NUR171 E3 CardioVascular

MI usually due to occlusion of the

coronary arteries

The _____ is known as the natural pacemaker.

SA node

The SA node is located in the

right atrium

The AV node is located at the

base of the right atrium

The bundle branches carry the electrical signal to the

ventricles

The bundle branches end in the _____ fibers in the ventricles.

Pukinje

SA node causes the heart to beat _____-_____ bpm.

60-100

AV node causes the heart to beat _____-_____ bpm.

40-60

Ventricles cause the heart to beat <= _____ bpm.

40

On an ECG, the firing of the SA node and depolarization of the atria correspond to the

P wave

On an ECG, the depolarization of the ventricles corresponds to the

QRS complex

On an ECG, repolarization of the ventricles corresponds to the

T wave

The cardiac cycle is composed of _____ and _____.

systole, diastole

Systole begins with closure of the _____ valves.

AV

Systole ends with closure of the _____ valves.

semilunar

During systole the _____ depolarize and contract to pump blood into the _____ and _____ circulation.

ventricles, pulmonary, systemic

Diastole begins with closure of the _____ valves.

semilunar

Diastole ends with closure of the _____ valves.

AV

During diastole the _____ repolarize and refill with blood.

ventricles

During atrial fibrillation, the _____ node fails to fire and something else in the atrium causes it to contract quickly.

SA

During atrial fibrillation, the heart rate is _____-_____ and always irregular (QRS complexes not evenly spaced).

300-600

Atrial fibrillation puts the patient at risk for _____ because the blood doesnt leave the atrium and pools.

clots

Causes of atrial fibrillation include

cardiac diseases, MI, CHF, cardiomyopathy, hyperthyroidism

Can try to stop afib by _____ or use meds such as _____ and _____.

defibrillate, Ca+ channel blockers, Coumadin

During ventricular tachycardia (VTAC) the heart rate is _____-_____ bpm.

100-250

VTAC is regular, has an abnormal rhythm, is either sustained or non-sustained, potentially lethal and can try to treat using _____ or with antidysrhythmics such as _____.

defibrillation, Lidocaine

Ventricular fibrillation is a _____ situation.

code

During ventricular fibrillation the ventricles are firing but not _____ (no organized method of firing in the heart).

contracting

A patient in VFIB has no _____, is usually _____, and not _____.

pulse, unconscious, breathing

Treat VFIB with meds and _____.

CPR

Asystole is when there is no or little electrical activity and is also called _____ _____.

flat lining

During asystole, defibrillation does or does not help.

does not

Normal BP is <_____ /><_____.

120/80

Hypertension is defined as a BP consistently over _____/_____> but sometimes can be a single reading of >=180/110.

140/90

Hypertensive complications include _____ and harmful to _____ (organ).

strokes (CVA), kidneys (acute renal failure)

Hypertension is more common _____-_____ years and in which ethnic group and sex.

25-55, female African Americans

BP is primarily regulated by _____ flow and _____ _____ resistance.

blood, peripheral vascular

BP is regulated by the _____ _____ system and the _____-_____ system.

sympathetic nervous, renin-angiotensin

_____ in produced in the _____ and plays a role in the conversion of angiotensin 1 to 2.

renin, kidneys

Angiotensin is a potent _____.

vasoconstrictor

The pituitary hormone ___ is also a vasoconstrictor.

ADH

_____ hypertension is does not have an underlying cause.

primary

_____ hypertension is does have an underlying cause.

secondary

Most cases (90-95%) of hypertension are _____.

primary

Contributing factors for primary hypertension are _____.

incr sympathetic ns activity, obesity, sedentary lifestyle, high salt, high ETON, hormonal imbalances, diabetes, smoking, age/gender, heredity, hyperlipidemia, meds

Hypertension is frequently asymptomatic but can present with what s/sx?

fatigue, dyspnea, palpitations, angina, headache, nosebleeds, dizziness (in severe HTN)

_____ is pain, discomfort, or pressure localized in the chest that is caused by an insufficient supply of blood (ischemia) to the heart muscle.

angina

Chronic hypertension left untreated can lead to _____.

stroke, blood vessel damage (arteriosclerosis), MI or heart failure, kidney failure

Untreated hypertension can lead to _____ _____ in which the walls of the hearts chambers thicken abnormally.

Hypertrophic cardiomyopathy

Additional lab work and tests for hypertension (by checking for systems damage) include _____.

BUN, creatinine, UA, serum electrolytes, blood sugar, ECG

Treatment for hypertension includes dietary approaches to stop hypertension (DASH), which is also an acronym for _____.

dietary, activity, stress, hydration

Medications for hypertension include _____ to reduce circulating blood volume.

diuretics

Medications for hypertension include _____ to reduce systemic vascular resistance (4).

angiotensin inhibitors, calcium channel blockers, beta blockers, vasodilators

_____ _____ = cardiac output x systemic vascular resistance.

blood pressure

Renin causes conversion of _____ to _____.

angiotensin 1, 2

Angiotensin-converting enzyme (ACE) inhibitors block the conversion of _____ to _____.

angiotensin 1, 2

Aldosterone is secreted by the adrenal cortex and causes increased _____ and _____ retention.

sodium, water

ACE inhibitors reduce _____ levels causing vasodilation.

aldosterone

ACE inhibitors are more effective in _____ than _____.

Caucasian, African Americans

ACE inhibitors increase _____ and lower ______.

vasodilation, PVD

ACE inhibitors all end in _____.

pril (Lisinopril, Captopril)

Contraindications for ACE inhibitors includes (3)

hypersensitivity, renal artery stenosis, hyperkalemia (from aldosterone)

Adverse effects for ACE inhibitors include (3)

dry, hacking cough (ACE cough), first-dose syncope, hyperkalemia

Considerations for ACE inhibitors include

admin 1 hr before meals, no K+ salt substitutes, monitor labs (K+), BP before dose, change position slowly, not skip or stop abruptly, antacids 2 hrs before/after, pt report periph edema, infection, facial swelling, loss of taste, dyspnea

ACE inhibitors are prone to damage from _____ and _____.

heat, moisture

_____-_____ is the resistance the left ventricle has to overcome to circulate blood.

after-load

Calcium Channel Blockers are a class IV _____.

antiarrhythmic

Calcium Channel Blockers inhibit ion influx into cells of _____ and _____ smooth muscle

myocardial, arterial

Calcium Channel Blockers dilate _____ arteries and _____.

coronary, arterioles

Calcium Channel Blockers increase _____ O2 delivery.

myocardial

Calcium Channel Blockers decrease _____-_____.

after-load

Calcium Channel Blockers uses include _____ and _____>

hypertension, angina

Calcium Channel Blockers meds include (4)

amlodipine (Norvasc), diltiazem (Cardizem), nifedipine (Adalat), verapamil (Calan)

Calcium Channel Blockers contraindications include (3)

sick sinus syndrome w/o pacemaker, 2nd or 3rd degree heart blocks, severe hypotension

Calcium Channel Blockers adverse effects include

hypotension, peripheral edema, tachycardia, flushing, headache, constipation, increase digoxin levels

Calcium Channel Blockers nursing considerations include

monitor P and BP before admin (hold if <90 /><50 hold), change positions slowly, report weight gain, assess freq and charac of anginal attacks

If the patient gains _____ lbs in one day or _____ lbs in one week they should notify physician due to volume overload.

3, 5

Alpha 1 receptors found in _____ and alpha 2 receptors found in _____.

periphery, CNS

Beta 1 receptors found in _____ and beta 2 receptors found in _____.

cardiac muscle, airways/lungs

Beta blockers block beta-adrenergic receptors which decreases _____ _____, _____ _____, and _____.

heart rate, blood pressure, contractility

Blocking the _____ receptor decreases heart rate, myocardial O2 demands and contraction, and slows conduction through the AV node.

Beta 1

Beta blockers uses include (4)

hypertension, angina pectoris, acute myocardial infraction, supraventricular tachycardia (SVT)

Beta blockers all end in _____ and include.

lol, atenolol, metoprolol

Contraindications for beta blockers include

CHF, bradycardia, hypotension, heart block, bronchospasm

Adverse effects for beta blockers include

bradycardia, hypotension, worsening CHF, bronchospasm, impotence, dizziness, masks signs of hypoglycemia

Nursing considerations for beta blockers include

dont discontinue abruptly, hold if HR <60><90, change position slowly, protect extremities from cold, report ocular symptoms (can lower intraocular pressure), daily weight and I/O

Alpha-Beta Blockers block selective alpha and beta receptors resulting in _____ and decreased _____, and reduced _____>

vasodilation, PVR, BP

Alpha-Beta Blockers also block beta receptors resulting in decreased _____ _____, _____ output, and _____ release from kidneys.

heart rate, cardiac, renin

Alpha-Beta Blockers used for (1)

hypertension

Alpha-Beta Blockers include

labetalol, carvedilol (Coreg)

Contraindications for Alpha-Beta Blockers include (4)

severe bradycardia, heart block, asthma, uncontrolled CHF

Adverse effects for Alpha-Beta Blockers include

headache, dizziness, fainting, orthostatic hypotension, edema, weight gain, bronchospasm, explosive diarrhea (common)

Nursing considerations for Alpha-Beta Blockers include

VS, with food or after meal (incr absorb), I/O, report weight gain, prolonged standing, hot baths or weather, and strenuous exercise intensifies orthostatic hypotension

Centrally-acting alpha-2 blockers (CAAs) stimulate alpha2 receptors which decreases sympathetic outflow (reduce epi, norepi) from the CNS brainstem to the (3)

heart, kidneys, peripheral vessels

CAAs result in a decrease in _____ and _____ and a reduced _____.

PVR (vasodilation), CO, BP

CAAs used for _____ but are not a first-line option.

hypertension

Common CAAs meds include

methyldopa (Aldomet - causes daytime sedation), clonidine, guanabenz

Contraindications for CAAs include

hypersensitivity, active hepatic disease, pheochromocytoma, concurrent use of MAOIs, clonidine shouldnt be used with SLE

Adverse effects for CAAs include

nasal congestion, dry mouth, constipation, impotence, headache, dizziness, orthostatic hypotension, weight gain, rebound HTN

Nursing considerations for CAAs include

use cautiously older adults, orthostatic hypotension intensified with prolonged standing, hot baths/weather, strenuous exercise, and alcohol, avoid more than 4 cups of caffeinated bev per day, take at bedtime to avoid drowsiness, slowly wean off

Alpha-1 blockers block stimulation of the SNS at the alpha-1 adrenergic receptor, which causes _____ and reduces _____.

vasodilation, BP

Alpha-1 blockers inhibit nor epinephrine reuptake by smooth muscle cells and reduces _____ and _____; this results in _____ and decreased _____

vasoconstriction, PVR; vasodilation, BP

Alpha-1 blockers cause _____ and _____ retention, resulting in _____>

sodium, water, edema

Alpha-1 blockers usually take about _____ weeks to achieve therapeutic affect.

2

Alpha-1 blockers meds all end in _____ and include.

sin, prazosin, doxazosin

Contraindications for Alpha-1 blockers include (1)

hypersensitivity

Adverse effects for Alpha-1 blockers include

first-dose phenom, flushing, headache, dizziness, fainting, edema, tachycardia, palpitations

Nursing considerations for Alpha-1 blockers include

take w/food min GI distress, postural hypotension and palpitations usually disappear over time, avoid sudden changes position, avoid excessive caffeine, report weight gain or ankle edema

Peripheral Adrenergic Antagonist block the exit of nor epinephrine, thereby inhibiting the activity of the _____ _____ _____.

sympathetic nervous system

Peripheral Adrenergic Antagonist uses include (1)

hypertension

Peripheral Adrenergic Antagonist meds include

reserpine, guanadrel, guanethidine

Contraindications for Peripheral Adrenergic Antagonist include (3)

hypersensitivity, depression, pheochromocytoma

Adverse effects for Peripheral Adrenergic Antagonist include

SOB, fatigue, headache, drowsiness, orthostatic hypotension, predisposition to peptic ulcer disease

Nursing considerations for Peripheral Adrenergic Antagonist include

delayed effect, incr orthostatic risk with hot, prolonged, and exercise, monitor BP and HR, predisposes patient to depression

Vasodilators are non-nitrate hypotensive agents that reduce _____ by direct effects on the vascular smooth muscles of _____

BP, arteries

Vasodilators uses include (3)

hypertension, adjunct for CHF, PVD (periph vascular disease)

Vasodilators meds include

hydralazine HCL (Alazine, Apresoline)

Contraindications for Vasodilators include (2)

inadequate cerebral perfusion, hypovolemia

Adverse effects for Vasodilators include

dizziness, hypotension, headache, palpitations, tachycardia, peripheral edema, orthostatic hypotension

Nursing considerations for Vasodilators include

monitor HR and BP before admin, take w/ food to incr absorption, wean off slowly to avoid paradoxical hypertensive effects, change position slowly, avoid hot tubs/baths

Angiotensin II Inhibitors (Angiotensin Receptor Blockers - ARBs) block the vasoconstrictive and aldosterone-producing effects of Angiotensin II at receptor sites, causing _____ and lowered _____.

vasodilation, BP

Angiotensin II Inhibitors (Angiotensin Receptor Blockers - ARBs) uses are (1)

hypertension

Angiotensin II Inhibitors (Angiotensin Receptor Blockers - ARBs) meds all end in _____ and include

-sartan, losartan (Cozaar), valsartan (Diovan)

Contraindications for Angiotensin II Inhibitors (Angiotensin Receptor Blockers - ARBs) include (2)

hypersensitivity, caution in renal/hepatic disease

Adverse effect for Angiotensin II Inhibitors (Angiotensin Receptor Blockers - ARBs) include

hypotension, dizziness, cough, gi upset, insomnia, tachy or bradycardia

Nursing considerations for Angiotensin II Inhibitors (Angiotensin Receptor Blockers - ARBs) include

VS, I/O, daily weights, K+ levels, dont discontinue abruptly, avoid salt substitutes, change position slowly

Thiazide Diuretics increase diuresis by inhibiting _____ in the distal collecting tubules and on the proximal tubules of the kidney.

sodium

Thiazide Diuretics uses include (4)

edema, hypertension, CHF, hepatic cirrhosis

Thiazide Diuretics meds include

hydrochlorothiazide, chlorothiazide, metolazone

Contraindications for Thiazide Diuretics include

hypersensitivity to sulfonamides, hypokalemia, anuria

Adverse effects of Thiazide Diuretics include

fluid/electrolyte imbalances, dry mouth, dizziness, impaired glucose tolerance, jaundice, muscle cramps, photosensitivity

Nursing considerations for Thiazide Diuretics include

VS, serum electrolytes, daily weights, I/O, dehydration, adequate tissue perfusion, weakness, muscle strength, restrict sodium intake, admin in morning or afternoon, change position slowly

Loop diuretics inhibit _____ reabsorption in the ascending loop of Henle. This promotes the excretion of water and what 3 electrolytes?

electrolyte, Na+, Cl-, K+

Uses for Loop diuretics include

FVE for disorders of the heart, liver, kidney -- HTN, CHF, chronic renal failure, hepatic cirrhosis, edema, pulmonary edema

Loop diuretics meds include

furosemide (Lasix), bumetanide, torsemide, ethacrynic acid

Contraindications for Loop diuretics include

electrolyte depletion, anuria, digitalis, sulfonamide allergy

Adverse effects for Loop diuretics include

orthostatic hypo, ototoxicity (tinnitus, hearing loss), dizziness, hypo, headache, electrolyte imbalances

Nursing considerations for Loop diuretics include

VS, serum electrolytes, daily weights, I/O, dehydration, admin in am and afternoon, cautiously in elderly, eat food high in K+, change position slowly, incr photosensitivity, otto-toxicity (more from IV pushed too fast)

Potassium-sparing act directly on distal convoluted tubule to incr _____ excretion and decrease _____ excretion.

Na+, K+

Potassium-sparing uses include (2)

hypertension, edema associated with heart failure

Potassium-sparing meds include

amiloride, spironolactone, triamterene

Contraindications for Potassium-sparing include

serum K+ levels > 5.5 mEq/mL, anuria, acute/chronic renal insufficiency, impaired hepatic function

Adverse effects for Potassium-sparing (4)

hyperkalemia, weakness/dizziness, headache, muscle cramps

Nursing considerations for Potassium-sparing

admin w/ food/milk, avoid salt sub, VS, UO, dehydration, lab values, excess K+ (nausea, diarrhea, abdominal cramps, tachycardia then bradycardia), can have photosensitivity

Preload is the amount of blood in the _____ prior to _____.

ventricles, contraction

Afterload is the resistance to blood being ejected by the _____

left ventricle

Cardiac output is _____ x _____.

stroke volume, HR

For a normal adult at rest, cardiac output is _____-_____ L/min.

4-8

BP = _____x_____.

CO, SVR

SVR is the force opposing movement of blood and is created primarily in the small _____ and _____>

arteries, arterioles

Heart failure is defined as impaired

cardiac pumping

Risk factors for HF include

advanced, age, CAD, HTN, diabetes, hyperlipidemia, smoking, obesity

Right-sided heart failure is called _____ _____.

cor pulmonale

Right-sided heart failure leading cause is ______ and other causes include

left-sided failure (also pulmonary disease), elevated pulmonary pressures, back up of blood into venous circulation

Left-sided heart failure leading causes is _____ and other causes include

left ventricular dysfunction assoc. w/ CAD & HTN, reduced left ventricular pumping, back up of blood into pulmonary vasculature

Clinical manifestations of HF include

dyspnea, orthopnea, tachypnea, crackles, cough (dry then productive), pink frothy sputum (PE), reduced UO, nocturia, weight gain, dependent edema, abdominal pain, anorexia, S3 & S4 heart sounds, chest pain

Extra sound after S2 is

S3

Blood going into the atria causes a soft sound before the first lub (S1) called

S4

S__ and S__ are considered gallops.

S3, S4

Diagnostic studies for HF

chest x-ray, electrocardiogram, echocardiogram, hemodynamic monitoring, cardiac catheterization, serum BNP

Serum BNP (brain natruretic peptide) responds to excessive stretching of the heart. Normal is <_____>_____ means patient has some HF.

100, 500

Physical assessment findings for HF include

wt gain, edema, crackles, JVD, dyspnea, tachypnea, decr O2 sats, cool, pale, diaphoretic skin, S3/S4, tachycardia, abdominal distention, liver engorgement, restless, confused

S1 is the closure of the _____ and _____ valves.

mitral, tricuspid

Time between S1 and S2 is

systole

Best way to diagnose JVD is with the bed at _____ angle.

45, high fowlers

Treat HF using Unload Fast which stands for

Upright position, Nitrates, Lasix, O2, ACE inhibitors, Digoxin, Fluids (decr), Afterload (decr), Sodium restriction, Testing (dig level, ABGs, K+ level)

Care for patient with HF by decreasing _____ volume, decreasing _____ return (preload), decreasing _____load, improving _____ exchange, and improving _____ function.

intravascular, venous, afterload, gas, cardiac

For HF, decrease intravascular volume using

diuretics (loop: Lasix, Bumex), fluid restriction, sodium restriction

For HF, decrease venous return (preload) by

elevate HOB, feed dependant, vasodilators (nitroglycerine)

For HF, decrease afterload using _____ to reduce SVR.

vasodilators

For HF, improve gas exchange using

supplemental O2, morphine

For HF, improve cardiac function by

increasing cardiac contractility (digitalis), reducing cardiac demands (rest)

HF meds

digitalis, ACE inhibitors (angiotensin converting enzyme), ARBs (angiotensin II receptor blockers, diuretics, beta blockers, vasodilators, morphine

A med, such as digitalis, increases muscular contraction and is known as

inotropic

A med, such as ACE inhibitors, are vasodilators, slow the heart and are known as

chronotropic

A med that decreases conduction of heart cells (decr electrical activity) are know as

dromotropic

This med decreases fluid overload and ECF.

diuretic

This med decreases venous blood return to the heart and decreases cardiac filling (decreases preload).

vasodilators

This type of med is usually contraindicated in person with HF because they decrease cardiac contractility.

beta blockers

When treating HF using diuretics, you usually start with _____ diuretics but may also use _____ and _____ sparing diuretics.

Thiazide, loop, K+

Digoxin and digitoxin are cardiac glycosides. They increase contractility and efficiency of myocardial contraction (+inotropic), slow HR (-chronotropic), decrease SA/AV node conduction (dromotropic) and are used for _____ and atrial _____.

HF, atrial dysrhythmias (atrial fib, atrial flutter, paroxysmal atrial tachycardia)

Symptoms of digitoxicity include

heart not beating right or racing, anorexic, hyperkalemic, n/v/d, visual disturbances (yellow, halos)

Of digoxin and digitoxin, one has 1/2 life of 36 hours and one has 1/2 life of 4-9 days.

digoxin (36), digitoxin (4-9)

Antidote for digoxin is _____. It binds with digoxin and enables it to be excreted.

digoxin immune FAB (Digibind)

Contraindications for cardiac glycosides (digoxin) include

hypersensitivity, digitoxicity, renal insufficiency, hypokalemia, acute MI, heart block (impulse between atria and ventricles not in sync)

Adverse effects for cardiac glycosides (digoxin) include

headache, n/v, loss of usual appetite, toxic effect (anorexia, visual disturbances (blurred, green, yellow, halos))

Nursing considerations for cardiac glycosides (digoxin) include

mon digoxin serum levels, toxicity, assess apical pulse, eat foods high in K+, daily weights, I/O

Normal therapeutic levels of digoxin are 0._ - _ ng/ml.

0.8 - 2

A level >_____ng/ml of digoxin is considered toxic.

2

When giving digoxin, you should monitor the apical pulse for 1 minute before giving. If <_____>_____ bpm, do not give it.

60, 120

Decreased oxygen-rich blood to an area which can cause pain and dysfunction is called

ischemia

PVD more commonly affects people _____-_____ years old.

60-80

Risk factors for PVD include

smoking, hyperlipidemia, diabetes, HTN

Clinical manifestations of PAD in lower extremities includes

intermittent claudication, paresthesia, reduced peripheral pulses, atrophy of muscle and skin, absence of hair, ulcerations leading to gangrene, cool, pale to cyanotic, dependant rubor (redness)

Diagnostic studies for PAD

Doppler, angiography, ankle brachial index

Treatment for PAD

angioplasty, stent, atherectomy (remove plaque, bypass, endarterectomy (roto-rooter), meds, exercise, diet, lifestyle

Care of patient post revascularization procedure include

peripheral pulses, skin color, temp, sensation, bleeding, hematoma, thrombosis, early ambulation, avoid knee flexed and extended sitting

Collaborative care for chronic venous insufficiency

compression, elevation of extremities, antibiotics, wound care, skin grafts

Risk factors for DVT

venous stasis (slow blood flow), endothelial damage, hypercoagulability

DVT clinical manifestations

unilateral leg edema, pain, warm skin, erythema

Prevent DVT by

early ambulation, leg exercises, prophylactic anticoagulants, ICDs, compression stockings

Treat DVT by

bed rest (bathroom privileges), anticoagulants, No ICDs or compression stockings, elevation of extremity, warm moist heat, avoid Valsalva maneuvers

No ambulation or compression once DVT is present because it might

dislodge embolism

PE clinical manifestations

chest pain, dyspnea, incr respiratory rate, decr O2 sat, cyanosis

PE diagnostic studies

perfusion scanning, ventilation scanning, d-dimer (serum blood test to measure clots that have broken up)

Coumadin prevents conversion of vitamin _____, which reduces several clotting factors and delays blood coagulation

K

Uses for Coumadin

DVT, PE, acute MI, heart valve replacement, atrial fibrillation, antiphospholipid syndrome

Contraindications for Coumadin

pregnancy, hemorrhage, malignant hypertension, liver failure

Adverse effects for Coumadin

bleeding, ecchymosis, n/d, abdominal cramping, hypotension, thrombocytopenia

Antidote for Coumadin is

vitamin K

Nursing considerations for Coumadin

slow onset, monitor baseline labs (PT, INR), lasts from several months to life long, minimize foods high in vitamin K (green leafy veg)

Coumadin often takes _____ days to get to therapeutic levels.

3-4 or up to 1 week

Check Coumadin levels using which test

INR (2-3 or 3-4.5 (mechanical heart valve replacement))

Heparin combines with the plasma heparin cofactor _____ and this inactivates specific clotting factors.

antithrombin III

Heparin uses

DVT, PE, embolism from atrial flutter, prophylactic trt for at risk for thrombi development, used to flush vascular access devices

Contraindications for Heparin

uncontrolled bleeding, thrombocytopenia, avoid concurrent w/ ASA, NSAIDs

Adverse effects for Heparin

heparin-induced thrombocytopenia, longer duration incr risk for osteoporosis

Nursing considerations for Heparin

monitor baseline labs, subQ admin, monitor for bleeding (Hemoccult all stools), verify dose with another RN, educate to monitor for bleeding, antidote is protamine sulfate

Check Heparin levels using which test

aPTT

Antidote for Heparin is

protamine sulfate

Antiplatelet agent uses

thrombus formation (hx of MI, stroke, cardiac surgery)

Antiplatelet agent meds

aspirin, ticlopidine (Ticlid), clopidogrel bisulfate (Plavix), dipyridamole (Persantine)

Contraindications for antiplatelet agents

hypersensitivity, bleeding disorders, asthma, pregnancy, peptic ulcer disease

Adverse effects for Antiplatelet agents

GI symptoms, increased bleeding, bruising, n/v

Nursing considerations for antiplatelet agents

baseline hema labs, VS, mon bleeding time, stopped 7 days before planned surgery, assess for ASA toxicity (tinnitus & ototoxicity)

Coronary artery disease is

endothelial injury, inflammatory response, accumulation of lipids in vessel wall, growth of smooth muscle over lipid plaque, plaques can rupture, accum of platelets leads to thrombosis

Non-modifiable risk factors for CAD

age, family history, sex (males, females after menopause)

Modifiable risk factors for CAD

smoking, blood sugar, HTN, obesity, Type A, inactivity, hyperlipidemia (increased LDL, decreased HDL)

LDL transport cholesterol from _____ to cells

liver

HDL transport cholesterol from _____ to liver where they are broken down.

cells

Increased LDL levels associated with

diabetes, genetics, excessive ETOH, obesity, inactivity, high fat diet, smoking

Cholesterol should be <_____

200

Triglyceride should be <_____

190-200

LDL levels should be <_____ />_____ mg/dL is a high risk.

130, 160

HDL levels should be >_____ mg/dL and if <_____ mg/dL is a high risk.

60, 40 (men) or 50 (women) - increases risk of CAD

Reduce blood lipids via meds and lifestyle changes such as

low saturated fats, high fiber, substitute soy based for animal proteins, fatty fish or Omega-3, weight reduction, exercise, quit smoking

Antilipidemics include

statins, Zetia, Questran, niacin (B3)

Statins include

Simvastatin (Zocor), lovastatin (Mevacor), atorvastatin (Lipitor)

Side effects of statins

muscle pain, SE rhabdomyolysis (flu like symptoms, tenderness, weakness), myopathy, strain on kidneys

Lab test to assess if muscle breakdown is occurring

myoglobin

Antilipidemics interactions

may increase effects of oral anticoagulants, combo of antilipidemics may increase risk of rhabdomyolysis

Nursing implications for statins

mon serum cholesterol, triglycerides, liver enzymes, follow diet, abd. Pain, d/n/v, take with evening meal or at bedtime, preg cat X, do not stop abruptly (MI or death)

Niacin uses

pellagra, hyperlipidemia, PVD that presents risk for pancreatitis

To get cholesterol lowering effect need large doses of Niacin of _____-_____ grams/day`

1.5-6

Niacin interactions

postural hypotension (ganglionic blockers), flushing, pruritus (avoid using with ETOH), myopathy, rhabdomyolysis (HMG-CoA reductase inhibitors)

Contraindications for Niacin

hypersensitivity, hepatic disease, peptic ulcer, hemorrhage, severe hypotension, lactation

Side effects of Niacin

postural hypotension, dizziness, blurred vision, n/v/d, dry skin, rash, itching

Nursing implications for Niacin

mon lipid, triglyc, choles, hepatic studies (AST, ALT, etc.), glucose, cardiac status, hepatic dysfunction (clay-colored stools, dark urine, jaundice), headache, paresthesias, n/v/d, anemia, confusion

Patient teaching for Niacin

flushing/feelings of warmth for several hours after taking (81-325 mg ASA to reduce flushing), no alcohol, avoid sunlight if skin lesions present, clay-colored stools, anorexia, jaundice, dark urine, GI upset

Angina is chest pain due to myocardial _____

ischemia

Angina due to myocardial ischemia is reversible or not reversible?

reversible

Clinical manifestations of Angina

pressure, squeezing, suffocation, SOB, may radiate to neck, jaw, arms, shoulders, may be silent, may be accompanied by cool diaphoresis, anxiety, impending doom, weakness

Three types of angina - chronic _____ angina, _____ angina, _____ angina

stable, unstable, vasospastic

Chronic stable angina caused by atherosclerosis, ischemic heart disease and triggered by exertion, smoke, caffeine, ETOH and _____ w/in 15 min of rest or med

subsides

Unstable angina is an early stage of _____ and can progress to MI.

CAD

Nursing interventions for chest pain rt to myocardial ischemia

rest, O2, 12 lead EKG, assess pain, VS, meds, cardiac markers

Diagnostic tests for angina

ekg, chest x-ray, lab tests (troponin, CK-MB (creatine kinase), C reactive protein

Meds used for angina and acute coronary syndrome

antiplatelet, nitroglycerine, B-adrenergic blockers, Ca+ channel blockers, thrombolytics, ACE inhibitors, antiarrhythmic drugs

Antianginal meds - 3 main classes

nitrates/nitrites, beta-blockers, Ca+ channel blockers

Overall goal of antianginal meds

increase blood flow and/or decrease O2 demand

Antianginal meds - 3 main therapeutic roles (objectives)

decrease freq and duration/intensity of angina, improve functional capacity, prevent/delay MI

Nitrates increase blood flow to myocardium, dilate venous system, reduce myocardial O2 demands and uses include

prophylactic trt of angina in patients with CAD, acute chest pain

Common Nitrates include

nitroglycerin (SL, SR, topical, transdermal), isosorbide dinitrate (Isordil), isosorbide (Imdur, Monoket)

Contraindications for Nitrates

hypersensitivity, severe anemia, head trauma, cerebral hemorrhage, cardiomyopathy, use of ED drugs within 24 hrs.

Adverse effects of Nitrates

headache (50%), flushing, hypotension, rash, local burning/tingling, GI upset with PO, contact dermatitis

Nursing considerations for Nitroglycerin

sit next to phone when taking SL NTG tablets, no more than 3 (1 every 5 min), wear gloves when applying paste, rotate location if patch, mon BP and HR, orthostatic hypotension, change position slowly