CAD Nursing Diagnosis

Here we are, as today is the final blog.  This has been a long journey, but today, we will be putting everything together from the previous blog posts and using our critical thinking noggins in order to create 3 nursing diagnosis that are related to coronary artery disease! Keep in mind a nursing diagnosis is NOT a medical diagnosis!  Rather, it is used to compliment a medical diagnosis and to explain holistically, what causes the patient's condition.  In general, in order to spot a nursing diagnosis vs. a medical diagnosis, a nursing diagnosis has a lot more words while a medical diagnosis explains the condition in one or two words. 

The three nursing diagnosis' that I want to highlight for CAD are: 

- Risk for decreased cardiac tissue perfusion related to blockage of the coronary arteries. 

(The patient is at risk for decreased cardiac perfusion because of the lipid particles blocking the coronary arteries, reducing the flow of blood to that part of the heart muscle)

- Activity intolerance related to lack of cardiac tissue perfusion and cardiac output. 

(The lack of blood going to the heart can lead to less oxygenation of the heart, which can cause some cardiac cells to die, or not get enough oxygen to function properly.  One of the greatest symptoms/manifestations of this is the decrease in activity tolerance)

- Acute pain related to blockages in the coronary arteries, presenting itself as stable or unstable angina. 

(Angina usually presents itself in physical activity in people with CAD (stable angina).  When it randomly appears and doesn't go away with rest, it is unstable angina, which is a medical emergency!)

Can you see the connections to the previous blog posts already?  One of the greatest things about a nursing diagnosis is that we can trace everything back to CAD and treat many of the symptoms associated with it.  We know what to treat and it gives us a very powerful tool in treating CAD and many other diseases and/or conditions involving mental/physical/social well being!  Now, can a medical diagnosis do that?  (Note; This post is not intended for any doctors or medical students) 

Nursing Care of Individuals with CAD

CAD is a very inconvenient and dangerous disease.  The narrowing of the coronary arteries is no laughing matter and may change somebody's life for the worse.  Fortunately, at the hospital, there is a great cohesive team that works together in order to provide the best care for the patient, including doctors, pharmacists, nurses, physical therapy, social work, nutrition, etc.  Each has different roles, and for nurses, the care of individuals with CAD differs from all of the other different professions.  

Nursing care for CAD is split into some basic steps, according to the site Nursingfile (1): 

-Keep nitroglycerin, aspirin, and beta blockers available in order to treat CAD, or when signs of angina (chest pain) show up. Educate the patient about what the drugs do or any potential side effects that they carry. 

-Keep a close eye on blood pressure and heart rate/rhythm.  Attach EKG leads to the patient in order to obtain heart rate/rhythm readings. Try to look for any abnormal readings/readings with large deviations from the "usual" measurement. Also, keep a close eye on the EKG readings for any abnormalities. 

-Record duration and grade of pain (0-10).  Also record the amount of medication required to relieve it and accompanying symptoms.

-Monitor the patient for any CAD symptoms, such as chest pain, hypotension, coronary artery spasm, and bleeding from the catheter site.  

-Educate the patient about cardiac catheterization to the patient, along with any procedures and events for the patient in the future. 

-Help the patient cope with stress and identify activities that precipitate pain. 

-Inform the patient to follow the prescribed drug regime. 

-Encourage the patient to change their way of life for the better, including maintaining the perscribed diet and encouraging them to practice regular, light to moderate exercise.  Also, if the patient is smoking, or drinking alcohol, educate them about the dangers of those substances in relation to their condition and let them make their decision to quit.

-Be on high alert for any signs of myocardial infarction (heart attack) and be prepared to perform CPR.  

I would post a video here, however, the darn search engine for videos on this blog needs to be fixed, so here is the link to a very helpful video showing acute coronary syndrome (partial/full blockage of blood to the heart): https://www.youtube.com/watch?v=VnHDVyB1bkU 

Remember to have fun, but most importantly stay educated and healthy!!!

Works Cited: 

1) Nursing Interventions for Coronary Artery Disease. (2010, September 21). Retrieved February 19, 2015, from http://nursingfile.com/nursing-care-plan/nursing-interventions/nursing-interventions-for-coronary-artery-disease.html

CAD Treatment Options 

There are many treatments for coronary artery disease.  First and foremost, the best treatments for CAD are lifestyle changes.  These are the least invasive and will actually help your entire body as well (not just your heart)!  These include, eating less fatty foods and including more fiber rich food, fruits, legumes, along with omega-fatty acid foots like fish in your diet (1).  It is also very important to limit alcoholic and salt intake, as these can both increase blood pressure, increasing the chances of obtaining coronary artery disease.... or perhaps something even more serious like a heart attack!  If you are a smoker, it is a good idea to quit as well as smoking can raise your risk of CAD (1). 

The second element for good preventative treatment for CAD is exercise!  Exercising can lower your bad cholesterol (LDL) and increase your good cholesterol (HDL) (1).  It can also help you stabilize your blood sugar, which is a huge plus if you have diabetes (1).  One of the biggest benefits of exercise is helping you maintain a healthy weight and getting rid of excess fat in your body.  This will lower your risk for CAD as well. 

Medicinal treatments include, cholesterol lowering drugs, aspirin, beta blockers, nitroglycerin, ACE inhibitors, and calcium channel blockers (2).  

If there are any significant obstructions to your heart, one of the main treatment options is a coronary artery bypass surgery.  The way this works is that blood vessels are taken from other parts of the body (chest, arm, and leg) and grafted onto the obstructed area of the coronary artery to allow blood to bypass the obstructed area (2). Another option is an angioplasty, where a tube with a balloon is placed into a blood vessel that goes to the obstructed are of the heart.  Once in place, a balloon inflates and opens up the obstructed artery.  A metal mesh called a stent is then left there to keep the narrowed vessel open (1). 

Angiography, Angioplasty, and Coronary Bypass

With so many life-saving options, why even worry about CAD?  Well, for one, would you rather go to the gym or have many procedures that can cost lots of $$$?  Also, there are risks for other complications such as an embolism that can go to the brain and cause a stroke, so take care of your body now so you don't get headaches later!!!! (pun intended)

Works Cited

1) How Is Coronary Heart Disease Treated? (2014, September 29). Retrieved February 13, 2015, from http://www.nhlbi.nih.gov/health/health-topics/topics/cad/treatment

2) Coronary Artery Disease - Treatment. (n.d.). Retrieved February 13, 2015, from http://cardiac-surgery.med.nyu.edu/coronary-artery-disease-treatment

Signs and Symptoms of CAD

How can you tell if you have CAD?  What are the signs and symptoms associated with CAD?  All those questions will be answered here and now!  There are a few very key symptoms that come with the lack of oxygen in the heart.  These symptoms include: chest pain (angina), shortness of breath, and heart attack (1).  Another symptom of CAD as reported by the National Heart, Lung, and Blood Institute is heart arrhythmias (irrregular heartbeat) (2).   Some people may report arrhythmias as the heart skipping beats or beating too fast (2).  It is reported as a fluttering feeling in the chest (2).  Sometimes, arrhythmias can cause the heart to suddenly stop, which is called sudden cardiac arrest (2).  This is a very dangerous condition that if left untreated, may cause death.  That is what we learned CPR for though, in case any of his happens, which will give the person a chance at life until help arrives! 

Coronary Artery Disease In Depth

During a heart attack, the coronary arteries are completely occluded, The heart muscles lose oxygen, which can cause parts of the heart that the occluded part of the artery serves to die.  The death of the heart muscles is also known as myocardial infarction.  A heart attack bears different symptoms of its own!  These include crushing pressure in the chest, pain in your shoulder/arm, and/or shortness of breath and sweating (1).  For women, it may be different, with nausea and back/jaw pain being reported (1).  

Coronary Artery Disease Signs and Symptoms as Explained By a Doctor

Works Cited

1) Coronary artery disease. (2014, April 12). Retrieved February 5, 2015, from http://www.mayoclinic.org/diseases-conditions/coronary-artery-disease/basics/symptoms/con-20032038

2) What Are the Signs and Symptoms of Coronary Heart Disease? (2014, September 29). Retrieved February 5, 2015, from http://www.nhlbi.nih.gov/health/health-topics/topics/cad/signs

Diagnosis and Progression of CAD 

The heart is an organ that is protected very well by the body.  It is a mysterious organ that has fascinated humans since the dawn of time.  It has hid it's secrets from us, good or bad...so how does one find out if we have plaque buildup or if we are in danger of a heart attack?!  There are six methods that are very effective at diagnosing any malaise in the heart, especially for CAD. However, CAD is not diagnosed with just one of these tests.  If the doctor suspects any CAD, he will order more than one of the following tests (1).  These include: 

EKG(Electrocardiogram):

The EKG/ECG test is a test that measures your heart's electrical activity to find out how strong and fast the heart is beating (1).  Any anomalies in the beats will mean that there is something that is affecting how the heart is beating. From reading the charts, it is also possible to determine where in your heart the problem is stemming from! 

Stress testing: 

Stress testing is a very clever way for us to see how your heart is doing..... by making it work!  What better way to test your heart than by making it exercise?  While you exercise, your heart is monitored to find any abnormalities.  If you can't exercise, medications are given to raise your heart rate instead.  If you can't exercise as long as the normal range for your age, the heart may not be getting enough blood due to the arteries being blocked from plaque buildup (1).  Other symptoms to look out for are, abnormal changes in heart rate and/or blood pressure, shortness of breath or chest pain, and abnormal changes in your heart activity/rhythm (1). 

Echocardiography: 

This amazing technology is used to visualize your heart by using the sounds of your heart!  Think of it as a bat that uses echolocation to visualize everything around it.  Now that is what an echocardiogram does. 

Chest X-Ray:

How can the x-ray help see your heart?  The x-ray can see whether your heart is larger or smaller, which is indicative of heart failure.  The larger the heart is, the harder it has to work, which means the heart is facing a pathological resistance (1).  

Blood Tests: 

The blood test is a great way to measure whether or not somebody is at risk of CAD.  This test draws out a person's blood, then measures the level of fats, cholesterol, proteins, and sugar in your blood (1).  It also measures certain chemicals released by your heart called bio-markers that indicate whether the heart has been damaged (2).  All of these factors can cause damage/measure damage to the arteries, in which fat can accumulate and narrow the passage to blood flow. 

Coronary Angiography and Cardiac Catheterization:  

 

Coronary angiography and cardiac Catheterization is the use of special dyes and x-rays in order to show the arteries in the heart (2).  Cardiac catheterization is the insertion of a special tube into your bloodstream, then a special dye is released (2).  A special x-ray is then used.  It can show any occluded arteries or ones that are in danger of being occluded. 

Works Cited 

1) How Is Coronary Heart Disease Diagnosed? (2014, September 29). Retrieved January 26, 2015, from http://www.nhlbi.nih.gov/health/health-topics/topics/cad/diagnosis

2) Voss, J. (Director) (2015, January 26). Acute Coronary Syndrome. Lecture conducted from , Seattle.

Etiology/Pathophysiology of CAD

As we all know, from the incessant repetitions from our parents and teachers back in the days of yore, we must always exercise and eat healthy.  "But I'm not overweight and look perfectly healthy!"  Yes, yes you do, however, there are more reasons to exercise and eat right than you think!  There are also other factors that play into the development of CAD, such as smoking, eating foods with high fats/cholesterol/sugar, and high blood pressure (1) .  This video shows what happens and what causes CAD: 

Etiology/Signs and Symptoms of CAD:

Basically, not exercising, eating the wrong foods, smoking, etc, all have the ability to damage the heart and arterial wall.  Once the arterial wall is damaged, it causes lipids to accumulate, forming a plaque.  Once the plaque accumulates, it narrows the artery(s) over time, which can cause a plethora of problems over time, such as myocardial infarction! 

Pathophysiology of CAD: 

What may happen when your coronary arteries are totally blocked?  Well, for one, your heart tissue can die from the lack of oxygen.  A thrombus can develop when the plaque ruptures, which causes red blood cells to aggregate and block the already tight arterial space even further.  A piece of the thrombus can also break away, which is called an embolism and block oxygenation distal parts of the coronary artery (2).   This is what many would a heart attack or myocardial infarction.  This can easily cause death if not treated promptly, but would be even better if preventative measures were put in place years beyond the condition!  That is why education and putting that knowledge into action is so important.  Yes, I know it is the hardest thing to get up and go for a little exercise or avoid that ever so delicious cheese burger, but is that little bit of gratification worth the long term risks or death?  You may snicker and respond "YOLO".  In which case that is the truth, you only do live once, but would you prefer a shorter life or longer one? 

Works Cited

(1) What Causes Coronary Heart Disease? (2014, September 29). Retrieved January 23, 2015 from http://www.nhlbi.nih.gov/health/health-topics/topics/cad/causes 

(2)Prizel KR, Hutchins GM, Bulkley BH. Coronary artery embolism and myocardial infarction. Ann Intern Med 1978; 88: 155-161

EPIDEMIOLOGY OF CAD

Coronary artery disease  is one of the most feared diseases and is a very popular topic of discussion today since it is so lethal and can affect many people, causing much death in its wake.  In order to understand how much of an impact CAD, has consider this: ischemic heart diseases are and continue to be the single largest cause of death in the world, according to Finegold, Asaria, and Francis.  Not even the U.S is spared.  "In the United States, coronary heart disease (CHD) is a leading cause of death for both men and women.  Each year, about 375,000 Americans die from CHD (2)."  This isn't even the whole story, as many people are afflicted with CAD in the US.  17.6 million to be exact, according to Wilson and Douglas.   

CAD Incidence By Race in US

As we can see from this chart, Non-Hispanic Whites males aged 18 and above have the highest chance of getting CAD. For persons aged 40 years old, the lifetime risk of obtaining CAD is 49% in men and 32% in women.  For those reaching the ripe age of 70, the risk decreases to 35% in men and 24% in women (4).  However, not everything is doom and gloom.  The deaths from CAD has actually been DECREASING since 1999 in the U.S! 

CAD Deaths per 100,000 in US Over 9 Years

This trend of decreasing deaths in develop countries is due to many factors.  One is improvements in therapy and the other half of this is due to change in risk factors (reduction in smoking, physical inactivity, cholesterol, systolic blood pressure, etc.) (4)  Other developing countries such as China, however, are projected to have an increase in CAD mortality from 9 million to 19 million from 1990 to 2020 (4).  

In order to keep this trend going, we must first decrease our own risk factors for this disease and that starts with education of the masses.  Although it is a far fetch, it is well within our grasp to lead the charge against CAD and eliminate it (as best as we can).  It all starts with us, so lets get up to the gym after this and eat a very well balanced meal after! 

Works Cited

(1) Finegold, J., Asaria, P., & Francis, D. (2013). Mortality from ischaemic heart disease by country, region, and age: Statistics from World Health Organisation and United Nations. International Journal of Cariology, 168(2), 934-945. Retrieved January 16, 2015, from http://www.sciencedirect.com/science/article/pii/S0167527312014210

(2)National Heart Lung and Blood Institute. Who Is at Risk for Coronary Heart Disease? (2014, September 29). Retrieved January 16, 2015, from http://www.nhlbi.nih.gov/health/health-topics/topics/cad/atrisk

(3)Health Resources and Services Administration. Heart Disease and Stroke. (n.d.). Retrieved January 16, 2015, from http://mchb.hrsa.gov/whusa11/hstat/hshi/pages/213hds.html

(4) Wilson, P., & Douglas, P. (2014, November 26). Epidemiology of coronary heart disease. Retrieved January 16, 2015, from http://www.uptodate.com/contents/epidemiology-of-coronary-heart-disease