Care Plan For Angina Pectoris Angina Pectoris Chief Complaint: Patient complains of having tightness and pain in his chest that seems to move down the left arm. Patient describes the pain as being sharp and can be sometimes a mild pain or an immobilizing pain. Medical Diagnosis: Coronary Artery Disease Pathophysiology of: Angina Pectoris Angina Pectoris develops when coronary blood flow becomes inadequate to meet myocardial oxygen demand. This causes myocardial cells to switch from aerobic to anaerobic metabolism, with a progressive impairment of metabolic, mechanical, and electrical functions.
Angina pectoris is the most common clinical manifestation of myocardial ischemia. It is caused by chemical and mechanical stimulation of sensory afferent nerve endings in the coronary vessels and myocardium. These nerve fibers extend from the first to fourth thoracic spinal nerves, ascending via the spinal cord to the thalamus, and from there to the cerebral cortex. (http:// emedicine. medscape. com/article/15021 5-overview, 6/1 5/10 12:30 pm) Medical Interventions: Diagnostic Tests: 1.
Coronary intravascular ultrasonography A coronary intravascular ultasonography is an invasive ultrasound performed rom a transducer within the lumen of the coronary arteries.
(Laboratory test and diagnostic procedures, By: Cynthia Chernicky, 5th Edition 2008). Electrocardiography is a noninvasive acoustic imaging procedure that determines the size, shape, position, thickness and movements of the heart valves, walls, and chambers during each cardiac cycle. (Laboratory test and diagnostic procedures, By: Cynthia Chernicky, 5th Edition 2008). Lipid Profile; Blood 3.
Lipid profile; blood is a test to check the units of each of the following: Total lipids, A. Triglycerides B. HDL Cholesterol C.
LDL Cholesterol D. E. Total HDL Cholesterol ratio. 4. Stress Exercise Test Stress exercise test measures the efficiency of the heart during a period of physical stress on a treadmill or on a stationary bicycle. Medications: 1. Nitroglycerin Tablets: Classification: Vasodilator, antihypertensive. Action: Reduces preload and afterload, decreasing myocardial workload and oxygen demand. Uses: To prevent or treat angina pectoris, hypertension, and heart failure.
Contraindications: Acute Myocardial Infarction, angle- closure glaucoma, cerebral hemorrhage, concurrent use of phosphodiesterase inhibitors, constrictive ericarditis. Route and Dosage: Adults: PO 1 mg. tablet every 5 hours while awake. (Buccal) 0. 1 To 0. 8 mg. ‘hr. worn 12 to 14 hours at a time. (Transdermal Patch) Adverse Reactions: Some side effects of this drug that should be reported to a healthcare provider if they become severe are as follows: headaches dizziness flushing lightheadedness reported to a healthcare provider immediately.
The adverse effects of nitroglycerin are: Nausea vomiting Weakness blurred vision fainting spell abdominal pain sweating chest pain pale skin rashes ? peeling of the skin blisters on the skin hives itching difficulty breathing Surgery: 1 Transluminal coronary angioplasty Your heart’s arteries can become clogged from a buildup of cholesterol, cells or other substances. This can reduce blood flow to your heart and cause chest discomfort.
Sometimes a blood clot can suddenly form or get worse and completely block blood flow, leading to a heart attack. Angioplasty opens blocked arteries and restores normal blood flow to your heart muscle. Angioplasty, a type of percutaneous coronary intervention (PCI), is not major surgery. It is done through a small puncture in a leg or arm artery and opens a clogged heart artery by inflating a tiny balloon in it. Assessment: Subjective: Patient is a 68 year old male with a history of coronary artery disease, and hypertension.
Vital Signs as follows: -r: 986 R: 25 p: 102 Objective: Patient seemed to be crying and in severe pain. Skin was flushed, and clammy. Right hand was over left shoulder as if he were trying to relieve the pressure of the pain. Nursing Diagnosis: 1 Physical: 1. Acute pain related to decreased oxygen supply to the myocardium. Nursing Intervention: . Patient will remain on oxygen as ordered for the next 12 hours. 2. Give Nitroglycerin Tablets sublingually every 5 minutes for the next 1 5 minutes. . Patient will sleep for at least 30 minutes every 2 hours for the next 8 hour shift. Nursing Evaluation/Outcome: 1. Patient was able to be taken off of oxygen after the first 12 hours. 2. Patients pain had stopped after 1 5 minutes of administration of the nitroglycerin tablets. 3. Patient was able to sleep for 30 minutes every 2 hours with no interruptions in the last 8 hour shift. Nursing Diagnosis: 2 Psychosocial: 1. Anxiety related to change in lifestyle. Nursing Interventions: 1.
Patient will be informed of the importance of taking the nitroglycerin at first sign of pain within an 8 hour shift. 2. Patient will learn how to decrease personal activities within 30 days. 3. Patient will Join a stress management course within the next month. 1. Patient was able to better understand the use of the nitroglycerin tablets after an 8 hour shift. 2. Patient was able to decrease physical activities in the last 30 days. 3. Patient was able to Join a stress management course in last month. Potential/ Risk: 1. Deflecient Knowledge related to coronary artery disease. . Patient will learn the causes of angina pectoris within an 8 hour shift. 2. Patient will learn the importance of side effects to medications within 8 hours. 3. Patient will make sure to get all information of medications before leaving the hospital. 1. Patient was better able to understand what caused the angina pectori by the time he left the hospital. References 1. Laboratory test and diagnostic procedures, By: Cynthia Chernicky, 5th Edition 2008. 2. http://emedicine. medscape. com/article/1 5021 5-overview, 6/1 5/10 12:30 pm