GENERAL OBJECTIVE

At the end of the presentation,

students are expected to gain the
necessary information regarding Ischemic
Heart Disease for them to determine the
appropriate nursing care management they
should provide to those patients having
this kind of illness
The students will be able to:
 Understand the nature of Ischemic Heart
Disease
 Distinguishes its clinical
manifestations and predisposing factors.
 Outline the Anatomy and Physiology of
the disease or condition.
 Demonstrate the Pathophysiology of the
disease.
 Determine the health status of the
patient through:
Knowing the past history and present
illnesses of the patient as well as
their family health history.
Conducting physical examination.
Analyzing the laboratory examination
done and correlate it to the present
condition of the patient.
 Determine the appropriate nursing care
that should be provided to the client.
 Understand the different drugs that the
client is taking and determine how it
will benefit the client as well as the
possible adverse effect it may give.
 Create a good and therapeutic nurse-
patient interaction.
 Teach the client’s relatives on how to
minimize the risk of developing Ischemic
Heart Disease.
Ischemic Heart Disease, otherwise known as
Coronary Artery Disease, is a condition
that affects the supply of blood to the
heart. The blood vessels are narrowed or
blocked due to the deposition of
cholesterol plaques on their walls. This
reduces the supply of oxygen and nutrients
to the heart musculature, which is
essential for proper functioning of the
heart. This may eventually result in a
portion of the heart being suddenly
deprived of its blood supply leading to
the death of that area of heart tissue,
resulting in a heart attack.
As the heart is the one that supplies
oxygenated blood to the various vital
organs like the brain, kidneys etc. this
leads to the death of tissue within these
organs and their eventual failure or
death. Ischemic heart Disease is the most
common cause of death in several countries
around the world. Coronary artery disease
the condition in which fatty
deposits (atheroma) accumulates in the
cells lining the wall of the coronary
arteries. These fatty deposits build up
gradually and irregularly in the large
branches of the two main coronary arteries
which encircle the heart and are the main
source of its blood supply.
This process is called atherosclerosis
which leads to  narrowing or hardening of
the blood vessels supplying blood to the
heart muscle (the coronary arteries ).
This  results in ischemia ( inability to
provide adequate oxygen) to heart muscle
and this can cause damage to the heart
muscle . Complete occlusion of the blood
vessel leads to a heart attack (myocardial
infarction).
 Severe chest pain of Myocardial Infarction
which may be fatal.
 Angina Pectoris- pain over the central
chest that may sometimes radiate down the
left arm, jaw or the back.
 Pain may be accompanied by sweating.
 The presence of anginal episodes is
virtually diagnostic of Ischemic Heart
Disease
Other signs that can be observed on clinical
examination:
 Presence of tendon Xanthomas
 Thickening of the Achilles Tendon and
Arcus Lipidus in young patients.
Risk factors:
 Fatty diet
 Smoking
 Sedentary lifestyle
 Stress

These are the main areas of focus in

prevention. Avoiding foods rich in
saturated fats is vital to reduce lipid
levels in the blood and to prevent
atherosclerosis. Adequate regular exercise
is also essential. DM and hypertension
should be kept under good control with
proper treatment
 Various treatments are offered in people
deemed to be high at risk of CAD. These
include:
 Control of cholesterol levels in those
with known high cholesterol.\
 Smoking cessation
 Control of high blood pressure.

The degree to which IHD affects each

individual depends on a varietyof factors
including:
 Age
 Genetics
 Diet
 Exercise habits
 smoking
Drug therapy with Nitrates, which dilate the
diseased coronary arteries, administered sub-
lingually are very effective in relieving the
pain in a few minutes. Drugs such as
Isosorbide Dinitrate and Isosorbide
Mononitrate belong to the category of
Nitrates. These drugs are also used as a
prophylactic to prevent the pain from
occurring. Beta-blockers like Propranolol are
also highly effective in relieving pain by
reducing myocardial oxygen demand, mainly by
decreasing the heart rate. Calcium channel
antagonists produce vasodilatation and relieve
the symptoms by reducing the excitability and
conductivity of cardiac muscle and by reducing
blood pressure. For patients with
hypercholesterolaemia, drugs may be used to
lower cholesterol levels.
 Angioplasty is the technique of
mechanically widening a narrowed or
obstructed blood vessel; typically as a
result of atherosclerosis. Tightly folded
balloons are passed into the narrowed
locations and then inflated to a fixed
size using water pressures some 75 to 500
times normal blood pressure (6 to 20
atmospheres).

 Coronary artery bypass surgery, also

coronary artery bypass graft surgery, and
colloquially heart bypass or bypass
surgery is a surgical procedure performed
to relieve angina and reduce the risk of
death from coronary artery disease. 
Arteries or veins from elsewhere in the
patient's body are grafted to the coronary
arteries to bypass atherosclerotic
narrowing’s and improve the blood supply
to the coronary circulation supplying the
myocardium (heart muscle). This surgery is
usually performed with the heart stopped,
necessitating the usage of cardiopulmonary
bypass; techniques are available to
perform CABG on a beating heart, so-called
"off-pump" surgery.
Current approaches to the treatment of
ischemic heart disease (such as CABG
surgery and angioplasty techniques) often
result in incomplete revascularization
because of the frequent presence of
diffuse coronary artery disease extending
into small peripheral vessels. As an
alternative to these techniques, recent
attention has been directed toward
harnessing the body's ability to generate
new blood vessels (natural angiogenesis).
This report documents the results of animal
and clinical studies that evaluated the
ability of fibroblast growth factor (FGF-1),
produced using genetic engineering techniques,
to induce angiogenesis.
After production, purification, and
demonstration of the potential for triggering
angiogenesis in animal models with FGF-1, a
clinical study was performed in 40 patients
with multivessel coronary artery disease
referred for CABG. All patients had proximal
disease of the left anterior descending artery
(LAD) as well as disease in the distal one
third of the LAD or at the origin of one of
its branches.
 The mean ejection fraction was 50 percent.
Between three and four bypass grafts were
placed in each patient. FGF-1 was injected
into the myocardium distal to the proximal
LAD anastomoses in 20 patients. The
remaining 20 patients had heat-denatured
FGF-1 substituted for FGF-1. After 12
weeks, coronary angiograms revealed the
presence of a capillary network sprouting
out of the LAD into the myocardium in all
20 patients who received active FGF-1. In
the control group, there was no evidence
of new vessel formation.
 Name: MR. OR
 Address: Purok I Brgy. Talao-Talao
Dalahican Lucena City
 Date of Birth: APRIL 28, 1928
 Age: 81
 Sex: MALE
 Nationality: Filipino
 Religion: Roman Catholic
 Attending Physician: DR. ROY ROXAS
PRESENT CONDITION:
 Patient is experiencing chest pain.

PAST HEALTH HISTORY:

General health:
The patient is weak in appearance upon
admission.

Childhood Illness:
The only illness she experienced was
common colds, cough, and fever.
Immunization
Complete immunization.

 Hospitalization
 The patient was hospitalized thrice prior to
the prensent hospitalization.

 Current Medication
 His current medications are: Isodril,
Catapres, Lanoxin, Norvasc, Imdur, Capoten.

 Allergies
 No known allergies.

 Habits
 Patient enjoys daily walk routine.
 Family Health History

MR. OR

FATHE MOTHE
R R

Asthma, Ulcer, Hypertension,

Hypertension, CVA
 Nutritional Metabolic Pattern
 Patient has a poor appetite.
 His usual daily menu is consist of rice,
pork and vegetables.

 Elimination Pattern
 The patient defecates once a day.
 The patient voids thrice a day.

 Activity-Exercise pattern
 The patient can perform ADL.
 The patient is not in respiratory
distress.
General Appearance
Body built is appropriate to age
Pale and weak in appearance
Conscious and coherent
Not in respiratory distress

Skin
Pallor skin
Good skin turgor
No lesions
HAIR
 Equally distributed on scalp
 Black, short hair
 Without tenderness or lesion on scalp

Nails \
 With long finger and toe nails

Skull and Face

 Skull is proportionate to body size
 Symmetrical skull
 Without masses or nodules
 Symmetrical facial grimace

EYES
 Eyebrows and eyelashes evenly distributed
 With pale conjunctiva
 No lesion in lacrimal glands
 Symmetric eyeballs, with equal size of
pupils and white

SCLERA
 Pupils equally dilated reacted to light
 Ears
 With symmetrical auricle position and size
 With elastic auricle
 Without discharge

NOSE
 Symmetrical
 Without nasal secretions
 Without tenderness
MOUTH
 With slightly dry lips
 With permanent teeth

NECK
 Neck muscle proportionate to body size
 With normal range
 With palpable lymph nodes

Neck
 Neck muscle proportionate to body size
 With normal range
 With palpable lymph nodes
Chest
 With symmetrical chest wall expansion
 Not in respiratory distress
 With normal breath sounds
 With normal heart sounds

Abdomen
 With flabby soft abdomen upon palpation
 Your heart is located under the ribcage in
the center of your chest between your
right and left lung. It’s shaped like an
upside-down pear. Its muscular walls beat,
or contract, pumping blood continuously to
all parts of your body.
 The size of your heart can vary depending
on your age, size, or the condition of
your heart. A normal, healthy, adult heart
most often is the size of an average
clenched adult fist. Some diseases of the
heart can cause it to become larger.
 The heart is the muscle in the lower half of
the picture. The heart has four chambers. The
right and left atria (AY-tree-uh) are shown in
purple. The right and left ventricles (VEN-
trih-kuls) are shown in red.
 Connected to the heart are some of the main
blood vessels—arteries and veins—that make up
your blood circulatory system.
 The ventricle on the right side of your heart
pumps blood from the heart to your lungs. When
you breathe air in, oxygen passes from your
lungs through blood vessels where it’s added
to your blood. Carbon dioxide, a waste
product, is passed from your blood through
blood vessels to your lungs and is removed
from your body when you breathe air out.
 The atrium on the left side of your heart
receives oxygen-rich blood from the lungs. The
pumping action of your left ventricle sends
this oxygen-rich blood through the aorta (a
main artery) to the rest of your body.
 The superior and inferior vena cavae are in blue to
the left of the muscle as you look at the picture.
These veins are the largest veins in your body. They
carry used (oxygen-poor) blood to the right atrium of
your heart. “Used” blood has had its oxygen removed
and used by your body’s organs and tissues. The
superior vena cava carries used blood from the upper
parts of your body, including your head, chest, arms,
and neck. The inferior vena cava carries used blood
from the lower parts of your body.
 The used blood from the vena cavae flows into your
heart’s right atrium and then on to the right
ventricle. From the right ventricle, the used blood
is pumped through the pulmonary (PULL-mun-ary)
arteries (in blue in the center of picture) to your
lungs. Here, through many small, thin blood vessels
called capillaries, your blood picks up oxygen needed
by all the areas of your body.
 The oxygen-rich blood passes from your lungs back to
your heart through the pulmonary veins (in red to the
left of the right atrium in the picture).
 Oxygen-rich blood from your lungs passes
through the pulmonary veins (in red to the
right of the left atrium in the picture). It
enters the left atrium and is pumped into the
left ventricle. From the left ventricle, your
blood is pumped to the rest of your body
through the aorta.
 Like all of your organs, your heart needs
blood rich with oxygen. This oxygen is
supplied through the coronary arteries as it’s
pumped out of your heart’s left ventricle.
Your coronary arteries are located on your
heart’s surface at the beginning of the aorta.
Your coronary arteries (shown in red in the
drawing) carry oxygen-rich blood to all parts
of your heart.
 The right and left sides of your heart are
divided by an internal wall of tissue
called the septum. The area of the septum
that divides the two upper chambers
(atria) of your heart is called the atrial
or interatrial septum. The area of the
septum that divides the two lower chambers
(ventricles) of your heart is called the
ventricular or interventricular septum.
 The picture shows the inside of your heart
and how it’s divided into four chambers.
The two upper chambers of your heart are
called atria. The atria receive and
collect blood. The two lower chambers of
your heart are called ventricles. The
ventricles pump blood out of your heart
into the circulatory system to other parts
of your body.
 The picture shows your heart’s four
valves. Shown counterclockwise in the
picture, the valves include the aortic
(ay-OR-tik) valve, the tricuspid (tri-
CUSS-pid) valve, the pulmonary valve, and
the mitral (MI-trul) valve.
 The arrows in the drawing show the direction
that blood flows through your heart. The light
blue arrows show that blood enters the right
atrium of your heart from the superior and
inferior vena cavae. From the right atrium,
blood is pumped into the right ventricle. From
the right ventricle, blood is pumped to your
lungs through the pulmonary arteries.
 The light red arrows show the oxygen-rich
blood coming in from your lungs through the
pulmonary veins into your heart’s left atrium.
From the left atrium, the blood is pumped into
the left ventricle, where it’s pumped to the
rest of your body through the aorta.
 For the heart to function properly, your blood
flows in only one direction. Your heart’s
valves make this possible. Both of your
heart’s ventricles has an “in” (inlet) valve
from the atria and an “out” (outlet) valve
leading to your arteries. Healthy valves open
and close in very exact coordination with the
pumping action of your heart’s atria and
ventricles. Each valve has a set of flaps
called leaflets or cusps, which seal or open
the valves. This allows pumped blood to pass
through the chambers and into your arteries
without backing up or flowing backward.
 Blood Flow

SVC
RA TV RV PV PA
LUNGS
IVC

Diffirent systen Aorta LV MV LA PV

 RISK Family
FACTORS: history of
Smoking, CAD
DM, (HEREDITY)
Hypertensio
n, Sedentary
Lifestyle,
Obesity

CHOLESTE
ROL
 FOAM
CELLS

OXIDIZED
LDL

PLAQUE
FORMATION

BLOOD VESSELS
ARE BLOCKED
 AFFECTS THE
SUPPLY OF BLOOD
TO THE HEART

REDUCES OXYGEN AND NUTRIENTS IN

THE HEART AND AFFECTS THE
SUPPLY OF OXYGEN TO THE VITAL
ORGANS

DEATH OF TISSUE WITHIN THESE

ORGANS AND THEIR EVENTUAL
FAILURE

HEART DEAT
ATTAC H
K
 The patient was admitted last July 13,
2009 to the ICU of Mount Carmel Diocesan
General Hospital under Dr. Roxas attending
to the chief complaint of chest pain. The
following orders were given: low salt
diet, for CBC, allergies and RBC.
 On July 14, 2009 at 7:30 AM, the ROD
ordered that the patient is for transfer
to private room, for FBS, urine,
cholesterol, BUN, creatinine, Catapress
given 150mg 1 tablet BID, Lasix 60mg IV
now. At 2:30PM the ROD ordered to continue
Isoket drip.
 At 6:30PM, a telephone order was given by Dr.
Roxas to R. Llerado. He ordered an IVF of
Plain NSS 500cc x KVO to follow on right arm.
 On July 15, 2009, a verbal order of Dr. Roxas
to NOD was made. The orders were as
follows:for repeat hemoglobin, hematocrit
now,if negative chest pain, may decrease
Isoket drip to 10 mgtts per minute and may
discontinue IVF at left arm.
 At 4:35PM, received phone order from Dr. Roxas
by CI: Mr. Noel Ayala. The patient’s RBS is
344mg/dl. He ordered to start RBS monitoring
5AM-5PM and to start Melformin 500mg/tablet
TID.
 At 6:33PM, the patient’s hemoglobin is
8.3. Telephone order of Dr. Roxas to NOD
Mark Tan for blood typing
 At 7:25PM, verbal order of Dr. Roxas to
NOD Mark Tan. The orders were to give
Lasix 60mg IV now, ½ ampule Lanox every 8
hours and to transfuse 3 units PRBC after
properly typed and cross matched.
 At 11:25PM, patient’s BP is 219/96 mmHg.
Telephone of Dr. Greys to NOD. He ordered
to start Nicardipine drip ( 1 ampule
Nicardifine plus 90cc Plain NSS at 10mgtts
per min).
ASSESSMEN DIAGNOSIS PLANNING INTERVENTIO EVALUATION
T N
S: “Gusto Activity At the end • Note Goal met,
niyang intolerance of the presence of the patient :
humiga , as r/t to nursing factors
hinahapo general interventi contributing • Lessen
kasi siya” asweakness as on and to fatigue report of
verbalized evidenced collaborati (e.g. acute or fatigue and
by the pt’s by lack of ve medical chronic discomfort
SO. interest in manageme illness, heart • Can
activity, bed nt the failure ambulate
O: rest and patient • Note client with
•Heart rate: will factors of assistance
abnormal
43 demonstra weakness, • can
heart rate
•Respiration te a fatigue, manage
and BP as
: 11 decrease pain,diffulcty body
response to
•BP: 180/100 in accomplishing weakness
•Discomfort activity physiologi task and • Have
when cal signs insomnia. interest on
performing of specific
ADL intoleranc activity.
ASSESSMEN DIAGNOSIS PLANNING INTERVENTIO EVALUATION
T
S: “Hindi Impaired At the end N
•Acknowledge Goal met.
siya adjustment of the client’ efforts The patient
masyadong related to nursing to now can:
nag-iiimik sa negative interventi adjust:exampl •Adjust on
una”, as attitude ons and e “Have you his
verbalized healthy collaborati done your environment
by thr behaviors, ve medical best”, to .
patient’s lack of manageme lessen •No
SO. motivation/c nts, the feelings of irritability
O: hange in patient blame/guilt noted.
demonstrati behavior as will and defensive •Can
on of non- evidenced initiate response.
motivate
acceptance by absence lifestyle •Provide an
and
of health of social changes open
socialize.
status support for that will environment
•Share
change change permit encouraging
Irritability behavior, adaptation communicatio interest and
beliefs and to current n so that beliefs to
practices. life expression of others
situation, feelings
identify concerning to
and use impaired
functions can
be dealt
ASSESSMEN DIAGNOSIS PLANNING INTERVENTIO EVALUATION
T appropriat N
•Provide
e support feedback
system, during and
demonstra after learning
te experience to
increasing enhance
interest/pa attention,
rticipation skills, and
in self- confidence.
care and •Explain
develop disease
ability to classes/causat
assume ive factors
responsibil and prognosis
ity for as
personal appropriate
needs and promote
when questioning to
possible. enhance
understandin
g.
ASSESSMEN DIAGNOSIS PLANNING INTERVENTIO EVALUATION
T
S: “Ah! Acute pain At the end N
•Note when Goal met.
Aray!” as related to of the pain occurs to The patient:
verbalized unrelieved nursing medicate •Now can
by patient. pain interventi prophylactical describe the
O: sleep (beyond ons and ly as level of
disturbance tolerance) collaborati appropriate. pain.
Restlessnes as ve medical •Encourage •Can
s evidenced manageme adequate rest manage it at
BP:180/100 by nt, the periods to the same
With expressive patient prevent time.
moderate behavior will have fatigue. •Lessen
pain (scores an •Review ways reports of
(moaning,
7 in the pain expected
irritability, to lessen paiun.
scale) pain
sighing, pain, •Not restless
manageme
restlessness including •Absence of
nt, accept
) level of techniques irritabily.
pain and such as BP:140/100
have a therapeutic
descriptio touch.
n of
response
to pain.
ASSESSMEN DIAGNOSIS PLANNING INTERVENTIO EVALUATION
T
S: “May Decreased At the end •MonitorN vital Goal
mga oras na cardiac of the signs partially
kung output nursing frequently to met:
minsan ay related to interventi promote •The patient
nahihirapan altered ons and response to now
akong heart rate collaborati activity. participate
huminga”, as ve medical •Restrict or in activity.
as evidenced manageme administer •Not in
verbalized by nt, the fluid as respiratory
by the restlessness patient indicated. distress.
patient. s. will have a •Provide •BP reading
O: Altered hemodyna adequate
is not stable
heart rate nmic fluid/free
BP:140/100-
HR:46 stability running
160/100
Shortness of e.g. blood water,
breath/dysp pressure, depending on
nea cardiac client needs,
Variation in output, assess hourly
blood etc. urinary
pressure report/de output/noting
readings;inc monsrtrae total fluid
reased/decr balance to
eased allow timely
alteration in
ASSESSMEN DIAGNOSIS PLANNING INTERVENTIO EVALUATION
T decrease N quiet
•Provide
episodes environment
of to promote
dyspnea, adequate
participate rest.
in •Alter
activities environment
that to maintain
reduce the adequate
workload body
of the temperature
heart, in near
demonstra normal range.
te an •Encourage
increase in relaxation
activity techniques to
tolerance. reduce
anxiety.
 LAB TEST RESULT NORMAL RANGE INTERPRETATIO
N
HGB, HCT:
Hgb 13.10 13.5 - 18 NORMAL
Hct 0.36 0.4 – 0.48 NORMAL
FLUID SERUM:
Glucose 103 74 - 106 NORMAL
Urea Nitrogen 25 9 - 20 (HIGHER)
Excessive
Creatinine 4.3 .7 – 1.2 protein
(HIGHER)intake
Heart
Failure
Cholesterol 415 0 - 200 (HIGHER)Hyperch
olesteremia,
Hypertension,
Myocardial
Infarction,
uncontrolled DM,
Triglycerides 367 0 - 150 (HIGHER)
Hyperlipidemia
Hypertension
 LAB TEST RESULT NORMAL RANGE INTERPRETATIO
N
Uric Acid 6.0 3.5 - 7 NORMAL
CBC, PLATELET
COUNT:
RBC 2.65 4.5 – 5.5 (LOWER)
Anemia,
Leukemia,
Multiple
Myeloma,
WBC 4.56 5 - 10 (LOWER) Bone
hemorrhage,
marrow failure,
Chemotheraphy
, Drug Toxicity
Segmente 0.68 .56 - .65 (HIGHER)
Cushing’s
Syndrome,
Eclampsia,
Gout,
Lymphocyte 0.32 .25 - .35 NORMAL
Inflammatory
MCV 89.40 82 - 92 NORMAL
diseases
MCH 31.30 27 - 32 NORMAL
 LAB TEST RESULT NORMAL RANGE INTERPRETATIO
N

MCHC 35 32 - 36 NORMAL
Hgb 8.30 13.5 - 18 (LOWER)
hemolytic
reactions,
Hemorrhage,
iron Deficiency
Hct 0.23 .4 - .48 (LOWER)
Anemia
Anemia, bone
marrow
dysfunction,
Hemorrhage,
Malnutrition
Platelet Count 184 150 - 400 NORMAL

TROPONIN Negative NORMAL

RBS 344, 314, 117, 70 - 125 (HIGHER) High
97, 91, 133 blood glucose
level, excess
production of
growth
 LAB TEST RESULT NORMAL VALUE INTERPRETATIO
N

URINALYSIS: Light yellow

Color

Transparency Sl. Turbid

Protein ++ NEGATIVE (HIGHER +)CHF,

Multiple
myeloma

Sugar +++ NEGATIVE (HIGER

+)Cushing
syndrome, DM
pH 7.0 4.6 – 8.0 NORMAL
Sp. Gravity 1.025 1.010 – 1.025 NORMAL
Pus cells 0 -2 0-2 NORMAL

RBC 0-2 NEGATVE Hematuria

 NAME ACTION INDICATIO DOSAGE ADVERSE NURSING
OF N REACTION RESPONSIBILI
DRUG TY
ROSUVA LOWER HYPERLIPI 1O mg 1 BILE • MONITOR
S- ELEVATED DE-MIA tab SEQUESTERI FASTING
TATIN LIPID LEVEL OFTEN NGDRUG LIPID PROFILE
DINNER MAY • CHEAK CK
CAUSED LEVEL IN A
BLOATING PATIET WHO
AND COMPLAINTS
CONSTIPATI OF MUSCLE
ON PAIN AND
WEAKNESS

IMDUR •MAY ACUTE 60mG 1 DIZZINESS MONITOR

REDUCE ANGINA, tab OD HEADACHE BLOOD
CARDIAC PROOHYLA WEAKNESS PRESSURE,
OXYGEN XIS IN NAUSEA HEART RATE,
DEMAND BY SITUATION VOMITTING RHYTM,
DECREASING LIKELY TO FLUSHING ITENSITY AND
DIALOSTOLI CAUSE AND DURATION OF
C ANGINA HYPOTENSI DRUG
• RELIEVES ON RESPONCE
ANGINA
 NAME ACTION INDICATION DOSAGE ADVERSE NURSING
OF REACTION RESPONSIBILI
DRUG TY
LASIX INHIBITS HYPERTENSI 60 mg DIZZINESS, •ASSESS
SODIUM AND ON IV FEVER, PATIENT
CHLORIDE (STAT) HEADACHE, UNDERLYING
REABSORTIO RESTLESSN CONDITION
N ESS, BEFORE
WEAKNESS, STRATING
ABDOMINAL THERAPY
DISCOMFOR (MONITOR
T AND WEIGHT,
VOMITTING PERIPHERAL
EDEMA,
BREATH
SOUND, BP,
FLUID,
INTAKE AND
OUTPUT,
ELECTROLYCE
S GLUCOSE
NORVAS DECREASE •TREAT HPN 10ml 1 HEADACHE, •AND BUN
DO NOT
C MTOCARDIAL •CHRONIC tab OD FATIGUE, CONFUSE
CONTRACTILI STABLE NAUSEA, NORVASC
TY AGINA DIZZINESS, WITH NA
SLEEP VANE
DISTURBAN
CE,DRY
NAME OF ACTION INDICATION DOSAG ADVERSE NURSING
DRUG E REACTION RESPONSIBILI
TY
CATAPRE ANTI TREAT MILD 150ml/t MAY •DO NOT
SS HYPERTENSI TO ab BID INTERFERE CONFUSE
VE MODERATE ABILITY TOCATAPRESS
HYPERTENSI WORK WITH
ON CATAFLAM
(NSAID)
• DONOT
CHANGE
REGIMEN OR
DISCONTINUE
DRUG
ABRUPTLY TO
PREVENT
LANOXIN •FOR CONTROL OF 0.25mg MUSCLE REBOUND
•MEASURE
MYOCARDIA RAPID ,½ WEAKNESS, HYPERTENSIO
LIQUIDS
L VETRICULAR amp. IV HYPOKALEM N
PRECISELY,
CONTRACTIO CONSTIPATI PUSH IA, USING A
N ON OD HYPOTENSI CALIBRATED
ON, DROPER OR
RESPIRATO SYRINGE
RY
DISTRESS
 Teach the pt. to understand the symptom
complex and avoid activities known to
cause anginal pain.
 Avoid exertion, exposure to cold, tobacco,
eat regularly but lightly, maintain
prescribed weight.
 Teach pt. to maintain an unhurried pace
throughout the day.
 Discourage over-the-counter drugs e.g.
diet pills, nasal decongestants, or drugs
that increase heart rate And blood
pressure.
1. Explain to the pt the importance of
anxiety reduction in control of angina.
Teach relaxation techniques.
2. Advise the pt on activity level to
prevent angina
 Begin a regular regimen of exercise as
directed by health care provider.
 Avoid lifestyles that may cause IHD/CHD-
smoking, drinking, inadequate rest and
sleep.
 Avoid activities known to cause anginal
pain- sudden exertion, walking against
wind, extremes of temperature, high
altitude, emotional stressful situations,
may accelerate heart rate, raise blood
pressure and increase cardiac work.
 Refrain from physical activity for 2 hrs.
after meals. Rest after each meal if
possible.
 Take home medsto decrease the oxygen
demands of the myocardium and increase the
oxygen supply through pharmacologic
theraphy and risk factor control:
 Nitrates remain the mainstay of theraphy
NTG.
 Beta-andrenergic blockers (Inderal)
 Calcium-ion antagonists/channel blockers
(Procardia, Isoptin, Calan)