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Cardio Reviewer
Cardio Reviewer
Cardio (DAY 1)
doc arreglo
• Cardiovascular – responsible for 1ssue perfusion
o Blood: carries oxygen
§ 5 to 6 liters of blood
§ If the blood volume has decrease, 1ssue perfusion also decreases
§ Shock it is the inadequate 1ssue perfusion
• Can lead to mul1ple organ dysfunc1on
• Decreased blood volume – HYPOVOLEMIC SHOCK
o Heart: pumps the blood
§ decrease pumping of the heart = decreased 1ssue perfusion
§ shock involving the heart – CARDIOGENIC SHOCK
• causes of cardiogenic shock
o Coronary causes: MI and CAD
o Non-coronary causes: all cardiac diseases except for
myocardial infarcLon (MI)
o ObstrucLve shock – the heart is compressed. Ex:
pneumothorax
o Blood vessels: distribute blood.
§ Artery: carries oxygenated blood except for pulmonary artery
§ Veins: carries unoxygenated blood except for pulmonary veins
§ Capillaries: for gas exchange
§ Vascular tone: the lining of the blood vessels is made up of smooth muscles
(constricts and dilates) à blood is pushed to different parts of the body
• loss of vascular tone à blood vessels vasodilate (massive
vasodila1on) à blood is note distributed properly à BP goes down
à DISTRIBUTIVE SHOCK or CIRCULATORY SHOCK
o causes of distribuLve shock
§ infec1on à inflamma1on à vasodila1on. à SEPTIC
SHOCK
§ allergy à inflamma1on à vasodila1on à
ANAPHYLACTIC SHOCK
§ spinal cord injury à inflamma1on occurs and loss
of SNS à severe dila1on à NEUROGENIC SHOCK
(peculiar type of shock = no SNS compensa1on thus
bradycardia occurs.
o PaLent in a shock: Priority
§ Refer to physician
§ Give oxygen
§ PosiLon the paLent à modified Trendelenburg.
• Trendelenburg – is contraindicated because the diaphragm is
compressed à the respira1on is compromised this is not prac1ce
in the hospital already for the adverse effects it can cause.
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• Vascular disorders
o Outline:
§ Vascular disease à (1) arterial disorders, (2) venous disorders, and (3) both
• Arterial disorders
o Aneurysm
o Arterial insufficiency
§ Arteriosclerosis obliterans (ASO)
§ Raynaud’s disease
• Venous disorders
o Varicose veins
o Deep thrombosis/Venous thromboembolism
• Both
o Buergers disease/ thromboagi1s obliterans
o Aneurysm
§ Is a localized sac or dila1on formed at a weak point in the wall of the artery.
§ Types of aneurysms: most common forms of aneurysm are saccular and
fusiform.
• Saccular – projects from one side of the heart
• Fusiform – en1re arterial segments become dilated
o one sided vessels are only dilated and affected à SACCULAR
à not treated à en1re arterial segments dilates à
FUSIFORM
o basically both are just connected type of aneurysm.
• Ruptured
o Congenital aneurysm
§ Common site: cerebral vessels à cerebral aneurysm
o Acquired aneurysm
§ Has cause
§ Common site: aorta à aor1c aneurysm (can also be
congenital)
§ Elderly are commonly affected by acquired
§ AorLc aneurysm
• ELology
o Presence of atherosclerosis (atheroma: atheromatous
plaque)
o Atherosclerosis does not happen in aor1c arc (very fast
blood flow); commonly in the ascending and descending
aorta
§ StarLng age: younger children
• Monitor children’s BP at 3 years old with
appropriate cuff
§ Plaque: fats deposits, cholesterol, Nico1ne (tar)
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§ Dysphagia
o Medical management
§ Beta blockers – controlling the blood pressure and
correc1ng risk factors are helpful
• Drug involved:
o Atenolol
o Metoprolol
o Carvedilol
§ Angiotensin’s receptor blocks (ARBs)
• Drug involved:
o Losartan
o Valsartan
o Irbesartan
§ Blood pressure should be maintained
• It is important to control the blood pressure
in pa1ent with dissec1ng aneurysm.
o Normal:
§ Systolic: 90 to 120 mmHg – to
maintain the arterial pressure
of 65 to 75 mmHg. Using the
beta-blockers
o Surgical management
§ Endovascular grag
• These endovascular graXs are inserted into
the thoracic aorta via various vascular access
routes, usually the brachial or femoral artery
§ Cerebrospinal fluid drainage
• Abdominal aorLc aneurysm
o most common causes is atherosclerosis
o it expands and con1nuously enlarges if not treated, it is
likely to rupture. It depends also to the size of the aneurysm.
§ At least 5.5cm – the standard treatment has been
open repair of the aneurysm.
o risk factor:
§ gender: male
§ race: white or Caucasian
§ age: older than 65 years old
§ HTN
o most of these aneurysm occur below the renal arteries
which are know to be as infrarenal aneurysm à untreated
à rupture à DEATH
o clinical manifestaLons
§ if associated with thrombus
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• Management
o Admit the pa1ent
§ Type A: ascending à surgery ward
• High risk of rupture (has high risk than the
surgery)
§ Type B: Medical ward
• To control BP first prior to surgery
o Monitor blood pressure.
§ Most important role of nurses in AA
o Surgery
§ Stent
§ Repair aneurysm to make it stable.
o Most important health teaching post-surgery
§ Live a healthy lifestyle/manage the risk factors
(AVOID RF)
• Vascular diseases
o Arteriosclerosis obliterans (ASO)
§ Most commonly affec1ng lower extremi1es
§ Hardening of the vessels and plaque deposits
§ Irreversible
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§ELology: idiopathic
§Risk factors
• Age
• Smoking
• Obesity
• Diet
• Family history
§ Gender: most prominent among men than women
§ ExtremiLes: Lower extremi1es > Upper extremi1es
§ Signs and symptoms:
• Leg pain
• Claudica1on
• Thinning of air
• Cool to touch
§ Nursing diagnoses:
• Acute pain
• Ineffec1ve peripheral 1ssue perfusion
• Risk for shoch
§ Management
• Posi1oning: reverse Trendelenburg
• Pain reliever: NSAIDs
• Vasodilators are rarely given
• Manage risk factors
• Avoid trauma
• Skin care
• Wound care
• Preven1on infec1on
• Amputa1on
• Rehabilita1on ager amputa1on
• Live a healthy lifestyle
o Raynaud’s disease
§ Upper extremi1es
§ Reversible
§ A disease characterized by arteriolar vasospasm
§ E1ology: idiopathic
§ Risk factors
• Young women than men
• Smoking
• Stress
• Hypertension
• Exposure to cold temperatures: coldness of an aircon can trigger an
a]ack
§ Extremi1es: upper extremi1es
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o Raynaud’s phenomenon
§ the signs and symptoms of Raynaud’s disease are seen in another disease
§ causes:
• rheumatoid arthriLs
o autoimmune disease of the synovial joints; first affects the
hands
• systemic lupus erythematosus
o autoimmune disease of the connec1ve 1ssues
• scleroderma
o hardening of the skin; also, an autoimmune disease; RARE
o skin in the hands – loss of palmar creases à syndactyly
o skin in the face – loss of facial lines
o skin of the chest and back
o Crest syndrome:
§ Calcinosis – deposi1on of calcium in sog 1ssue
§ Raynaud’s phenomenon
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§ Esophageal dysmoLlity
• Calcium is deposi1ng in the esophagus à
dysphagia à nutri1onal problem.
§ Syndactyly – fusion of the creases in the palms
§ Telangiectasia – abnormal vessels forma1on in the
skin
• Venous insufficiency
o Varicose veins
§ Superficial vein
§ Abnormal dila1on and tortuous forma1on of the superficial veins of the
lower extremi1es
§ ELology.
• Presence of incompetent valves (irreversible)
• Blood flow in the lower extremi1es: upwards (against the gavity)
o Valves help the blood to go up
§ Risk factors
• Prolonged standing
• Prolong sipng
• Prolong crossing of legs
• Obesity
• Pregnancy – enlarging uterus compresses the vein in the lower
extremity à blood flow slows down à increase venous conges1on
causes veins to dilate
§ Nurses’ diagnoses
• Acute vein à venous conges1on and phlebi1s
• Ineffec1ve venous circula1on
• Disturbed body image
§ Management
• Preven1on of varicose veins:
o Avoid
§ Prolong standing
§ Prolong sipng
§ Prolong crossing of legs
§ Obesity (weight reduc1on)
o Elevate legs
o Compression stockings
• Sclerotherapy
o Injec1on of sclerosing substance (hardens the vein à
straightens the vein à lighten the color)
o The blood flow will be redirected to collateral vessels
o For small varicose veins
• Veins stripping’s and liga1on
o Removal of vein for larger varicose veins
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• Pain or tenderness
• Redness
• Pallor
§ Management
• Preven1on
o Mobilize the legs
o Elevate the legs
o Compression stockings keep muscles contracted à blood
flow upward
• Complete bed rest without bathroom privileges
• Heparin IV
• Pain reliever: NSAIDs
• ThrombolyLc drugs to dissolve the thrombus
o Within 3 days from the onset of symptoms
o Adverse effect: Bleeding
o Example:
§ U-urokinase
§ S-streptokinase
§ A-alteplase
• TED hose (customized) – as ordered
o Wear 6 months (depends on the case)
o Removed when the pa1ents lie down à upon lying down,
elevate legs wear upon waking up
• Warfarin
o Oral an1coagulant
o Follow-up monthly to prevent another occurrence
• Surgery
o Filter to prevent the thrombus dislodging
• Post-surgery health teaching
o Early ambula1on
o Manage risk factors
o Live a healthy lifestyle
• Buerger’s disease (AKA thromboangiGs obliterans)
o ELology: idiopathic
o Risk factors
§ Smoking
§ Young adult men
§ stress
o Signs and symptoms (involves arteries and veins)
§ Leg pain
§ Claudica1on
§ Dark skin
§ Edema
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o IntervenLons
§ Stop smoking and avoid all forms of tobacco products
§ Avoid stress
§ Avoid trauma
§ Pain reliver: NSAIDs
§ Skin care
§ Wound care
§ Vasodilators are rarely given
• Heart
o Hallow muscular organ
o Middle medias1num
o Muscular 1ssue
§ Contrac1lity
§ Conduc1vity
§ Rhythmicity
§ Automa1city
§ Excitability
o Pathophysiology:
§ RA receives unoxygenated blood from the Upper extremity (via SVC), lower
extremity (via IVC), and from the heart (via coronary sinus) → Tricuspid
(AV) valve → RV to the lungs via pulmonary artery (only artery that carries
unoxygenated blood)
§ Pulmonic (SL) valve: to the lungs (pulmonary circula1on) for blood to be
oxygenated via the pulmonary vein (only vein that carries oxygenated
blood) to the LA → Bicuspid/Mitral (SL) valve to the LV
§ LV to the Aorta via Aor1c (SL) valve to the systemic circula1on
o Blood pressure
§ Systemic circula1on pressure: 110/70 mmHg
§ Pulmonary pressure: 25/9 mmHg
o Primary organ affected by HPN: heart
§ ↑ BP → ↑ Heart workload
o Heart has a good compensa1on mechanism
§ Normally: heart enlarges itself à Cardiomegaly as a compensa1on
§ Cardiomegaly can be normal among athletes d/t strenuous ac1vity which
increases their cardiac endurance
o Valve: prevent backflow of the blood
o 4 heart sounds
§ S1 (lub) – closing of the AV valve
§ S2 (dub) – closing of the SL valve
§ S3: rapid ventricular filling (blood from atria to ventricle)
• Inaudible
• If heard, the heart have enlarged
• Sound:
o Lub dub dub à ventricular gallop
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• Valvular diseases
o Valvular Insufficiency
§ Known as the valvular regurgitaLon.
§ Not enough func1on of the valve à inability of the valve to close
completely.
§ Blood back flows
§ ManifestaLons:
• Has murmur
• Decreased cardiac output.
• Non-coronary cause of cardiogenic shock
o Valvular stenosis
§ Stenosis or known as narrowing then blood does not flow smoothly
§ Inability of the valve to open completely.
§ ManifestaLons:
• Has murmur
• Decreased cardiac output
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o DiagnosLc test:
§ 2D echocardiography
• UTZ of the heart
• Allowed for pregnant and children
• No prepara1on needed
o Management for valvular disease
§ Provide rest
§ Avoid stress
§ Support cardiac func1on
§ Repair the valve
§ Valvular replacement
§ Manage heart failure
§ Prevent and manage shock
o Surgical management
§ Valvuloplasty
• Catheter with balloon – to prevent valvular dila1on
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• Suture valve
§ Valvular replacement
• Mechanical valve to replace aor1c valve
• Fibrous replacement: newer methid
• Layers of the heart
o Endocardium – inner lining
o Myocardium – myocardi1s is d/t coxsackievirus
o Epicardium AKA visceral pericardium
o Parietal pericardium - envelops visceral pericardium
§ Between visceral and parietal pericardium, there is a fluid to decrease the
fric1on in each contrac1on
Cardio (DAY 2)
doc arreglo
• Inflammatory in the heart
o PericardiLs – constric1ve pericardi1s
§ ELology:
• Infec1on due to open heart surgery
• Chest trauma
• SLE – autoimmune disease of the connec1ve 1ssue
o ALacks the ehart and pericardium
• MI-induced percardi1s (dressler’s syndrome)
• Malignancy (secondary) – metastasis in cancer
• Idiopathic
o If idiopathic: pericardiotomy – places a stent to prevent fluid
accumula1on
§ If not effec1ve, pericardiotomy à risk for
dysrhythmias
§ Signs and symptoms
• Redness, swelling, heat, and inflamma1on of the sac → heart is
compressed
§ SubjecLve: chest pain – most prominent symptom
• Rule out heart aLack
• MI pain: constant à not affected by breathing of the chest
• Pericardi1s pain”.
o Worsens with deep inspira1on, lying down, or turning
o Relieved by sipng or leaning (orthopneic/tripod posi1on) à
chest well is moved away from pericardium à less
irrita1on.
o Objec1ve: (+) Fric1on rub: auscultate in the 4th leg ICS
(Tricuspid valve) → creaky, leathery, scratching sound, heard
best at the end of expira1on (lung is collapsed) and when
pa1ent is in orthopneic posi1on
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§DiagnosLcs tests
• 2D echocardiography
• Chest x-ray
• CBC: high WBC
• ESR: (+) ESR systemic inflamma1on
• Depending on the cause:
o Culture and sensi1vity: blood is cultured.
o Coronary angiography
o Biopsy
o ANA test: an1-nuclear an1body test
§ Management
• Independent: orthopneic posi1on
• Pain reliever: NSAIDs
• AnL-inflammatory drugs: steroids
• Manage the cause
o If the infec1on, abx
o MI, treat MI
o Cancer, treat cancer
o SLE, treat SLE
• Prevent and manage the complicaLons
o Pericardial effusion: accumula1on of fluids in the
pericardial effusion
§ Pericardiocentesis – aspira1ng fluid from pericardial
effusion
• MD will do; RN will assist
• Posi1on: semifowlers positon
• Chest X-ray – to know the placement
• Ultrasound – to know how many fluids to
remove
• During procedure, the needle is connected
to the ECG à heart is normal = ECG should
be normal à if the needle touches the heart
à abnormal ECG à withdraw the needle
and aspirate the fluid again
o Cardiac tamponade – high amount of fluids in the
pericardium compresses the heart à LOW BP à the blood
backflows to the RA à JVD (neck vein disten1on)
o Pericardiocentesis
§ BP normalizes.
§ Heart sounds can now be heard.
§ Neck veins flaLens
§ Instant relief
o EndocardiLs – inflamma1on of the endocardium
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§ ELology:
• Two types
o Infec1ve: bacteria most common cause, known as the
infec1ve endocardi1s, and most common bacteria is
strep/staphylococcus
o Non-infec1ve
• Risk factors
o Exis1ng cardiac disorder the pa1ent becomes at risk.
§ RHD, CHD, VHD, and A.fib
o Immunocompromise state low immune system which
makes the pa1ent easily get infected.
§ Low immune system à decreased WBC
§ Extremes of ages
§ Chemotherapy pa1ents
§ HIV pa1ents
o Invasive procedure or surgery these when pa1ent is cut
open and bleeding occurs which predispose the pa1ent.
§ Cardiac catheteriza1on
§ Endoscopy
§ Surgery involves opening of blood vessels
o Poor hygiene and low socioeconomic status
• Pathophysiology
o Part I: when bacteria enter the blood vessels and
proliferates.
§ Pa1ent with valvular heart disease à has slow blood
flow in the leg side of the heart à dental extrac1on
à rupture of blood vessels à streptococcus enters
the blood vessels à which makes the pa1ent
immunocompromised à bacteria proliferate à
BACTERMIA.
o Part 2: signs and symptoms of fever, chest pain, fa1gue,
chills, weakness, and joint pains.
§ Bacteria goes to the heart à leg atrium has slow
blood flow à decreased CO à bacteria enter
endocardium (systemic inflamma1on) prominent
signs of symptoms is fever, chest pain, fa1gue, chills,
weakness, and joint pains.
• Note: fever or no fever pa1ent are s1ll prone
to endocardi1s which are more relevant
among geriatric pa1ents.
• Nursing diagnosis:
o Hypothermia
o Pain
o Risk for injury
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• Management:
o Nursing management no doctors involved these are
independent interven1ons, no drug therapy.
§ Manage fever.
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• Hypertrophic CDM
o Significant thickness of the myocardium especially the
interventricular septum then there is decrease size of the
chamber and during contrac1on aorta is compressed which
results to no blood flow à SUDDEN DEATH.
o Risk factors
§ Family history
• RestricLve CDM
o Ventricles becomes rigid can also have sudden death it is
because of hardened ventricles with idiopathic cause.
o Risk factors
§ Family history
• Arrhythmogenic right ventricular CDM
o Fibrosis or scarring of the right ventricle then right ventricles
fails because of these scarring which may result to leX
ventricles will also fail.
o Risk factors
§ Family history
§ ELology: Idiopathic
§ Risk factors
• Viral infec1on
• Alcoholism
• Pregnancy-induced CDM
• Family history
§ DiagnosLcs test: 2D echocardiography
§ Management:
• Avoid strenuous ac1vity.
• Provide rest
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• Avoid stress.
• Support cardiac func1on.
• Manage heart failure.
• Heart transplant
o No cure for CDM à only heart transplant
o Source: Human (brain dead)
§ Blood pressure: classifica1on of blood pressure for adults 18 years old and
above.
BP classificaLon Systolic pressure Diastolic pressure
Normal <120 <80 average: 110/70
Prehypertension <120 – 139 80-89
Stage 1 140 – 159 90-99
Stage 2 ≥160 ≥100
• Hypertension
o HPN – elevated blood pressure
o Type:
§ Primary HPN
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•
Idiopathic
•
Risk factors:
o Family history
o Age
o Obesity
§ Secondary
• Has known causes.
o Example:
§ DM
§ renal disease
§ pheochromocytoma (tumor of the adrenal medulla)
à increased SNS à high BP
• secondary hypertension is a sign of a disease
• hypertension is also a risk factor (modifiable)
o can cause stroke, aneurysm
• Hypertension called the silent killer
o Major is asymptoma1c à pa1ents generally do not care
un1l symptoms arises.
o NO SIGNS AND SYMPTOMS à Nsg Dx: Risk diagnosis
o ELology:
§ Primary HPN
§ Secondary HPN
o Clinical manifestaLons
§ AsymptomaLc
• Nsg Dx: Risk diagnosis
• Knowledge deficit
• Non-compliance – pt not taking medica1on.
• Ineffec1ve health maintenance – pt not exercising.
§ If with signs and symptoms:
• Headache (occipital pain) – acute pain r/t headache
• Dizziness – risk for fall or injury
• Blurred vision – impaired vision
• Epistaxis – risk for ineffec1ve airway clearance r/t clot or risk for
aspira1on
o Diagnos(c test:
§ Sphygmomanometer – measures BP
§ 180/100 mmHg à consult MD (HPN crisis)
§ Elder with HPN
• With maintenance an1hypertensive drug. give another dose of the
maintenance drug.
o Monitor BP before and ager
o Do not tell the BP to the pa1ent to avoid eleva1ng BP.
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b. Doxacosin
c. Terazosin
i. Avoid prolonged standing and warm shower aXer A-
1
2. Alpha-2 Agonist CNS à decrease NE flow à decrease SNS
a. Clonidine – catapres
b. Methyldopa -- Aldomet
i. S/E: drowsiness so it should be given at night, do not
drive and operate machine
3. Beta blockers – heart: vasodila1on it will slow down heart rate which will
lower the BP but it can also result to bradycardia, Lungs:
bronchoconstrictor.
a. Propranolol
b. Metoprolol
c. Long ac1ng CCB:
i. Dil1azem
ii. Verapamil
4. RAAS.
§ Pain scale
o T – Timing
§ Angina: less than 15 minutes
§ MI: more than 30 minutes
• Angina Pectoris
o Types of anginas
1. Stable angina – one of its causes is increased the cardiac workload.
2. Unstable angina – decreases O2 due to severe atherosclerosis (pre-
infarc1on)
3. Prinzmetal – decreases O2 due to coronary v-spasm but it is irreversible.
4. Intractable angina – severe excrucia1ng pain; no objec1ve sign except
LEVINES SIGN
5. Silent ischemia – pa1ent may have MI without feeling anything or without
signs and symptoms.
o Nursing diagnosis
§ Ineffec1ve myocardial 1ssue perfusion
§ Acute pain
§ Anxiety r/t fear of unknown
• Dangerous d/t physical symptoms
o Increased O2 demand, increased cardiac workload à pt
becomes restless.
§ Ineffec1ve health maintenance
§ Non-compliance
• Knowledge deficit
o Priority intervenLon
§ Stable angina
• Rest
• Posi1on: semi-fowlers posi1on
§ Unstable angina
• Nitroglycerine first then oxygen
o AcLon: dilate the coronary arteries first before giving
oxygen priority nursing management
o Priority nursing management: OXYGEN
o DiagnosLc test
§ Angiography – most defini1ve diagnos1c test for all cardiovascular
diseases
• invasive procedure
• local anesthesia is used for cardiac catheteriza1on.
• assess for shellfish allergy.
§ Blood test (not defini1ve but suggest test only)
§ ECG
• Non-invasive defini1ve test
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•
T-wave inversion – sign of myocardial ischemia
•
Best 1me to take ECG: during the pain which is less than 15 minutes;
when there is no longer pain then altera1on will not be seen.
o Medical management for angina (SUMMARY)
§ Rest
§ Manage risk factors.
§ Oxygen therapy
§ Drug therapy
• Nitroglycerine
o a type of nitrate
o medical management: stool soXener
o NGT:
§ Coronary vasodilators à increases O2
§ Peripheral vasodilators à low BP à low cardiac
workload
o nurses should monitor the BP before and aXer
o acute a]ack: given sublingual for fast ac1on for about 3-5
minutes.
§ Un1l 3 doses only (1 dose every 5 minutes)
§ Call 911 aXer 2nd dose.
• S1ll go with the EMT even if the angina is
gone in 2nd dose à con1nuity of care.
o S/E: headaches
o Low BP before giving an1-angina drugs: do not give but
rather posi1on the pa1ent to modified Trendelenburg in
which the pa1ent may be in shock, then give O2 aXerwards
refer to the physician.
• Isosorbide nitrate
o Coronary vasodilators
o Peripheral vasodilators
o Slow onset of ac1on and it is not for acute a]ack.
o Only given when pa1ents need to be maintained with
nitrate.
• Beta-blockers
o Low bp à low cardiac workload
o S/E: bradycardia
• Calcium channel blockers
o Long term: dil1azem and verapamil à peripheral
vasodilator à low bp à low cardiac output
• Ranolazine
o New medica1on
o Ac1on
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Nsg. Dx.
Ineffec1ve airway clearance
Ineffec1ve breathing pa]ern
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