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What is acute coronary syndrome (ACS)
Any condition in which there is a sudden blockage or reduction of blood flow to the heartWhen ischemia is prolonged and is not immediately reversible, acute coronary syndrome (ACS) develops.ACS encompasses - Unstable angina (UA) TERM 2
What is
angina
DEFINITION 2 Chest pain caused by reduced blood flow to the heart TERM 3
What is atherosclerosis
DEFINITION 3 Build up of fats, cholesterol, and other substances in the artery wallsStages of development: Chronic endothelial injury Fatty Streaks Fibrous Plaque Complicated lesion TERM 4
What is chronic stable
angina
DEFINITION 4 Predicable chest painAngina pectoris - Most common kind. TERM 5
What is collateral circulation
DEFINITION 5 Redundant circulation in an area of tissue or an organ that the blood can reach by more that one pathway
What is coronary artery disease (CAD)
Damage or disease in the heart's major blood vessels# killer in America TERM 7
What is a stent
DEFINITION 7 Small mesh tube that is used to treat narrow or weak arteries TERM 8
What is the etiology an pathphysiology of
CAD
DEFINITION 8 Heart disease that is a result of plaque buildup in the coronary arteries that leads to blockages, arteries becoming narrow and rigid, restricted blood flow to the heart, or when the heart can no longer pump properlyIn other words, O demand > O2 supply TERM 9
What are modifiable vs non-modifiable risk
factors
DEFINITION 9 Modifiable: elevated serum lipids, hypertension, tobacco use, physical inactivityNon-modifiable: age, gender, family HX, ethnicity, and genetic predisposition TERM 10
Identify 3 types of lipoproteins
DEFINITION 10 HDL (High density)LDL (Low density)VLDL (Very Low density)
Discuss the chronic stable angina etiology
and pathophysiology
Primary reason for insufficient blood flow is narrowing of coronary arteries by atherosclerosis. Referred pain in left shoulder and arm is from transmission of the pain message to the cardiac nerve roots. In other words, O2 demand > O supply TERM 17
What are the precipitating factors for
angina
DEFINITION 17 Risk factors include obesity, having a history of heart disease, high cholesterol or BP, diabetes, not enough exercise, smokingPrecipitating factors: physical exertion, temperature extremes, consumption of heavy meal, tobacco use/enviornmental tobacco smoke, sexual activity, stimulants, Circadian Rhythm patterns TERM 18
What are the manifestations of
angina
DEFINITION 18 SOB, nausea, fatigue, sweating, anxiety, dizziness TERM 19
What diagnostics tests are used for
angina
DEFINITION 19 Diagnostic studies (Health history/physical examination, Laboratory studies, 12-lead ECG, Chest x-ray, Echocardiogram, Exercise stress test, and angiography). TERM 20
What is the nursing role regarding these
tests
DEFINITION 20 12-lead ECG - prepare skin and apply electrodes, Position pt supine. Tell pt no discomfort is involved and to lay stillX-ray - Guard areas not being viewed and remove metal objectsEchocardiogram - put pt is left side laying position. Instruct pt about procedure (poressure and mechanical movement)Exercise stress test - instruct pt to wear comfortable clothes and shoes. Instruct pt about procedure and importance of reporting symptoms. Monitor vitals and ECG beofre, during, and after. angiography
What is nitroglycerine and what is its
protocols
Short-acting nitrates are first-line therapy for the treatment of angina. Nitrates produce their principal effects by dilating peripheral blood vessels, coronary arteries, and collateral vessels. Nitrates, such as isosorbide dinitrate (Isordil) and isosorbide mononitrate (Imdur), are longer acting than SL or translingual NTG and are used to reduce the incidence of anginal attacks. TERM 22
What are the teaching points for
nitroglycerine
DEFINITION 22 Advise pts to take tylenol if they experience a headache.If symptoms are worse or unchanged after 5 minutes, repeat every 5 minutes for a maxiumum of three doses and contact EMS if symptoms have not resolved completely It should be easily acceptable to pt at all timesStore away from light and heatOnce bottle is opened, the pills need replaced after 6 monthsPlace tablet under the tongue and let it desolveIf using the spray, spray on tongue don't inhale it Should cause a tingling sensation when administeredWarn pt about possible headache, dizziness, or flushingCaution pt to move slowly after administration TERM 23
Why is ASA given for
angina
DEFINITION 23 It slows the blood's clotting action and can decrease the symptoms TERM 24
What is the difference in stable and unstable
angina
DEFINITION 24 Stable angina usually has a predictable pattern and it usually triggered by heavy exercise, extreme emotions, smoking, or eating a heavy mealUnstable angina is unexpected, happens when blood flow to the heart is suddenly blocked or slowed, it is a warning sign for an MI TERM 25
Identify nursing interventions during
angina
DEFINITION 25 Acute interventions for anginal attack Administration of supplemental oxygen Assess vital signs, pulse oximetry. 12-lead ECG Prompt pain relief first with a nitrate followed by an opioid analgesic, if needed Auscultation of heart sounds
What is systolic heart failure
A pumping problem,Inability of heart to generate adequate cardiac output to vital tissuesMI is the most common causeContractility decreases, lower stroke volume, heart dilates, and increases preload TERM 32
What is syncope
DEFINITION 32 Tempoarry loss of consciousness by a sudden fall in blood pressure cardiomegaly TERM 33
What is cardiomegaly
DEFINITION 33 Enlargement of the heart TERM 34
What is the incidence of Heart failure
DEFINITION 34 Can be caused by previous MI, HTN, valvular disease, infection, atrial fibrillation, or other issue with the heart. These cause HF by either changing the structure or the functioning of the heart TERM 35
What is the prognosis of heart failure
DEFINITION 35 Many people (18 out of 100) have a stroke withing the first year of being diagnosedExtremely reduced quality of life and activity tolerance
What are the risk factors of heart failure
Primary: CAD and AgeContributing: Hypertension, diabetes, Tobacco, Obesity, and high serum cholesterol levelsHTN, previous MI, valvular disease, infection, atrial fibrillation, or other issues with the heartModifiable risk factors include excessive alcohol intake, smoking, unhealthy lifestyle TERM 37
What is the presentation for right sided heart
failure
DEFINITION 37 Back up into the bodyInability of right ventricle to provide blood flow to pulmonary circulationCan result from left sided heart failureSymptoms: rise om systemic venous circulation, distended jugular veins, fatigue, ascites, swelling in hands and fingers, edemaCor Pulmonale is right sided HF resulting from pulmonary congestion from chronic lung disease TERM 38
What is the presentation of left sided heart
failure
DEFINITION 38 Back up to the lungsSymptoms: cough, crackles, blood tinged sputum, restlessness, orthopnea, tachycardia, exertional dyspnea, cyanosis TERM 39
How is heart failure diagnosed
DEFINITION 39 By an EKG - used to detect cardiomyopathies, ischemia, and arrhythmiasComplete blood count is also taken to measure potassium and other electrolytesLiver function testBNP (high level indicates HF)Chest Xray, HX, and physical TERM 40
What is the medical/nursing management for
heart failure
DEFINITION 40 Treatment is focused on increasing the quality of life and preventing progression of the diseaseBehavioral modifications: Exercise is encouraged to suit individual capabilities, regulation of sodium and water intake
Identify common nursing diagnosis for
patients with heart failure
Activity IntoleranceFluid Volume excessImpaired gas exchangeAnxietyDeficient knowledge TERM 47
Identify common interventions for patients
with heart failure
DEFINITION 47 Activity intolerance- Build an activity regime that will eventually build up the clients tolerance over time- start slow and gradually do more Fluid volume excess- Daily weights, possible restriction of fluids and sodium Impaired gas exchange- Supplemental O2, high fowlers, continuous EKG monitoring TERM 48
What is aortic regurgitation (AR)
DEFINITION 48 Diastolic flow of blood from the aorta into the left ventricle due to incompetence of the aortic valve TERM 49
What is aortic stenosis
(AS)
DEFINITION 49 When the aortic valve narrow and prevents the valve from fully functioning and obstructs blood flow from the heart into the aorta TERM 50
What is cardiac tamponade
DEFINITION 50 Compression of the heart from an accumulation of fluid in the pericardial sac
What is cardiomyopathy (CMP)
An acquired or hereditary disease of the heart TERM 52
What is chronic contsrictive pericarditis
DEFINITION 52 Characterized by thickened, fibrotic pericardium which limits the heart's ability to function TERM 53
What is dilated cardiomyopathy
DEFINITION 53 The heart's ability to pump blood is decreased because the left ventricle is enlarged and weakened TERM 54
What is hypertonic cardiomyopathy
DEFINITION 54 A portion of the myocardium is hypertrophied TERM 55
What is infective endocarditis (IE)
DEFINITION 55 Inflammation of the inner tissues of the heart, such as its valves, usually caused by bacteria
What is rheumatic fever (RF)
Inflammatory disease involving the heart, joints, brain, and skin that develops several weeks after a strep throat infection TERM 62
What is rheumatic heart disease
DEFINITION 62 Develops from rheumatic fever characterized by scarring and deformity of the hart valves TERM 63
What is
stenosis
DEFINITION 63 Obstruction of blood flow int he heart due to a valve not being able to properly open TERM 64
Who is at risk for endocarditis
DEFINITION 64 Patients with cardiac conditions such as rheumatic heart disease, prosthetic valves, cardiac lesions.Invasive procedures can also put a patient at risk such as childbirth, dental procedures, IV drug use, renal dialysis, bronchoscopy TERM 65
What are the signs and symptoms of
endocarditis
DEFINITION 65 Low grade fever, chills, fatigue, splinter hemorrhages, activity intolerance, petechiae, heart murmur
What patients should have prophylactic
treatment with endocarditis and why
Prophylaxis is used as a precaution against others with infections. White blood cells do not reach the damaged heart valves and therefore the pt is at a higher risk for infection and fever TERM 67
What medications are used for
endocarditis
DEFINITION 67 Long term IV drug therapy 4-6 weeks (PICC) and AntipyretcsNSAIDS/ASA/Corticosteriods TERM 68
What is the medical and nursing management
for a patient with endocarditis
DEFINITION 68 Bed rest during febrile state, monitor temp closely, avoid others with infections, planned activity and rest periods, oral hygiene, frequent lab draws and CBC TERM 69
What are the signs and symptoms of
pericarditis
DEFINITION 69 Sharp chest/shoulder/back pain, changes with respiration pattern, dyspnea, feeling of fullness around chestPericardial friction rub is the hallmark sign (scratching, grating, pitched sound) TERM 70
What are the nursing interventions for a
patient with pericarditis
DEFINITION 70 Semi fowlers, NSAIDS/ASA/Corticosteriods, oxygen administration, rest, monitor cardiac rhythm, pericardiocentesis
What is the presentation of a patient with
rheumatic disease
carditis, scarring & contractures of heart valves TERM 77
What are the diagnostic procedures to valves
for a patient with rheumatic disease
DEFINITION 77 Jones Criteria TERM 78
What are the interventions for a patient with
rheumatic disease
DEFINITION 78 Geared towards reduction of the inflammation with anti- inflammatory medsPrevention involves early detection and immediate and thorough TX of strep throat TERM 79
What is the medical management of a patient
with rheumatic disease
DEFINITION 79 NSAIDS, Corticosteroids, Antibiotics TERM 80
Compare and contrast stenosis and
insufficiency
DEFINITION 80 Stenosis:Mitral symptoms include exertional dyspnea, fatigue, palpations, hemoptysis, loud S1, low pitched diastolic murmur- TX is valve repair or replacement. Aortic symptoms include angina, syncope, dyspnea with exertion, murmur- Causes an obstruction from left ventricle to the aorta and causes the left ventricle to increase in size-has a poor prognosisInsufficiency: Mitral valve prolapse is when the valve buckles back into the LA- Many times asymptomatic, but SX can include activity intolerance, mid-systolic click, chest pain- TX includes adequate hydration, regular exercise, no caffeineAortic valve regurgitation is d/t trauma, infective carditis, or rheumatic fever and- It is the backwards flow of blood from ascending aorta into the left ventricle during diastole- Sx include SOB, chest pain, left ventricular failure, cardiogenic shock
What are the nursing interventions for a
patient with stenosis
EKG, medications that slow the heart rate or decrease fluid such as Beta blockers or diuretics TERM 82
What are the nursing interventions for a
patient with insufficiency
DEFINITION 82 TX is aimed at reducing the symptoms and preventing DVT, such as TED hose TERM 83
What is
commissurotomy
DEFINITION 83 Open heart surgery that repairs a narrow mitral valve caused by mitral valve stenosisThe surgeon removes calcium deposits and scar tissue from the valve TERM 84
What is annuloplasty
DEFINITION 84 Repair for the leaking of mitral valves TERM 85
What is valvuloplasty
DEFINITION 85 Procedure for opening a blocked heart valveUses a balloon to stretch or break up scars in the valve
What is an aortic dissection
Result of a false lumen through which blood flows TERM 92
What is chronic venous insufficiency (CVI)
DEFINITION 92 Occurs when the venous wall or valves in the leg veins are not working effectively TERM 93
What is critical limb ischemia
DEFINITION 93 Severe obstruction of the arteries which markedly reduces blood flow to the extremities and can cause severe pain and sores TERM 94
What is deep vein thrombosis
(DVT)
DEFINITION 94 Formation of a blood clot in a deep vein, primarily the leg TERM 95
What is intermittent claudication
DEFINITION 95 Cramping pain in the leg is induced by exercise, typically caused by an obstruction of arteries
What is peripheral artery disease (PAD)
Circulatory condition in which narrowed blood vessels reduce blood flow to the limbs TERM 97
What is post-thrombotic syndrome (PTS)
DEFINITION 97 Venous stasis that can develop in nearly half of the patients who experience DVT TERM 98
What is Raynaud's phenomenon
DEFINITION 98 Excessively reduced blood flow due to emotional stress or extreme temperatures, causing discoloration of the fingers and toes TERM 99
What is superficial vein thrombosis (SVT)
DEFINITION 99 A venous thombosis in an upper extremity or even in the chest or breast TERM 100
What is thromboangitis obliterans (Buerger's
disease)
DEFINITION 100 Inflammation and thrombosis in small and medium sized blood vessels typically in the legs and leading to gangrene, associated with smoking
