Coronary Artery Disease Kevina Desai Objectives v Understand

+ Coronary Artery Disease Kevina Desai

+ Objectives v Understand what coronary artery disease (CAD) is v Understand the pathophysiology of CAD. v Know the common signs and symptoms of CAD and v Explain the nursing care of patients with CAD and identify proper nursing diagnosis associated with CAD v Review treatment for patients diagnosed with CAD

+ What is CAD? n Plague arteries build up in the n Plague is made up of cholesterol deposits n Atherosclerosis n Plague build up causes angina, heart failure, arrhythmias, heart attack n Overtime, CAD will weaken the heart muscle

+ Pathophysiology n Chronic Process n Endothelial Injury n Fatty Streaks n Lipid Deposits which calcify over time n Platelets and smooth muscle proliferation(reproduce rapidly, increase greatly) n Unstable Plague n Collateral Circulation

+ Prevalence n The National Center for Health Statistics 2011 Report n Cardiovascular disease remains the leading cause of mortality in the United States in men and women of every major ethnic group n It accounted for nearly 616, 000 deaths in 2011 n CAD is the most common type of heart disease n Every year, approximately 785, 000 Americans suffer a first heart attack and another 470, 000 will suffer an additional myocardial infarction (MI) n In 2010, CAD alone was projected to cost the U. S. $108. 9 billion including the cost of health care services, medications, etc.

+ Risk Factors Unmodifiable n Elevated serum cholesterol n Age n Gender n Ethnicity n Genetic Modifiable Inheritance n Hypertension n Smoking n Obesity n Diabetes

+ Signs/Symtoms n Angina pectoris, n Unstable angina pectoris, n Myocaridial Infarction (MI) n Cardiac dysrhythmias n Chest discomfort n Discomfort in the arm, throat, or jaw n Heartburn n Shortness of breath n Asymptomatic

+ Anginal Pain n Stable and Unstable n Usually substernal pressure. n May radiate to arm or jaw. n May be associated with diaphoresis or dyspnea. n Atypical presentations n Females n Diabetics n Elderly

+ Treatment of Angina n. Risk factor modification n. Antiplatelets n. Statins n. Nitroglycerin nΒ-Blockers n. Calcium Channel Blockers n. Possible PTCA or CABG

+ Myocardial Infarction n “Heart Attack” n Complications: n Arrhythmias n Chronic n STEMI n ST elevation on a ECG n NSTEMI Heart Failure n Heart attack without ST n Cardiogenic Shock elevation on a ECG n Pericarditis n Pulmonary Embolism n Papillary Muscle Dysfunction n Ventricular Aneurysm

+ Treatments for: STEMI n Emergent PCI (PTCA n Thrombolytics NSTEMI n Admit to CCU. n Bedrest. n Continuous n Assess monitoring. for complications. n Heparin/LMWH n Beta Blockers n Consider CABG PCI (PTCA) or

+ PCI (PTCA) n Percutaneous transluminal coronary angioplasty(PTCA) n Alternative n Catheter to surgical intervention is inserted with balloon on end n Cons: n Pros: n ambulatory after procedure n decreased length of hospital stay n dissection of dilated artery causing death n cardiac tamponade, n ischemia and MI n allergic reaction to dye

+ PCI (PTCA)

+ CABG n. A healthy artery or vein from the body is connected, or grafted, to the blocked coronary artery n The grafted artery or vein bypasses the blocked portion of the coronary artery n CABG may be an option if you have blockages in the heart that can't be treated with a stent n Goals n n of a CABG Improving the pumping action of your heart Improving your quality of life and reducing angina and other CAD symptoms

+ What to include in a History n Current symptoms n Complete list of comorbid conditions n Complete Family History n How closely are they related? n Age of diagnosis for that relative n Character and Location of discomfort n Radiation of discomfort n Associated/Aggravating/Alleviating symptoms

+ Important Labs n Glucose n Lipid Levels n Total cholesterol n high-density lipoprotein [HDL] n Low--density lipoprotein [LDL] n Triglycerides n High-sensitivity n Troponin levels C-reactive protein

+ n ECD Important Tests or EKG (electrocardiogram) n Echocardiogram n Exercise n Chest stress test X-ray n Cardiac catheterization n Coronary angiogram

+ Nursing Diagnoses n Acute n Pain Related to cardiac ishchemia n Excess n Related to fluid retention n Activity n Fluid Volume Intolerance related to insufficient oxygenation n Decreased n related to dysrhythmias n Ineffective n Cardiac Output Coping related to decreased physical status after myocardial infarction

+ Nursing Interventions n If patient is in pain, instruct patient to notify nurse immediately of chest pain n If fluid overload, administer diuretics as ordered and teach patient rational and side effect of medication n Weigh patient daily n Stress importance of daily weights n If decreased cardiac output, administer and teach antiarrhythmic medications, as ordered by health care provider n If activity intolerance, encourage participation in cardiac rehab program; teach how to monitor heart rate, blood pressure, and respirations; increase endurance and strength and prevent weight gain

+ A client is scheduled for a cardiac catherization using a dye. Which of the following assessments is most critical before the procedure? 1. Intake and output 2. Baseline peripheral pulse rates 3. Height and weight 4. Allergy to iodine or shellfish

+ A 60 -year-old male client comes into the emergency department with complaints of crushing chest pain that radiates to his shoulder and left arm. The admitting diagnosis is acute myocardial infarction. Immediate admission orders include oxygen by NC at 4 L/minute, blood work, chest x-ray, an ECG, and 2 mg of morphine given intravenously. The nurse should first: 1. Administer the morphine 2. Obtain a 12 -lead ECG 3. Obtain the lab work 4. Order the chest x-ray

+ Sublingual nitroglycerin tablets begin to work within 1 to 2 minutes. How should the nurse instruct the client to use the drug when chest pain occurs? 1. Take one tablet every 2 to 5 minutes until the pain stops. 2. Take one tablet and rest for 10 minutes. Call the physician if pain persists after 10 minutes. 3. Take one tablet, then an additional tablet every 5 minutes for a total of 3 tablets. Call the physician if pain persists after three tablets. 4. Take one tablet. If pain persists after 5 minutes, take two tablets. If pain still persists 5 minutes later, call the physician.

+ References Ackley B, Ladwig G: Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care, ed. 9, St Louis, Mosby, 2010. Centers for Disease Control and Prevention CDC. (2009, 12 07). Coronary artery disease (cad). Retrieved from http: //www. cdc. gov/heartdisease/coronary_ad. htm Gao, Z. , Xu, H. , & Shi, D. (2012). Analysis on outcome of 5284 patients with coronary artery disease: The role of integrative medicine. Journal of Ethnopharmacology, 141(2), 578 -583. Retrieved from http: //ejournals. ebsco. com/Direct. asp? Access. Token=95 X 5 DIJ 8 X 49 J 9 PJXEXE 5 X 49 J 4 Q 598 Q 5 MID &Show=Object Huether, S. E. , & Mc. Cance, K. L. (2012). Understanding Pathophysiology. (pg. 1052). St. Louis MS: Mosby, Inc. Mc. Person, D. (2012). Inflammation and coronary artery disease: insights from genetic studies. The Canadian Journal Of Cardiology, 28, Retrieved from http: //ehis. ebscohost. com/eds/detail? vid=8&sid=ad 8517 ad-e 57 d-4976 -8 efcc 1619413 e 7 e 8@sessionmgr 112&hid=16&bdata=Jn. Npd. GU 9 ZWRz. LWxpdm. U= The National Heart, Lung, and Blood Institute (NHLBI). (2012, 02 23). What is coronary artery bypass grafting? . Retrieved from http: //www. nhlbi. nih. gov/health-topics/cabg/ Rimmerman, C. M. (n. d. ). Coronary artery disease (cad). (2011) Retrieved from http: //www. clevelandclinicmeded. com/medicalpubs/diseasemanagement/cardiology/coronaryartery-disease/ Student Nursing Study Blog. (n. d. ). Coronary artery disease and hypertension. Retrieved from http: //amy 47. com/nclex-style-practice-questions/cardiac-mi-and-hf/cad-htn/