Podcast
Questions and Answers
What should the nurse focus on when developing a teaching plan for a 61-yr-old patient with multiple risk factors for coronary artery disease?
What should the nurse focus on when developing a teaching plan for a 61-yr-old patient with multiple risk factors for coronary artery disease?
Which nursing intervention is likely to be most effective for assisting a patient with coronary artery disease to make dietary changes?
Which nursing intervention is likely to be most effective for assisting a patient with coronary artery disease to make dietary changes?
Which assessment data suggest that a patient's chest pain is caused by an acute myocardial infarction (AMI)?
Which assessment data suggest that a patient's chest pain is caused by an acute myocardial infarction (AMI)?
Which information from a patient helps confirm a diagnosis of chronic stable angina?
Which information from a patient helps confirm a diagnosis of chronic stable angina?
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Which statement indicates effective teaching about sublingual nitroglycerin usage?
Which statement indicates effective teaching about sublingual nitroglycerin usage?
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Which statement indicates that further teaching is needed regarding the therapeutic lifestyle changes (TLC) diet?
Which statement indicates that further teaching is needed regarding the therapeutic lifestyle changes (TLC) diet?
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What should the nurse include when teaching about carvedilol (Coreg) in preventing anginal episodes?
What should the nurse include when teaching about carvedilol (Coreg) in preventing anginal episodes?
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Which laboratory test should the nurse monitor to determine if a patient has had an acute myocardial infarction (AMI)?
Which laboratory test should the nurse monitor to determine if a patient has had an acute myocardial infarction (AMI)?
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What action will the nurse take to evaluate the effectiveness of IV nitroglycerin in a patient with MI?
What action will the nurse take to evaluate the effectiveness of IV nitroglycerin in a patient with MI?
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Which question should the nurse ask to determine if a patient with an ST-segment-elevation myocardial infarction is a candidate for thrombolytic therapy?
Which question should the nurse ask to determine if a patient with an ST-segment-elevation myocardial infarction is a candidate for thrombolytic therapy?
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During thrombolytic agent administration, when should the nurse stop the drug infusion?
During thrombolytic agent administration, when should the nurse stop the drug infusion?
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Which nursing diagnosis is appropriate for a patient displaying anxiety after a myocardial infarction?
Which nursing diagnosis is appropriate for a patient displaying anxiety after a myocardial infarction?
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What statement indicates that additional preoperative teaching is needed for a patient scheduled for CABG surgery?
What statement indicates that additional preoperative teaching is needed for a patient scheduled for CABG surgery?
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What will they use during surgery to circulate blood?
What will they use during surgery to circulate blood?
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Where will the incisions be made during the vein removal?
Where will the incisions be made during the vein removal?
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What artery will be used to bypass the blocked area?
What artery will be used to bypass the blocked area?
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What medication will the patient need to take every day after surgery?
What medication will the patient need to take every day after surgery?
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When can sexual intercourse be resumed after a heart event?
When can sexual intercourse be resumed after a heart event?
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What is the appropriate timing for administering colesevelam (Welchol) in relation to other medications?
What is the appropriate timing for administering colesevelam (Welchol) in relation to other medications?
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What is the most important action to take when caring for a patient with a medication interaction risk?
What is the most important action to take when caring for a patient with a medication interaction risk?
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Which ECG change is most critical to report in a patient with chest pain?
Which ECG change is most critical to report in a patient with chest pain?
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What indicates that a patient recovering from an ST-segment-elevation myocardial infarction (STEMI) may be developing heart failure?
What indicates that a patient recovering from an ST-segment-elevation myocardial infarction (STEMI) may be developing heart failure?
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What is the primary purpose of captopril in a patient with chronic stable angina?
What is the primary purpose of captopril in a patient with chronic stable angina?
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Which patient requires immediate action by the nurse?
Which patient requires immediate action by the nurse?
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Study Notes
Coronary Artery Disease (CAD) and Acute Coronary Syndrome Overview
- Risk factors for CAD include elevated low-density lipoprotein (LDL) levels which should be prioritized in teaching.
- Nonmodifiable risk factors: family history, gender, and age.
- Dietary intervention aimed at modifying favorite high-fat recipes is more effective than strict dietary restrictions.
Chest Pain Assessment
- Chest pain lasting longer than 30 minutes typically indicates acute myocardial infarction (AMI).
- Pain relieved by nitroglycerin suggests stable angina, while reproducible pain may indicate musculoskeletal issues.
- Chronic stable angina is often relieved by rest or nitroglycerin administration.
Nitroglycerin Use and Patient Education
- Patients should call emergency services if chest pain persists despite taking three doses of nitroglycerin.
- Nitroglycerin does not directly prevent clot formation; it primarily improves blood flow.
- The correct use of nitroglycerin involves sitting down before administration to reduce cardiac workload.
Medications for Angina and Myocardial Infarction
- Carvedilol should not be abruptly discontinued due to the risk of increased angina.
- Troponin is the lab marker most indicative of an AMI, with levels rising 4 to 6 hours post-event.
- Diltiazem is effective for preventing coronary artery spasms in Prinzmetal's angina.
- Metoprolol monitoring is essential for hypotension and bradycardia risks.
Post-AMI Care and Complications
- Patients recovering from AMI should monitor for signs of complications such as pericarditis indicated by pain mitigation when leaning forward.
- Anxiety related to health status is common after AMI, necessitating appropriate nursing diagnoses.
- Long-term anticoagulation therapy is not routine following sudden cardiac death (SCD) without AMI evidence.
Discharge Planning and Lifestyle Modification
- The effectiveness of counseling regarding lifestyle changes can be measured by patients' activities without chest pain.
- Patients are often required to undergo additional diagnostic testing after SCD.
- Patients should be counseled regarding safe levels of physical activity, comparable to climbing two flights of stairs, before resuming sexual activity post-MI.
Patient Teaching for Medications
- Colesevelam (Welchol) should be given 2 hours apart from other medications to prevent absorption issues.
- Continuous education on dietary changes should reflect the therapeutic lifestyle changes diet, generally including monounsaturated fats.
Monitoring and Assessment During Treatments
- While monitoring IV nitroglycerin, assess chest pain for therapeutic effectiveness, along with vital stats.
- A drop in consciousness during thrombolytic therapy may suggest potential complications like intracranial bleeding.
Summary
- Effective management of CAD and AMI involves a comprehensive approach including risk factor modification, appropriate medication use, and ongoing patient education about changes in lifestyle and health understanding.### Aspirin and Colesevelam Interaction
- Concurrent use of aspirin and colesevelam may heighten gastrointestinal side effects like heartburn.
- Colesevelam is most effective when taken with meals.
Patient Care After Myocardial Infarction (AMI)
- Teaching for AMI patients should prioritize when cardiac rehabilitation will start.
- Emotional responses and complex medical information may be difficult to process due to anxiety or denial.
Pravastatin and Niacin Symptoms
- Generalized muscle aches when taking pravastatin indicate potential myopathy or rhabdomyolysis, necessitating medical evaluation.
- Other symptoms like dizziness, nausea, and flushing from niacin are less critical.
Emergency Department Medications
- Sildenafil (Viagra) presents immediate concerns if the patient needs nitrates due to severe hypotension risk from the combination.
Assessment Post-Bypass Grafting
- Pallor and weakness in the right hand post-cardiac bypass surgery highlight compromised blood flow and require urgent assessment.
Delegating Nursing Tasks
- Administering scheduled aspirin and lipid-lowering medications can be delegated to licensed practical/vocational nurses (LPNs/LVNs).
Important ECG Changes
- ST-segment elevation is a critical indicator of an ST-elevation myocardial infarction (MI) necessitating immediate intervention.
Significant Chest Pain Findings
- Severe chest pain after angioplasty suggests possible restenosis, needing swift nursing intervention.
Nursing Diagnoses in Cardiac Patients
- Decreased cardiac output due to cardiogenic shock is the priority diagnosis in patients displaying hypotension and tachycardia.
Initial Actions with NSTEMI
- The first action in admitting a non-ST-segment elevation myocardial infarction (NSTEMI) patient is placing them on a heart monitor to observe for dysrhythmias.
Thrombolytic Therapy Monitoring
- Continuous chest pain during thrombolytic therapy indicates ineffective treatment, requiring urgent reevaluation.
Complications After STEMI
- Crackles in lung bases post-ST-segment-elevation myocardial infarction suggest developing heart failure.
Delegating Teaching in Nursing Care
- Reinforcement of medication education can be delegated to LPNs/LVNs, while comprehensive teaching requires RN involvement.
Emergency Order Prioritization
- An electrocardiogram (ECG) is the first ordered test for a patient with chest pain to quickly assess for myocardial infarction.
Prioritizing Patient Assessments
- Patients returning from percutaneous coronary interventions (PCI) need immediate assessment to rule out hemorrhage from the access site.
Encouraging Physical Activity in Seniors
- Discussing preferred physical activities leads to better adherence to exercise regimens among older adults.
Purpose of Captopril in Cardiac Patients
- Captopril primarily aims to prevent ventricular remodeling in patients with chronic stable angina.
Risk Factor Modification for Coronary Artery Disease
- Educating patients about dietary changes to improve lipid levels is vital for reducing coronary artery disease risk.
Immediate Patient Care Needs
- Increased chest pain frequency in stable angina patients indicates potential unstable angina, warranting prompt intervention.
Communicating Critical Patient Findings
- Bilateral crackles indicate possible heart failure development, necessitating communication with healthcare providers for further management.
Studying That Suits You
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Description
Test your knowledge on coronary artery disease and acute coronary syndrome with this flashcard quiz. Designed specifically for nursing students, this quiz focuses on key concepts from Chapter 33 of Lewis Med-Surg. Enhance your understanding of risk factors and patient teaching plans related to CAD.
