Nursing Management: Coronary Artery Disease

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  • 1. Nursing Management: Coronary Artery Disease NURS 1228 Class 17
  • 2. Terms to Know
    • Angina Pectoris
    • Laser Angioplasty
    • Atherectomy
    • Plaque
    • Atherosclerosis
    • Prinzmetal’s Angina
    • Collateral Circulation
    • PTCA
    • Coronary Artery Disease
    • Stent Placement
    • Low fat diet
  • 3. Medications: Familiarize Yourself!
    • Antiplatelet Aggregation
    • Nitrates
    • Beta-adrenergic blockers
    • (  adrenergic blocker)
    • Calcium Channel Blockers
  • 4. Diagnostic Tests: Familiarize Yourself!
    • Chest X-ray
    • Lipid Level
    • ECG
    • Echocardiography
    • Exercise Stress Test
    • CK
    • Nuclear Imaging Studies
    • LDH
    • Position Emission Tomography
    • Cardiac Troponin
    • Coronary Angioplasty Studies
  • 5. Coronary Artery Disease What is it? How does it Happen?
    • Atherosclerosis:
    • Stages of development :
      • Fatty Streak
      • Raised Fibrous Plaque
        • (Smooth muscle cell proliferation)
      • Complicated Lesion
  • 6. Plaque Build Up
  • 7. Collateral Circulaton
    • What is it?
    • How is it formed?
  • 8. Coronary Circulation
  • 9. Risk Factors
    • Modifiable
      • Diet: Serum lipid levels
      • Smoking (You would guess this one, wouldn’t you??!)
      • Hypertension (stress does it, too!!)
      • Physical Inactivity (sorry, student nurses…)
      • Obesity
    • Unmodifiable
      • Age and gender
      • Family history and heredity
  • 10. Modifiable Contributing Risk Factors
    • Diabetes Mellitus
    • Stress and behavior patterns
      • This guy’s an MI and a cardiac arrest waiting for a chance to happen!! (To say nothing of a CVA which is not discussed in this class).
  • 11. Health Promotion
    • Identify and Manage High Risk Persons
      • Exercise: Begin young
      • Drug Therapy
        • Questran and Colestid
        • B vitamins
        • Lopid, Zocor, Lipitor, etc.
        • See table 32-7 on p.852
  • 12. CAD: What does it look like?
    • Insufficient blood supply to the heart itself
    • The heart muscle does not receive the oxygenated blood it requires
      • Atherosclerotic stenosis
      • Coronary artery spasm
      • Coronary thrombosis
    • All result in Myocardial Ischemia
      • Either silent or symptomatic (angina)
  • 13. Angina
    • When an occlusion occurs:
      • The myocardial cells do not get the glucose needed for aerobic metabolism
      • Anaerobic metabolism takes over; lactic acid produced (hence the pain)
      • Myocardial cells can live about 20 minutes without oxygen. When oxygen is restored, aerobic metabolism returns and things return to normal.
      • See p. 852 for precipitating factors that may be connected with myocardial ischemia
  • 14. Types of Angina
    • Stable Angina
      • Infrequent and controlled with medication; predictable
    • Unstable Angina
      • Unpredictable with less pattern discernable
      • Associated with seterioration of once stable atherosclotic plaque.
      • Thrombus formation occurs; can progress to an MI (Myocardial Infarction )
        • Treated with ASA and anticoagulants along with nitrates and Beta Blockers.
  • 15. Types of Angina Continued
    • Prinzmetal’s Angina
      • Occurs at rest; major coronary artery goes into spasm.
      • Patient may not have known CAD
      • May occur at night especially during REM sleep
      • May be cyclical
      • Confirmed with Coronary Angiography (detects obstruction of coronary arteries)
  • 16. Types of Angina Continued
    • Nocturnal Angina
      • Occurs only at night
      • Awake or asleep
      • Sitting up or laying down
    • Angina Decubitus
      • While the patient is lying down
      • Relieved by standing or sitting
  • 17. What does it look like?
    • Pain:
      • Substernal
      • Referred
      • GI
    • Feeling of anxiety
    • Shortness of breath, weakness, cold sweat, etc.
    • Prinzmetal’s: longer in duration; may wake patient from sleep
    • Can cause dysrhythmias, decreased myocardial contractility
  • 18. Other Diagnostic Studies
    • Chest x-ray
      • Detects:_________________
            • ________________________
            • ________________________
    • Lab tests: Serum Lipids, Cardiac enzyme values
    • ECG, ECG stress test
    • Ambulatory ECG Monitoring (“Holter Monitor”)
    • Angiography (Cardiac Catheterization)
    • Nuclear imaging (Thallium scan, Sestimbi)
    • Positron Emission Tomography (PET scan): identifies ischemia and infarcted areas.
    • Stress echocardiogram
  • 19. How cool is this?!
  • 20. Myocardial Infarction
  • 21. Treatment Options
    • Percutaneous Transluminal Coronary Angioplasty
    • Stent placement
    • Atherectomy
    • Laser Angioplasty
    • Coronary Artery Bypass Graft
  • 22. Drug Therapy
    • Antiplatelet aggregation therepy (aspirin!)
    • Nitrates – vasodiltors
      • Nitroglycerine
    •  -adrenergic blockers
    • Calcium Channel blockers
  • 23. NURSING IMPLEMENTATION
    • Health Promotion and Education
      • As discussed earlier
    • Acute Needs
      • Assessment: of pain, history, activity
      • Pain: deep or superficial? Diffuse or well located?
    • Care during anginal attack:
      • O 2 therapy
      • Vitals, ECG
      • Pain relief with Nitrate (& narcotic analgesic if ordered)
      • Assessment of heart and breath sounds
      • Patient comfort
      • Assessment of patient response to therapy
  • 24. Instructions regarding Nitrate Therapy
    • Storage of medicaton
    • Sub lingual administraton
    • Immediate side effects and experience of medication working should be discussed with the patient.
    • Sitting and standing – postural hypotension
    • # of tablets to take to obtain relief of pain
  • 25. End of Class Drive Carefully!