4. BROAD OBJECTIVES
• By the end of this presentation the
learners must be able to acquire
knowledge and skills on coronary
artery disease, causes and its
management.
5. SPECIFIC OBJECTIVES
• Definition of coronary artery disease.
• Describe etiology.
• Describe the risk factors.
• explain the pathophysiology.
• Describe the clinical manifestation.
• Describe the diagnostic studies.
• .Describe the medical management.
• Describe the nursing management.
• Describe the nursing assessment.
• Discuss the nursing diagnosis
• Explain patient education.
• Describe the complications
6. DEFINITION
• It is the accumulation of
plaque in the coronary
artery.
• This condition can occur in
any artery of the body but
has preference for the
coronary artery.
7. • CAD can also be described as a blood
vessel disorder that is included in
the general category of
atherosclerosis.
• CAD is also known as cardiovascular
heart disease
8. ETIOLOGY
• Atherosclerosis is the main cause of
coronary artery disease.
• It is characterized by the deposition
of cholesterol and lipids primarily in
the intimal wall of the artery.
9. RISK FACTORS.
• Factors that increase the risk of
atherosclerosis includes;
• Smoking, high blood pressure,
diabetes mellitus, obesity, age and
gender, family history and genetics
and stress.
10. PATHOPHYSIOLOGY.
• Atherosclerosis is the major cause of CAD
which is characterized by focal deposits of
cholesterol and lipids in the intimal wall of the
artery
• Coronary artery atherosclerosis is a progressive
disease that begins early in life.
• Although several risk factors are present
, endothelial injury is caused by an inflammatory
response in the intimal layer of the artery and
the deposition of the lipids in the wall.
11. PATHO CONT....
• The process has been shown to occur
in three developmental stages and
these are;
• Fatty streak
• Fibrous plaque
• Complicated lesion
12. PATHO CONT
Fatty streak.
• Early lesion of atherosclerosis by
lipid filled smooth muscle cells.
Fatty streak can be observed in the
coronary arteries by the age of 15
and progresses as patient ages.
• It is thought to be reversible.
13. PATHO CONT….
Fibrous plaque.
• This develops over time.
• The smooth muscle cells stimulated
by low density of lipo proteins and
platelets activated growth factors
proliferate, produce collagen and
migrate over the fatty streak.
• This forms a fibrous plaque. The
fibrous plaque is whitish or grayish in
color.
14. PATHO CONT….
• It may develop in one portion of the
artery or circle the entire lumen.
• Fibrous plaque contributes to loss of
arterial elasticity and impairs vessel
ability to vasodilate to meet
increased oxygen need.
15. PATHO CONT……
Complicated lesion.
• This involves the development of an
ulceration or rupture of plaque.
Platelets adhere to the lesion.
Platelets adherence trigger the
coagulation cascade with the
development of thrombus that
obstructs the artery.
18. DIAGNOSTIC STUDIES
• Chest x-ray for cardiac enragement
• Aortic calcifications and pulmonary
congestion.
• ECG
• Lab test for lipid profile.
19. MEDICAL
MANAGEMENT
• Administer Digoxin IV digitalised
dose 0.6 -1 mg 50% of the dose
initially, additional fractions are
given at 4- 8 hour intervals.
• Administer aspirin po 325 -650 mg
per day.
• Administer Prednisalone 5.0 mg.
• Administer Hydrcortisone 20.0 mg.
20. NURSING
MANAGEMENT
HEALTH HISTORY
• 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
down, eating or drinking, using of anti-acids.
• Assess for other symptoms ; in
digestion, heartburn, nausea, abdominal pain
• Assess for risk factors for CAD; positive family
history, lipid profile, tobacco use, stress level and
exercise pattern.
• Assess for other illnesses lines diabetes, hypertension
and sleeping disorder.
21. PHYSICAL
EXAMINATION
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.
22. 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
maximum lung expansion
• Administer oxygen therapy, 4-6litres/minute to
supplement oxygen supply. Discontinue oxygen therapy
if oxygen saturation is greater than 90%.
23. CONT……
• Altered comfort (chest pain) related
to inflammatory response of the
arteries as evidenced by patient
rubbing the chest.
Goal
• Pain relief ; patient should be free
from chest pain
24. CONT……
Intervention
• Nurse the patient in a position which
he/she is feeling comfortable
• Administer prescribed analgesics e.g.
pcm 1 gram po
25. 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.
26. CONT…
• Anxiety related to unknown outcome
of the disease as evidenced by
patient repetitive question.
Goal
• Patient will experience manageable
level of anxiety .
27. CONT….
Interventions
• Provide calm environment.
• Explain every procedure to the
patient.
• Keep family members informed of
the disease process.
28. PATIENT/ FAMILY
EDUCATION
• Provide specific verbal and written
instructions on smoking cessation,
stress management and diet
modification.
• Encourage adherence to a diet low in
saturated fats and cholesterol.
• Discuss benefits of stress
management techniques in decreasing
negative effort on oxygen demand.
29. COMPLICATIONS 0F
CAD
• Heart failure : It occurs in response to decreased
contractility secondary to ischemic myocardium .
• Dsyrithmia : this the disturbance in heart rhythms.
• Pericarditis : the heart pericardial lining can
become inflamed and fluid may accumulate
between the pericardial and the visceral layers
so, the patient complaints severe of pericardial
chest pain.
• Other complications include; cardiogenic shock and
ischemic cardiomapathy
30. SUMMARY
• Coronary artery disease is caused by
accumulation of cholesterol and lipids
in the artery of the heart.
• The development of the condition
occurs in three stages, namely fatty
streak, fibrous plaque and
complicated lesion.
• The diet which is high in lipids and
cholesterol increases susceptibility
of coronary artery disease.
31. References
• S. Lewis, M. Heitkemper, S.
Dirksen, P. Obrien and L. Bucher
(2007) Medical Surgical Nursing;
Assessment and Management of
Clinical problems (7th edition)St
Louisi, Mosby.
• A.D. LINTON (2007) Introduction to
medical Surgical Nursing, (4th
edition), St Louis Mosby.
• Phipps’ (2007) Medical Surgical
Nursing. Health and Illness
