entrance exam guide nr545

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NR545 exam 2 - Study guide for week 6


Pharmacology, Physical Assessment & Pathophysiology (Chamberlain University)




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ANGINA
 Angina
o Chest pain by stress or exertion classic or exertional angina;
 Relieved by rest or nitro variant angina, in which
 Usually due to atherosclerotic heart disease. vasospasm occurs at rest;
o Patho and unstable angina, a more
 Decreased blood flow or ischemia to the myocardial tissue serious form.
 Maybe by
 Atherosclerosis Unstable angina refers to
 Coronary artery spasm prolonged pain at rest and of
o Physical assessment recent onset, perhaps the
 Chest heaviness result of a break in an
 Chest pressure atheroma this can lead to MI
 Nausea
 Pallor
 Diaphoresis
 Squeezing or fullness
 Sometimes pain radiates to the left shoulder
 Or pain in the jaw
 Attack more than 30 minutes can be
 Acute coronary syndrome
 Medical history needs to be obtained
 Level of discomfort, location, radiation and the effect of nitro
Precipitating factors of angina attacks are related to activities that increase the demands on the heart, such as running
upstairs, getting angry, respiratory infection with fever, exposure to weather extremes or pollution, or eating a large
meal.
o Objective data
 If the pt does not experiencing angina during the exam so the exam is normal.
 Evaluation during angina will demonstrate
 Increase bp
 Gallop rhythm
 Apical murmur
o Laboratory/ diagnostics
 Troponin
 CK-MB
 To evaluate for acute coronary symptoms
 EKG
o Pharmacologic Management
 Nitro
 Relaxes and widens the blood vessels promoting easier blood flow to the heart muscle
 0.3-0.6 mg by translingual every 5 minutes x3 (3x5 = 15)
 Beta-blockers
 Demonstrated prolonging life in pt with coronary artery disease post MI
 ACE inhibitors
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 Reduce afterload resulting in the heart to work against less resistance
o Special considerations
 Women can present with vague symptoms could be dismissed
 Additional risk factors like
 Smoking cessation
 Weight control
 Hypertension
 Cholesterol
 Adolescents and younger adults should be investigated for potential drug use or abuse as vasospasm or
constriction can result in angina
o Complications
 Risk of further complications and potential acute coronary syndrome
o Referrals
 Specialist
 Futter procedures like revascularization
 Cardiology
 Interventional Cardiology
 Cardiothoracic surgery
MYOCARDIAL INFARCTION PG 134
 MI occurred
o Blood flow to the heart is minimized and it can be by
 Vasospasm may occur in the presence of a partial occlusion by the atheroma leading to total obstruction
 Cholesterol forms a plaque in the arteries, decreasing blood flow to the myocardium
 Destroying part of the heart muscle
o Pathophysiology
 Imbalance between myocardial oxygen supply and demand
 Prolonged ischemia >30 minutes lack of blood flow to the myocardium causes cellular death
 Decreasing heart’s ability to function
 The presence of collateral circulation may reduce the size of the infarct
o Physical assessment
o Angina pain during exercise – MI pain at rest
o Pain will not be relieved with nitro radiation to left arm
o Pain is not present (silent myocardial infarction)
o Light-headed
o Increase feeling of anxiety or impending doom
o Hypotension is common and the pulse is rapid and weak as cardiac output decreases and shock develops
o Nausea may be reported – common in right coronary artery occlusion
o Nausea, dizziness, dyspnea, pallor
o Low grade fever
o Objective data
 Pt may exhibit diaphoresis
 Syncope
 Dyspnea

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