Term
| The following tests may be conducted to diagnose coronary artery disease depending on patient condition: |
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Definition
Exercise stress test
Cardiac-specific blood tests
12 lead electrocardiography
(ECG) Echocardiography
Coronary artery catheterization |
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Term
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Definition
Subjective: Symptoms that occur with exertion and are relieved by rest.
Duration: Generally lasts for minutes
Location: Chest, neck, jaws, arms, back, or epigastric area.
Intensity: Patient to use pain scale to rate intensity from 0 (no pain) to 10 (worst pain).
Quality: Squeezing, burning, aching, heaviness, pressure, indigestion, smothering sensation.
Aggravating activities: When and what activities were done prior to symptoms. - Alleviating factors: May be relieved by rest and/or after taking prescribed nitroglycerine.
Expected relief of symptoms is 1 to 2 minutes.
Associated symptoms: Shortness of breath, fatigue, nausea, diaphoresis, palpations. - Personal meaning of the discomfort: Patient may report “something is wrong”.
Presentation in women, the elderly, and people with diabetes mellitus may be different than young men. |
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Term
| Two NANDA-I Nursing Diagnoses that may be applied to patients with several risk factors for CAD are: |
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Definition
Deficient knowledge related to unfamiliarity with disease process
Ineffective health maintenance related to insufficient knowledge or resources
The nurse should also assess the patient’s readiness for enhanced knowledge |
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Term
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Definition
Assess the patient’s readiness to learn more about risk factors and prevention strategies.
Educate patients and their families on identifying cardiovascular signs and symptoms and when to seek medical intervention. - - Identify barriers to learning: lack of time, confidence, information or motivation to change.
Create a teaching plan based on the individual patient’s and family needs. - - Provide reinforcement and support. |
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Term
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Definition
| Attention is paid to determining if patients and their families feel empowered to actively address coronary risk factors |
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Term
| Assessment for Stable Angina |
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Definition
activities that preceded or precipitated the event should be noted.
- A pain scale is used to describe the chest pain.
Females, patients with diabetes, and the elderly may present with signs and symptoms such as shortness of breath, fatigue, and indigestion rather than chest pain.
- Diagnostic tests that assist with definitive medical treatment may include stress testing and/or cardiac catheterization. |
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Term
| NANDA-I Nursing Diagnoses for Stable Angina |
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Definition
Ineffective cardiac tissue perfusion -Deficient knowledge
Anxiety
- noncompliance |
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Term
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Definition
Increase the patient’s oxygen supply and decrease oxygen demand.
Have the patient initially stop activity, then balance activity and rest.
Advise the patient to control personal risk factors by making lifestyle changes, such as:
a. Control cholesterol abnormalities
b. Heart healthy diet or Dietary Approaches to Stop Hypertension (DASH) diet
c. Promote cessation of tobacco use
d. Control diabetes mellitus |
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Term
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Definition
a. Nitroglycerin—decreases venous return, decreases oxygen consumption, and relieves pain.
b. Beta-adrenergic blocking agent—decreases oxygen consumption by reducing heart rate and myocardial contractility.
c. Antiplatelet and anticoagulant medication—prevents platelets from sticking together and subsequent thrombosis.
d. Oxygen—may increase blood oxygen levels. e. Calcium ion antagonists—if indicated as a means to reduce vasospasm |
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Term
| Evaluation of NI for Angina |
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Definition
The RN should evaluate if the patient can report and take action when symptoms occur. The patient should also demonstrate their adherence to a self-care program
- anxiety control
- disease process |
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Term
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Definition
When the patient presents with acute chest pain or discomfort, the nurse should:
Identify the patient’s personal risk factors and review the health history. Elicit the patient’s symptoms and activities that precipitated the event.
- chest pain or discomfort
- dyspnea
- palpitations
- unusual fatigue
- syncope
Facilitate diagnostic exams such as 12 lead electrocardiogram and cardiac-specific laboratory findings |
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Term
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Definition
a. Ineffective cardiac tissue perfusion
b. Deficient knowledge
c. Anxiety
d. Risk for ineffective peripheral tissue perfusion |
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Term
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Definition
Acetylsalicylic acid (Aspirin) Nitroglycerine
Morphine for pain/discomfort
Beta-adrenergic blocking agents
Oxygen
Restoring blood flow to ischemic cardiac muscle
Thrombolytics to dissolve thrombus
Emergency percutaneous coronary intervention (PCI) |
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Term
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Definition
Relieve pain: Increase oxygen supply and/or decrease oxygen demand.
Improve respiratory function: Initially administer oxygen and elevate the head of the patient's bed to 45 degrees.
Monitor and manage potential complications: Monitor for cardiac rhythm abnormalities and potential and adverse effects of therapies.
Promote self-care: Provide information on self-care at home through patient/family teaching.
Have the patient/family contact emergency response services when symptoms occur. |
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Term
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Definition
Experiences pain/symptom relief. Maintains a stable cardiac and respiratory status.
Maintains adequate tissue perfusion. Knows how to access resources for self-care and support in the community. |
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Term
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Definition
Patient history.
Chest pain/discomfort characteristics. Intensity: usually more intense and longer in duration than angina.
Timing: usually occurs at rest; not relieved by rest or nitrates.
Location: substernal pain or discomfort radiating to neck, jaw, arms, and back (these areas may be the only location of discomfort).
Quality: chest pressure ‘elephant sitting on the chest’; chest fullness to shortness of breath.
Other clinical signs/symptoms that may be present:
Pale, cool, diaphoretic skin.
Feelings of weakness or lightheadedness. Nausea or vomiting.
Complaints of dyspnea (seen more frequently in elderly and patients with diabetes).
Sense of apprehension or doom.
Patient appears very still and does not move about actively. |
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Term
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Definition
Decreased cardiac output
Ineffective cardiac tissue perfusion Acute pain
Anxiety
Risk for impaired gas exchange
Risk for ineffective peripheral tissue perfusion
Readiness for enhanced knowledge |
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Term
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Definition
Oxygen
Nitroglycerin
Beta-adrenergic blockers
Anti-platelet – antithrombotic therapy Angiotension converting enzymes (ACE) or angiotension 11 receptor blocker (ARB) - Statin (HMG-CoA reductase inhibitors) |
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Term
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Definition
Percutaneous coronary angioplasty and stent placement
Coronary Artery Bypass Graft Surgery (CABG) |
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Term
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Definition
Help relieve pain.
Monitor and manage complications.
Support or monitor the patient’s respiratory function.
Promote tissue perfusion.
Address the patient’s concerns and reduce anxiety.
Teach patient/family and promote self-care |
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Term
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Definition
Experiences pain relief.
Maintains a stable cardiac and respiratory status.
Verbalizes knowledge of self-care. |
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Term
| After a pt reports crushing substernal chest pain and left arm discomfort, |
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Definition
| it is best to immediately call for emergency services. Meanwhile, the patient should cease any activity and to chew an aspirin. |
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Term
| The medications that are included in the emergency treatment of acute coronary syndrome are |
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Definition
| oxygen, aspirin, and metoprolol |
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Term
| A patient with acute coronary syndrome does not adhere to the medication regimen. What action should an RN take to develop an individualized teaching plan for them? |
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Definition
| Despite knowing the importance of the medication, patients may experience other barriers to medication adherence. While the cost of medications can be a hindrance in medication adherence, one should not assume that free samples will fix the issue. Asking the patient to elaborate on their medication schedule will give the RN the additional data required to develop an individualized teaching plan for the patient. Telling the patient they will die will scare the patient and not get to the root of the reason for non-adherence. The RN needs to speak to their patient first and then the family. |
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Term
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Definition
Risk Factors: Some identifiable risk factors include: sleep apnea, chronic kidney disease, aldosteronism, renal-vascular disease, chronic steroid use, and Cushing syndrome.
- Signs and Symptoms: May have no signs or symptoms other than elevated BP. Often called the ‘silent killer’.
- Expected Patient Outcomes: BP less than 130/80.
- Treatment and Care: Lifestyle modification recommended: weight reduction, diet based on Dietary Approach to Stop Hypertension (DASH), reduced dietary sodium intake, regular physical activity, and moderate alcohol intake.
- Pharmacologic Treatment: Beta adrenergic blockers, Angiotensin-converting enzyme (ACE) inhibitors, Angiotensin II receptor blockers (ARBs), Diuretics, Calcium channel blockers.
- Nursing Interventions: Promote self-care |
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Term
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Definition
Risk Factors: Identifiable risk factors include: chronic lung diseases, sleep apnea, chronic embolic disease, HIV infection, and collagen vascular disease.
- Signs and Symptoms: Dyspnea is the main symptom.
- Expected Patient Outcomes: Improve quality of life.
- Treatment and Care: Treat the underlying cause with medication, oxygen, and pulmonary rehabilitation (exercise in controlled environment). Medications can be prescribed to control symptoms and improve quality of life.
- Pharmacologic Treatment: Different classes of medications are used and is based on the classification group status of the patient, cost, and the patient’s tolerance of the prescribed agents.
- Nursing Interventions: Promote self-care |
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Term
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Definition
Risk Factors: Identifiable risk factors include: smoking, atherosclerosis, hypertension, diabetes, and vasculitis.
- Signs and Symptoms: May be asymptomatic, or may have constant or ‘boring’ pain.
- Expected Patient Outcomes: Control BP and correct risk factors.
- Treatment and Care: Medical management and surgical options.
- Pharmacologic Treatment: The treatment aims at maintaining a tight control over blood pressure (systolic BP should be between 100 and 120).
- Nursing Interventions: Promote self-care. If surgically treated, educate on pre-operative and post-operative care |
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Term
| Arterial Occlusive Disease |
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Definition
Risk Factors: Identifiable risk factors include: nicotine use, hyperlipidemia, hypertension, diabetes, obesity, and lack of exercise.
- Signs and Symptoms: Intermittent claudication, non-healing ulcer, and impotence. In the affected extremity: diminished/loss of palpable pulses, decreased skin temperature, poor toenail or hair growth. The extremity may be cool, painful and pale when horizontal. Patients usually place the extremity in the dependent position which decreases pain and turns the skin to a reddish/blue color.
- Expected Patient Outcomes: Increase perfusion to extremities.
- Treatment and Care: Medical management and/or surgical options.
- Pharmacologic Treatment: Antiplatelet agents.
- Nursing Interventions: Promote self-care by: losing weight, regular exercise, smoking cessation, and controlling cholesterol, blood pressure, and diabetes mellitus. |
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Term
| NANDA-I nursing diagnoses for the patient who has peripheral arterial occlusive disease |
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Definition
Risk for impaired skin integrity
Ineffective peripheral tissue perfusion |
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Term
| Which instructions should the nurse include in a teaching plan for a patient with peripheral arterial occlusive disease? |
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Definition
Exercise is the first line of therapy for patients with peripheral artery disease. Smokers have three times the risk of peripheral artery disease and are at increased risk for amputations.
Meticulous foot care and ulcer prevention can help prevent an amputation.
Many herbal products and over the counter medications can interfere with prescribed medications.
If a food product is labeled ‘low cholesterol’ does not mean the food is low in fat content. |
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Term
| Which instructions should the nurse include in a teaching plan for a patient with peripheral arterial occlusive disease. |
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Definition
The RN should encourage a walking program, assess skin on feet daily
discourage crossing of the legs |
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Term
| Which instructions are included when teaching a patient to obtain blood pressure readings in the home setting |
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Definition
The patient should sit and place their feet flat on the floor,
support their arm at heart level,
avoid caffeine for 30 minutes,
and snuggly wrap the cuff on their upper arm |
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Term
| Which statement about aortic aneurysms is true? |
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Definition
- Surgery is a treatment option for expanding aneurysms that are more than 5.5 cm wide. - Small and stable aneurysm may be monitored over time by the physician/care provider. - Less than 40 percent of patients experience pain symptoms.
- Increased blood pressure causes increase stress on the artery wall
- and medications are frequently prescribed to maintain an acceptable BP |
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Term
| Identify the symptom most commonly experienced by a person with pulmonary hypertension |
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Definition
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Term
| Venous thromboembolism (VTE) is a common disease, and potentially lethal disorder that includes |
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Definition
| deep vein thrombosis (DVT) and pulmonary embolism |
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Term
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Definition
Risk Factors: Identifiable risk factors include: obesity, pregnancy, prolonged sitting or standing, and genetic factors.
Signs and Symptoms: Swelling in legs, leg pain exacerbated by standing, decreased when legs elevated, reports of itchy or burning feelings.
Expected Patient Outcomes: Reduce venous stasis and prevent ulceration.
Treatment and Care: Medical and surgical options; aggressive wound care if a venous ulcer occurs.
Pharmacologic Treatment: An antibiotic is prescribed if the venous ulcer is infected.
Nursing Interventions: Promote self-care: elevate the legs frequently through the day; avoid prolonged sitting/standing; apply compression stockings; keep feet clean, dry with nonconstricting clothing and foot wear |
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Term
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Definition
Risk Factors: Identifiable risk factors include: immobilization or bed rest, genetic clotting disorder, cancer, smoking, oral contraceptive use, obesity (BMI greater than 30), heart failure, injury to a vein, pregnancy, trauma, or a previous episode of thromboembolism.
Signs and Symptoms: May be subtle or severe. Initial sign is edema in the leg/ankle/foot or extremity with changes in skin color and/or increased warmth. Tenderness/pain in the extremity usually occurs later.
Expected Patient Outcomes: Monitor and manage complications. Prevent pulmonary embolism.
Treatment and Care: Prevent enlargement of thrombus; rarely the clot is removed by thrombolytic therapy or endovascular intervention.
Pharmacologic Treatment: Anticoagulation therapy; rarely thrombolytic therapy.
Nursing Interventions: Prevent thromboembolism, monitor and manage potential complications from anticoagulation therapy, encourage exercise, and promote self-care |
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Term
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Definition
Risk Factors: Some identifiable risk factors include: venous stasis, hypercoagulability, and vessel wall abnormalities. Certain disease states such as thrombophlebitis, trauma, postpartum, obesity, diabetes mellitus, chronic obstructive pulmonary disease, and heart disease are risk factors for pulmonary embolus.
Signs and Symptoms: Depending on the size of the thrombus and area of the pulmonary artery occluded, symptoms can include: dyspnea, chest pain, hemoptysis, anxiety, tachycardia, shock and/or sudden death.
Expected Patient Outcomes: Stabilize and improve respiratory and vascular status; relieve chest pain.
Treatment and Care: Oxygen therapy to correct hypoxemia. Supportive therapy; rarely surgical embolectomy.
Pharmacologic Treatment: Anticoagulation therapy; rarely thrombolytic therapy.
Nursing Interventions: Manage pain by administering prescribed medications. Encourage patient not to cross legs or sit with feet dependent for long periods of time. Vary patient’s position and encourage early ambulation to enhance blood flow. Encourage adequate fluids to avoid dehydration. Provide patient education for self-care |
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Term
| The spectrum of coronary heart disease includes |
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Definition
- coronary artery disease,
- chronic or stable angina,
- acute coronary syndrome, and
- acute myocardial infarction |
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Term
| is a form of coronary artery disease |
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Definition
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Term
| Acute coronary syndrome is a cardiovascular emergency involving chest pain or discomfort that could be a |
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Definition
| myocardial infarction or unstable angina |
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Term
| There are four types of peripheral artery disorders: |
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Definition
- arterial hypertension,
- pulmonary artery hypertension,
- aortic aneurysm, and
- peripheral artery insufficiency |
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Term
| There are two types of peripheral venous disorders: |
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Definition
- venous insufficiency and
- venous thromboembolism |
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Term
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Definition
- flushing
- throbbing headache
- hypoT
- tachycardia |
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Term
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Definition
side effects and contraindications:
- hypoT
- bradycardia
- advanced AV block
- acute HF |
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Term
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Definition
| pt has clinical signs of coronary ischemia, but ECG and cardiac biomarkers don't show evidence of an MI |
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Term
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Definition
- unstable angina
- STEMI
- NSTEMI |
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Term
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Definition
- pt has ECG evidence of acute MI with characteristic changes in 2 leads on a 12 lead
- significant damage to the myocardium |
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Term
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Definition
- pt has elevated cardiac biomarkers (troponin) but no definite ECG evidence of acute MI
- there may be less damage to the myocardium |
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Term
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Definition
- relief of pain or ischemia
- prevention of myocardial damage
- maintain respiration
- adequate tissue perfusion
- reduced anxiety
- compliance |
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Term
| Monitor pt with acute MI for: |
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Definition
- changes in HR and rhythm, and sounds
- BP
- chest pain
- respiratory status
- urinary output
- skin color and temp
- mental status
- ECG change
- lab values |
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Term
| Percutaneous Coronary Interventions |
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Definition
- percutaneous transluminal coronary angioplasty
- coronary artery stent |
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