Coronary Artery Disease Nursing Care Plan

Coronary Artery Disease Tabatha Turner Practicum I Arkansas Tech University Coronary Artery Disease â€Å"Acute coronary syndromes represent a spectrum of clinical conditions that are associated with acute myocardial ischemia† (Gulanick & Myers, 2011). Coronary Artery Disease (CAD) is one of these clinical conditions that affect approximately 13 million people (Rimmerman, 2011). Because coronary diseases are the leading cause of death in men and women, nurses need to be involved in the care and education of people with or without CAD. Prevention is the best cure. Nurses play an important role in the treatment of CAD by offering and supplying comfort for anxiety and pain, minimizing symptoms and side effects, educating patients on the disease process, and helping to reduce risks and promote healthier lifestyles. Pathophysiology The heart is supplied blood, oxygen, and nutrients by the coronary arteries. When functioning normally, the coronary arteries ensure adequate oxygenation of the myocardium at all levels of cardiac activity (Klabunde, 2010). CAD is a heart disease that is caused by impaired blood flow to or through the coronary arteries. Several disorders can arise from the disease ranging from myocardial ischemia to myocardial infarction. Blood flow through the coronary arteries is usually dictated by the heart’s need for oxygen. It is controlled by physical, metabolic and neural factors and uses 60 to 80% of the oxygen in the blood that flows through the coronary arteries (Porth, 2011). When this blood flow is interrupted, damage ensues. Blood flow can be blocked by atherosclerosis, the buildup of fats and cholesterol in and on the artery walls (plaques) (Mayo Clinic, 2012). These buildups can be either stable and obstruct blood flow or unstable, â€Å"which can rupture and cause platelet adhesion 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 heart of oxygen and can cause angina (chest pain) and necrosis of the heart muscle. Risk Factors There are modifiable and non-modifiable risk factors for CAD. Patient teaching should include modifiable risks that can be avoided such as smoking, obesity, uncontrolled hypertension, high LDL levels and low HDL levels, uncontrolled diabetes, high stress, and sedentary lifestyles (Mayo Clinic, 2012). Many of these can be controlled by diet, exercise, and smoking cessation. Non-modifiable risk factor include age, gender (men are more at risk for CAD but women’s risk increases after menopause), and family history. According to the Mayo Clinic, the patient’s risk is highest if their father or brother was diagnosed with heart disease before age 55, or their mother or sister developed it before age 65. Since these factors cannot be controlled, it is extremely important to control the modifiable ones especially if the patient 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 affected die before reaching the hospital (KU, 2012). MI is characterized by the ischemic death of myocardial tissue associated with CAD. This occurs when blood flow through the coronary arteries is significantly reduced or blocked and the heart muscle does not receive enough oxygen. A â€Å"heart attack† usually has a quick onset with chest pain being the significant symptom due to the lack of oxygen (Porth, 2011). Other symptoms can be fatigue, dyspnea, and heart palpitations. Treatment for CAD The goal in treating CAD is to restore adequate coronary perfusion. If that is not possible, medications can be used to reduce the oxygen demand by the heart (Klabunde, 2011). Treatment options for CAD include reducing risk factors, use of medications, and surgery. Patients can slow the disease process by stopping smoking, eating healthier, and participating in more active lifestyles. Medications that can be used are anti-platelets and anticoagulants that dissolve clots, or anti-angina drugs such as beta blockers (decrease myocardial oxygen consumption by decreasing the actions of the sympathetic nervous system), calcium channel blockers (decreases eart rate and strength of contraction and relaxes blood vessels, decreasing blood pressure), or nitroglycerin (dilates the arteries to increase blood flow, reducing myocardial oxygen consumption) (Smeltzer, S. , Hinkle J. , Bare, B. , & Cheever, K. 2010). Usually cardiac catheterizations are done to determine blockage percentages (Appendix B). In extreme cases of CAD, stents can be implanted within the artery to restore blood flow or bypass grafts can be placed from an artery or vein elsewhere in the body to bypass the diseased segment (Klamunde, 2010). Nursing Diagnoses CAD can be life threatening if the disease is allowed to progress. Therefore measures should be taken to prevent progression. Proper, thorough assessment and nursing interventions can help. The first priority nursing diagnosis for a patient with CAD would be: Ineffective cardiac tissue perfusion related to reduced coronary blood flow secondary to CAD as evidenced by chest pain, 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 fail and will result in inadequate circulation for the whole body which could cause death. The second priority nursing diagnosis would be: Acute pain related to ischemia secondary to CAD as evidenced by restlessness, increased blood pressure, 143/88, and verbal report of pain in left shoulder and left jaw of 8/10 (on a numeric 1-10 scale) that has been unrelieved by over the counter medications. If pain is not managed, the body systems will continue to respond increasing vasoconstriction which in turn increases BP which could eventually lead to a cardiovascular accident or death. The third nursing diagnosis for a patient with CAD that is a smoker and has an unhealthy diet is: Risk prone health behavior related to inadequate comprehension of disease process as evidenced by patient smoking ? a pack of cigarettes a day and eating fast food and fried foods regularly. These behaviors are both modifiable risk factors and should be included in the patient teaching. Nursing Goals For the priority nursing diagnosis of Ineffective Cardiac Tissue Perfusion, he goals would be:Patient will attain adequate tissue perfusion and cellular oxygenation as evidenced by a pulse ox of 96% or above on 2L oxygen by nasal cannula within 8 hoursPatient will verbalize an understanding of the disease process and the therapy regimen 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 every 2 hoursPatient will report pain goal of