Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsChapter 28Management of Patients WithCoronary Vascul...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsQuestionIs the following statement True or False?Ind...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsAnswerTrueIndividuals at highest risk for a cardiac ...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsCoronary Atherosclerosis• Atherosclerosis is the abn...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsPathophysiology of Atherosclerosis
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsCoronary Arteries
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsClinical Manifestations• Symptoms are due to myocard...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsQuestionWhich is considered a modifiable risk factor...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsAnswerDA modifiable risk factor for coronary artery ...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins• The most common symptom of myocardial ischemia isc...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsAngina Pectoris• A syndrome characterized by episode...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsAngina pain varies from mild to severe• May be descr...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsTreatment• Treatment seeks to decrease myocardial ox...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsMedications• Nitroglycerin• Beta-adrenergic blocking...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsQuestionIs the following statement True or False?Nit...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsAnswerTrueNitroglycerin tablets should never be remo...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsNursing Process: The Care of the Patientwith Angina ...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsNursing Process: The Care of the Patientwith Angina ...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsCollaborative Problems• Acute pulmonary edema• Heart...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsNursing Process: The Care of the Patientwith Angina ...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsTreatment of Angina Pain• Treatment of angina pain i...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsAnxiety• Use a calm manner• Stress-reduction techniq...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsPatient Teaching• Lifestyle changes and reduction of...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsMyocardial Infarction• An area of the myocardium is ...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsEffects of Ischemia, Injury, and Infarctionon ECG
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsClinical Manifestations and Diagnosis• Chest pain, o...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsQuestionWhat is the purpose of an echocardiogram?A.E...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsAnswerBThe echocardiogram is used to evaluate ventri...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsTreatment of Acute MI• Obtain diagnostic tests inclu...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsNursing Process: The Care of the Patientwith ACS—Ass...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsNursing Process: The Care of the Patientwith ACS—Dia...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsCollaborative Problems• Acute pulmonary edema• Heart...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsNursing Process: The Care of the Patientwith ACS—Pla...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsPercutaneous Coronary Intervention
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsCoronary Artery Bypass Grafts
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsGreater and lesser saphenous veins arecommonly used ...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsCardiopulmonary Bypass System
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsPostoperative Care of the Cardiac SurgicalPatient
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Cmanagement patient with coronary blood desorder

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Cmanagement patient with coronary blood desorder

  1. 1. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsChapter 28Management of Patients WithCoronary Vascular Disorders
  2. 2. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsQuestionIs the following statement True or False?Individuals at highest risk for a cardiac event within 10years are those with existing coronary artery disease.
  3. 3. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsAnswerTrueIndividuals at highest risk for a cardiac event within 10years are those with existing coronary artery disease andthose with diabetes, peripheral arterial disease,abdominal aortic aneurysm, and carotid artery disease.
  4. 4. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsCoronary Atherosclerosis• Atherosclerosis is the abnormal accumulation of lipiddeposits and fibrous tissue within arterial walls andlumen.• In coronary atherosclerosis, blockages and narrowing ofthe coronary vessels reduce blood flow to themyocardium.• Cardiovascular disease is the leading cause of death inthe United States for men and women of all racial andethnic groups.• CAD, coronary artery disease, is the most prevalentcardiovascular disease in adults.
  5. 5. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsPathophysiology of Atherosclerosis
  6. 6. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsCoronary Arteries
  7. 7. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsClinical Manifestations• Symptoms are due to myocardial ischemia• Symptoms and complications are related to the locationand degree of vessel obstruction• Angina pectoris• Myocardial infarction• Heart failure• Sudden cardiac death
  8. 8. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsQuestionWhich is considered a modifiable risk factor for coronaryartery disease?A.RaceB.GenderC.Family historyD.Cigarette smoking
  9. 9. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsAnswerDA modifiable risk factor for coronary artery disease iscigarette smoking. Race, gender, and family history arenonmodifiable risk factors.
  10. 10. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins• The most common symptom of myocardial ischemia ischest pain; however, some individuals may beasymptomatic or have atypical symptoms such asweakness, dyspnea, and nausea.• Atypical symptoms are more common in women and inpersons who are older, or who have a history of heartfailure or diabetes.
  11. 11. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsAngina Pectoris• A syndrome characterized by episodes or paroxysmalpain or pressure in the anterior chest caused byinsufficient coronary blood flow.• Physical exertion or emotional stress increasesmyocardial oxygen demand and the coronary vessels areunable to supply sufficient blood flow to meet the oxygendemand.• Types of angina.
  12. 12. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsAngina pain varies from mild to severe• May be described as tightness, choking, or a heavysensation.• Frequently retrosternal and may radiate to neck, jaw,shoulders, back or arms (usually left).• Anxiety frequently accompanies the pain.• Other symptoms may occur: dyspnea/shortness ofbreath, dizziness, nausea, and vomiting.• The pain of typical angina subsides with rest or NTG.• Unstable angina is characterized by increased frequencyand severity and is not relieved by rest and NTG.Requires medical intervention!
  13. 13. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsTreatment• Treatment seeks to decrease myocardial oxygen demandand increase oxygen supply• Medications• Oxygen• Reduce and control risk factors• Reperfusion therapy may also be done
  14. 14. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsMedications• Nitroglycerin• Beta-adrenergic blocking agents• Calcium channel blocking agents• Antiplatelet and anticoagulant medications• Aspirin• Clopidogrel and ticlopidine• Heparin• Glycoprotein IIB/IIIa agents
  15. 15. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsQuestionIs the following statement True or False?Nitroglycerin tablets should never be removed and storedin metal or plastic pillboxes.
  16. 16. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsAnswerTrueNitroglycerin tablets should never be removed and storedin metal or plastic pillboxes.
  17. 17. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsNursing Process: The Care of the Patientwith Angina Pectoris—Assessment• Symptoms and activities, especially those that precedeand precipitate attacks• Risk factors, lifestyle, and health promotion activities• Patient and family knowledge• Adherence to the plan of care
  18. 18. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsNursing Process: The Care of the Patientwith Angina Pectoris—Diagnoses• Ineffective cardiac tissue perfusion• Death anxiety• Deficient knowledge• Noncompliance, ineffective management of therapeuticregimen
  19. 19. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsCollaborative Problems• Acute pulmonary edema• Heart failure• Cardiogenic shock• Dysrhythmias and cardiac arrest• Myocardial infarction
  20. 20. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsNursing Process: The Care of the Patientwith Angina Pectoris—Planning• Goals include the immediate and appropriate treatmentof angina, prevention of angina, reduction of anxiety,awareness of the disease process, understanding ofprescribed care, adherence to the self-care program, andabsence of complications.
  21. 21. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsTreatment of Angina Pain• Treatment of angina pain is a priority nursing concern.• Patient is to stop all activity and sit or rest in bed.• Assess the patient while performing other necessaryinterventions. Assessment includes VS, and observationfor respiratory distress, and assessment of pain. In thehospital setting, the ECG is assessed or obtained.• Administer oxygen.• Administer medications as ordered or by protocol, usuallyNTG.
  22. 22. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsAnxiety• Use a calm manner• Stress-reduction techniques• Patient teaching• Addressing patient spiritual needs may assist in allayinganxieties• Address both patient and family needs
  23. 23. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsPatient Teaching• Lifestyle changes and reduction of risk factors• Explore, recognize, and adapt behaviors to avoid toreduce the incidence of episodes of ischemia• Teaching regarding disease process• Medications• Stress reduction• When to seek emergency care
  24. 24. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsMyocardial Infarction• An area of the myocardium is permanently destroyed.Usually caused by reduced blood flow in a coronaryartery due to rupture of an atherosclerotic plaque andsubsequent occlusion of the artery by a thrombus.• In unstable angina, the plaque ruptures but the artery isnot completely occluded. Unstable angina and acutemyocardial infarction are considered the same processbut at different point on the continuum.• The term acute coronary syndrome includes unstableangina and myocardial infarction.
  25. 25. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsEffects of Ischemia, Injury, and Infarctionon ECG
  26. 26. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsClinical Manifestations and Diagnosis• Chest pain, other symptoms• ECG• Laboratory tests—biomarkers– CK-MB– Myoglobin– Troponin T or I
  27. 27. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsQuestionWhat is the purpose of an echocardiogram?A.Evaluate arterial function of the heartB.Evaluate ventricular function of the heartC.Detect hyperkinetic wall motionD.Identify ischemia changes
  28. 28. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsAnswerBThe echocardiogram is used to evaluate ventricularfunction. It can detect hypokinetic and akinetic wallmotion and can determine the ejection fraction.
  29. 29. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsTreatment of Acute MI• Obtain diagnostic tests including ECG within 10 minutesof admission to the ED• Oxygen• Aspirin, nitroglycerin, morphine, beta-blockers• Angiotensin-converting enzyme inhibitor within 24 hours• Evaluate for percutaneous coronary intervention orthrombolytic therapy• As indicated; IV heparin or LMWH, clopidogrel orticlopidine, glycoprotein IIb/IIIa inhibitor• Bed rest
  30. 30. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsNursing Process: The Care of the Patientwith ACS—Assessment• A vital component of nursing care!• Assess all symptoms carefully and compare to previousand baseline data to detect any changes orcomplications.• Monitor ECG.
  31. 31. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsNursing Process: The Care of the Patientwith ACS—Diagnoses• Ineffective cardiac tissue perfusion• Risk for fluid imbalance• Risk for ineffective peripheral tissue perfusion• Death anxiety• Deficient knowledge
  32. 32. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsCollaborative Problems• Acute pulmonary edema• Heart failure• Cardiogenic shock• Dysrhythmias and cardiac arrest• Pericardial effusion and cardiac tamponade
  33. 33. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsNursing Process: The Care of the Patientwith ACS—Planning• Goals include the relief of pain or ischemic signs andsymptoms, prevention of further myocardial damage,absence of respiratory dysfunction, maintenance of orattainment of adequate tissues perfusion, reducedanxiety, adherence to the self-care program, andabsence or early recognition of complications.
  34. 34. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsPercutaneous Coronary Intervention
  35. 35. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsCoronary Artery Bypass Grafts
  36. 36. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsGreater and lesser saphenous veins arecommonly used for bypass graftprocedures.
  37. 37. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsCardiopulmonary Bypass System
  38. 38. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsPostoperative Care of the Cardiac SurgicalPatient

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