Dylan Angelo L.

Andres

BSN IV

Patient

Ms. AA., a 45-year-old, comes to the emergency department with a burning sensation in her epigastric
area that is extending into her sternum. She is diagnosed with Coronary Artery Disease (CAD).

1. What are MS. AA.’s risk factors for CAD?

 high LDL cholesterol, diabetes type 2, smoking, Obesity

According to the Assessment his LDL 160 mg/dL the normal LDL is Less than 100mg/dL, appears
overweight and withdrawn and has History of as a smoking history of one pack a day for 27 years, and
Has had type 2 diabetes mellitus since she was age 35.

2. What symptoms should lead the nurse to suspect the pain may be angina?
 Chest Pain
According to his history Has had chest pain with activity that is relieved with rest for the past 3
months. Angina pectoris or angina is temporary chest pain or discomfort as a result of decreased
blood flow to the heart muscle. Angina is not a heart attack, but it is a sign of increased risk for
heart attack. Angina may be stable (develops during physical activity, lasts five minutes or less
and is relieved with rest) or unstable (occurs during periods of rest, lasts longer, and symptoms
may be more severe)
3. Enumerate 6 nursing actions that you should be taken for her discomfort?
 Assess and document patient response/ effects of Medication
 Assess the patient’s willingness or ability to explore a range of techniques aimed at controlling
pain
 Identify precipitating event If any: Frequency, duration, Intensity, and location of pain
 Place Patient at complete rest during angina episodes
 Stay with patient who is experiencing pain or appears anxious
 Maintain Quiet comfortable environment: restrict visitor as necessary
 Provide light meals have patient rest for 1 hour after meals
4. What kind of ECG changes would indicate myocardial ischemia?
 The most familiar ECG patterns of ischemia are horizontal or down sloping ST segment
depression of 1 mm or more and T-wave inversion. Ischemia occurs when there is a mismatch
between myocardial O2 supply and demand and can occur with either decreased O2 supply or
increased O2demands. Ischemia is a reversible process if blood flow is restored to the
myocardium before permanent cell damage occurs. Patients presenting early in the ACS process
often have ECGs that show changes in the ST segment or T wave that are consistent with
myocardial ischemia, because ischemia precedes myocardial cell injury, and injury precedes
myocardial cell death
5. What information should the nurse provide for her before the treadmill testing?
 Instruct the patient to fast, restrict fluids (especially those containing caffeine), and abstain from
the use of tobacco products for 4 to 6 hr. prior to the procedure. Instruct the patient to withhold
medications for 24 hr. before the test, as ordered by the health-care provider (HCP). Protocols
 vary depending on the type of test, and in general, protocols may vary among facilities. The
patient should be instructed to wear comfortable shoes and clothing for the exercise stress test.
6. Priority Decision: What are the priority nursing measures that should be instituted to help Ms.
AA decrease her risk factors?
 -Administer medications as prescribed
 -Administer Oxygen
 -Obtain 12 lead ECG
 -Assess general health status
 -Monitor vital signs
7. Should her angina become chronic stable angina, explain the treatment that would be used
using the mnemonic A, B, C, D, E, and F
 A. Nitroglycerin
 B. Nitrates
 C. Calcium Channel blockers
 D. Beta Blockers
 E. Aspirin
 F. Oxygen
8. Priority Decision: Based on the assessment data presented, what are the priority nursing
diagnoses? Are there any collaborative problems?
 Acute pain
 Deficient knowledge
 Anxiety
 Risk for decrease cardiac output
 Ineffective cardiac tissue perfusion secondary to CAD as evidence by chest pain or other
prodromal symptoms
 Non-compliance Ineffective management of therapeutic regimen related to failure to accept
lifestyle changes
Collaborative problems include
 ACS/MI
 Dysrhythmias and cardiac arrest
 Heart failure
 Cardiogenic shock

Part II. PATHOPHYSIOLOGY

- Make the pathogenesis/pathophysiology of Ms. AA present it in a;

a) Schematic Diagram
b) Narrative explanation
In the case of the patient, the modifiable factors associated to his diagnosis are: first, he was a
smoker. According to his previous history he smoked at least one pack of cigarette a day for 27
years. He also had chest pain with activity that is relieved with rest for the past 3 months. Also,
according to his assessment, he has no regular exercise program, appears to be an overweight
withdrawn and has type 2 diabetes mellitus since she was 35 years old. While the non-modifiable
factors are: first is her age and her gender. These Modifiable and non-modifiable factors
contribute to diagnose him to have a Coronary Artery Disease.

The following is the flow how chest pain happens. First, her endothelial wall will damage and this
damage impairs the function of the endothelium, a condition called endothelial dysfunction.
Second is there will be endothelial desquamation that will happen that will increase molecular
adhesion of fats/ cells. After that, there will be formation of foam cells that indicates when
circulating monocyte-derived cells are recruited to the atherosclerotic lesion site or fat deposits in
the blood vessel walls. Then plaque formation that will be called atherosclerosis after that will be
decrease intraluminal surface area and lastly decrease myocardial perfusion that will result of the
chest pain.