin (zocor), Lovastatin (mevacor, altocor), Fluvastatin (lescol) |
| Atorvastatin | lipitor |
| pravastatin | pravachol |
| Simvastatin | zocor |
| Lovastatin | mevacor, altocor |
| fluvastatin | lescol |
| HDL's (HEALTHY) | contain more protein and less lipid, carry lipids away from arteries, increase with physical activity, decrease with age and hx of CAD |
| HDL level | >60 = negative risk <35 = major risk |
| VLDL's (LETHAL) | contain more triglycerides, lead to LDL's, elevation may increase the risk of premature atherosclerosis with other risk factors (DM, HTN, Smoking) |
| Triglycerides | made up of fatty acids (saturated, unsaturated), low triglycerides = high HDL's |
| Triglyceride level's | <150 = normal > 200+ = High |
| LDL's (LETHAL) | contain more cholesterol, have an affinity for arterial walls, decreased level desireable |
| LDL levels | < 130= desirable >160= high risk |
| Cholesterol comes from what foods? | (mostly animals) egg yolks, meath, poultry, fish, seafood, whole-milk products |
| Food that DO NOT contain cholesterol | fruits, vegetables, grains, nuts and seeds |
| Cholesterol levels | <200= desirable 240+ high |
| Saturated fats | major reason for elevating blood cholesterol |
| Daily cholesterol intake= | <300; limit to <200 if known heart disease |
| Side effects of statins include | constipation, abdominal pain and cramps ( mild to servere, but subside as therapy continues) |
| Benefits of statins | reduction of CHD mortality, overall reduction of coronary events, reduction of coronary procedures, reduction of strokes, reduction of overall mortality |
| Bile acid Sequestrants work by | binding with bile acids in the intestine, forming an insoluble complex that is excreted through the stool |
| Bile acid sequestants binds to | LDL's and cholesterols. Loss of bile acids raises cholesterol and LDL levels. tends to increase triglyceride levels |
| Bile acid sequestants interfere with absorption of | digoxin, b-adrenergic blockers, coumadin and synthroid |
| Bile acid sequestants side effects | constipation, nausea (decrease over time) |
| Bile acid sequestrants medications include | Cholestyramine (questran), Colestipol (colestid), Colesevelam (welchol) |
| Cholestyramine | aka Questran; bile acid sequestrant |
| Colestipol | aka Colestid; bile acid sequestrant |
| Colesevelam | aka Welchol; bile acid sequestrant |
| nursing considerations for bile acid sequestrants | give before meals, mix with applesauce or a beverage |
| Nicotinic acid medication | Niacin |
| Nicontinic acid works by | inhibiting synthesis and secretion of VLDL's, LDL's, triglycerides and cholesterol. Increase HDL levels |
| Nicontinic acid side effects | flushing, hyperglycemia, hyperuricemia, upper gi distress, hepatoxicity |
| Nursing considerations with nicontinic acid medications | take with food |
| Contraindications with nicontinic acid medication | liver disease, severe gout, peptic ulcer |
| Fibric acids work by | reducing triglycerides by decreasing VLDL's, decreases liver synthesis and secretion of VLDL's, increases HDL's |
| Nursing considerations of fibric acids | give before meals, may enhance the effects of anticoagulants and hypohlycemia |
| Fibric acid medications include | Gemfibrozil (lopid), Fenofibrate (tricor, lofibria) |
| Gemfibrozil | aka Lopid; fibric acid |
| Fenofibrate | aka Lofibra; fibric acid |
| Fibric acid side effects | dyspepsia, gallstones |
| Additional therapies include | Higher dose of statin Statin + Bile acid sequestant Statin + Nicotonic acid |
| Cardiac cath evaluates | heart valves, heart function, blood supply, abnormalities, ventricular aneurysms, cardiac enlargment, need for open heart surgery |
| Procedures performed in cardiac cath | angioplasty, stent placement, atherectomy, PCI |
| Angioplasty | a balloon is placed at site of occlusion and then inflated which mashes plaque against inner wall |
| Stent placement | the catheter is placed at the site of occlusion with a stent over the balloon, balloon is inflated which mashes the plaque and places the stent in place; requires anticoagulant therapy for approx. 6 months to 1 yr |
| Atherectomy | use of high speed drill,diamond cutter; cuts and pulverizes the plaque, balloon at end of catheter collects remnants of plaque |
| Closing the incsion from cardiac cath options | direct pressure with femstop or hand, suture such as roeder knot, or angio-seal (most ideal) callagen sponge and anchor and is absorbed in 60-90 days |
| Pre-operative to cardiac cath | NPO, informed consent, teaching (posistion, allergies, dye, cough, pain, sedation) |
| Post-operative to cardiac cath | flat in bed, hydration, vs q15 mins, site and pain assessment |
| Discharge instructions of cardiac cath | avoid heavy lifting, and rigorous activity for one week, may be small bump or bruising, notifiy MD if pain, swelling at insertion site, fever, chills, pain or change to extremity |
Created by:
stilsl
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