1. Nursing Management: Patients With Coronary Vascular Disorders
Chapter 14:
Nursing Management: Patients With Coronary Vascular Disorders

2. Coronary Atherosclerosis
The most common cause of cardiovascular disease.
Atheromas or plaques protrude into the lumen of the vessel.
Thrombi may form and obstruct blood flow, leading to sudden cardiac death or an acute MI.
The anatomic structure of the coronary arteries makes them particularly susceptible to the mechanisms of atherosclerosis.

3. Coronary Atherosclerosis

4. Risk Factors Nonmodifiable: Age Gender Race Family history Modifiable:
Diabetes, hypertension, smoking, obesity, physical inactivity, and high cholesterol

5. Risk Factor: Metabolic Syndrome
Consists of three or more of the following:
Insulin resistance
Abdominal obesity
Dyslipidemia
Hypertension
Proinflammatory state
Prothrombotic state

6. Question
The nurse is caring for a patient who had a recent MI. The nurse is aware that the plaque that likely contributed to this event is mostly made up of:
Lipids
Dead leukocytes
Interferons
Adipose tissue

7. Answer
A. Lipids
Rationale: Atherosclerosis begins as monocytes and lipids enter the intima of an injured vessel. A fibrous tissue develops, and this causes plaques to form on the inner lumen of vessel walls.

8. Clinical Manifestations of Atherosclerosis
Ischemia: An inadequate blood supply that deprives the cardiac muscle cells of oxygen needed for their survival
Angina pectoris: Chest pain that is brought about by myocardial ischemia
Classic signs and symptoms of myocardial ischemia include acute onset of chest pain, shortness of breath, extreme fatigue, diaphoresis, and nausea and vomiting

9. Prevention and Medical and Nursing Management
Control cholesterol levels:
Diet, exercise, medication, smoking cessation
Manage hypertension
Manage diabetes

10. Angina Pectoris
Almost always associated with a significant obstruction of a major coronary artery
Anginal pain can have widely varying characteristics
Diagnosis is usually by history, ECG, and cardiac biomarker analysis

11. Question
When discussing angina pectoris secondary to atherosclerotic disease with a patient, the patient asks why she experiences chest pain with exertion. The nurse informs the patient that exertion:
Increases the heart's oxygen demands
Causes vasoconstriction of the heart
Increases blood flow to the mesenteric area
Reduces the effectiveness of medications

12. Answer A. Increases the heart's oxygen demands
Rationale: Physical exertion increases the myocardial oxygen demand. If the patient has arteriosclerosis of the coronary arteries, then blood supply is diminished to the myocardium, resulting in pain. Exercise does not cause vasoconstriction, reduced effectiveness of medications, or increased blood flow to the mesenteric area.

13. Management of CAD and Angina
Nitrates
Beta blockers
Calcium channel blockers
Antiplatelet medications and anticoagulants
Oxygen administration

14. Percutaneous Coronary Interventions (PCIs)
Percutaneous transluminal coronary angioplasty
Intracoronary stent implantation
Nursing care

15. Question Is the following statement true or false?
A patient who has undergone a PCI has had one or more coronary vessels replaced with new, patent vessels.

16. Answer
False
Rationale: During a PCI, an occluded coronary artery is opened and reperfusion to the area that has been deprived of oxygen is reestablished. The vessel itself is not replaced.

17. Surgical Procedures: Coronary Artery Revascularization
Coronary artery bypass graft (CABG):
Indications
Qualification criteria

18. CABG

19. Nursing Process: The Postoperative Cardiac Surgery Patient
Initial postoperative care focuses on hemodynamic stability and recovery from general anesthesia.
Later care focuses on the monitoring of cardiopulmonary status, pain management, wound care, progressive activity, and nutrition.
Frequent, multisystemic assessment is imperative.

20. Nursing Interventions: The Postoperative Cardiac Surgery Patient
Restoring cardiac output
Maintaining adequate tissue perfusion
Maintaining body temperature
Preventing infection
Preventing fluid and electrolyte imbalances
Preventing impaired gas exchange
Promoting cerebral circulation
Pain control

21. Myocardial Infarction (MI)
Pathophysiology, risk factors, and manifestations are similar to those of angina.
Diagnosis and categorization of MI is based on ECG changes and analysis of cardiac biomarkers (CK-MB, myoglobin, troponin).
ECG analysis results in diagnosis of:
Unstable angina
ST-segment elevation MI (STEMI):
Non–ST-segment elevation MI (Non-STEMI)

22. Management of MI
Medications include aspirin, nitroglycerin, morphine, beta blockers, ACE inhibitors, and statins
Thrombolytics
Analgesics
Reperfusion therapy
Cardiac rehabilitation
Nursing care focuses on relieving pain, promoting respiratory function, promoting tissue perfusion, reducing anxiety, and monitoring for complications

23. Question
The nurse caring for a patient with an MI knows that the top priority in the care of this patient is what?
Balancing intake and output
Decreasing energy expenditure of the myocardium
Balancing myocardial oxygen supply with demand
Decreasing nutritional need of myocardial muscle

24. Answer C. Balancing myocardial oxygen supply with demand
Rationale: Balancing myocardial oxygen supply with demand (e.g., as evidenced by the relief of chest pain) is the top priority in the care of the patient with an MI. This supersedes interventions related to nutrition, fluid balance, or energy expenditure.