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Nursing Management: Coronary

Artery Disease

NURS 1228

Class 17

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Terms to Know

Angina Pectoris

Laser Angioplasty

Atherectomy Plaque

Atherosclerosis

Prinzmetals Angina

Collateral Circulation

PTCA

Coronary Artery

Disease

Stent Placement

Low fat diet

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Medications: Familiarize

Yourself! AntiplateletAggregation

Nitrates

Beta-adrenergic

blockers

(b adrenergic blocker)

Calcium Channel

Blockers

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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

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Coronary Artery Disease

What is it? How does it Happen?

Atherosclerosis:

Stages of development:Fatty Streak

Raised Fibrous Plaque

(Smooth muscle cellproliferation)

Complicated Lesion

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Plaque Build Up

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Collateral Circulaton

What is it?

How is it formed?

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Coronary Circulation

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Risk Factors

Modifiable

Diet: Serum lipid levels

Smoking (You would

guess this one, wouldnt

you??!) Hypertension (stress does

it, too!!)

Physical Inactivity (sorry,

student nurses)

Obesity

Unmodifiable

Age and gender

Family history and

heredity

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Modifiable ContributingRisk

Factors

Diabetes Mellitus

Stress and behavior patterns This guys an MI and a cardiac

arrest waiting for a chance to

happen!! (To say nothing of a

CVA which is not discussed inthis class).

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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

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CAD: What does it look like?

Insufficient blood supply to the heart itself

The heart muscle does not receive theoxygenated blood it requires

Atherosclerotic stenosis

Coronary artery spasm

Coronary thrombosis

All result in Myocardial IschemiaEither silent or symptomatic (angina)

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Angina

When an occlusion occurs:

The myocardial cells do not get the glucose needed for

aerobic metabolism

Anaerobic metabolism takes over; lactic acidproduced (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

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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.

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Types of Angina Continued

Prinzmetals Angina

Occurs at rest; major coronary artery goes intospasm.

Patient may not have known CAD

May occur at night especially during REMsleep

May be cyclicalConfirmed with Coronary Angiography

(detects obstruction of coronary arteries)

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Types of Angina Continued

Nocturnal Angina

Occurs only at night

Awake or asleepSitting up or laying down

Angina Decubitus

While the patient is lying downRelieved by standing or sitting

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What does it look like?

Pain:

Substernal

Referred

GI Feeling of anxiety

Shortness of breath, weakness, cold sweat, etc.

Prinzmetals: longer in duration; may wakepatient from sleep

Can cause dysrhythmias, decreased myocardialcontractility

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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

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Myocardial Infarction

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Treatment Options

PercutaneousTransluminalCoronaryAngioplasty

Stent placement

Atherectomy

Laser

Angioplasty Coronary

Artery BypassGraft

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Drug Therapy

Antiplatelet

aggregation therepy

(aspirin!)

Nitratesvasodiltors

Nitroglycerine

b-adrenergic

blockers Calcium Channel

blockers

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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:

O2 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

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Instructions regarding Nitrate

Therapy

Storage of medicaton

Sub lingual administraton

Immediate side effects and experience ofmedication working should be discussed

with the patient.

Sitting and standingpostural hypotension # of tablets to take to obtain relief of pain

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End of Class

Drive Carefully!