Angina .&. CAD
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| What is the accumulation of deposits of lipids/fibrous tissue within the walls of arteries? | Coronary Atherosclerosis
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| Coronary atherosclerosis is the major cause of what? | CAD
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| What is the #1 cause of death in the U.S.? | CV disease
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| Put the following in order as they happen during development of CAD: 1. Less bloodflow and O2 to heart 2. Fatty streaks form in arterial walls 3. Lumen of vessel narrows 4. Angina or MI 5. LDLs and platelets stick to arterial wall and form plaques | Correct order:
2, 5, 3, 1, 4
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| What is the term for when the heart has a number of different pathways for blood to reach it often occuring in old age? | Collateral circulation
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| What is the diet prescribed for CAD pt.s? | TLC diet (Therapeutic lifestyle changes diet)
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| What are the drugs that lower cholesterol? WHat do they usually end with? | HMG-CoA Reductase Inhibitors (Statin, tor, col)
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| What are 3 manifestations of CAD? | Angina, acute coronary syndrome and sudden cardiac death
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| What is chest pain or discomfort that is caused by REVERSIBLE myocardial ischemia? | Angina
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| With angina, there is insufficient coronary blood flow secondary to CAD which results in an increased blood demand and a decreased blood supply. | True
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| What is 'PQRST' in nursing? | Assessment technique for chest pain:
P- Precipitating events
Q- Quality
R- Radiation
S- Severity
T- Timing
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| What type of angina consists of a temporary decrease in o2 to myocardium? | Stable
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| What is another name for unstable angina and what does it entail? | Acute coronary syndrome: Rupture of plaque which can lead to MI; usually occurs without exertion
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| What is the term for a coronary vasospasm (type of angina)? | Prinzmetal's
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| What happens with silent angina? | No pain but changes seen on ECG
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| What 5 things must happen within 10 minutes of a pt reporting chest pain according to the ACC/AHA? | VS, IV access, 12 Lead EKG, Brief H&P, Blood dra for cardiac markers, lytes, coags
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| What test related to diabetes is considered for risk for CAD and what are the risk levels? | A1C greater than 8% is high risk for CAD
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| What complication from drug therapy for hyperlipidemia (statin)suggests that therapy should be stopped immediately? | Muscle pain/aches
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| What is a severe side effect of taking statins? | Can cause hypoglycemia, and increase platelet aggregation which can lead to formation of a thrombus
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| What water soluble vitamin can be given to reduce cholesterol and how does it work? | Niacin- reduces LDL, increases HDL
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| How to bile-acid sequestrants work? | Mixes bile with cholesterol and it is excreted in feces
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| What does ETOH raise in the blood? | Triglycerides
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| What cardiac complication is not reversible and therefore cannot cause angina? | Blockages
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| What are 3 factors that can contribute to angina? | Physical exertion, hyperlipidemia, plaques
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| When doing a CXR for chest pain, what are we looking for? | Enlarged heart
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| What cardiac test is performed with no ECG changes and negative enzymes? | Stress test
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| What cardiac test is performed for ECG changes consistent with MI and positive enzymes? | Cardiac Cath
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| What is med is initiated as first treatment med for angina? | Oxygen
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| What med is given for chest pain that dilates coronary arteries? | Nitro
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| What are two common side effects of nitro? | Decreased BP and HA
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| What are the typical dosing instructions for nitro? | 1 tab or spray q5minX3, if systolic drops below 90, stop drug and push fluid
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| What does the heart require more of in response to nitro? | Oxygen
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| What med decreases HR, BP, contractility, afterload, and demand for oxygen? | Beta blockers
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| At what HR should we hold beta blockers? | <60
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| What diabetes related event can be masked by beta blockers? | Hypoglycemia
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| For what type of heart blocks do we hold beta blockers? | 2nd and 3rd degree
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| Beta blockers are also contraindicated in pt.s with what respiratory disease? | Asthma
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| What med is substituted when B blockers are contraindicated? | Calcium channel blockers
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| For what type of angina are Ca channel blockers the first choice for? | Printzmetal's
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| How do Ca channel blockers work? | Systemic vasodilation
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| What range of ASA dosages are given to prevent MI? | 81-325mg
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| What are two common Ca channel blockers? | Cardizem and Norvasc
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| What is the inability of the heart to pump enough blood to meet the needs of the tissues for oxygen and nutrients? | Heart failure
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| Name the four characteristics of HF. | Ventricular dysfunction, reduced activity tolerance, diminished quality of life, shortened life expectancy
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| What are the 3 primary risk factors for HF? | Age, CAD, HTN
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| What are 4 interferences with CO contribute to onset of HF? | Injury/stress to myocardium, decreased elasticity for afterload, increased HR, decreased contractility
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| What are the four compensatory mechanisms? | SNS activation, RAAS, ventricular dilation, ventricular hypertrophy
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| What are the two types of HF? | Systolic HF- Impaired ventricular pumping
Diastolic HF- Impaired ventricular filling
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| What is the most common type of HF and what is it characterized by? | Systolic (pumping)- LV dilated and hypertrophied
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| What is diastolic HF characterized by? | Stiff, noncompliant ventricles
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| What are major causes of Systolic HF? | Decreased contractility from MI, increased afterload and mechanical abnormalities
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| What are major causes of diastolic HF? | Chronic HTN, aortic stenosis, pulmonary congestion
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| What is the most common type of HF that causes back up of blood into pulmonary vessels and causes fluid in alveoli? | Left sided HF
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| Where does blood back up with right sided HF and what is the primary cause? | Into venous circulation- Caused by left side HF
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| What are the S&S of left sided HF? | DOPE FACT:
Dyspnea
Oxygen decreased
Pink, frothy sputum
Elevated HR
Fatigue
Altered LOC
Crackles in lungs
Tachypnea
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| What are the S&S of right sided HF? | JAB A FEW:
JVD
Ascites
BP changes
Anorexia
Fatigue
Edema
Weight gain
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| What other S&S are found with chronic HF along with those listed above? | Orthopnea (lying down) and dusky color
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| What meds are necessary for HF? | Diuretics, vasodilators (ACE, B blockers, Nitrates), positive inotropes (Digoxin)
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| What hormone test is used to diagnose HF? | BNP- >100 = CHF
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| What is the choice med for CHF and what do they do? | Ace inhibitors ('prils')- decrease afterload (improving CO), decrease RAAS and decrease ventricular remodeling
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| What do diuretics reduce in the heart and what should be monitored for? | Preload- hypokalemia
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| What side effect can vasodilators have that is more dangerous due to elderly increase in falls? | Orthostatic hypotension
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| What does Digoxin do? | Increases CO, decreases HR and promotes diuresis
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| What are S&S of Dig toxicity? | Bradycardia, confusion
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| What is a nursing intervention to improve CO? | Administer o2, change position
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