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Coronary Artery Disease Concept Map

NSG/345

Pathophysiology of Coronary Artery Disease

Atherosclerosis is the major cause oc CAD. It is characterized by deposits of lipids within the artery. Endothelial injury and inflammation play a central role in the develpment of CAD.

The endothelium is normally nonreactive to platelets and leukocytes, as well as coagualation, fibrinolytic, and complement factors. However the endothelial lining can be injured as a result of tobacco use, hyperlipidemia, hypertension, toxins, diabetes, and infection causing a local inflammatory response

With this build up of plaque, the cornary arteries narrow, decreasing blood flow to the heart. Eventually the decreased blood flow may cause chest pain (angina), shortness of breath, and other S/S of CAD

Jonathan Ruybal

April 14, 2016

Monica Jarrell

Nursing Diagnosis #2

Education Plan

Risk for dcreased cardiac output related to changes in the rate, rythem, cardic conduction, myocardial infarction.

Other Possible Nursing Diagnosis

Major Modifiable Risk Factors

Interventions

1. Obtain a 12- lead electrocardiogram- ECG's are used to identify the area of ischemia or injury and guide treatment

2. Perform a full respiratory assessment and look for signs of tachypnea, rales, pleural friction rub, diminished breath sounds, and dullness on percussion- all are signs of a pulmonary embolism. Rales may be heard at the site of the embolism a pleural effuseion may be present during acute pulmonary infarction.

3.Monitor cardiac output, cardiac index, and sysetmic cascular resistance- Cardiac output will increase and systemic vascular resistance will decrease when the client develops vasodialation.

Clinical Manifestations

Activity intolerance related to imbalance between oxygen suppy and demand and the pressence of necrotic tissue in myocardial ischemia.

  • Pain or discomfort in other areas of the upper body including the arms, left shoulder, back, neck, jaw, or stomach.
  • Difficulty breathing or shortness of breath
  • Sweating or “cold sweat”.
  • Fullness, indigestion, or choking feeling (may feel like “heartburn”).
  • Nausea or vomiting.
  • Light-headedness, dizziness, extreme weakness or anxiety.
  • Rapid or irregular heart beats.

  • W.R's wife brought him to the emergency department after he complained of unrelieved “indigestion.”

Physical Activity- A physical activity program should be designed to improve physical fitness by following the FITT formula: Frequency(how often), Intensity(how hard), Type(isotonic), and Time(how long). Regular physical activity contributes to weight reduction, reduced BP, and an increase in HDL.

Nutritional Therapy- The national heart, lung and blood institute reccomend therapeutic lifestyle changes for all people to reduce the risk of CAD by lowering LDL cholesterol. These reccomendations emphasize a decrease in saturated fat and cholesterol and an increase in complex carbohydrates and fiber.

Smoking cessation- the benifits of quiting smoking are dramatic and almost immediate. CAD mortality rates drop too those of nonsmokers within 12 months. Reccomend group counseling session, nicotine replaement, smoking cessation medications.

Lipid lowering drug therapy- if cholesterol levels are greater then 240mg/dl his doctor may start him on medicine regimen and will need education.

Sublingual Nitroglygerin- Usually relieves pain in about 3 minutes. If symptoms are unchanged or worse after 5 min, tell the patient to repeat every 5 minutes for a maximum of 3 doses and contact EMS if symptoms are not resolved completly.

Thank You!

Diagnostic Tests

Patient Self-Care Behaviors

  • History and physical examination
  • ECG (12-lead)- obtained and compared to a previous tracing if posible to identify any abnormalities
  • Chest x-ray- to look for cardiac enlargemnet, aortic calcifications, and pulmonary congestion.
  • Exercise stress test- is needed to know the impact of the lesion on cornary blood flow.
  • Echocardiogram
  • Nuclear imaging studies
  • Electron beam CT scan- to obtain images of heart anatomy, coronary circulation and blood vessels
  • Positron emssion tomography- distinuishes viable and nonviable myocardial tissuue.
  • Coronary angiography
  • Laratory studies:
  • Cardiac troponin(Contractile proteins that are released after an MI.Highly specific to cardiac tissue), CK-MB(cardiospecific isozyme that is realeased in the presence of myocardial tissue injury), Myoglobin(Sensitive for myocardial injury), Lipid panel(Elevated cholesterol is a risk factor for CAD), CBC, C-reactive protein(marker of inflamation), Homocysteine

Contributing Modifiable Risk Factors

Nursing Diagnosis #3

Resources

Tobacco use- W.R reports a 36-pack-year smoking history. Nicotine in tobacco smoke causes catecholamine release. These neurohormones cause and increased heart rate, peripheral vasoconstriction, and increased Blood pressure. These changes increase the cardiac workload.

Obesity- W.R displays male-pattern obesity AEB "beer belly" and "large waist circumfrence. Mortality rate increases in obese persons. Obese persons may produce increased levels of LDL's and triglycerides, which are strongly related to atherosclerosis. Obesity is often associated with hypertension. As obesity increases, the heart grows and uses more oxygen.

Hypertension- W.R has a blood pressure of 202/124 upon admission. Hypertension increases the risk of death 10 fold. The stress of an elevated BP increases the rate of atherosclerotic development. In turn causes narrowed, thickend arterial walls. More force is needed to pump blood through diseased arteris and is reflected in increased BP and Pulse.

History of High Fat Diet- A diet high in saturated fat and cholesterol can cause elevated serum lipids. An elevated serum lipid level is one of the four mos firmly established risk factors of CAD

Ineffective self-health management related to lack of knowledge of disease process, risk factor reduction, and medications as evidence by hypertension, obesity, smoking, and diet high in fat.

Interventions

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Nursing Diagnosis #1

Acute pain related to an imbalance between myocardial oxygen supply and demand as evidence by patients reports of chest pain that radiates to his left shoulder and arm.

1. Instruct the patient and caregiver on cardiac risk factor modification (smoking cessation, diet, exercise- to increase patients control of the illness.

2. Instruct the patient and caregiver on appropriate prescribed medications- to promote compliance with medication regimens.

3.Instruct the patient and caregiver on self-care of chest pain (take nitroglycerin; if chest pain is unrelieved, seek emergency medical care.)

Interventions

1. Administer oxygen per nasal cannula as ordered. Maintaining a sao2 level of 90% or more will decrease he pain assoiated with myocardial ischemia by increasing the amount of oxygen delivered to the myocardium.

2. Administer aspirin as ordered. Aspirin inhibits platelet aggregarion to help stop clotting and also inhibits vasoconstriction by preventing the production of thromboxane A2.

3. Administration of nitroglycerin- Causes arterial and venous, dilation, thus reducing preload and afterload which reduces myocardial oxygen demand.

4. Morphine Sulfate as ordered- causes arterial and venous dialation, thus reducing preload and afterload which decreases the workload of the heart.

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