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33 - Coronary Artery Disease and Acute Coronary SyndromeAce Your Medical-Surgical Nursing, 10th Ed., Lewis, Dirksen, Heitkemper & Bucher Classes and Exams with Picmonic: #1 Visual Mnemonic Study Tool for Registered Nurse (RN) Students
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Medical-Surgical Nursing, 10th Ed., Lewis, Dirksen, Heitkemper & Bucher | Registered Nurse (RN) School Study Aid
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33 - Coronary Artery Disease and Acute Coronary Syndrome
45 Picmonics to Learn | 1 hr 23 mins
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Triglycerides Lab Value
- < 150 mg/dL
50 secs
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
Hypertension Assessment
- Mechanism
- Essential Hypertension
- Secondary Hypertension
- Assessment
- Headache
- Vision Changes
- Nosebleed (Epistaxis)
- Chest Pain
- Syncope (Fainting)
- Diagnosis
- Average 2 Sets, 2 Minutes Apart
- After 2 or More Visits
- Nursing Considerations
- Take BP Both Arms
- Common in African Americans
2 mins
Blood Pressure Classification (JNC 7)
- Classifications
- Normal
- Systolic (< 120)
- Diastolic (< 80)
- Prehypertension
- Systolic +20 (120-139)
- Diastolic +10 (80-89)
- Stage 1 Hypertension
- Systolic +20 (140-159)
- Diastolic +10 (90-99)
- Stage 2 Hypertension
- Systolic + > 20 (160)
- Diastolic + > 10 (100)
- Hypertensive Crisis
- Systolic > 180
- Diastolic > 110
4 mins
Metabolic Syndrome
- Assessment
- Dyslipidemia
- Central Obesity
- Insulin Resistance
- Hypertension
- Increased C-Reactive Protein (CRP)
- Increased Fibrinogen
- Considerations
- Increased Risk Cardiovascular Disease
1 min
Statins
- Rhabdomyolysis
- Hepatotoxicity
- HMG-CoA reductase inhibitors
- Decrease LDL
- Decrease Triglycerides
- Increase HDL
2 mins
Bile Acid Resins
- Indications
- Hyperlipidemia
- Mechanism of Action
- Bile Acid Reabsorption Prevented
- Slight Increase HDL/Triglycerides
- Decrease LDL
- Drugs
- Colestipol (Colestid)
- Cholestyramine
- Colesevelam
- Side Effects
- Cholesterol Gallstones
- Decreased Absorption of Fat-soluble Vitamins
- Patients Hate It
2 mins
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
Ezetimibe
- Indications
- Hyperlipidemia
- Mechanism of Action
- Cholesterol Absorption Blocker
- Decreases LDL
- Side Effects
- Diarrhea
- Increased LFT Values
56 secs
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
Gemfibrozil (Fibrates)
- Mechanism of Action
- Decreases Triglycerides
- Increase in HDL
- Slight Decrease in LDL
- Indications
- Hypertriglyceridemia
- Side Effect
- Hepatotoxicity
- Cholesterol Gallstones
- Myopathy
- Considerations
- Do Not Combine with Statins
- Warfarin Toxicity
2 mins
Atorvastatin (Lipitor)
- Characteristics
- -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
Fibrates
- Indications
- Hyperlipidemia
- Mechanism of Action
- Upregulate LPL
- Decreases Triglycerides
- Slight Increase in HDL
- Slight Decrease in LDL
- Side Effect
- Hepatotoxicity
- Cholesterol Gallstones
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
2 mins
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
2 mins
Unstable Angina
- Assessment
- Chest Pain with Rest or Exertion
- Limits ADLs
- > 15 Minutes
- Less Likely Relieved by Nitroglycerin
- ST Depression
- Fatigue
- Considerations
- Acute Coronary Syndrome (ACS) Treatment
- Emergency Treatment
2 mins
Coronary Artery Bypass Grafting (CABG)
- Indications
- ST-Segment Elevation Myocardial Infarction (STEMI)
- Cardiovascular Disease (CAD)
- Uncontrolled Angina
- Considerations
- Internal Mammary Artery
- Saphenous (Leg) Vein
- Transient Limb Edema
- Closely Monitor Patients
- Venous Thromboembolism (VTE) Prophylaxis
- Incentive Spirometer
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
2 mins
Angiotensin-Converting Enzyme (ACE) Inhibitors
- "-pril" Suffix
- Mechanism of Action
- Block Renin Angiotensin-Aldosterone System (RAAS)
- Indications
- Hypertension
- Heart Failure
- Side Effects
- Dry Non-productive Cough
- Hypotension
- Dizziness
- Possible Hyperkalemia
- Angioedema
- Nursing Considerations
- Slowly Change Position
- Do Not Stop Abruptly
2 mins
Angiotensin II Receptor Blockers (ARBs)
- Ends in "-sartan"
- Mechanism of Action
- Blocks Angiotensin II Receptor
- Indications
- Hypertension
- Side Effects
- Angioedema
- Contraindications
- Renal Artery Stenosis
- Pregnancy
1 min
Clopidogrel (Plavix)
- Mechanism
- ADP Receptor Antagonist
- Prevent Platelet Aggregation
- Indications
- Acute Coronary Syndrome (ACS)
- Prevention of Thrombotic Events
- Side Effects
- Bleeding
- Thrombotic Thrombocytopenic Purpura (TTP)
- Pancytopenia
- Abdominal Pain
- Considerations
- Withhold Before Surgery
2 mins
Calcium Channel Blockers (Verapamil and Diltiazem)
- Mechanism of Action
- Slows AV Conduction
- Indications
- Angina Pectoris
- Arrhythmias
- Essential Hypertension
- Side Effects
- Bradycardia
- Hypotension
- Constipation
- Peripheral Edema
- Gingival Hyperplasia
- Nursing Consideration
- Medication Education
2 mins
Warfarin (Coumadin)
- Mechanism of Action
- Inhibits Clotting Factors
- Indications
- Atrial Fibrillation
- Venous Thrombosis
- Pulmonary Embolism
- Assessment
- PT/INR Levels
- Observe for Bleeding
- Contraindications
- Pregnancy
- Nursing Considerations
- Vitamin K and Fresh Frozen Plasma
- Prolonged Therapeutic Onset
- Maintain Same Diet
2 mins
Enoxaparin (Lovenox)
- Mechanism of Action
- Inhibits Clotting Factors
- Factor Xa
- Indications
- Clot Formation Prevention
- Side Effects
- Heparin Induced Thrombocytopenia (HIT)
- Bleeding
- Considerations
- Medication Education
- Subcutaneous Injection
- 2 Inches from Umbilicus or Incisions
- Antidote
- Protamine Sulfate
2 mins
Heparin (Unfractionated)
- Mechanism of Action
- Suppresses Coagulation
- Indications
- Deep Vein Thrombosis (DVT)
- Pulmonary Embolism
- Side Effects
- Hemorrhage
- Heparin-Induced Thrombocytopenia (HIT)
- Considerations
- Monitor aPTT
- Preferred (Safe) During Pregnancy
- Antidote
- Protamine Sulfate
2 mins
Abciximab and Tirofiban (GP IIb/IIIa Inhibitors)
- Mechanism
- IIb/IIIa Receptor Inhibitors
- Inhibits Platelet Aggregation
- Indications
- Thrombotic Event Prevention
- Acute Coronary Syndrome (ACS)
- Percutaneous Coronary Intervention (PCI)
- Side Effects
- Bleeding
- Considerations
- Expensive
- Combination Drug Therapy
2 mins
Alteplase
- Mechanism
- Tissue Plasminogen Activator
- Indications
- Thrombosis
- Side Effects
- Bleeding
- Contraindications
- Intracranial Hemorrhage
- Internal Hemorrhaging
- Considerations
- Minimize Bleeding
- Monitor for Shock
- Antidote
- Aminocaproic Acid
2 mins
Transdermal Medication Administration
- Application
- Patch or Disc
- Directly on Skin of Arms, Chest, Upper Back
- Benefits
- Avoids First Pass Metabolism
- Sustained Administration of Medication
- Nursing Considerations
- Clean Skin After Removal
- Rotate Sites of Patches
- Apply to Dry Skin
- Avoid Shaved Skin
- Avoid Heat
- Nitro Effects Lost After 24 Hours
2 mins
Morphine
- Mechanism
- Opioid Receptor Agonist
- Indications
- Pain
- Myocardial Infarction
- Side Effects
- Nausea and Vomiting
- CNS Depression
- Biliary Colic
- Constipation
- Increased Intracranial Pressure (ICP)
- Pupillary Constriction
- Hypotension
2 mins
Cardiac Catheterization
- Considerations
- Fluttering Sensation
- Contrast Media
- NPO 6-12 Hours
- After Procedure
- Bed Rest
- Assess Circulation
- Assess for Bleeding
- Monitor Vital Signs
2 mins
Acute Digoxin Toxicity
- Clinical Symptoms
- Hyperkalemia
- Cholinergic (Nausea, Vomiting, Diarrhea)
- Blurry Yellow Green Vision with Halo of Light
- Arrhythmia
- Bradycardia
- EKG Changes
- Prolonged PR interval
- Decreased QT
- Scooping on EKG
- T Wave Inversion
2 mins
Digoxin (Lanoxin)
- Mechanism of Action
- Increases Inotropy
- Indications
- Heart Failure
- Atrial Fibrillation
- Side Effects
- Bradycardia
- Fatigue
- Contraindications
- Heart Block
- Nursing Considerations
- Heart Rate Below 60
- Hypokalemia
- Monitor for Toxicity and Visual Changes
- Digibind
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)
2 mins
Left Heart Failure Assessment
- Pulmonary Assessment
- Pulmonary Congestion
- Pink Frothy Sputum
- Wheezing or Crackles
- Dyspnea with Exertion
- Cough
- Systemic Assessment
- Fatigue
- Tachycardia
- Weak Peripheral Pulse
- S3, S4 Heart Sounds
1 min
Inflammatory Response
- Pathogens Infect Tissue
- Mast Cells Release Histamine
- Histamine Dilates and Increases Capillary Permeability
- Macrophages Engulf Pathogens
- Macrophage Signals Cells With Cytokines
- Responding Neutrophils Cross Capillary Wall
- B And T Lymphocytes Arrive At Injury Site
2 mins
Types of Shock
- Hypovolemic
- Depleted Volume
- Cardiogenic
- Pump Failure
- Obstructive
- Indirect Pump Failure
- Distributive
- Lost Vascular Tone
- Neurogenic
- Anaphylactic
- Septic
2 mins
Acute Pericarditis Assessment
- Pericardial Sac Inflammation
- Assessment
- Sharp Chest Pain
- Increased with Inspiration
- Pain Decreased by Leaning Forward
- Pericardial Friction Rub
- Diffuse ST-Elevation
- T Wave Inversion
- Fever
- Considerations
- May Be Asymptomatic
- Cardiac Tamponade
2 mins
Acute Pericarditis Causes
- Idiopathic
- Infection
- Trauma
- Cardiac
- Myocardial Infarction
- Autoimmune Diseases
- Uremia
- Tumor
- Radiation
2 mins
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
2 mins
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
2 mins
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
Cardiovascular Effects of Beta-Blockers
- Cardiac Myocytes and Vasculature
- Decrease cAMP
- Decreases SA and AV Node Conduction Velocity
- Lower Blood Pressure
- Decrease O2 Consumption
- Decreases Mortality Post-MI
2 mins
Anxiety Assessment
- Mild
- Increased Alertness
- Heightened Perception
- Moderate
- Perception Narrowed
- Short Attention Span
- Shaking
- Severe
- Ineffective Problem Solving
- Automatic Behavior
- Hyperventilation
- Panic
- Hallucinations
- Inability to Function or Communicate
2 mins
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