Daily CLINICAL EXPERIENCE LOG

Date: 23/11/2022 Site: CICU Preceptor: Dr. Jihad & Dr. Anas

Therapeutic
Age/Sex Diagnosis Pertinent Assessment Findings Nursing
Interventions
61 male DX: The HX: Nursing Diagnosis:
decreased  Medical Hx: IHD, last cath in - Acute pain related
level of 2013, 7 stents. to the disease
consciousnes  History of recent COPD and process as
s and COPD DM diagnosis evidenced by the
 Recently COPD exacerbation patient verbalizing
CC: patient admission to ICU in prince chest pain-like
said” I have rashed hospital, discharged 10 heaviness sensation.
had difficulty days ago.
breathing and  Heavy smoker 2 packs daily -Risk for decreased
feeling of  no previous surgeries, no cardiac tissue
dizziness for known drug or food allergies perfusion related to
2 days ” HPI: the disease process
The patient was admitted according to (ischemia).
his family when they noticed his
decreased level of consciousness, -Fear/Anxiety
increased dry cough, and shortness of related to possible
breath, his blood pressure was found disease
80/50, his status of bedridden was complications and
since 1 month. Co2 was found 102 catheterization
patient with co2 retention so the patient procedure as
was put on BiPAP in ER and evidenced by
transferred to ICU depardment. patient face
expressions and
Abnormal Labs results: questions related
WBC 12.2 increased . 4-9 procedure.
H.B 8 g/d decreased 13-16
HCT 23.6 decreased 35-45 -Risk for bleeding
Plt 410 high 150-400 related to potential
hemorrhage from
- Creatinine 25.9umol/l low (62-115) secondary to cardiac
- calcium 2.3 low mmol/l 2.2-2.7 catheterization.
- PCO2 59 high 35-45 respiratory
acidosis Nursing
HCO3 38 high 22-26 Interventions:
- administer pain-
relieving
-ECG: PVCS medications as
prescribed it will
-Chest x-ray: right lower lobe reduce pain and
consolidation. prevent other
- ECHO: good LV function, sclerotic myocardial muscle
aortic valve, trace TR RVSP= 55 needs and
MMHG infractions.

-assess pain level

Current Medications: frequently and pain
Carvedilol 3.25 1*2 characteristics and
Baby aspirin 100mg 1*1 teach the patient
Plavix 75mg 1*1 about chest pain
Atorvastatin 20mg 1*1 characteristics
Enalapril 10mg 1*1 related to ischemic
Omeprazole 20mg 1*1 heart disease.
Metformin 850mg 1* 3
Enoxaparin 60mg * 2 - provide oxygen
supplements as
Vitals: needed it will
BP: 126/80 mmHg increase
RR: 18 B/minute tachypnea oxygenation to the
Pulse: 88 B/minute myocardium.
T: 36.7 °C
Current Pain: 2/10 -teach the patient
O2 sat: 98% on room air. about administering
GCS: 15 nitroglycerin tablet
Braden risk assessment for pressure medication and
sore (mild risk) other
Morese fall scale antihypertensive RX
With folyes catheter as prescribed and
Wt: 75 kg when to seek further
Ht: 1759cm help.
-Assess symptoms
No significant abnormal physical exam and risk for
findings. impaired cardiac
tissue perfusion,
Chest
The patient planed for possible cardiac pain, shortness of
catheterization. breath, diaphoresis,
indigestion, and
associated anxiety
can indicate
decreased cardiac
perfusion.

-monitor lab results

shiftily, Cardiac
enzymes such as
troponin levels,
electrolytes, ABGs,
and more are
important to obtain
when analyzing
chest pain.
-Monitor vital signs
frequently, Blood
pressure, pulse,
ECG, and O2
saturation should be
monitored
continuously for
changes.

- Encourage bed rest

or limit activity to
prevent oxygen
consumption and
reduce cardiac
workload.
- Administer
medications as
ordered,
Vasodilators relax
and open blood
vessels, and
Anticoagulants keep
blood thin, Digoxin
increases cardiac
output.
Antihypertensive
reduces the force on
arteries.

-Educate the patient

on lifestyle
modifications,
Treating the
underlying cause
requires lifestyle
modifications such
as reducing sodium
and fat intake,
quitting smoking,
and increasing
physical activity in
the discharge plan.
- Explaining to the
patient all
procedures and
trying to provide
support and
reassurance while
the patient
verbalizes fear and
emotions can help
reduce the patient’s
anxiety levels, also
calmly rub the
patient’s back or
hold their hand to
offer physical
support.
- Teach the patient
strategies to calm
themselves such as
breathing exercises
or distraction
techniques for
alarming symptoms
such as chest pain
and dyspnea.
-assess if the patient
has sensitivity from
contrast dying and
assess kidney
function test before
catheterization.

-maintain bed rest

for at least 6 hours
after cath and limit
movement and
avoid strenuous
exercise and
activities to prevent
complications such
as bleeding and
hematoma.
- monitor for vital
signs after
catheterization
every 15 minutes
for 4 hours and
monitor for pain,
bleeding, and
hematoma at the
catheterization
insertion site.

-instruct the patient

to observe any sign
of bleeding after
catheterization and
notify immediately.

-avoid flexion of the

hip more than 30
degrees to prevent
bleeding and blood
circulation
compromise.

-assess blood
circulation to lower
extremities, pulses,
skin color, and
sensations.
- encourage the
patient to take
adequate fluid
consumption after
cath to dilute
contrast.

-apply pressure
dressing on cath
insertion site and
teach family
 member the
dressing type and
teach them signs of
bleeding to inform
health professionals.
-teach and explain
to the patient the
importance of
aerobic and
resistance exercise
discharge program
and encourage them
to modify sedentary
lifestyles to prevent
other complications.

Log experience submission for date: 19/10/2022

A Summarization of the Leaning Synthesis from the Day’s Experiences:

Coronary artery disease, risk factors, and physical activity
Coronary artery disease CAD is a chronic inflammatory disease, and the progression of
the disease can lead to a rapid change in the functional capacity of CAD patients.
Exercise training is a major component of cardiac rehabilitation and reduces
cardiovascular mortality, morbidity, and rehospitalization as well as improves
psychological stress and controls risk factors of CAD, such as diabetes mellitus,
hypertension, and obesity. It is possible that the quality of life of patients with CAD can
be improved by using appropriate exercise therapy.
Age, hyperlipidemia, hypertension, cigarette use, diabetes mellitus, and sedentary activity
are risk factors for the development of CAD. Some of these factors can be modified such
as diet, smoking, and still-life activity. Sedentary behaviors increase the risk of
cardiovascular mortality. Acute myocardial infarction (AMI), unstable angina pectoris,
cardiac arrest, and heart failure may occur as a result of CAD. Atherosclerosis not only
relates to being a cholesterol storage disease characterized by the collection of cholesterol
and thrombotic debris in the artery, but it also associates with chronic inflammation and
endothelial dysfunction. Physical activity levels decrease systemic markers of
inflammation, thrombosis, and endothelial dysfunction. Genetic inheritance and lifestyle
are important determining factors for CAD development. Therefore, physical activity has
a key role in preventing CAD development via decreasing endothelial dysfunction and
inflammation. Avoiding a sedentary lifestyle during adulthood not only prevents
cardiovascular disease independently of other risk factors but also substantially expands
the total life expectancy and the cardiovascular disease-free life expectancy for both
sexes. This effect is seen at moderate levels of physical activity, and the gains in
cardiovascular disease-free life expectancy are highly increased at higher activity levels.
It also found that life expectancy for sedentary people at age 50 years was found to be
1.5 years shorter than for people engaging in moderate daily physical activity and more
than 3.5 years shorter than for people with high physical activity levels. These differences
were similar for both sexes’ CAD severity, and the number of coronary artery vessels’
involvement, the degree of myocardial ischemia, the severity of angina, left ventricle
function, and general health condition is important determinants of life expectancy and
quality in patients with CAD. In the treatment of CAD, many methods are used together,
such as physical activity, weight control, smoking cessation, blood pressure control,
control of lipid levels in the blood, diabetes control, and drug use (acetylsalicylic acid,
beta-blockers, nitrates, etc.). It is also recommended that patients with CAD receive
annual influenza vaccines. Regular exercise is not only beneficial for both CAD
prevention and treatment, but it also helps in the modification of CHD risk factors such as
diabetes, hypertension, and hyperlipidemia. Increased myocardial and peripheral artery
perfusion and higher exercise capacity are related to lower mortality and morbidity of
CAD. It is stated that this situation may be due to the improvement of endothelial
functions and a decrease of inflammation.
CAD patients with complete revascularization and without ischemia or myocardial
depression can do competitive sports or do exercise at higher intensity according to their
symptom threshold.
Both dynamic (aerobic) and static (resistance) exercise modes are proposed for all CAD
patients. Dynamic exercise should be at least 20–30 min (preferably 30–45 min), and
static exercise should be 10–15 repetitions, 1–3 sets of 8–10 different exercises for all
extremities. The frequency of dynamic exercise should include most days (at least 4–
5 days/week and preferably 6–7 days/ week). The frequency of static exercise should
include two to three sessions weekly (nonconsecutive days).
References

Winzer EB, Woitek F, Linke A. Physical Activity in the Prevention and Treatment of

Coronary Artery Disease. J Am Heart Assoc. 2018 Feb 8;7(4):e007725. doi:

10.1161/JAHA.117.007725. PMID: 29437600; PMCID: PMC5850195.

Bueno-Antequera, J., & Munguía-Izquierdo, D. (2020). Exercise and Schizophrenia.

In Advances in Experimental Medicine and Biology (Vol. 1228, pp. 317–332).

Springer. https://doi.org/10.1007/978-981-15-1792-1_2.

Coronary Artery Disease: Prevention, Treatment, and Research. Copyright © 2022. The

Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins

Health System. https://www.hopkinsmedicine.org/health/conditions-and-

diseases/coronary-artery-disease-prevention-treatment-and-research

Chest Pain. Cleveland Clinic. May 23,

2022. https://my.clevelandclinic.org/health/symptoms/21209-chest-pain.

Chest Pain. Mayo Clinic. October 20, 2021. https://www.mayoclinic.org/diseases-

conditions/chest-pain/symptoms-causes/syc-20370838
Daily Objective addressed/accomplished:
At the end of this clinical day I will be able to:

1. Provide complete comprehensive nursing care for patients with ischemic heart disease
pre and post catheterization.
2. Establish effective health teaching and education preventive strategies for IHD.
3. Perform a thorough assessment and physical exam to patient with unstable angina.
4. Apply comprehensive cardiac physical examination for patients with ischemic heart
disease.
5. Encourage the patient to change his life styles like quitting smoking and arranging an
exercise program for physical activity to enhance the quality of life.