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LSC Cardiovasc

Nursing

QuestionAnswer
The 4 E's of Angina Exercise, Excitement/Emotion, Eating, Environment - removal of these usually relieves pain & discomfort
Chronic Stable Angina Activity demand for O2 > O2 in heart, Activity moderate to prolonged, Discomfort/pain, symptoms unchangeing, stop activity, If Rx for NTG - Pain goes away
Acute Coronary Syndrome UNSTABLE ANGINA - Increased anginal attacks, comes w/less degree activity, pain not relieved by rest or NTG, increased severity and frequency MI - ST Segment elevation traditional, non ST segment elevation (f), Unstable angina, positive Troponins
Variant (Prinzmetal) Unstable Angina Chest pain or discomfort resulting from coronary artery spasm typically AFTER REST, Tx Calcium Channel Blockers
Pre Infarction Angina Chest pain occurs days - weeks b4 MI, Increase frequency, duration and intensity, occurs shortly b4 MI, Symptoms mimic MI
Myocardial Infarction MI Heart Attack, Abrupt O2 depletion to myocardium, Irreversible myocardial cell death - lack of coronary blood flow and therefore O2, CAUSES: vasospasm, thrombosis, cocaine, trauma, abrupt hypotension
Zones of Cell Death Zone of Necrosis: Tissue Death, Zone of surrounding necrosis: Injury, Zone of surrounding injury: Ischemia
Left Anterior Descending (MI Location) most of the LV muscle, *Leads to decreased pumping ability, *Highest Mortality
Left Circumflex (MI Location) Back side of LV, may affect electrical system (SA & AV)
Right Coronary Artery (MI Location) Right Ventricle, electrical system impact, *Dysrhythmias
MI Symptoms in women Atypical: dyspnea, indigestion, pain between shoulders, radiating, choking sensation, 78% have symptoms for a month b4 MI
Cultural/Gender Impact women: Do not recognize the signs of heart disease, protected by estrogen, heart disease increases after menopause, AA & Hispanic women, American Indians & Alaskan Natives, Leading cuase of death Euro Americans
Omega 3's Decrease lipids, decrease sudden death events, fish 3x/wk or daily 1g fish oil supplement, flaxseed, flaxseed oil, walnuts and cnola oil
Nursing Intervention for CAD EDUCATION on prevention!
Priority Actions for pt w/CAD Symptoms Rapid Assessment of chest pain, *PAIN RELIEF* Morphine Sulfate (or nitro), O2 2-4L, VS need to stabalize q5-15min, when stabalized - continue assessing
Nursing Dx: Acute PAIN Related to O2 need & demand to myocardial, outcome - relieve pain, ER interventions - eval pain, IV access, chew one ASA to prevent further occlusion, ECG, Monitor vitals q5 min
NTG Hospital 1 tablet every 5 minutes x3 to relieve pain, VS: If BP falls >100, Lower HOB, IV NTG drip titrated until relief, If BP falls >90, stop NTG or add IV vasopressor (Dobutamide) to maintain BP on IV Nitro Drip *Do not give to pts taking viagara!
Morphine Sulfate IV given if unresponsive to NTG, Decreases myocardial O2 demand, relieves anxiety, Decreases circulating catecholamines, given in 1-2mg IV boluses, Monitor RR & SE of MS, Resp Depression, N&V, *NALOXONE (NARCAN) antedote
Antedote for Morphine Sulfate IV Naloxone (Narcan)
More Interventions for MI O2 2-4L/min, Semi Fowlers Position (when BP is stable), Calm Quiet Environment), Deep Breaths to increase O2, Explain the tx and interventions to pt And family, Teach family about equipment and to remain calm
NTG @ Home Take 1 tablet, wait 5 minutes, if pain is still present, CALL 911 and take 2nd tablet. if pain still present (5 min later) take 3rd tab. only up to 3x. Storage: Dark brown bottle, Light and heat sensative, refill q 3-5 months
ASA disrupts blood clotting, effects on platlets within 1 hr. @ HOME: take 1 325mg tab or 4 81 mg(baby asprin) tabs and call 911
Thrombolytic Therapy - Fibrinolytics Tissue plasminogen activator (t-PA), Alteplase (Activase), Reteplase (Retavase), Tenectiplase (TNK) *monitor for bleeding
Thrombolyitcs - Nursing Interventions Route is IV or intra coronary during angiogram, Give within 1st 4-6hrs to be effective, contraindications (hemorrhage, stroke, active bleeding), Monitor for signs of bleeding - Neuro stats
Gluycoo-protein inhibitors Abciximab (ReoPro) IV, Prevents fibrin from attaching to platlets, Unstable angina, givin prior to PTCA, Thrombolytics doses are decreased.
Beta Blockers Carvedilol (Coreg, Coreg CR) Metoprolol (Lopressor) Monitor HR & BP, Decrease size of infarction, slow HR and decrease force of contraction
ACE Inhibitors Monitor 1st 48hrs for Decreased U/O, Low BP, and Cough end in -pril
Stool Softners Drug also prescribed post MI
Calcium Channel Blockers ARE NOT USED FOR POST MI, Used for Angina, Varient Angina, HTN, Stable Angina *Monitor Hypotension* Enolzaine (Ranexa) added if CCB Not effective
Plavix (Clopidrogel) Can be combined w/ASA for MI and Stroke Take with food, bleeding and bruising may occur - ice and elevate. GI Upset
Reperfusion after PTCA done 2-3hrs after onset of symptoms, ASA & IV Heparin is given to prevent reocclusion of artery, Heparin 3-5days, (PTT) or Lovenox, Coumadin, Plavix
After Lysis of Clot Monitor FOR: Abrupt Cessation of pain/discomfort, Decreased HR, Dyspnea, Sudden onset of Ventricular *Dysrhythmias, and Resolution of ST Seg Depression
Nursing Intervention: Activity Intolerance Outcomes: Walk at least 200ft 4x/day w/o chest pain or dyspnea
Cardiac Rehab Phase I Hospital Phase, Phase II After D/C - Monitored Activity, Phase III Long Term Conditioning - Elective Monitor Phase I or II Monitor I and II HR BP RR level of fatigue pain do not advance if not tolerated
Nursing Intervention: Potential For Dysrhythmia's Dysrhythmia's are leading cause of deathOutcome: to return to normal sinus rhythem with normal BP
Nursing Diagnosis: Potential for recurrent symptoms and extension of injury Outcome: Minimal Angina w/ADL's and Exercise, Use meds as prescribed Use NTG as needed for pain or before exercise,
Nursing Diagnosis: Potential for Heart Failure Leads to decreased cardiac output, pulm congestion, systemic edema - legs and ankles, sacral, jugular and liver distention
Home Care Management Do not D/C to home alone, Teach Family CPR, Defib, call 911 at 1st signs of uncontrolled angina, healing will be 6-8 weeks,
Coronary Artery Bypass Surgery - OLDER ADULT Mortality Rates are higher in pts > 60, Monitor Neuro and Mental status, Obsdrve for SE of cardiac drugs, Monitor for dysrhythmias, 4-6postop surgery fatigue, chest discomfort, no appetite, teach pt to notify where they are going
Activity for pt w/CAD 400ft 3x/day, carry NTG with you at all times, check HR before, after and during exercise, STOP IF PULSE increases above 20bpm, dyspnea, angina, or dizziness, exercise outside when weather is good, gradually increase walking distance AVOID STRAINING!
Nitroglycerin (Nitrostat, Nitroquick) Nitrolingual Translingual Spray Lie down HOB at level of comfort, Monitor BP, let Sublingual Tablet disolve do not swallow, check exp. date (3-5mo shelf life) Monitor for HA, Determine if pain is relieved
Isosorbide dinitrate (Isordil, Iso-Bid) Long term, Sublingual, Instruct pt to lie down, Monitor BP and assess for dizziness
Isosorbide mononitrate(Imdur) extended release, tolerance may develop, take at time when pain is at it's highest
Nitroglcerin patch (Minitran, Nitro-Dur, Nitrek) Remove patch b4 Defibrillation, rotate application sites, apply to a clean, dry, hairless area, Remove old patch & apply new after 12-14hrs each day - NURSE: Wear gloves when applying
Created by: ginabeana
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