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Title: Coronary Artery Disease Hesi CS Post by: MrsO9706 on Feb 5, 2015 Which information in Kyra's Hx increases her risk for CAD? Positive family history for hyperlipidemia
Other risk factors for CAD include obesity, smoking 2 packs of cigarettes per day, and reported job stress Since Kyra has numerous risk factors for CAD, she attends an online class to learn how to reduce her risk. At the conclusion of the class Kyra tells the nurse, "I don't need any more of these classes, because I know that God is going to take care of my heart. Which nursing diagnosis is most appropriate for Kyra? Adjustment impaired related to health condition What is the best response by the nurse to Kyra's statement? You feel that you don't need to be involved in your health care? This is an example of a therapeutic technique called clarification, which encourages further communication. Kyra's lab results are: Serum cholesterol 280 LDL of 180 HDL of 32 Kyra asks the nurse if these results are bad. What info should the nurse include in teaching plan? An HDL of less than 50 for women indicates increased risk. • HDL is "good" cholesterol • HDL="highly desirable level" • HDL less than 50 for women is too low to safeguard the arteries Serum lipid profile Serum cholesterol should be less than 200 • LDL less than 100 is now considered to be optimal, with readings above 190 considered very high. Kyra is prescribed the antihyperlipedimc agent Lovastatin 20 mg PO daily What instructions should the nurse include in teaching about the use of antihyperlipidemic? Report any side effects. Side effects and drug reactions with Statins Rhabdomyolysis, especially when taken with other drungs like erythromycin. Side effects include increased liver enzymes, rhabdomyolysis and CNS effects • lovastatin is better absorbed when taken with food • other statins can be taken without regard to food intake • all statins can cause adverse GI effects (cramps, diarrhea, constipation, flatus, and heartburn) • they are generally taken with the evening meal or at bedtime Which ongoing lab test should Kyra anticipate during treatment with antihyperlipidemics? Liver enzymes Several months later, Kyra reports to clinic for routine lab work. She complains of chest pain. Following assessment and EKG, she's diagnosed with stale angina and receives 2 prescriptions: • Nitroglycerine 0.2 mg/hour transdermal patch. Apply every a.m. and remove at bedtime daily • Nitroglycerine 0.3 mg sublingual PRN for chest pain Which instruction should the nurse include when teaching Kyra about the use of sublingual nitroglycerin? Place table under tongue every 5 minutes until the pain is relieved, up to 3 tablets Sublingual nitroglycerin used when chest pain occurs, not on a daily basis • tablets should tingle slightly if they are fresh • replace tablets every 6 months to ensure potency • if pain is not relieved after 3 doses, pt should go to ED • tablets should not be exposed to light or air • check expiration date and keep med in original container • no need for refrigeration Transdermal nitroglycerin used daily to prevent angina attacks The nurse should prepare Kyra for which adverse effect that can occur when starting a daily dose of transdermal nitroglycerin? Dizziness • it's a nitrate that causes systemic vasodilation, often leading to hypotension. Instruct pt to change positions slowly and avoid prolonged standing. Other s/s include tachycardia and headache. What instructions should be given prior to a stress echocardiogram? It is important to return to exam table immediately after exercising. This is so that the heart is still stressed from the exercise when echo is performed. Her angina remains stable and she undergoes a hysterectomy for dysmenorrhea r/t uterine fibroids. The day after being discharged from hospital, Kyra comes to ED with crushing substernal chest pain radiating down her left arm. She is dyspneic, pale, and diaphoretic. Which nursing intervention should be implemented first? Administer oxygen. ABC's: 1) ensure open airway 2)ensure circulation (establish IV access and start IV fluids) 3) obtain more data based on observations (BP, collect specimen, start EKG, and get chest x-ray) ECG findings show that Kyra has had an MI. Which intervention should the nurse implement first? Inform the ED physician of Kyra's recent surgery. SHe may not be a candidate for some post-MI treatments, such as tPA. tPA is a thrombolytic agent, or coagulation modifier, that breaks down clots in the coronary arteries. If blood flow is established quickly, the heart muscle will not become ischemic or necrotic. To be most effective tPA should be given within the first 4 hours following an MI. IV nitroglycerin (Tridil) is prescribed for Kyra. What is the primary goal of this medication? Perfuse cardiac tissue by dilating coronary arteries. Nitrates cause coronary blood vessels to dilate, allowing improved O2 delivery to cardiac muscle. In addition they cause systemic vasodilation reducing workload of the heart, which in turn reduces the myocardium's need for oxygen. Nitrates dilate cerebral vessels which is why patients often complain of a headache as an adverse effect Cardiac serial enzymes are ordered. The Dx of MI is confirmed by ECG changes and the elevation of cardiac enzymes and isoenzymes. Which ECG change is indicative of myocardial injury? ST segment elevation ST segment elevation is indicative of myocardial injury ST depression and inverted T waves are indicative of ischemia Development of pathological Q wave is indicative of: myocardial necrosis Peaked T waves represent right atrial enlargement, not indicative of myocardial injury Inverted P waves are characteristic of dysrhythmias associated with abnormal conduction within the atria or at the atrioventricular junction (AV node) Prolonged PR interval typical of 1st degree AV block (electrical conduction disturbance within the heart) Which cardiac isoenzyme is the most sensitive indicator for myocardial damage? CK-MB Creatine Kinase - MB Fraction (CK-MB) peak elevation occurs within 24 hours • serum troponin (a protein, not an enzyme) is a marker of myocardial injury with a broad diagnostic time frame, especially useful when pts are seen several hours after the suspected infarction has occurred The nurse assesses Kyra's symptoms during the myocardial infarction. Which question should the nurse include in the assessment of Kyra's chest pain? What other symptoms are you experiencing? Pt should describe onset, location, duration, quality of pain and any pain radiation. Additional s/s include dyspnea, palpitations, or diaphoresis should be noted. Also any actions that were taken in an attempt to relieve the pain should be noted. Following a HCP's prescription or agency protocol, the nurse should ensure that Kyra receives adequate analgesia. Morphine sulfate is frequently prescribed to relieve the pain of MI. It should be administered IV to get fastest relief and to avoid the muscle damage caused by IM injections. Other important interventions include maintaining O2 per NC, ensuring calm/quiet environment, providing adequate rest, and gradually increasing activity. On her second day post-MI, nurse notes changes in cardiac monitor. The rhythm strip changes from normal sinus rhythm with short runs of ventricular tachycardia. The nurse assesses Kyra, whose blood pressure is now 100/54. She is lethargic, but arousable. Which intervention should the nurse initiate first? Administer amiodarone (cordarone) IV The treatment of choice for PVCs and ventricular tachycardia is an immediate IV bolus of amiodarone Kyra is started on a continuous IV infusion of lidocaine at 2 mg/min. The v-tach is controlled and strip shows sinus rhythm with occasional PVCs. The nurse monitors for side effects of the lidocaine infusion including: hypotension, drowsiness, seizures, bradycardia, and confusion. Kyra is scheduled for percutaneous transluminal coronary angioplasty (PTCA) via femoral insertion PTCA involves insertion of balloon-tipped catheter into diseased coronary artery. When inflated, it compresses plaque against vessel wall, resulting in increase in the inner diameter of blood vessel so blood can flow more easily. Which nursing intervention should be implemented when Kyra returns to her room? Immobilize the affected leg. High priorities post-procedure: prevention of dislodgement and bleeding/oozing at insertion site immediately post-op Site should be immobilized and closely monitored for s/s of hematoma formation AMB bleeding, inflammation, tenderness, and swelling. Distal circulation should be monitored closely by assessment of pedal pulses, color, warmth, and cap refill Title: Re: Coronary Artery Disease Hesi CS Post by: NikGis on Oct 18, 2015 CORONARY ARTERY DISEASE
1. BE – Positive family history of hyperlipidemia; smoking 2 packs/day cigarettes 2. B – Risk prone behaviors related to health condition 3. C – Do you feel you do not need to be involved in your health care? 4. D – HDL <50 for women indicates increased risk 5. B – Report any side effects 6. B – Liver enzymes 7. C – Place a tablet under the tongue every 5 minutes until pain is relieved; up to 3 tabs. 8. C – Dizziness 9. D – It’s important to return to table immediately after exercising 10. B – Admin O2 11. C – Inform ED physician of recent surgery 12. B – Perfuse cardiac tissue by dilating coronary arteries 13. A – ST segment elevation shows myocardial injury 14. B – Creatine Kinase – MB Fraction (CK-MB) 15. C – What other symptoms are you experiencing? 16. D – Admin morphine sulfate IV PRN for pain 17. B – Administer amiodarone (cordarone) IV - The treatment of choice for PVCs and ventricular tachycardia is an immediate IV bolus of amiodarone 18. 33 – 500 / 900 = .5555 * 60 19. B – Immobilize affected leg 20. B – Unstable angina with chest pain 21. C – The right to have information about the qualifications of caregivers 22. AE – Walking as main exercise; Chooses diet low in saturated fat and cholesterol |