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Coronary Artery Disease

Coronary Artery Disease. Angina. Case Scenario.

murphy-moreno
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Coronary Artery Disease

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  1. Coronary Artery Disease Angina

  2. Case Scenario • B.J. is a 37-year-old traveling salesman, who is married with 3 children. He visited his nurse practitioner recent complaints of chest pain twice last week that occurred while he was at work. After consultation with a cardiologist, BJ is scheduled for a stress test.

  3. Question # 1 • What is a stress test? How is coronary artery disease diagnosed with this procedure?

  4. Question # 2 • BJ’s cardiologist informed him that the results of his stress test indicate that he has angina. • What are the typical manifestations of angina?

  5. Question # 3 • Distinguish between angina, atherosclerosis, and ischemia

  6. Question # 4 Distinguish between stable angina and unstable angina. When doing your nursing history, what kind of questions would you ask a patient in effort to determine whether s/he has stable angina or unstable angina.

  7. Question # 5 In light of his angina, BJ is given a prescription for nitroglycerin (NTG), a beta-blocker, and is scheduled for a coronary angiogram. • What is a coronary angiogram (i.e., coronary arteriogram)? How is it performed? How is coronary artery disease diagnosed with this procedure?

  8. Question # 6 • What patient teaching should you provide BJ with respect to his upcoming coronary angiogram (most frequently called cardiac catheterization)?

  9. Question # 7 • You are assessing BJs understanding of how to use his nitroglycerin. What information would you be looking for to ensure that his understanding of how to use this medication is correct?

  10. Case Scenario (cont’) • You are a nurse at the cardiac prevention and rehabilitation center to which BJ was referred after his coronary angiogram. B.J.’s wife comes along to help him with healthy lifestyle changes. You take the following nursing history: • Father died of sudden cardiac death at 42 yrs • His mother (still living) had a CABG x 4 (quadruple coronary artery bypass graft) at age 52 • Has HTN controlled with nifedipine (Procardia) 90 mg PO qd (takes regularly) • Smokes average of 1.5 pack cigarettes/day • Drinks “occasional” beer (“a 6-pack every weekend) • Dietary history of fried and fast foods • Weight: 235 lbs • Height: 5'8“ • Waist circumference 48” • V/S: 138/88, 82, 18, 37°

  11. Question # 8 • Calculate B.J.’s smoking history in terms of pack-years.

  12. Question # 9 • List three non-modifiable risk factors for CAD.

  13. Question # 10 • 3. List six modifiable risk factors for CAD.

  14. Question # 11 • Underline each of the responses in questions 1 and 2 that represent B.J.’s personal CAD risk factors.

  15. Question # 12 • You would like to know more about B.J.’s hyperlipidemia. What 4 common laboratory values do you need to know?

  16. Question # 13 • B.J. laughingly tells you he believes in the 5 all-American food groups: salt, sugar, fat, chocolate, and caffeine. • Identify health-related problems in this case description; the problem that is potentially life-threatening should be listed first.

  17. Question # 14 • Of all his behaviors, which one is the most significant in promoting cardiac disease?

  18. Question # 15 • What is the most important priority problem that you need to address with B.J.? Identify the teaching strategy you would use with him. • HINT: What you think is the most important may not be what he considers the most important, or the one he is willing to work on.

  19. Question # 16 • What is the second problem you would work with B.J. to change? Identify an appropriate strategy to resolve the problem.

  20. Case Scenario (cont’) Six weeks after you start working with B.J., he admits that he has been under a lot of stress. He rubs his chest and says, “It feels really heavy on my chest right now.” You feel his pulse and note that his skin is slightly diaphoretic, and that he is agitated and appears to be very anxious.

  21. Question # 17 • What are you going to do to obtain additional information?

  22. Question # 18 • B.J. continues to feel symptomatic. Now what are you going to do?

  23. Question # 19 • Use principles of oxygen supply and demand to explain how beta-adrenergic blocking agents (i.e., beta blockers) help prevent ischemia/angina.

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