Case study C A D
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Case study C A D Case study C A D Presentation Transcript

  • Name of patientAtiah Atitullah AL-ShaikhiHe is 73 old . He is MarriedLevel Education : Secondary schoolAdmitted to hospital 14/4/2012up Smoker or not : was a smoker he givessmokingLength : 161cmWeight : 61kg
  • Chief Complaints- Coronic Arty dieses* Present Complaint- CoughMedical Diagnosis- CAD* Medical history- DM-H.T.NThe cardiac catheterization View slide
  • Coronary artery disease Coronary artery disease (CAD; also atherosclerotic heart disease) is the result of the accumulation of atheromatous plaques within the walls of the coronary arteries[1] that supply the myocardium (the muscle of the heart) with oxygen and nutrients. It is sometimes also called coronary heart disease (CHD). Although CAD is the most common cause of CHD, it is not the only one. View slide
  • Pathophysiology Limitation of blood flow to the heart causes ischemia (cell starvation secondary to a lack of oxygen) of the myocardial cells. Myocardial cells may die from lack of oxygen and this is called a myocardial infarction (commonly called a heart attack). It leads to heart muscle damage, heart muscle death and later myocardial scarring without heart muscle regrowth
  • Symptoms : - Chest discomfort, mild pain - Coughing - Crushing chest pain - Dizziness - Dyspnea (shortness of breath) - Face seems gray
  • Symptoms :- A feeling of terror that your life iscoming to its end- Feeling really awful (generalfeeling)- Nausea- Restlessness- The person is clammy and sweaty- Vomiting
  • Diagnosing coronary heart disease(coronary artery disease) The doctor will probably ask that the patient questions about their medical history, symptoms and carry out a physical examination . One or some of the following diagnostic tests may also be ordered :
  • - ECG (electrocardiogram)- A Holter monitor- An echocardiogram- street test- Coronary catheterization- CT (computerized tomography)- MRA (magnetic resonance angiogram)- Nuclear ventriculography- Blood tests
  • Risk Factors The following are confirmed independent risk factors for the development of CAD : - Hypercholesterolemia (specifically, serum LDL concentrations) Smoking - Hypertension (high systolic pressure seems to be most significant in this regard)
  • - Hyperglycemia (due to diabetes mellitusor otherwise) [citation needed-Type A Behavioural Patterns, TABP.Added in 1981 as an independent riskfactor after a majority of research into thefield discovered that TABPs were twice aslikely to exhibit CAD as any otherpersonality type.
  • - Hemostatic Factors: High levels offibrinogen and coagulation factor VII areassociated with an increased risk of CAD.Factor VII levels are higher in individualswith a high intake of dietary fat[citationneeded]. Decreased fibrinolytic activityhas been reported in patients withcoronary atherosclerosis.
  • - Hereditary differences/genetic polymorphismsin such diverse aspects as lipoprotein structureand that of their associated receptors, enzymesof lipoprotein metabolism such as cholesterylester transfer protein(CETP) and hepatic lipase(HL), homocysteineprocessing/metabolism, etc.[citation needed- High levels of Lipoprotein(a), a compoundformed when LDL cholesterol combines with asubstance known as Apoliprotein (a).
  • Significant, but indirect risk factorsinclude: Lack of exercise Consumption of alcohol Stress Diet rich in saturated fats Diet low in antioxidants Obesity Men over 60; Women over 65 A recent study done in India (Pondicherry) shows its association with hemoglobin
  • What are the treatment options forcoronary heart disease (coronary arterydisease ) Although coronary heart disease cannot be cured, it can be managed much more effectively today than in the past. Treatment consists mainly of lifestyle changes, and perhaps some medical procedures and medications.
  • Lifestyle Lifestyle - some specific lifestyle changes can significantly improve the health of the arteries: Stop smoking Eat a healthy and well balanced diet Exercise regularly Aim for an ideal bodyweight Reduce emotional/mental stress
  • Medications Medications to modify cholesterol levels Low-dose aspirin and clot-busting medication Beta blockers Nitroglycerin ACE (angiotensin-converting enzyme) inhibitors Calcium channel blockers
  • Surgery if fatty deposit build-up has left the blood vessels very narrow, or if symptoms are not responding well enough to medications, surgery may be required to open up or replace blocked arteries. Percutaneous coronary revascularization Coronary bypass surgery Heart transplant Laser surgery
  • Prevention of coronary heart disease(coronary artery disease) If you can keep your LDL levels low and your HDL levels high, your risk of developing coronary heart disease is significantly lower (than someone who cant). The following lifestyle measures can help: Be physically active Consume alcohol in moderation or not at all Do not smoke Eat a healthy and balanced diet
  • Keep your blood pressure under controlKeep your diabetes under controlMaintain a healthy body weightReduce/control emotional and mentalstressIf you already have coronary heartdisease, follow your doctors instructionsin order to prevent complications. Thisincludes taking the prescribedmedications.
  • Care planNursing diagnosis: Ineffective Airway Clearance related /to secretions in the bronchi.Goal After 4 hours of nursing intervention, airway patency will be maintained, secretions will be readily expectorated and there will be signs ofreduction in congestion.
  • Nursing intervention: Independent:1-Vital signs monitored and recorded.2-Assisted in semi-fowler’s position.3-Encouraged deep breathing exercise.Dependent:1-Administered prescribed medications.2-Provided supplemental humidification via useof nebulizer
  • Rational :This is for baseline comparison.Proper positioning helps in draining secretions.This will promote proper lung expansion.Prescribed meds such as bronchodilator helps in aidingeffective airway clearance.Mobilization helps in liquefying secretions for better andfaster expectorating the secretions.
  • Evaluation:After 4 hours of nursing intervention, thegoal is met through maintenance of airwaypatency and reduction in congestion.
  • END