University:
York University
Course:
NURSING 2534 | Pathophysiology
Academic year:

2023
Views:

244

Pages:

3
Author:

Niklas

DISEASE: ANGINA * chest pain → myocardial ischemia * x primary ds → atherosclerosis * cause: coronary atherosclerosis ↳ hardening + stiffening of arteries ↳ plaque streaks → invitation for clotting ↳ nitric oxide (NO) ✓ Blood Supply + demand prob. RISK FACTORS 1. Lifestyle ✓ Diet ✓ Smoking/Alcoholism ✓ ↓ exercises ✓ Obesity 2. Diabetic ✓ viscosity ↑ glucose in blood ✓ TFA bic of glucose in cells → compensatory mechanism 3. Hypertension ✓ ↑O2 demand of ♡ ✓ ↑ pressure in BV 4. Men ✓ ↓ Estrogen → cardioprotective hormone 5. Old Age TRIGGERS 5ES 1. Excessive Exercise 2. Excessive Eating 3. Excessive Smoking 4. Emotional Stress 5. Exposure to Cold PATHOPHYSIOLOGY * DM-atherosclerosis-supply * ↑ exercise * emotional stress ↑ demand * anaerobic metabolism → creation of energy in absence of O₂ lactic acid Pain TYPES 1. Stable → predictable, triggered by SEs, easiest to manage ↳ REST + nitroglycerin 2. Unstable → preinfarction/crescendo → ↑ time ↑ pain, angina at rest ↳ AKA: Vasospasm of CA → closed/very constricted artery ↳ ↑ hypercalcemia → ↑ Ca muscle contraction ↳ TK: calcium channel blocker (-dipine) 3. Silent → x chest pain; ECG T-wave inversion ↳ ischemia: T wave inversion ↳ infarction: ST segment elevation ↳ DM ↳ 70ld Age S/SX 1. Chest Pain ↳ Position → sided/substernal/retrosternal ↳ Quality → pressing, vise-like, heaviness ↳ Radiation → jaw, neck, shoulder, arm, hand, fingers ↳ Relief → rest + nitroglycerin ↳ Severity → mild/moderate ↳ Time/Duration → 15 min. * most important/clear differentiator DIAGNOSIS 1. ECG → T-wave inversion 2. Cardiac Enzymes ✓ Troponin I ✓ CKMB ✓ Myoglobin not rule out MI MANAGEMENT 1. Rest → ↓ workload, O₂ demand, → O₂ via cannula → 2-1 L/physician order 1 to 5 L 2. Nitroglycerin → #1 venodilator → anti-anginal → photosensitive → shelf life: 6 mos. → S.E. headache → give acetaminophen → Hypotension → assess BP SUBLINGUAL PATCHES 1. Tablets 1. intact, hairless skin 2. under tongue 2. hair trim, clip 3. can crush 3. 10-12 h x tolerance 4. give before chest pain 5. max: 3 doses at 5 min interval