PR AC

S
ES E
AT E
Coronary Artery DiseaseIO TN
Congestive Heart Failure
HyPertensioN
Arellano University
Main
N Group # 40 Cluster 1- IIIDiuretics
Mr. Rogelyn Edrada RN
Clinical Instructor – Ospital ng Sampaloc –
 i. INTRODUCTION
CORONARY ARTERY
DISEASE
Also known as Coronary (CAD)
Heart Disease (CHD)
 Single largest killer in America as of 2008 (WHO)
 AA and Hispanics women have higher CAD risk
factors
 CAD risk factors: HTN, smoking, high cholesterol,
ANGINA PECTORIS
Temporary imbalance obesity, DMcoronary
between the
arteries’ ability to supply oxygen and the cardiac
muscle’s demand for oxygen
Ischemia that occurs with angina is limited in
duration and does not cause permanent damage
of tissue
3 types: Stable angina; Unstable angina,
Prinzmetal
Group # 40 Cluster 1- IIIDiuretics
Arellano University Mr. Rogelyn Edrada RN
Main Clinical Instructor – Ospital ng Sampaloc –
 STABLE ANGINA
 Chest discomfort that occurs with moderate to prolonged
exertion in a pattern that is familiar to the client
 Frequency, duration and intensity of symptoms remain stable
over the preceding several months
 Results in only slight limitation of activity
 Associated with stable atherosclerotic plaque
 Usually relieved by Nitroglycerin or rest and managed
medically with medication such as calcium channel blockers and
beta=blocking medications

OUTCOME MANAGEMENT FOR CHRONIC STABLE ANGINA

 Aspirin
 Beta-blockers
 Smoking cessation and lowering cholesterol
 Diet
 Exercise

Group # 40 Cluster 1- IIIDiuretics

Arellano University Mr. Rogelyn Edrada RN
Main Clinical Instructor – Ospital ng Sampaloc –
  Part of the Acute Coronary Syndrome (ACS) which also
UNSTABLE
includes MI ANGINA
 Atherosclerotic plaque in the coronary artery ruptures,
resulting in platelet aggregation, thrombus formation and
vasoconstriction
 Between 10%-30% of clients with unstable angina progress
to having an MI within 1 year of onset and 29% diet of MI
within 5 years of the disease
 Occurs with rest or with exertion and causes marked
limitation of activity
 Last longer than l5 minutes or may be poorly relieved by
MYOCARDIAL INFARCTION
rest or nitroglycerin
 Common cause is complete or nearly complete occlusion
of coronary artery
 There is a rupture of a vulnerable atherosclerotic plaque
and thrombus formation
 Untreated angina can lead to a heart attack
 Myocardial tissue is abruptly and severely deprived of
oxygen
 Ischemia develops which leads to injury and necrosis
Group # 40 Cluster 1- IIIDiuretics
Arellano University Mr. Rogelyn Edrada RN
Main Clinical Instructor – Ospital ng Sampaloc –
 CONGESTIVE HEART FAILURE
Congestive heart failure is a major chronic disease for older adults,
accounting for about 260,000 deaths a year. The majority of the nearly 5
million U.S. patients with heart failure are older than 65 years. In 1995, $3.4
billion was paid by Medicare for heart failure. As the "baby boomers" age
during the next 40 years, the number of heart failure patients older than 65
is expected to double.
 It is a major chronic disease for older adults, accounting for about 260,000
deaths a year. The majority of the nearly 5 million U.S. patients with heart
failure are older than 65 years. In 1995, $3.4 billion was paid by Medicare for
heart failure. As the "baby boomers" age during the next 40 years, the
number of heart failure patients older than 65 is expected to double.
 People diagnosed with chronic heart failure (CHF) can live longer and be
more active, as long as CHF is diagnosed early and treated properly.
Treatment hinges on two factors, heart failure type, and level of severity. A
doctor will frequently use a three-pronged attack in treating CHF, using
medicines, ongoing patient care, and lifestyle adjustments. In this way,
certain goals can be met:
Improve quality of life, increased lifespan
Reduction of symptoms
Stop progress of heart failure
Treat root causes of failure, like high blood pressure, artery disease

Group # 40 Cluster 1- IIIDiuretics

Arellano University Mr. Rogelyn Edrada RN
Main Clinical Instructor – Ospital ng Sampaloc –
 HYPERTENSION
Hypertension is a chronic medical condition in which the blood pressure is
elevated. It is also referred to as high blood pressure or shortened to HT, HTN
or HPN. The word "hypertension", by itself, normally refers to systemic,
arterial hypertension.
Hypertension can be classified as either essential (primary) or
secondary. Essential or primary hypertension means that no medical cause
can be found to explain the raised blood pressure. It is common. About 90-
95% of hypertension is essential hypertension. Seconary hypertension
indicates that the high blood pressure is a result of (i.e., secondary to)
another condition, such as kidney disease or adrenal adenoma or
pheochromocymotoma).
Persistent hypertension is one of the risk factors for strokes, heart
attacks, heart failures and arterial aneurysm, and is a leading cause of
chronic renal failure. Even moderate elevation of arterial blood pressure
leads to shortened life expectancy. At severely high pressures, defined as
mean arterial pressures 50% or more above average, a person can expect to
live no more than a few years unless appropriately treated. Beginning at a
systolic pressure (which is peak pressure in the arteries, which occurs near
the end of the cardiac cycle when the ventricles are contracting) of
115 mmHg and diastolic pressure (which is minimum pressure in the arteries,
which occurs near the beginning of the cardiac cycle when the ventricles are
filled with blood) of 75 mmHg (commonly written Group #as40115/75 mmHg),
Cluster 1- IIIDiuretics
Arellanocardiovascular
University disease (CVD) risk doubles for eachMr. increment of
Rogelyn Edrada RN
Main 20/10 mmHg.
Clinical Instructor – Ospital ng Sampaloc –
 ii. obJECTIVES
General
At the end of the case presentation, there will be able an
acquisition in the knowledge, skills, and attitude of delivering holistic
care for patient diagnosed with CAD, CHF & Hypertension.
Specific
At the end of the case presentation, the participants will be able to:
 Discuss the anatomy and physiology of cardiovascular system.
 Define and be familiarized with the 3 diseases.
 Learn about major etiologic cause of these 3 disease processes.
 Know the different drugs and their actions and perform necessary
nursing responsibility for each drug.
 Know the pathophysiology and identify clinical manifestation and
risk factors of CAD,CHF & Hypertension.
 Formulate a nursing care plan applicable to a patient with CAD,CHF
& Hypertension.
 Identify the medical and surgical management appropriate for
these 3 dse. Conds..
 Establish a nurse patient interaction through exchanging of
information. Group # 40 Cluster 1- IIIDiuretics
Arellano University Mr. Rogelyn Edrada RN
Main Clinical Instructor – Ospital ng Sampaloc –
 iii. Theoretical framework
Nursing Theory
Foundation of any profession is the development of a specialized
body of knowledge. Theories should be developed in nursing, not borrow
theories form other disciplines.
HILDEGARD PEPLAU’S INTERPERSONAL RELATIONS MODEL
Based on psychodynamic nursing
using an understanding of one’s own behavior to help others identify their
difficulties
Applies principles of human relations
Patient has a felt need
Person
An individual; a developing organism who tries to reduce anxiety caused by needs
Lives in instable equilibrium
Environment- Not defined
Health
Implies forward movement of the personality and human processes toward
creative, constructive, productive, personal, and community living
Nursing
A significant, therapeutic, interpersonal process that functions cooperatively with
others to make health possible
Involves problem-solving

Group # 40 Cluster 1- IIIDiuretics

Arellano University Mr. Rogelyn Edrada RN
Main Clinical Instructor – Ospital ng Sampaloc –
 iV. CLIENT’S PRESENTATION
a. Patients profile
Clients Initials: R.M. Rm./Wd.503,General Ward Date
admitted: Nov. 23, 2009 Address: Arlequi St. Quiapo
Manila Age: 65 y/o Sex: male
Nationality: Filipino Religion: Roman Catholic Educational
Attainment: High School Graduate Civil Status: Widower
Admission Complaint/s: Dsypnea Admitting V/S: BP:
200/100 mmHg HR: 142 bmp RR: 36
b. History
Family: N/A
Past Medical History: Mr. R.M stated that he have asthma and
Positive Tuberculosis
History of Present Illness: Mr. R.M. stated that
before his admission he already has difficulty of breathing.
Positive palpitation and positive chest pain ADL before and during
hospitalization: His usual daily activities include walking for
exercise, reading news paper, watching television.

Group # 40 Cluster 1- IIIDiuretics

Arellano University Mr. Rogelyn Edrada RN
Main Clinical Instructor – Ospital ng Sampaloc –
 iV. CLIENT’S PRESENTATION
a. Patients profile
Clients Initials: R.M. Rm./Wd.503,General Ward Date
admitted: Nov. 23, 2009 Address: Arlequi St. Quiapo
Manila Age: 65 y/o Sex: male
Nationality: Filipino Religion: Roman Catholic Educational
Attainment: High School Graduate Civil Status: Widower
Admission Complaint/s: Dsypnea Admitting V/S: BP:
200/100 mmHg HR: 142 bmp RR: 36
b. History
Family: N/A
Past Medical History: Mr. R.M stated that he have asthma and
Positive Tuberculosis
History of Present Illness: Mr. R.M. stated that
before his admission he already has difficulty of breathing.
Positive palpitation and positive chest pain ADL before and during
hospitalization: His usual daily activities include walking for
exercise, reading news paper, watching television.

Group # 40 Cluster 1- IIIDiuretics

Arellano University Mr. Rogelyn Edrada RN
Main Clinical Instructor – Ospital ng Sampaloc –
 iV. CLIENT’S PRESENTATION
c. Physical Assessment – cephalocaudal
Skin- dry skin, various interruptions in skin integrity
Skull- rounded, no tenderness
Scalp- no lesion, no tenderness nor
masses Hair- black, dry hair and
thin Face- symmetrical, have
involuntary movements Eyes- no discharge,
equal movement, hair evenly distributed, skin intact Ears- ear
lobes are bean shaped, parallel and symmetrical, skin is same
color as in the complexion
Nose- symmetric and straight, have discharge from
nares Mouth- lips is dry, teeth is brown and
there are part that is color brown, discoloration of the enamel
Neck- straight, no
mass or lumps, symmetrical Breast- no
lumps or masses, no tenderness Abdomen-
skin color is uniform no lesions, no tenderness
Extremities- both extremities are equal in size, temperature is
warm and even, have bipedal edema

Group # 40 Cluster 1- IIIDiuretics

Arellano University Mr. Rogelyn Edrada RN
Main Clinical Instructor – Ospital ng Sampaloc –
 V. Anatomy & physiology

Group # 40 Cluster 1- IIIDiuretics

Arellano University Mr. Rogelyn Edrada RN
Main Clinical Instructor – Ospital ng Sampaloc –
 V. Anatomy & physiology
A closed system of the heart and blood vessels
The heart pumps blood
Blood vessels allow blood to circulate to all parts of
the body
The function of the cardiovascular system is to deliver
oxygen and nutrients and to remove carbon dioxide
and other waste products
Pericardium – a double serous membrane
Visceral pericardium
Next to heart
Parietal pericardium
Outside layer
Serous fluid fills the space between the layers of
pericardium
Group # 40 Cluster 1- IIIDiuretics
Arellano University Mr. Rogelyn Edrada RN
Main Clinical Instructor – Ospital ng Sampaloc –
 V. Anatomy & physiology
HEART WALLS
Three layers
Epicardium
Outside layer
This layer is the parietal pericardium
Connective tissue layer
Myocardium
Middle layer
Mostly cardiac muscle
Endocardium
Inner layer
Endothelium

Group # 40 Cluster 1- IIIDiuretics

Arellano University Mr. Rogelyn Edrada RN
Main Clinical Instructor – Ospital ng Sampaloc –
 V. Anatomy & physiology

Group # 40 Cluster 1- IIIDiuretics

Arellano University Mr. Rogelyn Edrada RN
Main Clinical Instructor – Ospital ng Sampaloc –
 V. Anatomy & physiology
CHAMBERS:
• Right and left side act as separate pumps
• Four chambers
• Atria
• Receiving chambers
• Right atrium
• Left atrium
• Ventricles
• Discharging chambers
• Right ventricle
• Left ventricle
Group # 40 Cluster 1- IIIDiuretics
Arellano University Mr. Rogelyn Edrada RN
Main Clinical Instructor – Ospital ng Sampaloc –
 V. Anatomy & physiology
Right and left side act as separate pumps
Four chambers
Atria
Receiving chambers
Right atrium
Left atrium
Ventricles
Discharging chambers
Right ventricle
Left ventricle

Group # 40 Cluster 1- IIIDiuretics

Arellano University Mr. Rogelyn Edrada RN
Main Clinical Instructor – Ospital ng Sampaloc –
 V. Anatomy & physiology

Group # 40 Cluster 1- IIIDiuretics

Arellano University Mr. Rogelyn Edrada RN
Main Clinical Instructor – Ospital ng Sampaloc –
 V. Anatomy & physiology
VALVES
Allow blood to flow in only one direction
Four valves
Atrioventricular valves – between atria and ventricles
Bicuspid valve (left)
Tricuspid valve (right)
Semilunar valves between ventricle and artery
Pulmonary semilunar valve
Aortic semilunar valve

Group # 40 Cluster 1- IIIDiuretics

Arellano University Mr. Rogelyn Edrada RN
Main Clinical Instructor – Ospital ng Sampaloc –
 V. Anatomy & physiology
Valves open as blood is pumped through
Held in place by chordae tendineae (“heart
strings”)
Close to prevent backflow

Group # 40 Cluster 1- IIIDiuretics

Arellano University Mr. Rogelyn Edrada RN
Main Clinical Instructor – Ospital ng Sampaloc –
 V. Anatomy & physiology

Group # 40 Cluster 1- IIIDiuretics

Arellano University Mr. Rogelyn Edrada RN
Main Clinical Instructor – Ospital ng Sampaloc –
 V. Anatomy & physiology

Group # 40 Cluster 1- IIIDiuretics

Arellano University Mr. Rogelyn Edrada RN
Main Clinical Instructor – Ospital ng Sampaloc –
 vI. Pathophysiology
(Please refer to the MS Word
documents)

Group # 40 Cluster 1- IIIDiuretics

Arellano University Mr. Rogelyn Edrada RN
Main Clinical Instructor – Ospital ng Sampaloc –
 VII. LABORATORY AND
DIAGNOSTIC EXAMINATION

Group # 40 Cluster 1- IIIDiuretics

Arellano University Mr. Rogelyn Edrada RN
Main Clinical Instructor – Ospital ng Sampaloc –
 VIII. Nursing care plan

Group # 40 Cluster 1- IIIDiuretics

Arellano University Mr. Rogelyn Edrada RN
Main Clinical Instructor – Ospital ng Sampaloc –
 ix. Nursing care plan

Group # 40 Cluster 1- IIIDiuretics

Arellano University Mr. Rogelyn Edrada RN
Main Clinical Instructor – Ospital ng Sampaloc –
 M- The patient take home medicines such as Lanoxin, Furosemide,   
Aldactone, Amlodipine, Omepazole, and Cefazoline.
Advise to take the entire course of any prescribed medications.
 
E- Get plenty of rest. Adequate rest is important to maintain
progress toward full recovery. It is helpful also tom have a ROM
exercise to help the patient to prevent joint immobility and
muscle cramping.
 
T- The patient has IV therapy (PNSS).
 
H- Provide health education to the client concerning health status
and medications.
 
O- Emphasize the importance of regular follow up visits. Remind the
patient to keep all follow up appointments, even though the
patient feels better it is important to have the doctor monitor his
progress..
 

D- The patient is on DAT diet.

Group # 40 Cluster 1- IIIDiuretics

Arellano University Mr. Rogelyn Edrada RN
Main Clinical Instructor – Ospital ng Sampaloc –
 VIII. MEDICAL AND SURGICAL
MANAGEMENT
PTCA – Percutaneous Transluminal Coronary
Angioplasty
Done to compress the plaque against the vessel wall.
Increasing the arterial lumen

CABG – Coronary Artery Bypass Graft

To improve the bloodflow to the myocardial tissue

Group # 40 Cluster 1- IIIDiuretics

Arellano University Mr. Rogelyn Edrada RN
Main Clinical Instructor – Ospital ng Sampaloc –