Instructions for Side by Side Printing
- Print the notecards
- Fold each page in half along the solid vertical line
- Cut out the notecards by cutting along each horizontal dotted line
- Optional: Glue, tape or staple the ends of each notecard together
Nursing 4 unit 1
front 1  | back 1  |
front 2  | back 2  |
front 3  | back 3  |
front 4  | back 4  |
front 5  | back 5  |
front 6  | back 6  |
front 7  | back 7  |
front 8  | back 8  |
front 9  | back 9  |
front 10  | back 10  |
front 11  | back 11  |
front 12 HMG-CoA REDUCTASE INHIBITORS lovastatin (Mevacor) | back 12 PO; 10–80 mg daily (max: 80 mg/day) Headache, dyspepsia, abdominal cramping, myalgia, rash or pruritus lovastatin (Mevacor) pitavastatin (Livalo) |
front 13 BILE ACID SEQUESTRANTS | back 13 PO; 4–8 g bid–qid (max: 32 g/day) |
front 14 FIBRIC ACID AGENTS | back 14 PO; 54 mg daily (max: 200 mg/day) |
front 15 PO; 4 g daily with food | back 15 OTHER AGENTS |
front 16 INTERACTIONS | back 16 Drug–Drug: Atorvastatin interacts with many other drugs. Azole antifungals, HIV protease inhibitors, and telaprevir are contraindicated due to an increased risk for myopathy and rhabdomyolysis. Atorvastatin may increase levels of digoxin and oral contraceptives containing norethindrone and ethinyl estradiol. Erythromycin may increase atorvastatin levels 40%. Risk of rhabdomyolysis increases with concurrent administration of atorvastatin with macrolide antibiotics, cyclosporine, and niacin. Ethanol should be avoided during therapy because of its effects on hepatic function. Lab Tests: May increase serum transaminase and creatine kinase levels. Herbal/Food: Grapefruit juice inhibits the metabolism of statins, allowing them to reach toxic levels. Red yeast rice contains small amounts of natural statins and may increase the effects of atorvastatin. Because statins also decrease the synthesis of coenzyme Q10 (CoQ10), patients may benefit from CoQ10 supplements. Manifestations of CoQ10 deficiency include high blood pressure, congestive heart failure, and low energy. Treatment of Overdose: There is no specific treatment for overdose. |
front 17 bile acid sequestrants or resins | back 17 bind bile acids, which contain a high concentration of cholesterol. Because of their large size, these drugs are not absorbed from the small intestine, and the bound bile acids and cholesterol are eliminated in the feces. The liver responds to the loss of cholesterol by making more LDL receptors, 292293which removes even more cholesterol from the blood in a mechanism similar to that of the statin drugs. The bile acid sequestrants are capable of producing a 20% drop in LDL cholesterol. They are no longer considered first-line drugs for dyslipidemias, although they are sometimes combined with statins for patients who are unable to achieve sufficient response from the statins alone. The three bile acid sequestrants have equivalent efficacy and similar safety profiles. |
front 18 Cholestyramine (Questran) Therapeutic Class: Antihyperlipidemic
Pharmacologic Class: Bile acid sequestrant ADMINISTRATION ALERTS Mix thoroughly with 60 to 180 mL of water, noncarbonated beverages, highly liquid soups, or pulpy fruits (applesauce, crushed pineapple), and have the patient drink it immediately to avoid potential irritation or obstruction in the GI tract. Give other drugs more than 2 hours before or 4 hours after the patient takes cholestyramine. Pregnancy category C. PHARMACOKINETICS 24–48h | back 18 ADVERSE EFFECTS |
front 19 is a vitamin-like substance found in most animal cells. It is an essential component in the cell’s mitochondria for producing energy or ATP. Because the heart requires high levels of ATP, a sufficient level of CoQ10 is essential to that organ. Foods richest in this substance are pork, sardines, beef heart, salmon, broccoli, spinach, and nuts. Older adults appear to have an increased need for CoQ10 | back 19 Coenzyme Q10 (CoQ10) |
front 20 Gemfibrozil (Lopid) Therapeutic Class: Antihyperlipidemic
Pharmacologic Class: Fibric acid agent (fibrate) PHARMACOKINETICS Onset Peak Duration 1–2 h | back 20 ADVERSE EFFECTS |
front 21 is absorbed from the intestinal lumen by cells in the jejunum of the small intestine | back 21 Cholesterol |
front 22 Lipids can be classified into three types, based on their chemical structures | back 22 triglycerides, phospholipids, and sterols.Triglycerides and cholesterol are blood lipids that can lead to atherosclerotic plaque |
front 23 ______________are carried through the blood as lipoproteins; VLDL and LDL are associated with an increased incidence of cardiovascular disease, whereas HDL exerts a protective effect. | back 23 Lipids |
front 24 1. The client is to begin taking atorvastatin (Lipitor) and the nurse is providing education about the drug. Which symptom related to this drug should be reported to the health care provider? | back 24 1. Constipation 2. Increasing muscle or joint pain 3. Hemorrhoids 4. Flushing or “hot flash” 1. Answer: 2 |
front 25 2. A client is receiving cholestyramine (Questran) for elevated low-density lipoprotein (LDL) levels. As the nurse completes the nursing care plan, which of the following adverse effects will be included for continued monitoring? | back 25 2. Answer: 1 |
front 26 3. The nurse is instructing a client on home use of niacin and will include important instructions on how to take the drug and about its possible adverse effects. Which of the following may be expected adverse effects of this drug? (Select all that apply.) | back 26 1. Fever and chills 2. Intense flushing and hot flashes 3. Tingling of the fingers and toes 4. Hypoglycemia 5. Dry mucous membranes 3. Answer: 2, 3 |
front 27 4. The community health nurse is working with a client taking simvastatin (Zocor). Which client statement may indicate the need for further teaching about this drug? 1. “I’m trying to reach my ideal body weight by increasing my exercise.” 2. “I didn’t have any symptoms even though I had high lipid levels. I hear that’s common.” 3. “I’ve been taking my pill before my dinner.” 4. “I take my pill with grapefruit juice. I’ve always taken my medications that way.” 297298 | back 27 1. “I’m trying to reach my ideal body weight by increasing my exercise.” 2. “I didn’t have any symptoms even though I had high lipid levels. I hear that’s common.” 3. “I’ve been taking my pill before my dinner.” 4. “I take my pill with grapefruit juice. I’ve always taken my medications that way.” 297298 4. Answer: 4 |
front 28 5. A client has been on long-term therapy with colestipol (Colestid). To prevent adverse effects related to the length of therapy and lack of nutrients, which of the following supplements may be required? (Select all that apply.) | back 28 1. Folic acid 2. Vitamins A, D, E, and K 3. Potassium, iodine, and chloride 4. Protein 5. B vitamins 5. Answer: 1, 2 |
front 29 6. A client has been ordered gemfibrozil (Lopid) for hyperlipidemia. The nurse will first validate the order with the health care provider if the client reports a history of which disorder? | back 29 1. Hypertension 2. Angina 3. Gallbladder disease 4. Tuberculosis 6. Answer: 3 |
front 30 1. The nurse is preparing a teaching plan for a 39-year-old female patient who has been prescribed atorvastatin (Lipitor). Identify key information | back 30 1. Atorvastatin (Lipitor) is used along with diet and exercise modifications to lower serum lipid levels. After assessing the patient’s current diet for possible modifications, the nurse may consider the need for consultation with a dietitian, or may include teaching about how to make small modifications over time (e.g., switching to a smaller plate size so that portions seem larger or using the “My Plate” visual guide to increase amounts of vegetables and fruits). Because atorvastatin is a category X drug and this patient is within child-bearing age, clear instruction on the need to avoid pregnancy during drug therapy is vital. Atorvastatin may be taken at any time of the day. Although headache and GI complaints may be common, any unusual soreness or muscle pain, especially if increasing, should be reported to the health care provider. Periodic laboratory testing will also be needed to ensure that the drug is having therapeutic effects and that no adverse effects such as hepatotoxicity are occurring. 2. Cholestyramine (Questran), like other bile acid sequestrants, has the possibility of causing esophageal irritation, so taking the proper fluids or food with this medication is important. Mixing the drug powder well with fruit juice or with pulpy fruit such as applesauce, followed by a glass of water, may decrease the occurrence of esophageal irritation, and it also may help prevent the constipation caused by the drug. Any other medications must be taken 2 hours before or 4 hours after the cholestyramine to prevent a potential delay in absorption or binding of the drug. 3. The nurse should assess the amount of niacin the patient is taking and advise him to seek medical advice before self-medicating, especially because this patient also has diabetes, and many drugs may affect blood glucose levels or interact with drugs used to treat diabetes. Niacin may cause a rise in fasting glucose levels and his serum glucose levels should be evaluated. The flushing and hot flashes are normal side effects of niacin; if his health care provider recommends that he continue taking it, the nurse may recommend taking the drug with cold water and, after confirming with his provider, with one 325 mg of aspirin. |
front 31 2. A patient has been prescribed cholestyramine (Questran) for elevated lipids. What teaching is important for this patient? | back 31 2. Cholestyramine (Questran), like other bile acid sequestrants, has the possibility of causing esophageal irritation, so taking the proper fluids or food with this medication is important. Mixing the drug powder well with fruit juice or with pulpy fruit such as applesauce, followed by a glass of water, may decrease the occurrence of esophageal irritation, and it also may help prevent the constipation caused by the drug. Any other medications must be taken 2 hours before or 4 hours after the cholestyramine to prevent a potential delay in absorption or binding of the drug. |
front 32 3. A male patient with diabetes presents to the emergency department with complaints of being flushed and having “hot flashes.” The patient admits to self-medicating with niacin for elevated lipids. What is the nurse’s best response? | back 32 3. The nurse should assess the amount of niacin the patient is taking and advise him to seek medical advice before self-medicating, especially because this patient also has diabetes, and many drugs may affect blood glucose levels or interact with drugs used to treat diabetes. Niacin may cause a rise in fasting glucose levels and his serum glucose levels should be evaluated. The flushing and hot flashes are normal side effects of niacin; if his health care provider recommends that he continue taking it, the nurse may recommend taking the drug with cold water and, after confirming with his provider, with one 325 mg of aspirin. |
front 33 1. The client is prescribed digoxin (Lanoxin) for treatment of HF. Which of the following statements by the client indicates the need for further teaching? 1. “I may notice my heart rate decrease.” 2. “I may feel tired during early treatment.” 3. “This drug should cure my heart failure.” 4. “My energy level should gradually improve.” | back 33 1. Answer: 3 |
front 34 2. The nurse reviews laboratory studies of a client receiving digoxin (Lanoxin). Intervention by the nurse is required if the results include which of the following laboratory values? 1. Serum digoxin level of 1.2 ng/dL 2. Serum potassium level of 3 mEq/L 3. Hemoglobin of 14.4 g/dL 4. Serum sodium level of 140 mEq/L | back 34 2. Answer: 2 |
front 35 3. A client with heart failure has an order for lisinopril (Prinivil, Zestril). Which of the following conditions in the client’s history would lead the nurse to confirm the order with the provider? 1. A history of hypertension previously treated with diuretic therapy 2. A history of seasonal allergies currently treated with antihistamines 3. A history of angioedema after taking enalapril (Vasotec) 4. A history of alcoholism, currently abstaining | back 35 3. Answer: 3 |
front 36 4. The teaching plan for a client receiving hydralazine (Apresoline) should include which of the following points? 1. Returning for monthly urinalysis testing 2. Including citrus fruits, melons, and vegetables in the diet 3. Decreasing potassium-rich food in the diet 4. Rising slowly to standing from a lying or sitting position | back 36 4. Answer: 4 |
front 37 5. Lisinopril (Prinivil) is part of the treatment regimen for a client with HF. The nurse monitors the client for the development of which of the following adverse effects of this drug? (Select all that apply.) 1. Hyperkalemia 2. Hypocalcemia 3. Cough 4. Dizziness 5. Heartburn | back 37 5. Answer: 1, 3, 4 |
front 38 6. The client who has not responded well to other therapies has been prescribed milrinone (Primacor) for treatment of his heart failure. What essential assessment must the nurse make before starting this drug? 1. Weight and presence of edema 2. Dietary intake of sodium 3. Electrolytes, especially potassium 4. History of sleep patterns and presence of sleep apnea | back 38 6. Answer: 3 |
front 39 1. A patient is newly diagnosed with mild heart failure. The patient has been started on digoxin (Lanoxin). What objective evidence would indicate that this drug has been effective? | back 39 1. The nurse should note improved signs of perfusion including the patient’s skin color (e.g., warm, noncyanotic), blood pressure and heart rate within normal limits or to parameters set by the provider, and an increase in urine output. If lung congestion was present, adventitious lung sounds should be clearing or absent. The ECG may also show improvement if dysrhythmias were present before beginning drug therapy. |
front 40 2. A 69-year-old patient has a sudden onset of acute pulmonary edema. The patient has no past cardiac history, is allergic to sulfa antibiotics, and routinely takes no medications. The health care provider orders furosemide (Lasix) to relieve the pulmonary congestion, along with digoxin (Lanoxin) to improve the patient’s hemodynamic status. What interventions are essential in the care of this patient? | back 40 2. There is a potential cross-sensitivity between sulfa and furosemide (Lasix) and the nurse should notify the health care provider of the patient’s allergy before beginning the medication. Because furosemide will cause loss of potassium, the nurse will frequently monitor the patient’s serum potassium levels while the patient is on digoxin (Lanoxin). Hypokalemia may increase the risk for dysrhythmias related to digoxin therapy. |
front 41 3. A patient who has diabetes and hypertension is started on lisinopril (Prinivil) for mild heart failure. What teaching is important for this patient? | back 41 3. This patient with diabetes should have a baseline assessment of renal function to detect any decline in renal function and electrolyte levels. Hyperkalemia may occur during drug therapy with lisinopril (Prinvil) and patients 824825with renal insufficiency may be at greater risk. The patient should be taught to maintain normal amounts of potassium-containing foods in his diet; avoid the use of salt substitutes, which contain potassium; and return regularly for laboratory tests to monitor his kidney function and other values. The lisinopril will also treat the patient’s hypertension but the nurse should assess what other medications the patient is currently taking for the condition. Safety should be emphasized, especially regarding postural hypotension and the patient should be taught to rise slowly from a lying or sitting position to standing. |
front 42 1. The client is being discharged with nitroglycerin (Nitrostat) for sublingual use. While planning client education, what instruction will the nurse include? 1. “Swallow three tablets immediately for pain and call 911.” 2. “Put one tablet under your tongue for chest pain. If pain does not subside, you may repeat in 5 minutes, taking no more than three tablets.” 3. “Call your health care provider when you have chest pain. He will tell you how many tablets to take.” 4. “Place three tablets under your tongue and call 911.” | back 42 1. Answer: 2 |
front 43 2. Nitroglycerin patches have been ordered for a client with a
history of angina. What teaching will the nurse give to this client?
1. Keep the patches in the refrigerator. 2. Use the patches only if
the chest pain is severe. 3. Remove the old patch before applying a
new one. 4. Apply the patch only to the upper arm or thigh areas. in
prolonged and severe hypotension when combined with nitrates. 3. They
will adequately treat the patient’s angina as well as erectile
dysfunction. 4. They will increase the possibility of nitrate
tolerance developing and should be avoided unless other drugs can be
used. | back 43 2. Answer: 3 |
front 44 3. Which of the following assessment findings in a client who is receiving atenolol (Tenormin) for angina would be cause for the nurse to hold the drug and contact the provider? (Select all that apply.) 1. Heart rate of 50 beats/minute 2. Heart rate of 124 beats/minute 3. Blood pressure 86/56 4. Blood pressure 156/88 5. Tinnitus and vertigo | back 44 3. Answer: 1, 3 |
front 45 4. The nurse is caring for a client with chronic stable angina who is receiving isosorbide dinitrate (Isordil). Which of the following are common adverse effects of isosorbide? 1. Flushing and headache 2. Tremors and anxiety 3. Sleepiness and lethargy 4. Light-headedness and dizziness 375376 | back 45 4. Answer: 4 |
front 46 5. Place the following nursing interventions in order for a client who is experiencing chest pain. 1. Administer nitroglycerin sublingually. 2. Assess heart rate and blood pressure. 3. Assess he location, quality, and intensity of pain. 4. Document interventions and outcomes. 5. Evaluate the location, quality, and intensity of pain. | back 46 5. Answer: 3, 2, 1, 5, (2), 4 |
front 47 6. Erectile dysfunction drugs such as sildenafil (Viagra) are contraindicated in clients taking nitrates for angina. What is the primary concern with concurrent administration of these drugs? | back 47 6. Answer: 2 |
front 48 Normal Parameters of the following: | back 48 HR: 60-100 |
front 49 What are the effects of each of the following types of drugs: | back 49 inotropy = increased contraction |
front 50 What will be the CO, SV, SVR, SvO2, and urine output of the patient
receiving positive: 1. Inotropic: Contraction 2. Chronotropic: Heart Rate 3. Dromotropic: Cardiac Conduction Lisinopril, captopril, enalapril, ramipril...etc. class Ace inhibitors Lisinopril, captopril, enalapril, ramipril....etc. indications Heart failure Ace inhibitor mechanism of action (ie. lisinopril, enalapril, captopril...etc.) Inhibits aldosterone secretion (blocks sodium and water resorption) --> diuresis --> decreased preload --> decreased workload on the heart Losartan, Irbesartan, Valsartan class ARB (angiotensin receptor blockers) Losartan, Irbesartan, Valsartan mechanism of action blocks the angiotensin II receptors -->
vasodilation --> decreased afterload Metoprolol and carvedilol class Beta Blockers metoprolol and carvedilol mechanism of action Reduce SNS stimulation = reduced HR and contractility = reduced hypertrophy Spironolactone and Eplerenone Class Aldosterone antagonist Spironolactone mechanism of action Works at the distal convoluted tubule to prevent water resorption- also keeps in potassium Eplerenone mechanism of action selective aldosterone b | back 50 1. Inotropic: Contraction 2. Chronotropic: Heart Rate 3. Dromotropic: Cardiac Conduction |
front 51 Lisinopril, captopril, enalapril, ramipril...etc. class | back 51 Ace inhibitors |
front 52 Lisinopril, captopril, enalapril, ramipril....etc. indications | back 52 Heart failure |
front 53 Ace inhibitor mechanism of action (ie. lisinopril, enalapril, captopril...etc.) | back 53 Inhibits aldosterone secretion (blocks sodium and water resorption) --> diuresis --> decreased preload --> decreased workload on the heart |
front 54  | back 54  |
front 55  | back 55  |
front 56  | back 56  |
front 57  | back 57  |
front 58  | back 58  |
front 59  | back 59  |
front 60  | back 60  |
front 61  | back 61  |
front 62  | back 62  |
front 63  | back 63  |
front 64  | back 64  |
front 65  | back 65  |
front 66  | back 66  |
front 67  | back 67  |
front 68  | back 68  |
front 69  | back 69  |
front 70  | back 70  |
front 71  | back 71  |
front 72  | back 72  |
front 73  | back 73  |
front 74  | back 74  |
front 75  | back 75  |
front 76  | back 76  |
front 77  | back 77  |
front 78  | back 78  |
front 79  | back 79  |
front 80  | back 80  |
front 81  | back 81  |
front 82  | back 82  |
front 83  | back 83  |
front 84  | back 84  |
front 85  | back 85  |
front 86  | back 86  |
front 87  | back 87  |
front 88  | back 88  |
front 89  | back 89  |
front 90  | back 90  |
front 91  | back 91  |
front 92  | back 92  |
front 93  | back 93  |
front 94 Coronary Atherosclerosis | back 94 ¨Atherosclerosis is the abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and lumen. ¨In coronary atherosclerosis, blockages and narrowing of the coronary vessels reduce blood flow to the myocardium. ¨Cardiovascular disease is the leading cause of death in the United States for men and women of all racial and ethnic groups. ¨CAD, coronary artery disease, is the most prevalent cardiovascular disease in adults. |
front 95 ¨Nonmodifiable ¤Family history of CAD (first degree relative) ¤Increasing age (>45yrs for men; >55yrs for women) ¤Gender ¤Race (African American higher incidence) ¨Modifiable ¤Hyperlipidemia ¤Cigarette/tobacco use ¤HTN ¤DM ¤Metabolic Syndrome ¤Obesity ¤Physical inactivity | back 95 Risk factors for CAD and prevention |
front 96 ¨Water insoluble fats are encased in lipoproteins which permits transportation within the circulatory system ¤Lipoproteins are classified by density, which increases with the presence of protein ¤Four elements of fat metabolism nTotal cholesterol nLDL: “Bad” deposits on the artery walls nHDL: “Good” carries cholesterol from artery wall to liver nTriglycerides: fat made by the body; associated with diets high in carbs. | back 96 Cholesterol |
front 97 ¨Diet modification ¤Veggies, legumes, low fat, soluble fiber, decrease in red meat ¨Physical activity ¨Statins ¤Atorvastatin (Lipitor): blocks cholesterol synthesis, decrease LDL and TG, increase HDL nMonitor LFTs, Rhabdomylsis | back 97 Management of Cholesterol |
front 98 ¨Symptoms of myocardial ischemia ¤Angina pectoris: chest pain from ischemia ¤Nausea, shortness of breath, weakness, referred pain ¤Dysrhythmias ¨Symptoms and complications are related to the location and degree of vessel obstruction ¤Myocardial infarction ¤Heart failure ¤Sudden cardiac death | back 98 Clinical Manifestations of CAD |
front 99 ¨A syndrome characterized by episodes or paroxysmal pain or pressure in the anterior chest caused by insufficient coronary blood flow; CAD is the primary cause ¤Myocardial oxygen demand increases Physical exertion Exposure to cold causes vasoconstriction Heavy meal increases blood flow to mesenteric area Stress, increase in HR | back 99 Angina Pectoris |
front 100 ¨Stable: predictable, consistent; pain with exertion relieved with rest and nitroglycerin ¨Unstable: symptoms increase with frequency, not relieved with rest and nitro ¨Refractory: severe incapacitating chest pain ¨Variant ( Prinzmetal’s ): pain at rest with reversible ST segment elevation; coronary artery spasms ¨Silent ischemia: objective findings of ischemia but patient denies pain. | back 100 Types of Angina and Presentation |
front 101 ¨Treatment seeks to decrease myocardial oxygen demand and increase oxygen supply ¨Medications ¨Oxygen ¨Reduce and control risk factors ¨Reperfusion therapy may also be done | back 101 TREATMENT OF ANGINA |
front 102 ¨Nitrates | back 102 vasodilatation, decreases left ventricular end diastolic pressure and left ventricular end diastolic volume (Preload), reduces myocardial oxygen consumption |
front 103 ¤Isosorbide (Imdur) | back 103 vasodilation decrease left ventricular end diastolic pressure and left ventricular diastolic volume (Preload), increases blood flow through coronary arteries, reduces myocardial consumption of oxygen |
front 104 ¨Aspirin: prevents platelet aggregation, decreases arterial wall inflammation ¨Clopidogrel (Plavix): inhibits platelet aggregation, by irreversibly inhibiting the binding of ATP to platelet receptors ¨Beta Blockers ¨CCB | back 104 Pharmacotherapy Angina and CAD |
front 105 ¨Symptoms and activities, especially those that precede and precipitate attacks ¨Risk factors, lifestyle, and health promotion activities ¨Patient and family knowledge ¨Adherence to the plan of care | back 105 Nursing Management: CAD/Angina |
front 106 Goals include the immediate and appropriate treatment of angina, prevention of angina, reduction of anxiety, awareness of the disease process, understanding of prescribed care, adherence to the self-care program, and absence of complications | back 106 Nursing Process: The Care of the Patient with Angina Pectoris—Planning |
front 107 ¨Treatment of angina pain is a priority nursing concern. ¨Patient is to stop all activity and sit or rest in bed. ¨Assess the patient while performing other necessary interventions. Assessment includes VS, and observation for respiratory distress, and assessment of pain. In the hospital setting, the ECG is assessed or obtained. ¨Administer oxygen. Administer medications as ordered or by protocol, usually NTG | back 107 Treatment of Angina Pain |
front 108 ¨Use a calm manner ¨Stress-reduction techniques ¨Patient teaching ¨Addressing patient spiritual needs may assist in allaying anxieties ¨Address both patient and family needs | back 108 NURSING CARE: ANXIETY |
front 109 ¨Lifestyle changes and reduction of risk factors ¨Explore, recognize, and adapt behaviors to avoid to reduce the incidence of episodes of ischemia ¨Teaching regarding disease process ¨Medications ¨Stress reduction ¨When to seek emergency care | back 109 PATIENT TEACHING : ANXIETY |
front 110 ¨ACS: rupture of atherosclerotic plaque breaks off, but coronary artery is not completely occluded ¨MI: coronary artery is completely occluded, area of the myocardium is permanently destroyed. ¤The right coronary artery supplies: nright atrium, SA and AV node nright ventricle nbottom portion of both ventricles and back of the septum ¤The left coronary arteries supply: nCircumflex artery - supplies blood to the left atrium, side and back of the left ventricle nLeft Anterior Descending artery (LAD) - supplies the front and bottom of the left ventricle and the front of the septum n | back 110 NURSING CARE:Acute Coronary Syndrome/ Myocardial Infarction |
front 111 ¨MI classified ¤Type: NSTEMI vs STEMI ¤Location of injury to the ventricular wall Inferior Anterior Posterior Lateral | back 111 MI: Ischemia, Injury, Infarction |
front 112 ¨ECG (within 10 minutes of arrival) ¨Oxygen ¨Aspirin, nitroglycerin, morphine, beta-blockers ¨Angiotensin-converting enzyme inhibitor within 24 hours ¨Evaluate for percutaneous coronary intervention or thrombolytic therapy ¨As indicated; IV heparin or LMWH, clopidogrel or ticlopidine, glycoprotein IIb/IIIa inhibitor ¨Bed rest | back 112 TREATMENT OF ACUTE MI |
front 113 ¨Laboratory tests—biomarkers ¤CK-MB: increases in a few hours, peaks within 24 hrs ¤Troponin T or I: increases in a few hours, remains elevated for a longer period, serial labs until peak then trend down ¤Myoglobin: increase within 1-3 hrs, peaks 12 hrs ¨Echo ¨Stress Test | back 113 DIAGNOSTIC TESTING: ACUTE MI |
front 114 ¨Relieving pain and other symptoms of ischemia ¤ balance oxygen supply and demand ¤Frequent vital signs ¨Respiratory function ¤Fluid volume status ¨Tissue Perfusion ¤Activity restrictions ¤Urine output ¤Cap refill/pulses ¨Reducing anxiety | back 114 Nursing Management: MI/ACS |
front 115 ¨Acute pulmonary edema ¨Heart failure ¨Cardiogenic shock ¨Dysrhythmias and cardiac arrest ¨Pericardial effusion and cardiac tamponade | back 115 COLLABORATE : MI/ACS |
front 116 Cardiac Hemodynamics | back 116 ¨CO = SV × HR ¨Preload ¨Afterload ¨Contractility |
front 117 ¨The inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients. ¤A syndrome characterized by fluid overload or inadequate tissue perfusion. ¤indicates myocardial disease, in which there is a problem with the contraction of the heart (systolic failure) or filling of the heart (diastolic failure). ¨Some cases are reversible, most heart failure is a progressive, lifelong disorder managed with lifestyle changes and medications. | back 117 HEART FAILURE |
front 118 ¨Right-sided failure ¤RV cannot eject sufficient amounts of blood and blood backs up in the venous system. This resuts in perpheral edema, hepatomegaly, ascites, anorexia, nausea, weakness, and weight gain. ¨Left-sided failure ¤LV cannot pump blood effectively to the systemic circulation. Pulmonary venous pressures increase and result in pulmonary congestion with dyspnea, cough, crackles, and impaired oxygen exchange. ¨Chronic heart failure is frequently biventricular. | back 118 Clinical Manifestations |
front 119 ¨NYHA classification of heart failure ¤Classification I , II, III, IV ¨ACC/AHA classification of heart failure ¤Stages A, B, C, D ¨Treatment guidelines are in place for each stage | back 119 CLASSIFICATION OF HF |
front 120 ¨Eliminate or reduce etiologic or contributory factors. ¨Reduce the workload of the heart by reducing afterload and preload. ¨Optimize all therapeutic regimens. ¨Prevent exacerbations of heart failure. ¨Medications are routinely prescribed for heart failure. | back 120 Medical Management of Heart Failure |
front 121 ¨Angiotensin: converting enzyme inhibitors ¨Angiotensin II receptor blockers ¨Beta-blockers ¨Diuretics ¨Digitalis (Digoxin): +inotropic: inhibiting NA K ATPase, accumulation of NA causes release of CA -chronotropic: suppress SA node and slow conduction through the AV node ¤Page 802 (Taylor) and Page 353 (Adams) | back 121 MEDICATIONS OF HF |
front 122 ¨Health history ¨Sleep and activity: paroxysmal nocturnal dysnpnea ¨Knowledge and coping ¨Physical exam ¤Mental status ¤Lung sounds: crackles and wheezes ¤Heart sounds: S3: volume entering the ventricles at the beginning of diastole ¤Fluid status/signs of fluid overload nDaily weight and I&O ¨Assess responses to medications ¨ | back 122 Nursing Process: The Care of the Patient with Heart Failure—Assessment |
front 123 ¨Activity intolerance and fatigue ¨Excess fluid volume ¨Anxiety ¨Powerlessness ¨Noncompliance | back 123 Nursing Process: The Care of the Patient with Heart Failure—Diagnoses |
front 124 ¨Cardiogenic shock ¨Dysrhythmias ¨Thromboembolism ¨Pericardial effusion and cardiac tamponade ¨ | back 124 Collaborative Problems/Potential Complications |
front 125 ¨Goals may include promoting activity and reducing fatigue, relieving fluid overload symptoms, decreasing anxiety or increasing the patient’s ability to manage anxiety, encouraging the patient to make decisions and influence outcomes, teaching the patient about the self-care program. | back 125 Nursing Process: The Care of the Patient with Heart Failure—Planning |
front 126 ¨Bed rest for acute exacerbations ¨Encourage regular physical activity; 30–45 minutes daily ¨Exercise training ¨Pacing of activities ¨Wait 2 hours after eating for physical activity ¨Avoid activities in extreme hot, cold, or humid weather ¨Modify activities to conserve energy ¨Positioning; elevation of the HOB to facilitate breathing and rest, support of arms | back 126 ACTIVITY INTOLERANCE : HF |
front 127 ¨Assessment for symptoms of fluid overload ¨Daily weight ¨I&O ¨Diuretic therapy; timing of meds ¨Fluid intake; fluid restriction ¨Maintenance of sodium restriction | back 127 FLUID VOLUME EXCESS/ OVERLOAD |
front 128 ¨Medications ¨Diet: low-sodium diet and fluid restriction ¨Monitoring for signs of excess fluid, hypotension, and symptoms of disease exacerbation, including daily weight ¨Exercise and activity program ¨Stress management ¨Prevention of infection ¨Know how and when to contact health care provider ¨Include family in teaching ¨ | back 128 PATIENT TEACHING : HF |
front 129 ¨Acute event in which the LV cannot handle an overload of blood volume. Pressure increases in the pulmonary vasculature, causing fluid movement out of the pulmonary capillaries and into the interstitial space of the lungs and alveoli. ¨Results in hypoxemia. ¨Clinical manifestations: restlessness, anxiety, dyspnea, cool and clammy skin, cyanosis, weak and rapid pulse, cough, lung congestion (moist, noisy respirations), increased sputum production (sputum may be frothy and blood-tinged), decreased level of consciousness. | back 129 PULMONARY EDEMA |
front 130 ¨Prevent ¨Early recognition: monitor lung sounds and for signs of decreased activity tolerance and increased fluid retention ¨Place patient upright and dangle legs ¨Minimize exertion and stress ¨Oxygen ¨Medications ¤Morphine ¤Diuretic: furosemide | back 130 MANAGEMENT OF PULMONARY EDEMA |
front 131
| back 131 Cerebrovascular Accident |
front 132 Anterior: Carotid Arteries – middle & anterior cerebral arteries frontal, parietal, temporal lobes; basal ganglion; part of the diencephalon (thalamus & hypothalamus) Posterior: Vertebral Arteries – basilar artery Mid and lower temporary & occipital lobes, cerebellum, brainstem, & part of the diencephalon Circle of Willis – connects the anterior & posterior cerebral circulation | back 132 Anatomy of Cerebral Circulation: Blood Supply |
front 133 High blood pressure Diabetes Cigarette smoking TIA (Aspirin) High blood cholesterol Obesity Heart Disease Atrial fibrillation Oral contraceptive use Physical inactivity Sickle cell disease Asymptomatic carotid stenosis Hypercoagulability | back 133 Controllable Risks with Medical Treatment & Lifestyle Changes: |
front 134
| back 134 Manifestations of Ischemic Stroke |
front 135
| back 135 STROKE ALERT |
front 136
| back 136 DIAGNOSTIC STUDIES - STROKE |
front 137
| back 137 Preventive Treatment and Secondary Prevention- STROKE |
front 138
| back 138 Medical Management: Acute Phase of Stroke |
front 139
| back 139 Nursing Process: The Patient Recovering From an Ischemic Stroke—Assessment |
front 140
| back 140 Improving Mobility and Preventing Joint Deformities |
front 141
| back 141 Improving Mobility and Preventing Joint Deformities |
front 142
| back 142 NURSING INTERVENTIONS POSITIONING FROM STROKE |
front 143
| back 143 HEMMORAGIC STROKE |
front 144
| back 144 MANIFESTATIONS OF HEMMORGIC STROKE |
front 145
| back 145 Medical Management HEMMORAGIC STROKE |
front 146
| back 146 Nursing Process: The Patient With a Hemorrhagic Stroke—Assessment |
front 147
| back 147 Collaborative Problems and Potential Complications- HEMORRHAGIC STROKE |
front 148
| back 148 Nursing Process: The Patient With a Hemorrhagic Stroke—Planning |
front 149
| back 149 no data |
front 150
| back 150 Home Care and Education for the Patient Recovering from a Stroke |
front 151 Cerebrovascular Accident Clinical Manifestations Right Brain – Left Brain Damage | back 151 no data |
front 152 What are expected patient outcomes for a patient recovering from a hemorrhagic stroke?
| back 152 A.Exhibits absence of vasospasm Expected patient outcomes for a patient recovering from a hemorrhagic stroke include absence of vasospasm, no seizures, normal speech patterns, and no visual changes. |
front 153 What intervention would not be included in aspiration precautions for a patient in the acute phase of a stroke? A.Referral to speech therapy B.Have patient tuck their chin toward the chest when swallowing C.Thickened fluids or pureed diet D.Raise HOB to 30 degrees when feeding | back 153 D.Raise HOB to 30 degrees when feeding Interventions to prevent aspiration include a referral to speech therapy for swallowing evaluation; having the patient tuck the chin toward the chest when swallowing to close off the trachea, preventing aspiration into the lungs; providing thickened fluids or a pureed diet; and sitting the patient at a full upright position (90 degrees) when feeding or providing fluids. The patient’s HOB should be elevated to 30 degrees at all times to prevent aspiration of secretions but would not prevent aspiration of food or fluids when feeding |
front 154 A patient with right-sided paresthesias and hemiparesis is hospitalized and diagnosed with a thrombotic stroke. Over the next 72 hours, the nurse plans care with the knowledge that the patient:
| back 154 no data |
front 155 While performing health screening at a health fair, the nurse identifies which of the following individuals at greatest risk for experiencing a stroke?
| back 155 no data |
front 156 What is agnosia?
| back 156 A.Failure to recognize familiar objects perceived by the senses Agnosia is failure to recognize familiar objects perceived by the senses. Aphasia is an inability to express oneself or to understand language. Apraxia is an inability to perform previously learned purposeful motor acts on a voluntary basis. Ataxia is an impaired ability to coordinate movement, often seen as a staggering gait or postural imbalance. |
front 157 1 Describe the pathophysiology, clinical manifestations, and treatment of coronary atherosclerosis | back 157 Pathophysiology: What is Atherosclerosis? A disease in which plaque builds up inside your arteries Pathophysiology: What is Plaque? Plaque is a sticky substance made up of fat, cholesterol, calcium, and other substances found in the blood. Pathophysiology: What happens when plaque hardens and narrows in your arteries? It limits the flow of oxygen-rich blood to your body. Pathophysiology: What can Atherosclerosis lead to? It can lead to Coronary Artery Disease, Carotid Artery Disease, and Peripheral Arterial Disease. Pathophysiology: Advanced with again, what can Atherosclerosis do? It can cause critical narrowing of the arteries resulting in tissue ischemia (lack of blood and oxygen). Epidemiology: When does Atherosclerosis begin? Begins in childhood with the development of fatty streaks Epidemiology: As these individuals age, there is an increased incidence of advanced complicated lesions which leads to...? the organ-specific clinical manifestations of the disease. Epidemiology: What are the primary risk fators of Atherosclerosis? o Cigarette smoking o High blood pressure o Elevated serum cholesterol (total and LDL) o Advancing age o Diabetes mellitus Epidemiology: What are the secondary risk factors of Atherosclerosis? o Obesity o Psychosocial factors o Physical inactivity o Family history of early CAD o Ethnic characteristics Symptoms: Many people don't have Atherosclerosis until they have these two medical emergencies...? Heart attack or strokes Symptoms: The type of symptoms depends on what? Location of blocked artery Symptoms: What are Atherosclerosis symptoms in Carotid Arteries? o Sudden weakness o Confusion o Problems breathing o Dizziness o Sudden and severe headache Symptoms: What are Atherosclerosis symptoms in Peripheral Arteries? Numbness o Pain o Dangerous infection Symptoms: What a |
front 158 2 Describe the pathophysiology, clinical manifestations, and treatment of angina pectoris. | back 158 Pathophysiology Angina is usually caused by atherosclerotic disease. Almost invariably, angina is associated with a significant obstruction of at least one major coronary artery. Normally, the myocardium extracts a large amount of oxygen from the coronary circulation to meet its continuous demands. When demand increases, flow through the coronary arteries needs to be increased. When there is blockage in a coronary artery, flow cannot be increased and ischemia results. The types of angina are listed in Several factors are associated with typical anginal pain:
Unstable angina is not closely associated with these listed factors. It may occur at rest. See the later discussion of unstable angina in Acute Coronary Syndrome and Myocardial Infarction section. Clinical Manifestations Ischemia of the heart muscle may produce pain or other symptoms, varying from mild indigestion to a choking or heavy sensation in the upper chest. The severity ranges from discomfort to agonizing pain. The pain may be accompanied by severe apprehension and a feeling of impending death. It is often felt deep in the chest behind the sternum (retrosternal area). Typically, the pain or discomfort is poorly localized and may radiate to the neck, jaw, shoulders, and inner aspects of the upper arms, usually the left arm. The patient often feels tightness or a heavy choking or strangling sensation that has a viselike, insistent quality. The patient with diabetes may not have severe pain with angina because diabetic neuropathy can blunt nociceptor transmission, dulling the perception of pain. Women may have differe |
front 159 3 Use the nursing process as a framework for care of clients with angina pectoris. https://quizlet.com/25072853/nurs-432-ch-40-flash-cards/ | back 159 Goal: pain is reduced / resolved. Outcomes: Patient states / shows the pain is relieved, Patient reported angina episodes decreased in frequency, duration and severity. Interventions: 1. Instruct the patient to notify nurse quickly in the event of chest pain. Rationale: Pain and decreased cardiac output can stimulate the sympathetic nervous system to release large amounts of nor epinephrine, which increases platelet aggregation and thromboxane A2 issued. Pain cannot be detained cause vasovagal response, reducing BP and heart rate. 2. Identification of the precipitating factors, if any: frequency, duration, intensity and location of pain. Rationale: Helps distinguish chest pain early and the possibility of progress evaluation tool becomes unstable angina (stable angina usually ends 3 to 5 minutes while unstable angina longer and can last more than 45 minutes. 3. Evaluation report pain in the jaw, neck, shoulder, hand or arm (especially on the left side). Rationale: cardiac pain may spread to the sample surface pain more often innervated by the same spinal level. 4. Instruct the patient on bed rest during episodes of angina. Rationale: Reduce myocardial oxygen demand to minimize the risk of tissue injury or necrosis. 5. Elevate the head of the bed when the patient is short of breath. Rationale: Facilitate the exchange of gases to reduce repetitive hypoxia and shortness of breath. 6. Monitor the speed or rhythm of the heart. Rationale: Patients with unstable angina have increased life-threatening dysrhythmias in acute, which occurs in response to ischemia and or stress. 7. Monitor vital signs every 5 minutes during an attack of angina. Rational: BP can rise early with respect to sympathetic stimulation, then dropped when the cardiac output is affected. 8. Maintain a calm, comfortable environment, limit the visitor when necessary. Rationale: mental or emotional stress increase myocardial work. 9. Give soft foods. Let the patient rest for 1 hour after eating. Rationale: Reduces myocardial work in connection with the work of digestion, manurunkan risk of angina attacks 10. Give antianginal as indicated. Rationale: For the treatment and prevent angina pain. |
front 160 4 Describe the pathophysiology, clinical manifestations, and treatment of myocardial infarction. | back 160 What is myocardial infarction? Treatment Guidelines for Acute Myocardial Infarction
Acute Myocardial Infarction Core Measure Set
When coronary blood flow is interrupted for a period of time, death of the myocardium occurs. What are the causes of M.I.? Atherosclerosis, and coronary vasospasm How does atherosclerosis cause M.I.? Plaque is disrupted and thrombus formation leads to acute decrease in coronary blood flow. What causes a plaque to rupture? Shear forces, inflammation, apoptosis, macrophage-derived degradative enzymes. What causes blood clot formation over lesion? |
front 161 5 Use the nursing process as a framework for care of a clients with acute coronary syndrome. | back 161 https://quizlet.com/99890304/nursing-management-coronary-artery-disease-and-acute-coronary-syndrome-flash-cards/ http://www.coursewareobjects.com/objects/evolve/E2/book_pages/lewismedsurg/pdfs/nursing_care_plans.pdf |
front 162 6 Use the nursing process as a framework for care of a clients who has undergone cardiac surgery. | back 162 Pathophysiology a. The disorder is characterized by a narrowing of coronary arteries due to atherosclerosis, spasm or, rarely, embolism. b. Atherosclerotic changes in coronary arteries results in damage to the inner layers of the coronary arteries with stiffening of vessels and diminished dilatory response. c. Accumulation of fatty deposits and lipids, along with development of fibrous plaques over the damaged areas in the vessels, causes narrowing of the arteries, thus reducing the size of the vessel’s lumen and impeding blood flow to the myocardial tissues. d. Decreased delivery of oxygen and nutrients to the tissues causes transient myocardial ischemia and pain. e. Hard plaque causes hardened arteries, whereas soft plaque can cause formation of blood clots. II. Types b. Unstable i. May be new onset of pain with exertion or at rest, or recent acceleration in severity of pain ii. Occurs in no regular pattern, usually lasts longer (30 minutes), not generally relieved with rest or medications iii. Sometimes grouped with myocardial infarction (MI) under the diagnosis of acute coronary syndrome (ACS)c. Variant (Prinzmetal’s) i. Rare, usually occurs at rest—midnight to early morning hours ii. Pain possibly severe iii. Electrocardiogram (ECG) changes due to coronary artery spasmIV. Etiology Discharge Goals 1. Desired activity level achieved, with return to activity baseline, and self-care needs met with minimal or no pain. 2. remains free of complications. 3. Disease process, prognosis, and therapeutic regimen understood. 4. Participates in treatment program and behavioral changes. 5. Plan in place to meet needs after discharge. NURSING DIAGNOSIS: acute Pain May be related to Increased cardiac workload and oxygen consumption Decreased myocardial blood flow, tissue ischemia Possibly evidenced by Reports of pain varying in frequency, duration, and intensity, especially as condition worsens Narrowed focus Distraction behaviors, such as moaning, crying, pacing, or restlessness Autonomic responses, such as diaphoresis, BP and pulse rate changes, pupillary dilation, increased or decreased respiratory rate Desired Outcomes/Evaluation Criteria—Client Will Pain Level Report anginal episodes decreased in frequency, duration, and severity. Demonstrate relief of pain as evid |
front 163 7.Describe the management of patients with heart failure. | back 163
Etiology
|
front 164 8.Use the nursing process as a framework for care of patients with heart failure. | back 164 Nursing Intervention
Discharge and Home Healthcare Guidelines
|
front 165 The Pathway of Blood to and from the Heart | back 165
|
front 166 HF TERMINOLOGY | back 166 acute coronary syndrome (ACS): signs and symptoms that indicate unstable angina or acute myocardial infarction angina pectoris: chest pain brought about by myocardial ischemia atheroma: fibrous cap composed of smooth muscle cells that forms over lipid deposits within arterial vessels and protrudes into the lumen of the vessel, narrowing the lumen and obstructing blood flow; also called plaque Atherosclerosis: abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and the lumen Contractility: ability of the cardiac muscle to shorten in response to an electrical impulse coronary artery bypass graft (CABG): a surgical procedure in which a blood vessel from another part of the body is grafted onto the occluded coronary artery below the occlusion in such a way that blood flow bypasses the blockage high-density lipoprotein (HDL): a protein-bound lipid that transports cholesterol to the liver for excretion in the bile; composed of a higher proportion of protein to lipid than low-density lipoprotein; exerts a beneficial effect on the arterial wall ischemia: insufficient tissue oxygenation low-density lipoprotein (LDL): a protein-bound lipid that transports cholesterol to tissues in the body; composed of a lower proportion of protein to lipid than high-density lipoprotein; exerts a harmful effect on the arterial wall metabolic syndrome: a cluster of metabolic abnormalities including insulin resistance, obesity, dyslipidemia, and hypertension that increase the risk of cardiovascular disease myocardial infarction (MI): death of heart tissue caused by lack of oxygenated blood flow percutaneous coronary intervention (PCI): a procedure in which a catheter is placed in a coronary artery, and one of several methods is employed to reduce blockage within the artery percutaneous transluminal coronary angioplasty (PTCA): a type of percutaneous coronary intervention in which a balloon is inflated within a coronary artery to break an atheroma and open the vessel lumen, improving coronary artery blood flow stent: a metal mesh that provides structural support to a coronary vessel, preventing its closure sudden cardiac death: abrupt cessation of effective heart activity thrombolytic: a pharmacologic agent that breaks dow |
front 167 A client with known coronary artery disease reports intermittent chest pain, usually on exertion. The physician diagnoses angina pectoris and orders sublingual nitroglycerin to treat acute angina episodes. When teaching the client about nitroglycerin administration, which instruction should the nurse provide? | back 167 "Be sure to take safety precautions because nitroglycerin may cause dizziness when you stand up." Nitroglycerin commonly causes orthostatic hypotension and dizziness. To minimize these problems, the nurse should teach the client to take safety precautions, such as changing to an upright position slowly, climbing up and down stairs carefully, and lying down at the first sign of dizziness. To ensure the freshness of sublingual nitroglycerin, the client should replace tablets every 6 months, not every 9 months, and store them in a tightly closed container in a cool, dark place. Many brands of sublingual nitroglycerin no longer produce a burning sensation. The client should take a sublingual nitroglycerin tablet at the first sign of angina. He may repeat the dose every 5 minutes for up to three doses; if this intervention doesn't bring relief, the client should seek immediate medical attention. Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 27: Management of Patients With Coronary Vascular Disorders, p. 738. |
front 168 The nurse, caring for a patient after cardiac surgery, is aware that fluid and electrolyte imbalance is a concern. Select the most immediate result that needs to be reported. | back 168 Potassium level of 6 mEq/L Changes in serum electrolytes should be immediately reported, especially a potassium level of 6 mEq/L. An elevated blood sugar is common postoperatively, and the weight gain isn't significant. The abnormal breath sounds are of concern, but the electrolyte imbalance is the most immediate condition that needs to be addressed. Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 27: Management of Patients With Coronary Vascular Disorders, pp. 761-2, Chart 27-13. |
front 169 When the nurse notes that the post cardiac surgery patient demonstrates low urine output (< 25 mL/hr) with high specific gravity (> 1.025), the nurse suspects | back 169 Inadequate fluid volume Urine output of less than 25 mL/hr may indicate a decrease in cardiac output. A high specific gravity indicates increased concentration of solutes in the urine, which occurs with inadequate fluid volume. Indices of normal glomerular filtration are output of 25 mL or greater per hour and specific gravity between 1.010 and 1.025. Overhydration is manifested by high urine output with low specific gravity. The anuric patient does not produce urine. Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 27: Management of Patients With Coronary Vascular Disorders, p. 764. |
front 170 The nurse is educating a patient diagnosed with angina pectoris about the difference between the pain of angina and a myocardial infarction (MI). How should the nurse describe the pain experienced during an MI? (Select all that apply.) | back 170 • It is substernal in location. • It is sudden in onset and prolonged in duration. • It is viselike and radiates to the shoulders and arms. Chest pain that occurs suddenly, continues despite rest and medication, is substernal, and is sometimes viselike and radiating to the shoulders and arms is associated with an MI. Angina pectoris pain is generally relieved by rest and nitroglycerin. Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 27: Management of Patients With Coronary Vascular Disorders, p. 742. Chapter 27: Management of Patients With Coronary Vascular Disorders - Page 742 |
front 171 A client has a blockage in the proximal portion of a coronary artery. After learning about treatment options, the client decides to undergo percutaneous transluminal coronary angioplasty (PTCA). During this procedure, the nurse expects to administer an: anticoagulant. | back 171 no data |