Podcast
Questions and Answers
What emotional response may patients with CAD, angina, and/or AMI exhibit following a cardiac event?
What emotional response may patients with CAD, angina, and/or AMI exhibit following a cardiac event?
How can inactivity in patients with angina affect their condition?
How can inactivity in patients with angina affect their condition?
Which nursing intervention is essential for promoting adherence to the therapeutic regimen?
Which nursing intervention is essential for promoting adherence to the therapeutic regimen?
What is a key component of cardiac rehabilitation programs?
What is a key component of cardiac rehabilitation programs?
Signup and view all the answers
What should the nurse reinforce to patients regarding chest pain?
What should the nurse reinforce to patients regarding chest pain?
Signup and view all the answers
What does effective patient teaching about medications involve?
What does effective patient teaching about medications involve?
Signup and view all the answers
What is the frequency of outpatient sessions for most patients after discharge from cardiac rehabilitation?
What is the frequency of outpatient sessions for most patients after discharge from cardiac rehabilitation?
Signup and view all the answers
What is a potential consequence of denial regarding prescribed medication?
What is a potential consequence of denial regarding prescribed medication?
Signup and view all the answers
What is the primary purpose of thrombolytic therapy in the context of coronary artery disease (CAD)?
What is the primary purpose of thrombolytic therapy in the context of coronary artery disease (CAD)?
Signup and view all the answers
Which manifestation should prompt immediate notification of the healthcare provider (HCP) in a patient receiving thrombolytic therapy?
Which manifestation should prompt immediate notification of the healthcare provider (HCP) in a patient receiving thrombolytic therapy?
Signup and view all the answers
Which of the following is a sign of reperfusion in a patient after thrombolytic therapy?
Which of the following is a sign of reperfusion in a patient after thrombolytic therapy?
Signup and view all the answers
What should be monitored frequently in a patient after thrombolytic therapy?
What should be monitored frequently in a patient after thrombolytic therapy?
Signup and view all the answers
Which ECG finding should be interpreted as indicating potential reperfusion dysrhythmias?
Which ECG finding should be interpreted as indicating potential reperfusion dysrhythmias?
Signup and view all the answers
If the patient is not a candidate for thrombolytic therapy, what could be a significant adjustment in care?
If the patient is not a candidate for thrombolytic therapy, what could be a significant adjustment in care?
Signup and view all the answers
What should be the response to a patient stating that they will not quit smoking despite knowing the risks?
What should be the response to a patient stating that they will not quit smoking despite knowing the risks?
Signup and view all the answers
What is an evaluation of Mrs. Williams regarding her pain after the administration of morphine and thrombolytic therapy?
What is an evaluation of Mrs. Williams regarding her pain after the administration of morphine and thrombolytic therapy?
Signup and view all the answers
Which members of the interdisciplinary cardiac rehabilitation team are responsible for assessing and establishing a plan of care?
Which members of the interdisciplinary cardiac rehabilitation team are responsible for assessing and establishing a plan of care?
Signup and view all the answers
What is a common evaluation goal for a patient in cardiac rehabilitation?
What is a common evaluation goal for a patient in cardiac rehabilitation?
Signup and view all the answers
What symptoms did Mrs. Williams present that indicated a possible acute myocardial infarction (AMI)?
What symptoms did Mrs. Williams present that indicated a possible acute myocardial infarction (AMI)?
Signup and view all the answers
Which medication was initially administered to relieve Mrs. Williams's pain during her treatment?
Which medication was initially administered to relieve Mrs. Williams's pain during her treatment?
Signup and view all the answers
What is a main nursing intervention for Mrs. Williams as part of her care plan?
What is a main nursing intervention for Mrs. Williams as part of her care plan?
Signup and view all the answers
Which vital sign change indicates a potential complication in Mrs. Williams's condition?
Which vital sign change indicates a potential complication in Mrs. Williams's condition?
Signup and view all the answers
What type of heart sound was auscultated in Mrs. Williams's examination?
What type of heart sound was auscultated in Mrs. Williams's examination?
Signup and view all the answers
What psychological issues did Mrs. Williams exhibit related to her health condition?
What psychological issues did Mrs. Williams exhibit related to her health condition?
Signup and view all the answers
Which medication prescribed to Mrs. Williams is classified as a diuretic?
Which medication prescribed to Mrs. Williams is classified as a diuretic?
Signup and view all the answers
What potential risk is associated with the use of thrombolytic therapy in Mrs. Williams's treatment?
What potential risk is associated with the use of thrombolytic therapy in Mrs. Williams's treatment?
Signup and view all the answers
What does the term 'inadequate protection' refer to in Mrs. Williams's nursing diagnoses?
What does the term 'inadequate protection' refer to in Mrs. Williams's nursing diagnoses?
Signup and view all the answers
What is a primary focus of the implementation phase of Mrs. Williams's care plan?
What is a primary focus of the implementation phase of Mrs. Williams's care plan?
Signup and view all the answers
Which outcomes should the nursing interventions aim to achieve for Mrs. Williams?
Which outcomes should the nursing interventions aim to achieve for Mrs. Williams?
Signup and view all the answers
What characterizes an ischemic stroke?
What characterizes an ischemic stroke?
Signup and view all the answers
What is the primary risk factor for stroke among individuals aged 65 and older?
What is the primary risk factor for stroke among individuals aged 65 and older?
Signup and view all the answers
Which statement about the brain's blood flow autoregulation is true?
Which statement about the brain's blood flow autoregulation is true?
Signup and view all the answers
What occurs to brain cells within 4 to 5 minutes of interrupted blood flow?
What occurs to brain cells within 4 to 5 minutes of interrupted blood flow?
Signup and view all the answers
What is the term for the area of minimally perfused cells surrounding the core of dead brain tissue after a stroke?
What is the term for the area of minimally perfused cells surrounding the core of dead brain tissue after a stroke?
Signup and view all the answers
Which factor does NOT contribute to neurological damage following a stroke?
Which factor does NOT contribute to neurological damage following a stroke?
Signup and view all the answers
What is a common outcome in terms of mortality related to stroke in the United States?
What is a common outcome in terms of mortality related to stroke in the United States?
Signup and view all the answers
What physiological change occurs that can impede blood flow after a stroke, even if circulation is restored?
What physiological change occurs that can impede blood flow after a stroke, even if circulation is restored?
Signup and view all the answers
What is the primary cause of hemorrhagic strokes?
What is the primary cause of hemorrhagic strokes?
Signup and view all the answers
Which type of hemorrhage occurs when bleeding takes place within the brain tissue?
Which type of hemorrhage occurs when bleeding takes place within the brain tissue?
Signup and view all the answers
What can be a consequence of increased intracranial pressure (ICP) from a stroke?
What can be a consequence of increased intracranial pressure (ICP) from a stroke?
Signup and view all the answers
What is the primary factor that contributes to the survival of brain cells during a stroke?
What is the primary factor that contributes to the survival of brain cells during a stroke?
Signup and view all the answers
What type of stroke is characterized by the blockage of blood flow leading to brain infarction?
What type of stroke is characterized by the blockage of blood flow leading to brain infarction?
Signup and view all the answers
Which of the following is a common clinical symptom of a hemorrhagic stroke?
Which of the following is a common clinical symptom of a hemorrhagic stroke?
Signup and view all the answers
Which of the following is a common site for embolic strokes?
Which of the following is a common site for embolic strokes?
Signup and view all the answers
Which lifestyle factor significantly increases the risk of a stroke?
Which lifestyle factor significantly increases the risk of a stroke?
Signup and view all the answers
Which condition is considered a major risk factor for stroke due to cardiovascular changes?
Which condition is considered a major risk factor for stroke due to cardiovascular changes?
Signup and view all the answers
What is a significant characteristic of a transient ischemic attack (TIA)?
What is a significant characteristic of a transient ischemic attack (TIA)?
Signup and view all the answers
What is the main cause of a hemorrhagic stroke?
What is the main cause of a hemorrhagic stroke?
Signup and view all the answers
What is a critical step in stroke prevention according to recommended guidelines?
What is a critical step in stroke prevention according to recommended guidelines?
Signup and view all the answers
Which ethnicity is noted to have almost double the incidence of first-ever strokes in the United States?
Which ethnicity is noted to have almost double the incidence of first-ever strokes in the United States?
Signup and view all the answers
Which type of stroke occurs when a blood clot forms in place and occludes a large cerebral vessel?
Which type of stroke occurs when a blood clot forms in place and occludes a large cerebral vessel?
Signup and view all the answers
What dietary habit can help in preventing strokes?
What dietary habit can help in preventing strokes?
Signup and view all the answers
What neurological effect results from a stroke affecting the right hemisphere of the brain?
What neurological effect results from a stroke affecting the right hemisphere of the brain?
Signup and view all the answers
What kind of stroke is often a warning sign of an impending ischemic thrombotic stroke?
What kind of stroke is often a warning sign of an impending ischemic thrombotic stroke?
Signup and view all the answers
Which of the following medications is commonly prescribed to prevent subsequent strokes?
Which of the following medications is commonly prescribed to prevent subsequent strokes?
Signup and view all the answers
What is commonly observed in diabetic patients that increases their stroke risk?
What is commonly observed in diabetic patients that increases their stroke risk?
Signup and view all the answers
What is a possible outcome if an embolus breaks into smaller components during an embolic stroke?
What is a possible outcome if an embolus breaks into smaller components during an embolic stroke?
Signup and view all the answers
What condition is a common precursory event leading to a thrombotic stroke?
What condition is a common precursory event leading to a thrombotic stroke?
Signup and view all the answers
What does the acronym FAST help to recognize?
What does the acronym FAST help to recognize?
Signup and view all the answers
Which of the following are known causes of hemorrhagic strokes?
Which of the following are known causes of hemorrhagic strokes?
Signup and view all the answers
What is a typical risk factor for stroke specifically identified for females?
What is a typical risk factor for stroke specifically identified for females?
Signup and view all the answers
What is the speed of onset typically associated with embolic strokes?
What is the speed of onset typically associated with embolic strokes?
Signup and view all the answers
Which demographic region in the U.S. is known as the 'stroke belt' for its higher stroke mortality rates?
Which demographic region in the U.S. is known as the 'stroke belt' for its higher stroke mortality rates?
Signup and view all the answers
What is the primary effect of a stroke on the motor pathways crossing at the decussation level?
What is the primary effect of a stroke on the motor pathways crossing at the decussation level?
Signup and view all the answers
Study Notes
Promoting Adherence to the Therapeutic Regimen
-
Effective Therapeutic Regimen Management: Nurses can help patients with CAD and angina by promoting effective therapeutic regimen management.
-
Assessing Patient Understanding: Assess the patient's knowledge and understanding of CAD and angina. This allows nurses to tailor teaching and interventions to the individual patient's needs.
-
Providing Education: Teach patients about angina and atherosclerosis, building upon their existing knowledge base and helping them understand that angina can be managed.
-
Enhancing Adherence: Provide both written and verbal instructions about prescribed medications and their use. Reinforce the importance of taking chest pain seriously while maintaining a positive attitude.
Cardiac Rehabilitation
- Interdisciplinary Program: Cardiac rehabilitation involves a multidisciplinary team with nurses, physicians, exercise physiologists, dieticians, and psychologists/behavioral medicine practitioners.
- Supervised Exercise and Education: Includes supervised, progressive exercise, education, nutritional and psychosocial assessment, and counseling.
- Emphasis on Lifestyle Change: Focuses on realistic application of information for long-term lifestyle changes.
- Outpatient Program: Most patients attend a 2-3 times per week outpatient program, for approximately 8 weeks.
- Progressive Program: Exercise intensity and duration gradually increase based on patient tolerance and physiological parameters.
-
Commonly Covered Topics in Cardiac Rehabilitation:
- Anatomy and Physiology of the Heart
- CAD and Implications of Acute Myocardial Infarction
- Purposes and Side Effects of Prescribed Medications
- Importance of Adhering to the Medical Regimen
Example of Cardiac Rehabilitation Program
-
Scenario: An example of a cardiac rehabilitation program implementation with a patient with AMI.
- Patient: Nancy Williams, a 62-year-old woman with a history of type 2 diabetes, angina, hypertension, and a 45-year history of cigarette smoking.
- Admission: Admitted to the ED with severe chest pain.
- Diagnosis: Diagnosed with acute anterior MI.
- Intervention: Thrombolytic therapy with alteplase (Activase) administered.
- Outcome: Demonstrated successful reperfusion with relief of chest pain, return of the ST segment to baseline on the ECG, and peaking of CK levels.
Assessing a Patient with AMI
- Example: Dan Morales, RN, assesses Mrs. Williams, who is alert, oriented, and demonstrates reduced chest pain after receiving morphine sulfate. She verbalizes concern about the drug and understands its purpose.
-
Nursing Diagnoses:
- Acute pain
- Anxiety
- Fear
- Inadequate protection
- Potential for decreased CO
Planning Care for Patient with AMI
- Goals:
- Reduced chest pain
- Verbalized reduced anxiety and fear
- Absence of bleeding problems
- Maintaining adequate CO
Implementing Care for Patient with AMI
-
Initial Implementation:
- Report chest pain to staff
- Monitor and evaluate pain
- Titrate IV nitroglycerin infusion
- Administer morphine sulfate for unrelieved pain
-
Addressing Anxiety and Fear:
- Encourage the patient to express concerns.
- Respond honestly to questions
- Explain the purpose of thrombolytic therapy
- Explain the need for close monitoring
-
Monitoring for Bleeding and Reperfusion:
- Assess for bleeding signs and symptoms
- Test stools, urine, and vomitus for occult blood
- Monitor for signs of reperfusion
- Monitor ECG for changes
-
Cardiac Care and Rehabilitation:
- Discuss continuing cardiac care and rehabilitation.
Evaluating Care
-
Evaluation:
- Initial morphine reduced Mrs. Williams's pain from 8 to 4.
- Nitroglycerin infusion further reduced pain after 24 hours.
- Reperfusion indicated by relief of chest pain, return of the ST segment to baseline, and peaking of CK levels.
- Outcome: Mrs. Williams transferred to the floor after 36 hours in the CCU.
Critical Thinking
- Patient Not Candidate for Thrombolytic Therapy: If Mrs. Williams were not a candidate for thrombolytic therapy, the initial plan of care would have included alternative strategies such as percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).
- Palpitations and Frequent PVCs: If Mrs. Williams experiences palpitations with frequent PVCs, further assess for the cause, monitor for cardiac ischemia, and administer antidysrhythmic medications as ordered.
-
Health Promotion Topics: Before discharge, teach Mrs. Williams about:
- Lifestyle modifications (smoking cessation, healthy diet, exercise)
- Medications
- Importance of adherence to treatment plan
- Cardiac rehabilitation and support groups.
- Addressing Smoking Cessation: Acknowledge Mrs. Williams's concerns about smoking cessation. Encourage her to consider the benefits of quitting and offer resources and support for smoking cessation.
Stroke
- A stroke is a sudden loss of brain function due to interruption of blood flow, resulting in neurological deficit.
- Stroke is the fourth leading cause of death in the United States.
- Every 40 seconds, someone has a stroke, and every 4 minutes, someone dies from a stroke.
- Approximately 795,000 Americans experience a stroke annually, with 160,000 succumbing to the event.
- Stroke risk increases with age, with those over 65 at the highest risk.
- Women are also at risk during pregnancy and the early postpartum period (6 weeks).
- Two main types of stroke:
- Ischemic stroke: occurs when a blood clot, foreign matter, or narrowing of blood vessels interrupts blood supply.
- Hemorrhagic stroke: occurs when a blood vessel ruptures and bleeds into surrounding tissue, damaging neurons.
Cerebral Blood Flow and Ischemia
- The brain accounts for 20% of oxygen consumption despite being only 2% of body weight.
- Autoregulation maintains constant blood flow to the brain during varying blood pressure levels.
- When blood flow is interrupted, even for a short time, cells become depleted of glucose, glycogen, and ATP, leading to swelling and further reduced blood flow.
- Even with restored circulation, vasospasms and increased blood viscosity can continue to impede blood flow.
- Severe or prolonged ischemia leads to cell death.
Ischemic Stroke
- Ischemic strokes are classified as:
- Transient ischemic attack (TIA): a temporary period of localized cerebral ischemia lasting less than 24 hours, often a warning sign of an impending stroke.
- Thrombotic stroke: occurs when a blood clot forms in a cerebral vessel, often in large vessels narrowed by atherosclerotic plaque.
- Embolic stroke: occurs when a blood clot or other material travels from another location and lodges in a cerebral vessel.
Hemorrhagic Stroke
- Hemorrhagic strokes occur when a cerebral blood vessel ruptures, leading to bleeding into the brain tissue or spaces surrounding the brain.
- Common causes include hypertension, aneurysms, and trauma.
- Types of hemorrhagic stroke:
- Intracerebral hemorrhage: bleeding within the brain tissue.
- Subarachnoid hemorrhage: bleeding into the spaces around the brain.
Stroke Risk Factors
-
Major risk factors:
- High blood pressure
- Heart disease
- Diabetes mellitus
- Sleep apnea
- High cholesterol
- Smoking
- Substance abuse
- Sickle cell disease
-
Other risk factors:
- Family history of stroke
- Obesity
- Sedentary lifestyle
- Recent infections
- Previous transient ischemic attacks (TIAs)
-
Specific risk factors for females:
- Hormonal contraceptive use, especially in smokers
- Pregnancy and childbirth
- Menopause
- Migraine headaches with aura
- Autoimmune disorders (e.g., diabetes, lupus)
- Clotting disorders
Stroke Prevention
-
Lifestyle Modifications:
- Control blood pressure
- Maintain a healthy weight
- Exercise regularly
- Eat a healthy diet, low in cholesterol and saturated fats
- Avoid smoking
- Manage diabetes
-
Medications:
- Antiplatelet drugs
- Anticoagulants
Recognizing Stroke Signs and Symptoms
-
FAST:
- Face: Facial drooping?
- Arm: Arm weakness?
- Speech: Slurred speech?
- Time: Call 9-1-1 immediately if any of these are present.
Other Stroke Warning Signs
- Sudden weakness or numbness of the face, arm, or leg, especially on one side of the body
- Sudden confusion, difficulty speaking, or difficulty understanding speech
- Sudden trouble walking, dizziness, or loss of coordination
- Sudden difficulty with vision in one or both eyes
- Sudden severe headache without a known cause
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
This quiz focuses on promoting adherence to therapeutic regimens in patients with coronary artery disease (CAD) and angina. It discusses effective management strategies, assessing patient understanding, providing education about heart conditions, and the role of interdisciplinary teams in cardiac rehabilitation.
