Nursing 211

N211: Health Differences Across the Lifespan I of 148 Arteriosclerotic Heart Disease (Coronary Heart Disease, CAD) is a common disorder caused by a buildup of fatty, fibrous plaques that narrow the coronary artery lumen. Medical Management: reduce lipid levels (Clofibrate, Cholestyramine (Questran)), reduce hypertension, modify diet to limit meat, dairy and high-fat foods, and quit smoking. Limit alcohol intake to 2 ounces. Complications include angina, MI, CHF, and arrhythmias. 1.8 Angina Angina is chest discomfort or pain that occurs when myocardial oxygen demands exceed supply. Common causes are atherosclerotic heart disease, hypertension, coronary artery spasm and hypertrophic cardiomyopathy. Non-modifiable risk factors include age (over 50), gender (male) with increased incidence of disease in postmenopausal women (loss of the protective effects of estrogen), ethnic background (African Americans) and family history. Modifiable risk factors include stress, sedentary lifestyle, hypertension, obesity, cigarette smoking, diabetes mellitus, increased cholesterol (hyperlipidemia), and alcohol intake. Total serum cholesterol above 300mg/dl: four time’s greater risk for developing CAD. Low density lipoprotein (LDL), “bad cholesterol”, a molecule of LDL is approximately 50% cholesterol by weight (<100 mg/dl desirable). High density lipoprotein (HDL), “good cholesterol” is inversely related to the risk for developing CAD (> 60mg/dl is desirable). Nursing Assessment Pain is dull squeezing or crushing pressure resulting from decreased blood flow to the heart. Substernal, may radiate to the left arm and/or shoulder, jaw, right shoulder, usually lasts 3-5 minutes. Client may complain of sweating, pallor, nausea, vomiting, cool extremities and fainting. Pain is mild to severe in intensity. Pain may be transient or prolonged, with gradual or sudden onset. Pain is often precipitated by exercise, exposure to cold, heavy metal, mental tension, sexual intercourse. Pain is relieved with rest and/or nitroglycerin. Additional signs and symptoms include dyspnea, tachycardia, palpitations, nausea, vomiting, fatigue, diaphoresis, pallor, weakness, syncope, dysrhythmias. Unstable angina is not predictable and may occur even at rest. Diagnostics EKG is generally at client baseline unless taken during an angina attack, when ST segment depression and T wave inversion may occur. Exercise stress test shows ST segment depression and hypotension. Stress echocardiogram: looks for changes in wall motion (indicated in women). Coronary angiogram: detects coronary artery spasms. ©2012 Achieve Page 16