Jabian, Patricia Jeanne M.

N3B
CORONARY HEART DISEASE
DIAGNOSIS:
Decreased Cardiac Output related to accumulation of plaque in the artery as evidenced by increased blood pressure of 150/110 mmHg.

SCIENTIFIC
ASSESSMENT PLANNING INTERVENTIONS RATIONALE EVALUATION
RATIONALE

Subjective: Smoking, Obesity and NIC: Increased NOC: Oxygen Therapy NIC: Increased
The patient Physical Inactivity. Cardiac Output Cardiac Output
verbalized that: ↓ INDEPENDENT INDEPENDENT
Fatty acids starts to Short Term: Monitor I&O; weigh the patient Decreasing urine output and Short Term:
“Nahihirapan akong build up Within 2 hours of daily weight gain can occur as a result Within 2 hours of
huminga, palagi ↓ nursing interventions, of decreased cardiac nursing interventions,
akong naghahabol ng Accumulation of plaque the patient will be able contractility, which can cause the patient will be able
hininga. Minsan kahit in the artery to: decreased renal perfusion and to:
wala akong ↓ ● Report that the fluid retention ● MET: Report
ginagawa, The lumen in the artery pain is that the pain is
napapagod ako.” is narrowed controlled. Auscultate the patient’s lung This is to monitor left-sided controlled.
↓ ● Demonstrate fields for adventitious sounds. manifestations of heart failure ● MET:
“Matagal na akong Increasing the blood stability in that could lead to decreased Demonstrate
naninigarilyo, pressure cardiac output as oxygenation of the patient and stability in
dalawang dekada na. ↓ evidenced by to manage complications as cardiac output as
Nakakaisang kaha Decreased Cardiac controlled blood soon as they appear. evidenced by
ako ng sigarilyo sa Output pressure. controlled blood
loob ng isang araw. Place the patient in These positions also help in pressure.
Hindi rin ako Long Term: High-Fowler's position, elevate decreasing the preload to the
masyadong After 3 days of nursing the head of the bed. heart and prevent congestion Long Term:
nageehersisyo.” interventions, the that might cause right-sided and After 3 days of nursing
patient will be able to: left sided complications. interventions, the
● Demonstrate patient will be able to:
“Hindi rin ako increase in Avoid strenuous activities. This causes an increase in ● MET:
mahilig kumain ng activity tolerance. intrathoracic pressure, leading to Demonstrate
mga gulay at prutas. ● Display signs of reduction in preload to the heart. increase in
Mahilig ako sa managed cardiac activity
lechon at crispy pata. function. Encourage exercise with a This is to help make the heart tolerance.
● Participate in minimum of 30 minutes daily and blood flow more efficiently. ● MET: Display
Objective: activities that for 3 to 5 times a week This will also help lower the signs of
● Chest Pain reduce workload (Minimum of 1.5 hours and cholesterol level to decrease risk managed cardiac
● Shortness of in the heart, like maximum of 2.5 hours a week) of heart attack. function.
Breath the Cardiac ● MET:
● Difficulty Rehabilitation DEPENDENT DEPENDENT Participate in
Breathing Program activities that
● S3 and S4 Administer medications as Providing these medications will reduce workload
murmurs prescribed. allow the patient to manage and in the heart, like
● BP: 150/120 ● Simvastatin control the existing risk factors. the Cardiac
mmHg ● Nitrates Rehabilitation
● Hyperlipidemia ● Fenofibrates Program

Administer oxygen therapy as The failing heart may not be

prescribed. able to respond to increased
oxygen demands. Oxygen
saturation needs to be greater
than 90%.

COLLABORATIVE COLLABORATIVE

Refer the patient to a cardiac A thoroughly monitored

rehabilitation program for exercise program can improve
education, evaluation, and both functional capacities and
guided support to increase left ventricular function. Cardiac
activity and rebuild a life. rehabilitation can improve
 quality of life and functional
capacity and decrease mortality.
Refer the patient to a dietician Dietary changes can lead to
fir a diet modification to follow positive health outcomes.
a DASH low-sodium, and Decreasing the amount of
low-fat diet. sodium and fat will contribute to
the prevention of fluid retention
and plaque build up
respectively.

Encourage the patient to join a Tobacco increases levels of

smoking cessation program.
triglycerides, makes sticky
blood which is more likely to
have a clot, makes plaque
buildup and thickens and
narrows blood vessel and
damage their linings
SINTOMAS
PANANAKIT NG
RISK
FACTORS
CORONARY t disease
DIBDIB hear
Mas nanganganib kayong
Chest Pain magkaroon ng coronary heart
Maaaring sumakit ang dibdib ng mga disease kung kayo ay: Ang coronary heart disease
pasyente pagkatapos ng masiglang
ehersisyo o pagsailalim sa emosyonal na ay tinatawag ding sakit sa
DIYABETES NANINIGARILYO
stress. Ang sakit ay maaaring
Diabetes Mellitus Smoking puso o atherosclerosis. Ito
magpatuloy kahit na magpahinga.
ay sanhi ng pagdami ng
mga deposito ng taba na
KAKAPUSAN NG tinatawag na plaque sa mga
PAGHINGA daluyan ng dugo ng puso.
Shortness of Breath
Maaaring magkaroon ang mga pasyente
ng kakapusan ng paghinga at MATAAS NA MATAAS NA
pagkapagod sa pisikal na pagsisikap.
PRESYON NG KOLESTEROL
DUGO Hypercholesterolemia
Kabilang sa iba pang mga sintomas ay Hypertension
ang mga sumusunod:

PAKIRAMDAM NG
PAGKAPAGOD
Fatigue
Ang pagbabago sa kahit isa lamang
MATAAS NA PRESYON sa mga sanhi ng panganib ay
NG DUGO maaaring magpabuti sa kalusugan
Hypertension ng inyong puso. Maaari ninyong
LABIS NA pigilan ang paglala ng karamdaman
PAGPAPAWIS at maaari pang tumulong upang
Sweating mapabuti ito.

D I A G N O S T I C
tests
Upang malaman ng doktor kung
ikaw ay may Coronary Heart Disease,
maaari kang sumailalim sa mga
sumusunod:
Electrocardiogram (ECG or EKG)
upang suriin ang elektrikal na
aktibidad ng inyong puso.
Cardiac Magnetic Resonance
Imaging (MRI) upang kumuha ng
mga larawan kung gaano kaayos
na gumagana ang inyong puso.
Echocardiogram upang makita
ang laki at hugis ng inyong puso
at kung gaano ito kaayos na
gumagana.
MEDIKASYON
ANTILIPEMICS
Upang mapababa ang lebel ng LDL o ng
kolesterol sa ating katawan.
ANTI-PLATELET
Upang maiwasan ang patuloy
pamumuo ng dugo sa mga arteries.
ANTIHYPERTENSIVE
Upang mapababa ang patuloy
pagtaas ng presyon ng dugo.
SURGERY
A N G I O P L A S T Y
Kung may malubhang pagsisikip o
pagkabara na ipinapakita sa
coronary angiogram, magsasagawa
ang doktor ng balloon angioplasty
sa pamamagitan ng paggamit ng
isang espesyal na lobo upang
palakihin ang daluyan ng dugo at
isang angkop na tubo ang ilalagay
doon upang mapanatiling hindi
barado ang daluyan ng dugo.
C O R O N A R Y
B Y P A S S
Ito ay isang pangunahing operasyon
na bukas ang puso. Lumilikha ang
doktor ng bypass gamit ang isang
na vessel mula sa ibang bahagi ng
iyong katawan upang hayaang
dumaloy ang dugo sa paligid ng
baradong lugar sa pamamagitan ng
na pangunahing arterya patungo sa
nasirang mga kalamanan ng puso.
P A A N O
M A I I W A S A N A N G
C O R O N A R Y H E A R T
D I S E A S E ?
Ang malusog na pamumuhay at regular na
pagsusuri ng kalusugan para sa maagang
paggamot ng mga talamak na sakit ay
napakahalaga.
MALUSOG NA PAMUMUHAY
Kumain ng masusustansyang pagkain
Iwasan ang maalat, matatamis, at
matatabang mga pagkain. Kumain ng
masusustansyang pagkain na mataas sa
fiber tulad ng mga gulay at prutas.
Iwasan ang paninigarilyo
MAG EHERSISYO
Gumawa ng hindi bababa sa 30 minuto ng
katamtamang lakas na ehersisyo 5 araw sa
isang linggo o ng isang kabuuang 2 oras at
30 minuto ng katamtamang lakas na
ehersisyo bawat linggo
IWASAN ANG STRESS
 Manatiling mahinahon at iwasan ang
pagiging sobrang stress. Makisali sa
malusog na mga aktibidad upang
mabawasan ang pag-aalala at stress.
 coronary
HEART DISEASE
ALSO KNOWN AS ISCHEMIC HEART DISEASE
broad heart condition characterized by partial and

complete obstruction of blood flow to the heart

WHAT ATHEROSCLEROSIS
CAUSES
CORONARY
HEART Accumulation of plaque
in the artery.

DISEASE? "Ang mga artery ay nagiging makitid o nabarahan,

mababawasan ang pagdaloy ng dugo sa puso at ang supply
ng oxygen sa mga kalamnan ng puso ay bababa o hihinto."

4 M 4A major
J O R R risk
I S K factors
FACTORS

SMOKING DIABETES

HIGH BLOOD HIGH

PRESSURE CHOLESTEROL

MOST COMMON
SIGN OF CAD
medications
SIMVASTATIN
NITRATES
CHEST
PAIN
FENOFIBRATE

M management
ANAGEMENT
CARDIAC REHABILITATION

Walking
Early Ambulation
Exercise Regularly
1 hr and 30 min (Minimum/week)
2 hrs and 30 min (Maximum/week)

HEALTHY LIFESTYLE

Eat a heart healthy diet

Lose weight
Avoid smoking
Manage stress

Always consult your doctor to prevent worsening of the disease!