FAR EASTERN UNIVERSITY

Nicanor Reyes Street, Sampaloc, Manila

Institute of Health Sciences and Nursing
Second Semester, A.Y. 2022 – 2023

A CASE STUDY OF PATIENT WITH VASCULAR HEART DISEASE

Submitted by: Christine V. Dela Cruz, 310-2B

Submitted to: Sir Jomar M. Rodriguez, R.N.
Date Submitted: April 25, 2023

PATIENT’S INFORMATION
NAME: R.M.D.
AGE: 49 years old
GENDER: Female
RELEVANT MEDICAL HISTORY:  Chronic heart failure and/or atrial fibrillation and flutter
 Previous heavy alcoholic drinker during her 20s-30s
 Hypertension
 DM Type 2
 Iron deficiency anemia
CHIEF COMPLAINT: Easy fatigability, weakness, increased shortness of breath, pallor
DIAGNOSIS: Vascular Heart Disease
 FAR EASTERN UNIVERSITY
Nicanor Reyes Street, Sampaloc, Manila
Institute of Health Sciences and Nursing
Second Semester, A.Y. 2022 – 2023

TREATMENT PLAN
CUES NURSING GOALS & NURSING RATIONALE
DIAGNOSIS OBJECTIVES INTERVENTION
Subjective: Activity Goals:
Intolerance After 48 of nursing
 “Ang bilis ko related to interventions, the patient
po mapagod generalized will be able to participate
kapag nagda- weakness as in desired activities, meet
drive lalo na evidenced by own self-care needs, and
kapag weakness, achieve measurable
umaakyat fatigue, increase in activity
ako ng dyspnea, and tolerance, evidenced by
hagdan ng pallor. reduced fatigue and
mga 2 flights weakness and by vital \
isguro.” signs within acceptable
limits during activity.
 “Tapos
nagiging
constant din Objectives:
yung 1. After 1 hour of 1. Monitor and 1. Vital signs and oxygen
palipitations nursing evaluate the saturation levels should
ko.” intervention, heart patient’s response be monitored before,
rate should return to activities. during, and immediately
 “Madalas din to baseline within after activity to
ako nahihilo 3 minutes determine whether they
talaga pag following the are within the desired
napapagod.” activities. range. Heart rate should
return to baseline within
 FAR EASTERN UNIVERSITY
Nicanor Reyes Street, Sampaloc, Manila
Institute of Health Sciences and Nursing
Second Semester, A.Y. 2022 – 2023

3 minutes following the

activity. Moderate
Objective: continuous training is
efficient, safe, and well-
Vital Signs: tolerated by HF patients,
BP: 100/70 and it is recommended
PR: 70 by the Heart Failure
RR: 21 Association Guidelines
T: 37.3 (Cattadori et al., 2018). If
O2%: 94% the patient can tolerate
activity, use the data
 Pallor obtained to develop goals
 Weakness to increase the intensity
and fatigue and duration of the
 Dyspnea activity gradually.

2. After 8 hours of 2. Encourage the use 2. The 6-minute walk test

nursing
interventions, the
patient will be
able to perform
the 6-minute walk
test with
assistance.
of the 6-minute (6MWT) is an
walk test (6MWT) assessment that a doctor
to determine the may use to determine a
patient’s physical person’s exercise
ability. tolerance. It is a low-risk
test that measures how
far a person can walk in 6
minutes. It may be useful
for measuring the
functional ability and
 FAR EASTERN UNIVERSITY
Nicanor Reyes Street, Sampaloc, Manila
Institute of Health Sciences and Nursing
Second Semester, A.Y. 2022 – 2023

fitness of people with

certain health conditions,
specifically the cardio-
pulmonary response
(West, 2021).

3. After 24 hours of 3. Start with warm-up 3. Regular exercise has

nursing activities and end many benefits for
interventions, the with cool-down patients with heart
patient will be activities such as failure. A regular activity
able to perform warm-up program will help reduce
self-care activities calisthenics (10 heart disease risk factors
with gradual reps), Bike (x7 and the chance of having
increasing of mins: 4.0-7.0 kph), future heart problem,
intensity with and treadmill strengthen the heart and
independence (x5mins: 2.5 kph cardiovascular system,
within prescribed speed) improve circulation and
limits. help the body use oxygen
better, help increase
energy levels so you can
do more activities
without becoming tired
or short of breath,
improve muscle tone and
strength, improve
balance, and joint
flexibility (Cleveland
 FAR EASTERN UNIVERSITY
Nicanor Reyes Street, Sampaloc, Manila
Institute of Health Sciences and Nursing
Second Semester, A.Y. 2022 – 2023

Clinic, 2023).

4. Some people with severe

4. After 48 hours of 4. Encourage patient
nursing
interventions, the
patient will be
able to have
adequate bed rest
and sleep.
heart failure need periods
to have adequate of bed rest. To reduce
bed rest and sleep; congestion in the lungs,
provide a calm and the patient's upper body
quiet environment. should be elevated. For
most patients, resting in
an armchair is better than
lying in bed. Relaxing
and contracting leg
muscles are important to
prevent clots. As the
patient improves, a
doctor will progressively
recommend more activity
(University Health Care
System, 2023).

FOLLOW-UP:
 FAR EASTERN UNIVERSITY
Nicanor Reyes Street, Sampaloc, Manila
Institute of Health Sciences and Nursing
Second Semester, A.Y. 2022 – 2023

As of April 24, 2023, 48 hours after nursing interventions, the patient is now seen comfortable and relieved from fatigue
and weakness, dyspnea, and pallor. Moreover, the patient is alert and coherent. The patient is also ambulatory without assistive device.
The patient is also amenable to all activities, cardio rehabilitation programs, and treatment given to her. The patient must be monitored
for continued sessions with gradual increase in intensity upon observable improvements.

Discharge plan:
 6-minute walk test (6MWT)
 Warm-up activities and end with cool-down activities such as warm-up calisthenics (10 reps), Bike, and treadmill (increasing
intensity when condition is improving)
 Adequate bed rest and sleep

The patient’s medications to be continued are the following:

 Entresto 50 mg OD (1/2 tab if BP decreases)

 Spironolactone
 Carvedilol
 Trimetazidene
 Rosuvastin
 Empagliflozin
 Ferrous sulfate + FA
 Lanoxin

DISCUSSION:
 FAR EASTERN UNIVERSITY
Nicanor Reyes Street, Sampaloc, Manila
Institute of Health Sciences and Nursing
Second Semester, A.Y. 2022 – 2023

Potential Causes Vascular disease (vasculopathy) affects the blood vessels that carry oxygen and nutrients throughout your body
and remove waste from your tissues. Common vascular problems happen because plaque (made of fat and
cholesterol) slows down or blocks blood flow inside your arteries or veins. Lifestyle changes often help, but
some people need medication or surgery.

Risk Factors Vascular disease risk factors include:

 High cholesterol.
 High blood pressure.
 Smoking or using tobacco products.
 Diabetes.
 Genes you get from your parents.
 Medicines.
 Injury.
 Infection.
 Blood clots.

Treatment For the client with vascular heart disease with Activity Intolerance related to generalized weakness as
Options evidenced by weakness, fatigue, dyspnea, and pallor are the following:
 6-minute walk test (6MWT)
 Warm-up activities and end with cool-down activities such as warm-up calisthenics (10 reps), Bike, and
treadmill (increasing intensity when condition is improving)
 Adequate bed rest and sleep
 Medications:
o (Entresto 50 mg OD (1/2 tab if BP decreases) – for heart failure
o Spironolactone – for HTN and heart failure
o Carvedilol – for HTN
 FAR EASTERN UNIVERSITY
Nicanor Reyes Street, Sampaloc, Manila
Institute of Health Sciences and Nursing
Second Semester, A.Y. 2022 – 2023

o Trimetazidene – prevent and treat symptoms of angina (chest pain)

o Rosuvastin – slows production of cholesterol
o Empagliflozin – treat DM type 2
o Ferrous sulfate + FA – treat iron deficiency anemia
o Lanoxin – for heart failure

Other tests to help diagnose/monitor VHS may include:

 Electrocardiogram (ECG or EKG)
 Echocardiogram.
 Exercise stress test
 Stress echo
 Nuclear stress test
 Heart (cardiac) CT scan
 Cardiac catheterization and angiogram

Patient’s response to treatment:

The patient is amenable to treatments and and responsive, did not complain of chest pain, difficulty of breathing
and dizziness during session. O2 sat is 100%.

References:
 FAR EASTERN UNIVERSITY
Nicanor Reyes Street, Sampaloc, Manila
Institute of Health Sciences and Nursing
Second Semester, A.Y. 2022 – 2023

 Cattadori, G., Segurini, C., Picozzi, A., Padeletti, L., & Anzà, C. (2018). Exercise and heart failure: an update. ESC Heart

Failure, 5(2), 222–232. https://doi.org/10.1002/ehf2.12225

 West, M. (2021, June 23). What is the 6-minute walk test, and what is its purpose? Www.medicalnewstoday.com.

https://www.medicalnewstoday.com/articles/6-minute-walk-test

 Cleveland Clinic. (2023). Heart Failure: Exercise and Activity for Patients with Heart Failure. Cleveland Clinic.

https://my.clevelandclinic.org/departments/heart/patient-education/recovery-care/heart-failure/exercise-activity

 University Health Care System. (2023). Heart Failure: Treatment | University Health Care System. Www.universityhealth.org.

https://www.universityhealth.org/heart-failure/treatment/

 Cleveland Clinic. (2019). Vascular Disease Overview | Cleveland Clinic. Cleveland Clinic.

https://my.clevelandclinic.org/health/diseases/17604-vascular-disease

 CDC. (2019, December 9). Heart disease risk factors. Centers for Disease Control and Prevention.

https://www.cdc.gov/heartdisease/risk_factors.htm