Podcast
Questions and Answers
What is a potential complication of a cardiac catheterization procedure?
What is a potential complication of a cardiac catheterization procedure?
What nursing action should be taken if a client develops cardiac tamponade after a cardiac catheterization procedure?
What nursing action should be taken if a client develops cardiac tamponade after a cardiac catheterization procedure?
Which of the following is a potential complication of coronary artery bypass graft (CABG) surgery?
Which of the following is a potential complication of coronary artery bypass graft (CABG) surgery?
What nursing action should be taken if a client experiences hypothermia after CABG surgery?
What nursing action should be taken if a client experiences hypothermia after CABG surgery?
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What is the primary purpose of administering prophylactic antibiotics before CABG surgery?
What is the primary purpose of administering prophylactic antibiotics before CABG surgery?
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What is the most common cause of cardiovascular disease in the United States?
What is the most common cause of cardiovascular disease in the United States?
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Which of the following is an indication for CABG surgery?
Which of the following is an indication for CABG surgery?
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What is a potential complication of a femoral artery puncture during a cardiac catheterization procedure?
What is a potential complication of a femoral artery puncture during a cardiac catheterization procedure?
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Which of the following is NOT a risk factor for coronary artery disease (CAD)?
Which of the following is NOT a risk factor for coronary artery disease (CAD)?
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What post-procedure education should be provided to a client after a cardiac catheterization procedure?
What post-procedure education should be provided to a client after a cardiac catheterization procedure?
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What is the primary goal of medical management for patients with coronary artery disease?
What is the primary goal of medical management for patients with coronary artery disease?
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Which of the following medications may be administered pre-operatively for a CABG surgery?
Which of the following medications may be administered pre-operatively for a CABG surgery?
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Which of the following medications is used to reduce the oxygen demand of the myocardium?
Which of the following medications is used to reduce the oxygen demand of the myocardium?
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What is the primary nursing action to prevent pulmonary complications in a client after CABG surgery?
What is the primary nursing action to prevent pulmonary complications in a client after CABG surgery?
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What type of angina is characterized by chest pain that is predictable and consistent and can be relieved by rest or nitroglycerin?
What type of angina is characterized by chest pain that is predictable and consistent and can be relieved by rest or nitroglycerin?
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What is the significance of the “Time is muscle” concept in the management of acute coronary syndrome?
What is the significance of the “Time is muscle” concept in the management of acute coronary syndrome?
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Which of the following is NOT a component of the MONA treatment for acute myocardial infarction (MI)?
Which of the following is NOT a component of the MONA treatment for acute myocardial infarction (MI)?
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What is the purpose of deploying a stent during a percutaneous coronary intervention (PCI)?
What is the purpose of deploying a stent during a percutaneous coronary intervention (PCI)?
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What is the primary difference between bare-metal stents and drug-eluting stents?
What is the primary difference between bare-metal stents and drug-eluting stents?
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Which of the following is the correct definition of atherosclerosis?
Which of the following is the correct definition of atherosclerosis?
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Study Notes
Coronary Vascular Disorders Management
- Cardiovascular disease is the leading cause of death in the US for all racial and ethnic groups, male and female.
- Coronary artery disease (CAD) is the most prevalent type of cardiovascular disease in adults.
- Coronary atherosclerosis is the most common cause of cardiovascular disease in the US.
- Atherosclerosis is the abnormal accumulation of lipids and fibrous tissue in arterial walls.
- Pathogenesis begins with endothelial injury and progresses over years, possibly due to smoking, hypertension, and hyperlipidemia.
- Inflammation attracts macrophages, leading to stable or unstable plaque formation.
- Vulnerable plaque, thin fibrous cap with ongoing inflammation, can lead to acute myocardial infarction (MI).
- Clinical manifestations of CAD include angina (ischemia), sudden cardiac death, and diminished blood supply.
- Risk factors include elevated LDL cholesterol, metabolic syndrome (enlarged waist, elevated triglycerides, reduced HDL), hypertension, and type 2 diabetes.
Prevention and Risk Management
- Adults aged 20+ should have a fasting lipid profile every 5 years to control cholesterol abnormalities.
- Dietary modifications such as a Mediterranean diet, weight reduction, and increased physical activity are crucial.
- Medications like statins can lower lipids, and tobacco cessation programs are critical.
- Managing hypertension through early detection and adherence to therapeutic regimens prevent complications.
- Gender differences in symptom presentation and mortality rates for women compared to men should be considered.
Angina Pectoris
- Angina is the chest pain caused by increased oxygen demand during physical exertion, cold exposure, or heavy meals.
- Stable angina is predictable and responds to rest or nitroglycerin.
- Unstable angina is not relieved by rest or nitro, and may be a sign of impending MI.
- Variant angina has an unclear etiology but is associated with CAD.
Gerontologic Considerations
- Elderly patients may not always exhibit typical pain profiles. Age can diminish pain transmission.
Assessment and Diagnostic Findings
- 12-lead ECG is common for assessment.
Medical Management
- Medical management focuses on decreasing oxygen demand and increasing oxygen supply to the myocardium.
- Medications such as nitroglycerin (vasodilator), beta-blockers (e.g., metoprolol), antiplatelet drugs (e.g., aspirin, warfarin, clopidogrel), and calcium channel blockers (e.g., amlodipine, diltiazem) are often used.
- Percutaneous coronary intervention (PCI) procedures for opening blocked coronary arteries.
Acute Coronary Syndrome (ACS) and Myocardial Infarction (MI)
- MI is an emergent situation with acute myocardial ischemia and related myocardial death.
- ACS includes unstable angina, non-ST-segment elevation MI (NSTEMI), and ST-segment elevation MI (STEMI).
- Reduced blood flow from ruptured atherosclerotic plaques, clot formation, and pain are key features.
- "Time is muscle" highlights the urgency of treatment.
- Clinical manifestations include sudden and persistent chest pain, nausea, anxiety, cool/pale skin, and possible T-wave inversion.
- Laboratory testing involves monitoring troponin, creatine kinase (CK), and myoglobin levels for diagnosis.
MI Medical Management (MONA)
- MONA (Morphine, Oxygen, Nitroglycerin, Aspirin) is a crucial treatment approach.
- Obtaining a 12-lead ECG immediately.
- Administration of angiotensin-converting enzyme (ACE) inhibitors within 24 hours.
- Anticoagulation with heparin and platelet inhibitors.
Percutaneous Coronary Intervention (PCI) Procedures
- PCI involves opening coronary arteries using atherectomy (shaving or laser) and/or stent placement (bare-metal or drug-eluting).
- Percutaneous transluminal coronary angioplasty (PTCA) uses balloon inflation to widen arteries and can involve stent placement.
PCI Complications
- Complications include artery dissection (perforation), cardiac tamponade, hematoma formation, allergic reactions, external bleeding, emboli, and retroperitoneal bleeding.
Nursing Actions - PCI Post Procedure
- Immediate post-procedure actions involve monitoring site for bleeding, applying pressure, maintaining leg/arm straightness, and assessing for potential allergic reactions.
Coronary Artery Bypass Grafts (CABG)
- CABG is invasive surgery restoring myocardial vascularization, often indicated for severe CAD.
- Pre-procedure involves informed consent, baseline assessments, and administration of pre-operative medications (e.g., anxiolytics, prophylactic antibiotics, anticholinergics).
- Post-procedure nursing actions include maintaining airway, managing ventilation, splinting incisions, pain management (treating angina), and diet.
CABG Complications
- Post-CABG complications include pulmonary issues (atelectasis, pneumonia, pulmonary edema), hypothermia, decreased cardiac output, hypovolemia, electrolyte disturbances, neurologic deficits, and more.
- Nursing interventions focus on addressing these complications (e.g., turning, deep breathing exercises, warming measures).
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Description
This quiz focuses on the management of coronary vascular disorders, particularly coronary artery disease (CAD). It covers the pathogenesis, clinical manifestations, and risk factors associated with CAD, including lifestyle and biological contributors. Test your knowledge on this critical aspect of cardiovascular health.
