Ischemia 101
What is ischemia?
Inadequate blood flow/oxygen to the tissues
Differentiate stable & unstable angina
Stable angina is predictable & often linked to physical exertion
Unstable angina is unpredictable, happens at rest & signals an MI
What lab value is an indicator of heart failure and ventricular stretching?
BNP (B-type natriuretic peptide)
A patient with suspected myocardial ischemia reports chest pressure that began 10 minutes ago. Which assessment finding requires the nurse's priority intervention?
A. Blood pressure of 142/88 mm Hg
B. Heart rate of 96/min
C. Chest pressure radiating to the left arm
D. Respiratory rate of 20/min
C. Chest pressure radiating to left arm
A patient comes in with high LDL cholesterol and coronary artery disease. Which medication is best to reduce their cardiovascular risk?
A. Atorvastatin
B. Nitroglycerin
C. Aspirin
D. Metoprolol
A. Atorvastatin
What is atherosclerosis?
Buildup of fatty plaque that narrows and hardens arteries
What are symptoms of peripheral artery disease (PAD)?
Cool, pale extremity; diminished pulses; intermittent claudication; arterial insufficiency; slow wound healing
The nurse is caring for a patient experiencing an acute myocardial infarction (MI). Which lab value is most specific for myocardial injury?
A. Hemoglobin
B. Troponin
C. Sodium
D. Creatinine
B. Troponin
A patient with PAD has a foot that is pale, cool, and painful. Which nursing action is appropriate?
A. Apply a heating pad to the foot
B. Massage the affected extremity
C. Assess peripheral pulses and capillary refill
D. Elevate the extremity above the level of the heart
C. Assess circulation, including pulses, skin color, temperature, sensation, and capillary refill
A patient taking nitroglycerin for angina reports feeling dizzy after taking a dose. What should the nurse do first?
A. Have the patient stand and walk
B. Assess the patient's blood pressure
C. Give another dose of nitroglycerin
D. Encourage the patient to drink water
B. Assess the patient's blood pressure
What is a myocardial infarction (MI)?
Loss of perfusion to the heart (complete coronary occlusion leads to prolonged ischemia causing irreversible cell death and necrosis)
Which of the following are consistent with tissue ischemia?
A. Pain
B. Pallor
C. Cool to the touch
D. Bounding pulses
E. Improved oxygen delivery
F. Paresthesia
A, B, C, F
A patient with severe hypotension has an elevated lactate level. What does this finding suggest?
A. Increased tissue oxygenation
B. Poor tissue perfusion
C. Improved cardiac output
D. Decreased metabolic activity
B. Poor tissue perfusion
A patient with ischemic heart disease takes several medications. Which finding should the nurse report first?
A. Patient taking atorvastatin reports mild muscle soreness
B. Patient taking metoprolol has a heart rate of 48/min
C. Patient taking aspirin has a small bruise
D. Patient taking lisinopril reports a mild dry cough
B. Metoprolol & HR of 48
A patient has hypertension and recently had an MI. They have Metoprolol ordered. What would be an indication to hold the medication until confirming with the provider?
Low heart rate
Name at least two causes of ischemia
Atherosclerosis, blood clot (thrombosis or embolism), vasospasm, mechanical compression (tumor, swelling, hernia or trauma), hypotension
A patient suddenly develops shortness of breath, sharp chest pain that worsens with deep breathing, oxygen saturation of 89% and a heart rate of 118/min. The patient had knee surgery 5 days ago. Which condition should the nurse suspect?
A. Myocardial infarction
B. Pulmonary embolism
C. Stable angina
D. Heart failure
B. Pulmonary embolism
A patient comes in with angina and elevated troponin. What diagnosis do you suspect?
Myocardial infarction (MI)
A patient taking nitroglycerin for angina reports feeling dizzy after taking a dose. What should the nurse do first?
A. Have the patient stand and walk
B. Assess the patient's blood pressure
C. Give another dose of nitroglycerin
D. Encourage the patient to drink water
B. Assess the patient's blood pressure
What is an indication for Nitroglycerin and why?
Angina/myocardial ischemia
Vasodilator; decreases preload (decreases stress on heart)
Differentiate an ischemic and hemorrhagic stroke
Ischemic stroke happens when blood clot blocks perfusion to brain
Hemorrhagic stroke happens when blood vessel in brain bursts & bleeds
Which symptoms can occur with myocardial ischemia in addition to chest discomfort? Select all that apply.
A. Shortness of breath
B. Nausea
C. Diaphoresis
D. Unusual fatigue
E. Jaw discomfort
F. Increased appetite
A, B, C, D, E
The nurse is caring for four patients. Which patient should the nurse assess first?
A. Patient with BNP of 400 pg/mL and mild ankle edema
B. Patient with LDL of 140 mg/dL
C. Patient with chest pain and elevated troponin
D. Patient with potassium of 3.7 mEq/L
Answer: C. Patient with chest pain and elevated troponin
A nurse is assessing four patients. Which patient should they see first?
A. Chronic PAD reporting mild calf pain after walking
B. Stable angina whose chest discomfort resolved after rest
C. Acutely cool & pale extremity with absent pulse
D. Chronic venous insufficiency and ankle edema
C. Acutely cool & pale extremity with absent pulse
A patient with ischemic heart disease has hypertension and needs a medication that decreases afterload. Which medication would be the most beneficial for this patient?
A. Lisinopril
B. Aspirin
C. Clopidogrel
D. Nitroglycerin
A. Lisinopril