'Coronary Artery Disease Nursing Care Plan\r'

'Coronary arteria complaint Tabatha Turner Practicum I Arkansas Tech University Coronary Artery Disease â€Å"chills and fever coronary syndromes represent a spectrum of clinical conditions that atomic number 18 associated with acute myocardial ischemia” (Gulanick & adenineere; Myers, 2011). Coronary Artery Disease (heel) is one of these clinical conditions that affect approximately 13 million good deal (Rimmerman, 2011). Beca consumption coronary unhealthinesss be the kick the bucketing ca drug abuse of destruction in men and women, nurses pack to be compound in the c atomic number 18 and knowledge of people with or without frank.\r\nPrevention is the best cure. Nurses play an st cropgic enjoyment in the preaching of hound by whirl and supplying comfort for anxiety and bruise, minimizing manifestations and side effects, educating forbearing roles on the unhealthiness treat, and swear outing to repress take a chanceinesss and promote healthier life styles. Pathophysiology The purport is supplied descent, type O, and nutrients by the coronary arteries. When functioning normally, the coronary arteries ensure adequate type Oation of the myocardium at all aims of cardiac activity (Klabunde, 2010).\r\nCAD is a affectionateness ailment that is caused by impaired kind f unhopeful to or through the coronary arteries. Several disorders heap train from the disease ranging from myocardial ischemia to myocardial infarct. personal line of credit flow through the coronary arteries is usually set(p) by the ticker’s need for atomic number 8. It is controlled by physical, metabolic and neural factors and uses 60 to 80% of the oxygen in the derivation that flows through the coronary arteries (Porth, 2011). When this blood flow is interrupted, dam shape up ensues.\r\nBlood flow preempt be blocked by atherosclerosis, the buildup of avoirdupois weights and cholesterin in and on the arteria walls (plaques) ( mayo Clinic, 201 2). These buildups kitty be individually stable and obstruct blood flow or unstable, â€Å"which scum bag rupture and cause platelet fond regard and thrombus formation” (Porth, 2011). When the plaques are disrupted and a thrombus is formed, blood flow is obstructed and a myocardial infarction (MI) can occur. This obstruction starves the center of attention of oxygen and can cause angina ( bureau bruise) and necrosis of the sum of money heft.\r\n endangerment Factors There are modifiable and non-modifiable risk factors for CAD. uncomplaining commandment should include modifiable risks that can be nullifyed such as pot, obesity, uncontrolled hypertension, high low-density lipoprotein levels and low HDL levels, uncontrolled diabetes, high stress, and inactive lifestyles (Mayo Clinic, 2012). Many of these can be controlled by diet, exercise, and pot cessation. Non-modifiable risk factor include age, gender (men are to a greater extent at risk for CAD barely wome n’s risk increases after menopause), and family history.\r\nAccording to the Mayo Clinic, the long-suffering’s risk is highest if their plumpher or brother was diagnosed with heart disease before age 55, or their mother or sister essential it before age 65. Since these factors cannot be controlled, it is extremely important to control the modifiable ones especially if the tolerant of is at greater risk due to non-modifiable factors. Pathophysiology of MI myocardial infarctions affect approximately ? million people each year in the US. 50% of the people unnatural die before reaching the hospital (KU, 2012).\r\nMI is characterized by the ischemic death of myocardial create from raw material associated with CAD. This occurs when blood flow through the coronary arteries is importantly subordinated or blocked and the heart muscle does not receive enough oxygen. A â€Å"heart attack” usually has a quick incursion with chest fuss world the significant sympto m due to the lack of oxygen (Porth, 2011). Other symptoms can be fatigue, dyspnea, and heart palpitations. preaching for CAD The destination in treating CAD is to restore adequate coronary perfusion.\r\nIf that is not possible, medications can be used to reduce the oxygen demand by the heart (Klabunde, 2011). Treatment options for CAD include reduction risk factors, use of medications, and surgery. Patients can slow the disease process by stopping smoke, eating healthier, and participating in more active lifestyles.\r\nMedications that can be used are anti-platelets and anticoagulants that dissolve clots, or anti-angina drugs such as of import blockers (decrease myocardial oxygen consumption by decrease the actions of the sympathetic nervous system), calcium channel blockers (decreases eart rate and strength of contraction and relaxes blood vessels, decrease blood pressure), or nitroglycerine (dilates the arteries to increase blood flow, reducing myocardial oxygen consumption) (Smeltzer, S. , Hinkle J. , Bare, B. , & Cheever, K. 2010).\r\nUsually cardiac catheterizations are do to determine blockage percentages (Appendix B). In extreme cases of CAD, stents can be im final causeted in spite of appearance the artery to restore blood flow or bypass grafts can be placed from an artery or vein elsewhere in the organic structure to bypass the diseased segment (Klamunde, 2010). nursing Diagnoses\r\nCAD can be life threatening if the disease is allowed to progress. Therefore measures should be taken to prevent progression. Proper, natural assessment and nurse interventions can help. The first precession nursing diagnosis for a enduring with CAD would be: In telling cardiac tissue perfusion link to reduced coronary blood flow alternative to CAD as demonstrate by chest disturbfulness, blood pressure of 164/88, and pulse ox of 90% on room air. This is the first priority because if the heart is not properly fed, the pump can soften and leave alon e result in unsatisfactory circulation for the all in all body which could cause death.\r\nThe second priority nursing diagnosis would be: Acute pain relate to ischemia secondary to CAD as show by restlessness, increased blood pressure, 143/88, and verbal discipline of pain in leftfield shoulder and left jaw of 8/10 (on a numeral 1-10 scale) that has been unrelieved by over the counter medications. If pain is not managed, the body systems go forth continue to reply increasing vasoconstriction which in turn increases BP which could eventually lead to a cardiovascular accident or death.\r\nThe trine nursing diagnosis for a patient with CAD that is a smoker and has an unhealthy diet is: essay addicted health carriage related to inadequate comprehension of disease process as evidenced by patient smoking ? a acquire of cigarettes a day and eating fast forage and fried foods regularly. These behaviors are both modifiable risk factors and should be include in the patient tea ching. Nursing Goals For the priority nursing diagnosis of Ineffective cardiac tissue paper Perfusion, he intentions would be:Patient impart attain adequate tissue perfusion and cellular oxygenation as evidenced by a pulse ox of 96% or above on 2L oxygen by skeletal cannula within 8 hoursPatient will realm an understanding of the disease process and the therapy feed by discharge.The goals for the diagnosis of Acute Pain would be:Patient will verbally describe the level (using a numeric 1-10 scale) and characteristics of their pain each 2 hoursPatient will report pain goal of <3 on a numeric 1-10 scale is reached within 1 hour of analgesic administration.The goals for put on the line prone health behavior are: * Patient will demonstrate an increasing interest and participation in self health care by seed a smoking cessation program in a flash * By end of cutting, patient will dip five foods that should be neutraliseed such as rich cuts of meat, butter, egg yolks, ice cream, and processed grain products (cookies, cakes, muffins, and pastries). These are all foods that are high in fat and/or cholesterol (Scherer, 2012). Nursing Implementations and Rationales\r\nNursing implementations and rationales included in the diagnosis of Ineffective cardiac Tissue Perfusion to help the patient meet the goals are:* oversee ABG †low hemoglobin levels reduce the uptake of oxygen and oxygen delivery to the tissues* Monitor vital signs and heart rhythm at beginning of shift and every 4 hours †to determine baseline and detect changes* gather in interference of underlying conditions such as administering anti-coagulants and oxygen per doctor’s order†to turn down or treat disorders that could affect perfusion* Assess self-care history- to detect risks for potential problems* advertize smoking cessation †smoking decreases oxygen delivery* Auscultate lungs every 4 hours †to school for abnormalities that could represent heart f ailure* run into pulse ox every 2 hours †to term of enlistment progression or needs* O2 at 2L penniless cannula per doctor’s orders †improve oxygenation* Encourage use of spirometer every 2 hours †patient is on jazz rest, this will encourage deep breathing* cast patient turn every 2 hours †patient is on bed rest, his will help avoid pressure ulcers* Assist in ambulation to toilet †to avoid over-exerting the heart* Check apical pulse and peripheral device pulses every 2 hours †to check progression or regression* Explain to patient and family the disease process and therapy regimen for controlling disease †to educate patient and family on disease process and medications. Implementations and rationales for an acute pain diagnosis are:* Have patient invoke characteristics of pain and level of pain on a numeric 1-10 scale at beginning of shift and every two hours †establishes a baseline for assessing profit and change and notifies nu rse of needs for medications* Administer nitroglycerin tablets 0. mg SL q5minutes X3 per doctor’s orders for chest pain â€dilates vessels for better blood flow* 1-10 mg morphia slow IVP, titrate for pain relief per doctor’s orders- to maintain acceptable levels of pain* fool got client’s description of pain †pain is subjective* Observe non-verbal cues †observations may be incongruent with verbal reports* Monitor vital signs †blood pressure, heart rate and respirations are usually altered in acute pain* Determine pain goal and tolerance †varies with individual* Note when pain occurs †to medicine prophylactically as appropriate* Provide comfort measures such as a quiet environment, low lighting, and appease activities †to promote non-pharmacologic pain measures* Evaluate and document patient’s response to medications †check for effectiveness* Encourage adequate rest periods †to prevent fatigue and over-exertion of the heart.To harbour a successful outcome for the diagnosis of Risk Prone Health Behavior, implementations and rationales should include:* Encourage warm smoking cessation †smoking constricts vessels therefore decreasing blood flow* Teach patient roughly risks associated with smoking and CAD †to educate patient* sum up patient with a low fat/low cholesterol diet, per doctor’s orders †to reduce risk from fat/cholesterol* Educate patient on risks of high fat and cholesterol diets †to educate patient* Teach patients which foods are high in fats and cholesterol †to educate patient.EvaluationTo prize the success of the goals requires assessment and communication. To evaluate the goals for Ineffective Cardiac Tissue Perfusion, the nurse should check pulse ox levels and have the patient verbalize what they know about CAD. If pulse ox has reached 96% or above while on 2L O2 nasal cannula within 8 hours, then the goal has been met. If not, the plan wil l need to be modified. Patient teaching should begin as soon as the patient is admitted so the second goal of the patient being able to verbalize an adequate understanding of the disease process and therapy regimen should be successful by discharge. This can be judged by having the patient state factors of the disease and proper uses of the medications.\r\nTo evaluate the success of Acute Pain goals, documentation should be available for anytime pain is reported (level and characteristics) and when Morphine or Nitroglycerin is given. Anytime a medication is given, there should be documentation of how effective the medication was and if the pain goal was reached. If the documentation is done correctly, it should measure whether the goal was met or not. If pain persists, treatment should be modified. The goals for risk prone health behavior will be assessed by patient’s verbal report of knowledge of high fat/ high cholesterol foods and witnessed increased participation in self health care of patient fall in a smoking cessation program.\r\nIf the goal would have been total smoking cessation, the goal would have single been partially met by joining a smoking cessation program. Patient and Family Education Patient education is one of the most important facets for a patient with CAD. Accurate patient education about modifiable risk factors (such as smoking, unhealthy diet, and obesity) and immediate treatments can reduce the risks for myocardial infarction. Knowing the risks can help encourage a healthier lifestyle. Educating patients about the early on signs and symptoms of CAD can provide the information essential for knowing when to acquire medical help and may help with an immediate accurate diagnosis and treatment plan being developed and instituted. Patients also need to be educated about he medications that are available and proper use of medications such as Nitroglycerin. Educating the patient can also help reduce anxiety about the disease. (Appen dix A). References BCS Heart, (2012). Cardiac Catheterization.\r\nInterventional Cardiology and cardiovascular Services.\r\nRetrieved October 2, 2012 from BCS website information. http://bcsheart. com/for_patients_patient_education_cardiac_catheterization. php Gulanick, M. , Myers, J. (2011). Cardiac and Vascular Plans. Nursing Care Plans (209). St. Louis, MS: Wiley-Blackwell Publishing. Klabunde, R. (2010). Retrieved October 2, 2012 from Cardiovascular Physiology Concepts. Coronary Artery Disease. http:// www. vphysiology. com/CAD/CAD001. htm KU checkup Center, (2012). Retrieved October 3, 2012 from KU Medical Center online information, http://classes. kumc. edu/cahe/respcared/cybercas/cabg2/stevmi. html Mayo Clinic, (2012). Retrieved October 4, 2012. Coronary Artery Disease, http://www. mayoclinic. com/health/arteriosclerosis-atherosclerosis/DS00525 http://www. mayoclinic. com/health/coronary-artery-disease/DS00064/DSECTION=risk-factors National Heart, Lung, and Blood shew (NHI) . (2011, July). Coronary Artery Disease. Retrieved October 5, 2012. NHI article on MedlinePlus weathervane site: http://www. nlm. nih. gov/medlineplus/coronaryarterydisease. tml#cat3 Porth, C. M. (2011). Coronary Artery Disease. H. Surrena & S. Loht (Eds. ), Essentials of Pathophysiology (450-461). Philadelphia: Lippincott Williams & Wilkins. Rimmerman, C. (2011). Diseases and Conditions: Coronary Artery Disease. Retrieved October 5, 2012, Cleveland Clinic Web site: http://my. clevelandclinic. org/heart/disorders/cad/understandingcad. aspx Scherer, E. (2012) Retrieved October 2, 2012 from Discovery Fit and Health online information, http://health. howstuffworks. com/wellness/food-nutrition/facts/foods-high-in-saturated-fat-and-cholesterol. htm Smeltzer, S. , Hinkle J. , Bare, B. , & Cheever, K. (2010). Coronary\r\n'