Acute care Cardiac Exam|2023 LATEST UPDATE|GUARANTEED SUCCESS

Coronary Artery Dz AKA (2) Athlerosclerosis Acute Coronary Syndrome Number 1 symptom of CAD angina 00:38 01:13 Continuum of CAD 1. stable angina 2. acute coronary syndrome 3. MI Non modifiable risks for CAD (4) 1. family hx 2. age 3. gender - males + postmenopausal women 4. Race - African Americans Modifiable risk factors for CAD (8) 1. HTN 2. DM 3. Smoking 4. Cholesterol levels 5. Obesity 6. Exercise 7. Oral Contraceptives 8. Stress What are the ABC's of Acute Coronary Syndrome (ACS) (10) A = Aspirin + Anti-anginals B = Beta Blockers + Blood pressure control C = Cholesterol management + Cigarette smoking D = Diet + Diabetes control E = Exercise + Education What is one of the highest risks for acute coronary syndrome uncontrolled HTN who is 3x more likely to have acute coronary syndrome obese ppl Cholesterol lowering medications end in... 1 main thing that this med can interact with - statin - liver function, should be monitored by lab work What is the classic triad of acute coronary syndrome 1. Ischemia - not enough oxygen to the heart - is reversible 2. Injury - lack of oxygen to the heart for increased amount of time causing injury - is reversible 3. Infarction - Ischemia and Injury don't get fixed. Death and necrosis of the cardiac muscle cells happens - is irreversible angina pectoris chest pain that results when the heart muscle does not get enough oxygen 2 main types of angina 1. stable 2. unstable 00:01 01:13 what is stable angina - predictable - consistent - brought on by exertion - relieved by rest or meds what is unstable angina - unpredictable - brought on by a new activity unknown to cause angina before - pre-infarction - 1st time someone has angina it is always considered unstable 5 drug types used for management of angina 1. Antiplatlets 2. Anticoagulants 3. Nitrates 4. Beta-blockers 5. Calcium channel blockers 2 types of antiplatlets used for angina 1. Aspirin 2. Clopidogrel (Plavix) How is aspirin given for prevention vs acute (MI) - Prevention = 81mg baby aspirin, enteral coated - Acute = 325mg non enteral coated to decrease further damage from MI what 3 anticoagulants are given for angina 1. Warfarin 2. Heparin 3. Enoxaparin (Lovonox - synthetic heparin) How can heparin be given and why is it given in those ways 1. IV - for acute MI 2. SubQ - for prevention How is IV heparin given 1. Always through a pump 2. dosage based on wt What blood work is monitored for Heparin PTT - Partial Thromboplastin Time - Baseline taken - Then 6hrs after Heparin is started - Then continue this until therapeutic levels are reached and maintained X3 PPT's what is the therapeutic range for heparin on the PTT 50-80sec What is the antidote for heparin? protamine sulfate why are smokers 10X's more likely to have sudden death - arteries constrict while smoking - nicotine causes stickiness and causes blockage What should a pt on warfarin avoid - asparin (ASA) - food high in vitamin K how long does it take for warfarin to reach therapeutic range - what do you do until this time - 3-5 days - The pt will be started on both warfarin and heparin until the warfarin kicks in then the heparin will be removed what labs are monitored for warfarin INR what is the INR international normalized ratio = based on PT what is antidote for warfarin vitamin K what is the teaching for nitro (3) 1. meds degrade in light and moisture 2. Replace q 6mos 3. keep on your person at all times what are some differences between warfarin and heparin Heparin = - blocks fibrin from becoming fibrinogen - dose is based on wt - when given IV action is almost immediate - given IV or SubQ Warfarin = - interferes w. synthesis of clotting factors from liver - given orally - takes 3-5days Nitroglycerin AKA: TNG how long does it take for sublingual nitro to relieve pain and how long does it last - 3-5mins - lasts 60mins how should a pt take nitro when having chest pain take one every 5mins until pain subsides - if you have to take 3 call 911 SE of nitro - flushing - dizziness - HA - tachycardia - hypotension What forms does nitro treat angina and which forms are preventative Treat = sublingual and IV Prevention = Extended release caps, ointment and patch Rules with nitro patch and ointment (3) 1. need 8hr nitrate free time 2. RN should wear gloves when handling 3. needs to go where there's no hair what is the onset and how long do nitro ointment or patches last Ointment = 1hr onset - lasts 8hrs Patch = 1hr onset - lasts 24hrs what do beta blockers do (4) - slow HR - reduces myocardial O2 demand - decreases force of contractility - lowers BP what are beta blockers used for (4) - BP control - Prevent MI - During MI - Arrhythmia ending of beta blockers lol What should you teach a pt about taking beta blockers (2) - orthostatic hypotension and standing slowly - decreased libido