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INTRODUCTION
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The heart muscle needs a constant supply of oxygen-rich blood. The
coronary arteries, which branch off the aorta just after it leaves the heart,
deliver this blood. Coronary artery disease can block blood flow, causing
MI).
average, men develop it about 10 years earlier than women because, until
Among people aged 75 and older, a higher proportion of women have the
deposits in the artery walls and may progress to narrowing and even
sex and race) of people aged 20 and older. The death rate increases with
age and overall is higher for men than for women, particularly between the
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ages of 35 and 55. After age 55, the death rate for men declines, and the
rate for women continues to climb. After age 70 to 75, the death rate for
women exceeds that for men who are the same age.
Coronary artery disease affects people of all races, but the incidence is
extremely high among blacks and Southeast Asians. The death rate is higher
for black men than for white men until age 60 and is higher for black women
II. OBJECTIVES
A. GENERAL OBJECTIVES
B. SPECIFIC OBJECTIVES
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Student Nurse Centered
disease.
complication.
Client’s Centered
complication.
health status
Name: JGM
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Age: 50
Sex: Female
Nationality: Filipino
FAMILY HISTORY
The client stated that they don’t have any history of the disease.
HEALTH HISTORY
In her younger years she was very workaholic and has no time
for relaxation. Mrs. JC had great fun of eating fatty and salty foods, and also
smoking since 30 years old. These unhealthy lifestyles contribute a lot for
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The client stated that when she was 40 years old she was check up at
given medication and despite of her illness she continues working hard.
Mrs. JC and other Brgy. Officials had attended a seminar in Baguio last
March 2008, and after three days of staying she felt a severe chest pain,
shortness of breath, headache and blurry vision. When she was on her way
to the terminal riding on a taxi and suddenly taxi driver noticed her face and
neck was red in appearance. And the taxi driver decided to bring her in
Baguio General Hospital. At the emergency room she was given oxygen
inhalation and medication. After a few hours when she was already on good
Artery Disease.
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IV. PHYSICAL EXAMINATION
2. Thin hair
5. Dry lips
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NUTRITION AND METABOLIC PATTERN
• 3-5 glasses/day
• None
Any Supplements:
• None
• Bladder
Usual frequency: 5-6 times/ day
• Bowel
Time: No specific
Color: Brownish
Consistency: Semi-form
• None
Sleep Pattern:
V. CASE DISCUSSION
A. DEFINITION OF DISEASE
found in the blood. When plaque builds up in the arteries, the condition
is called atherosclerosis.
Atherosclerosis
Figure A shows a normal artery with normal blood flow. Figure B
Plaque narrows the arteries and reduces blood flow to your heart
muscle. It also makes it more likely that blood clots will form in your
Overview
blood can't reach your heart muscle. This can cause angina or a heart
attack.
may feel like pressure or squeezing in your chest. The pain also may
A heart attack occurs when blood flow to an area of your heart muscle
death.
Over time, CAD can weaken the heart muscle and lead to heart failure
Outlook
• Atherosclerosis
• Heart disease
THE HEART
chest between your right and left lung. It’s shaped like an upside-
The heart is the muscle in the lower half of the picture. The heart
has four chambers. The right and left atria are shown in purple.
The ventricle on the right side of your heart pumps blood from
the heart to your lungs. When you breathe air in, oxygen passes
from your lungs through blood vessels where it’s added to your
blood. Carbon dioxide, a waste product, is passed from your
blood from the lungs. The pumping action of your left ventricle
The superior and inferior vena cavae are in blue to the left of the
muscle as you look at the picture. These veins are the largest
right atrium of your heart. “Used” blood has had its oxygen
superior vena cava carries used blood from the upper parts of
your body, including your head, chest, arms, and neck. The
inferior vena cava carries used blood from the lower parts of your
body.
The used blood from the vena cavae flows into your heart’s right
The oxygen-rich blood passes from your lungs back to your heart
through the pulmonary veins (in red to the left of the right atrium
in the picture).
pulmonary veins (in red to the right of the left atrium in the
picture). It enters the left atrium and is pumped into the left
Like all of your organs, your heart needs blood rich with oxygen.
HEART INTERIOR
The
Septum
The right and left sides of your heart are divided by an internal
wall of tissue called the septum. The area of the septum that
divides the two upper chambers (atria) of your heart is called the
Heart Chamber
The picture shows the inside of your heart and how it’s divided
into four chambers. The two upper chambers of your heart are
called atria. The atria receive and collect blood. The two lower
chambers of your heart are called ventricles. The ventricles
pump blood out of your heart into the circulatory system to other
Heart Valves
valve, the tricuspid valve, the pulmonary valve, and the mitral
valve or Bicuspid.
Blood Flow
The arrows in the drawing show the direction that blood flows
through your heart. The light blue arrows show that blood enters
the right atrium of your heart from the superior and inferior vena
cavae. From the right atrium, blood is pumped into the right
The light red arrows show the oxygen-rich blood coming in from
your lungs through the pulmonary veins into your heart’s left
atrium. From the left atrium, the blood is pumped into the left
ventricle, where it’s pumped to the rest of your body through the
aorta.
For the heart to function properly, your blood flows in only one
heart’s ventricles has an “in” (inlet) valve from the atria and an
your heart’s atria and ventricles. Each valve has a set of flaps
Pu
lmonary Artery
Different Systems
Lungs
C. PATHOPHYSIOLOGY
Modifiable Risk Factors
High blood cholesterol level Non-modifiable Risk Factors
Cigarette smoking, tobacco use Family history of coronary heart disease
Hypertension Increasing age
Diabetes mellitus Gender (heart disease occurs three times
Lack of estrogen in women more often in men than
Physical inactivity in premenopausal women)
Obesity Race (higher incidence of heart disease in
African Americans than
in Caucasians)
Cholesterol
Foam Cells
Oxidized LDL
Plaque Formation
D. CAUSES
certain factors damage the inner layers of the coronary arteries. These
factors include:
• Smoking
• High amounts of certain fats and cholesterol in the blood
diabetes
When damage occurs, your body starts a healing process. Excess fatty
heart muscle.
Plaque also can crack, which causes blood cells called platelets to
clump together and form blood clots at the site of the cracks. This
attack.
E. RISK FACTORS
Smoking – Cigarette smoking contributes to the
ways:
pressure.
the intima.
development of atherosclerosis.
Age – As you get older, your risk for CAD increases. Genetic
55.
alcohol a day.
patient:
• Chest pain • Chest Pain
• Shortness of Breath
• Shortness of Breath
• Palpitations
• Palpitations
• Fatigue
• Dizziness • Fatigue
• Nausea
• Dizziness
• Weakness
• Nausea and Vomiting
• Peripheral Edema
• Headache
• Blurring of vision
G. DIAGNOSTIC TEST
Your doctor will diagnose coronary artery disease (CAD) based on:
• Your medical and family histories
procedures
No single test can diagnose CAD. If your doctor thinks you have CAD,
ECG (Electrocardiogram)
An ECG is a simple test that detects and records the electrical activity
of your heart. An EKG shows how fast your heart is beating and
whether it has a regular rhythm. It also shows the strength and timing
CAD is likely. An EKG also can show signs of a previous or current heart
attack.
Stress Testing
During stress testing, you exercise to make your heart work hard and
beat fast while heart tests are performed. If you can't exercise, you're
When your heart is beating fast and working hard, it needs more blood
rich blood to meet your heart's needs. A stress test can show possible
activity
During the stress test, if you can't exercise for as long as what's
considered normal for someone your age, it may be a sign that not
enough blood is flowing to your heart. But other factors besides CAD
can prevent you from exercising long enough (for example, lung
(MRI) to take pictures of your heart when it's working hard and when
it's at rest.
These imaging stress tests can show how well blood is flowing in the
different parts of your heart. They also can show how well your heart
Echocardiography
This test uses sound waves to create a moving picture of your heart.
your heart and how well your heart chambers and valves are working.
The test also can identify areas of poor blood flow to the heart, areas
Chest X-ray
A chest x ray takes a picture of the organs and structures inside the
Blood tests check the levels of certain fats, cholesterol, sugar, and
proteins in your blood. Abnormal levels may show that you have risk
EBCT isn't used routinely to diagnose CAD, because its accuracy isn't
yet known.
fee) if other tests or factors show that you're likely to have CAD. This
test uses dye and special x rays to show the insides of your coronary
arteries.
To get the dye into your coronary arteries, your doctor will use a
called a catheter is put into a blood vessel in your arm, groin (upper
thigh), or neck. The tube is then threaded into your coronary arteries,
and the dye is released into your bloodstream. Special x rays are taken
may feel some soreness in the blood vessel where your doctor put the
catheter.
VI. TREATMENT
are to:
• Relieve symptoms
buildup of plaque
• Lower the risk of blood clots forming, which can cause a heart
attack
Lifestyle Changes
Making lifestyle changes can often help prevent or treat CAD. For some
healthy weight
find out how much and what kinds of activity are safe for you.
smoke.
With the TLC diet, less than 7 percent of your daily calories should
come from saturated fat. This kind of fat is mainly found in meat and
your daily calories should come from all fats, including saturated,
You also should have less than 200 mg a day of cholesterol. The
help block the digestive track from absorbing cholesterol. These foods
include:
source of omega-3 fatty acids, which may help protect the heart from
blood clots and inflammation and reduce the risk for heart attack. Try
to have about two fish meals every week. Fish high in omega-3 fats are
You also should try to limit the amount of sodium (salt) that you eat.
This means choosing low-sodium and low-salt foods and "no added
salt" foods and seasonings at the table or when cooking. The Nutrition
Facts label on food packaging shows the amount of sodium in the item.
Try to limit alcoholic drinks. Too much alcohol will raise your blood
gain. Men should have no more than two alcoholic drinks a day.
Your doctor may recommend the DASH eating plan if you have high
whole grains, and other foods that are heart healthy and lower in
salt/sodium.
This eating plan is low in fat and cholesterol. It also focuses on fat-free
or low-fat milk and dairy products, fish, poultry, and nuts. The DASH
eating plan is reduced in red meat (including lean red meat), sweets,
Regular physical activity can lower many CAD risk factors, including
Physical activity also can lower your risk for diabetes and raise your
CAD).
Check with your doctor about how much and what kinds of physical
activity are safe for you. Unless your doctor tells you otherwise, try to
get at least 30 minutes of moderate-intensity activity on most or all
days of the week. You can do the activity all at once or break it up into
during your first year of treatment. This amount of weight loss can
After the first year, you may have to continue to lose weight so you
can lower your body mass index (BMI) to less than 25.
If you smoke or use tobacco, quit. Smoking can damage and tighten
blood vessels and raise your risk for CAD. You also should avoid
Reduce Stress
Research shows that the most commonly reported "trigger" for a heart
anger. Also, some of the ways people cope with stress, such as
Physical activity can help relieve stress and reduce other CAD risk
Medicines
Medical Procedures:
Angioplasty
outward against the wall of the artery. This widens the artery and
Angioplasty can improve blood flow to your heart, relieve chest pain,
procedure.
CABG
Coronary artery bypass surgery, also coronary artery bypass
Cardiac Rehabilitation
when combined with medicine and surgical treatments, can help you