Study guide flashcards on CV and IE part 1

What is Arthersclerosis?

A condition characterized by the buildup of plaques in the arterial walls, leading to narrowed arteries and reduced blood flow.

What is collateral circulation

Alternative pathways formed by small blood vessels that develop to supply blood to heart tissues when primary arteries are blocked.

What are the modifiable and non-modifiable risk factors of CAD?

Modifiable:

• Hypertension

• Diabetes

• Smoking

• High cholesterol (Also HDL and LDL)

• Obesity

• Physical inactivity

Non-Modifiable:

• Age

• Gender

• Family history

What is optimal HDL levels?

> 60 mg/dL (Above 60)

What is optimal LDL levels?

<100 mg/dL (less than 100)

What is the goal A1C level?

<7% for most adults with diabetes.

What is the nursing management of CAD?

Nutritional therapy and medication management.

Nutritional therapy:

• Incorporate healthy options and follow the DASH (Dietary Approaches to Stop Hypertension) diet recommendations, which focus on fruits, vegetables, whole grains, and low-fat dairy.

Medication management:

• Statins: Lower cholesterol levels.

• Antihypertensives: Control blood pressure.

• Antiplatelet agents: Reduce blood clot risk.

• Aspirin Role: Helps to prevent blood clots by inhibiting platelet aggregation.

Define chronic stable angina

Predictable pattern of pain during activities

Define unstable angina

Occurs unexpectedly and can happen at rest; more severe/

What are clinical manifestations of angina?

Chest pain, pressure, or tightness; may radiate to arm, back, neck, or jaw.

What are atypical symptoms of women and older adults?

• Fatigue

• Shortness of breath

• Indigestion

• Nausea

What are some variants of chronic stable angina?

Prinzmetal’s angina: a type of angina caused by coronary artery spasm, leading to temporary decrease in blood flow to the heart.

Microvascular angina: a type that occurs when the small coronary arteries do not function properly, causing chest pain despite no significant blockages in larger arteries.

What is the role of nitroglycerin? What is important patient teaching for this med?

Nitro is a vasodilator that improves blood flow; patients should be taught:

• How to take it sublingually.

• The importance of calling for help if pain persists after the 1st dose; up to three doses can be taken 5 minutes apart.

What are some precipitating factors of an anginal attack?

Precipitating factors of an anginal attack include physical exertion, emotional stress, extreme temperatures, heavy meals, and tobacco use.

When should you report finding to the provider depending on a 12 lead ECG?

Findings that indicate ischemia or infarction, such as ST segment elevation or new left bundle branch block, should be reported immediately to the provider.

What are nursing care procedures of cardiac catheterization?

Nursing care procedures for cardiac catheterization include ensuring informed consent, monitoring vital signs and access site, assessing for complications like bleeding, and providing post-procedure instructions.

What are the diagnostic tests for acute coronary syndrome?

Diagnostic tests for acute coronary syndrome include ECG, cardiac biomarkers (such as troponin and CK-MB), and imaging studies like echocardiography or coronary angiography.

What are nursing care considerations for acute coronary syndrome?

Nursing care considerations for acute coronary syndrome involve evaluating the patient's hemodynamic status, administering medications as prescribed (such as antiplatelet agents and anticoagulants), providing emotional support, and educating the patient about lifestyle modifications and cardiac rehabilitation.

What are the clinical manifestations of an MI?

Clinical manifestations of a myocardial infarction (MI) include chest pain or discomfort, shortness of breath, nausea, sweating, and pain radiating to the jaw, neck, back, or arms.

What is the nursing management of an MI?

Nursing management of a myocardial infarction (MI) includes monitoring vital signs, administering prescribed medications, providing oxygen therapy, and preparing the patient for possible reperfusion therapies, along with education on lifestyle changes and rehabilitation.

What cardiac enzymes/biomarkers are used to confirm MI?

Cardiac enzymes and biomarkers used to confirm myocardial infarction (MI) include troponin I, troponin T, creatine kinase-MB (CK-MB), and myoglobin, which help assess myocardial damage and guide treatment decisions.

• Normal troponin T is 0 to 0.2 ng/mL.

What are the medications used for acute coronary syndrome?

• Antiplatelets: Aspirin, clopidogrel, ticagrelor.

• Anticoagulants: Heparin IV (weight-based protocol). Monitor $aPTT$ (target $1.5-2.5$ times normal). Monitor for bleeding and Heparin-Induced Thrombocytopenia ($HIT$) for up to $3\,\text{months}$. Warfarin (monitor $PT/INR$;(PT goal is 1.5 times the normal; INR goal $2.0-3.0$). Enoxaparin ($SQ$ ).

• Beta-Blockers: Decrease $BP$, slow $HR$, and reduce contractility to decrease myocardial $O_2$ demand.

• Thrombolytic Therapy (Fibrinolytics): (e.g., alteplase - $t-PA$, reteplase, tenecteplase). Used for $STEMI$ when $PCI$ is not available (lysis of the thrombus). Goal: admin within $30\,\text{minutes}$ of arrival. Contraindicated in active bleeding, aortic dissection, history of cerebral hemorrhage, or severe uncontrolled $HTN$. Reperfusion signs: cessation of chest pain and $ST$ segment return to baseline.

• Comfort/Other: IV Nitroglycerin, Morphine, and Oxygen (if saturation stays $\le 90\%$; target goal > 93\%).

What are important nursing interventions pre-cardiac catheterization?

Assess electrolytes, gather baseline nursing data (pulses, $HR$, neuro), withhold aspirin, and maintain $NPO$ at midnight.

What are important nursing interventions post-cardiac catheterization?

• Monitor surgical sites (chest and harvest sites like legs/radial).

• Promote airway/gas exchange: Assess breath sounds, encourage use of incentive spirometer, and teach splinting (holding a pillow over the incision) during coughing/deep breathing.

  • Assess respiratory breath sounds, cough, sputum, pulse oximetry.

  • Pain meds to promote turn, cough, deep breathing.

  • Splint incision, change position.

• Pain management and $DVT$ prevention (early ambulation, compression devices).

• Monitor fluid balance and kidney function (target urine output > 30\,cc/hour).

• Assess for complications:

  • Pulmonary: Atelectasis, pleural effusion, pneumonia.

  • Cardiac instability & dysrhythmias

  • Neuro changes

  • Fluid imbalance and fever

  • Immobility

  • Sleep disturbance

What are the contraindications and monitoring framework for thrombolytics?

(e.g., alteplase - $t-PA$ , reteplase, tenecteplase). Used for $STEMI$ when $PCI$ is not available (lysis of the thrombus). Goal: admin within $30\,\text{minutes}$ of arrival. Contraindicated in active bleeding, aortic dissection, history of cerebral hemorrhage, or severe uncontrolled $HTN$. Reperfusion signs: cessation of chest pain and $ST$ segment return to baseline.

Monitor for signs of thrombosis resolution and bleeding complications.

What is the nursing assessment, nursing diagnoses, and complications for chronic stable angina and ACS?

• Nursing Assessment: Gather patient history, assess for symptoms of ischemia, and monitor vital signs.

• Nursing Diagnoses: Potential for decreased cardiac output, acute pain, and anxiety.

• Complications of MI: Arrhythmias, heart failure, cardiogenic shock.

What is infective endocarditis? What are the risk factors?

A bacterial infection of the heart valves or the inner lining. Risk factors include;

• Previous heart valve disease, prosthetic heart valves, intravenous drug use, dental procedures, and immunocompromised states.

What are the clinical manifestations of IE?

• Symptoms: Fever, chills, night sweats, fatigue, heart murmur.

• Janeway lesions: Non-tender lesions on palms or soles; Osler nodes: Tender lesions on fingers or toes.

What diagnostic studies are done for IE?

Diagnosis includes blood cultures, echocardiography (Transthoracic or transesophageal), and complete blood count.

How is an IE treated?

With broad-spectrum antibiotics, may require surgical intervention for valve replacement or repair.

What surgical therapy is available for IE? What should be monitored with valve replacement?

Surgical therapy for IE includes valve replacement or repair, which is necessary in cases of severe valve dysfunction or persistent infection. Post-surgery, patients should be monitored for complications such as prosthetic valve endocarditis, thromboembolism, and heart failure.

What is important patient teaching for IE?

Patients should be educated on the importance of maintaining good oral hygiene, as dental procedures can increase the risk of bacteremia. They should also be informed about the signs and symptoms of infection and the need for prophylactic antibiotics before procedures.

What are Roth spots?

Retinal hemorrhages with white centers seen in endocarditis, indicative of emboli. Found ophthalmic exam. Thought to be due to embolic bacterial infiltrates producing localized retinal abscesses.

What are Osler’s nodes?

Painful, erythematous nodules on the pads of the fingers and toes. Thought to also be septic micro emboli originating from the heart or maybe an immune mediated vasculitis. Maybe both.

Associated with sub acute bacterial endocarditis and appear late in the disease course.

What are Janeway lesions?

Numerous small hemorrhages with slight nodular character on the palms of hands and soles of feet that are nonpainful. Thought to be necrotic micro abscesses with an inflammatory infiltrate involving the dermis. Associated with acute bacterial endocarditis. Similar to Osler’s nodes but location is different. Osler’s on pads of fingers.

What are splinter hemorrhages?

2-3 mm long and lie under the distal 1/3 of the nail, traveling outward as the nail grows. Early, the hemorrhage is reddish-brown, but turn brown to black. Usually non-painful, but can be painful. Often associated with IE.

What are more common findings of IE?

Murmur (94%) and fever (87%)