Nu 372 Final Exam ALREADY PASSED
Angina - =-chest pain brought about by *myocardial ischemia*
*Manifestations:*
-*Chest Pain*: substernal, precordial, may *radiate to neck/arms/shoulders or jaw*
-Usually lasts *2-5 minutes*
-Quality: tight, squeezing, constricting, heavy sensation, burning, dull, aching, constant
-Dyspnea, pallor, tachycardia, anxiety and fear, indigestion, nausea, vomiting, upper back pain
-ECG changes: *T-wave inversion and depressed ST segments* (*inverted T-wave = myocardial
ischemia*)
*Treatment*:
-*Nitroglycerin*: goal is to reduce oxygen demand and increased oxygen supply to the
myocardium
-*Organic nitrates*: short and long-term forms, used to treat acute angina attacks and prevent
angina
*Nursing interventions*:
-know when the angina is happening
-decrease demands of O2 needed on the heart
-increase effectiveness of medication
-reduce anxiety
-patient should *stop all activity and sit and rest* in bed (*semi-fowler position*)
-*administer oxygen* 2 L/min through nasal cannula
-assess patients *pain, vital signs, RR*
-*Tell patient to carry nitroglycerin at all times*
Stable angina - =-Most common type
-Chest pain that occurs when a person is *active or under severe stress* (cold, etc.)
,-Usually *subsides with rest*
-*Treatment*: nitrates, reducing stress/activity
*Clinical Manifestations*: angina that usually occurs when work of the heart increased by
physical exertion: physical activity, emotion, stress, eating a heavy meal, exposure to cold
Unstable angina - =-Angina that is *not relieved with rest*
-Requires *medical intervention*
-Occurs with *increased frequency, severity, and duration*
-Pain occurs with decreasing level of activity or stress
-May occur when the patient is just resting
-Patient is *at risk for myocardial infarction* (MI)
*Clinical manifestations*:
-*chest pains* during periods of rest or very little activity
Nitroglycerin - =*Short acting sublingual Nitroglycerin*:
-Drug of choice for treating acute angina
-Takes effect in *1-2 minutes*
-Decreases myocardial workload and oxygen demand
-Make sure no lesions/abrasions under the tongue that could effect absorption
-*Do not swallow*: could cause medicine to lose its effectiveness if it enters the stomach
-*1 sublingual tablet* dissolved under the tongue or in the buccal pouch as soon as angina
begins. *Repeat every 5 minutes*, if needed, to a *maximum of three doses* within a 15-minute
period. Client must *call for medical assistance* if angina is not relieved after third dose
*Longer acting Nitroglycerin prep*:
-comes in an oral tablet, ointment, or transdermal patches
-used to *prevent* angina attacks—*NOT to treat acute* attacks
,-main problem is *development of tolerance*
-*nitrate free periods* can limit tolerance by scheduling with a period of *8-10 hrs* per day
-scheduled to give *at night* when patient is less likely to experience angina
*Transbuccal administration*:
-Check the inside of the patients cheek to make sure there are *no ulcerations or abrasions* that
could interfere with the absorption of the drug
-Have the patient *place between gums and cheek* until full absorbed
-Do not swallow
-*Rotate from side to side with each dose*
*Transdermal administration*:
-discuss the administration with the patient
-make sure the patient knows to *take off old transdermal patches and wash the area before
replacing a new one* to prevent severe hypotension
-inform patients that they should *label in big writing their tubes* to prevent someone (or
themselves) from using it as hand lotion which would cause drug toxicity
*Headache is common side effect for both long and short acting nitrates*
Cardiomyopathy - =-a disease that affects the heart muscle and its ability to *pump* effectively
-Heart is *enlarged* and the walls become *thick and rigid*
*Complications*: Heart becomes weaker and has a *hard time pumping blood* leading to *heart
failure and dysrhythmias*
*Causes*:
-*Acquired*: develops from another disease
-*Inherited*: results from genetic conditions passed from parent to the child
-*Idiopathic*: unknown why it happens
, *Diagnostic tests*:
-*Echocardiography*: to measure the *ejection fraction*
-*Chest X-ray*: to see enlargement of heart
-*Cardiac catheterization*: to view inside the heart
*Management*:
*Pharmacological therapy*:
-Ace inhibitors, calcium channel blockers, beta blockers, Digoxin (*slow the HR down*)
-*Digoxin*: monitor for hyper-contractile pump
*Surgical options*:
-*Heart transplant*: is the *only cure for dilated* cardiomyopathy (DCM)
-*Left ventricular assistive devices (LVads)*: these can increase the patients *cardiac output*
while they wait for a heart donor; it's an *electrical pump surgically implanted* in the abdominal
cavity; aid in perfusion; patient needs to be *hooked up to a power source* the entire time
-*Pacemakers or ICDs* (implantable cardioverter defibrillator)
Dilated Cardiomyopathy (DCM) - =-Most common
-Ventricular *enlargement*
-*Reduced ejection fraction* (EF) due to diastolic and systolic volumes increasing
-*Risk Factors*: Men, genetics
-*S/S*: dyspnea, fatigue, weakness, *edema*, *S3 & S4* (you'll hear both), dysrhythmias
-Overtime *causes heart failure* because the muscle becomes weaker
-*Clinical manifestations*: shortness of breath, fatigue, and *swelling of the lower extremities*,
*JVD*
Angina - =-chest pain brought about by *myocardial ischemia*
*Manifestations:*
-*Chest Pain*: substernal, precordial, may *radiate to neck/arms/shoulders or jaw*
-Usually lasts *2-5 minutes*
-Quality: tight, squeezing, constricting, heavy sensation, burning, dull, aching, constant
-Dyspnea, pallor, tachycardia, anxiety and fear, indigestion, nausea, vomiting, upper back pain
-ECG changes: *T-wave inversion and depressed ST segments* (*inverted T-wave = myocardial
ischemia*)
*Treatment*:
-*Nitroglycerin*: goal is to reduce oxygen demand and increased oxygen supply to the
myocardium
-*Organic nitrates*: short and long-term forms, used to treat acute angina attacks and prevent
angina
*Nursing interventions*:
-know when the angina is happening
-decrease demands of O2 needed on the heart
-increase effectiveness of medication
-reduce anxiety
-patient should *stop all activity and sit and rest* in bed (*semi-fowler position*)
-*administer oxygen* 2 L/min through nasal cannula
-assess patients *pain, vital signs, RR*
-*Tell patient to carry nitroglycerin at all times*
Stable angina - =-Most common type
-Chest pain that occurs when a person is *active or under severe stress* (cold, etc.)
,-Usually *subsides with rest*
-*Treatment*: nitrates, reducing stress/activity
*Clinical Manifestations*: angina that usually occurs when work of the heart increased by
physical exertion: physical activity, emotion, stress, eating a heavy meal, exposure to cold
Unstable angina - =-Angina that is *not relieved with rest*
-Requires *medical intervention*
-Occurs with *increased frequency, severity, and duration*
-Pain occurs with decreasing level of activity or stress
-May occur when the patient is just resting
-Patient is *at risk for myocardial infarction* (MI)
*Clinical manifestations*:
-*chest pains* during periods of rest or very little activity
Nitroglycerin - =*Short acting sublingual Nitroglycerin*:
-Drug of choice for treating acute angina
-Takes effect in *1-2 minutes*
-Decreases myocardial workload and oxygen demand
-Make sure no lesions/abrasions under the tongue that could effect absorption
-*Do not swallow*: could cause medicine to lose its effectiveness if it enters the stomach
-*1 sublingual tablet* dissolved under the tongue or in the buccal pouch as soon as angina
begins. *Repeat every 5 minutes*, if needed, to a *maximum of three doses* within a 15-minute
period. Client must *call for medical assistance* if angina is not relieved after third dose
*Longer acting Nitroglycerin prep*:
-comes in an oral tablet, ointment, or transdermal patches
-used to *prevent* angina attacks—*NOT to treat acute* attacks
,-main problem is *development of tolerance*
-*nitrate free periods* can limit tolerance by scheduling with a period of *8-10 hrs* per day
-scheduled to give *at night* when patient is less likely to experience angina
*Transbuccal administration*:
-Check the inside of the patients cheek to make sure there are *no ulcerations or abrasions* that
could interfere with the absorption of the drug
-Have the patient *place between gums and cheek* until full absorbed
-Do not swallow
-*Rotate from side to side with each dose*
*Transdermal administration*:
-discuss the administration with the patient
-make sure the patient knows to *take off old transdermal patches and wash the area before
replacing a new one* to prevent severe hypotension
-inform patients that they should *label in big writing their tubes* to prevent someone (or
themselves) from using it as hand lotion which would cause drug toxicity
*Headache is common side effect for both long and short acting nitrates*
Cardiomyopathy - =-a disease that affects the heart muscle and its ability to *pump* effectively
-Heart is *enlarged* and the walls become *thick and rigid*
*Complications*: Heart becomes weaker and has a *hard time pumping blood* leading to *heart
failure and dysrhythmias*
*Causes*:
-*Acquired*: develops from another disease
-*Inherited*: results from genetic conditions passed from parent to the child
-*Idiopathic*: unknown why it happens
, *Diagnostic tests*:
-*Echocardiography*: to measure the *ejection fraction*
-*Chest X-ray*: to see enlargement of heart
-*Cardiac catheterization*: to view inside the heart
*Management*:
*Pharmacological therapy*:
-Ace inhibitors, calcium channel blockers, beta blockers, Digoxin (*slow the HR down*)
-*Digoxin*: monitor for hyper-contractile pump
*Surgical options*:
-*Heart transplant*: is the *only cure for dilated* cardiomyopathy (DCM)
-*Left ventricular assistive devices (LVads)*: these can increase the patients *cardiac output*
while they wait for a heart donor; it's an *electrical pump surgically implanted* in the abdominal
cavity; aid in perfusion; patient needs to be *hooked up to a power source* the entire time
-*Pacemakers or ICDs* (implantable cardioverter defibrillator)
Dilated Cardiomyopathy (DCM) - =-Most common
-Ventricular *enlargement*
-*Reduced ejection fraction* (EF) due to diastolic and systolic volumes increasing
-*Risk Factors*: Men, genetics
-*S/S*: dyspnea, fatigue, weakness, *edema*, *S3 & S4* (you'll hear both), dysrhythmias
-Overtime *causes heart failure* because the muscle becomes weaker
-*Clinical manifestations*: shortness of breath, fatigue, and *swelling of the lower extremities*,
*JVD*
