Hypertension and

Atherosclerotic
Coronary Artery
Disease (HAS CAD)
 BIOGRAPHIC DATA

Name: Y.Y. Marital Status: Widow

Address: Santor, Occupation: none
Malolos, Bulacan Religious Orientation: Roman
Catholic
Age: 75 years old
Source of Income: Pension
Sex: Female
Diagnosis: Hypertension &
Race: Asian Atherosclerotic CAD
INTRODUCTION (What is Atherosclerotic Cardiovascular Disease?)

● The accumulation of lipids, sodium, carbohydrates

and fibrous tissue in the blood vessel (intima layer
of artery) – “Atheromas” – plaques
● a generalized disease of the arteries, and when it is
present in the extremities, it is usually present
elsewhere in the body (Favero et al., 2014)
INTRODUCTION (Signs and
Symptoms)
● Claudication (pain and weakness in the legs during
physical activity w/ch improves with rest)
● Decreased or absent pulses
● Coolness or numbeness (tingling sensation)
● Skin changes: shiny, tight or discolored skin,
especially on the legs and feet.
● Hair loss (on legs or feet)
● Slow healing wounds progresses to gangrene
● Erectile dysfunction (men)
INTRODUCTION (Risk Factors)
● Increasing Age. ● Smoking or nicotine use
● Female ● Obesity
● Familial predesposition ● Unhealthy and
● Sedentary lifestyle unbalanced diet.
● High blood pressure/ HPN ● Hyperlipidemia
● Heart and blood vessel ● Elevated C-reactive
conditions. protein
● Diabetes. Hyperhomocysteinemia
INTRODUCTION (Treatment)

● Angioplasty and stent

● Lifestyle modification(diet, exercise,
quitting smoking)
● Medications (anti-HPN, Statins,
Antiplatelet)
CLIENT’S CONDITION

● Last Friday (Feb 23, 2024) – The client felt sudden pain
felt on the pelvic while pulling a pail of water
Chief complaint: “naghihila ako ng tubig biglang
parang may pumitik sa balakang ko”.
● The pain progresses until (Feb 26, 2024 – Monday) he
can not move his lower limbs – the reason they went to
hospital and be admitted.
● Pt. manifests claudication, tingling and pain sensation on
pelvic area, shiny skin, edema both feet, unable to walk
without support & sit alone
CLIENT’S CONDITION

● Diagnostic tests Blood Chemistry, CBC, Lipid

Profile, Radiology, Urinalysis, ECG & COVID
Antigen Test
● The patient undergo series of pharmacological
regimen & now Pt. Y.Y. is on going medical
treatment from the day of hospitalization (02/26/24)
Additional Client Information

●
((((((
No Allergies in medication or food
● Doesn’t smoke or dink (but secondary hand smoke from the husband
of her daughter whom lives with her)
● Take OTC drugs for fever, colds & flu.
● Does not drink any herbal medicine or/and vitamins.
● Had COVID Vaccine with 1 booster shot.

●
( (

Father & mother died with complication in the lungs (tuberculosis &
Pneumonia respectively)
● She being the 1st child has 6 siblings alive (2 boys & 4 girls) & 1 girl
died. All without comorbidity and same illness with the pt.
 HISTORY OF PRESENT ILLNESS

Medication during hospitals: ● Paracetamol + Vit B tab OD

● Losartan 5mg/tab O.D. ● Dexamethasone 4mg TIV q12
● Amlodipine 5mg/tab O.D. ● Na+ Atenaronate 70mg OD
● Clopidogrel 75mg/tab O.D ● Clonidine 75mg/tab OD
● Etericoxib 12g ● Flexipro cap BID
 HISTORY OF PAST ILLNESS

DATE/EVENT: SITUATION:

1964 First Born Child thru NSD

Around 2016 UTI (confined 3 days)

 ACTIVITY-EXERCISE PATTERN
PRIOR TO HOSPITALIZATION DURING HOSPITALIZATION
ADL Score ADL Score

Feeding 0 Feeding 0

Toileting 0 Toileting II

Bathing 0 Bathing II

Bed Mobility 0 Bed Mobility II

Dressing 0 Dressing II

Grooming 0 Grooming II

Outdoor Activities 0 General Mobility II

General Mobility 0

FUNCTIONAL HEALTH PATTERN

 <> DIET MEDICAL MANAGEMENT
GENERAL
TYPE OF INDICATION/PU SPECIFIC FOOD CLIENT’S
DESCRIPT NURSING RESPONSIBILITIES
DIET RPOSE TAKEN RESPONSE
ION

Low Salt Dietary ● Blood Ginisang The client was Prior:

Low Fat approach pressure ampalaya able to eat what ● Review patient’s medical record
focused on control was given without and verify order
reducing ● Cholestero Piniritong manok any complications ● Collaborate and request to the
both salt l of nausea and
hospital dietitian a low salt low
and fat managem Half cup or rice vomiting.
intake ent fat diet for the patient.
● Inflammati (from the hospital However, the During:
on dietitian) client still eats ● Give oral meds as ordered with
reduction binagoongan and meals.
salty meals. After:
● Assess & evaluate patients
tolerance and compliance to the
diet modification.
● Document procedure
MEDICAL MANAGEMENT <> EXERCISE

TYPE OF GENERAL INDICATION/PUR CLIENT’S

NURSING RESPONSIBILITIES
EXERCISE DESCRIPTION POSE RESPONSE

Active- This is typically To promote body Client’s Prior:

Assisted done when a movements and response was ● Place the patient in a comfortable
Range patient requires prevent stasis of not observe posture that allows for good body
of Motion outside blood to the alignment and stability.
(AAROM) assistance to peripheral parts of ● Identify and explain the procedure to
move because of the body most the patient
weakness, pain, specifically legs. ● Administer pain meds to aid in
or changes in cooperation
muscle tone. Promote increase During
body movement ● Inform the patient that she must not feel
tolerance. discomfort.
● If pain occurs stop and note what are
the exercises that was unable to
perform to evaluate progress and aid
throug support.
After:
● Document procedure.
● Evaluate progress and patient’s
tolerance
01 DIAGNOSTIC PROCEDURE
DATE INDICATION AND ACTUAL
PROCEDURE NORMAL VALUES
PERFORMED PURPOSE VALUES/RESULTS

02/26/24 A blood test is called a (The ff. data are Complete Blood
Complete Count
complete blood count summarized to abnormal
Blood (CBC). It is used to values)
examine general health MCV MCV
Count and identify a variety of 96.6 82-95%
diseases, such as
anemia, infections, and Gran # Gran #
assessing clotting factors. 8.5 2.0-7.0

Gran % Lymph Gran % Lymph

85.8 50-70

MCH
MCH 27-31
31.7
Lymph
Lymph 20-40
7
01 DIAGNOSTIC PROCEDURE

ANALYSIS AND INTERPRETATION

Increase in Granulocytes of the pt. indicates there is an inflammation or

infection, the pelvic pain, possibly mean that there is tear pelvic muscle
causing its elevation.

Lymphocites are another kind of WBC which it is a part of immune response.

Its decrease in the blood indicates that this type of WBC fights where the
inflammation occurs (probably the pelvic area) causing the patient is
immunocompromised due to lack of WBC in his system.

Elevation of the Mean Corpuscular Volume and Mean Corpuscular

Hemoglobin level may indicates nutritional deficiency in folate causing anemia.
02 DIAGNOSTIC PROCEDURE
DATE ANALYSIS AND
INDICATION AND ACTUAL NORMAL
PROCEDURE PERFOR INTERPRETATIO
PURPOSE VALUES/RESULTS VALUES
MED N

02/26/ A blood test aids Cholesterol : 261.6 150 - 200 Increase in

Blood in assessing cholesterol level
24 in blood provides
chemistry functions various
risk to
organs and
system of the atherosclerosis
body. (formation of
plaque) like the
pt.
 NURSING Intervention
For thisRESPONSIBILITIES
procedure, the nursing students was not able to assist the patient, but the following are the expected duties:

PRIOR DURING AFTER

● Verify the physician’s
order
● Send a request to the
laboratory.
● Explain to the patient
and significant other
that a laboratory test
was ordered by the
doctor.
● Assist patient to go to
laboratory if needed
and inside the
hospital.
● Instruct the patient to
remain still during the
procedure.
● Monitor the patient’s
condition.
● Provide comfort measures
to divert her attention from
pain or discomfort such as
teaching deep breathing
techniques or talking to
the client.
● Inform the pt. and significant
other that bruising, pain, or
swelling may appear at the site of
the extraction, but the symptoms
don’t last for more than two days
and may use cold compress to
relieve.
● Insruct pt to not touch site and
hold the site with cottonballs for a
few minute to avoid bleeding.
● Attach the result in the patient’s
chart once received.
01
MEDICAL MANAGEMENT DRUG STUDY

DATE
ROUTE OF
ORDERED/GI
ADMINISTRAT MECHANISM OF
MEDICATION VEN OR
ION/DOSAGE/
INDICATION
TAKEN/DISC ACTION
FREQUENCY
ONTINUED

Generic: Date Ordered: Route of Its anti-inflammatory and Treatment or

Eterocoxib 2 / 26 / 24 Administration: analgesic action is exhibited management for
Oral by inhibition of prostaglandin pain &
Brand: Date Taken: synthesis via inhibition of inflammation.
Arcoxia 2 / 26 / 24 Dosage: COX-2. Absorb b the GI
12mg tract.
Classification Date
selective cyclo- Discontinued: Frequency:
oxygenase-2 N/A Once daily
(COX-2)
inhibitor:
NSAIDs
02
MEDICAL MANAGEMENT DRUG STUDY

DATE
ROUTE OF
ORDERED/GI
ADMINISTRAT MECHANISM OF
MEDICATION VEN OR
ION/DOSAGE/
INDICATION
TAKEN/DISC ACTION
FREQUENCY
ONTINUED

Generic: Date Ordered: Route of Suppresses neutrophil Used primarily as an

Dexamethason 2 / 27 / 24 Administration: migration, decreases anti-inflammatory .
e Through IV production of inflammatory
Date Taken: mediators, reverses
Brand: 2 / 27 / 24 Dosage: increased capillary
Intensol 4mg permeability
Date causing decreases
Classification Discontinued: Frequency: inflammation and
Long-acting N/A Every 12 hours suppresses normal immune
glucocorticoid: response through
Corticosteroid
03
MEDICAL MANAGEMENT DRUG STUDY

DATE
ROUTE OF
ORDERED/GI
ADMINISTRAT MECHANISM OF
MEDICATION VEN OR
ION/DOSAGE/
INDICATION
TAKEN/DISC ACTION
FREQUENCY
ONTINUED

Generic: Date Ordered: Route of Blocks vasoconstrictor, Treatment of

Losartan 2 / 27 / 24 Administration: aldosterone-secreting hypertension may or
Per orem or effects of angiotensin II, may not with
Brand: Date Taken: through oral inhibiting combined to other
Cozaar 2 / 27 / 24 binding of angiotensin II to hpn medications.
Dosage: AT1
Classification Date 5mg receptors.
Angiotensin 2 Discontinued: Causes
receptor N/A Frequency: vasodilation, decreases
antagonist : Once Daily peripheral resistance,
Antihypertensiv decreases B/P.
e
04
MEDICAL MANAGEMENT DRUG STUDY

DATE
ROUTE /
ORDERED/GI MECHANISM OF
MEDICATION
VEN/DISCON
DOSAGE / INDICATION
FREQUENCY ACTION
TINUED

Generic: Date Ordered: Route of Inhibits calcium movement Treatment of

Amlodipine 2 / 26 / 24 Administration: across cardiac and vascular hypertension and
Per orem or smooth muscle cell coronary artery
Brand: Date Taken: through oral membranes. disease.
Norvasc 2 / 26 / 24 Therefore, dilates coronary
Dosage: arteries, peripheral
Classification Date 5mg/tab arteries/arterioles.
Calcium Discontinued: Decreases total peripheral
channel N/A Frequency: vascular resistance and
blocker. Once Daily B/P by vasodilation
Antihypertensiv
e, antianginal
 MEDICAL MANAGEMENT
DRUG STUDY
CONTRAI CLIENT’S
NDICATIO RESPONS NURSING RESPONSIBILITIES
N E

All given Unable to Prior:

or assess 1. Verify doctors order.
stated 2. Prepare medications following right dose and right
meds
medication.
has no
contrain 3. Obtain baseline data (Specifically BP to Anti-
dication hypertensive drugs, withhold if BP is lower than normal
to the and notify physician before giving)
patient.
4. Identify pt. & explain procedure
 MEDICAL MANAGEMENT
DRUG STUDY
NURSING RESPONSIBILITIES NURSING RESPONSIBILITIES
During: 5. Administer following 12R’s. After:
● Right preparation ● Document and record the time,
● Right dose route, amount, and name of
● Right route medication.
● Right medication ● Watch out for any adverse or side
● To Right patient effects and especially hypotension,
● At right time (to HPN meds) and report to
● With right education physician if there’s any.
● Right to refuse ● Advise patient for compliance with
● Right response therapy regimen.
● Right documentation - Avoid tasks that require alertness,
● Right history & assessment motor skills & straining
01 NURSING CARE PLAN
NURSING MANAGEMENT
NURSING
ASSESSMENT PLANNING EVALUATION
DIAGNOSIS

Subjective: Acute Pain r/t Short Term: Short Term Evaluation:

“masakit ndi ako injuring agents After 10 – 20 mins the client will identify After 10 – 20 mins the client was able
makatagilid” (physically) as some of nonpharmacological regimen to identify some of
evidenced by and will report decrease in pain as nonpharmacological regimen and will
Objective: reports of pain with evidenced by feedback of understanding report decrease in pain as evidenced
Pain scale: 10/10 10/10 pain score, & lower pain score. by feedback of understanding &
Facial Grimace unable to move lower pain score.
Unable to move freely, and facial Long term: _/_ partially met
or reposition grimace. Within the shift the client will be able to Long term:
freely use of nonpharmacological management Within the shift the client will be able
Level 2 in Activity- of pain as evidenced by not relying to to use of nonpharmacological
Exercise Pattern prescribed pharmacological medication, management of pain as evidenced by
and use of diversional activities (sleep, not relying to prescribed
talking to other patient in ward, and pharmacological medication, and use
surfing in the internet) of diversional activities (sleep, talking
to other patient in
_/_ partially met
01 NURSING CARE PLAN
NURSING MANAGEMENT
INTERVENTION RATIONALE

Independent:
• Determine and document presence of
physiological causes of pain and note location.
• Note client’s attitude toward pain and
locus od control
• Accept and acknowledge client’s description of
pain.
• Monitor skin color and temperature and vital
signs
To assess etiology/precipitating contributory factors.
Individuals with external locus of control may take
little or no responsibility for pain management
Pain is a subjective experience and cannot be felt
by others
Which are usually altered in acute pain.

• Note when pain occurs to medicate prophylactically, as appropriate

• Determine factors in client’s lifestyle Alcohol, use of Aspirin can affect responses to
analgesics and/or choice of interventions for pain
management.
01 NURSING CARE PLAN
NURSING MANAGEMENT
INTERVENTION RATIONALE

Independent:
• Provide comfort measures and manage source of pain
that does not require doctor’s order or any
pharmacological management SUCH AS:
- Quiet environment, Calm Activities
- Back rub, use of heat / cold compress. DBE,
socialization or talking to co-pt or to student nursea,
surfing on the internet
Dependent:
• Administer analgesics, as indicated, to maximum
dosage, as needed
• Evaluate and document client’s response to analgesia
and assist in transitioning or altering drug regimen,
based on individual needs and protocols
To promote nonpharmacological pain
management
- to maintain “acceptable” level of pain.
Notify physician if regimen is inadequate to
meet pain control goal
- Increasing or decreasing dosage, stepped
program (switching from injection to oral
route, increased time span as pain lessens)
helps in self -management of pain
02 NURSING CARE PLAN
NURSING MANAGEMENT
NURSING
ASSESSMENT PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS

Subjective: Ineffective Short Term: Independent: Short Term

“biglang may Peripheral Tissue After 20-45 mins • Note current To determine Evaluation:
pumitik sa Perfusion r/t the client will be situation or the underlying After 20-45 mins
balakang…lunes Hypertension as able to Verbalize presence of factors of the the client was
ndi na ko evidenced by understanding of conditions Eg. patients able to Verbalize
makagalaw” Extremity pain & condition, therapy Coagulopathies condition. understanding of
Altered motor regimen, side • Identify presence Place client at condition,
Objective: functio effects of of high-risk factors greater risk for therapy regimen,
 Weakness to medications, and or conditions e.g developing side effects of
pelvic joint & when to contact hypercholesterole (PVD) medications, and
lower healthcare mia when to contact
extremeties provider as • Note location of May restrict cir- healthcare
 Swelling lower evidenced by restrictive clothing, culation to limb. provider as
limbs feedback and pressure evidenced by
verbalization of dressings, circular feedback and
understanding. wraps, cast, or verbalization of
traction device understanding.
02 NURSING CARE PLAN
NURSING MANAGEMENT
PLANNING INTERVENTION RATIONALE EVALUATION

Long Term: Independent: Long Term:

After the end of the • Ascertain impact of condition on Leg pain may restrict After the end of the shift
shift the client will be functioning and lifestyle ambulation or person the client will be able to
able to Demonstrate may develop skin Demonstrate behaviors
behaviors and lifestyle ulceration and healing and lifestyle changes to
changes to improve problems that improve circulation as
circulation as seriously impact quality of evidenced by relaxation
evidenced by life. techniques, ROM
relaxation techniques, • Assess skin color, temperature, Determining exercises, diet
ROM exercises, diet moisture, and whether changes are location and type of modification, increase
modification, increase widespread or localized perfusion problem fluid intake and following
fluid intake and • Compare skin temperature and color Helps differentiate type of pharmacological
following with other limb when assessing problem (e.g., deep management.
pharmacological extremity circulation. redness in both hands __Met
management. triggered by __unmet
vibrating __Partially met
02
NURSING MANAGEMENT
INTERVENTION
Independent:
• Measure capillary refill
• Inspect lower extremities for skin texture, skin breaks and
ulceration.
• Evaluate extremity pain reports, noting associated symptoms
• Determine time that symptoms are worse, precipitating or
aggravating events and relieving factors
• Assess motor and sensory function.
• Review laboratory studies such as lipid profile, coagulation
studies, hemoglobin/hematocrit, renal/cardiac function tests
NURSING CARE PLAN
RATIONALE
Determine adequacy of systemic circulation.
that often accompany diminished peripheral circulation
(e.g., cramping or heaviness, discomfort with walking;
progressive temperature or color changes; paresthesias)
Help isolate and differentiate problems such as
intermittent chronic claudication versus loss of function
and pain due to acute sustained ischemia related to loss
of arterial blood flow.
Problems with ambu-
lation; hypersensitivity; or loss of sensation, numbness,
and tingling are changes that can indicate neurovascular
dysfunction or limb ischemia
to determine probability, location, and degree of
impairment
02 NURSING CARE PLAN
NURSING MANAGEMENT
INTERVENTION RATIONALE

Independent:
• Health teaching Provide health teahing or education to improve perfusion
- Provide interventions to promote peripheral circulation and prevent other complications.
- Limit complications associated with poor perfusion:
- Encourage early ambulation when possible
- importance of avoiding use of aspirin Some OTC, alcohol and smoking may increase risk of
• Reposition patient complications

Dependent
• Recommend regular exercise as needed and ordered.
• Recommend or provide foot and ankle exercises when client
unable to ambulate freely to reduce venous pooling
• Administer fluids, electrolytes, nutrients, and oxygen, as promote optimal blood flow, organ perfusion,
indicated and function
Collaborative
• Refer to community resources such as exercise group to provide support for lifestyle changes
• Refer to dietitian for well-balanced, low-saturated fat, low-
cholesterol diet, or other modifications as indicated
 BULACAN STATE
UNIVERSITY
COLLEGE OF NURSING
City of Malolos, Bulacan

ABLEN,
Princess Leah B.

The End oof Presentation Thank You!

Prepared by:
CUSTODIO,
Ravel Lynne M.
BSN 4-C Group 3