CORONARY

ARTERY
DISEASE
PRESENTED BY:
ALCONCEL, GEMIE DIANNE T.
RIODIL, CHARINA AUBREY
(BSN-SPCIS)
 I. PATIENT’S GENERAL INFORMATION
NAME:

AGE: GENDER:
C.K.V 45 Male

ADDRESS: CIVIL
STATUS:
Beddeng Daya,
MARRIED
Vigan City
 I. PATIENT’S GENERAL INFORMATION
EDUCATIONA
L
ATTAINMENT: RELIGION :
COLLEGE GRAD Roman Catholic
OCCUPATION:
BUSINESSMAN

HOSPITAL: ROOM AND BED #:

Doctor’s hospital #1 PRIVATE ROOM

 I. PATIENT’S GENERAL INFORMATION

CHIEF
COMPLAINT:
“Nahihirapan akong huminga
tapos mabilis akong DIAGNOSIS:
mapagod” as verbalized by
the patient. CORONARY ARTERY
DISEASE

ATTENDING
PHYSICIAN:
DR. J.A
II. BACKGROUND KNOWLEDGE
1. Definition
(Diagnosis)
Coronary artery disease is caused 2. Causative
by plaque buildup in the wall of Agent/Etiologhy
the arteries that supply blood to
the heart (called coronary • A family history of CAD
arteries). Plaque is made up of • Gender (men develop CAD
at an earlier age than
cholesterol deposits. Plaque
women)
buildup causes the inside of the • Cigarette smoking, tobacco
arteries to narrow over time. This use
process is called atherosclerosis. • Hypertension
• Obesity
3. Clinical • Physical inactivity
Manifestations • Unhealthy Diet
• Alcohol consumption
• Acute onset of chest pain
• Dyspnea
• Shortness of breath.
 Risk Factors:
Non-Modifiable: Modifiable:
● Family history ● Hyperlipidemia
● Increasing age ● Cigarette smoking
● Gender (men develop ● Hypertension
CAD earlier than women) ● Diabetes mellitus
● Race (higher incidence in ● Obesity
African American) ● Physical inactivity
 Medical/Surgical/Nursing Management

Medical Management ● Surgical Management

● Open IV access
● High flow oxygen  None
● ECG monitoring
● Bisoprolol ● Nursing Management
● benazepril (Lotensin)  Monitor vital signs
● atenolol (Tenormin)  establish trust and rapport
● aspirin  Maintain quiet, comfortable
environment.
 Educate patient on stress
management, deep breathing
exercises, and relaxation
techniques
 Prognosis/Complications

PATIENT’S BASED BOOK BASED

● Chest pain (angina) ● Heart failure

● Heart attack ● Heart attack
● Heart failure ● Stroke
● Abnormal heart rhythm (arrhythmia) ● Peripheral artery disease
● Sudden cardiac arrest
 Prevention

● Controlling cholesterol abnormalities

● Diet: low salt, low fat, high fiber
● Physical activity
 30min. Regular moderate exercise (brisk walking)
 5 min. warm-up and cool down period
 Instruct to wear loose fitting clothing
 STOP if chest pain, unusual shortness of breath, dizziness,
lightheadedness or nausea occurs
 Stop smoking
 Managing HPN and DM
 III. NURSING HEALTH HISTORY
a. Chief complaint B. History of present illness

“Nahihirapan akong huminga tapos • Cigarette smoking, tobacco use

mabilis akong mapagod” as verbalized • Hypertension
by the patient. • Obesity
• Physical inactivity
• Unhealthy Diet
• Alcohol consumption
 PAST MEDICAL HISTORY

● The patient past medical history is chicken

pox, hypertension and heart disease.
 Immunizations/Tests

a. BCG ______/________
b. DPT ______/________
c. OPV ______/________
d. HEP B _____/________
e. Measles ____X_________
f. Flu _____/_________
 Hospitalizations Injuries

The patient last The patient did not have

hospitalization was any experience in accident
January 2020.
 Transfusions
• The patient has not experience blood transfusion
 Medications
• atenolol (Tenormin)
• benazepril (Lotensin)
• Bisoprolol
• Aspirin
 Family History
Name of Parents, Age Health status or Cause
Spouse, Children, etc. of Death

A.D.V (wife) 44 Alive and Healthy

P.V (daughter) 18 Alive and Healthy

 Nutrition and Metabolic Pattern
2.1 Food Intake/Preference
Before Admission: At Present:

Breakfast – sandwich Breakfast – 1 bowl of lugaw with

boiled egg
Lunch – 1 cup of rice and 1
Lunch – 1 cup of rice and 1 serving
serving of pinakbet, 1 banana
of fish with vegetables, 1 banana
Dinner – Half rice and 1 afritada Dinner – 1 cup of rice and half
serving of chopsuey and half serving
of chicken breast, 1 orange
 Nutrition and Metabolic Pattern
2.2 Fluid Intake
Before Admission: At Present:

● Patient drinks a plenty of ● Patients drinks water (7-

water everyday (8 glass 8 glass of water)
of water) and also drinks
juice and softdrinks.
 Nutrition and Metabolic Pattern
2.3 Any Food Restrictions

● limit unhealthy fats and sodium.

● Avoid sugary and processed foods.
 Nutrition and Metabolic Pattern
2.4 Any Problem with ability to eat:
● The patient eating ability
has no problem
 Nutrition and Metabolic Pattern
2.5 Any Supplements (Vitamins, Feeding)

● Vitamin C
● Vitamin E
 III. Elimination Pattern
3.1 Bladder
Before Admission: At Present:

The patient is able to The patient is able to

urinate properly and pass urinate properly and pass
through without any pain. through without any pain.
 III. Elimination Pattern
3.2 Bowel
Usual Pattern (TIME,Frequency, Complaint on the usual Patterns
Color and Consistency) of Bowel movement

● A patient take his bowel ● The patient has no complaint

everyday in the morning, color regarding his usual pattern of
brown and normal-like stool. bowel movement.
Nutrition and Metabolic Pattern
3.3 Any Assertive Device:

● The patient doesn’t have

any assertive device
 Nutrition and Metabolic Pattern
3.4 Skin (Rectum)
● Unable to identify due to privacy.
 IV. Activity and Exercise
4.1 Usual Daily/Weekly Activities
Exercise Leisure
● Walking ● Watching televisions.
 IV. Activity and Exercise
4.2 Any Limitation of Physical Activity

● The Patient have limitation of physical activity. Avoid exercises

that require or encourage holding your breath, such as push-
ups, sit-ups, and isometric exercises. Also avoid heavy lifting.
 IV. Activity and Exercise
4.3 History of Dyspnea or Fatigue

● The patient has history of dyspnea or

fatigue.
 V. Sleep – Rest Pattern
5.1 Usual Sleep Pattern
Before Admission: At Present:

● Patient usually sleeps at 11pm ● Patient doesn’t usually get

and wakes up at 7am. enough sleep due to
monitoring of vital signs.
 V. Sleep – Rest Pattern
*Number of Pillows:
Before Admission: At Present:

● Patient has 2 pillows at ● Patient has 2 pillows at her

her head and 1 pillow on head and 1 pillow on side.
side.
 V. Sleep – Rest Pattern
Sleep Routine

● Patient doesn’t have enough sleep due to chest

pain, difficulty breathing and environment.
V. Sleep – Rest Pattern
5.3 Usual Remedies

● Listening to music
● Watching television
 VI. Cognitive Perceptual Pattern
6.1 Any Deficit in Sensory Perception (hearing, sight,
touch)
Hearing: Sight:

● Patient has no deficits ● Patient has no reading glass

in hearing because she and has a vision of 20/20.
is able to hear me and
answers right away.
 VI. Cognitive Perceptual Pattern
6.2 Ability to read and write. Any difficulty in reading?

● The patient is able to read and write

without any difficulty because he can fill
up the forms and understand well.
VI. Cognitive Perceptual Pattern
6.3 Any Complaints

● Patient has no complaints

 VII. Self-Perception Pattern
7.1 What the clients is most concerned about?

● The patient is concerned about his condition

VII. Self-Perception Pattern
7.2 Present Health Goals?
● The patient healthy goals is to
live his life in healthy way.
 VII. Self-Perception Pattern
7.3 Effect of Present Illness to Self (Physically,
Emotionally)

● In physically state, the patient are increased risk of

weight gain due to lack of physical activity
● In emotionally state, the patient feels sad because he
feels like he is a burden in his family.
 VIII. Role Relationship Pattern
8.1 Language Spoken?

● The patient uses Tagalog dialect.

VIII. Role Relationship Pattern
8.2 Manner of Speaking

● Speak coherently and respond to

questions.
 VIII. Role Relationship Pattern
8.3 Significant Person to Client

● The most significant person to the patient is

family
 VIII. Role Relationship Pattern
8.4 Complaints regarding Family
● The patient has no complaints regarding in his
family.
 VIII. Role Relationship Pattern
8.5 Living with (members of the Family)

● He is living with his family.

 IX. Sexuality – Sexual Pattern
9.1 Anticipated change in sexual relations because of
illness
• Patient didn’t experience any anticipated change in sexual
relations because of illness
 X. Coping – Stress Management Pattern
10.1 Decision making ability

• The patient decides because he is the head of the family

 X. Coping – Stress Management Pattern
10.2 Any Significant Stress in the past year

• The significant stress of the patient in the past year is

knowing about his condition coronary artery disease
X. Coping – Stress Management Pattern
10.3 Management Stress

• Going to a quite place

 X. Coping – Stress Management Pattern
10.4 Expectations from nurses to provide comfort and security
during hospitalizations

• The family members expect them to provide quality

of care and a good relationship with them.
 XI. Value Belief System
11.1 Source and strength & meaning

• The sources of strength and meaning to him is his

family.
 XI. Value Belief System
11.2 Importance of God to Client

• He sees God as the source of everything and

that god will help recover from his illness
 XI. Value Belief System
11.3 Religious Practices

• He prays at the house and sometimes attend Sunday

mass with family
 XII. Developmental Task

● General Task: Generativity vs. Stagnation

Psychologically, generativity refers to "making your mark" on the world
through creating or nurturing things that will outlast an individual.
During middle age individuals experience a need to create or nurture
things that will outlast them, often having mentees or creating positive
changes that will benefit other people.
● Indicators of Positive Resolution:
Despite on the patient’s condition and problems he still
believe that he can surpass this things by controlling
condition such as high blood pressure, Stay physically
active, eating healthy foods, maintain a healthy weight and
reduce and manage stress.
 V. PHYSICAL ASSESSMENT
1. General Survey
● Height of the patient is 5’6, weight 84kg, body make-up is endomorph
● communication pattern speaks coherently
● Skin color is light brown
● Skin: No bruises and signs of dehydration
● Eyes: black
● Pupils: dilated
● Respiratory: In distress
 V. PHYSICAL ASSESSMENT
2. Vital Signs

● HR: 85/ MINUTE

● Temperature: 36.6
● Capillary Refill: Normal
● RR: 23
● BP Supine R/L arm: 130/80mmHg
● BP Sitting R/L arm:130/80 mmHg
● Standing R/L arm: 130/90 mmHg
 V. PHYSICAL ASSESSMENT
3. Body Position/ Alignment

● The patient is in Fowler’s position and alignment is

appropriate
 V. PHYSICAL ASSESSMENT
4. Mental Acuity

● The patient is oriented, coherent and appropriately

responsive
 V. PHYSICAL ASSESSMENT
5.Sensory/ Motor Restriction

● The patient has NO amputation, deformity,

paresis, paralysis, gait, hearing disorder
and problem with speech.
 V. PHYSICAL ASSESSMENT
6. Emotional status

● The patient is not euphoric, depressed,

apprehensive, angry.
 V. PHYSICAL ASSESSMENT
7. Other health related patterns

● The patient experience restlessness, pains,

weakness and dyspnea.
 V. PHYSICAL ASSESSMENT
8. Activities of daily living

● The client can perform feeding, dressing,

brushing teeth, combing, bathing
 PATHOPHYSIOLOGY
CAD
Myocardial Ischemia

Angina Pectoris Myocardial Infarction

Irreversible damage to the myocardium

Scar tissue formation

Cardiac dysfunction

Heart failure Cardiac dysrhythmias/ arres

 REVIEW OF SYSTEMS:
1. General Description:

● The patient experience weakness

● The patient don’t have weight loss, night sweats,
anorexia and fatigue
 REVIEW OF SYSTEMS:
2. Skin

● The don’t experience itchiness, rash, lesions, bruising and

bleeding.
 REVIEW OF SYSTEMS:
3. Eyes
● No pain, itch, vision loss, diplopia,
blurring, excessive tearing of eye
● The patient is not using eyeglasses or
contact lens.
 REVIEW OF SYSTEMS:
4. Ears
● No earaches, discharge, tinnitus and
hearing loss
 REVIEW OF SYSTEMS:
5. Nose
● No obstruction, epistaxis and discharge
 REVIEW OF SYSTEMS:
6.Throat and Mouth
● No sore throat, bleeding gums, toothaches,
decay
 REVIEW OF SYSTEMS:
7. Neck
● No swelling, dysphagia, hoarseness
 REVIEW OF SYSTEMS:
8. Chest
● Patient experience pain on respiration,
chest pain and dyspnea
● No cough, hemoptysis, wheeze, discharge,
lumps and pain on breast.
 REVIEW OF SYSTEMS:
9. CVS
● Patient experience chest pain, dyspnea on
exertion
 REVIEW OF SYSTEMS:
10.GIT
● Patient experience heartburn
 REVIEW OF SYSTEMS:
11. GU
● No dysuria, nocturia, retention, polyuria,
dribbling, hematuria, flank pain, penile
discharge, lesion and testicular pain.
 REVIEW OF SYSTEMS:
12. Extremities
● No Joint pains, edema, varicose veins,
stiffness, claudication and deformities.
 REVIEW OF SYSTEMS:
13. Neurologic
● No headaches, syncope, seizure, dizziness,
vertigo, paralysis, memory loss, numbness,
paresis.
SUMMARY OF ABNORMAL FINDINGS

● WEAKNESS
● PAIN ON RESPIRATION
● CHEST PAIN
● DYSPNEA ON EXERTION
● HEARTBURN
 I. HEALTH TEACHING GUIDE
Time Allotment: 30minutes
OBJECTIVES CONTENT TEACHING EVALUATION
STRATEGY
• Provide >Discussion to the patient > Discussion > After 30 minutes of
information about about coronary artery disease to the patient. nursing intervention
patient’s condition Definition of coronary artery the patient was able to
and conduct disease understand the
health teaching • Etiology(causes of discussion and
coronary artery disease) appreciated.
• Risk factor
• Patho
• Prevention
• Treatments
• Importance of healthy
lifestyle especially the diet
of patient
 J. DISCHARGE PLANNING
Date of possible discharge: August 2021
1. Medication to be taken home:
• Encourage to take the medications regularly
• Explain the side effects and adverse effects of the drug

2. Diet:
• Limit unhealthy fats and sodium.
• Avoid sugary and processed foods.
• Eat a variety of fruits and vegetables.
• Choose whole grains.
• Choose low-fat protein sources, like skinless chicken and
fish.
• Choose skim or low-fat dairy products.
3. Activities Restricted:
• Avoid Drinking Alcohol
• Avoid Smoking
J. DISCHARGE PLANNING
Date of possible discharge:
4. Treatment:
• Lifestyle changes
• Making a commitment to the following healthy
lifestyle changes can go a long way toward
promoting healthier arteries:
• Quit smoking.
• Eat healthy foods.
• Exercise regularly.
• Lose excess weight.
• Reduce stress.
J. DISCHARGE PLANNING
Date of possible discharge:
5. Special health teachings:
• Engage in a regimen of physical conditioning
• Walk daily
• Avoid physical exercises
• Participate in a daily program of exercise
J. DISCHARGE PLANNING
Date of possible discharge:
6. Check-up schedule:

Keeping follow-up appointments and with

adhering to the prescribed cardiac
rehabilitation regimen. The patient may
need reminders about follow-up
monitoring, including periodic laboratory
testing, as well as ongoing assessment
of cardiac status.
 THANK
YOU FOR
LISTENING
!