Management of Patients with Cardiovascular Disorders

Activity
Written Assignment: Prepare a chart that compares the pathophysiology, clinical
manifestations, and treatment of coronary atherosclerosis, angina pectoris, and myocardial
infarction.
Group Assignment: Break into three groups and use the nursing process as a framework to
prepare a nursing care plan for a patient with angina pectoris, acute coronary syndrome
(myocardial infarction), and heart failure. Review nursing care plans with classmates.

Case Study: Coronary Artery Disease

Patient Profile: H.C., a 47-year-old Navajo woman, comes to the emergency department with a burning
sensation in her epigastric area extending into her sternum.

Subjective Data
• Has had chest pain with activity that is relieved with rest for the past 3 months
• Has had type 2 diabetes mellitus since she was age 35
• Has a smoking history of one pack a day for 27 years
• Is more than 30% over her ideal body weight
• Has no regular exercise program
• Expresses frustration with physical problems
• Is reluctant to get medical therapy because it will interfere with her life

NCM 112
• Has no health insurance

Objective Data
Physical Examination
• Anxious, clutching fists
• Appears overweight and withdrawn
Diagnostic Studies
• 12-lead ECG
• Cholesterol: 248 mg/dL (6.41 mmol/L)
• LDL: 160 mg/dL (4.14 mmol/L)
• Glucose: 210 mg/dL (11.7 mmol/L)

Collaborative Care
• Metoprolol (Toprol) XL 100 mg PO daily
• Nifedipine (Procardia) 10 mg tid
• Nitroglycerin 0.4 mg sublingual PRN for chest pain
• Exercise treadmill testing

Critical Thinking & Discussion Questions

Using a separate sheet of paper, answer the following questions:
1. What are H.C.’s risk factors for CAD?
2. What symptoms should lead the nurse to suspect the pain may be angina?
3. What nursing actions should be taken for H.C.’s discomfort?
4. What kind of ECG changes would indicate myocardial ischemia?
5. What information should the nurse provide for H.C. before the treadmill testing?
6. Priority Decision: What are the priority nursing measures that should be instituted to help H.C.
decrease her risk
7. factors?
8. Priority Decision: Based on the assessment data presented, what are the priority nursing
diagnoses? Are there any collaborative problems?

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