CAMILLA FRANKLIN IHUMAN WEEK #10, A 48 -Yrs -OLD FEMALE WITH FATIGUE AND IRRITABILITY, Exams of Nursing

Download CAMILLA FRANKLIN IHUMAN WEEK #10, A 48 -Yrs -OLD FEMALE WITH FATIGUE AND IRRITABILITY and more Exams Nursing in PDF only on Docsity! CAMILLA FRANKLIN IHUMAN WEEK #10, A 48 -Yrs -OLD FEMALE WITH FATIGUE AND IRRITABILITY Physical Ean Assessment Test Results | Response {arn not sleeping wel and om trad nh i tre. Lom worried something is wre e HPI How can | help you today? Foust ge owt got m? Wall, my husband says fm “snarky” Do you have any over sy pias or his nice way of saying Im moody by ® HP concerns we shoud suas? help it. When you-aru fied all lve havo a short fuse Yen tos ard bom ae yak pl ‘Aro you having sry difficulty sleeping? aed gross. Ws reations slong, I you \ you wake in the midge of the night, are |Syrpiom oy ato total asiep 2707 HPI "Powe your fatguatirecnss prove ae? pons nigh rest? ed Wee od Serr ras usnan Poe  Initial test for pts with normal resting ECG -Positive test = ST depressions, hypertension/hypotension, arrhythmia, symptoms -False positives --> stress imaging Exercise stress test indications -Confirm diagnosis of angina -Determine severity of limitation of activity -Assess prognosis in CAD pts -Evaluate response to therapy -Screen asymptomatic populations for silent CAD* Myocardial perfusion imaging (MPI) -Localizes areas of ischemia with baseline ECG abnormalities. -SPECT imaging with radiotracer (thallium or technetium) -Exercise or pharmacologic (dipyridamole or adenosine) Stress ECHO Localizes exercise or pharmacologic induced sentimental wall abnormalities. Also assesses LV and valve function. Coronary angiography Gold standard. Outlines coronary anatomy with location & severity of CAD. -Confirms or excludes CAD in pts -Evaluates CAD pts who may benefit from revascularization Aspirin Mainstay therapy for established/high-risk CAD pts. MOA: prevents platelet activation/aggregation CI: active ulcers, bleeding disorder Clopidogrel if aspirin intolerant. Nitroglycerin DOC in acute angina. Sublingual. MOA: reduces vessel tone, preload & afterload, O2 demand; can be used prophylactically. SE: flushing, headache, hypotension, peripheral edema, tolerance CI: hypotension, RV infarct, viagara Acute MI/unstable angina: survival benefit Chronic/stable CAD: dec. chest pain Not shown to reduce risk or MI or prolong life* Enhanced external counterpulsation (EEC) Noninvasive method of improving blood flow and reducing angina. Repetitive pneumatic compression/decompression following diastole/systole. Ind: refractory or CI to revascularization. CAD lifestyle changes Prevents coronary lesions from developing --> prevents 70% CAD. -Exercise (stress test prior) -Mediterranean diet: 3 servings fish, 4 servings nuts/wk. Lipid goals Total cholesterol <200 HDL >45 TG <150 HDL Removes LDL from plaque. -Low HDL --> CAD (even if low LDL) HMG-CoA reductase inhibitors (statins) Reduces LDL* MOA: inhibit hepatic cholesterol synthesis SE: myalgias* --> 50% pts stop taking statins w/in 1y -Cutting dose 50% only reduces efficacy 7% Rosuvastatin & pravastatin benefits Longest half lives, only 1-2 doses per week Fluvastatin benefit Unique metabolic pathway --> lowest risk for myalgias Coenzyme Q10 Controversial evidence for helping statin-induced myopathy (mainly used for systolic HF, HTN, migraines) -No lipid altering effects Monascus purpureus: yeast that grows on rice Best OTC tx for lowering cholesterol. Good alternative for pts w statin myopathy. Red yeast rice cautions *Citrinin: nephrotoxic fermentation by-product in certain brands of red yeast rice Obtain baseline LFTs & renal function tests. SE: myalgias (much less than statins) No LT effects reported. Vitamin B3 (Niacin/Nicotinic acid) Increases HDL*, reduces LDL & TG. Ind: monotherapy in pts intolerant of statins. SE: flushing, warm sensation, pruritis (give aspirin/NSAIDs), hyperuricemia* *Niacinamide/nicotinamide NOT the same thing. Vitamin B-complex Lower homocysteine, lower CAD risk. Green tea & extract Active ingredient = EGCG -Lowers cholesterol absorption. -Lowers LDL. -Inc. mitochondrial energy expenditure. -Mimics insulin. -Weight loss. Plant stanols/sterols Compete with cholesterol for intestinal absorption --> reduces LDL. Psyllium (fiber) Reduces intestinal cholesterol absorption. -Aka metamucil SE: diarrhea Fish oil