Instructor : Mrs: Zainab

DONE BYFAISAL AL-ATIBIABDULAZIZ AL-

SHAMRANIABDUL-KAREM ALI

Case Study

Name of patient Atiah Atitullah AL-Shaikhi

He is 73 old . He is MarriedLevel Education : Secondary schoolAdmitted to hospital 14/4/2012Smoker or not : was a smoker he gives.up smoking Length : 161cmWeight : 61kg

Chief Complaints -Coronic Arty dieses *Present Complaint

-Cough Medical Diagnosis

-CAD *Medical history

-DM- H.T.NThe cardiac catheterization

Coronary artery disease

Coronary artery disease (CAD; also atherosclerotic heart disease) is the result of the accumulation of atheromatous plaques within the walls of the coronary arteries[1] that supply the myocardium (the muscle of the heart) with oxygen and nutrients. It is sometimes also called coronary heart disease (CHD). Although CAD is the most common cause of CHD, it is not the only one.

Pathophysiology

Limitation of blood flow to the heart causes ischemia (cell starvation secondary to a lack of oxygen) of the myocardial cells. Myocardial cells may die from lack of oxygen and this is called a myocardial infarction (commonly called a heart attack). It leads to heart muscle damage, heart muscle death and later myocardial scarring without heart muscle regrowth.

Symptoms :

  -Chest discomfort, mild pain

-Coughing -Crushing chest pain

-Dizziness -Dyspnea (shortness of breath)

-Face seems gray

Symptoms :

-A feeling of terror that your life is coming to its end

-Feeling really awful (general feeling)

-Nausea -Restlessness

-The person is clammy and sweaty - Vomiting

Diagnosing coronary heart disease (coronary artery disease)

The doctor will probably ask that the patient questions about their medical history, symptoms and carry out a physical examination . One or some of the following diagnostic tests may also be ordered:

-ECG (electrocardiogram) -A Holter monitor

-An echocardiogram -street test

-Coronary catheterization -CT (computerized tomography)

-MRA (magnetic resonance angiogram) -Nuclear ventriculography

-Blood tests

Risk Factors The following are confirmed independent risk factors for the

development of CAD: -Hypercholesterolemia (specifically,

serum LDL concentrations)Smoking

-Hypertension (high systolic pressure seems to be most significant in this regard)

-Hyperglycemia (due to diabetes mellitus or otherwise) [citation needed-Type A Behavioural Patterns, TABP. Added in 1981 as an independent risk factor after a majority of research into the field discovered that TABP's were twice as likely to exhibit CAD as any other personality type.

-Hemostatic Factors: High levels of fibrinogen and coagulation factor VII are associated with an increased risk of CAD. Factor VII levels are higher in individuals with a high intake of dietary fat[citation needed]. Decreased fibrinolytic activity has been reported in patients with coronary atherosclerosis.

-Hereditary differences/genetic polymorphisms in such diverse aspects as lipoprotein structure and that of their associated receptors, enzymes of lipoprotein metabolism such as cholesteryl ester transfer protein(CETP) and hepatic lipase (HL), homocysteine processing/metabolism, etc.[citation needed

-High levels of Lipoprotein(a), a compound formed when LDL cholesterol combines with a

substance known as Apoliprotein ( )a.

Significant, but indirect risk factors include:

Lack of exerciseConsumption of alcoholStressDiet rich in saturated fatsDiet low in antioxidantsObesity Men over 60; Women over 65A recent study done in India (Pondicherry) shows its association with hemoglobin 

What are the treatment options for coronary heart disease (coronary artery disease )

Although coronary heart disease cannot be cured, it can be managed much more effectively today than in the past. Treatment consists mainly of lifestyle changes, and perhaps some medical procedures and medications.

Lifestyle

Lifestyle - some specific lifestyle changes can significantly improve the health of the arteries:

Stop smokingEat a healthy and well balanced dietExercise regularlyAim for an ideal bodyweightReduce emotional/mental stress

MedicationsMedications to modify cholesterol levelsLow-dose aspirin and clot-busting medicationBeta blockersNitroglycerinACE (angiotensin-converting enzyme) inhibitorsCalcium channel blockers

Surgery 

if fatty deposit build-up has left the blood vessels very narrow, or if symptoms are not responding well enough to medications, surgery may be required to open up or replace blocked arteries.

Percutaneous coronary revascularizationCoronary bypass surgeryHeart transplantLaser surgery

Prevention of coronary heart disease (coronary artery disease)

If you can keep your LDL levels low and your HDL levels high, your risk of developing coronary heart disease is significantly lower (than someone who can't). The following lifestyle measures can help:

Be physically activeConsume alcohol in moderation or not at allDo not smokeEat a healthy and balanced diet

Keep your blood pressure under controlKeep your diabetes under controlMaintain a healthy body weightReduce/control emotional and mental stressIf you already have coronary heart disease, follow your doctor's instructions in order to prevent complications. This includes taking the prescribed medications.

Care planNursing diagnosis:

Ineffective Airway Clearance related /to secretions in the bronchi.

Goal After 4 hours of nursing intervention, airway patency

will be maintained, secretions will be readily expectorated and there will be signs of

reduction in congestion.

Nursing intervention: Independent:1-Vital signs monitored and recorded.2-Assisted in semi-fowler’s position.3-Encouraged deep breathing exercise.Dependent:1-Administered prescribed medications.2-Provided supplemental humidification via use of nebulizer

 Rational :This is for baseline comparison.Proper positioning helps in draining secretions.This will promote proper lung expansion.Prescribed meds such as bronchodilator helps in aiding effective airway clearance.Mobilization helps in liquefying secretions for better and faster expectorating the secretions.

Evaluation: After 4 hours of nursing intervention, the goal is met through maintenance of airway patency and reduction in congestion.

END