for nursing faculty

2. REVIEW OF CARDIOVSCULAR
SYS..

5. DEFINITION AND INTRO….
 Coronary artery disease (CAD), also
known as ischemic heart disease (IHD), is
the most common of the cardiovascular
diseases.
 Coronary artery disease (CAD) causes
impaired blood flow in the arteries that
supply blood to the heart.
 The most common cause of CAD is
vascular injury with cholesterol plaque
buildup in the arteries, known
as atherosclerosis. Reduced blood flow
occurs when one or more of these arteries
becomes partially or completely blocked.

6. Risk factors include
 Age. Simply getting older increases your risk of
damaged and narrowed arteries.
 Sex. Men are generally at greater risk of coronary
artery disease. However, the risk for women
increases after menopause.
 Family history. A family history of heart disease is
associated with a higher risk of coronary artery
disease, especially if a close relative developed
heart disease at an early age.
 Smoking. People who smoke have a significantly
increased risk of heart disease.
 High blood pressure. Uncontrolled high blood
pressure can result in hardening and thickening of
your arteries, narrowing the channel through which
blood can flow.

7. RISK FACTORS
 High blood cholesterol levels. High levels of
cholesterol in your blood can increase the risk of
formation of plaque and atherosclerosis.
 Diabetes. Diabetes is associated with an increased
risk of coronary artery disease. Type 2 diabetes and
coronary artery disease share similar risk factors,
such as obesity and high blood pressure.
 Overweight or obesity. Excess weight typically
worsens other risk factors.
 Physical inactivity. Lack of exercise also is
associated with coronary artery disease and some
of its risk factors, as well.

8. RISK FACTORS….
 High stress. Unrelieved stress in your life may
damage your arteries as well as worsen other
risk factors for coronary artery disease.
 Unhealthy diet. Eating too much food that has
high amounts of saturated fat, trans fat, salt
and sugar can increase your risk of coronary
artery disease.
 Sleep apnea. This disorder causes you to
repeatedly stop and start breathing while
you're sleeping. Sudden drops in blood oxygen
levels that occur during sleep apnea increase
blood pressure and strain the cardiovascular
system, possibly leading to coronary artery
disease.

9. CONT…
 Preeclampsia. This condition that can
develop in women during pregnancy
causes high blood pressure and a higher
amount of protein in urine. It can lead to a
higher risk of heart disease later in life.
 Alcohol use. Heavy alcohol use can lead to
heart muscle damage. It can also worsen
other risk factors of coronary artery
disease.
 Autoimmune diseases. Conditions such as
rheumatoid arthritis and lupus (and other
inflammatory rheumatologic conditions)
have an increased risk of atherosclerosis.

10. Clinical sign
 chest pain
 heaviness
 tightness
 burning
 squeezing
 pain in the arms or shoulders
 shortness of breath
 sweating
 dizziness

11. Clinical sign
 nausea
 vomiting
 back pain
 jaw pain
 shortness of breath without
feeling chest pain

12. DIAGNOSTIC MEASURE
 Histroy collection & physical
examination
 ECG
 Echocardiogram
 Heart CT scan
 Coronary angiography
 Exercise ECG – Stress test

13. MEDICAL MANG..
 Medication
 Statins, which reduce cholesterol,
reduce the risk of coronary artery
disease
 Nitroglycerin
 Calcium channel blockers and/or
beta-blockers
 Antiplatelet drugs such as aspirin

14. Surgical management…
 Balloon angioplasty: to widen blocked
arteries and smoosh down the plaque
buildup, usually performed with insertion
of a stent to help keep the lumen open
after the procedure
 Coronary artery bypass graft surgery: to
restore blood flow to the heart in open
chest surgery

15. Nursing management…
 Assess for chest pain : focus on the
 location, severity, intensity, duration and
onset.
 Precipitating factors ; exercises, stress
and smoking.
 Measures attempted, to control pain for
example, lying
 Assess for other symptoms ; in
 digestion, heartburn, nausea, abdominal
pain
 Assess for risk factors for CAD; positive
family

16. Physical exam
 Assessing for the following ;
 Posture indicating chest pain e.g.
rubbing chest, leaning forward.
 Changes in vital signs ;
 tachycardia, bradycardia,
hypertension or hypotension
 Dyspnea, crackles, dsyrhythmia.
 Levels of consciousness
 Vomiting
 Decline in urine output.

17. Nursing diagnosis…
 Altered breathing pattern related to
imbalance between myocardial oxygen
supply and demand as
evidenced by an increase in respiratory rate.
 Goal
 The patient will have normal respirations
 Intervention
 Nurse the patient in a high fowler’s
position to allow
 Administer oxygen therapy, 4-
6litres/minute to supplement oxygen
supply. Discontinue oxygen therapy if
oxygen saturation is greater than 90%.

18. Cont..
 Activity intolerance related to dyspnea
 as evidenced by inability to perform
some of ADLs
 Goal
 Patient will tolerate gradually with
increasing levels of activities.
 Intervention
 Promote , encourage and provide
activities of daily living.

19. Cont…
 Anxiety related to unknown outcome of
the disease as evidenced by patient
repetitive question.
 Goal
 Patient will experience manageable
level of anxiety .
 Interventions
 Provide calm environment.
 Explain every procedure to the
patient.
 Keep family members informed
of the disease process.