081-PP02L021 ELO B_Coronary Artery Disease _V 2.0_.pdf

DISORDERS OF THE HEART NP02L021 ELO B · Version 2.0 Coronary Artery Disease Foundations and Adult Health Nursing, 8th ed., pp. 1535-1546 TERMINAL LEARNING OBJECTIVE Determine nursing care for a patient with a disorder of the heart without error. LEARNING STEP ACTIVITY Explain the care for patient...

DISORDERS OF THE HEART NP02L021 ELO B · Version 2.0 Coronary Artery Disease Foundations and Adult Health Nursing, 8th ed., pp. 1535-1546 TERMINAL LEARNING OBJECTIVE Determine nursing care for a patient with a disorder of the heart without error. LEARNING STEP ACTIVITY Explain the care for patients diagnosed with coronary artery disease. RISK FACTORS 1. Indicate predispositions for developing cardiovascular disease 2. Presence of more than one risk factor is associated with an increased risk for developing cardiovascular disease NON-MODIFIABLE Family History Age Gender Ethnicity MODIFIABLE RISK FACTORS Smoking (vasoconstriction) Lipids (VLDL, LDL, HDL) Hypertension (> 140/90 mmHg) Physical activity (improve heart effiency) Obesity (increase workload) Diabetes (damage to arterial intima) Stress (catecholamines / vasoconstriction) Psychosocial factors (Type D personality) CORONARY ATHEROSCLEROTIC Coronary artery disease is a term used to describe a variety of conditions Atherosclerosis is the basic underlying disease Develops over a prolonged period of time Severity of the disease ACTIVITY Choose a patient (a loved one, friend, or yourself) List modifiable and non-modifiable risk factors for the development of cardiovascular disease. Identify patient teaching to decrease risks. ANGINA PECTORIS & MYOCARDIAL INFARCTION ETIOLOGY/PATHOPHYSIOLOGY Angina means a spasmodic, cramp like, choking feeling. Pectoris refers to the breast or chest area. Decreased or lack of oxygen to the myocardium Oxygen demand exceeds supply = ischemia  ETIOLOGY/PATHOPHYSIOLOGY Oxygen consumption or demand (HR) Contractility (BP) Afterload Preload Hypertension Stress Oxygen consumption Strenuous Activity Smoking Oxygen Supply Atherosclerosis CAUSES FOR ANGINA DECREASE IN BLOOD FLOW INCREASE OXYGEN DEMAND Vasospasm Increase heart rate Stenosis Elevated blood pressure Thrombosis Increased preload and afterload MYOCARDIAL INFARCTION MYOCARDIAL INFARCTION Necrosis (death) of heart muscle Caused by obstruction of a major coronary artery or one of its branches A decrease in blood flow or supply such as vasospasm MYOCARDIAL INFARCTION Paroxysmal, spasmodic thoracic pain and choking feeling caused by decreased oxygen or anoxia of the myocardium COMPARE AND CONTRAST Clinical Manifestations – Angina pectoris Pain is the outstanding characteristic of angina pectoris. Pain is described as a heaviness or tightness and may be confused with indigestion. Patient may describe the pain as "gas" or "heartburn" or "something sitting on my chest." Transient attack of retrosternal, substernal, or precordial pain that may radiate to the left shoulder and arm. Women often complain of pain or squeezing on the left side of the chest or pain in the abdomen, mid back or scapular area. Other symptoms you may notice are dyspnea, pallor, diaphoresis, faintness, palpitations, and dizziness. COMPARE AND CONTRAST Clinical Manifestations – Myocardial Infarction (MI) Associated with irreversible ischemia/like angina pectoris Chest pain - usually is more severe than during an angina attack Pain is prolonged lasting 30 minutes to hours and is unrelieved by nitroglycerin tablets Pain is described as “crushing” or viselike, like something heavy is sitting on the chest In men, it often radiates down the left arm, jaw, teeth, and epigastric area Early signs of acute MI in women are unusual fatigue, sleep disturbances, shortness of breath, weakness, anxiety and indigestion  ASSESSMENT SUBJECTIVE OBJECTIVE Pain (onset, location, quality, duration, Observation of patient behavior radiation) Shortness of Breath VS: Hypotension, tachycardia, thready pulse, elevated temperature Dizziness RR: Labored Anxiety, Fear Cardiac dysrhythmias Weakness; Unusual fatigue Skin: Ashen color, cool, clammy, diaphoresis Measures to relieve pain Vomiting Precipitating factors Diagnostic Tests DIAGNOSTIC TESTS - ANGINA Interpreting the data may include those tests that lead to a diagnosis of angina The diagnosis is frequently based on patient history EKG for transient ischemic changes Exercise stress ECG is a form of monitoring the heart’s capability Coronary Angiography is an invasive procedure under sterile conditions used to visualize coronary arteries DIAGNOSTIC TESTS - MI Cardiac Markers are certain proteins release into the circulation as a result of damage to the cardiac cells. CK-MB: creatinine kinase is a cardiac enzyme Myoglobin is released into circulation within a few hours after an MI Troponins are myocardial muscle (contractile) proteins released into the circulation after a MI. Troponin I is a sensitive and specific cardiac marker Elevated WBCs 12,000 - 15,000 EKG changes MEDICAL MANAGEMENT Chest radiograph is performed to note the size and configuration of the heart Echocardiogram: non-invasive ultrasound of the heart MEDICAL MANAGEMENT Radioisotopes studies (thallium scan) to assess location of infarction Positron emission tomography Multiple Gated Acquisition Scan (MUGA) MEDICAL MANAGEMENT- ANGINA / MI Goal of management is to control symptoms by reducing cardiac ischemia Restore cardiac tissue perfusion Cardiovascular modifiable risk factors are identified and corrected MEDICAL MANAGEMENT- MI Medications Anti-platelet therapy is the first line of defense for angina Aspirin Nitrates Beta-blockers Calcium channels blockers Vasodilators High-risk patients with unstable angina should be given supplemental oxygen Morphine MEDICAL MANAGEMENT- ANGINA / MI Limit size and extent of injury with reperfusion Fibrinolytic agents tissue plasminogen activator (tPA) Streptokinase (Streptase) “Best < 3 hours can be started within 12 hours of onset Contraindicated Active internal bleeding Suspected aortic dissection aneurysm Recent head trauma