General Objective:

The purpose of this study is to enhance and gain knowledge about HASCVD (Hypertensive arteriosclerotic cardiovascular disease), to develop communication and nursing skills, to provide privacy and maintain confidentiality of the patient and to apply the right attitudes of the student nurses in rendering and giving care to the patient with HASCVD (Hypertensive arteriosclerotic cardiovascular disease), its importance and implication.

Specific Objectives:

Understand condition of HASCVD (Hypertensive arteriosclerotic cardiovascular disease) and associate it with the patient through the introduction of the case.

To illustrate the Anatomy and Physiology to the affected organ or the part of the body.

To discuss the pathophysiology of the disease. To be clinically aware of the clinical manifestation and its complication. To develop an effective skill on how to plan and manage proper care in patient

with To formulate a drug study with regards to the patient’s condition. To correlate the laboratory result to its normal value. To provide the client nursing care plan and discharge plan to assure client’s total

wellness during his hospitalization up to the time of his hospital discharge. To apply right attitude by respect through providing privacy and maintaining

client’s confidentiality.

I. Introduction

A. Background of the Study

HASCVD (Hypertensive arteriosclerotic cardiovascular disease) is a fancy way of saying "blocked arteries secondary to cholesterol plaques and in the setting of hypertension." It describes a common clinical syndrome, where the walls of coronary (heart) arteries are lined with cholesterol plaques. The plaques have a tendency to grow slowly over time and narrow the arteries. Unfortunately, some of these plaques can suddenly burst open, blocking the artery completely. Such blocked artery leads to blood deprivation to the heart muscle, a phenomenon we all know as a heart attack.

It’s the progressive hardening of the arteries due to long standing hypertension. In this case cardiovascular arteries are hardened, compromising blood flow to the heart muscle and tissue. Complications include Angina Pectoris, MI (Heart Attack) and Heart failure.

B. Rationale for choosing the case

The group decided to choose the case of HASCVD (Hypertensive arteriosclerotic cardiovascular disease) to make a difference in the usual case presentations where in diseases are presented. To give us learning regarding the disease and to be able to know the nursing care appropriate for such case.

C. Significance of the Study

The significance of this study is to gain and enhance knowledge, to develop skills and to apply the right attitudes of student nurses in rendering and giving care to the

patient with HASCVD (Hypertensive arteriosclerotic cardiovascular disease), its importance and implication. This study will serve as guidelines in assessing and providing proper nursing care to patient with the same problem or disease.

These are other significance of the study that would support the above statement:1. Understand condition of HASCVD (Hypertensive arteriosclerotic cardiovascular

disease) and associate it with the patient through the introduction of the case.2. To know the Nursing history: Personal data, Health history and physical

assessment of the patient.3. Illustrate the anatomy and physiology and pathophysiology of the affected body

organ or system.4. Discuss and determine manifestations and complications.5. Apply effective skill on how to manage proper care in patient with HASCVD

(Hypertensive arteriosclerotic cardiovascular disease). Formulate a drug study of the drug’s that is being used for the patient’s treatment.

6. Correlate the lab result to its normal value.7. To formulate a nursing care plan and discharge plan to serve as guidelines for

patient’s continuous care during his hospitalization up to the time of his hospital discharge.

D. Scope of limitation of the study

The study would only focus on HASCVD (Hypertensive arteriosclerotic cardiovascular disease), its background, signs and symptoms and effects which is indicative to the client’s health condition and its underlying nursing care relevant for the client within the three week duty at MCDGH.

E. Conceptual and Nursing Theory

Theoretical Framework: Dorothea OremOrem Model of Nursing

Since the diagnosis of our patient is Hypertensive Arteriosclerotic Cardiovascular Disease, we relate Dorothea Orem theory of self care Model of Nursing. It is particularly used in rehabilitation and primary care setting where the patient is encouraged to be as independent as possible. The Orem model is based upon the philosophy that all "patients wish to care for themselves". They can recover more quickly and holistically if they are allowed to perform their own self cares to the best of their ability.

F. Related literature of the study

Related literature of the study

Hypertensive Arteriosclerotic Cardiovascular disease

Atherosclerosis (also known as Arteriosclerotic Vascular Disease or ASVD) is the condition in which an artery wall thickens as the result of a build-up of fatty materials such as cholesterol.

It is a syndrome affecting arterial blood vessels, a chronic inflammatory response in the walls of arteries, in large part due to the accumulation of macrophage white blood cells and promoted by Low-density lipoproteins (plasma proteins that carry cholesterol and triglycerides) without adequate removal of fats and cholesterol from the macrophages by functional high density lipoproteins (HDL), (see apoA-1 Milano). It is

commonly referred to as a hardening or furring of the arteries. It is caused by the formation of multiple plaques within the arteries.

Causes

Atherosclerosis develops from low-density lipoprotein molecules (LDL) becoming oxidized (ldl-ox) by free radicals, particularly oxygen free (ROS). When oxidized LDL comes in contact with an artery wall, a series of reactions occur to repair the damage to the artery wall caused by oxidized LDL. The LDL molecule is globular shaped with a hollow core to carry cholesterol throughout the body to generate brain tissues, vitamin D, and so on. Cholesterol can move in the bloodstream only by being transported by lipoproteins.

The body's immune system responds to the damage to the artery wall caused by oxidized LDL by sending specialized white blood cells (macrophages and T-lymphocytes) to absorb the oxidized-LDL forming specialized foam cells.

Atherosclerosis typically begins in early adolescence, and is usually found in most major arteries, yet is asymptomatic and not detected by most diagnostic methods during life. Atheroma in the arm, more often in leg arteries, which produces decreased blood flow, is called peripheral artery occlusive disease (PAOD).

Physiologic factors that increase risk

Various anatomic, physiological & behavioral risk factors for atherosclerosis are known.[8] These can be divided into various categories: congenital vs acquired, modifiable or not, classical or non-classical. The points labelled '+' in the following list form the core components of "metabolic syndrome".

Treatment

If atherosclerosis leads to symptoms, some symptoms such as angina pectoris can be treated. Non-pharmaceutical means are usually the first method of treatment, such as cessation of smoking and practicing regular exercise. If these methods do not work, medicines are usually the next step in treating cardiovascular diseases, and, with improvements, have increasingly become the most effective method over the long term. However, medicines are criticized for their expense, patented control and occasional undesired effects.

II. Clinical Summary

A. General Data Profile

Name: Mrs. X

Address: Brgy. Market View 2 Calumpit St. Lucena, City

Birthday: December 12, 1937

Birth Place: Lucban, Quezon

Spouse Name: Rommel Abuan

Nationality: Filipino

Religion: Roman Catholic

Occupations: House Wife

Date of admission: January 19, 2010

Admitting Diagnosis: Hypertensive Arteriosclerotic Cardiovascular Disease

Admitting Physician: Dr. Ma. Delta A. Canela

 

B. Chief Complaint

Prior to admission the patient experienced dizziness and vertigo.

C. Nursing History

1. History of present Illness

a. Childhood illness/ Manifestationsb. Immunizationsc. Allergiesd. Accidentse. Hospitalizationsf. Medication used or currently takingg. Domestic Travel

E. Social History – Include Theories of Growth and Development

PSYCHOSOCIAL THEORY ACCORDING TO ERIK ERIKSONSTAGE AGE CENTRAL

TASKINDICATORS OF POSITIVE RESOLUTION

INDICATORS OF NEGATIVE RESOLUTION

Maturity 65 to death Ego integrityVs

Despair

Older adults need to look back on life and feel a sense of fulfilment. Success at this stage leads to feeling of wisdom

Failure at this stage results in regret, bitterness, and despair.

According to this theory maturity had acceptance of worth and uniqueness of one’s own life. They look back on life and feel sense of fulfilment. Acceptance of death occurs. Based on our interview with the patient, we found out that the theory of Erikson correlates with the information that we’ve gathered to the patient, because according to her she accepts whatever may happen to her. She only believes that God is always beside her and she knows that having great faith in him, everything will be alright.

ACCORDING TO SIGMUND FREUD’S THEORY ON PSYCHOSEXUAL DEVELOPMENT

STAGE AGE CHARACTERISTICS IMPLICATION

Genital Puberty and after Energy is directed toward full sexual maturity and function and development of skills needed to cope with the environment.

Encourage separation from parents, achievement of independence, and decision makings.

According to this theory, the genital stage correlates to her stage because she already achieves independence and decision making when it comes to her health and family. Now she feels much fulfilled with her life and have strong faith with God.

F. Environment/Living Condition

The client lives in a village where the environment is said to be clean. They have a little garden in their backyard where they grow different kinds of flowers. Their way of disposing garbage is collected by the city garbage collector. The water that they use for bathing, dishwashing and laundry came from metropolitan water district while they buy the water that they drink from a refilling station. There location is accessible to a hospital, school, church and mall.

G. Physical Assessment

PARAMETERS NORMAL FINDINGS ACTUAL FINDINGS INTERPRETATIONGeneral Appearance -Clean in appearance

and well groomed- Cooperative

-weak in appearance- Cooperative-not well groomed

The patient is weak in appearance due to accident and not well groomed.

Skin -With good skin turgor - with good skin turgor-warm to touch-skin is dry with a minimum of perspiration- with hematoma on the right cheeks - With slight swelling on her left arm.

- Due to the accident she encountered.

Hair -Evenly distributed hair -Thick hair

-Evenly distributed

-Thin hair

- because of age

Nails -With good capillary refill of 1-2 seconds-with pinkish nail beds-with clean and short nails

- With good capillary refill of 1-2 seconds-with slightly pale nail beds-with dirty and long nails in both hands and feet- with nail polish on toe nails

- Patient has a good capillary refill which indicates good circulation. With dirty long nails in both hands and feet which indicates poor hygienic care.

Skull & Face -Mount uniform -Mount uniform - Patient has a slight

consistency absence of nodules and masses -Rounded smooth skull contour-Symmetrical facial movement

consistency absence of nodules and masses-Rounded smooth skull contour-Symmetrical facial movement-with slight hematoma on right cheeks

hematoma on right cheeks because of the accident.

Eyes -No eye discharge-With anicteric sclera-Eyebrows hair evenlydistributed/skin intact -(+) blink reflex -With pinkish conjunctive

-No eye discharge-with jaundice sclera-Eyebrows hair evenly distributed/skin intact-(+) blink reflex-with slightly pale conjunctive

- Patient has pale conjunctive maybe due to weakness and fatigue because of the pain she feels on her left arm.

Ears -Auricle colour same as facial skin-Auricle are mobile firm and not tender-Able to hear on both ears

-Auricle colour same as facial skin-Auricle are mobile firm and not tender-Able to hear on both ears

Mouth -Pinkish lips-Without missing teeth-With pink gums-No foul odour-With symmetrical contour

-slightly pale lips-with missing teeth-with pinkish gums-without foul odour-with symmetrical contour

Musculosketal (Upper & Lower extremities

-symmetrical-No atrophy-With full range of motion

-symmetrical-no atrophy-with arm sling and splint on left arm-with poor range of motion- with slight defect on her right leg- with limited range of motion on the left arm

- Due to massive and greater force on the injured part due to fracture.

Abdomen -No abdominal distention-Flat rounded abdomen-Symmetrical contour-No surgical incision

-no abdominal distention-flat rounded abdomen-symmetrical contour-no surgical incision

H. Patterns of Functioning

Functional Health Pattern Before Hospitalization

During Hospitalization

Interpretation

Health Management Self medication

Monthly check-ups

Treatment The patient has accepted that he needs medical attention

because of his condition

Nutritional/Metabolica. number of meals per day

b. appetite

c. glass of water per day

d. body built

e. height and weight

4 times a day

w/ good appetite

8 glasses of water

w/ normal body built

5’0” feet

135 pounds

3 times a day

w/ fair appetite

2 glasses of water

Weak in appearance

5’0”

130 pounds

The patient still eats normally each day but her appetite decreased and his fluid intake has also decreased resulting to slightly change to her body size.

Eliminationa. frequency of urination

b. amount of urine per day

c. frequency of bowel movement

d. consistency of the feces

e. amount defecated per day

3-5 times per day

Moderate

Once a week

Formed

Moderate

2-3 times per day

Moderate

Not at all

The frequency of his urination decreased but still with same amount. Her bowel movement is abnormal though she said from the very start her bowel movement is like that. This maybe caused by her decreased fluid intake and afraid of moving due to her affected arm.

Activity and Exercisea. exercise

b. fatigability

c. ADL

Walking,

Easy to get tired

gardening cleaning the

house doing the

laundry

unable to walk due to weakness

easy to get tired

can’t do all the activities of daily living due to her accident

This is due to her condition and being afraid of moving because of her affected arm.

cooking taking care

of her grand daughter

active member of the church

on her left arm

Cognitive/Perceptuala. orientation

b. responsiveness

Oriented to time, place and person

Responds appropriately to verbal and physical stimuli

Oriented to time, place and person

Responds appropriately to verbal and physical stimuli

Roles/Relationshipa. as a daughter

b. as a sister

c. as a wife

d. as a mother

With good relationship to her parents when still living

With good relationship to his sisters and brothers

With good relationship to her husband when he is still alive

With good relationship with her sons and daughters.

With good relationship to her parents when still living

With good relationship to his sisters and brothers

With good relationship to her husband when he is still alive

With good relationship with her sons and daughters.

Self Perception/Self Concept

Have a high self worth/importance

Have a high self worth/importance

Coping Stress She seeks peace of mind by reading her

She seeks peace of mind by reading her

bible or watching her favourite tv shows when she has problems, burdens and stresses. She also trusts God in everything she does.

bible or watching her favourite tv shows when she has problems, burdens and stresses. She also trusts God in everything she does.

Values/Beliefs She has awareness that God really exist and have strong faith in him

When there is still life there is hope

Believe more in medical sciences than such folk beliefs when it comes to health

She has awareness that God really exist and have strong faith in him

When there is still life there is hope

Believe more in medical sciences than such folk beliefs when it comes to health

I. Course in the ward

Jan.19, 2010

Jan.20, 2010

Jan.21, 2010

J. Laboratory Diagnostic Exam

HEART DIAGNOSTIC TEST

DIMENSION PATIENT NORMAL FUNCTION PATIENT NORMALLV (ed) 4.2 (4.5-5.0) LVEPVLV (es) 3.0 LVESVRV (ed) 3.1 (2.2-3.5) Stoke

Volume44 ml

LA (es) 3.1 (3.0-3.5) C. O. 2.0 l/minRA (es) 3.1 3.5 EF % 55.0 % (55-77.0)Aorta 2.9 3.5 FS % 28.0 % (28-92.0)PA 2.5 3 VCF (0.8-1.5)

IVS (ed) 1.1 (0.8-1.1) EPSS (< 195)IIS (es) 1.3 Wall stress

(S)( < OOD )

LVP W (ed) 1.1 (0.8-1.1) Wall stress (D)

LVPW (es) 1.3 LVWMSI 1MV ANNU LVTD 1.7

Interpretation

Normal left ventricle dimension with mild hypokinesia of the asterior interventicular septum from base to apex. The rest of LV segments have adequate wall motion and contractility. Normal RV dimension of adequate wall motion and contractility. Normal LV and RA dimension thickened mitral valve and chordae without restriction of motion. Thickened aortic cups without restriction of motion, Aortic annular calcification. Structurally normal tricuspid valve and pulmonic valve of good opening and closing motion.

TEST RESULT NORMAL RESULTCreatinine .8 mg/dl .5-1.0

Sodium 141. mnol/l 137.- 145

Potassium 4.2 mnol/l 3.5- 5.1

RBS RESULT

K. Impression/Diagnosis

HASCVD (Hypertensive ArterioSclerotic Cardiovascular Disease), Hypertension, Essential Stage 2 uncontrolled Dyslipidemia, BPPV (Benign Paroxysmal Positional Vertigo)

III. Clinical Discussion of the Disease

1. ANATOMY and PHYSIOLOGY

The heart is a hollow muscular organ of a somewhat conical form; it lies between the lungs in the middle mediastinum and is enclosed in the pericardium. It is placed obliquely in the chest behind the body of the sternum and adjoining parts of the rib cartilages, and projects farther into the left than into the right half of the thoracic cavity, so that about one-third of it is situated on the right and two-thirds on the left of the median plane.     Size. The heart, in the adult, measures about 12 cm. in length, 8 to 9 cm. in breadth at the broadest part, and 6 cm. in thickness. Its weight, in the male, varies from 280 to 340 grams; in the female, from 230 to 280 grams. The heart continues to increase in weight and size up to an advanced period of life; this increase is more marked in men than in women

Component Parts. The heart is subdivided by septa into right and left halves, and a constriction subdivides each half of the organ into two cavities, the upper cavity being called the atrium, the lower the ventricle. The heart therefore consists of four chambers, right and left atria, and right and left ventricles.   

 The division of the heart into four cavities is indicated on its surface by grooves. The atria are separated from the ventricles by the coronary sulcus (auriculoventricular groove); this contains the trunks of the nutrient vessels of the heart, and is deficient in front, where it is crossed by the root of the pulmonary artery. The interatrial groove, separating the two atria, is scarcely marked on the posterior surface, while anteriorly it is hidden by the pulmonary artery and aorta. The ventricles are separated by two grooves, one of which, the anterior longitudinal sulcus, is situated on the sternocostal surface of the heart, close to its left margin, the other posterior longitudinal sulcus, on the diaphragmatic surface near the right margin; these grooves extend from the base of the ventricular portion to a notch, the incisura apicis cordis, on the acute margin of the heart just to the right of the apex.

RESULT NORMAL VALUE150 -100

BLOOD FLOW THROUGH THE HEART

1. Deoxygenated blood returning from the body enters the heart through the superior vena cava and inferior vena cava.

2. Blood passes into the right atrium and right ventricle

3. Right ventricle pushes the blood through the pulmonary arteries

4. Blood passes through the lungs where it loses carbon dioxide and picks up oxygen

5. This oxygenated blood returns to the heart via the pulmonary veins

6. Blood enters the left atrium and left ventricle

7. The left ventricle pushes the blood out through the main artery, the aorta

8. Blood travels to all parts of the body where it delivers oxygen and picks up carbon dioxide

THE CORONARY ARTERIES branch from the aorta as soon as it emerges from the heart (please see diagram of the heart at left). They deliver oxygenated blood the the heart muscle. Coronary artery disease (or coronary heart disease) involves the buildup of deposits in these crucial vessels. This reduces and sometimes completely blocks the flow of blood resulting in a heart attack

ARTERIES: are vessels that take blood away from the heart VEINS: are vessels that bring blood towards the heart ATRIUM: smaller chamber of the heart through which blood enters the heart VENTRICLE: larger chamber of the heart which pushes blood away from the

heart AORTA: major artery carrying blood away from the left ventricle VENA CAVA: main vein returning blood to the right atrium CORONARY ARTERIES: the first vessels to branch from the aorta; they

supply blood to the heart muscle

b. Pathophysiologyi. book basedii. client based

c. Drug Study

IV. Nursing Process

A. Long term objectives

B. Prioritized list nursing problems

C. NCP

D. Discharge Plan

METHOD

Medications:

• Metoprolol 50mg 1tab twice a day (8am-6pm) • Amlodipine 10mg 1 tab once a day (8pm)• Telmisartan (Pritor) 80mg 1tab once a day (8am)• Betahistine (Serc) 16mg 1 tab thrice a day (8am-1pm-6pm)• Atorvastatin (Lipitor) 80mg 1tab once a day at hours of sleep (8pm) • Advise patient to take the prescribed medications continuously at home • Always check the expiration date of the medicine before taking.

Environment:

• Avoid crowded areas, especially during cold and flu season• Avoid close contact with anyone who is ill.• Provide safety measure to promote safe environment and individual safety• Sanitary handling of food and water

Treatment:

• Eating a healthy diet, including the DASH diet (eating more fruits, vegetables, and low fat dairy products, less saturated and total fat).

• Reducing the amount of sodium in your diet to 2,300 milligrams (about 1 teaspoon of salt) a day or less.

• Getting regular aerobic exercise (such as brisk walking at least 30 minutes a day, several days a week).

• Limiting alcohol to two drinks a day for men, one drink a day for women. • In addition to lowering blood pressure, these measures enhance the

effectiveness of high blood pressure drugs. • Angiotensin-converting enzyme (ACE) inhibitors • Angiotensin || receptor blockers (ARBs)• Diuretics • Beta-blockers • Calcium channel blockers

Health Teachings:

• Teach the patient to use a self-monitoring blood pressure cuff and to record the reading at least twice a week.

• Tell the patient to take his blood pressure at the same hour each time, without more than usually activity preceding the measurement.

• Tell the patient and family to keep a record of drugs used in the past. • To encourage compliance with antihypertensive therapy, suggest establishing a

daily routine for taking medication. Warn the patient that uncontrolled hypertension may cause stroke and heart attack. Tell him to report any adverse reactions to prescribed drugs. Advise him to avoid high-sodium antacids and over-the-counter cold and sinus medications containing harmful vasoconstrictors.

• Help the patient examine and modify his lifestyle behavior. • Suggest stress-reduction groups, dietary changes, and an exercise program. • Encourage a change in dietary habits. Help the obese patient plan a reducing

diet. • Tell to the patients to avoid high-sodium foods, table salt, and foods high in

cholesterol and saturated fat. • Encourage a change in dietary habits. Help the obese patient plan a reducing

diet.

• Tell to the patients to avoid high-sodium foods, table salt, and foods high in cholesterol and saturated fat.

Out Patient Referral Check-up:

After discharge, advise patient to come back to specified date said by the physician.

Diet:

reduction of sodium intake moderation of alcohol weight loss in the obese possibly increasing potassium and calcium intake ingestion of a vegetarian diet or fish oil supplements.