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CAD Nursing RN
Cornary Artery Disease RN Nursing
| Question | Answer |
|---|---|
| Define atherosclerosis | plaque formation with vessel |
| What is the major cause of CAD | atherosclerosis |
| What starts as soft fatty streaks in the intimal wall? | atherosclerosis |
| What are the unmodifiable Risk factors for CAD | age, family history, gender |
| Who is at more risk for CAD? | Men |
| What are the modifiable risk factors for CAD | hypertension, smoking, inactivity, obesity |
| What does hypertension do to the coronary vessels? | Causes undo force on the vessel wall which can cause breaks or tears, causing shearing. Plaques can form at a greater rate |
| What does smoking do to the coronary arteries? | produces vasoconstriction, narrowing the vessels more. |
| What does inactivity do to the coronary arteris? | Body unable to use up catecholamines and there is no build up of collaterals circulation |
| What is collateral circulation? | circulation of blood through a network of minor vessels that become enlarged and joined with adjacent vessels when a major vein or artery is impaired, as by obstruction. |
| What effect does diabetes play with CAD | drastically increase risk |
| What is the normal value of total cholesterol for the general population? | Goal is >200 |
| What is the normal value of total cholesterol for CAD patients and patients at risk? | >160 |
| What is the goal for HDL? | <45 for all patients |
| Why is HDL important for all people? | HDL is the good lipid because they are unable to accumulate in the arterial wall |
| What is the goal for LDL? | >100 for general population, >70 for at risk individuals as they contribute to fatty streaks |
| Triglycerides are affected by? | fat and simple carbohydrates |
| What is homocysteine levels associated with? | increased risk of CAD |
| What are high levels of homocysteine treated with? | Folic acid |
| What does LPa have to do with CAD? | It is associated with a genetic marker for CAD |
| The categories of CAD all result from? | ischemia to myocardium |
| Define stable angina? | It is angine that is predictable and reverasable. Everytime I swim I get chest pain. Can stop with rest |
| What are some of the activities that can cause stable angina? | stress, intercourse, mowing lawn, eating large meal |
| Define unstable angina? | It is unpredicatable and last longer. I doesn't go away with rest. It can happen at anytime. |
| Does unstable angine cause cell death? | NO |
| Define a MI. | loss of blood supply of oxygen to the myocardium that results in cell death |
| How are MI classified? | According to region affected |
| What are the regions that can be affeted with an MI? | anterior, lateral, septal, posterior, inferior |
| What is cornary circulation? | The circulation there the coronary arteries around the heart |
| What are the major ateries that can be occluded in an MI? | Left descending anterior artery, circumflex artery, right coronary artery |
| What is meant by "time is muscle?" | if myocardial tissue goes 4-6 hours without oxygen cell death occurs |
| Where is the area of ischemia? | area of cell death and the tissue that surrounds the cell death |
| After cell death occurs will the effect cells contract? | NO |
| Can a MI be reveresed? | Yes, if the coronary artery affected is open, fixed, restoring oxygen supply back to tissue |
| After an MI, ischemic attack what is formed? | Scar tissue |
| What can be produced if ischemia is continous over time? | collateral circulation |
| What is collateral circulation? | small little vessles the become enlarged and supply oxygen to the ischemic tissue |
| What happens to the ventrical after MI? | ventricular remodeling |
| What is ventricular remodeling? | Myocytes respond the damaged tissue making myocardium thicker |
| Why do patients have fever after MI? | Its the bodies response to necrotic tissue |
| When does the fever appear? | usually in 2-3 days and last for 24-48 hours |
| What are the 7 characteristics the nurse needs to ask with a patient with chest pain? | 1.. duration--how long have you had the pain 2.. onset--when did it start 3.. Frequency 4.. precipitating factors 5.. radiation--does it radiate to jaw, left arm 6.. quality 7.. intensity 0-10 scale |
| When women have chest pain how does it usually present? | GI problems |
| When elderly have chest pain how does it usually present? | they tend to have fatigue |
| chest pain related to a heart attack or another heart problem is associated with one or more of the following | Pressure, fullness or tightness in your chest Shortness of breath, sweating, dizziness or nausea Crushing or searing pain that radiates to your back, neck, jaw, shoulders and arms, especially your left arm |
| Chest pain that isn't related to a heart problem is more often associated with | burning sensation behind your breastbone Pain that intensifies when you breathe deeply or cough Pain that gets better or worse when you change your body position |
| What are some things that can aggravate chest pain? | exercise, sexual intercourse, taking deep breath |
| What are some relieving factors of chest pain? | rest, changing position |
| After an MI your patient EKG shows an arrythmia? What is likely to be? | PVC's b/c of lack of oxygen, the irritated tissue has increase automaticity and can initiate own beat |
| After an MI you patient now has CHF. Why is this? | The portion of the ventrical that sustained cell death is not as strong, loss of ejection fraction |
| Define pericarditis after MI? | irritation, inflammation to pericardial sack around the heart |
| What are the complications of MI? Name all 5 | arrthymia--PVC's Congestive Heart failure papillary muscle damage ventricular aneurysum pericarditis |
| What can happen to papillary muscle after MI? | laceration or tearing of the papillary muscles or chordae tendineae--causes mitral regurgitation |
| MI can also cause ventricular aneurysum? What is this? | It is a ballooning of a section of a blood vessel in the heart that first appears several days or weeks |
| Describe the stress test used to diagnose CAD? | used prefore MI occurs, stress from exercise or medication is used to stress the heart |
| What test are performed in Emergency Room when patient complains of chest pain? | enzymes and EKG, troponin levels, myoglobin |
| What labs are used to diagnoses CAD? | CKMB->5% of total MB, TNI--any measureable amount shows damage to heart cells |
| What does an echocardiogram do? | allows accurate measurement of the heart chambers valves and the major blood vessels that exit from the left and right ventricle |
| What is an angiogram? | performed when CAD is suspected, invasive procedure, ability to visualize the coronary vessels |
| What does a EKG do? | evaluates the electrical current changes |
| What will the EKG show when ischemia in the mycardium if evident? | ST elevation and Qwave and Twave inversions If back of heart is affected can have ST depression |
| What does MONA stand for? | IV morphine, oxygen, nitrates, aspirin, these are used to stop chest pain |
| Your patient arrives at the ED complaining of chest pain. What is protocol? | MONA, EKG--mulitiple 6-8 hours apart, cardiac enzymes,angioplasty/stent, PCI, CABG, fibrolytics |
| What are they testing for when testing for cardiac enzymes? | CKMB and troponin |
| What is a Cardiac Catheterization and Coronary Angiogram? | is an invasive, non-surgical procedure done to study the arteries that bring blood to the heart muscle and to check the function of the main pumping chamber of your heart |
| Decribe the procedure of catherization and angiogram? | insertion of small, hollow tube (catheter), into an artery or vein, which is guided into the heart using x-ray. The cardiologist injects contrast (x-ray dye) through the catheter to outline the arteries and to show any blockages or narrowings |
| What may your patient feel during angiogram catheter insertion? | Flusing feeling |
| What is PCI | Percutaneous Coronary Intervention |
| PCI does multiple things. Explain | Balloon catheter angioplasty Stent |
| What is ballon angioplasty? | the balloon is inserted into the narrowed area of the artery and is expanded with liquid. This pushes the plaque (blockage) to the sides of the artery where it remains |
| Explain the stent procedure | cardiologist places a small, hollow metal (mesh) tube called a "stent" in the artery to keep it open following a balloon angioplasty |
| What drugs are used after stent procedures and why? | Antiplatelets like aspirin, Plavix to prevent re-stenosis |
| AFter the PCI procedure the patient will? | remain flat in bed for 6 hours to prevent bleeding from catheter site |
| What does CABG stand for? | Coronary artery bypass grafting |
| Describe the CABG procedure? | a healthy artery or vein from another part of the body is connected, or grafted, to the blocked coronary artery. This graft bypasses goes around) the blocked portion routes oxygen-rich blood around the blockage to the heart muscle |
| Why are fibrinolytics used for CAD? | help dissolve blood clots and improve blood flow to the heart--mostly used when no cathlab available. Doesn't open area up, just dissolves clot |
| What drugs are used with CAD? | beta blockers, ace inhibitors, antiplatelets, vasodilators, statins |
| What is the function of beta blockers with CAD? | decrease oxygen consumption, decrease response of sympathetic nervous system (epi, norepi) |
| What is the function of ace inhibitors with CAD? | to decrease ventricular remodeling |
| What are the function of antiplatelets with CAD? | to decrease clot formation after angioplasty, stent procedure |
| What are the function of vasodilators with CAD? | nitrates--cause massive vasodilation |
| What are the function of statins? | To control cholesterol problems |
| What is the prepocedure care for angioplasty/stents | Fluid, and informed consent |
| What is the post procedure care for angioplasty/stents? | antiplatelet regimen, circulation checks, monitor kidney function, site checks-retroperiteneal bleeds |
| What is the antiplatelet regimen after angioplasty/stent (PCI) | Reopro used with heparin/asprin to decrease cardiac ischemic complications Integrilin--decrease platelet aggregation asprin |
| What are we looking for after PCI procedure when we check circulation? | We are checking pulses below where the catherter was inserted to check for blockage |
| If we check the site after PCI, and the patient is complaining of back pain what is possible? | retroperiteneal bleed |
| What are the complications with PCI (angioplasty/stents)? | dissection of artery, embolism, spasm, restenosis, arrythmias--PVC's-common |
| Why must we monitor kidney damage after angioplasty? | The radio-opaque dye can damage kidney cells |
| How many bypasses can be performed with one surgery? | 5-6 is max |
| Where are the grafts normally obtained from? | radial artery, saphenous vein, from your leg, internal mammary artery in chest |
| What are the incision and insertion sites that must be monitored after CABG? | chest-sternalincision, harvested site-arm-leg, chest tubes--used to prevent pericarditis-24 hours, pacer wires-below epigatric area, central lines(swan ganz) |
| What doe we want to monitor post op for CABG? | pericarditis--chest tubes-for fluid removal arrhythmia--pvc Infection of sternum and harvested sites |
| What kind of respiratory care is given after CABG? | incentive spirometer every hour while awake, cough and deep breathing, ambulation |
| What post op care is given for the bowels after CABG? | clear liquid diet until bowels start working, colace to prevent straining |
| What can we do to prevent DVT after CABG? | Ted stockings to prevent edema, DVT, helps to return blood to heart (prevents stasis), ambulation |
| What is cardiac rehab? | Rehab after CABG, last for about 3 months, 3 times a week. |
Created by:
nurseuhrin
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