Peripheral Artery Disease and Angina Quiz
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Questions and Answers

Which intervention is the priority for a patient experiencing acute limb ischemia?

  • Elevating the affected limb to promote venous return.
  • Encouraging range-of-motion exercises to improve muscle function.
  • Administering anticoagulants to prevent further thrombus formation. (correct)
  • Applying warm compresses to the affected limb to improve circulation.

    • A patient with peripheral artery disease (PAD) reports pain in their calf that occurs with exercise and is relieved by rest. What term appropriately describes this symptom?

  • Acute limb ischemia
  • Rest pain
  • Intermittent claudication (correct)
  • Deep vein thrombosis

    • Which of the following is a non-modifiable risk factor for peripheral artery disease?

  • Age (correct)
  • Smoking
  • Hypertension
  • Hyperlipidemia

    • What is the rationale for keeping the affected extremity level or slightly dependent in patients with peripheral arterial disease?

    <p>To enhance arterial blood flow. (B)</p> Signup and view all the answers

    Following an angioplasty and stent placement in the superficial femoral artery, what should the nurse monitor to assess for potential complications?

    <p>Development of cyanosis and diminished pulses in the treated extremity. (B)</p> Signup and view all the answers

    What should be done if pain is not relieved after administering nitroglycerin?

    <p>Call 911 (B)</p> Signup and view all the answers

    What precaution should be taken when applying nitroglycerin patches or pastes?

    <p>Wear gloves (B)</p> Signup and view all the answers

    Which of the following actions is advised before administering beta blockers?

    <p>Consult an MD if blood pressure is below 90 systolic (C)</p> Signup and view all the answers

    What is a primary characteristic of unstable angina?

    <p>It is a change from previously stable anginal episodes (C)</p> Signup and view all the answers

    Which medication may not be effective in women for treating angina?

    <p>Antianginal agent (ranolazine) (C)</p> Signup and view all the answers

    What is the primary difference between arteriosclerosis and atherosclerosis?

    <p>Arteriosclerosis is a natural aging process, whereas atherosclerosis is typically due to lifestyle factors. (A)</p> Signup and view all the answers

    Which of the following is a modifiable risk factor for coronary artery disease?

    <p>Hypertension (C)</p> Signup and view all the answers

    What is the role of statins in managing cholesterol levels?

    <p>They are the first line agents to decrease cholesterol production by the liver. (C)</p> Signup and view all the answers

    What is a common symptom of angina besides chest pain?

    <p>Sense of impending doom (B)</p> Signup and view all the answers

    What should be done if chest pain is unrelieved or worsening after taking nitroglycerin?

    <p>Call 911 and take a second nitroglycerin dose immediately. (A)</p> Signup and view all the answers

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

    <p>Regular exercise (A)</p> Signup and view all the answers

    Which laboratory test is crucial in the data collection for patients with atherosclerosis?

    <p>Serum lipid levels (D)</p> Signup and view all the answers

    What lifestyle changes are recommended for patients at risk of coronary artery disease?

    <p>Adopt a heart-healthy diet. (C)</p> Signup and view all the answers

    What is a potential side effect of using statins that patients need to be aware of?

    <p>Muscle pain (B)</p> Signup and view all the answers

    Which of the following statements about aortic aneurysms is true?

    <p>They can lead to serious complications if they rupture. (C)</p> Signup and view all the answers

    Which types of myocardial infarction are identified based on ECG changes?

    <p>ST-Elevation MI and Non-ST Elevation MI (A)</p> Signup and view all the answers

    What is NOT a common sign or symptom of myocardial infarction?

    <p>Extreme euphoria (C)</p> Signup and view all the answers

    What is the primary diagnostic test for peripheral arterial disease?

    <p>Ankle-brachial index test (C)</p> Signup and view all the answers

    Which of the following is a risk factor for developing an abdominal aortic aneurysm?

    <p>Congenital abnormalities (C), High blood pressure (D)</p> Signup and view all the answers

    An individual with peripheral arterial disease may NOT experience which symptom?

    <p>High blood pressure (D)</p> Signup and view all the answers

    What medication type is used as a therapeutic measure for myocardial infarction?

    <p>Antiplatelets (C)</p> Signup and view all the answers

    Which of the following is a sign of Raynaud’s phenomenon?

    <p>Pallor or cyanosis in fingers (D)</p> Signup and view all the answers

    What is considered a typical sign of venous insufficiency?

    <p>Brownish discoloration of lower extremities (A)</p> Signup and view all the answers

    What should be monitored post-operatively after an aneurysm repair?

    <p>Circulation, movement, and sensation in lower extremities (D)</p> Signup and view all the answers

    What condition is characterized by dilated, twisted veins?

    <p>Varicose veins (B)</p> Signup and view all the answers

    Which of the following is a potential complication of myocardial infarction?

    <p>Both B and C (A)</p> Signup and view all the answers

    What lifestyle modification is recommended for managing peripheral arterial disease?

    <p>Smoking cessation (D)</p> Signup and view all the answers

    In client education regarding myocardial infarction, which aspect is essential to cover?

    <p>Risk factors for heart disease (D)</p> Signup and view all the answers

    Flashcards

    Occlusive Cardiovascular Disorders

    Conditions that block or narrow blood vessels, reducing blood flow.

    Nursing Care

    The comprehensive care provided to patients by nursing professionals.

    Symptoms of Occlusion

    Signs indicating reduced blood flow, like pain or swelling in limbs.

    Risk Factors

    Conditions or behaviors that increase the likelihood of cardiovascular disorders.

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    Treatment Approaches

    Strategies used to alleviate occlusive disorders, often including medications or surgeries.

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    Nitroglycerin

    A medication used to prevent anginal attacks by dilating blood vessels.

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    Nitrate Contraindications

    Nitrates are contraindicated in patients with certain cardiovascular dysfunctions.

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    Angina

    Chest pain due to reduced blood flow to the heart, often relieved by rest or nitroglycerin.

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    Acute coronary syndrome

    A term encompassing unstable angina and myocardial infarction, indicating severe heart distress.

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    Monitoring Blood Pressure

    Essential before administering beta blockers or calcium channel blockers; hold if systolic BP < 90 or pulse < 60.

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    Arteriosclerosis

    Thickening and rigidity of arterial walls due to aging.

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    Atherosclerosis

    Buildup of plaque within artery walls, leading to narrowed arteries.

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    Coronary Artery Disease (CAD)

    A type of atherosclerosis specifically affecting the coronary arteries.

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    Modifiable Risk Factors

    Lifestyle factors that can be changed to reduce CAD risk.

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    Non-Modifiable Risk Factors

    Unchangeable factors such as age, gender, and genetics that affect CAD risk.

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    Symptoms of Angina

    Chest pain, dyspnea, pallor, and diaphoresis caused by heart muscle hypoxia.

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    Health Teaching for CAD

    Education on tobacco cessation, diet control, and monitoring blood pressure.

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    Statins

    First-line medications for lowering cholesterol by reducing liver production.

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    Efficacy of Medications

    Medications for CAD may take 4-6 weeks to show effects.

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    Unstable Angina

    Angina pain that changes patterns, occurs more frequently and severely, or at rest.

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    Myocardial Infarction

    Sudden blockage in the heart leading to death of heart muscle tissue.

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    STEMI vs Non-STEMI

    STEMI is a heart attack with ST elevation, while Non-STEMI indicates no ST elevation.

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    Signs of Myocardial Infarction

    Symptoms include crushing pain, shortness of breath, dizziness, and sweating.

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    Diagnosis of MI

    Diagnosis is based on patient history, ECG, and cardiac markers.

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    MI Therapeutic Interventions

    Main treatments include antiplatelets, nitrates, and beta blockers.

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    Peripheral Arterial Disease

    Chronic narrowing of arteries causing ischemia, often due to atherosclerosis.

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    Signs of Peripheral Arterial Disease

    Symptoms include claudication pain, pale skin, diminished pulses, and cold extremities.

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    Raynaud’s Phenomenon

    Vasospasm causing color changes and pain in fingers due to cold or stress.

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    Aneurysms

    Dilations in artery walls that pose risks of rupture and bleeding.

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    Abdominal Aortic Aneurysm Symptoms

    Symptoms may include back pain, nausea, and a pulsating abdominal mass.

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    Varicose Veins

    Dilated veins caused by valve defects, leading to pain and swelling.

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    Venous Insufficiency

    Chronic condition with blood pooling in the legs due to valve dysfunction.

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    Stasis Ulcers

    Ulcers caused by chronic venous insufficiency and pressure.

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    Study Notes

    Nursing Care of Patients with Occlusive Cardiovascular Disorders

    • Objectives: Focus on pathophysiology, data collection, medications, evidence-based therapy, and health teaching for conditions like arterio/atherosclerosis, acute coronary syndrome, unstable angina, myocardial infarction, peripheral arterial disease, varicose veins/venous insufficiency, and aneurysms.

    Arterio/Atherosclerosis

    • Arteriosclerosis: Thickening and rigidity of arterial walls due to aging.
    • Atherosclerosis: Plaque buildup within artery walls.
    • Coronary Artery Disease (CAD): Atherosclerosis affecting coronary arteries. (Ch 24, p 378)

    Atherosclerosis/CAD Risk Factors

    • Modifiable: Diabetes mellitus, hypertension, high cholesterol (high LDL), high homocysteine, excessive alcohol, stress, obesity, sedentary lifestyle, tobacco use (including exposure to second-hand and third-hand smoke).
    • Non-Modifiable: Age, ethnicity, gender, genetics. (Ch 24, table 24.1, p 378)

    Atherosclerosis/CAD Data Collection

    • Serum lipid levels (total cholesterol, low-density lipoproteins).
    • Cardiac angiography.
    • Signs and symptoms (angina, dyspnea on exertion). (Ch 24, pp 378, 379)

    Atherosclerosis/CAD-Evidence Based Therapeutic Measures

    • Lifestyle modification (diet, smoking cessation, exercise).
    • Medications (may take 4-6 weeks to show effect; injectable monoclonal antibodies for chromosomal deficiency). (Ch 24, p 379)

    Atherosclerosis/CAD-Medications

    • Statins (HMGOA reductase inhibitors): First-line agent to lower cholesterol; decrease cholesterol production by the liver; monitor liver function tests; monitor for rhabdomyolysis; teach to take in the evening and report unexplained muscle pain.
    • Others: Niacin, fibrates, cholesterol absorption inhibitors. (Ch 24, table 24.3, p 379)

    Health Teaching

    • Prevention of tobacco use and exposure (second-hand, third-hand smoke); resources from the American Cancer Society.
    • Control of cholesterol and blood pressure; monitor blood pressure; cardiac rehabilitation. (Ch 24, p 379)

    Angina

    • Chest pain caused by hypoxia to heart muscle (squeezing, pressure, burning, or heaviness).
    • May radiate to neck, arms, shoulders, jaw or back (may occur without chest pain, especially in women).
    • Other symptoms: dyspnea, pallor, diaphoresis, sense of impending doom, heaviness in the arm. (Ch 24, p 380)

    Nitroglycerin

    • Sublingual, buccal sprays, intravenous infusion (for acute angina).
    • If pain unrelieved or worsens after 5 minutes, take additional nitroglycerin and call 911.
    • If pain is not totally relieved, but not worsening, take one tablet every 5 minutes, for three doses; call 911 if pain still unrelieved.
    • Nitroglycerin patches/pasts used for prevention; remove them for 10-12 hours a day; wear gloves while applying and dispose of properly; avoid use with erectile dysfunction medications.
    • Teaching: Keep in original brown bottle; protect from light, heat, moisture; replace every six months for continued potency. Use before activities that may cause chest pain; sit/lie down if possible before taking; monitor blood pressure before and after administration. (Ch 24, tables 24.4, 24.5, p 381)

    Angina - Other Medications

    • Antiplatelets (aspirin, clopidogrel, ticaglor).
    • Beta blockers (for exertional angina); consult MD if BP below 90 systolic or pulse below 60 before administering.
    • Calcium channel blockers; hold if systolic BP below 90 or pulse below 60.
    • Antianginal agent (ranolazine) may not be effective in women.
    • Statins. (Ch 24, table 24.4, p 381)

    Acute Coronary Syndrome

    • Unstable angina: Any change in pattern from previously stable anginal episodes.
    • Myocardial infarction (heart attack): Ischemia (injury) to heart muscle; Silent ischemia may occur without pain (especially in women and geriatrics); infarction (death) of heart muscle. (Ch 24, p 384)

    Unstable Angina

    • Any change in a previous pattern of anginal pain.
    • Takes longer to resolve.
    • Occurs more often and with less activity.
    • Increased severity.
    • Occurs at rest.
    • Requires more nitroglycerin to relieve.
    • Also referred to as pre-infarction angina. (Ch 24, p 384)

    Myocardial Infarction (Heart Attack)

    • Sudden partial or complete blockage leads to death of myocardial tissue.
    • Two types: ST-Elevation MI (STEMI) and Non-ST Elevation MI (non-STEMI).

    Myocardial Infarction (MI) - Signs and Symptoms

    • Crushing, viselike pain, radiating to arm/shoulder/neck/jaw.
    • Shortness of breath, restlessness, dizziness and fainting, nausea, and sweating. (Ch 24, table 24.6, p 386)

    Myocardial Infarction (MI) - Diagnosis

    • Consider patient history.
    • Serial ECG.
    • Cardiac troponin I or T, CK-MB.
    • Potassium, magnesium.
    • Vital signs, O2 saturation. (Ch 24, table 24.6, p 386)

    Myocardial Infarction (MI) - Therapeutic Interventions

    • Antiplatelets, oxygen, nitrates, anticoagulants, beta blockers, statins. (Ch 24, p 387)

    Myocardial Infarction (MI) - Revascularization Therapy

    • Percutaneous coronary intervention (PCI) with stents.
    • Thrombolytics. (Ch 24, p 387)

    Myocardial Infarction (MI) - Additional Interventions

    • Daily weights, bedrest with bedside commode/bathroom privileges, low sodium diet (no caffeine).
    • Cardiac rehabilitation. (Ch 24, table 24.6, p 386)

    Myocardial Infarction (MI) - Complications

    • Arrhythmias, heart failure, cardiogenic shock, valvular insufficiency.

    Women and Heart Disease

    • Leading cause of death; myocardial infarctions (compared to men), older age, higher mortality rate, more complications (possibly due to delay in seeking treatment).
    • Atypical symptoms: extreme fatigue, epigastric pain, lower jaw pain, nausea/vomiting/dyspnea, unusual fatigue, shortness of breath, sleep disturbances.

    Gerontologic Issues

    • May not experience chest pain.
    • May experience shortness of breath, syncope, falls, restlessness.
    • Fewer complications compared to younger infarction survivors.

    Client Education

    • Disease, diet, medications, lifestyle modifications.
    • Myocardial infarctions can affect all aspects of clients' lives; anxiety about resuming sexual activities.
    • Nitroglycerin can be taken before activities like intercourse to prevent pain.
    • Most people are safe to resume normal activities after 1-2 months or when able to climb two flights of stairs without chest pain.

    Cardiac Rehab

    • Begins once acute symptoms subside; gradual increase in activity according to protocols (phase 1).
    • Outpatient rehab continues for 4-6 weeks (phase 2), focusing on returning to previous level of function.
    • Clients encouraged to continue lifestyle modifications, exercise and weight loss (phase 3).

    Peripheral Arterial Disease

    • Chronic, progressive narrowing of arterial lumen.
    • Usually caused by atherosclerosis; ischemia develops.

    Peripheral Arterial Disease - Signs and Symptoms

    • Pain (intermittent claudication); cramping pain in calves during activity, relieved by rest.
    • Pallor when elevated above heart level, dependent rubor (res-purple or cyanotic skin in dependent position).
    • Pulses diminished, progressing to pulselessness; paresthesia (numbness, tingling, burning); poikilothermy (cold extremities).

    Peripheral Arterial Disease - Additional Symptoms

    • Taut, shiny skin; thick, brittle nails; hair loss on feet, ankles, and calves; loss of muscle mass in legs.

    Peripheral Arterial Disease - Diagnostic Tests

    • Ankle-brachial index test; pressures in thigh and calf usually higher than in arm; lower pressure indicates peripheral arterial disease.
    • Arterial duplex ultrasound.
    • Exercise stress test.

    Peripheral Arterial Disease - Therapeutic Measures

    • Lifestyle modifications (smoking cessation, exercise); statins; cilostazol; invasive procedures (angioplasty, stenting, threctomy, femoral aortic bypass graft).

    Peripheral Arterial Disease - Nursing Interventions

    • Monitor quality of peripheral pulses, capillary refill time, color, presence of edema.
    • Maintain extremities lower than the heart; avoid bending knees, pillows under knees, prolong standing or crossing legs.

    Raynaud's Phenomenon

    • Excessive vasospasm in response to stress or cold; occurs primarily in fingers.
    • Signs and symptoms: pain, pallor or cyanosis with vasospasms; tingling, burning, reddening of digits as circulation returns.
    • Episodes last about 15 minutes.
    • Interventions: Keep hands warm; avoid vasoconstricting substances like caffeine, nicotine, decongestants, alcohol, and emotional stress.
    • Medications: Nitrates, calcium channel blockers (if symptoms unrelieved).

    Aneurysms

    • Dilation of a weakened area in an artery wall.
    • Risk factors: atherosclerosis, hypertension, smoking, trauma, congenital abnormalities, heredity.

    Abdominal Aortic Aneurysm

    • Incidence increases with age; men over 50 have highest risk of death from bleeding or rupture.
    • Elective repair before rupture/dissection improves mortality.
    • Dissection: separation of artery wall layers; blood enters between layers, expanding aneurysm, increasing risk of rupture.

    Abdominal Aortic Aneurysm - Signs and Symptoms

    • None, back, flank, or abdominal pain, nausea/feeling of fullness (can be relieved by position changes), pulsating abdominal mass, bruit, thrill.
    • Do not palpate.

    Abdominal Aortic Aneurysm - Diagnostic Tests

    • Ultrasound, CT scan, aortography.

    Abdominal Aortic Aneurysm - Therapeutic Measures

    • Monitor aneurysm size, maintain normal blood pressure, beta blockers, surgical repair or graft, smoking cessation, no heavy lifting.

    Abdominal Aortic Aneurysm - Complications

    • Rupture (surgical emergency), hemorrhage, shock.

    Abdominal Aortic Aneurysm - Nursing Process Following Aneurysm Repair

    • Monitor neurovascular status (circulation, movement, and sensation); detect reduced blood flow; avoid ischemia.
    • Measure abdominal girth or detect slow bleed or hematoma.
    • Monitor CBC.

    Varicose Veins

    • Dilated, twisted, elongated veins, usually due to structural defects in veins (incompetent vein valves).
    • Etiologies: obesity, prolonged standing, pregnancy, anything that increases pressure in lower extremities.

    Varicose Veins - Signs and Symptoms

    • Superficial: telangiectasis (spider veins); moderately severe: dull pain/cramping/heaviness in legs (especially after prolonged standing); may be relieved by ambulation or elevation of extremities; edema, ulcers.

    Varicose Veins - Therapeutic Interventions

    • Compression stockings, elevation, exercise; measures to remove/decrease varicosity appearance(injection sclerotherapy, laser or light therapy, laser ablation).

    Venous Insufficiency

    • Chronic pooling of blood in lower extremities; signs and symptoms: edema, brownish discoloration of lower extremities, venous stasis ulcers; dys-functional valves impair venous return, increasing venous pressure; ulcerations are common at medial malleolus and difficult to cure; affects quality of life.

    Venous Insufficiency - Therapeutic Measures

    • Compression, elevation, avoiding prolonged standing/sitting, elevate foot of bed, exercise, do not cross legs, do not wear constricting clothing.

    Stasis Ulcers - Therapeutic Interventions

    • Topical antibiotics, zinc oxide, compression dressings (Una boots), skin grafts.

    Vascular Surgery: Post-Operative Care

    • Monitor neurovascular status (circulation, motion, sensitivity) every 1-4 hours.
    • Rationale: to detect compromised circulation that can lead to ischemia, necrosis.
    • Avoid constriction of extremities (tight dressings, tape) to prevent reduction in blood flow.
    • Assist with ambulation as ordered to decrease immobility complications and increase blood flow.

    Neurovascular vs. Neurological Checks

    • Neurovascular: Movement, sensation (numbness/tingling), vascular (pulses, capillary refill, color, temperature).
    • Neurological: Level of consciousness (Glasgow coma score); orientation; ability to follow commands; pupil response.

    Review

    • Artherosclerosis, coronary artery disease, angina, myocardial infarction, peripheral arterial disease, aneurysms, varicose veins, venous insufficiency.

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    Nursing Care of Patients with Occlusive Cardiovascular Disorders Chapter 24 PDF

    Description

    Test your knowledge on critical care for patients with Peripheral Artery Disease (PAD) and angina. This quiz covers topics including treatment interventions, symptoms, risk factors, and medication guidelines. Perfect for nursing and healthcare students seeking to enhance their understanding of cardiovascular conditions.

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