INTRODUCTION

Coronary Artery Disease (CAD) is characterized by the presence of atherosclerosis in the epicardial
coronary arteries. Atherosclerotic plaques, the hallmark of atherosclerosis, progressively narrow the
coronary artery lumen and impair myocardial blood flow. The reduction in coronary artery flow may be
symptomatic or asymptomatic, may occur with exertion or at rest, and may culminate in a myocardial
infarction, depending on obstruction severity and the rapidity of development.

OBJECTIVES: General Objective:

Through this paper, we will be able to present details about Coronary Artery Disease. The proponent
gathered data through interviewing the patient, making use of the patient’s records from the hospital, and
other researches to provide the readers information about the said condition.

This case study would preserve and improve the quality of nursing responsibilities by rendering care,
holistically, and whole heartedly in a manner that the client, the student nurses and others would benefit.
This case study would be able to:
• COGNITIVE: Discuss in details of the chosen illness for the case study so as to gain insight and
knowledge about CAD.
• PSYCHOMOTOR: Enhance the ability to identify and apply nursing interventions to provide a
better care for the client’s suffering from the mentioned illness.
Specifically, this paper would be able to:
• Present the patient’s personal data with accuracy.
• Present the genogram that includes the disease of the family members
• Discuss the health status of the patient that includes the past and present condition
• Present and discuss the complete diagnosis of the patient
• Interpret and discuss the developmental data of the patient
• Obtain the physical assessment of the patient
• Discuss the anatomy and physiology of the affected system
• Trace the pathophysiology of the disease and its underlying causes in relation to the patient’s
predisposing and precipitating factors
• Discuss the different laboratory and diagnostic examinations done top the patient
• Make a drug study on the drugs prescribed to the patient
• Formulate nursing care plans for the patient
• State the prognosis and relate it with the patient’s condition
 Case Abstract

A 70 year old patient was brought to the emergency room of Ospital ng Cabuyao in July 14,
2010 at 4:42 pm with the chief complaint of chest pain and shortness of breath. She lives in El Sol
Brgy. 3 Cabuyao Laguna.One month PTA, the patient experienced body weakness. Two weeks
PTA, the patient experienced paroxysmal nocturnal dyspnea. She had difficulty sleeping during the
night. A day PTA, patient has been having episode of chest pain and shortness of breath.
Her husband who was bedridden and diagnosed with NIDDM and was later deceased last
2005. This pushed patient X to work in place of her husband to sustain the needs of her family.
Patient X worked as a cook in a carenderia for almost 40 years.
Upon admission, Patient X was administered with O2 inhalation @ 5Liters per minute via
nasal cannula. The physician ordered for NPO for1 hour, if tolerated diabetic diet, requested for
FBS, IVF of plain NSS 1L to run for 12 hours. Prescribed Losartan 1 tab OD, levofloxacin 500 mg
1 tab OD, Glipizide 80 mg 2 tab before breakfast, Metformin 50 mg 1 tab Bid, Citicholine 1g IV
q12,Trental 40 mg 1tab OD, Aspirin 1 tab after meal, Imidapril 5 mg 1 tab OD, and Nitroglycerin,
the doctor requested for laboratory tests and the admitting diagnosis was, NIDDM and
Hypertension. Her final diagnosis was Coronary Artery disease.
On her first day of dmission, the patient’s vital signs were T- 36.9⁰C, P- 91 bpm, R- 29
bpm, BP- 170/80 and weakness was persistent up to the following day. Gradual improvement of her
condition has been observed throughout the confinement, and was finally ordered for discharge on
her fourth day of hospitalization.
Upon discharge patient X was referred to have her weekly check-up on Toledo Clinic to
monitor her blood pressure and Hgt. Her usual BP is ranging from 130/80 – 140/80 and her Hgt.
value ranges from 126 – 132 mg/dl. Patient X also stated that she is still taking the maintenance
drugs that was prescribed to her and is still following the health teachings that was given to her,
upon her discharge like doing some exercise and is mostly following the diet that was advised for
her.
 COMPLETE DIAGNOSIS
Diagnosis: Coronary Artery Disease,
Coronary
• Term applied to vessels
• Used to describe the arteries that supply blood to the muscle tissue of the heart, or the veins that take
blood away from it Relating to or being the coronary arteries or coronary veins, or relating to the
heart
Artery
• A vessel through which the blood passes away from the heart to the various parts of the body
• Blood vessel that carries blood away from the heart Are muscular blood vessels that carry away
blood from the heart
Disease
• A definite morbid process having a characteristic train of symptoms

• Any departure from health of a structure, organ, or system (Medical Dictionary by Gupta and Gupta)

• Disorder with a specific cause and recognizable signs and symptoms, any bodily abnormality or
failure to function properly (Webster Dictionary)
Coronary Artery Disease
• A disease in which there is a narrowing or blockage of the coronary arteries Characterized by the
presence of atherosclerosis in the epicardial coronary arteries.
• Occurs when the arteries that supply blood to the heart muscle (the coronary arteries) become
hardened and narrowed

PATIENT’S DATA

Patient’s Name: Patient X Citizenship: Filipino

Age: 70 years old Birthday: April 26, 1940
Sex: Female Birthplace: Bataan
Address: Barangay III, El sol Subd., Cabuyao, Laguna Medical Diagnosis: Coronary Artery Disease,
Civil Status: Widow Chief Complaint: shortness of breath and chest pain.
Religion: Roman Catholic Date and Time Admitted: July 14, 2010 / 4: 42 pm
 HEALTH STATUS

A. Family Background
The family has been living in Felix St., ElSol Subd. Brgy. III since Pt. X got married. The couple has five
children with 3 girls and 2 boys.
Among the five children only three of them were able to finish college and the rest were only able to study until
their high school years for varied reasons. Unfortunately one of her son died and her youngest daughter stowed away. All
of their children got married and one of her daughter –in –law lives with her.
Both of them work as a cook in a Malibay, a kind of restaurant. She worked for almost 40 years. But she stopped
working since she experienced paraplegia last 2009. By year 2005, her husband died due to NIDDM. This pushed Pt. X
to work in place of her husband; she supported her family’s daily needs, educational needs and others with that kind of
job. She is also fond of eating meat and sweet foods compared to fish and vegetables.
Furthermore, Pt. X’s brother also died due to diabetes and they have a history of Kidney Disease and
Hypertension.

B. History of Past Illness

The first confinement of Pt. X was last December 14, 2005 because of hypertension and diabetes, she was
advised for a diabetic diet and low fat diet. She was discharge on December 16, 2005 to attend the burial of his husband.
She was admitted again on December 17, 2005 due to hemiparesis.
Last June 26, 2009 she experienced paraplegia for four months, she told us that she just forced herself to move
her extremities through daily exercise, proper diet and maintenance of antihypertensive medications.

C. History of Present Illness

One month PTA, the patient experienced body weakness. Two weeks PTA, the patient experienced paroxysmal
nocturnal dyspnea. She had difficulty sleeping during the night. A day PTA, patient has been having episode of chest
pain and shortness of breath.

Characteristics Of Chest Pain felt by the patient:

Position- (+) Levine’s sign
Quality- heaviness
Radiation- radiates to left arm
Severity- pain scale of 8/10
Timing- lasts for 10 minutes, after stopping her activity.
 PHYSICAL ASSESSMENT
I. General appearance & mental status
Patient X, a 70 year old female client, was admitted on July 14, 2010 in Ospital ng Cabuyao. Upon assessment
the patient was lying on bed in moderate high back rest and is awake, conscious, coherent & responsive. She has an IVF
of PNSS 1000cc @ 300cc level running at KVO infusing well @ right cephalic vein, with O2 inhalation @ 5Liters per
minute via nasal cannula.

The client has a generalize weakness and needs assistance upon moving or position changes. She has shortness
of breath. She is 5’4” in height and weighs 72 kg.

II. Vital Signs:

July 14, 2010 (6pm-6am)
VITAL 8pm 10pm 12am 2am 4am 6am
SIGNS
Temp 36.4⁰C 36.0⁰C 36.4⁰C
Pulse 71 90 87
Resp. Rate 27 28 27
BP 140/80 140/80 160/80 140/80 140/80 150/80
July 15, 2010 (6am-6pm)
VITAL 8am 10am 12pm 2pm 4pm 6pm
SIGNS
Temp 36.4⁰C 36.5⁰C 36.2⁰C 36.4⁰C 36.7⁰C
Pulse 90 94 94 92 90
Resp. Rate 24 25 25 26 29
BP 120/90 140/90 110/70 120/70 170/90
(6pm-6am)
VITAL 8pm 10pm 12am 2am 4am 6am
SIGNS
Temp 36.7⁰C 36.1⁰C 36.1⁰C 36.1⁰C 36.3⁰C
Pulse 91 94 94 89 90
Resp. Rate 25 25 26 24 23
BP 130/90 130/90 130/90 130/90 140/90

July 16, 2010 (6am-6pm)

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VITAL 8am 10am 12pm 2pm 4pm 6pm
SIGNS
Temp 36.2⁰C 36.4⁰C 36.4⁰C 36.5⁰C 36.6⁰C
Pulse 83 80 81 81 85
Resp. Rate 23 21 22 21 21
BP 130/80 130/70 150/80 140/80 140/80
(6pm-6am)
VITAL 8pm 10pm 12am 2am 4am 6am
SIGNS
Temp 36.9⁰C 36.7⁰C 36.9⁰C 36.8⁰C 36.4⁰C
Pulse 91 87 81 83 83
Resp. Rate 23 21 20 21 20
BP 130/80 130/90 130/90 130/80 130/80

III. Skin
The color of the skin is brown with rough texture. The patient has good skin turgor and clammy to touch. Scars
in lower extremities are observed; no wounds or lesions are noted.
IV. Head
She has a normocephalic configuration with head circumference of 57 cm. Her facial movements are symmetric
and she has, evenly distributed, black in color hair because she is using dye. Scalp is dry but there is no presence of
dandruff or lice upon inspection.
V. Eyes
Eyes have symmetrical lids and normal periorbital area. Conjunctiva is pinkish in color. Both left and right
pupils are black in color and briskly reactive to light. Eye bugs present with eyebrows and eyelashes evenly distributed.
Client wears eyeglasses only upon reading.
VI. Ears
Client’s ears are symmetrical. No tenderness and lesions noted. Absence of discharges on the external canal is
noted. No hearing problem noted.
VII. Nose
No discharges are noted. There are no deformities or inflammation on the nose noted. With nasal flaring and
both nostrils are patent. She has an O2 inhalation via nasal cannula.

VIII. Mouth
The mucosa and gums of the client are pinkish and lips are dry. She uses dentures. She has no difficulty of swallowing
and no bleeding noted upon observation.
IX. Neck

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 There are no signs of abnormal growth or enlargement of the nodes of the neck of the client. There are no lesions
noted.
X. Chest and Lungs
The client has rapid, shallow breathing at the rate of 29 bpm.
XI. Heart
She has a capillary refill time of 2 seconds. Her heart’s sound is normal and regular in rate and rhythm with a
rate of 94 bpm.
XII. Abdomen
The skin in this area has uniform color and no lesions. She has normal bowel sound of one every 15 seconds.
XIII. Genito-Urinary
She can urinate and defecate without difficulty; she defecates at least once a day.
XIV. Back and Extremities
Client needs assistance upon moving around and in doing activities of daily living. She can extend and flex both
her upper and lower extremities with (-) bipedal edema or anasarca. Weakness upon movement is noted.
XV. Nutrition- Metabolic Pattern
The patient stated that her appetite didn’t affect her hospitalization. She still can eat her preferred foods and a
little of everything. She’s on a diabetic and low fat diet.
XVI. Eliminating Pattern
While admitted at the hospital, the patient defecates once a day with a characterized by brownish, form stool.
The Patient urinates 3-5 times a day with characterized by light yellowish urine.
XVII. Activity-Exercise Pattern
Before
The patient usually sweeps the front yard of their house every morning. Wash dishes and cooks food. Sometimes wash
clothes. She takes a nap every afternoon and sleeps well at night.
Present
While the patient was hospitalized, she can feed herself. Assisted by family member when taking a bath and while
dressing, and doing self-care activities. She can’t sleep well at night because of the environment.
XVIII. Coping-Stress Tolerance
The Patient stated that her life changed when her husband died. Because of her grieves she got overly stressed
and have a hard time coping.

ANATOMY and PHYSIOLOGY

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 9. Right Atrium
1. Right Coronary 10. Right Ventricle
2. Left Anterior Descending 11. Left Atrium
3. Left Circumflex 12. Left Ventricle
4. Superior Vena Cava 13. Papillary Muscles
5. Inferior Vena Cava 14. Chordae Tendineae
6. Aorta 15. Tricuspid Valve
7. Pulmonary Artery 16. Mitral Valve

8. Pulmonary Vein 17. Pulmonary Valve

Aortic Valve (Not pictured)

Coronary Arteries

Because the heart is composed primarily of cardiac muscle tissue that continuously contracts and relaxes, it must have a
constant supply of oxygen and nutrients. The coronary arteries are the network of blood vessels that carry oxygen- and
nutrient-rich blood to the cardiac muscle tissue.

The blood leaving the left ventricle exits through the aorta, the body’s main artery. Two coronary arteries, referred to as
the "left" and "right" coronary arteries, emerge from the beginning of the aorta, near the top of the heart.

The initial segment of the left coronary artery is called the left main coronary. This blood vessel is approximately the
width of a soda straw and is less than an inch long. It branches into two slightly smaller arteries: the left anterior
descending coronary artery and the left circumflex coronary artery. The left anterior descending coronary artery is
embedded in the surface of the front side of the heart. The left circumflex coronary artery circles around the left side of
the heart and is embedded in the surface of the back of the heart.

8
Just like branches on a tree, the coronary arteries branch into progressively smaller vessels. The larger vessels travel
along the surface of the heart; however, the smaller branches penetrate the heart muscle. The smallest branches, called
capillaries, are so narrow that the red blood cells must travel in single file. In the capillaries, the red blood cells provide
oxygen and nutrients to the cardiac muscle tissue and bond with carbon dioxide and other metabolic waste products,
taking them away from the heart for disposal through the lungs, kidneys and liver.

When cholesterol plaque accumulates to the point of blocking the flow of blood through a coronary artery, the cardiac
muscle tissue fed by the coronary artery beyond the point of the blockage is deprived of oxygen and nutrients. This area
of cardiac muscle tissue ceases to function properly. The condition when a coronary artery becomes blocked causing
damage to the cardiac muscle tissue it serves is called a myocardial infarction or heart attack.

Superior Vena Cava

The superior vena cava is one of the two main veins bringing de-oxygenated blood from the body to the heart. Veins
from the head and upper body feed into the superior vena cava, which empties into the right atrium of the heart.

Inferior Vena Cava

The inferior vena cava is one of the two main veins bringing de-oxygenated blood from the body to the heart. Veins from
the legs and lower torso feed into the inferior vena cava, which empties into the right atrium of the heart.

Aorta

The aorta is the largest single blood vessel in the body. It is approximately the diameter of your thumb. This vessel
carries oxygen-rich blood from the left ventricle to the various parts of the body.

Pulmonary Artery

The pulmonary artery is the vessel transporting de-oxygenated blood from the right ventricle to the lungs. A common
misconception is that all arteries carry oxygen-rich blood. It is more appropriate to classify arteries as vessels carrying
blood away from the heart.

Pulmonary Vein

The pulmonary vein is the vessel transporting oxygen-rich blood from the lungs to the left atrium. A common
misconception is that all veins carry de-oxygenated blood. It is more appropriate to classify veins as vessels carrying
blood to the heart.

9
Right Atrium

The right atrium receives de-oxygenated blood from the body through the superior vena cava (head and upper body) and
inferior vena cava (legs and lower torso). The sinoatrial node sends an impulse that causes the cardiac muscle tissue of
the atrium to contract in a coordinated, wave-like manner. The tricuspid valve, which separates the right atrium from the
right ventricle, opens to allow the de-oxygenated blood collected in the right atrium to flow into the right ventricle.

Right Ventricle

The right ventricle receives de-oxygenated blood as the right atrium contracts. The pulmonary valve leading into the
pulmonary artery is closed, allowing the ventricle to fill with blood. Once the ventricles are full, they contract. As the
right ventricle contracts, the tricuspid valve closes and the pulmonary valve opens. The closure of the tricuspid valve
prevents blood from backing into the right atrium and the opening of the pulmonary valve allows the blood to flow into
the pulmonary artery toward the lungs.

Left Atrium

The left atrium receives oxygenated blood from the lungs through the pulmonary vein. As the contraction triggered by
the sinoatrial node progresses through the atria, the blood passes through the mitral valve into the left ventricle.

Left Ventricle

The left ventricle receives oxygenated blood as the left atrium contracts. The blood passes through the mitral valve into
the left ventricle. The aortic valve leading into the aorta is closed, allowing the ventricle to fill with blood. Once the
ventricles are full, they contract. As the left ventricle contracts, the mitral valve closes and the aortic valve opens. The
closure of the mitral valve prevents blood from backing into the left atrium and the opening of the aortic valve allows the
blood to flow into the aorta and flow throughout the body.

Papillary Muscles

The papillary muscles attach to the lower portion of the interior wall of the ventricles. They connect to the chordae
tendineae, which attach to the tricuspid valve in the right ventricle and the mitral valve in the left ventricle. The
contraction of the papillary muscles opens these valves. When the papillary muscles relax, the valves close.

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Chordae Tendineae

The chordae tendineae are tendons linking the papillary muscles to the tricuspid valve in the right ventricle and the mitral
valve in the left ventricle. As the papillary muscles contract and relax, the chordae tendineae transmit the resulting
increase and decrease in tension to the respective valves, causing them to open and close. The chordae tendineae are
string-like in appearance and are sometimes referred to as "heart strings."

Tricuspid Valve

The tricuspid valve separates the right atrium from the right ventricle. It opens to allow the de-oxygenated blood
collected in the right atrium to flow into the right ventricle. It closes as the right ventricle contracts, preventing blood
from returning to the right atrium; thereby, forcing it to exit through the pulmonary valve into the pulmonary artery.

Mitral Value

The mitral valve separates the left atrium from the left ventricle. It opens to allow the oxygenated blood collected in the
left atrium to flow into the left ventricle. It closes as the left ventricle contracts, preventing blood from returning to the
left atrium; thereby, forcing it to exit through the aortic valve into the aorta.

Pulmonary Valve

The pulmonary valve separates the right ventricle from the pulmonary artery. As the ventricles contract, it opens to allow
the de-oxygenated blood collected in the right ventricle to flow to the lungs. It closes as the ventricles relax, preventing
blood from returning to the heart.

Aortic Valve

The aortic valve separates the left ventricle from the aorta. As the ventricles contract, it opens to allow the oxygenated
blood collected in the left ventricle to flow throughout the body. It closes as the ventricles relax, preventing blood from
returning to the heart.

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 Blood Flow through the Human Heart
The heart is the pump of the human circulatory system. The left side of the heart has two connected chambers,
the left atrium and the left ventricle. The right side of the heart also has two connected chambers, the right atrium and the
right ventricle. These two sides, or pumps, of the heart are not directly connected with one another.
Oxygenated blood from the lungs travels through large vessels called the pulmonary veins and enters the left side
of the heart, emptying directly into the left atrium. The pulmonary veins are unusual in that they carry oxygenated blood;
other veins, because they carry blood back to the heart from the body tissues, carry deoxygenated blood.

12
 From the left atrium, blood flows through a one-way valve, called the left atrioventricular valve (also known as
the bicuspid valve), into the left ventricle. Most of this flow- roughly 70%- occurs while the heart is relaxed. The atrium
then contracts, filling the remaining 30% of the ventricle with its blood.
After a slight delay, the ventricle contracts. The contraction forces the blood to exit into the opening that leads to
the largest artery in the body- the aorta. The atrioventricular valve closes and prevents the backflow of blood into the
atrium.
The aorta is closed off from the left ventricle by a one-way valve, the aortic semilunar valve. It is oriented to
permit the flow of the blood out of the ventricle, but it snaps shut in response to backflow.
Many arteries branch from the aorta, carrying oxygen-rich blood to all parts of the body. The pathway of blood
vessels to the body regions and organs other than the lungs is called the systemic circulation. The systemic circulation
brings blood to the neck and head and to organs in the rest of the body. The systemic circulation gives up oxygen to the
body tissues and receives carbon dioxide.
The blood that flows into the arterial system eventually returns to the heart after flowing through the capillaries.
As it returns, blood passes through a series of veins, eventually entering the right side of the heart. Two large veins
collect blood from the systemic circulation. The superior vena cava drains the upper body, and the inferior vena cava
drains the lower body. These veins dump deoxygenated blood into the right atrium.
Blood passes from the right atrium into the right ventricle through a one-way valve, the right atrioventricular
valve (also called as the tricuspid valve).
Blood passes out of the contracting right ventricle through a second valve, the pulmonary semilunar valve, into a
single pulmonary artery, sometimes called the pulmonary trunk, which subsequently branches into arteries that carry
deoxygenated blood to the lungs. The blood then returns from the lungs to the left side of the heart, replenished with
oxygen and cleared of much of its load of carbon dioxide.
The pumping of the heart is a repeated cardiac cycle of relaxation and contraction of the atria and ventricles.

13
DIAGNOSTIC EXAMINATIONS

14
LABORATORY INDICATION
TEST
Blood sugar
• Fasting  Obtained as supportive
Blood data in many diagnoses,
Sugar(FBS) because metabolic factors
will influence glucose use
and storage.
 Evaluate to diagnose and
manage patients diabetes
mellitus, and it is more
accurate than RBS.
Cholesterol  Used to identify
individuals at risk for
coronary artery disease
(CAD) and as an
evaluation tool to
determine the
effectiveness of “heart
healthy” changes in
lifestyle.
Triglycerides  Evalutes the body’s ability
to metabolize fats.
Blood Urea  Used to evaluate renal
Nitrogen(BUN) function.
Creatinine  Used to evaluate renal
(serum) function and to estimate
the effectiveness of
glomerular filtration.
RESULT NORMAL CLINICAL
RATE SIGNIFICANCE
210.8mg/dL 75-115mg/dL  The result of glucose
is increased, thus, tha
amount of sugar in
the patients blood is
higher and may
indicate Diabetes
Mellitus.
296.0mg/dL 150-  Elevated cholesterol
200mg/dL levels are known to
increase the risk of
CAD, and may rule
out the narrowing of
the blod vessels due
to cholesterol
blockage.
184.0mg/dL 36-165mg/dL  Increased level of
triglycerides
indicates risk for
arteriosclerosis.
 Increased level
indicates hypertension
and diabetes mellitus.
41.0mg/dL 10-50mg/dL  The result is in
normal range, thus,
the patients has a
good renal function.
1.3mg/dL 0.5-1.7mg/dL  The result is in
normal range thus,
it may indicate that
the kidneys are abl
to excrete urea and
protein, and her
kidneys are in good
condition.
15
Uric Acid  Used to confirm the
(Female) diagnosis of gout and helps
detect renal impairment that
causes Prerenal Azotemia
and Renal Failure
6.0 mg/dL 2.4 – 5.7  Increased level of
mg/dL uric acid signifies
Pt. is at risk for
having gout arthritis.

High Density  Used to identify individuals 35.4 mg/dL Ave. 65.0  Decreased level of
Lipoprotein at risk for Coronary Artery mg/dL HDL may indicate
(Female) Disease and as an risk for
evaluation tool to determine atherosclerotic
the effectiveness of “heart vessel disease.
healthy” changes and
lifestyle.

Low Density  Used to identify individuals
Lipoprotein at risk for Coronary Artery
(female) Disease and as an
evaluation tool to determine
the effectiveness of “heart
healthy” changes and
lifestyle.
223.6 mg/dL 65-175 mg/dL  Increased level of
LDL associate with
a greater incidence
of Coronary artery
disease.

Very Low  Used to identify individuals 36.8 mg/dL 0-40 mg/dL  The patient has
Density at risk for Coronary Artery normal VLDL
Lipoprotein Disease and as an therefore it signifies
evaluation tool to determine
the effectiveness of “heart
healthy” changes and
lifestyle.

DATE: July 15, 2010

16
LABORATORY INDICATION RESULT NORMAL RATE CLINICAL
TEST SIGNIFICANCE

Chest X-ray  Chest X-ray is Atheromatous The normal chest x-ray  The result indicates
done to screen aorta, otherwise (-) will show normal higher risk for
for a serious chest problem. structure of the age and coronary artery
pulmonary or medical history of the disease, because of
cardiac patient and no anatomic formation of plaque.
diseases. It is abnormalities will
also provides noted.
data about the
heart,
including it’s
size and shape.

Blood Sugar Monitoring

DATE TIME RESULT

7/14/10 6pm 63mg/dL
11pm 57mg/dL
7/15/10 5am 52mg/dL
8am 92mg/dL
11am 49mg/dL
1:15pm 147mg/dL
5pm 55mg/dL
6pm 70 mg/dL
11pm 54 mg/dL
7/16/10 5am 121 mg/dL
1pm 94 mg/dL
5pm 111 mg/dL
11pm 144 mg/dL
7/17/10 5am 127 mg/dL

DRUG STUDY

Name of drug indication Action contraindication Adverse Nursing responsibilities

reaction
Ranitidine Benign Reduces Hypersensitivity CNS: Assess vital signs
HCl gastric gastric acid to drugs and its headache.

17
 ulcer secretion component Monitor CBC and liver
Brand name: and GI: nausea, function test
Gavislat Erosive increases History of acute vomiting,
Zantac esophagitis gastric porphyria Caution patient to avoid driving
mucus and and other hazardous activities
Classification: bicarbonate until he knows how drug affects
Antacid production, concentration and alertness
creating a
1 amp IV q8 protective Tell patient that smoking may
coating on decrease drug effects
gastric
mucosa

Name of drug indication Action Adverse contraindication Nursing responsibilities

reaction
Amlodipine Essential Inhibits CNS: Hypersensitivit Monitor patient of
besylate hypertension, influx of headache y to drugs worsening of angina
chronic extracellular dizziness,
Brand name: stable angina calcium ions, GI: nausea, Monitor heart rate and
Norvasc pectoris and thereby abdominal rhythm of BP, especially
vasospastic decreasing discomfort at start of therapy
Classification: angina myocardial
Antihypertensive contractility, Respiratory: Assess for heart failure,
relaxing shortness of report sign and
10mg OD 1Tab coronary and breath, symptoms (peripheral
vascular dyspnea edema, dyspnea) to
muscles, and prescriber promptly.
decreasing
peripheral Caution patient to avoid
resistance driving and other
hazardous activities until
he knows how drug
affects concentration and
alertness

Name of drug indication Action Adverse contraindication Nursing

reaction responsibilities
Imidapril HCl Hypertension Prevents CNS: History of Monitor for sudden
conversion of headache, angioneurotic blood pressure drop
Heart failure angiotensin I to dizziness. edema within 3 hours of
Brand name: angiotensin II, initial dose if
Vasconde which leads to GI:nausea patient is receiving

18
 Norten vasoconstriction concurrent diuretics
and ultimately Respiratory: and on low-sodium
Classification: lower the blood dyspnea diet.
ACE inhibitor pressure .
5mg tab OD Also decreases Inform patient that
BP by dizziness, fainting,
increasing and light-
rennin headedness usually
secretions from disappear once his
kidney and body adjust to
reducing drug.
aldosterone
secretion from Tell paitient that
adrenal cortex. the ability to taste
Decreased may decrease
aldosterone during first 2-3
secretion months of therapy
prevents
sodium and
water retention

Name of indication Action Adverse contraindication Nursing responsibilities

drug reaction
Olmesartan H Selectively blocks CNS: Hypersensitivity Monitor VS and
medoxomil Y binding of angiotensin headache, to drug and its cardiovascular status.
P II to specific tissue dizziness component
Brand E receptors in vascular Watch for angioedema.
Name: R smooth muscle and GI: nausea
Benicar T adrenal gland. This Tell patient to take at
Olmetec E action blocks same time each day,
N vasoconstrictive effects with or without food.
Clasiificatio S of rennin-angiotensin
n: I system as well as Caution patient to avoid
Antihyperte O aldosterone release , driving and other
nsive N thereby reducing blood hazardous activities
OD 1 tab pressure and possibly until he knows how
preventing vascular drug affects
remodeling related concentration and
arteriosclerosis alertness

Name of drug indication Action contraindication Adverse Nursing responsibilities

reaction
Glipizide To control Lowers Hypersensitivity CNS: Monitor blood glucose level,
blood blood to drug headache, especially during periods of
Brand name: glucose in glucose level dizziness increased stress.
Glucotrol type 2 DM by Severe renal,
patient who stimulating hepatic, thyroid, GI: nausea, Evaluate CBC and renal

19
Classification: have some insulin or other vomiting function test
Hyploglycemic pancreatic release from endocrine dse.
80mg 2 Tabs function and pancreas, Teach patient how to
don’t increasing Uncontrolled recognize signs and
respond to insulin infectio, seroiu symptoms of hypoglycemia
diet therapy sensitivity at burns, or trauma and hyperglycemia
receptor
sites,and Diabetic Stress importance of diet
decreasing ketoacidosis and exercise to help control
hepatic diabetes.
glucose
production. Caution patient to avoid
Also driving and other hazardous
increases activities until he knows
peripheral how drug affects
tissue concentration and alertness
sensitivity to
insulin and
causes mild
dieresis.

Name of drug indication Action Adverse contraindication Nursing responsibilities

reaction
Citicoline Status Thought to limit CNS: Hypersensitivity Assess blood pressure
epilepticus seizure activity headache, to drug an its and heart rate especially
Brand name: by promoting atigue,dizzine component. during IV loading dose
Generalize sodium efflux ss, dowsiness
Classification: tonic-clonic from neurons in EvaluateCBC, kidney
CNS and complex motor cortex CV: chest and liver function test
stimulant partial and reducing pain
seizure activity in brain Caution patient not to
1g IV q12 stem centers stop therapy abruptly.
responsible for
tonic phase of
tonic-clonic
seizures.

Name of drug indication Action Adverse contraindication Nursing

reaction responsibilities
NitroglycerinManagement Inhibits CNS: Hypersensitivity Monitor for
and calcium dizziness, to drug other angina relief.
CLASSIFICATION: propjylaxis of transport into headache organic nitrates, Instruct patient to
antianginal angina myocardial nitrites or place SL tablet
pectoris and vascular adhesive. directly under

20
 smooth tongue and hold
muscles cells their as it
suppressing dissolves.
contractions.
Dilates main
coronary
arteries and
arterioles,
inhibits
coronary
artery
spasm,increase
oxygen
delivery to
heart and
reduces
frequency and
severity of
angina.

Mechanism of Nursing
I.V. Fluids Classification Indication Action Precaution
Hypertonic to replace provide sources instruct patient to
D5Lactated Ringer extracellular of water and report pain or
fluid electrolytes swelling at
&electrolyte infusion site
losses

Mechanism of Nursing
I.V. Fluids Classification Indication Action Precaution

PNSS Isotonic Administered to Replace body fluids Check the doctor’s

Plain Normal saline prevent and is the order regarding to
solution dehydration for safest fluid to give what type of IVF to

21
 patient who cannot quickly in large be used and also its
consume volumes volume and rate.
liquids and nutrients
by Before giving the
mouth and use as a loading dose, obtain
solvent for drugs the baseline data
that are (heart rate and
to be administered rhythm, B.P., and
parenterally electrolytes

Maintain sterility
when preparing
and administering
the
medication

Document the
procedure
and note the
patient’s reaction.

22
 PROGNOSIS

In the Philippines, 92 percent of Filipinos 20 years and above have at least one of the risk
factors that may soon lead to coronary artery disease if not addressed immediately. These risk
factors include diabetes, hypercholesterolemia (high cholesterol levels in the bloodstream),
obesity, high blood pressure and smoking. In addition the National Nutrition and Health Survey
(NNHeS) report also showed that 22 out of 100 Filipino adults are hypertensive (with blood
pressure of 140/90 or higher), and 40 percent of those between 20 and 29 already have
prehypertensive findings.

Prognosis is highly variable and depends on a number of factors related largely on

atherosclerotic plaques, the hallmark of atherosclerosis; progressively narrow the coronary artery
lumen. Prognosis is significantly worsened if a mechanical complication were to occur.
When patient X was brought to the hospital on July 14, 2010, she was complaining of chest pain.
Her doctor requested for laboratory test and Diagnostic examinations. After 3 days of confinement, the
patient displayed improvements on her condition. She is no longer experiencing chest pain with vital
signs taken as BP- 130/80; RR- 20; PR- 83; Temp. - 36.4 °C; and an Hgt of 127 mg/dL.
Overall, the prognosis is good. This is for the reason that the patient’s condition has been
improved. The patient is very willing to take all the available prescribed medications. The patient’s
willingness to comply with all the medical regimens that would possibly help her condition that normal
respiratory rate would be achieved. Regardless of lacks of the financial support, they prioritized need for
medical intervention and this is also with respect to the patient’s age. On the fourth day, the patient was
ordered for discharge.
At the completion of home care instructions, the patient and significant other will be able to:
• Reduce the probability of an episode of chest pain by balancing rest with activity:
• Avoid exercises requiring sudden burst of activity
• Avoid second-hand smoke (because it increases Blood Pressure)
• Eat diet low in saturated fat, high in fiber
• Achieve and maintain normal Blood Pressure and Blood Glucose Levels

• Achieve and maintain normal Take medications as prescribed:

• Normetec 5/20 mg 1 tab OD (2am)

• Vascoride 10/12 mg 1 tab OD (9am)

• Aspirin 80 mg 1 tab OD (1pm)

• Levofloxacin 500 mg 1 tab OD for 3 days (8am)

 • Diamicron MR 2 tab before breakfast (5am)

• Metformin 500 mg 1 tab BID (8am-6pm)

Three months after discharge, we went back to Mrs. X for follow up care. Mrs. X was in good
condition, she is still doing the health teachings that were instructed to her. The family is always there to
provide assistance and support the patient. Although this is the case the family still lacks assistance on
other matter such as financial aid. The help that patient gets from his daughter is not enough to sustain all
that should necessarily be done to achieve optimal health. She had a weekly check-up on Dr. Toledo’s
clinic and also Hgt monitoring done with her son.