Question

 

Question 1. Compare / Contrast the anginas by creating a chart and then complete a list of 5 clinical manifestations associated with stable angina, unstable angina, and MI

Question 2. Create a patient teaching handout that incorporates a list of modifiable and nonmodifiable risk factors for coronary artery disease (CAD). Have students include pertinent teaching information about how patients could modify behaviors to address modifiable risk factors.

Question 3.Discuss at least 5 ways to help educate community members about the prevention of shock or sepsis, recognizing hypovolemic shock, and pre-hospital actions to take.

Answer 1

1, Types of Angina

Stable Angina / Angina Pectoris	Unstable Angina	Variant (Prinzmetal) Angina	Microvascular Angina
Etiology Myocardial ischemia	Rupture of thickened plaque	coronary vasospasm	Spasms within the walls of these very small arterial blood vessels causes reduced blood flow to the heart muscle leading to a type of chest pain
Episodic pain lasts a short time (5 minutes or less to 15 minutes) Is relieved by rest or medicine nitroglycerin May feel like gas or indigestion May feel like chest pain that spreads to the arms, back, or other areas	Often occurs while you may be resting, sleeping, or with little physical exertion May last longer than stable angina Rest or medicine usually do not help relieve it May get worse over time Can lead to a heart attack	Usually occurs while resting and during the night or early morning hours triggered by smoking Are usually severe Can be relieved by taking medication	May be more severe and last longer than other types of angina pain occur with shortness of breath, sleep problems, fatigue, and lack of energy Often is first noticed during routine daily activities and times of mental stress

symptoms of myocardial infarction

• severe pain, not relieved by rest or nitroglycerin and lasts for 30 minutes or longer
• nausea and vomiting
• diaphoresis
• dyspnea
• dysarrythmias
• feeling of fear and anxiety
• pallor, coolness of extemities, cyanosis

2. Patient teaching

Risk factors for coronary artey disease

modifiable factors	non modifiable factors
Age Gender - men Ethnicity- African americans more Hereditary	Elevated serum lipids hypertension smoking physical inactivity obesity stressful lifestyle diabetes mellitus

Hypertension

• Have regular checkup
• Reduce salt intake
• Stop smoking
• Control weight
• Exercise regularly

Elevated Serum lipids

• Reduce total fat intake
• Reduce animal (saturated) fat intake
• Adjust total caloric intake to achieve and maintain ideal body weight
• Engage in regular exercise program
• Increase amount of complex carbohydrates and vegetable proteins in diet

Smoking

• Enroll in program to stop smoking
• Change daily routines associated with smoking to reduce desire to smoke
• Substitute other activities for smoking
• Ask family members to support efforts to stop smoking

Physical Inactivity

• Develop and maintain routine for physi cal activity that is done at least three to four times a week
• Increase activities to a fitness level

Stressful Lifestyle

• Increase awareness of behaviors that are detrimental to health
• Alter patterns that are conducive to stress and rushing (get up 30 min earlier so breakfast is not eaten on way to work)
• Set realistic goals for self
• Reassess priorities in light of health needs
• Learn effective coping strategies
• Avoid excessive and prolonged stress
• Take 20 min/day to meditate
• Plan time for adequate rest and sleep

Obesity

• Change eating patterns and habits
• Reduce calorie intake
• Exercise regularly to increase caloric expenditure
• Avoid fad and crash diets which are not effective in the long run
• Avoid large, heavy meals

Diabetes Mellitus

• Follow the recommended diet
• Reduce weight and control diet
• Monitor blood glucose levels regularly

3. Prevention of shock or sepsis

Symptoms of Septic Shock

• A higher or lower body temperature- This can mean a fever higher than 101.3 degrees or a body temperature lower than 95 degrees
• A racing heart rate, beating faster than 90 beats per minute
• Confusion and difficulty answering questions
• Fast and shallow breathing, taking more than 20 breaths per minute
• Shaking or trembling

Prevention

• Get regular vaccinations against viral infections, such as flu, pneumonia, chickenpox, HIV, and other infections that could potentially lead to sepsis.
• Practice good hygiene, such as bathing and changing clothes regularly. Washing the hands frequently, especially after handling food, touching pets, and using bathroom facilities, is another way to keep infection at bay.
• Care for and clean any open or gaping wounds. Wear disposable gloves, and rinse wounds with clean, soap-free water to clear out debris or dirt. Cover the wound to protect it, and see a doctor if the wound does not close or might still contain dirt.
• Look out for signs of infection, such as fever, chills, rapid breathing, rash, or confusion.
• For any bacterial infections, follow the doctor’s advice on how to take the antibiotics and finish the whole course of treatment. Store the medicine according to the packaging instructions.
• Treat fungal and parasitic infections as soon as symptoms appear, and use medication specific to the particular fungus or parasite.
• Control diabetes, if relevant.
• Avoid smoking

Symptoms of hypovolemic shock can be related to volume depletion, electrolyte imbalances, or acid-base disorders that accompany hypovolemic shock.

Mild symptoms

• headache
• fatigue
• nausea
• profuse sweating
• dizziness

Severe symptoms

• cold or clammy skin
• pale skin
• rapid, shallow breathing
• rapid heart rate
• little or no urine output
• confusion
• weakness
• weak pulse
• blue lips and fingernails
• lightheadedness
• loss of consciousness

Signs and symptoms of internal hemorrhaging include:

• abdominal pain
• blood in the stool
• black, tarry stool (melena)
• blood in the urine
• vomiting blood
• chest pain
• abdominal swelling

Emergency care and first aid

Untreated hypovolemic shock will lead to death. Hypovolemic shock is a medical emergency. Call 911 immediately if you observe a person experiencing shock symptoms. Until responders arrive:

• Have the person lie flat with their feet elevated about 12 inches.
• Refrain from moving the person if you suspect a head, neck, or back injury.
• Keep the person warm to avoid hypothermia.
• Don’t give the person fluids by mouth.
• Don’t elevate their head.
• Remove any visible dirt or debris from the injury site.
• Do not remove embedded glass, a knife, stick, arrow, or any other object stuck in the wound.
• If the area is clear of debris and no visible object protrudes from it, tie fabric, such as a shirt, towel, or blanket, around the site of injury to minimize blood loss.
• Apply pressure to the area.