Management of Coronary Vascular Disorders Chapter 23

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Questions and Answers

What is atherosclerosis?

Atherosclerosis is an abnormal accumulation of lipid [or fatty substances] and fibrous tissue in the lining of arterial blood vessel walls.

What is angina pectoris?

Angina pectoris is a clinical syndrome usually characterized by episodes of pain (or pressure) in the anterior chest. It is usually caused by atherosclerotic disease.

Which of the following is NOT a modifiable risk factor for atherosclerosis?

Family history of CAD (correct)

Hyperlipidemia

Smoking

Obesity

What is the primary cause of angina pectoris?

Reduced blood flow to the heart muscle due to narrowing or blockages in the coronary arteries Signup and view all the answers

What is the most concerning side effect of administering nitroglycerin to a patient with chest pain?

Blood pressure of 86/58 mm Hg Signup and view all the answers

Stable angina is characterized by unpredictable and inconsistent pain.

False Signup and view all the answers

Silent angina is a type of angina that causes severe chest pain.

False Signup and view all the answers

Which of the following is NOT a trigger for angina?

Deep sleep Signup and view all the answers

Match the type of angina with its description:

Stable angina = Pain may be more severe and last longer than stable angina, and may not go away with rest or medication. Unstable angina = It has predictable (i.e., expected frequency) and consistent (i.e., expected severity) pain, and usually lasts a short time (5 minutes or less). Pain goes away with rest or medication. Variant (Prinzmetal's) angina = Occurs without the typical symptoms of chest pain or discomfort. Detected during routine tests, such as an ECG or stress test. Silent angina = Rare type of angina that occurs at rest, often in the middle of the night. Caused by a spasm of the coronary arteries, rather than a blockage. Signup and view all the answers

Describe the nursing process steps for managing a patient with angina pectoris.

The nursing process for managing a patient with angina pectoris includes assessment, diagnosis, planning, implementation, and evaluation. Signup and view all the answers

What is a potential complication of untreated angina?

All of the above Signup and view all the answers

Study Notes

Management of Patients with Coronary Vascular Disorder, Atherosclerosis & Angina Pectoris

The topic is the management of patients with coronary vascular disorder, atherosclerosis, and angina pectoris
The speaker is Hanan Abdelrahman, RN, PhD, assistant professor at Sultan Qaboos University
This is chapter 23 of a course

Learning Outcomes

Learners will be able to describe the pathophysiology of coronary vascular disorders, including atherosclerosis and angina pectoris
Learners will list clinical manifestations of coronary vascular disorders, including atherosclerosis and angina pectoris
Learners will discuss treatment for coronary vascular disorders, including atherosclerosis and angina pectoris
Learners will use the nursing process as a framework for patient care of coronary vascular disorders, including atherosclerosis and angina pectoris

Atherosclerosis

Atherosclerosis is an abnormal buildup of lipid (or fatty substances) and fibrous tissue in the lining of arterial blood vessel walls
This buildup blocks and narrows coronary vessels, reducing blood flow to the myocardium

Pathophysiology

Atherosclerosis progression occurs in stages, beginning with endothelial injury (A)
Followed by monocyte emigration and smooth muscle proliferation (B and C)
This then develops into a fatty streak (D), followed by a fibrofatty atheroma (E)

Progression of Atherosclerosis

Atherosclerosis progresses over time, with fatty streaks initially developing
This is followed by fibrous plaque formation
Over time, the plaque can become complicated, including ulceration, hemorrhage, and calcification
These complications can lead to critical events like myocardial infarction, stroke, and gangrene

Risk Factors

Modifiable: Hyperlipidemia, smoking, hypertension, diabetes mellitus, obesity, physical inactivity
Non-modifiable: Family history of coronary artery disease (CAD), increasing age, gender, race

Clinical Manifestations

Symptoms and complications of atherosclerosis stem from vessel obstruction
Decreased blood flow to the cardiac muscle causes muscle injury/less oxygen, angina pectoris, chest pain
Cardiac ischemia, low cardiac output, heart failure, and sudden death are possible outcomes

Management of Atherosclerosis

Lifestyle changes: Healthy diet, regular physical activity, smoking cessation
Medications: Cholesterol-lowering medications (statins), blood pressure medications (ACE inhibitors, beta-blockers, calcium channel blockers), Aspirin
Procedures: Angioplasty, stenting, coronary artery bypass surgery

Angina Pectoris

Angina pectoris is a clinical syndrome characterized by episodes of chest pain or pressure, usually caused by atherosclerosis
It's often associated with significant obstruction of at least one major coronary artery
Angina is commonly triggered by physical exertion, cold exposure, eating a heavy meal, or stress

Causes & Pathophysiology of Angina

Reduced blood flow to the heart muscle due to narrowing or blockages in the coronary arteries
Buildup of plaque (fatty deposits) on the artery walls (atherosclerosis)

Risk Factors of Angina

Age, family history of heart disease, smoking, high blood pressure, high cholesterol, diabetes, sedentary lifestyle, stress, obesity
Other medical conditions (kidney disease, peripheral artery disease, rheumatoid arthritis)

Triggers of Angina

Physical exertion, exposure to cold, eating a heavy meal, stress and emotional situations

Types of Angina

Stable: Predictable, consistent pain, usually short lasting; relieved with rest or medication
Unstable: Occurs at rest or with minimal exertion, more severe and prolonged, may not go away with rest or medication; requiring immediate intervention
Variant (Prinzmetal's): Occurs at rest, often at night, caused by coronary artery spasm (not a blockage)
Silent: Occurs without typical symptoms

Clinical Manifestations of Chest Pain

Symptoms can include, chest pain, shortness of breath, nausea, vomiting, pallor and diaphoresis and epigastric pain
Angina chest pain may be described as a sensation of tightness, choking, or heaviness
Pain often radiates to the neck, jaw, shoulders, back, or arms (often the left arm)
Anxiety is common

Characteristics of Angina Chest Pain

Pain is often retrosternal
Pain may radiate to (neck, jaw, shoulders, back, arms)
Usually accompanied by anxiety
Pain subsides with rest or nitroglycerin
Unstable angina is characterized by increasing frequency and severity of pain, not relieved by rest or medication, requiring emergency care

Assessment and Diagnostic Findings

Health history
Cardiac biomarkers
ECG
Stress test
Echocardiography
Cardiac catheterization/Angiography

Management of Angina

Lifestyle changes: Regular exercise, heart-healthy diet, smoking cessation, stress reduction
Medications: Nitroglycerin to relieve pain, beta-blockers to reduce the workload on the heart, calcium channel blockers to relax blood vessels, statins to lower cholesterol
Procedures: Angioplasty, stenting, coronary artery bypass surgery
Urgent medical care is necessary for unstable angina

Complications of Angina Pectoris

Heart attack, heart failure, arrhythmias, stroke, anxiety and depression, sudden death

Nursing Process for Patient with Angina Pectoris

Assessment: Patient history, vital signs, symptoms, medications
Diagnosis: Ineffective tissue perfusion, acute pain, anxiety
Planning: Medication administration, monitoring vital signs, education.
Implementation: Administer medications, monitor symptoms and vital signs, provide education and emotional support
Evaluation: Monitor effectiveness of the care plan, modify as needed.

Additional Information

Self-administration of nitroglycerin should be detailed for patients.
Always refer to the chart in question for specific details about procedure instructions.

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Description

This quiz focuses on chapter 23 regarding the management of patients with coronary vascular disorders, atherosclerosis, and angina pectoris. Learners will explore the pathophysiology, clinical manifestations, and treatment strategies for these conditions, guided by the nursing process. Enhance your understanding and application of care using evidence-based practices.