1. Cardiac Alterations -Mandy.docx - NURSING 410...

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NURSING 410 – NURSING 410 – Cardiovascular Cardiovascular Alterations Alterations Quick Review Quick Review Signs of Stable Angina – predictable, heaviness/pain in chest. Use of nitro = responds well. If people want to do something exertional, take a nitro beforehand. Can tell a patient to take nitro before exercising and that is in the nursing scope of practice. Part of nursing is PREVENTION. Need to take the nitro before exertional activities, then wait for 5 minutes, then get up slowly, then go do activity. Treatment for Stable Angina Medications Beta blockers – decreases HR, decreases contractility decreases demand of the heart Nitroglycerine – sublingual, patch, orally (a couple times/day) o Period of 8 hours when patient is nitrate free so the patient does not physiologically become dependent on nitro and decrease its effectiveness. Calcium channel blockers – prinzmetal’s angina – angina from vasospasm Meds for hyperlipidemia Statins – stabilizes plaque and prevents plaque rupture Meds for erectile dysfunction Why are we discussing this in cardiac? Vasodilates, so cannot take with another vasodilator!! Chronic Stable Angina Chronic Stable Angina Intermittent chest pain that occurs over a long period with the same pattern of onset, duration, and intensity of symptoms Reversible (temporary) myocardial ischemia = Angina (chest pain) O 2 demand > O 2 supply Primary reason for insufficient blood flow is narrowing of coronary arteries by atherosclerosis Pain usually lasts 3 to 5 minutes. Subsides when the precipitating factor is relieved Pain at rest is unusual. [Should not have this, if they do it is a MEDICAL EMERGENCY ] ECG reveals ST-segment depression and/or T-wave inversion (ST depression reflects ischemia) PREDICTABLE Pain often relieved after 1 nitroglycerine sl tablet Who is at risk for a silent MI? Women and diabetics Location of Pain during Angina (figure in book) Location of Pain during Angina (figure in book) Silent Ischemia Ischemia that occurs in the absence of any subjective symptoms Often associated with diabetic neuropathy So, if someone was a diabetic and had a heart attack, would they always experience chest pain? No 1
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Feeling of impending doom, women may also have this What is our role as a nurse? Educate them on all the signs, not just the typical ones. Diabetics may have arm pain, they know something is not right but can’t put their finger on it (sense of impending doom) Educate patients about coming in WHEN they get pain and not wait until the a.m. Confirmed by ECG changes Prinzmetal’s Angina (Variant Angina) Occurs at rest usually in response to spasm of major coronary artery Seen in patients with a history of migraine headaches and Reynaud’s phenomenon Spasm may occur in the absence of coronary artery disease When spasm occurs Chest pain Marked, transient ST-segment elevation Often occurs during REM sleep May be relieved by moderate exercise or may disappear spontaneously
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