Stable Angina: chest discompfort that occurs with moderate to prolonged exertion in a familiar patternrelieved by rest, nitroglycerin, and

drug therapy (only slight activity limitation) Acute Coronary Syndrome: describes people with unstable angina or acute MIatherosclerotic plaque ruptures resulting in platelet aggregation, thrombus formation, and vasoconstriction Unstable Angina: chest pain or discomfort that occurs at rest or with exertion leading to severe activity limitationincreasing attacks and intensity Variant Prinzmetals Angina: chest pain or discomfort resulting from coronary artery spasm and typically occurs after rest Pre-Infarction Angina: chest pain that occurs in the days or weeks before an MI Atherosclerosis: thickening or hardening of the arterial wallinvolves the formation of plaque within the arterial wall and is the leading risk factor for cardiovascular disease Signs and Symptoms: hypertension, cool extremities with absent pulse, bruits in the large arteries, a decrease in intensity or complete loss of a pulse Responsible Factors: low HDL, high LDL, increased triglycerides, genetic predisposition, DM, obesity, sedentary lifestyle, smoking, and stress, African American or Hispanic Diet: enriched/ fortified cereals with folic acid, vit B6, and B12, multivitamins, heart healthy diet fat intake of less than 30% of total calories, less than 10% from saturated fat (meats and eggs), up to 10% from polyunsaturated fat (safflower and sunflower oil), and 10-15% from monounsaturated fat (canola oil), cholesterol intake should be less than 300 mg per day (meat and eggs) Hyprlipidemia: an elevation of serum lipid levels Signs and Symptoms: Responsible Factors: Diet: Automaticity: the ability of cardiac cells to generate an electrical impulse spontaneously and repetitively Excitability: the ability of non pacemaker heart cells to respond to an electrical impulse generated form pacemaker cells and to depolarze Conductivity: the ability to transmit an electrical stimulus from cell membrane to cell membrane Repolarization: return of ions to their resting state Depolarization: when normally negatively charged cells develop a positive charge

Premature Atrial Contractions: occurs when the atrial tissue becomes irritablethe ectopic focus fires an impulse before the next sinus impulse is due Signs and Symptoms: sometimes heart palpitations Treatment: treat the underlying causes (stress management), antidysrhythmic drugs may become necessary Nutrition: avoid caffeice, nicotine, and alcohol Tachycardia: a heart rate greater than 100 bpm Bradycardia: a heart rate less than 60 bpm Acute/Chronic Atrial Fibrillation: multiple rapid impulses from many atrial foci depolarize the atria in a totally disorganized manner at a rate of 350-600 times per minutechaotic rhythm with no Pwave, no atrial contractions, loss of atrial kick, and an irregular ventricular response Signs and Symptoms: fatigue, weakness, SOB, distended neck veins, dizziness, decreased exercise tolerance, anxiety, syncope, palpitations, chest discomfort or pain, and hypotension Activity Modifications: Nutrition: Medication: antidysrhythmic and anticoagulant drugs Right Heart Failure: the right ventricle does not empty completely increased volume and pressure develop in the venous system and peripheral edema results Left Heart Failure: systolicthe heart cannot contract forcefully enough during diastole to eject adequate blood into the circulation, diastolicthe left ventricle cannot relax adequately during diastole, leads to inadequate cardiac output MI: occurs when the myocardial tissue is abruptly and severely deprived of oxygenmost result from atherosclerosis or a coronary artery, rupture of plaque, thrombosis, and occlusion of blood flow Valve Disorders Stenotic Mitral Valve: valve leaflets fuse and become stiff and the chorade tendinae contract and shorten, narrowing the valve opening preventing normal blood flowleft atrial pressure rises, left atrium dilates, pulmonary artery pressure increases and the right ventricle hypertrophies Dyspnea on exertion, orthopnea, PND, palpitation, dry cough, hemoptysis, pulmonary edema, hepatomegaly, neck vein distention, and pitting edema Pulmonary congestion, right sided HF, and decreased cardiac output Prolapsed Mitral Valve: occurs because the valvular leaflets enlarge and prolapse into the left atrium during systolemay progress to pronounced mitral regurgitation

Chest pain, palpitations, exercise intolerance, dizziness, syncope, and palpitaions Stenotic Aortic Valve: aortic valve orifice narrows and obstructs left ventricular outflow during systoleresults in ventricular hypertrophy Dyspnea, angina, syncope on exertion, fatigue, debilitation, peripheral cyanosis Lab Tests Myoglobin: <90 mcg/L Serum LDH: 105-333 IU/L CK-MB Isoenzyme: 0% of total CK Troponin T: <0.20 ng/mL EKG changes in patients with MI: Assessment of patient with acute diarrhea: gastroenteritisask about travel, assess for nausea and vomiting, myalgia, headache, and malaise, asses abdomen for distention, hyperactive bowel sounds, and diffuse tenderness, assess for dehydration with poor skin turgor, dry mucus membranes, orthostatic blood pressure changes, hypotension, and oliguria commonly limited to 24-48 hourscampylobacter 20-30 per day X 7 days, e coli blood in the stool diarrhea for 10 days, and shigella blood and mucus up to 5 days Teaching related to colonoscopy: clear liquid diet for 12-24 hours pre-op (NPO 6-8 hours pre-op), avoid aspirins and NSAIDs, avoid driving for 12 hours post-op Testing occult blood: pH of stomach: <5 Hypoglycemia Signs and Symptoms: warmth, weakness, fatigue, difficulty thinking, confusion, behavior changes, emotional lability, seizures, loss of consciousness, brain damage, shaky, pounding heart, nervous/anxious, sweaty, hungry, tingling, death Hyperglycemia Signs and Symtpoms: increased thirst, headaches, difficulty concentrating, blurred vision, frequent urination, fatigue, weight loss Blumbergs Sign: rebound tenderness Murphys Sign: increased pain with deep inspiration Crohns Disease: inflammatory disease of the small intestine, colon, or bothcaused by genetic, immune, and environmental factors Esophageal Reflux: occurs due to reflux of GI contents into the esophagus resulting in inflammation due to the irritationoccurs when the lower esophageal sphincter relaxes excessively

Hiatal Hernia: involves protrusion of the stomach through the esophageal hiatus of the diaphragm into the chest Inguinal Hernia: indirecthernia pushes down into the inguinal canal, directhernia passes thorugh a weak point in the abdominal wall Umbilical Hernia: congenitalappear in infancy, acquiredresult from increased intra abdominal pressure (obese people) Ventral Hernia: occur at the site of previous surgical incision Femoral Hernia: protrude through the femoral ring Herniorrhapy Surgery: laparoscopic surgery where many small incisions are made, the defect is located, and then replaced into the abdomen patient should be NPO pre-op and arrange for transportation home, post-op the patient should rest for several days, do not operate heavy machinery if on opioids, observe incision for heat, redness, swelling, drainage, and increased pain Gastric Ulcer: acid, pepsin, and H. pylori play a key role, when the mucosal barrier is broken HCl injures the epithelium, resulting in a gastric ulcer when back diffusion occurs or dysfunction of the pyloric sphincter causing reflux of bile acids that break the mucosal barrier integrity and produce inflammation the membrane of the gastric mucosa is destroyed, gastric emptying is delayed which worsens the injury, blood flow is decreased which alters the defense barrier allowing for ulcerationusually occur on the lesser curvature of the stomach Peritonitis: life threatening, acute inflammation of the visceral/parietal peritoneum and endothelial lining of the abdominal cavitycaused by infection by bacteria or chemicals by entering through perforations or penetration Key features include rigid, boardlike abdomen, abdominal pain, distended abdomen, nausea, anorexia, vomiting, diminished bowel sounds, inability to pass flatus or feces, rebound tenderness in the abdomen, high fever, tachycardia, dehydration, decreased urine output, hiccups, compromised respiratory status Upper GI Bleed: bright red or coffee ground vomitus (hematemesis), tarry stools or frank bright red blood in the stools, melena, decreased blood pressure, increased weak and thready pulse, decreased H and H, vertigo, acute confusion, dizziness, syncope Gastric Lavage: requires insertion of a large bore NG tube with instillation of room temperature solution (sterile saline/water or tap water it doesnt matter) in volumes of 200-300 mL, repeatedly withdraw solution and blood until returns are clear or light pink without clots, patient must lie on left side to limit outflow of solution Diverticular Disease: diverticulosispresence of many abnormal pouchlike herniations in the intestine wall, diverticulitisinflammation of one of the diverticulausually occur in the sigmoid colon, often where blood vessels interrupt the muscle layer Unless pain or bleeding develops, the condition may go undiagnosed diverticulosis--may have intermittent pain in the LLQ and constipation,

and abdominal tenderness, diverticulitislow grade fever, nausea, and abdominal pain, as well as rectal bleeding, abdominal distention, rebound tenderness, elevated WBC and decreased H and H Esophageal Varices: occur when fragile, thin walled esophageal veins become distended from increased pressuremost often occur in the distal esophagus but can also occur in the stomach and rectum, variceal bleeding can lead to severe blood loss causing shock, hematemesis and melena can occur, loss of consciousness may occur before bleeding is noticed, can be spontaneous but any activity that increases abdominal pressure may increase the likelihood of bleeding, as well as chest trauma or dry, hard food in the esophagus Colostomy Nursing Care: assess color and integrity of stoma (reddish pink and moist), should protrude 0.5-1 inch from the abdominal wall, assess peristomal skin for irritation, keep clean and dry, make sure pouch fits properly and is not leaking, empty gas and feces when it is 1/3 full Teaching Objectives: avoid heavy lifting and straining for defecation to prevent tension, normal appearance of the stoma, signs and symptoms of complications, measurement of the stoma, the choice, use, care, and application of appropriate covering appliance, how to protect peristomal skin, nutrition changes to control gas and odor and resumption of normal life activities Nutrition: avoid broccoli, beans, spicy foods, onions, brussel sprouts, cabbage, cauliflower, cucmbers, mushrooms, peas, chewing gum, smoking, beer, and skipping mealscrackers, toast, yogurt, buttermilk, cranberry juice, and parsely help prevent odors Ileostomy Nursing Care: patient is NPO at first, NG tube used for suction, replace fluids actively to prevent dehydration, skin care, ostomy care, bag changes Teaching Objectives: ileostomy care, be cautious of strenuous physical activity, high environmental heat, and episodes of diarrhea and vomiting, ways to adjust to daily living Nutrition: avoid foods that cause gas or make stool thicker (nuts, raw cabbage, corn, celery, apples with peels, and popcorn)include adequate amounts of salt and water Salmonella Food Poisoning Nursing Care: treatment is symptomatictreat with antibiotics and be prepared to treat for diarrhea and dehydration Priority Nursing Actions: symptom control (fever, nausea, vomiting, cramping, abdominal pain, diarrhea) Teaching Objectives: wash hand before and after meals and defecating

Laennecs Cirrhosis: caused by chronic alcoholism Enlarged Liver (Hepatomegaly): occurs in the early stages of cirrhosis Venous Congestion: Portal Systemic Encephalopathy: a disorder in liver failure and cirrhosis that affects the brainleads to sleep disturbances, mood disturbances, mental status changes, speech problems, altered LOC, impaired thinking process, and neuromuscular problemsprobably a result of shunting of portal venous blood into the central circulation so the liver is bypassed Obstructive Jaundice: obstructed bile flow caused by edema of the ducts or gallstone (extrahepatic), or inflammation of bile ducts or channels increasing circulating bilirubin (intrahepatic)excessive bile salts accumulate in the skin Signs and Symptoms: pruritis, clay colored stools, dark and foamy urine, Cholecystitis: inflammation of the gallbladder Signs and Symptoms: flatulence, dyspepsia, eructation, anorexia, nausea, vomiting, abdominal pain/discomfort, pain in the RUQ or that radiates to the right shoulder or scapula, biliary colic (obstructions of the cystic duct) can lead to tachycardia, pallor, diaphoresis, and prostration, jaundice, clay colored stools, dark urine, steatorrhea, fever, dehydration, Murphys and Blumbergs signs Choesystectomy: surgical removal of the gallbladder Nursing Care: Teaching Objectives: pain management, incision care, follow up appointments Assessment Findings: Jackson Pratt: self contained system that drains wounds directly thorough a tube via gravity and vacuumempty, measure, and record drainage every shift, note amount and color of drainage T-Tube: Small Bore Nasoduodenal Tube: used for short term enteral feeding (less than 4 weeks)are safer for patients at risk of aspiration since the tip is placed below the pyloric sphincter into the duodenum, small bore causes less complications such as nasal irritation, sinusitis, tissue erosion, and pulmonary compromise Salem Sump NG Tube: double lumentube with an air vent to keep the tube from grabbing the gastric mucosa allowing easy drainage and prevent mucosal damagesuction is continuousassess for color, consistency, and amount of drainage every 8 hours, make sure it is secure and is not causing skin irritation TPN: IV therapy in which any and all nutrients can be givenusually given through a PICC line or subclavian or internal jugular veins

Priority actions with various complaints Normal Lab Values Sodium: 136-145 mEq/L Potassium: 3.5-5.0 mEq/L Chloride: 98-106 mEq/L Prealbumin: 15-36 mg/dL BUN: 10-20 mg/dL OR 2.1-7.1 mmol/L Creatinine: female 0.5-1.1 mg/dL males 0.6-1.2 mg/dL