Coronary Artery DiseaseCoronary Artery Disease

AnginaAngina

Case ScenarioCase Scenario

B.J. is a 37-year-old traveling B.J. is a 37-year-old traveling salesman, who is married with 3 salesman, who is married with 3 children. He visited his nurse children. He visited his nurse practitioner recent complaints of practitioner recent complaints of chest pain twice last week that chest pain twice last week that occurred while he was at work. occurred while he was at work. After consultation with a After consultation with a cardiologist, BJ is scheduled for a cardiologist, BJ is scheduled for a stress test. stress test.

Question # 1Question # 1

What is a stress test? How is What is a stress test? How is coronary artery disease diagnosed coronary artery disease diagnosed with this procedure?with this procedure?

Question # 2Question # 2

BJ’s cardiologist informed him that the results of his stress test indicate that he has angina.

What are the typical manifestations of angina?

Question # 3Question # 3

Distinguish between angina, atherosclerosis, and ischemia

Question # 4Question # 4

Distinguish between stable angina and unstable angina. When doing your nursing history, what kind of questions would you ask a patient in effort to determine whether s/he has stable angina or unstable angina.

Question # 5Question # 5

In light of his angina, BJ is given a prescription for nitroglycerin (NTG), a beta-blocker, and is scheduled for a coronary angiogram.

What is a coronary angiogram (i.e., coronary arteriogram)? How is it performed? How is coronary artery disease diagnosed with this procedure??

Question # 6Question # 6

What patient teaching should you What patient teaching should you provide BJ with respect to his provide BJ with respect to his upcoming coronary angiogram (most upcoming coronary angiogram (most frequently called cardiac frequently called cardiac catheterization)?catheterization)?

Question # 7Question # 7

You are assessing BJs You are assessing BJs understanding of how to use his understanding of how to use his nitroglycerin. What information nitroglycerin. What information would you be looking for to ensure would you be looking for to ensure that his understanding of how to that his understanding of how to use this medication is correct?use this medication is correct?

Case Scenario (cont’)Case Scenario (cont’) You are a nurse at the cardiac prevention and rehabilitation You are a nurse at the cardiac prevention and rehabilitation

center to which BJ was referred after his coronary center to which BJ was referred after his coronary angiogram. B.J.’s wife comes along to help him with healthy angiogram. B.J.’s wife comes along to help him with healthy lifestyle changes. You take the following nursing history:lifestyle changes. You take the following nursing history:• Father died of sudden cardiac death at 42 yrsFather died of sudden cardiac death at 42 yrs• His mother (still living) had a CABG x 4 (quadruple coronary His mother (still living) had a CABG x 4 (quadruple coronary

artery bypass graft) at age 52artery bypass graft) at age 52• Has HTN controlled with nifedipine (Procardia) 90 mg PO qd Has HTN controlled with nifedipine (Procardia) 90 mg PO qd

(takes regularly)(takes regularly)• Smokes average of 1.5 pack cigarettes/daySmokes average of 1.5 pack cigarettes/day• Drinks “occasional” beer (“a 6-pack every weekend)Drinks “occasional” beer (“a 6-pack every weekend)• Dietary history of fried and fast foodsDietary history of fried and fast foods• Weight: 235 lbsWeight: 235 lbs• Height: Height: 5'8“5'8“• Waist circumference 48”Waist circumference 48”• V/S: 138/88, 82, 18, V/S: 138/88, 82, 18, 37°37°

Question # 8Question # 8

Calculate B.J.’s smoking history in Calculate B.J.’s smoking history in terms of pack-years. terms of pack-years.

Question # 9Question # 9

List three non-modifiable risk factors List three non-modifiable risk factors for CAD. for CAD.

Question # 10Question # 10

3. List six modifiable risk factors for 3. List six modifiable risk factors for CAD. CAD.

Question # 11Question # 11

Underline each of the responses in Underline each of the responses in questions 1 and 2 that represent questions 1 and 2 that represent B.J.’s personal CAD risk factors. B.J.’s personal CAD risk factors.

Question # 12Question # 12

You would like to know more about You would like to know more about B.J.’s hyperlipidemia. What 4 B.J.’s hyperlipidemia. What 4 common laboratory values do you common laboratory values do you need to know? need to know?

Question # 13Question # 13

B.J. laughingly tells you he believes B.J. laughingly tells you he believes in the 5 all-American food groups: in the 5 all-American food groups: salt, sugar, fat, chocolate, and salt, sugar, fat, chocolate, and caffeine.caffeine.

Identify health-related problems in Identify health-related problems in this case description; the problem this case description; the problem that is potentially life-threatening that is potentially life-threatening should be listed first. should be listed first.

Question # 14Question # 14

Of all his behaviors, which one is the Of all his behaviors, which one is the most significant in promoting cardiac most significant in promoting cardiac disease?disease?

Question # 15Question # 15

What is the most important priority What is the most important priority problem that you need to address problem that you need to address with B.J.? Identify the teaching with B.J.? Identify the teaching strategy you would use with him. strategy you would use with him.

HINT: HINT: What What you you think is the most think is the most important may not be what important may not be what he he considers the most important, or the considers the most important, or the one he is willing to work on.one he is willing to work on.

Question # 16Question # 16

What is the second problem you What is the second problem you would work with B.J. to change? would work with B.J. to change? Identify an appropriate strategy to Identify an appropriate strategy to resolve the problem. resolve the problem.

Case Scenario (cont’)Case Scenario (cont’)

Six weeks after you start working Six weeks after you start working with B.J., he admits that he has been with B.J., he admits that he has been under a lot of stress. He rubs his under a lot of stress. He rubs his chest and says, “It feels really heavy chest and says, “It feels really heavy on my chest right now.” You feel his on my chest right now.” You feel his pulse and note that his skin is slightly pulse and note that his skin is slightly diaphoretic, and that he is agitated diaphoretic, and that he is agitated and appears to be very anxious.and appears to be very anxious.

Question # 17Question # 17

What are you going to do to obtain What are you going to do to obtain additional information? additional information?

Question # 18Question # 18

B.J. continues to feel symptomatic. B.J. continues to feel symptomatic. Now what are you going to do? Now what are you going to do?

Question # 19Question # 19

Use principles of oxygen supply and Use principles of oxygen supply and demand to explain how beta-demand to explain how beta-adrenergic blocking agents (i.e., adrenergic blocking agents (i.e., beta blockers) help prevent beta blockers) help prevent ischemia/angina.ischemia/angina.