Chapter 34 Nursing Management Coronary Artery Disease and

Coronary Artery Disease Etiology and pathophysiology Developmental stages • Fatty streak • Fibrous plaque

Fig. 34 -1 Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of

Fig. 34 -2 Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of

Fig. 34 -3 Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of

Coronary Artery Disease (cont’d) Risk factors for coronary artery disease Ø Nonmodifiable risk factors

Fig. 34 -4 Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of

Coronary Artery Disease (cont’d) Ø Modifiable major risk factors • • • Elevated serum

Fig. 34 -5 Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of

Fig. 34 -6 Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of

Coronary Artery Disease (cont’d) Ø Modifiable contributing risk factors • Diabetes mellitus • Metabolic

Nursing and Collaborative Management Coronary Artery Disease Health promotion Identification of high-risk persons Ø

Nursing and Collaborative Management Coronary Artery Disease (cont’d) Cholesterol-lowering drug therapy Drugs that restrict

Gerontologic Considerations Coronary Artery Disease Copyright © 2007, 2004, 2000, Mosby, Inc. , an

Chronic Stable Angina Manifestation of Coronary Artery Disease Etiology and pathophysiology Copyright © 2007,

Chronic Stable Angina Silent ischemia Nocturnal angina and angina decubitus Ø Prinzmetal’s angina Ø

Fig. 34 -7 Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of

Collaborative Management Chronic Stable Angina Drug therapy Short-acting nitrates • Sublingual nitroglycerin Ø Long-acting

Fig. 34 -8 Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of

Collaborative Management Chronic Stable Angina (cont’d) -Adrenergic blockers Ø Calcium channel blockers Ø Angiotensin-converting

Collaborative Management Chronic Stable Angina (cont’d) Diagnostic studies Exercise stress testing Ø Cardiac catheterization

Fig. 34 -9 Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of

Fig. 34 -10 Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of

Acute Coronary Syndrome Etiology and pathophysiology Copyright © 2007, 2004, 2000, Mosby, Inc. ,

Fig. 34 -11 Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of

Manifestations of Acute Coronary Syndrome Copyright © 2007, 2004, 2000, Mosby, Inc. , an

Unstable Angina Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of Elsevier

Myocardial Infarction Clinical manifestations of myocardial infarction Pain Ø Sympathetic nervous system stimulation Ø

Fig. 34 -12 Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of

Fig. 34 -13 Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of

Fig. 34 -14 Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of

Myocardial Infarction (cont’d) Complications of myocardial infarction Dysrhythmias Ø Heart failure Ø Cardiogenic shock

Diagnostic Studies Unstable angina and myocardial infarction Electrocardiogram findings Ø Serum cardiac markers Ø

Fig. 34 -15 Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of

Collaborative Care Emergent PCI Fibrinolytic therapy Indications and contradictions Ø Procedure Ø Copyright ©

Collaborative Care (cont’d) Drug therapy Ø Ø Ø Ø IV nitroglycerin Morphine sulfate -Adrenergic

Collaborative Care (cont’d) Nutritional therapy Coronary surgical revascularization Coronary artery bypass graft surgery Ø

Fig. 34 -16 Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of

Nursing Management Chronic Stable Angina and Acute Coronary Syndrome Nursing assessment Nursing diagnoses Planning

Nursing Management Chronic Stable Angina and Acute Coronary Syndrome (cont’d) Nursing implementation: Acute coronary

Nursing Management Chronic Stable Angina and Acute Coronary Syndrome (cont’d) Coronary revascularization Ø Ambulatory

Nursing Management Chronic Stable Angina and Acute Coronary Syndrome (cont’d) Evaluation Copyright © 2007,

Sudden Cardiac Death Etiology and pathophysiology Nursing and collaborative management: Sudden cardiac death Copyright

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Coronary Artery Disease Etiology and pathophysiology Developmental stages • Fatty streak • Fibrous plaque • Complicated lesion Ø Collateral circulation Ø Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of Elsevier Inc. All Rights Reserved.

Coronary Artery Disease (cont’d) Risk factors for coronary artery disease Ø Nonmodifiable risk factors • Age, gender, and ethnicity • Family history and genetics Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of Elsevier Inc. All Rights Reserved.

Coronary Artery Disease (cont’d) Ø Modifiable major risk factors • • • Elevated serum lipids Hypertension Tobacco use Physical inactivity Obesity Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of Elsevier Inc. All Rights Reserved.

Coronary Artery Disease (cont’d) Ø Modifiable contributing risk factors • Diabetes mellitus • Metabolic syndrome • Psychologic states • Homocysteine Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of Elsevier Inc. All Rights Reserved.

Nursing and Collaborative Management Coronary Artery Disease Health promotion Identification of high-risk persons Ø Management of high-risk persons Ø Physical activity Nutritional therapy Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of Elsevier Inc. All Rights Reserved.

Nursing and Collaborative Management Coronary Artery Disease (cont’d) Cholesterol-lowering drug therapy Drugs that restrict lipoprotein production Ø Drugs that increase lipoprotein removal Ø Drugs that decrease cholesterol absorption Ø Antiplatelet therapy Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of Elsevier Inc. All Rights Reserved.

Collaborative Management Chronic Stable Angina Drug therapy Short-acting nitrates • Sublingual nitroglycerin Ø Long-acting nitrates • Nitroglycerin ointment • Transdermal controlled-release nitrates Ø Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of Elsevier Inc. All Rights Reserved.

Collaborative Management Chronic Stable Angina (cont’d) -Adrenergic blockers Ø Calcium channel blockers Ø Angiotensin-converting enzyme inhibitors Ø Ranolazine Ø Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of Elsevier Inc. All Rights Reserved.

Collaborative Management Chronic Stable Angina (cont’d) Diagnostic studies Exercise stress testing Ø Cardiac catheterization Ø Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of Elsevier Inc. All Rights Reserved.

Myocardial Infarction Clinical manifestations of myocardial infarction Pain Ø Sympathetic nervous system stimulation Ø Cardiovascular manifestations Ø Nausea and vomiting Ø Fever Ø Healing process Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of Elsevier Inc. All Rights Reserved.

Myocardial Infarction (cont’d) Complications of myocardial infarction Dysrhythmias Ø Heart failure Ø Cardiogenic shock Ø Papillary muscle dysfunction Ø Ventricular aneurysm Ø Pericarditis Ø Dressler syndrome Ø Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of Elsevier Inc. All Rights Reserved.

Diagnostic Studies Unstable angina and myocardial infarction Electrocardiogram findings Ø Serum cardiac markers Ø Coronary angiography Ø Other measures Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of Elsevier Inc. All Rights Reserved.

Collaborative Care (cont’d) Drug therapy Ø Ø Ø Ø IV nitroglycerin Morphine sulfate -Adrenergic blockers Angiotensin-converting enzyme inhibitors Antidysrhythmia drugs Cholesterol-lowering drugs Stool softeners Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of Elsevier Inc. All Rights Reserved.

Collaborative Care (cont’d) Nutritional therapy Coronary surgical revascularization Coronary artery bypass graft surgery Ø Minimally invasive direct coronary artery bypass • Off-pump coronary artery bypass Ø Transmyocardial laser revascularization Ø Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of Elsevier Inc. All Rights Reserved.

Nursing Management Chronic Stable Angina and Acute Coronary Syndrome Nursing assessment Nursing diagnoses Planning Nursing implementation: Chronic stable angina Health promotion Ø Acute intervention Ø Ambulatory and home care Ø Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of Elsevier Inc. All Rights Reserved.

Nursing Management Chronic Stable Angina and Acute Coronary Syndrome (cont’d) Nursing implementation: Acute coronary syndrome Ø Acute intervention • Pain • Monitoring • Rest and comfort • Anxiety • Emotional and behavioral reactions Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of Elsevier Inc. All Rights Reserved.

Nursing Management Chronic Stable Angina and Acute Coronary Syndrome (cont’d) Coronary revascularization Ø Ambulatory and home care • Patient teaching • Physical activity • Resumption of sexual activity Ø Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of Elsevier Inc. All Rights Reserved.

Sudden Cardiac Death Etiology and pathophysiology Nursing and collaborative management: Sudden cardiac death Copyright © 2007, 2004, 2000, Mosby, Inc. , an affiliate of Elsevier Inc. All Rights Reserved.