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CAD and ACSMedical Surgical Nursing

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What is involved in calculating the 10 year risk of a person having a nonfatal MI or dying from a cardiac event?
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-Age -Gender -Tobacco use -Systolic BP -Use of BP meds -Total cholesterol -HDL cholesterol level
The goal for serum LDL is...
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Less than 160 unless they have a high risk. High risk is less than 70
Why is smoking associated with an increased risk of CAD?
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Nicotine causes catecholamine release (norepinephrine and epinephrine) which increases heart rate and cardiac workload and it also promotes platelet adhesion that increases the risk of emboli formation
What were identified as the common barriers to smoking cessation? (5)
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History of relapses, stress, gaining weight, no support, depression
How does a diagnosis of diabetes impact the risks for developing CAD?
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People with diabetes, even if it is well controlled, develop CAD more often and earlier and with no differences in gender.
What are the cluster of risk factors referred to as Metabolic Syndrome? (5)
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Obesity, elevated triglycerides, hypertension, abnormal serum lipids, elevated fasting blood glucose.
How can a person reduce the amount of homocysteine in their system (which is a risk factor for CAD)?
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By taking B-complex vitamins (B6, B12, folic acid)
What is the FITT formula?
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Frequency. Intensity (how hard). Type (isotonic) Time (how long)
When is a complete lipid profile recommended?
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Every 5 years, starting at age 20
What are the initial treatments for someone who has a serum cholesterol over 200 mg/dL?
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Dietary caloric restriction if overweight, decreased fat and cholesterol intake, increased physical activity
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Although rare, what are the risks associated with use of statin medications to control serum lipid levels?
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Liver damage, myopathy that progresses to rhabdomyolysis
What labs should be monitored for a patient on statins?
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Liver enzymes: aspartate and alanine transferase, and creatine kinase if muscle aches or weakness occurs
What can increase the risk of developing rhabdomyolysis in patients taking Zocor?
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Concurrent use with Gemfibrozil (Lopid) or Niacin
______ is a vitamin that has been shown to be effective in lowering LDL and triglyceride levels but has many side effects like flushing, pruritis, GI disturbances, and orthostatic hypotension.
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Niacin
What would you recommend to a patient who was taking Niacin but frequently experienced flushing?
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Aspirin or NSAIDS 30 minutes prior to the Niacin
Which group of drugs are the most effective for lowering triglyceride levels?
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Fibric acid derivatives like TriCor and Lopid
What are the recommendations related to aspirin therapy for women to decrease the risk of CAD related events?
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Women have no cardiac benefit from aspirin until over the age of 65, therefore it isn't recommended until then unless they are high risk
What are the recommendations for a physical activity program for older adults?
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Longer warm up period, longer periods of low level activity/rest, exercise 30-40 minutes at least 3-4 times a week, avoid extreme temps, maintain a moderate pace
When is an elderly client most likely to consider changes for the benefit of their heart health?
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When hospitalized, and when symptoms result from CAD and not normal aging
______ is the clinical manifestation of reversible myocardial ischemia.
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Angina
How much of an artery needs to be occluded before angina occurs?
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75%
  
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