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1. Instructor : Mrs: Zainab
DONE BY
FAISAL AL-ATIBI
ABDULAZIZ AL-SHAMRANI
ABDUL-KAREM ALI

2. Name of patient
Atiah Atitullah AL-Shaikhi
He is 73 old . He is Married
Level Education : Secondary school
Admitted to hospital 14/4/2012
up Smoker or not : was a smoker he gives
smoking
Length : 161cm
Weight : 61kg

3. Chief Complaints
- Coronic Arty dieses
* Present Complaint
- Cough
Medical Diagnosis
- CAD
* Medical history
- DM
-H.T.N
The cardiac catheterization

4. Coronary artery disease
Coronary artery disease (CAD; also
atherosclerotic heart disease) is the result
of the accumulation of atheromatous
plaques within the walls of the coronary
arteries[1] that supply the myocardium
(the muscle of the heart) with oxygen and
nutrients. It is sometimes also called
coronary heart disease (CHD). Although
CAD is the most common cause of
CHD, it is not the only one.

5. Pathophysiology
Limitation of blood flow to the heart
causes ischemia (cell starvation
secondary to a lack of oxygen) of the
myocardial cells. Myocardial cells may die
from lack of oxygen and this is called a
myocardial infarction (commonly called a
heart attack). It leads to heart muscle
damage, heart muscle death and later
myocardial scarring without heart muscle
regrowth

6. Symptoms :
- Chest discomfort, mild pain
- Coughing
- Crushing chest pain
- Dizziness
- Dyspnea (shortness of breath)
- Face seems gray

7. Symptoms :
- A feeling of terror that your life is
coming to its end
- Feeling really awful (general
feeling)
- Nausea
- Restlessness
- The person is clammy and sweaty
- Vomiting

8. Diagnosing coronary heart disease
(coronary artery disease)
The doctor will probably ask that the
patient questions about their medical
history, symptoms and carry out a
physical examination . One or some of the
following diagnostic tests may also be
ordered :

9. - ECG (electrocardiogram)
- A Holter monitor
- An echocardiogram
- street test
- Coronary catheterization
- CT (computerized tomography)
- MRA (magnetic resonance angiogram)
- Nuclear ventriculography
- Blood tests

10. Risk Factors
The following are confirmed
independent risk factors for the
development of CAD :
- Hypercholesterolemia
(specifically, serum LDL concentrations)
Smoking
- Hypertension (high systolic pressure
seems to be most significant in this
regard)

11. - Hyperglycemia (due to diabetes mellitus
or otherwise) [citation needed
-Type A Behavioural Patterns, TABP.
Added in 1981 as an independent risk
factor after a majority of research into the
field discovered that TABP's were twice as
likely to exhibit CAD as any other
personality type.

12. - Hemostatic Factors: High levels of
fibrinogen and coagulation factor VII are
associated with an increased risk of CAD.
Factor VII levels are higher in individuals
with a high intake of dietary fat[citation
needed]. Decreased fibrinolytic activity
has been reported in patients with
coronary atherosclerosis.

13. - Hereditary differences/genetic polymorphisms
in such diverse aspects as lipoprotein structure
and that of their associated receptors, enzymes
of lipoprotein metabolism such as cholesteryl
ester transfer protein(CETP) and hepatic lipase
(HL), homocysteine
processing/metabolism, etc.[citation needed
- High levels of Lipoprotein(a), a compound
formed when LDL cholesterol combines with a
substance known as Apoliprotein (a).

14. Significant, but indirect risk factors
include:
Lack of exercise
Consumption of alcohol
Stress
Diet rich in saturated fats
Diet low in antioxidants
Obesity
Men over 60; Women over 65
A recent study done in India (Pondicherry)
shows its association with hemoglobin

15. What are the treatment options for
coronary heart disease (coronary artery
disease )
Although coronary heart disease cannot
be cured, it can be managed much more
effectively today than in the past.
Treatment consists mainly of lifestyle
changes, and perhaps some medical
procedures and medications.

16. Lifestyle
Lifestyle - some specific lifestyle changes can
significantly improve the health of the arteries:
Stop smoking
Eat a healthy and well balanced diet
Exercise regularly
Aim for an ideal bodyweight
Reduce emotional/mental stress

17. Medications
Medications to modify cholesterol
levels
Low-dose aspirin and clot-busting
medication
Beta blockers
Nitroglycerin
ACE (angiotensin-converting
enzyme) inhibitors
Calcium channel blockers

18. Surgery
if fatty deposit build-up has left the blood
vessels very narrow, or if symptoms are not
responding well enough to medications, surgery
may be required to open up or replace blocked
arteries.
Percutaneous coronary revascularization
Coronary bypass surgery
Heart transplant
Laser surgery

19. Prevention of coronary heart disease
(coronary artery disease)
If you can keep your LDL levels low and your
HDL levels high, your risk of developing
coronary heart disease is significantly lower
(than someone who can't). The following
lifestyle measures can help:
Be physically active
Consume alcohol in moderation or not at
all
Do not smoke
Eat a healthy and balanced diet

20. Keep your blood pressure under control
Keep your diabetes under control
Maintain a healthy body weight
Reduce/control emotional and mental
stress
If you already have coronary heart
disease, follow your doctor's instructions
in order to prevent complications. This
includes taking the prescribed
medications.

21. Care plan
Nursing diagnosis:
Ineffective Airway Clearance related /to secretions in the
bronchi.
Goal
After 4 hours of nursing intervention, airway patency will
be maintained, secretions will be readily expectorated and
there will be signs of
reduction in congestion.

22. Nursing intervention:
Independent:
1-Vital signs monitored and recorded.
2-Assisted in semi-fowler’s position.
3-Encouraged deep breathing exercise.
Dependent:
1-Administered prescribed medications.
2-Provided supplemental humidification via use
of nebulizer

23. Rational :
This is for baseline comparison.
Proper positioning helps in draining secretions.
This will promote proper lung expansion.
Prescribed meds such as bronchodilator helps in aiding
effective airway clearance.
Mobilization helps in liquefying secretions for better and
faster expectorating the secretions.

24. Evaluation:
After 4 hours of nursing intervention, the
goal is met through maintenance of airway
patency and reduction in congestion.

25. END