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Angina pectoris -1
pn 141 test 1 book med surg nursing pg 611
| Question | Answer |
|---|---|
| Def of angina pectoris | chest pain that occurs when there is a temporary imbalance between myocardial blood supply and demad |
| What is the pattern of angina in relation to exercise and rest | exercise brings on the pain and rest relieves it |
| What leads to angina | CHD and atherosclerosis |
| The heart muscle may receive enough blood and oxygen to meet its needs at __________ | rest |
| Anything that can further _______ blood flow or _______ oxygen demands can cause angina | reduce, increase |
| exercise increases or decreased myocardial oxygen demand | increases |
| What causes the pain | lactic acid, that stimulate nerve fibers are released |
| what are the three types of angina | stable, unstable, prinsmetals |
| What is the most common and predictable form of angina | stable angina |
| When does stable angina occur | with a known amount of activity or stress |
| can stable angina be relieved, if so how | yes, by rest and nitrates |
| Unstable angina charecteristics | unpredictable, more frequent than stable, lonfer duration |
| Does pain occur at rest with unstable angina | yes |
| pt w/ unstable angina are at risk for what | MI |
| What is prinzmetal's angina | it is atypical angina that occurs w/out identifiable cause. |
| prinzmetal's angina: occurs at the same _____ each day | time |
| prinzmetal's angina: cause of it | coronary artery spasm |
| What is the progression of angina marked by | a change from stable to unstable angina |
| what is the cardinal manifestation of angina | chest pain |
| What is the chest pain preceded by | physical activity, stress, eating a heavy meal, exposure to cold. |
| how long does angina pain usually last, relieved by what | less then 15 minutes, rest & nitroglycerin |
| s/s of angina | chest pain in substernal or precordial radiates to neck, back and shoulders. Pain will be tight constricting and heavySOB, pallor, anxiety, fear |
| How is it diagnosed | by pt s/s, past medical Hx, and family Hx, and phys assessment |
| Why are diagnostic tests done | to evaluate the extent of coronary heart disease and angina (ECG, stress testing, angiography) |
| ECG: will a resting one be normal? | yes |
| ECG: When will changes be seen | in an anginal episode |
| ECG: what changes will be noted during an anginal episode | ST-segment depression, and T-wave invertion |
| AEBCT: what will this testing reveal | calcium depostits, indicative of CHD |
| What is the "gold standard" for evaling coronary arteries | angiography |
| Angiography: a narrowed vessel >_____% is considered significant | 50 |
| Drug of choice for angina | Sublingual nitroglycerin |
| Why is Nitro drug of choice | b/c it acts w/ in 1-2 minutes |
| Nitro: What are the short acting forms used for | Tx of an attack |
| Nitro: What are the long acting forms used for | prevent attacks |
| What other two meds can be used to prevent angina, long term prophylaxis, besides nitro | calcium channel blockers and beta blockers |
| Beta blockers are contraindicated in pt with what issues , why? | COPD and asthma; b/c they may cause severe bronchospasms |
| Why is a client at risk for an MI | Because there is a significant narrowing of the coronary arteries |
| Why is low dose aspirin often prescribed? | to decrease the risk for blood clots to form in narrowed arteries, causing an MI |
| Med- Nitrate: Names | nitroglycerin, nitro-dur, nitro-bid, transderm-nitro, isosoribide, |
| Med- Nitrate: the purpose of nitrate | they dilate blood vessals, increasing blood flow to the myocardium, and reducing the workload of the heart |
| Med- Nitrate: Nursing considerations | administer sublingual at onset of pain, wear gloves w/ transderm, remove nitro patches at night |
| Med- Nitrate: why should you remove nitro patches at night | to prevent tolerance to the drug |
| Med- Nitrate: pt teaching | use rapid acting to treat acute attacks, dissolve tabs under tongue, up to three doses q 5 min- after third dose call for medical help, |
| med: Beta blockers: names end in | lol |
| med: Beta blockers: trade names | tenormin, lopressor, inderal, corgard |
| med: Beta blockers: why are they used | they decrease cardiac workload by blocker sympathetic nervous system stilumation, used to prevent angina and treat HTN |
| med: Beta blockers: Nursing implications | check HR before admin. (w/hold if hr is <50-60), check bp, assess for contraindications to beta blockers(COPD asthma), do not abruplty D/c |
| med: Beta blockers: Teaching | They do not work immediately so keep a supply of fast acting NTG, do not abruptly stop, check pulse daily, |
| Med- Calcium channel blockers: what do they end in | pine |
| Med- Calcium channel blockers: trade names | procardia, cardizem, calan, vascor |
| Med- Calcium channel blockers: why are they used | used for angina, HTN and dysrhythmias, they reduce cardiac workload and increase blood flow to the myocardium, often for pt with coronary artery spasm's (prinsmetals angina) |
| Med- Calcium channel blockers: Nursing implications | check hr and BP before admin (w/ hold if HR is < 50) |
| Med- Calcium channel blockers: mainifestations of toxicity | n, generalized weakness, decreased CO, Hypotension, dysrhythmias |
| Med- Calcium channel blockers: PT teaching | take pulse before hand, keep NTG for acut attacks, |
| Surgery: with what angina will pt undergo surgery | unstable |
| PCR: What does it stand for | percutaneous revascularization |
| PCR: what will it do | restore blood flow |
| PTCA: what does this procedure stand for | percutaneous transluminal coronary angioplassty |
| PTCA: what does this procedure do | it increased bloow flow to the heart muscle |
| PTCA: where is this procedure performed | in cardiac cath lab |
| PTCA: what does the procedure consist of | balloon tipped cath is threaded into affected coronary artery. The balloon is placed over obstruction. the balloon is them inflated |
| PTCA: why is the balloon inflated | to reduce the area of narrowing and increase amount of blood flow |
| PTCA: what is usually inserted at the same time and the cath | a stent |
| PTCA: does the stent remain | yes, as a prop |
| PCR: where can bleeding commonly occur | at cardiac cath site |
| CABG: what does this stand for | coronary artery bypass graft |
| CABG: what is done in this procedure | a vein or arterial graft is used to bypass, or bridge the coronary artery obstruction and provide blood to the ischemic portion of the heart |
| CABG: what is the main vein and artery commonly used in this procedure | the internal mammary and saphenous vein graft |
| CABG: What is done when the saphenous vein is used | it is reversed, so it doesn't interfere with blood flow and is usually attached to the aorta and area distal to occlusion |
| CABG: is heart stopped during the procedure, why or why not | yes, it makes it easier to work on the heart |
| CABG: what machine is used when the heart is stopped | the cardiopulmonary bypass pump (venous blood removed from the vena cava and is pumped through the oxygenator and returned to the body via ascending aorta) |
| Nursing DX- ineffective tissue perfusion: nursing care for this | keep nitro at beside, start oxygen, space activities to allow rest, manage risk factors, impliment exercise program, smoking cessation |
| Nursing DX- Risk for ineffective theurapeutic regimen management: nursing care for this | assess knowledge of angina, stress importance of taking chest pain seriously, cardiac rehab |
| NTG: storage guidlines | it is affected by heat and light, so keep it stored in cool, dry, dark place, and no more than a 6 month supply on hand. |
| CABG: what two coronary arteries are commonly plugged up | L. coronary artery and L. anterior descending artery |
| CABG: what does LIMA or RIMA graft stand for | left or right internal mammary artery |
| CABG: if only one artery is clogged, what is the best arerty/ vein to used | a LIMA or RIMA |
| CABG: what is the most common post op complaints | shoulder and back pain r/t positioning in surgery |
Created by:
jmkettel
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