Abstract
The cardiovascular system is vital to human health because it mainly delivers oxygen to the cells and supports their functioning. Many disorders might challenge the work of this system, and coronary artery disease (CAD) is a specific condition under analysis in this paper. Attention will be paid to the evaluation of the chosen disease and the required nursing assessments to diagnose patients with CAD. Identifying patient problems and nursing diagnoses is necessary to clarify which nursing interventions will be helpful in treating patients with CAD, predict risks, and promote healthy lifestyles through professional support and education.
Care for a Patient with Coronary Artery Disease
Disease Description
Coronary artery disease, also known as CAD, is among the most commonly observed types of heart disorders. Damaged arteries characterize this condition, the primary function of which is to supply blood to the heart (Cooper & Gosnell, 2022a). During the last several years, more than 42% of all cardiovascular-related deaths have been provoked by CAD (Cooper & Gosnell, 2022a). This disease may occur due to an acute or chronic mismatch of myocardial oxygen demand and coronary blood supply to the heart muscle.
Obstructive (severe plaque buildup) and non-obstructive (no or low plaques) causes should be recognized during patient assessment (Cooper & Gosnell, 2022a). The progress of ischemic areas, ischemic damage, necrosis, and scarring in the myocardium, accompanied by impaired systolic or diastolic heart function, are the main forms of expression for this damage.
Depending on the severity of the condition, the hearts of CAD patients might or might not have plaque on the arterial walls composed of cholesterol deposits. However, as soon as plaques are developed, the coronary arteries cannot work properly, and chest pain, discomfort, shortness of breath, and nausea are possible symptoms among patients. If not timely diagnosed and treated, CAD can provoke a heart attack or other severe complications like arrhythmia and heart failure.
Sometimes, people may live a long life with CAD being developed asymptomatically until a heart attack occurs and causes severe damage. Therefore, this specific condition should be appropriately assessed and diagnosed with the help of professional tools and techniques.
Nursing Assessments
Before any intervention, a nurse should assess the patient subjectively and objectively. The subjective examination includes patient complaints, general symptoms, and the evaluation of significant risks. The objective examination is an intensive observation to investigate the patient’s physical condition. It includes the assessment of consciousness and mental state, position in bed, facial expression, skin condition, assessment of hydration, detection of pain, and bleeding.
In CAD patients, attention should be paid to vital signs (the pulse rate and blood pressure are compromised by decreased oxygenated blood supply) and an electrocardiogram (EKG) to gather cardiac history (Cooper & Gosnell, 2022a). Additional instrumental nursing assessment methods include a coronary calcium scan to identify the calcium level on the heart’s walls and stress tests to check the quality of the heart’s work.
It is also important to use laboratory methods like emergency tests of blood, urine, and oxygen balance because an elevated serum cholesterol level is a critical risk factor (Cooper & Gosnell, 2022b). The nurse is responsible for calculating CAD risks, focusing on the patient’s age, gender, race, medications, and the presence/absence of chronic conditions.
Patient Problems
The patient is diagnosed with CAD, a myocardial pathology that develops when arterial blood flow to the heart tissue reduces or ceases. CAD’s common cause is atherosclerotic changes within the coronary arteries (Cooper & Gosnell, 2022a). Without proper oxygenation and nutrients, the heart is less able to perform its functions. Most of the patient’s problems are rooted in the necessity for the arteries to dilate and ensure the heart obtains enough blood and oxygen. Plaques prevent regular blood flow, and consequently, the patient experiences chest pain, shortness of breath, arrhythmia, restlessness, anxiety, fatigue, weakness, sweating, and dizziness.
Several critical conditions have to be recognized and reported by nurses. Patient problems include compromised blood flow related to decreased arterial blood flow, discomfort related to chest pain, anxiety related to changes in the patient’s health status, and the inability to tolerate activity because of weakness (Cooper & Gosnell, 2022a). While some patients are aware of their possible risks and health threats, they can manage their anxiety and concentrate on stabilizing their heart condition.
However, many people do not have enough experience in managing their healthy lifestyles, and heart complications are common. Therefore, it is necessary to admit that insufficient knowledge of disease processes and prescribed therapies challenges some patients. They do not understand what is happening to them and start panicking, causing additional harm to their hearts.
Nursing Diagnoses
In general, CAD patients face several major problems, and nursing diagnoses have to be based on the patient’s information and lab results. First, acute pain is related to decreased blood flow and increased cardiac workload, as evidenced by chest pain. Nurses should gather information about vital sign changes and pain characteristics to assess the situation.
Second, anxiety is related to health status change and pain, as evidenced by poor awareness of physiological symptoms, nausea, and helplessness. In most cases, anxiety is a normal reaction among people who experience stress, and nurses must combine the treatment of anxiety and CAD.
Decreased cardiac output is related to altered heart rates, as evidenced by EKG changes and fatigue. It is hard for people to maintain adequate oxygenation without professional help; this diagnosis is required to prevent severe complications. Finally, the primary nursing diagnosis for CAD patients is altered tissue perfusion related to plaque formation and narrowed arteries, evidenced by hypotension and tachycardia. Plaques narrow arteries and challenge the blood supply, damaging the heart.
Goals
Depending on the problems and nursing diagnosis, specific, realistic, measurable goals should be attributed to patient care. The main goal is to reduce the risk of complications and deaths among patients with CAD. Short-term goals include the patient’s stabilization, restoration of vital functions, and reduction of severe symptoms within a week. Long-term goals cover improving lifestyle modifications in six months and improving cardiac output in one year.
Other important goals and outcomes touch upon a particular problem of the patient (Cooper & Gosnell, 2022a):
- The goal of pain management is necessary to ensure the patient feels comfortable with the offered treatment (pain relief in two hours; stable vital signs in 24 hours; verbalization of symptoms and discomfort areas in 24 hours).
- Anxiety management is required to create a good and supportive environment for the patient (reduction of anxiety signs in 48 hours maximum; communication with nurses about anxieties in 48 hours; relaxation in 24 hours; improved awareness of the condition in 24 hours).
- Cardiac output insufficiency is a serious healthcare goal to ensure no internal complications are observed (oxygen saturations at 91% in 25 hours; vital signs within normal limits in 72 hours; normal lung sounds in 24 hours).
Nursing Interventions
Each patient’s problem, diagnosis, and goal is characterized by a list of nursing interventions that must be properly applied to care for patients with CAD. In this specific condition, nurses should take certain steps, following all the given prescriptions and completing their direct responsibilities. Depending on the problem and the offered diagnosis, the following interventions must be implemented:
Insufficient cardiac output and altered tissue perfusion are the two serious problems related to CAD, and the nurse has to follow specific steps to improve the health status:
- Improve rest periods and create a stress-free environment (Cooper & Gosnell, 2022a).
- Administer medications according to the doctor’s advice to improve blood flow.
- Control physical activities so as not to allow cardiac workload.
- Monitor vital signs and oxygen saturation regularly to indicate any critical changes as soon as possible.
Acute chest pain is common among CAD patients, and the nurse’s interventions are as follows:
- Administration of oxygen and medications.
- Monitoring vital signs.
- Rest promotion.
- Comfort positioning (head is raised on the bed).
- Communication to recognize additional triggers of pain.
Patients may be anxious because of their health problems and limited awareness of the changes, and the nurse has to support them by:
- Introducing and discussing coping techniques.
- Reassuring about safety and control.
- Sharing credible and clear information about the condition.
- Answering questions to decrease fears (Cooper & Gosnell, 2022a).
- Administrating medications.
- Maintaining a safe environment.
References
Cooper, K., & Gosnell, K. (2022a). Adult health nursing (9th ed.). Elsevier.
Cooper, K., & Gosnell, K. (2022b). Foundations of nursing. (9th ed.). Elsevier.