Questions for the Simulated Clinical Experience: Coronary Artery Disease

Risk Factors/Health Promotion Measures for Coronary Artery Disease (CAD)

Coronary Artery Disease is the most common form of heart disease. It is the primary source of death in both men and women. In time, coronary artery disease has the potential to deteriorate the heart muscle and is a factor in heart malfunction and arrhythmias later on. This means that the heart cannot propel blood adequately to the rest of the body. Good Arrhythmias would mean that there are differences in the regular beating of the heart. Because Coronary Artery Disease is such a risky health condition, it is very important that promotional measures be taken to avoid these dangers, especially when they can worsen. In the elderly, unstable glucose tolerance, obesity, and hypertension contribute to coronary artery disease; smoking and a poor diet are also risk factors for coronary artery disease in the elderly. Simple prevention measures are to quit smoking, exercise (as much one can), stay on a healthy diet and at a healthy weight.

Symptoms of Chest Pain in Various Patients

There are both classic and non-classic symptoms of chest pain, and these symptoms can differentiate between men and women, even in the elderly. The typical signs of chest pain are heaviness and stiffness in the chest; squashing or intense pain that engenders through to the back, neck, mandible, shoulders, and arms — mainly in the left arm; pain that persists for beyond a few minutes and varies in intensity. These symptoms also include shortness of breath, nausea, dizziness, and/or sweating. Other symptoms are characterized by trouble swallowing, tenderness as the patient touches their chest and pain that worsens as you cough or breathe deeply - this pain that worsens as the patient moves. For the elderly, it is very important to know and recognize the symptoms of chest pain, and how it can worsen. As with other patients, education is important.

There have been more cases of women reported as developing unstable angina and other chest pain-related problems, significantly higher than those in men. It can be said, then, that elderly women are even more at risk, and such measures should be taken to make sure that elderly women with even the slightest sign should be monitored and told to take the proper health measures. An elderly person experiencing chest pain will be pale, clammy, and anxious, as well as feeling pain in the chest area. It is important to check vitals and administer emergency care immediately.

Management of a Patient Post Cardiac Catheterization

The medical and nursing management of a patient that is post-cardiac catheterization is an important step. There is potential for complications if not handled correctly. Cardiac catheterization is an invasive procedure that contains the attachment of a radiopaque line via the peripheral artery or vein, into the heart. Before the patient undergoes Cardiac Catheterization, they should be fully educated on the procedure, the purpose, and what will happen after the operation. This education must happen before the patient goes in to have the operation.

In order to care for a person who has just undergone Post Cardiac Catheterization, apply pressure to the wound and dress it accordingly. Protect this area. Any bleeding should be taken care of immediately. Make sure to take the patient’s vitals every 15 minutes for two hours, every 30 minutes for the next two, and then every hour for the next two. Any bleeding should be taken care of immediately. Make sure that the parent is stable; direct the patient’s questions to their doctor.

Coronary Artery Bypass Graft Surgery

Coronary Artery Bypass Graft Surgery is an invasive procedure in which one obstructed coronary arteries are detoured by a blood vessel graft to guarantee that blood movement to the heart is adequate. The grafts typically are from the patient’s other arteries and veins placed in the saphenous, radial, and/or thoracic. The procedure follows the clogged to produce new passageways for blood that is rich in oxygen to run through to the heart.

It is vital to avoid complications because it is an invasive surgery. The doctor will make a minor opening underneath the obstruction of the artery, and if a saphenous or radial vein is being used, one is linked to the artery and one is attached to the aorta. When the summary artery is used, one of the ends is joined to the artery and the other stays on the aorta. The graft is stitched into the opening; this part of the procedure helps the blood to be redirected throughout the blockage and on to where it needs to go. This process is repeated if other coronary arteries are affected, and it is very common for three of these arteries to be bypassed. Being a very intricate surgery, there is room for complications and it is important to be educated in all these steps because the subjects are very delicate. The post-operative measures to be taken include the patient avoiding the incision from the surgery. As well, the patient should move slowly and carefully after surgery and should not lift more than a few pounds. This includes reaching above or below the head.

Cardiac Catheterization

What is happens if a catheterization site is saturated with blood? When a nurse notices this, it is important to first call a doctor immediately while adding firm pressure to the bleeding area. The site may need stitches after the catheter is removed, but most importantly, the blood should be stopped with pressure.

Calculation

For an order of 2 milligrams of Morphine in an Intravenous Pyelogram every 15 minutes, it can go up to 10 milligrams for chest pain that is not relieved by nitroglycerin. The Morphine vial contains 10 milligrams in 10 milliliters. It would take 1 milliliter in order to draw up 2 milligrams of Morphine.

Medications Cards List

Alprazolam. Alprazolam is more commonly known as Xanax and is used to treat anxiety disorders. It would be recommended to this patient because he seems to be exhibiting symptoms of high stress and anxiety.

Nitroglycerin. Nitroglycerin is used to treat high blood pressure and the symptoms associated with angina, but it is not fast-acting. It is typically taken as an injection. The nurse has to monitor this medication because it is taken via IV, and it ‘drips.’

Acetaminophen. Commonly known as Tylenol, acetaminophen is also used to relieve pain and contains caffeine.

Aspirin. Aspirin (acetylsalicylic acid) is a pain reliever.

Atorvastatin. Atorvastatin helps to lower high cholesterol and triglyceride levels. It also reduces the risk of heart attack and chest pain, which the patient is at risk because of personal and family history.

Morphine Sulfate. The pain reliever Morphine Sulfate is also known as DepoDur®. It is taken via an epidural, injection or by mouth (tablet), and would not be recommended to this patient as he is not in any pain; Morphine Sulfate is a very strong high pain reliever.

References

Ignatavicius, D. D., & Workman, M. L. (2010). Clinical decision-making study guide for medical surgical nursing: Patient centered collaborative care (6th ed.). St. Louis, MO: Saunders Elsevier.

PubMed Health. (2014). Morphine (Epidural route). U.S. Library National Library of Medicine. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0011274/?report=details#side_effects

PubMed Health. (2014). Oxycodone/Acetaminophen (By mouth) (Percocet). U.S. Library National Library of Medicine. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0011543//