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Coronary Artery Disease - Nursing Management - Lewis 33


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What is Coronary Artery Disease?
CAD is a type of Atherosclerosis involving the coronary arteries.
What is Atherosclerosis?
Atherosclerosis is a buildup of cholesterol and lipids (fat) in the intimal wall of the artery.
What are the theories of Atherogeneses?
Endothelial injury, lipid filtration, aging, thrombogenic, vascular dynamics and inflammation.
Describe collateral circulation.
As the coronary arteries become narrowed, the body tries to compensate by growing supplemental, collateral arteries. As the blockage grows, more and more collateral vessels develop. Aging does not adversely affect this ability.
What are the developmental stages of CAD?
(1)fatty streak
(2)raised fibrous plaque resulting from smoooth muscle cell proliferation and (3)complicated lesion.
What are unmodifiable risk factors of CAD?
Age, family hx, gender, heredity.
What are some MAJOR modifiable factors of CAD?
Hyperlipidemia, hypertension, smoking, physical inactivity, obesity.
What are some "contributing" modifiable factors of CAD?
Diabetes, stress, elevated homocysteine levels - these may damage the arteries inner wall.
Describe some health promotion factors for CAD.
Identify high risk patients through screening, manage high risk pts. aggressively, increase physical activity and EDUCATION.
Describe some nutrtional therapy for CAD.
Limitations on Trans fats, saturated fats, ETOH (alcohol), and Na+ in the diet are great for a healthy heart!
What are the three major clinical manifestations of CAD?
Angina pectoris, acute coronary syndrome and sudden cardiac death.
What is acute coronary syndrome?
When the oxygen supply is prolonged and not immediately reversible ACS develops.
What is stable angina?
When the lack of oxygen supply is temporary and reversible.
What are the two treatments for Atherosclerosis?
Angioplasy and bipass surgery.
What is ischemia?
Lack of oxygen supply to the heart.
What is Myocardial Ischemia?
Develops when the demand for myocardial oxygen exceeds the ability of the coronary arteries to supply the heart with oxygen.
What is angina pectoris?
Chest pain.
What is Prinzmetal's angina?
Also called "variant angina" often occurs at rest and usually in response to spasm of a major coronary artery.
What is unstable angina?
Angina that is new in onset, occurs at rest or has a worsening pattern.
What are the clinical manifestations of angina?
Chest pain, some may feel a strange feeling, pressure or ache in the chest. Pain is often described as constricting, squeezing, choking or suffocating sensation. Also it usually does not change with position or breathing.
What are some diagnostic studies of angina?
Hx and PE, CXR, ECG, lab tests (c-reactive protein, serum), CT scan, PET, treadmill exercising, echocardiogram.
What is some collaborative care for angina?
The tx of stable angina is aimed at decreasing oxygen demand and/or increasing oxygen supply.
Describe drug therapy for angina.
Nitrates usually initially to enhance coronary blood flow. Antiplatelet aggregation therapy (ASA)is a first line on treatment for angina.
What is Atherectomy?
Another treatment used for CAD - plaque is shaved off.
What are the six nursing measures taken if a nurse is present during and anginal attack?
(1)administer O2
(2)determination of VS
(4)prompt pain relief first w/nitrate followed by narcotic analgesic if necessary
(5)auscultat heart sounds
(6)comfortable positioning of patient

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