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CAD/ CHD
pn 141 test 1 book: med surg nursing pg 607
| Question | Answer |
|---|---|
| by controlling HTN, what does that decrease the risk for | Heart disease, stroke, renal failure |
| Hyperlipidemia increases the risk for what | CHD |
| Lipoproteins carry what to the blood | Cholesterol |
| What is is LDL (inregards to lipids) | Low density lipoprotein |
| What is HDL | High Density lipoprotein |
| what is the primary carrier of cholesterol LDL or HDL | LDL |
| what is associated with abnormal blood lipids | central abdominal obesity |
| Defination of Coronary Heart Disease (CHD or CAD) | impaired blood flow to the heart muscle |
| Primary Cause of impaired blood flow to the heart | Athersclerosis |
| what does atherosclerosis to coronary arteries | narrows them |
| s/s of CHD | none or chest pain (angina), MI from complete obstruction |
| who does CHD affect | both men and women |
| Why does CHD effect women later in life | b/c of the protective efffects of estrogen, but after menopause they are at equal risk for it |
| what is the leading cause of death and disability in the US | CvD |
| What are the two major conditions/ heart disorders of CVD | CHD and dysrhythmias |
| LDL is less healthy, why | b/c it deposits cholesterol on artery walls |
| Why is HDL highly healthy | B/c it clears cholesterol from arteries by transporting it to the liver for excretion |
| Total cholesterol should be < _______ | 200 |
| LDL should be < ______ | 100 |
| HDL should be > _______ | 35 |
| Def of atherosclerosis | Disease in which lesions (plaque) called atheromas develop in the lining of medium and large arteries |
| what does plaque do to arteries | it protrudes into the arteries and can affect blood flow through the artery |
| Where does plaque usually occur in a blood vessel | it occurs where the BV divide, curve and narrow |
| What happens to the cell supply when the coronary BV is occluded | it becomes ischemic w/o blood and O2 to meet demands |
| What are the 2 categories of Ischemic CHD | Acute and Chronic coronary syndrome |
| S/s of Acute ischemic CHD- acute coronary syndrome | unstable angina, MI |
| s/s of chronic ischemic CHD-chronic coronary syndrome | stable angina, asymptomatic myocardial ischemia |
| What are the two main focuses of care for a pt with CHD | 1) to decrease plaque buildup and 2) maintain adequate coronary blood flow |
| Diagnostic test for CHD: what does total serum cholesterol & lipid panal eval? | Serum lipid levels |
| Diagnostic test for CHD: What does serum c-reactive protein levels indicate? | inflamation |
| Diagnostic test for CHD: what does ankle brachial index predict | non-invasive test of PVD that predicts CHD |
| Diagnostic test for CHD: What does the ECG stress test/ EBCT eval? What does it identify? | The risk for CHD & indetifies myocardial ischemia |
| Diet: What will a decrease in fat and cholesterol do for the PT with CHD? | This will control blood lipid levels & promote weight loss |
| Diet: what types of foods with Sat. fats should a pt cut out? | whole milk |
| What is the name for the description of this special diet for CHD: "vegetarian,pt can have egg whites, 1 cup of non-fat milk/day, no oil, no fat, 2 oz of alcohol/day. Included in diet is stress reduction, daily stretching, walk 1 hr/3 days wk | Ornish diet |
| What is the name for the description of this special diet for CHD: "basically vegetarian, increase in complex carbs & fiber, decrease cholest. and fat, egg wjites ok, multi vit, 45 min walk daily | Pritkin diet |
| What is thought to cause the start of lipid and cholesteral accumilation in CHD | inflammation |
| What happens to the smooth muscle cells and connective tissue that contributes to plaque growth | they proliferate in the wall of the BV |
| when plaque develops it gradually occludes the BV _______ . | Lumen |
| When the BV lumen is occluded it impairs the Blood vessel's ability to ______ in response to ______. | dilate, increases O2 demands |
| Why does an increase of triglycerides contribute to CHD? | b/c they are used for fat storage by the body |
| What risk factor of CHD is the link unclear | stress |
| Metabollic syndrome def | Group of related risk factors occuring in the same person |
| What are the 6 risk factors of metabollic syndrome | 1) Hyperlipidemia, 2) HTN, 3) abdominal obesity 4) insulin resistance 5) tendency to clot 6) inflammation |
| A person with metabollic syndrome risk factors contribute to what 3 diseases | DM, CHD, Stroke |
| Nursing care for CHD | Smoking cessation, teach diet and exercise (decrease fat intake) |
| What is the cause of atherosclerosis | cause is unknown |
| Nonmodifiable risk factors for CHD (4 things) | age, gender, race (ethnic background), heredity |
| Physiologic risk factors for CHD (9 things) | increase BP, DM, increase in blood lipids, abdominal obesity, hyperlipidemia, HTN, insulin resistance, clotting tendencies, inflamation tendencies |
| Lifestyle/ modifiable risk factors of CHD (6 things) | smoking, obesity, physical inactivity, diet high in sat. fat, oral contraceptives, hormone replacement therapy |
| What should cholesterol reducing meds be used in conjunction with | diet low in sat. fats, and low in total fat intake |
| Meds- Nicotinic Acids: What do they do/ action | they decrease LDL levels, tryglyceride levels, and total cholesteral levels. They increase HDL levels |
| Meds- Nicotinic Acids: Name (generic and brand) | Niacin (Nicobid, Nicolar, niaspan) |
| Meds- Nicotinic Acids: is a prescription needed for this med? | NO |
| Meds- Nicotini Acids: What lab values should be monitored with this med (3) | BG, uric acids, liver functions test |
| Meds- Nicotini Acids: How should this med be administered to decrease GI effect? | With a cold drink |
| Meds- Nicotini Acids: Common side effects of the med | flushing, hot flashes, pruritis (these effect diminish over time, dizziness |
| Meds- Bile Acids Sequestrants/resins: How does this me work | it binds w/ bile acids and cholesterol in the intestinesto form an insoluble substance that can't be absorbed, promoting its excretion in the feces |
| Meds- Bile Acids Sequestrants/resins: Used to do what? | decrease LDL levels |
| Meds- Bile Acids Sequestrants/ resins: Names both generic and brand | Cholestyramine (Questran), Colestipol (colestid), coleserelam (Welchol) |
| Meds- Bile Acids Sequestrants/resins: How to administer med | Mix powder w/ 4-6 oz of drink, admin. with meals, don't take in conjuntion w/ other meds, do not omit doses |
| Meds- Bile Acids Sequestrants/resins: why should pt increase fluid intake? | to decrease risk for constipation |
| Meds- Bile Acids Sequestrants/resins: What side effects should pt report | abdominal pain, Nausea |
| Meds- Bile Acids Sequestrants/resins:With loss of bile acids, the liver uses ______ to create more bile. This actions hels decrease _____ levels | cholesterol, cholesterol |
| Meds- Bile Acids Sequestrants/resins: Reason on med | Hyperlipidemia |
| Meds- Bile Acids Sequestrants/resins: adverse reactions of med | severe constipation, increase bleeding tendencies |
| Meds- Bile Acids Sequestrants/resins: this med can decrease the absorbtion of ______, | other drugs |
| Meds: Statins: Action | inhibits the manufacture of cholesterol & promotes the breakdown of cholesterol thus decreases total cholest. levels, LDL and tryglycerides |
| Meds: Statins: what should they be used in combo with? | Diet low in cholesterol and fat |
| Meds: Statins: What med is it used with | bile acid resins |
| Meds: Statins: What does the generic name end in | statin |
| Meds: Statins: common brand names | Lipitor, zocor, lescor |
| How is CHD caused | by the narrowing of the coronary arteries that supply the blood to the heart muscle (atherosclerosis is primary cause of this narrowing0 |
| What race tends to have a higher incidence of BP and develop atherosclerosis earlier in life | African Americans |
| Why is educating a women about CHD important | b/c many do not realize that their risk after menopause is just as high as men's risk |
| What risk factors for CHD can be controlled and eliminated | Lifestyle risk factors |
| When someone quits smoking it reduces their risk for what almost immediately, no longer how long they smoked | heart disease |
| Atherosclerosis: When does it begin | Early in life |
| Atherosclerosis: What accumilates in the vessel wall | lipids, cholesterol |
| Atherosclerosis: What happens to the vascular smooth muscle | it's cells multiply and scar tissue forms, it becomes a lesion that protrudes into the artery |
| Atherosclerosis: this protrusion into the artery effects ________ flow | blood |
| Atherosclerosis: if the surface of the plaque roughens and errodes what can accumulate? | platelets, forming a blood clot |
| Angina: what is it charecterized by | episodes of chest pain |
| Angina: When the heart muscle needs more oxygen than partially occluded vessels can supply, what happens to the cells | they become ischemic |
| Angina: What produces the pain; when does the pain subside | lactic acid produced by the ischemic cell nerve endings; when cells again receive enough oxygen to meet their needs |
| Def of ischemia | decreased blood flow to body tissure or organ |
| def of ischemic | inadequate blood and oxygen to meet the tissue's metabollic needs |
| Diagnostic tests: What does serum reactive protein levels indicate | inflammation |
| Diagnostic tests: What is the ankle brachial index | a non-invasive test of peripheral vascualr disease, can predict CHD |
| Diet: What should a pt eat as primary protein sources to lowe cholesteral | nonfat dairy, fish, poultry |
| Meds- Nicotini Acids: What can agreavate the side effects (itching rash etc) | alcohol |
| Meds: Statins: client teaching | report muscle pain, hives, abdom pain, N/V, do not use when pregnant |
Created by:
jmkettel
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