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Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th Ed., Hinkle & Cheever Nursing (RN) School Study Aid


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27 - Management of Patients With Coronary Vascular Disorders
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Cardiac Enzyme Evaluation: Creatine Kinase CK-MB
Measures
Skeletal or Cardiac Muscle Injury
Time Ranges
Onset: 4-8 Hours
Peak: 12-24 Hours
Return to Normal: 2-3 Days
1 min
Cardiac Enzyme Evaluation: Myoglobin
Measures
Skeletal or Cardiac Muscle Injury
Time Ranges
Onset: 1 - 4 Hours
Peak: 12 Hours
Return to Normal: 24 Hours
Considerations
Elevation After 24 Hours: Reinfarction
1 min
Cardiac Enzyme Evaluation: Troponin
Measures
Cardiac Muscle Injury
Time Ranges
Onset: 1 Hour
Peak: 10 - 24 Hours
Return to Normal: 5 - 14 Days
Considerations
Most Specific for Cardiac Muscle
Treated Aggressively
1 min
Cholesterol Lab Values
LDL (Low Density Cholesterol)
< 100 mg/dL
HDL (High Density Cholesterol)
> 40 mg/dL Males
> 50 mg/dL Females
Total Cholesterol
< 200 mg/dL
1 min
Troponin Lab Values
Troponin T (cTnT)
< 0.1 ng/mL Normal
Troponin I (cTnI)
< 0.5 ng/mL Normal
> 2.3 ng/mL Myocardial Injury
1 min
Therapeutic Diets
Common Therapeutic Diets
High Fiber
Low Residue (Fiber)
Low Sodium
Low Cholesterol
Diabetic
Renal
Dysphagia
Nursing Considerations
Diet Education
1 min
Heart Failure Interventions
Diagnostic Tests
Echocardiogram
Invasive Hemodynamic Monitoring
Improve Gas Exchange
High Fowler's Position
Oxygen
Advanced Airway
Drugs and Devices
Diuretics
Beta Blockers
Angiotensin II Receptor Blockers (ARBs)
ACE Inhibitors
Digoxin (Lanoxin)
Pacemaker
2 mins
Myocardial Infarction Assessment
Assessment
Substernal Chest Pain
Crushing or Dull Sensation
Arm, Jaw, and Neck
> 20 Minutes
Unrelieved by Nitro
Palpitations
Diaphoresis
Fear of Impending Doom
Nausea and Vomiting
Shortness of Breath
Considerations
Monitor for Arrhythmias
2 mins
Myocardial Infarction Diagnosis
Diagnosis
12 Lead ECG
ST Elevation
Q Wave
T Wave Inversion
Troponin T and I
CK-MB
Considerations
Early ECG
Cardiac Stress Test
2 mins
Myocardial Infarction Interventions
MONA
Morphine
Oxygen
Nitrates
Aspirin
Thrombolytics (tPA)
Invasive Procedures
Cardiac Catheterization
Stent Placement
Angioplasty
Coronary Artery Bypass Grafting (CABG)
Considerations
Decrease Modifiable Risk Factors
Resuming Activity (Physical, Sexual)
1 min
Stable Angina
Assessment
Chest Pain with Exertion
Relieved within 15 Minutes
ST Depression
Interventions
Nitroglycerin
Up to 3 Doses q 5 Minutes
Rest
Antiplatelet Medication
CABG
Angioplasty
1 min
Unstable Angina
Assessment
Chest Pain with Rest or Exertion
Limits ADLs
> 15 Minutes
Not Relieved by Nitroglycerin Alone
ST Depression
Fatigue
Considerations
Acute Coronary Syndrome (ACS) Treatment
Emergency Treatment
1 min
Alteplase
Mechanism
Tissue Plasminogen Activator
Indications
Thrombosis
Side Effects
Bleeding
Contraindications
Intracranial Hemorrhage
Internal Hemorrhaging
Considerations
Minimize Bleeding
Monitor for Shock
Antidote
Aminocaproic Acid
1 min
Aspirin (Acetylsalicylic Acid)
Mechanism
Inhibits Platelet Aggregation
NSAID
Indications
Thrombotic Event Prevention
General Pain
Inflammatory Conditions
Fever
Side Effects
Pancytopenia
GI Ulcers
Bleeding
Considerations
Withhold Before Surgery 7-10 Days
Reye's Syndrome
2 mins
Calcium Channel Blockers (Verapamil and Diltiazem)
Mechanism of Action
Slows AV Conduction
Indications
Angina Pectoris
Essential Hypertension
Arrhythmias
Side Effects
Bradycardia
Hypotension
Constipation
Peripheral Edema
Gingival Hyperplasia
Nursing Consideration
Medication Education
1 min
Atorvastatin (Lipitor)
-statin suffix
Mechanism
HMG-CoA Reductase Inhibitors
Indications
High Cholesterol
Side Effects
Hepatotoxicity
Rash
Rhabdomyolysis
Myopathy
Considerations
Monitor Liver Enzymes
Administer at Bedtime
Avoid Grapefruit
2 mins
Beta Blockers
"-olol" suffix
Mechanism
Decreases Heart Rate and Contractility
Decreases Peripheral Vascular Resistance
Decreases Renin Release
Indications
Hypertension
Heart Failure
Angina Pectoris
Contraindications
Asthma and Heart Block Patients
Nursing Considerations
Assess Blood Pressure and Heart Rate
Masking Signs of Hypoglycemia
Do Not Stop Abruptly
1 min
Bile Acid Resins
Indications
Hyperlipidemia
Mechanism of Action
Bile Acid Reabsorption Prevented
Decrease LDL
Drugs
Colestipol (Colestid)
Cholestyramine (Questran)
Colesevelam (Welchol)
Side Effects
GI Distress
Cholesterol Gallstones
Decreased Absorption of Fat-soluble Vitamins
1 min
Nitroglycerin
Mechanism of Action
Decreases Preload
Indications
Angina
Up to 3 doses q 5 mins
Side Effects
Headache
Hypotension
Contraindications
Viagra (Sildenafil)
Nursing Considerations
Assess Blood Pressure
Protect From Light
Use Glass Bottle and Special Tubing
Gloves for Applying Topically
1 min
Vitamin B3 - Niacin (Nicotinic Acid)
Mechanism
Decreases Triglycerides
Decreases LDL
Increases HDL
Indications
Dyslipidemia
Pellagra
Diarrhea
Dermatitis
Dementia
Side Effects
Flushing
GI Distress
Hepatotoxicity
2 mins
Coronary Arteries
Aortic Root
Right Coronary Artery (RCA)
Right (Acute) Marginal Artery
Posterior Descending Artery (PDA)
Left Coronary Artery (LCA)
Left Anterior Descending (LAD) Artery
Circumflex Artery
Left Marginal Artery
1 min
Statins
Rhabdomyolysis
Hepatotoxicity
HMG-CoA reductase inhibitors
Decrease LDL
Decrease Triglycerides
Increase HDL
1 min

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