Chapter 23: Management of Coronary Disorders

Questions and Answers

Plaque on the inner lumen of the arteries is composed chiefly of what?

White blood cells

High-density cholesterol

Lipids and fibrous tissue (correct)

Lipoproteins

Angina is most often attributable to what cause?

Infarction of the myocardium

Decreased cardiac contractility

Decreased cardiac output

Coronary arteriosclerosis (correct)

What nursing diagnosis underlines the discomfort associated with angina?

Anxiety related to fear of death

Impaired skin integrity related to CAD

Ineffective cardiopulmonary tissue perfusion related to coronary artery disease (CAD) (correct)

Ineffective breathing pattern related to decreased cardiac output

If the patient's symptoms are due to an MI, what will have happened to the myocardium?

It may have developed an increased area of infarction during the time without treatment. Signup and view all the answers

How should the nurse interpret initial data of a client with pale skin and mid-sternal chest pain?

The symptoms indicate an acute coronary episode and should be treated as such. Signup and view all the answers

The vessel most commonly used as a source for a CABG is what?

Greater saphenous vein Signup and view all the answers

Which syndrome should the nurse suspect based on the findings including high blood pressure and waist circumference?

Metabolic syndrome Signup and view all the answers

What is the nurse's best response to a client feeling afraid of dying during surgery?

Explore the factors underlying the client's anxiety. Signup and view all the answers

Before administering nitroglycerin, what potential adverse effects should the nurse inform the client about?

Throbbing headache or dizziness Signup and view all the answers

What risk factors can be controlled or modified for coronary artery disease?

Cholesterol levels, hypertension, and smoking Signup and view all the answers

What nursing assessment activity is a priority on admission to the CCU for a client with MI?

Begin ECG monitoring Signup and view all the answers

What should the focuses of CAD treatment be for a client without symptoms?

Diet therapy and smoking cessation Signup and view all the answers

What should a patient do during activity if they experience which symptoms?

Experience chest pain, palpitations, or dyspnea Signup and view all the answers

What therapeutic effect is intended by treating a client with amlodipine?

Reducing the heart's workload by decreasing heart rate and myocardial contraction Signup and view all the answers

What is the desired goal for cholesterol levels?

Low LDL values and high HDL values Signup and view all the answers

What are the primary ways that tobacco use impacts coronary artery disease?

Decreases the supply of oxygen to the myocardium Signup and view all the answers

To minimize cardiac damage on admission, what intervention should the nurse expect to administer?

Morphine sulfate, oxygen, and bed rest Signup and view all the answers

In which order should the nurse assess and treat a client reporting chest pain?

The client receives the first dose of nitroglycerin. Signup and view all the answers

When assessing a client with angina pectoris, what information is most important for the nurse to gather?

The client's symptoms and the activities that precipitate attacks Signup and view all the answers

What is the nurse's most appropriate initial action when an angina attack begins?

Place the client on bed rest in a semi-Fowler position Signup and view all the answers

What drug should the nurse anticipate administering to a client with suspected MI?

Morphine Signup and view all the answers

What signs and symptoms are suggestive of acute coronary syndrome (ACS)?

Syncope Signup and view all the answers

How can the nurse best meet the psychosocial needs of a client with ACS?

Directly address the client's anxieties and fears Signup and view all the answers

What drug should a nurse anticipate administering to a patient post coronary artery stent placement?

Clopidogrel Signup and view all the answers

What anticipatory guidance should the nurse provide to a client scheduled for PCI?

A sheath will be placed over the insertion site after the procedure. Signup and view all the answers

What is the nurse's most appropriate action when a client begins bleeding from the PCI access site?

Call for help and apply pressure to the access site Signup and view all the answers

What signs and symptoms of MI are particularly common in female patients?

Indigestion Signup and view all the answers

What is the nurse's most appropriate action for a postoperative client producing 20 ML of urine in 3 hours?

Contact the provider and continue to assess fluid balance and renal functions Signup and view all the answers

What intervention best addresses the risk for ineffective airway clearance related to pulmonary secretions?

Client consistent performance of deep-breathing and coughing exercises Signup and view all the answers

Study Notes

Cholesterol and Coronary Artery Disease

Elevated cholesterol levels lead to plaque formation in arteries, primarily composed of lipids and fibrous tissue.
Angina, characterized by chest pain on exertion, is often caused by coronary arteriosclerosis.

Angina Classification and Nursing Diagnosis

Unstable angina presents with severe, prolonged pain typically at rest without precipitating factors.
Nursing diagnosis for angina discomfort includes ineffective cardiopulmonary tissue perfusion related to coronary artery disease (CAD).

Myocardial Infarction (MI) and Assessment

Delayed treatment during an MI increases myocardial infarction area, leading to more cardiac damage.
Acute coronary episodes are indicated by symptoms such as unrelieved chest pain and pale skin.

Surgical Procedures and Risk Factors

The greater saphenous vein is the most commonly used graft for coronary artery bypass grafting (CABG).
Metabolic syndrome, a cluster of risk factors including obesity and hypertension, significantly increases cardiovascular disease risk.

Client Education and Management in Cardiac Care

Clients should be taught to cease activity if experiencing chest pain, palpitations, or dyspnea.
Therapeutic lifestyle changes for high cholesterol include targeting low LDL and high HDL levels.

Pharmacotherapy in Cardiac Conditions

Common treatments for angina may include nitroglycerin; potential side effects include headaches or dizziness.
Morphine is part of the initial treatment for MI, following the MONA protocol (morphine, oxygen, nitroglycerin, aspirin).

Psychosocial Considerations

Addressing client anxieties and fears regarding cardiac procedures is essential for psychological well-being.
Educating clients and their families about coronary artery disease risk factors that can be modified, such as hypertension and smoking, is crucial.

Follow-Up and Postoperative Care

After procedures like PCI, maintaining a clear and open access site is vital; apply pressure to control bleeding if it occurs.
Monitoring urine output post-surgery is key; low output may indicate renal insufficiency and requires timely intervention.

Gender-Specific Symptoms in MI

Women may experience atypical symptoms during a myocardial infarction such as indigestion and nausea, alongside common signs like shortness of breath.

Cardiac Rehabilitation and Lifestyle

Engaging clients in cardiac rehabilitation and ensuring they participate in deep-breathing exercises post-surgery promotes recovery and effective airway clearance.
Clients should be made aware of their particular risk factors for CAD and empowered to make lifestyle changes accordingly.

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Description

This quiz focuses on the management of patients with coronary vascular disorders, based on key concepts from Chapter 23. It includes essential questions about cholesterol levels and plaque composition. Perfect for nursing students and healthcare professionals preparing for exams.