EXAM 2 - medsurg III - cardiac disorders (atherosclerosis, hypertension, AAA, MI)

what is plaque buildup in arteries?

atherosclerosis

what are the major risk factors of atherosclerosis (3)?

1. high cholesterol

2. type II diabetes

3. HTN

T/F: symptoms typically start early on in atherosclerosis

false

what are the symptoms of atherosclerosis in the carotid arteries (6)?

1. HA

2. dizziness

3. facial drooping

4. slurred speech

5. unilateral weakness

6. confusion

what are the symptoms of atherosclerosis in the peripheral arteries (4)?

1. pain in the extremity with exercise that improves with rest

2. decreased blood flow

3. difficulty walking

4. gangrene

what are the symptoms of atherosclerosis in the coronary arteries (3)?

1. chest pain

2. shortness of breath

3. arrhythmias

how is atherosclerosis diagnosed (6)?

1. lipid profile (HDL, LDL)

2. c-reactive protein (CRP)

3. EKG

4. cardiac imaging studies CT and CT angiogram

5. heart cath

6. ankle brachial index (ABI) (ultrasound that compares blood flow in the wrists to blood flow in the ankle)

what is normal total cholesterol?

less than 200

what is normal HDL?

40-60

what is normal LDL?

up to 150

what does c-reactive protein indicate?

inflammation

what does treatment mostly consist of with atherosclerosis?

treating underlying causes, reducing risk factors, and symptom management

what should we teach a patient with atherosclerosis (4)?

1. smoking cessation

2. AHA diet (lean proteins)

3. mild to moderate exercise

4. stress reduction

when would we need to put an atherosclerosis patient on anticoagulants?

to prevent associated clotting

what surgeries can be done, if needed, for patients with atherosclerosis?

bypass, endarterectomy, or stenting

what is an endarterectomy?

surgical removal, or cleaning, or plaques from the arteries, usually coronary

what are the two main nursing diagnoses for atherosclerosis?

1. ineffective tissue perfusion

2. pain

what is important to assess on patients with atherosclerosis (3)?

1. pulses

2. bruits (bc this sound is caused by blockages)

3. blood pressure and HR

what is important to do with teaching patients about atherosclerosis?

follow up!!

what medications are used to treat atherosclerosis?

(for underlying causes - HLD, HTN, DM)

1. HmG-CoA reductase inhibitors - atorvastatin - for HLD

2. beta blockers, ACE inhibitors, ARBs, CCBs, diuretics - for HTN

3. insulin, biguanides, sulfonylurea, and GLP-1s - for diabetes

where are baroreceptors found and what do they do?

aortic arch; sense pressure for regulation of BP

how does antidiuretic hormone play a role in HTN?

increase in ADH causes retention of fluids, which causes high blood pressure

what are the manifestations of HTN?

- HA

- chest pain

- vision changes (eyes are a target organ)

- shortness of breath

- renal dysfunction

- dizziness

- fatigue

- nosebleeds

what is normal BP?

systolic 105-120 and diastolic 65-80

what is elevated BP?

systolic 120-129 and diastolic 65-80

what is stage 1 HTN?

systolic 130-139 or diastolic 80-89

what is stage 2 HTN?

systolic greater than or equal to 140 OR diastolic greater than or equal to 90

what is hypertensive crisis?

systolic greater than 180 AND/OR diastolic greater than 120

what is the main treatment of HTN?

lifestyle changes:

- diet: low sodium, low cholesterol

- exercise: mild to moderate

- limit alcohol consumption

what medications can we give patients with HTN?

diuretics and antihypertensives (beta blockers, CCBs, ARBs, ACE inhibitors)

what are the complications with hypertension (3)?

- hypertensive crisis

- renal failure

- stroke

what are the priority nursing diagnoses with HTN (3)?

1. therapeutic regimen management

2. tissue perfusion

3. cardiac output

what labs are important to assess on pts with HTN?

kidney function - perfusion to kidneys can be effected

what intervention is important that we can also teach the patient about with HTN?

daily weights and I&O

what is peripheral artery disease?

atherosclerosis in the legs

what does PAD cause with symptoms?

intermittent claudication where there is pain in extremities when moving around and it improves with rest

what manifestations can occur with PAD?

fatigue and extremity temperature and color changes

how is PAD diagnosed?

ABI testing - less than 0.9 in either leg is a diagnostic of PAD

how is PAD treated?

prevent progression and manage symptoms

what medications can help manage symptoms of PAD?

antihypertensives, antiplatelets, statins, and diabetics meds

what surgical options can become necessary with patients with PAD?

percutaneous transluminal angioplasty (heart cath in leg)

what are the complications of PAD (2)?

1. critical limb ischemia

2. acute limb ischemia

what is important to assess with critical or acute limb ischemia?

the 6 P's: pain, pallor, pulselessness, parasthesia, paralysis, and poikilothermia

what does acute limb ischemia require?

immediate intervention with IV heparin, revascularization interventions, and pain management

what are the priority nursing diagnoses with PAD (4)?

1. pain

2. impaired mobility

3. decreased tissue perfusion

4. activity intolerance

when do we see manifestations with carotid artery disease?

only when cerebral perfusion is impaired

what are the manifestations we see with carotid artery disease>

1. bruit

2. stroke or TIA symptoms (slurred words, weakness, severe headache, sudden vision loss, facial droop, dizziness)

how is carotid artery disease diagnosed?

- presence of carotid bruit

- carotid ultrasound

- CT angiography

- MRI

what is the main treatment of carotid artery disease?

lifestyle changes and medications for underlying disorders (HTN, HLD, diabetes)

what surgery can be done for carotid artery disease?

carotid endarterectomy (CAE) where an incision is cut into the artery, plaque is removed, and artery is sewn back up

what is very important to assess post-op carotid artery disease procedures? Why?

blood pressure and HR because systolic blood pressure MUST remain within ordered limits

what is important post-op CEA instructions?

keep head at neutral position

what nursing diagnoses are priority with carotid artery disease (3)?

1. ineffective cerebral tissue perfusion

2. risk for injury

3. anxiety

what is important teaching with carotid artery disease?

s/s of stroke

what is aortic artery disease?

aneurysm in the abdominal aorta (AAA)

what is dangerous about the manifestations of a AAA?

often are completely asymptomatic until they rupture, and mortality rate is high

if we can catch it early, what are some manifestations of AAA?

palpable pulsatile mass in abdomen and spontaneous chest, back, or flank pain

saccular

what is this aneurysm?

pseudoaneurysm

what is this aneurysm?

fusiform

what is this aneurysm?

how can a AAA be diagnosed?

CT, echo, or cardiac MRI

what medications can help prevent and treat AAA?

antihypertensives, statins, and antibiotics

what surgeries can be done to treat AAA?

1. aneurysmectomy

2. endovascular aneurysm repair (EVAR)

what are the complications of AAA?

aortic dissection or aneurysm rupture

what is important and different about coronary artery disease (CAD)?

these arteries supply blood directly to the heart

what are the common manifestations of CAD?

1. stable angina (CP with activity that goes away with rest)

2. unstable angina (CP with activity AND rest) - indicated more serious problem

3. prinz metal's angina (basically unstable angina caused by coronary artery spasms)

what can we use to diagnose CAD?

labs, EKG, exercise stress test, coronary angiography

what medications are often used with CAD?

antiplatelets to prevent clots forming on plaques or stents

T/F: antiplatelets CANNOT prevent DVT

true

what lifestyle management can we teach patients with CAD, PAD, or carotid artery disease?

- maintain healthy body weight

- diet

- mild-moderate exercise

- smoking cessation

- screening and treatment for depression

- limit alcohol use

- cardiac rehabilitation

what surgery options are there for CAD?

PTCA (heart cath) or coronary artery bypass graft (CABG)

what are complications of CAD?

acute coronary syndrome, dysrhythmias, heart failure

what is the most common cause of MI?

coronary artery disease and blockages

what are the risk factors of MI?

smoking, sedentary lifestyle, hx of previous MI, family hx of MI, illicit drug use

what is an NSTEMI?

non ST-elevated MI caused by PARTIAL coronary artery obstruction

what is a STEMI?

ST-elevated MI caused by COMPLETE occlusion of coronary artery

what is happening when we see ST elevation?

transmural damage to the heart muscle

what are common manifestations of MI?

1. chest pain

2. shoulder and arm pain, upper back pain

3. shortness of breath

4. jaw and tooth pain

5. N/V

6. sweating

7. generalized fatigue

how is MI diagnosed?

- labs: troponin (3 times), CK, CKMB

- imaging: EKG, echo, stress testing, coronary angiography

what are the goals of MI treatment (5)?

1. oxygenation

2. control pain for BP and HR control

3. dilate coronary arteries

4. prevent clots

5. decrease myocardial workload

what is typical treatment of MI?

MONA therapy: morphine sulfate, oxygen, nitroglycerin, aspirin

what treatment can we do with MI patients if perfusion is a major issue?

percutaneous coronary intervention (heart cath/stent) or fibrinolytics

what surgery can be done for an MI?

coronary artery bypass graft (CABG) or stenting

what is a CABG?

healthy artery or vein from another part of body is attached to the aorta and coronary artery distal to occlusion

what are teh complications of MI?

heart failure and arrhythmias

what nursing diagnoses are priority with MI (4)?

1. altered tissue perfusion

2. decreased cardiac output

3. pain

4. activity intolerance

why should we monitor urinary output in MI?

perfusion of kidneys is impaired

what is important interventions regarding IVs with MI patients?

need two large bore IVs (at least 20 gauge)

what should we teach MI patients about?

nitroglycerin administration instructions - keep on you at all times

what do beta blockers do?

effects sympathetic nervous system response - decreased BP and HR

what do ACE inhibitors do?

prevent vasoconstriction (decreasing BP) and decrease aldosterone release, preventing retention of water

what do ARBs do?

same as ACE inhibitors - prevent vasoconstriction (decreasing BP) and decrease aldosterone release, preventing rention of water

what do CCBs do?

decrease force of contraction and allows relaxation of blood vessels

what is important post CABG nursing assessments?

1. HR and BP

2. hemodynamic monitoring

3. chest tube (output, color, volume, dressing)

4. continuous cardiac monitoring

5. heart tones

6. breath sounds

7. core temperature

8. LOC, pupuls, responsiveness

9. I&O

10. skin color, temp, pulses, edema, cap refill

11. sternal splint (pillow)