MS1 exam 2- cardiovascular patient and CAD

definition of coronary artery disease (CAD)

blood vessels supplying the heart become narrowed or blocked with atherosclerosis

modifiable risk factors for atherosclerosis and CAD

increased total cholesterol, hypertension, diabetes, obesity, smoking, activity, diet, alcohol, stress, metabolic syndrome

what is part of metabolic syndrome

insulin resistance, abdominal obesity, dyslipidemia, hypertension

nonmodifiable risk factors for atherosclerosis and CAD

males > 45, post menopause, ethnicity, family history of 1st degree relative

_______ angina is caused by physical exertion, stress, heavy meals, etc. it is relieved with rest and nitroglycerin and lasts 5 minutes or less

stable

______ angina can occur at rest, is sudden, lasts > 15 mins, stays with rest and nitroglycerin; usually caused when plaque breaks off, blocks bloodflow, and leads to MI

unstable

_______ angina is when the arteries are clean but they spasm and cause pain

Prinzmetals or vasospastic

surgical management for CAD

percutaneous transluminal coronary angioplasty and coronary artery bypass graft

door to balloon time should be ____

90 minutes or less

what is given if CAD is emergent

thrombolytic TPA (tissue plasminogen activator)

door to needle time should be _____ for TPA

30 minutes or less

treatment guidelines for myocardial infarction

1. rapid transport to hospital

2. 12 lead EKG to be read within 10 minutes

3. obtain labs (CK-MB and Troponin)

4. obtain other dx to clarify

5. routine interventions (oxygen, nitro, morphine, ASA, BB, ACE or ARB within 24 hours)

6. evaluate for need for reperfusion therapy (PCI or TPA)

7. continue tx as indicated

male symptoms of MI

chest pain radiating to left arm and jaw; elephant on the chest

female symptoms for MI

vague, nausea, pain of right shoulder, fatigue, pain between shoulders

goal for CAD or MI

resolved angina without cardiac tissue loss and function; 0/10 pain!

nursing diagnosis for CAD or MI

decreased tissue perfusion of the myocardium

physical assessment sx of CAD

pale, diaphoretic, nausea, vomiting, SOB, chest pain, elephant on chest

what recreational drugs can cause MI

cocaine and amphetamines

what are the 2 lab values for MI

CK-MB and troponin

nursing intervention priorities for myocardial infarction

1. oxygen if sats are < 90

2. obtain EKG

3. meds as ordered (MONA)

what are the meds for myocardial infarction in order

oxygen is sats are < 90, nitroglycerin if BP > 90, morphine if not relieved, aspirin 325 mg chewed

what does morphine do for myocardial infarction

analgesia, vasodilation, decreased preload

what does aspirin do for myocardial infarction

antiplatelet; makes them slippery to go through the blockage

conditions for nitroglycerin

don’t give if BP < 90, HR < 50 or > 100, or right ventricular infarction

why do you maintain fluids after a PCI

to flush the dye because it can cause AKI

pathophysiology of heart failure

myocardial cell dysfunction, inability of the heart to meet needs of the body or send enough blood

risk factors for heart failure

CAD, HTN, DM, metabolic syndrome, obesity, smoking, high sodium intake

_____ heart failure has a normal ejection fraction

diastolic

______ heart failure has a reduced ejection fraction

systolic

what is ejection fraction

volume of blood pumped with each contraction

normal ejection fraction

50-70%

symptoms of left sided heart failure

fatigue, SOB, orthopnea, crackles, weight gain, increased HR, hypotension or hypertension, murmurs

symptoms of right sided heart failure

JVD, ascites, edema in legs, hepatomegaly, murmurs, hypotension

what is preload

amount of stretch on the ventricle walls at the end of diastole (filling); basically how much blood the heart has to move to the ventricles or body

what is contractility

how strong the heart is to move blood

what is afterload

amount of resistance to overcome in order to eject blood from the ventricle out to the body

_____, _____, and ______ increase preload

salt, water, and fluid

______ decreases contractility

myocardial infarction

_____, ______, and ______ increase afterload

atherosclerosis, blockages, and hypertension

what would the CXR show with heart failure

enlarged heart or pleural effusion

what does a multigated acquisition scan measure (MUGA)

how effectively the ventricles pump blood

what lab is increased with heart failure

brain naturietic peptide

why is BNP increased with heart failure

preload is increased, so the ventricles release BNP to promote diuresis, vasodilation, and suppression of RAAS

what do beta blockers do for heart failure

decrease contractility (negative inotrope), lets heart rest, decreases HR, decreases vasoconstriction, decreases myocardial demand

what do aldosterone antagonists do for heart failure

decreases preload, allows kidneys to excrete sodium and water

what is the aldosterone antagonist and what should you monitor

spironolactone; monitor potassium

what do ACE inhibitors do for heart failure

decrease preload and afterload, causes vasodilation and decreases myocardial workload

side effects of ACE inhibitors

cough, angioedema, hypotension, worsening kidney function, potassium retention

what do calcium channel blockers do for heart failure

decrease contractility and HR

what does digoxin do for heart failure

increases contractility, decreases HR, increases workload of heart and oxygen demand

what do diuretics do for heart failure

prompt kidneys to rid sodium and water, decreasing fluid volume and preload

what are the surgical managements for heart failure

internal cardiac defibrillator, ventricular assist device, transplant

what does a LVAD do

mechanical blood pumping

if ejection fraction is less than _____, you are at risk for sudden cardiac death and ventricular defibrillation

30%

what should patients report about weight gain or loss

gain or loss of 2.2 pounds in a day or 5 pounds in a week

complications of heart failure

flash pulmonary edema and renal failure

symptoms of flash pulmonary edema

thick frothy sputum, decreased oxygen, and crackles

nursing interventions for flash pulmonary edema

sit patient up with legs as far down as possible to decrease preload

meds for pulmonary edema

morphine first for vasodilation, then diuretics (typically furosemide)

general symptoms of heart failure

poor mentation, anorexia, exercise intolerance, SOB, orthopnea, JVD, dependent peripheral edema, weak pulses, cool extremities, delayed capillary refill, cardiac cachexia, generalized muscle wasting

why do heart failure symptoms occur

weakened cardiac contraction, decreased cardiac output, backup of blood, poor peripheral perfusion

goal of heart failure

decreased exacerbations, visits to ER, and hospitalizations related to heart failure

nursing diagnosis for heart failure

impaired oxygenation, decreased cardiac output, ineffective peripheral perfusion

labs to check for heart failure

BNP, hemoglobin, hematocrit, hemoglobin, potassium, BUN, creatinine

nursing actions for heart failure

oxygen as needed, elevate HOB, meds (BB, ACE, diuretics, digoxin), fluid restriction, daily weights