CORONARY

ARTERY
DISEASE
SUBTITLE
INTRODUCTION

Coronary artery disease is the most common type of heart disease

and the leading cause of death worldwide. It occurs when the
arteries that supply blood to the heart becomes narrowed or
blocked by a buildup of plaque- cholesterol or other fatty
deposits that build on the inner wall of the artery. Over time, this
plaque build-up results in a reduction of blood flow to the heart,
which can cause chest pain. If the artery becomes completely
blocked, usually by a blood clot, oxygen is prevented from reaching
the heart, which can result in a heart attack and/or damage to the
heart tissue.
 Due to the increasing incidence of CAD across the world, it has
been describe as an epidemic. Globally, from the updated records
of World Health Organization (WHO) showed an estimated 17.7
million people died from Cardiovascular disease (CVD) in 2015,
representing 31% of all global deaths and of these deaths, an
estimated 7.4 million were due to Coronary Heart Disease (CHD),
of which approximately 3.8 million men and 3.4 million women die
from CAD each year. Over three quarters these deaths take place
in low-and middle-income countries.
 According to the latest WHO data published in May 2014, about
87,881 or 16.86% of total death in the Philippines were due to
CHD and CAD. The age adjusted death rate is 161.43 per 100,000
of population ranks Philippines #29 in the world. According to the
National Statistics Office, it was noted that the most number of
deaths was at the age of 80 and over with 85,705 or 17.8%. From
these, 59.6% (51,074) were females while the remaining 40%
(34,631) were males. The most number of deaths in the
Philippines occurred in National Capital Region, which accounted
for 75,019 or 15.6 percent of all deaths in the country
 In Davao Province, heart diseases which include CVD, CAD and
CHD ranked second to cerebrovascular diseases in year 2002.
However, 2004, heart diseases slipped to the fifth rank, with a
mortality rate of 29.8% equivalent to 1,206 cases over the 1,811
cases in the past 5-year average equivalent to 48.1%
 CAD is the most common cause of CVD deaths (45% of all CVD deaths)
and it is estimated that this disease will be responsible for a total of 11.1
million deaths globally in 2020.
It is apparent that number of CAD cases increases, globally, nationally
and locally. Decisively coronary artery disease (CAD) develops over time,
the symptoms depend on the stage of illness. Damage may be present
without outward signs. Treatments work better early on, which is why
early identification and intervention are so important. Living in the
shadow of potential heart attack or other heart problems can be
unnerving-but it can also be motivating, thus, we have chosen this topic
in our research study. With this study, we hope to afford appropriate
information dissemination; CAD is preventable by living a healthy
lifestyle that incorporates good nutrition, weight management and
getting plenty of physical activity, which play a big role in avoiding CAD.
 IDENTIFICATION OF THE CASE

Patient: Angkol
Sex: Male
Age: 61 y/o
Religion: Catholic
Nationality: Filipino
Occupation: Kagawad
Civil Status: Married
Address: Blk. 12 lot Piape Boulevard, Brgy. 22-c
Davao City
 Case #: 2017382576
Date Admitted: June 19,2017
Time Admitted: 1:06 am
Chief Complaint: Chest pain and Dyspnea
Admitting Diagnosis: CAD (+) LVH (-) LVD, Sinus Tachycardia with SVT. CCS I
Admitting Dr.: Dr. Michelle Angeli G. Sibre
Final Diagnosis: CAD (+) LVH (-) LVD, Sinus Tachycardia with SVT. CCS I
Requesting Dr.: Dr. Anuar M. Metmug
 Medical History

In 1990, the patient had a minor operation due to a cyst at his foot at San Pedro Hospital in
Bohol. Few years after, in 1995 he was admitted at the same hospital due to stress, but he could
not recall how many days he was admitted and what medication he had taken.
In 2002, he had a medical check-up due to a lump on his testicle, According to the examining
physician, it was due to a bacteria and was prescribed with a medicine, which he could not tell
what was it.
He also suffers severe abdominal pain that radiates to his back and got admitted in 2005. It was
then he was discovered to have a gall bladder stone and was operated.
He was diagnosed with PTB in 2010 and underwent to DOTS with 6 months medication. He could
no longer recall the name of medicines he had taken then.
After 7 years he already resides in Davao City; he experienced shortness of breath and had a
check-up at Sure-health clinic in Davao City. He was discovered to have a high level of uric acid. A
medication was prescribed for him to be taken for 1 month. Again, he could not tell the name of
the medicine. After medication, however, he still had shortness of breathing. After 15 days, he
went to a clinic in Cabaguio and according to the heart specialist who assesed him stated that his
condition was not due to high level of uric acid but rather something's wrongs in his heart, he was
then advised to be admitted in SPMC.
History of Present Illness

On June 18, 2017, he went to a clinic in Cabaguio and according to

the heart specialist who assessed him, there is something's wrong
in his heart, he was then advised to be admitted in a hospital.
Later that night he experienced chest pain and dyspnea, thus he
was admitted to SPMC.
Socio Economic Background

Patient Angkol is a barangay kagawad with a salary of 12,000

pesos per month. He had an internet business that earns more or
less 5,000 pesos in a month. He is also a distributor of soft drinks
with more or less 10,000 pesos monthly income. And from May to
June he would make a bag with 2,000 gross earnings per day. He
also has paid employee for his businesses.
ANATOMY AND PHYSIOLOGY
ETIOLOGY AND SYMPTOMATOLOGY
PATHOPHYSIOLOGY
 MEDICAL MANAGEMENT: IDEAL

Treatment of coronary artery disease is aimed at controlling symptoms and slowing

or stopping the progression of disease. The method of treatment is based on many
factors determined by the symptoms, a physical exam, and diagnostic testing.
These various drugs can be used to treat coronary artery disease:
Cholesterol-modifying medications.
Aspirin
Beta blockers
Nitroglycerin
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor
blockers (ARBs).
Sometimes more aggressive treatment is needed. Here are some options:

Angioplasty and stent placement (percutaneous coronary

revascularization)
Coronary artery bypass surgery.
DOCTORS ORDER
LABORATORY FINDINGS
NURSING THEORY

1. Philosophy of Human Caring

By: Jean Watson

2. Self-Care Deficit Theory

By: Dorothea Elizabeth Orem

3. The Nature of Nursing Model

By: Virginia Henderson
NURSING ASSESSMENT

NEUROLOGICAL
The patient is oriented to time, place, and date when asked.
He is alert and answers the question appropriately. Speaks clearly
and able to obey instructions. The patient does not show any signs of
neurological problems such as confusion, hallucinations and etc.
 EYE/ VISON
The clients eyebrows are distinct and symmetrically aligned.
Eyelashes appeared to be equally distributed and curled slightly
outward. The eyes are evenly placed and in line with each other,
none protruding. There were no presence of discharges, no
discoloration and lids close symmetrically with epicanthal fold. The
sclera appeared to be white in color. The irises appeared brown and
the lens appears almost spherical. PERRLA (pupils equally round
respond to light accommodation), illuminated and non-illuminated
pupils constricts. The patient has the ability to follow objects to
midline. No tears or swelling noted.
 EARS/ HEARING
The Auricles are symmetrical and has the same color with his
facial skin. The auricles are aligned with the outer canthus of eye.
The pinna recoils when folded with cartilage present. No swelling,
redness or tenderness assessed, tympanic membrane appears
pearly and pink in color, no signs of hearing impairment noted.
Without impacted cerumen noted.
 NOSE
The nose appeared symmetric, straight and uniform in color.
There was no presence of discharge or flaring. When lightly
palpated, there were no tenderness and lesions. Nose is symmetric
and straight, with minimal nasal flaring noted, uniform in color.
Mucosa is pink, no lesions and nasal septum intact and in middle
with no tenderness.
 MOUTH/ TONGUE/ TEETH
The lips of the client are cyanotic in color and dry in texture.
The buccal mucosa of the client appeared as pink in color; moist,
soft, glistening and with elastic texture; mucous membranes are
non- inflamed. The tongue of the client is centrally positioned. It is
pale in color, moist and slightly rough. The smooth palates are light
pink and smooth while the hard palate has a more irregular texture.
The uvula of the client is positioned in the midline of the soft palate.
There are clear to whitish oral secretions noted. Clients teeth are
complete although some are decayed.
 THROAT/ NECK
The neck is positioned at the midline without tenderness and
flexes easily. The neck muscles are equal in size. Neck can move
freely. The lymph nodes of the client are not palpable. The trachea is
placed in the midline of the neck and is palpable. No mass palpated
on the anterior neck but there is a round and tender mass palpated
on the nape.
 RESPIRATORY SYSTEM
Theres a full and symmetric expansion of the lung. The client
manifested labored and arrhythmic breathing pattern. Crackles
sound heard on both lung fields upon auscultation. The patient has
manifested an episode of Dyspnea; use of accessory muscles for
respiration and elevated shoulders upon breathing. He was given
oxygen inhalation @ 4 Liters per hour via nasal cannula.
 CIRCULATORY/ CARDIOVASCULAR SYSTEM
The patient has a pulse rate of 120 beats per minute which is
within normal range and rhythm is normal as well as the quality of
the pulse. No cyanosis noted and has capillary refill of 3 seconds. No
abnormal heart sounds noted upon auscultation. Blood pressure of
122/63.
 GASTROINTESTINAL
There is round and tender mass palpated on the left upper
quadrant of the abdomen. Dull sound heard upon percussion. Slight
distention of abdomen noted. The patient was not able to defecate
for 6 days.
 GENITOURINARY
The bladder of the patient is not palpable. With urine output:
25-50cc/ hour. No presence of hematuria noted.

MUSCOLOSKELETAL
The extremities are symmetrical in size and length. There
were no presence of bone deformities, tenderness and swelling.
With normal circumflexion of the shoulders and abduction and
adduction of arms and legs are normal. There is a round and tender
mass palpated on the left upper leg.
 INTEGUMENTARY
The patient has a good skin turgor, when skin is pinched it
goes to previous state within 1-2 seconds. Patients skin
temperature is within normal limit: 36 C. With dry skin noted. No
bleeding and skin lesions observed. There are round and tender
mass noticed upon palpation in the abdominal area, left leg and
nape.
 ACTIVITIES OF DAILY LIVING
Since the patient was still in the ICU, he is dependent when it
comes to eating, bathing and etc. He still needs to be assisted in his
ADLs and turning from side to side.

PRESENT BEHAVIOR
The patient is alert and responsive to questions asked. He is
in a good mood and smiles often. The patient is open to several
nursing intervention.
 SOCIO- ECONOMIC STAUS
The patient is currently a Barangay Kagawad with a salary of
12,000 pesos a month. He also have internet business and earns
5,000 pesos every month. He is also a distributor of soft drinks
which earns more or less 15,000 pesos a month. And every May to
June, he is fond of making school bags and earns 2,000 pesos per
day. He also has paid his employees for his business.
 FAMILY CONCERNS
The familys greatest concern is about the recovery condition of the patient. They
are hopeful that the patient will gain improvement on his condition immediately as they
wanted to bring him home to enjoy life with him. They are also worried about possible
nosocomial infections they may acquire due to prolonged stay in the hospital.

Latest Vital Signs

BP- 122/63
PR-121 bpm
Temp.- 36.8 degrees celcius
O2 Sat- 98
NURSING MANAGEMENT
 HEALTH TEACHINGS

Primary:

Encourage the patient to have a sufficient rest.

Encourage patient not to do strenuous activities.
Encourage patient to perform active range of motion intermittently and
activities of daily living.
Encourage patient to eat nutritious foods rich in protein, iron, vitamin C
such as lean meat, green leafy vegetables, as ordered.
Encourage patient to avoid foods rich in cholesterol.
Secondary:

Orient the patients family about the patients condition and necessary
information/treatment and recovery process.
Instruct the family to remain at patients side to give physical support and
encouragement.
Teach significant others to assist the patient always in a comfortable position.
Instruct significant others to wash hands before and after contact with patient.
Instruct the family to maintain the environment of the patient safe and clean at all
times.
Tertiary:

Instruct the patient to take the medications prescribed by the

physician.
Instruct the patient to report for any abnormalities immediately to
the physician or nurse.
 DISCHARGE PLANNING

Medications:
Discuss all take home medications to the patient and significant others.
Inform patient that the drugs may exhibit undesirable side effects.
Inform patient about the possible adverse effects that the drugs can
cause.
Encourage to report to the physician if he suffers any of the adverse
effects immediately.
Encourage patient to comply with the prescribe medication.
Exercises:
Encourage patient to have adequate rest and sleep.
Encourage patient to take regular breaks from any activity that
demands to give him stress.
Encourage to do deep breathing to manage stress.
Encourage to exercise regularly if tolerated.
Encourage to maintain healthy weight.
Treatment:
Orient the patients family about the patients condition and
necessary information, treatment and recovery process.
Encourage to comply with treatment regimen.
Encourage to quit smoking and avoid secondhand smoking
Hygiene:
Encourage patient to maintain good hygiene by taking a bath
regularly
Outpatient Orders:
Encourage the patient to have regular medical check-ups or to
consult the physician once complications are noticed.
Diet:
Encourage to eat more nutritious foods such as green leafy
vegetables, fruits, whole grains, legumes and nuts-and is low in
saturated fat, cholesterol and sodium.
Drink at least 8-10 glasses of water every day
Significant Others:
Encourage significant others to have a healthy lifestyle as well to
prevent the risk from developing any heart problems.
Encourage to prepare foods that are healthy.
PROGNOSIS
 EVALUATION

Coronary artery disease (CAD) is characterized by atherosclerosis in the

epicardial coronary arteries. Atherosclerotic plaques, the hallmark of
atherosclerosis, progressively narrow the coronary artery lumen and impair
antegrade myocardial blood flow. The reduction in coronary artery flow may be
symptomatic or asymptomatic, occur with exertion or at rest, and culminate in
a myocardial infarction, depending on obstruction severity and the rapidity of
development.
The patient has a good prognosis. The family can provide the medication
prescribed, and supportive towards the recovery. The patient comply and
understand the importance of the medication regimen and his family
participates for the continuum of care for faster recovery.
IMPLICATION OF THE STUDY

Coronary heart disease (CHD) is a disease in which a waxy

substance called plaque builds up inside the coronary arteries.
These arteries supply oxygen-rich blood to your heart muscle.
When plaque builds up in the arteries, the condition is called
atherosclerosis. The buildup of plaque occurs over many years.
Over time, plaque can harden or rupture (break open). Hardened
plaque narrows the coronary arteries and reduces the flow of
oxygen-rich blood to the heart. If the plaque ruptures, a blood clot
can form on its surface. A large blood clot can mostly or
completely block blood flow through a coronary artery. Over time,
ruptured plaque also hardens and narrows the coronary arteries.
The cause of this plaque formation is too much intake of food rich
in cholesterol and a poor physical exercise.
 The patient has understood his condition and is aware of the
treatment and procedure that he will undergo. Patient Angkol now
knows how to maintain a healthy lifestyle to prevent the onset of
chest pain and other complications. Not only did the patient
benefited from the study but also the members of the group. With
the case of Patient Angkol, the group has applied the knowledge
and skills acquired from lectures and lessons. Through
interviewing, the group has applied therapeutic communication
which allowed them to established rapport with the patient and
the patients significant others. Through the study, the group has
enhanced and furthered their knowledge on effective patient care
specifically in the intensive care unit area of the hospital.