STUDY GUIDE ACTIVITY #1

Care of Patients with Coronary

Artery Disorders

Name of Student: Jore, Julianna Rheaven P.

______________________________________________________________________________
Care of Patients with Coronary Artery
Disorders
TERMINOLOGY

Directions: Define the following terms relatives to the heart.

1. Angina pectoris: Chest Pain or discomfort due to a coronary heart disease. This is
caused when the heart muscle doesn’t get enough oxygen and blood, also known as
ischemia.
2. Coronary insufficiency: _Also known as myocardial ischemia, occurs when heart
muscles blood supply is insufficient to meet its oxygen requirements. This happens
when the coronary arteries, which carry blood to the heart, narrow or are blocked
as a result of the development of atherosclerosis or other factors, such as the
accumulation of plaque.
3. Drug-eluting stent: Vascular prostheses used by specialists to reopen and maintain
patent coronary arteries narrowed by arteriosclerosis. It is coated with a
slow-release medication to help prevent blood clots from forming in a
stent.________
4. Myocardial infarction: More commonly known as a Heart Attack, is an extremely
dangerous condition that happens because of a lack of blood flow to the heart
muscle. The lack of blood flow can occur because of many different factors but is
usually related to a blockage in one or more of heart’s arteries. Without blood flow,
the affected heart muscle will begin to die. If blood flow isn’t restored quickly, a
heart attack can cause permanent heart damage and death.
5. Infarction: .Obstruction of the blood supply to an organ or region of tissue, typically
by a thrombus or embolus, causing local death of the tissue.
6. Ischemia: Inadequate blood supply (circulation) to a local area due to blockage of
the blood vessels supplying the area. Ischemic means that an organ (e.g., the heart)
is not getting enough blood and oxygen

COMPLETION

Directions: Fill in the blanks to complete the statements.

1. As the coronary vessels narrow, the patient may experience symptoms of ischemia
such as chest pain (angina) and shortness of breath .

2. Women are more likely to experience heart attacks after reaching Menopause;
however, poor Lifestyle habits, Sedentary lifestyle, and High level of stress
contribute to development of cardiovascular earlier in life.
31. For women, the main symptoms of a heart attack
may be diffuse chest pain, extreme fatigue, and
tenderness to touch or a burning or tingling sensation, which may be mistake for
other less serious conditions such as indigestion or anxiety.

4. Any activity that increases the heart’s workload increases its need for oxygen and
nutrients.

5. The prognosis of the patient who suffers an acute myocardial infarction (MI) depends
on the size of the artery obstructed, the location, and the amount of heart tissue that is
damaged.

6. Another treatment method for occlusion of a coronary artery other than coronary artery
bypass graft is the procedure called percutaneous coronary intervention (PCI) or
coronary angioplasty.

7. To lower cholesterol and maintain a healthy diet, it is recommended to eat fish at least
Two times a week.

8. A thrombolytic agent must be administered with 12 hours of experiencing the

symptoms of MI, in order to prevent or decrease damage to the heart muscle.

9. After receiving a heart transplant, the patient must take immunosuppressive

medication for life.

10. Two constant potential complications that the heart transplant patient must deal with
are organ rejection and immunosuppression-related complications.

11. The doctor orders IV fluid for a postoperative patient to infuse at 125 mL/hour. The
drop factor is 10 gtts/mL. what is the drip rate? 20.8 or 20-21 drops per minute

12. Omega-3 fatty acids have been found to reduce triglyceride levels in patients with
hyperlipidemia.

13. If a person is suspected of having a heart attack at home, besides immediately calling
911 and having the person lie down, it is wise to give the person aspirin.
TABLE ACTIVITY

Cardiac Surgeries

Directions: Fil in the block below with type of surgery that matches the description. The first
block has been done for you.

Type of Surgery Description

Coronary artery bypass graft (CABG) Surgery bypasses the blocked artery replacing it with
sections of a vein or artery taken from another part of
the patient’s body.

Does not require stopping the heart’s activity, and

Off-pump coronary artery bypass
technique for CABG procedures-
Minimally invasive direct coronary
artery bypass (MIDCAB)
Percutaneous transluminal coronary
angioplasty (PTCA)
therefore does not require using the heart-lung
machine.
Invasive and similar to the procedure used for cardiac
catheterization where a catheter is introduced through
th femoral vessel.

Accomplished with a mechanical or biological device.

Heart valve replacement

Performed for selected patients who have end-stage

Heart Transplant left ventricular failure resulting from cardiomyopathy.

APPLICATION OF THE NURSING PROCESS

Care of Patient with Angina Pectoris

Directions: Provide the answer to the following questions.

Scenario: Mr. Souza, age 62, is admitted to the hospital with chest pains. Over the past year, he
has gradually more fatigues and uncomfortable whenever he exerts himself. His admitting
diagnosis is possible angina pectoris.

1. What specific questions would you ask when taking Mr. Souza’s history that could be
helpful in assessing his cardiovascular status?

a. Do you have a family history of heart diseases?

 b. Can you describe what kind of pain do you
experience? (Dull, sharp, stabbing, pricklly,
burning)

c. Does the pain occur in your shoulder blades?

d. Does the pain radiate down in one or both of your arms?

2. Two nursing diagnoses on Mr. Souza’s nursing care plan are Pain and Knowledge deficit. List
three specific nursing interventions appropriate for each nursing diagnosis.

Pain related to decreased coronary artery circulation:

a. Assess the patient’s vital signs and characteristics of pain at least 30 minutes
after administration of medication.

Rationale: To monitor effectiveness of medical treatment for the relief of angina. The time of
monitoring of vital signs may depend on the peak time of the drug administered.

b. b. Elevate the head of the bed if the patient is short of breath. Administer
supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target
range, or as ordered by the physician.

Rationale: To increase the oxygen level and achieve an SpO2 value of at least 94%.

c. Place the patient in complete bed rest. Educate patient on stress management,
deep breathing exercises, and relaxation techniques.

Rationale: Stress causes a persistent increase in cortisol levels, which has been linked to people
with cardiac issues. The effects of stress are likely to increase myocardial workload.

d. Knowledge deficit related to self-care:

A. Educate the patient about the disease process, therapeutic regimen, and
complications. Emphasize the need for stress management to prevent and manage
anginal episodes.

Rationale: One of the main focuses of therapeutic management is promoting a healthy lifestyle
and bring awareness. Explaining the pathophysiology of the disease helps enhance patients’
literacy of their condition. It prevents fear of uncertainty and brings them a sense of control.
Moreover, patients who are knowledgeable about the purpose of intervention and regimen are
more likely to adhere to the planned care plan.

B. Explain the effect of the disease on the desired lifestyle. Povide rsupport can satisfy
the patient’s interest in making lifestyle modifications and transitions to reducing
debilitating habits.
Rationale: When a patient is fearful of the condition,
hesitancy and noncompliance can be observed. Increasing
the patient’s awareness of his or her health status and expressing ovide support, consultation, and
privacy as needed

C. Instruct the patient to be vigilant for indications of fatigue, respiratory distress, and
sexual dysfunction and promptly contact the health care provider if any of these
signs or symptoms are noticed.

Rationale: Patients taking drugs may experience adverse effects such as hypotension. They must
also be aware of the potential for rebound tachycardia if the medication is discontinued.

3. Which objective data indicate(s) that Mr. Souza’s level of physical activity is appropriate to
his recovery?
a. Patient asks for assistance when he becomes fatigued.
b. Patient’s heart rate and respiratory rate are stable after ambulation.
c. Patient’s activity is observed by the physical therapist.
d. Family tell you that he is walking like he used to prior to hospitalization.

PRIORITY SETTING

Directions: Read the scenario and prioritize as appropriate.

You are working in an extend facility. Mr. Ido is walking down the hall and reports to you that t
he is having angina. He has a PRN order for sublingual nitroglycerine and he asks you to assist
him with the medication that is on this bedside table. Prioritize the steps in adminsitering the
nitroglycerine.

5th a. If the pain has not eased or if BP increases, administer a second tablet.
3rd b. Give one tablet, placed under the tongue, wait 5 minutes.
9th c. Notify the physician regarding pain.
1st d. Assist the patient to lie in bed.
4th e. Wait 5 minutes, reassess pain.
2nd f. Obtain a baseline BP.
6th g. Reassess pain and recheck BP
7th h. Administer a third tablet if pain persists.
8th i. Recheck BP; it should have decreased
REVIEW QUESTIONS FOR THE NCLEX EXAMINATION

Directions: Choose the best answer(s) for the following questions.

1. The risk factors that lead to a higher incidence of atherosclerosis include: (Select all that
apply.)
1. High levels of high-density lipoproteins
2. Cigarette smoking
3. A history of hypertension and diabetes mellitus
4. Age (>age 40) gender, and race
5. Women on oral contraceptives or estrogen replacement therapy

2. What is the most significant in diagnosing damage to the myocardium?

1. Elevated level of troponin
2. Elevated level of creatinine phosphokinase (CPK)
3. Elevated level of creatinine phosphokinase-MB (CK-MB)
4. Elevated level of lactate dehydrogenase (LDK)

3. The patient taking lovastatin (Mevacor) for treatment of hypercholesterolemia should

have follow-up because of the potential for:
1. nephrotoxicity.
2. cardiotoxicity.
3. hepatotoxicity.
4. ototoxicity

4. The patient presents in the emergency department with severe chest pain. Which drugs
are likely to be prescribed during the initial emergency care?
1. Morphine, oxygen, nitrated, aspirin
2. Beta-blockers, clopidogrel (Plavix)
3. Simvastatin (lipitor), lorazepam (Ativan)
4. Oxygen, dobutamine (Dobutrex)

5. Which statement by the patient indicates a need for additional teaching about taking his
nitroglycerine?
1. “I should try to sit or lie down before I take a tablet.”
2. “If I get a headache, I should not take any more.”
3. “I can take up to three tablets before I call my doctor.”
4. “The tablets should be stored in a dark bottle.”

6. When an elderly person sustains and MI, symptoms expressed are often:
 1. severe chest pain, nausea, and dizziness.
2. dyspnea, nausea, confusion, or indigestion.
3. pain in the arms and clammy skin.
4. palpitation, chest pain, and fatigue

7. The physician is considering using fibrinolytic therapy such as t-PA (Activase) for a
patient who has come into the ED experiencing an MI. Which information is most
important to relay to the physician?
1. History of hypertension
2. History of hemorrhage stroke
3. Symptoms onset 3 hours ago
4. Intraspinal surgery during childhood

8. Which criteria would indicated that the interventions after an MI are helping meet the
expected outcome of “patient will suffer no further cardiac damage”?
1. Lessened chest pain
2. Conscious and interacting appropriately
3. Maintained in sinus rhythm without PVCs
4. No complaints of heartburn

9. For a patient who is taking a statin drug, an important teaching point to include would be
to:
1. report muscle tenderness or pain that persists for more than a few days.
2. increase consumption of grapefruit juice to supply K+.
3. have follow-up appointments to monitor platelet count.
4. discontinue medication when the target weight goal is met.

10. You are ready to begin your patient assessments after receiving report. Which patient you
assess first?
1. A 36-year-old with mitral stenosis scheduled for a balloon valvuloplasty later in
them in the morning.
2. An 82-year-old one day postoperative after coronary bypass surgery who has a
temperature of 100.50 F
3. A 52-year-old with cardiomyopathy who developed chest pain and shortness of
breath during shift change
4. A 63-year-old who had coronary angioplasty yesterday afternoon who has
occasional chest pain since the procedure.

11. There are several patients on a busy cardiac rehabilitation unit who need assistance.
Which task would be appropriate to assign to the nursing assistant?
1. Find out why a depressed patient is not doing his physical therapy
2. Answer a family member’s question about how to contact a local support group.
3. Escort a patient who has been discharged home to his wife’s car.
 4. Listen to a patient who is complaining about the
bad hospital food.

12. After a myocardial infarction, the patients is monitored for cardiogenic shock. A sign that
cardiogenic shock is impending might be:
1. crackles in the lungs upon auscultation.
2. slowing of the pulse rate.
3. a cardiac arrhythmia.
4. decreasing urine flow to 20 mL per hour.