CAD Quiz 2

Pathophysiology & Etiology of CAD

• Atherosclerosis, characterized by plaque buildup in arterial walls, stands as the primary cause of CAD.
• Atheromas commonly consist of lipids, collagen (fibrous tissue), calcium, and cellular debris.
• Priority intervention for patients with elevated LDL and low HDL involves educating them on cholesterol-lowering strategies.
• Conditions reducing coronary perfusion and potentially leading to myocardial ischemia include coronary artery spasm, vessel occlusion by plaque, and platelet aggregation.
• Insufficient oxygen delivery to cardiac muscle leads to myocardial ischemia, potentially causing angina or myocardial infarction (MI).
• Atherosclerosis primarily affects the intimal and medial layers of the arterial wall in CAD.
• A ruptured plaque in a CAD patient raises the priority concern of thrombus formation, increasing MI risk.
• High LDL levels increase CAD risk due to LDL's role in promoting plaque development and arterial wall damage.
• Myocardial oxygen demand is directly affected by preload, afterload, and heart rate.
• ECG changes observed in CAD patients most likely indicate ischemia or infarction due to decreased oxygen delivery.

Risk Factors, Prevention & Clinical Manifestations

• Age is a nonmodifiable CAD risk factor, while smoking, diet, and obesity are modifiable.
• Factors unique to women regarding CAD risk include menopause, oral contraceptive use, and atypical chest pain presentation.
• Atypical symptoms in women, notably those over 55, warrant immediate action as potential CAD/MI.
• Modifiable risk factors such as hypertension, smoking, and hyperlipidemia should be addressed during CAD assessment.
• A 48-year-old male with an LDL of 180 mg/dL faces the highest CAD risk, especially in middle age.
• Elevated LDL levels significantly increase CAD risk, especially in middle-aged males.
• Lifestyle changes, including quitting smoking and managing diabetes, help prevent CAD development and progression.
• Angina and myocardial infarction are hallmark clinical manifestations of CAD.
• Stable angina is predictable and typically resolves with rest or nitroglycerin, while unstable angina can occur unpredictably.
• Atypical CAD symptoms commonly seen in women and older adults include fatigue, indigestion, jaw pain, and shortness of breath, rather than classic chest pain.
• Older adults may present CAD atypically with confusion and dizziness due to poor perfusion.

Diagnostic Tests & Pharmacologic Therapies

• Cardiac troponins are the most specific and sensitive markers for myocardial injury diagnosis.
• Diagnostic tests commonly used for subclinical CAD include C-reactive protein, myocardial perfusion imaging, and stress testing.
• Sublingual nitroglycerin should be placed under the tongue for rapid absorption during acute anginal episodes.
• A BP of 80/50 mmHg is an assessment finding that requires immediate follow-up after administering nitroglycerin for chest pain, as it indicates hypotension.
• Beta-adrenergic blockers reduce cardiac workload by lowering heart rate and contractility, improving oxygen balance.
• During an acute MI, medications such as aspirin, sublingual nitroglycerin, and morphine sulfate may be used for initial treatment.
• Statins are the first-line medication for long-term cholesterol management in CAD patients.
• After alteplase (tPA) administration for MI, nurses must closely monitor for bleeding due to its thrombolytic action.
• Therapeutic effects of aspirin in CAD management include anti-inflammatory, antiplatelet, and analgesic properties.
• IV nitroglycerin can cause rapid BP changes and arrhythmias, requiring close hemodynamic monitoring post-MI.

Surgical Interventions & Lifespan Considerations

• Coronary artery bypass grafting (CABG) aims to bypass blocked coronary arteries to restore perfusion.
• Percutaneous coronary intervention (PCI) involves placing a stent or balloon to open blocked arteries.
• Post-CABG nursing interventions: monitor chest tube output, encourage early ambulation, assess incision sites, and provide education on lifestyle changes. Fluid restriction depends on patient condition, not routine.
• Elderly CAD patients with abdominal pain, dizziness, and confusion indicate an atypical presentation of myocardial ischemia.
• Atypical CAD symptoms more frequently seen in women include indigestion, epigastric pain, jaw pain, and fatigue.
• In a female patient presenting with nausea, weakness, and SOB, further assessment for cardiac etiology is necessary.
• Challenges in diagnosing CAD in women include symptoms often dismissed as anxiety or GI issues, delayed diagnosis due to atypical symptoms, and worse outcomes from delayed care.
• Older adults are at increased risk of complications from CAD due to decreased pain perception, potentially leading to delayed diagnosis.
• Confusion in an older adult with CAD indicates poor perfusion or hypoxia, necessitating checking oxygenation and perfusion as the priority.
• A patient statement indicating understanding after CABG is "This surgery helps blood flow around blockages," acknowledging that lifestyle changes and medications remain necessary.

Nursing Interventions & Implementation

• The primary goal of morphine administration during an MI is to relieve pain and reduce myocardial oxygen demand.
• Effective tissue perfusion actions in CAD patients involve monitoring oxygen saturation, assessing consciousness, monitoring ECG, and assessing vital signs regularly.
• Prophylactic sublingual nitroglycerin should be taken before activities known to trigger angina.
• Interventions supporting acute pain management during chest pain include administering morphine, providing oxygen, and promoting physical and psychological rest.
• Key teaching about nitroglycerin at home: call 911 if chest pain persists after one dose due to nitroglycerin's light-sensitive nature, it must be stored in its original dark container
• CAD risk factor modification requires regular medication intake, regardless of symptoms, for preventative purposes.
• The best intervention for a CAD patient showing signs of anxiety and fear is to allow expression of feelings and ask questions, fostering emotional support and therapeutic communication.
• Interventions supporting health maintenance in CAD patients include educating about smoking cessation, discussing dietary recommendations, and providing cardiac rehab referrals.
• Relaxation techniques like guided breathing and yoga are effective nonpharmacologic ways to reduce stress in CAD.
• Post-MI discharge instructions should emphasize medication adherence, recognizing and reporting chest pain signs, and participation in cardiac rehabilitation for effective management.