CAD BASICS
Insufficient oxygen is available based on the current need, limited in duration and does not cause permanent damage?
What is Ischemia
Myocardial muscle protein releases with injury to myocardial tissue after a MI takes 6 hours to show this level.
Troponin
Normal Range <0.2 mg/mL
A patient has been admitted for acute angina. Which diagnostic test identifies if the patient will benefit from further invasive management after acute angina or a MI
a) exercise tolerance b) cardiac catheterization c) thallium scan e) Muga scan
b) cardiac catheterization
A patient with chronic stable angina is taking calcium channel blockers for which complication does the nurse monitor with this patient?
a) wheezes b) hypotension c) tachycardia d) forgetfulness
b) hypotension
Diltiazem, Amlodipine, Verapamil they promote vasodilation and myocardial perfusion that is why you want to monitor for hypotension do not administer SBP <90
If a pt is experiencing a STEMI how long do we have to rush them to the heart cath lab?
90 mins
Necrosis or cell death due to a lack of oxygen when severe ischemia is prolonged and decreased perfusion causes irreversible damage to cardiac tissue
What is Infarction
Creatine Kinase is a enzyme specific to cells of the brain, myocardium, and skeletal muscle what is the normal range for females and males?
Female 30-135 units/L
Male 55-170 units/L
The cardiac catherization is a test done to determine the location and extent of CAD blockage what are the three post procedure nursing considerations
1. watch for bleeding at the insertion site, 2. monitor peripheral pulses, skin and temp 3. straight extremity ( lay flat and sand bag 4 hours)
The physician refers the client with unstable angina for a cardiac catheterization. The nurse explains to the client that this procedure is being used in this specific case to:
A
Open and dilate the blocked coronary arteries
B
Assess the extent of arterial blockage
C
Bypass obstructed vessels
D
Assess the functional adequacy of the valves and heart muscle
B
Assess the extent of arterial blockage
Which patient has the highest risk for MI?
a) 49 year old on estrogen replacement therapy
b) 55 year old with unstable angina
c) 23 yr old with diabetes that is not well controlled
d) 60 year old with well controlled hypertension
C 55 yr old unstable angina
Chest pain that typically occurs with activity and subsides with rest or nitroglycerin
Stable Angina
Isoenzyme of CK found specifically in myocardial tissue 0-4%?
CK-MB
. A patient calls the cardiac clinic you are working at and reports that they have taken 3 sublingual doses of Nitroglycerin as prescribed for chest pain, but the chest pain is not relieved. What do you educate the patient to do next?*
B call 911
The nurse teaches the client with angina about the common expected side effects of nitroglycerin, including:
A
Headache
B
High blood pressure
C
Shortness of breath
D
Stomach cramps
a) Headache
a patient is in the acute phase ( phase 1 ) of cardiac rehabilitation which task is the best to delegate to the unlicensed assistive personal
a) assist pt to ambulate 200 feet 3x daily
b) assist pt with ambulation to bathroom
c_ assess heart rate bp resp rate and fatigue with each higher level of activity
d_ assist pt to the bathrub
b) assist pt with ambulation to the bathroom
three phases of cardiac rehab
phase 1) promote rest and limit mobility
phase 2) re-strengthening of heart muscle
phase 3) long term maintenance
chest pain that occurs at rest or exertion causing severe activity limitations
12 lead EKG changes will be present but cardiac labs ( CK or Troponin) will not be elevated
Unstable Angina
Normal range for Myoglobin, a low molecular weigh heme protein found in cardiac and skeletal muscle?
<90mcg/L
a patient has had an MI the nurse anticipates which type of drug will be prescribed within 48 hours to prevent the development of ventricular remodeling and heart failure?
a) calcium channel blocker B) ace inhibitor c) beta blocker d) diuretic
B) ace inhibitors Enalapril and Lisinopril
A 57-year-old client with a history of asthma is prescribed propranolol (Inderal) to control hypertension. Before administered propranolol, which of the following actions should the nurse take first?
A
Monitor the apical pulse rate
B
Instruct the client to take medication with food
C
Question the physician about the order
D
Caution the client to rise slowly when standing
A monitor the apical pulse rate
a pt is having an elective CABG with a minimally invasive surgical technique what does the nurse include in the pre-op teaching?
a) prevention of edema and scarring at the harvest site
b) protection and splint of the chest incision while coughing
c) availability of analgesics if needed but probably unnecessary
d) limitation of ambulation for several days
B) Protection and splinting of the chest incision while coughing
***also we want to look for infection post CABG
Nursing considerations for stent placement
observe for bleeding at the puncture site
frequent vital signs, cardiac rhythm, and chest pain monitoring,
frequent monitoring of bilateral pulse,
administer ordered anticoagulants
tell pt chest pain 3-6 months following sent placement can indicate stent closure or artery occlusion
Normal Ranges for Cholesterol
Total Cholesterol
Triglycerides
LDL for high and low cardiac risk
HDL
Total C- <200 mg/dl
Trigly- <150 mg/dl
LDL low cad risk <70 mg/dl
high cad risk <100 mg/dl
HDL >40 mg/dl
which diagnostic test is performed after angina or MI to determine cardiac changes that are consistent with ischemia to evaluate medical interventions and to determine whether invasion intervention is necessary?
a)exercise tolerance test b) electrocardiogram c) echocardiogram d)x-ray
a) exercise stress test
the heart is stress through exercise or medication injected into a vein
vital signs an cardiac rhythms are monitored closely for change
an elevation of ST segment could be immediate concern!
Following a treadmill test and cardiac catheterization, the client is found to have coronary artery disease, which is inoperative. He is referred to the cardiac rehabilitation unit. During his first visit to the unit he says that he doesn’t understand why he needs to be there because there is nothing that can be done to make him better. The best nursing response is:
A
“Cardiac rehabilitation is not a cure but can help restore you to many of your former activities.”
B
“Here we teach you to gradually change your lifestyle to accommodate your heart disease.”
C
“You are probably right but we can gradually increase your activities so that you can live a more active life.”
D
“Do you feel that you will have to make some changes in your life now?”
A
“Cardiac rehabilitation is not a cure but can help restore you to many of your former activities.”
the ICU nurse is caring for a pt who has had a CABG the patient has a systolic bp of 80 mm Hg what is the primary concern for this patient?
a) it is associated with warm cardioplegia
b) it may result in the collapse of a graft
c) it will result in acute tubular necrosis
d) it is related to mechanical ventilation
B) it may result in collapse of the graft