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JM Angina

Angina

QuestionAnswer
What is the relationship of the kidneys to the cardiovascular system? Kidneys filter about 1 L of blood/min. Decreased CO=urinary output decreased.So,decreased urinary output may be sign of cardio prob.30ml/hr or 0.5mlof urine/kg of body wt considerd minimally adequate to perfuse vital organs.
What is angina? Chest discomfort or pain that occurs when myocardial O2 demands exceed supply.
Name 4 common causes of angina. Atherosclerotic heart disease,HTN,Coronary artery spasm,Hypertrophic cardiomyopathy.
Define hypertrophic cardiomyopathy. A disorder in which the heart muscle is so thick that it does not relax enough to fill the heart with blood and so has reduced pumping ability.
Discuss nursing assessments for the pain associated with angina. Pain:heavy,squeezing,pressing,choking,burning,aching,feeling of apprehension;substernal,radiating to left armand/orshoulder,jaw,RT SHOULDER,transient/prolonged,gradualorsuddeenonset,typically short duration.
Discuss nursing assessments for angina other than pain. Dyspnea, tachycardia,palpitations,N/V,diaphoresis,pallor,weakness,fatigue,syncope,dysrhythmias
What diagnostic information is used for to diagnose angina? ECG, Exercise stress test:ST-seg depression and hypotension,Stess echo-looks for changes in wall motion (indicated in women),coronary angiogram-detects coronary artery spasms, cardiac cath-detects blockage.
Discuss ECG for angina. ECG-baseline unless tkn during attack,when ST-segment depression and T-wave inversion may occur.
What are some nonmodifiable risk factors for angina? Heredity, male gender until menopause then equal risk,African American,age.
What are some modifiable risks for angina? Hyperlipidemia,total serum cholesterol above 300mg/dl;4Xgreater risk for CAD than with levels less than 200, LDL less than 100mg/dl, HDL(inversely related to risk)>60, HTN,smoking,obesity,physical inactivity, DM,stress.
Discuss nursing diagnoses for angina. Acute pain r/t, Anxiety r/t
Discuss nursing plans/interventions for pt with angina. Monitor meds,teach pt proper admin,teach lifestyle changes to decrease preciptiating factors,teach risk factors and ID pt’s own risk factors.
What are nursing plans/interventions for during an anginal attack?
Provide immediate rest,V/S,record ECG,ADMIN NO MORE THAN 3 NITRO TABS, 5 MIN APART, seek emergency tx if no relief after nitro.
Name three types of drugs used for angina. Nitrates:nitro(NTG),Isosorbide dinitrate (Isordil),Isorbide mononitrate(Imdur);BetaBlockers: PropanololHCL(Inderal)Atenolol(Tenormin),Nadolol(Corguard)Metoprolol(Lopressor);Ca+CB:Verapamil(Calan),NifedipineHCL(Procardia),Diltiazem HCL(Cardizem,Norvasc).
Name three drugs used for anginal prophlaxis, what type they are,their action/indications, besides anginal prophlaxis. Nitro (NTG),Isosorbide dinitrate (Isodil),Isosorbide mononitrate (Imdur);Nitrates; acute attack,reduces vascular resistance.
Discuss side effects of Nitrates. HA,flushing,dizziness,weakness,hypotension,nausea
What are some nursing implications with Nitrates? Monitor relief,have pt rest,V/S,STORE MEDICATION IN ORIGINAL CONTAINER AND PROTECT FROM LIGHT.
Name three beta blockers and their actions/indications. Propranolol HCL (Inderal),Metoprolol (Lopressor),Nadolol (Corgard), Atenolol (Tenormin);anginal prophlaxis,reduceO2 demand,decreaseHR,force of contraction,delays impulse conduction.
Discuss possible side effects of Beta Blockers. Fatigue,lethargy,hallucinations,impotence,bracycardia,hypotension,HF,wheezing
Discuss nursing implications for BetaBlockers. monitor apical HR,assess for decreased BP,DO NOT STOP ABRUPTLY,CAUTION W/hf,BRONCHITIS, ASTHMA,copd,RENAL OR HEPATIC INSUFFICIENCY-INCREASED CHANCE OF ADVERSE REACTION.
Name three CA+ channel blockers and their actions/indications. verapamil (Calan);Nifedipine HCL (Procardia),Diltiazem HCL (Cardizem, Norvasc); anginal prophylaxis,inhibits influx of Ca+ions,decreases force of contraction,HR,peripheral vascular resistance.
Discuss possible adverse reactions to Calcium channel blockers. Dizziness,hypotension,fatigue,HA,syncope,peripheral edema,HYPOKALEMIA,dysrhythmia,HF
Discuss nursing implications for calcium channel blockers. Pts w/HF & older ptsincreased risk of side effects; assess for decreased BP;monitor K+,swallow pills whole,store at room temp;DO NOT STOP ABRUPTLY; TAKE ONE HOUR BEFORE MEALS OR 2 HRS AFTER.
What teaching should RN do in regards to exercise and angina? AVOIDANCE OF ISOMETRIC ACTIVITY, implement an exercise program, sex may be resume after exercise is tolerated(two flights of stairs w/o exertion),Nitro can be used prophylactically before intercourse.
What nutritional info should RN provide concerning angina? Modify fats (saturated) and sodium. Antilipemic meds may be prescribed.
What medical interventions may be used for angina? Percutaneous transluminal coronary angioplasty (PTCA),Arthrectomy,CABG coronary laser therapy,coronary artery stent.
What is a percutaneous transluminal angioplasty (PTCA)? A balloon cath repeatedly inflated to break up plaque,arterial wall is tretched,a rotoblade used to pulverize plaque.
What is arthrectomy? A cath with a collection chamber used to remove plaque that is trapped in the chamber.
What meds are appropriate for ACUTE angina?What meds are not? Nitro-causesdilationofcoronary arteries,moreO2toheartmusc,Propranolol(Inderal) NOTAPPROPRIATE-use long-termstableanginacontrolsvasoconstriction;DIGOXIN NOT APPROPRIATE-INCREASESSTRENGTH/ CONTRACTILITY(inanginaheartmuscnotenufO2) .ATROPINENOTAPPROPRIATE
What action/indication does atropine have? Increases HR by blocking vagal stimulation, which suppresses the HR.
Created by: 100000255019352
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