1. Describe the pathophysiology of coronary artery disease. 2. Discuss risk factors for coronary artery disease and health promotion measures. 3. What are the classic and non-classic symptoms of chest pain? How are they different in men and women?
1. Describe the pathophysiology of coronary artery disease. 2. Discuss risk factors for coronary artery disease and health promotion measures. 3. What are the classic and non-classic symptoms of chest pain? How are they different in men and women?
Chapter17: Drugs And Dissection
Section: Chapter Questions
Problem 1.2CS
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Question
The patient is a 44-year-old, overweight
female who presented to her primary
healthcare provider yesterday with
complaints of recent episodes of shortness of breath that occur with minimal activity such as walking a flight of stairs or with increased stress. Her symptoms are relieved with rest.
She denied any chest, arm or jaw pain but
did have some diaphoresis with one or
two episodes.
- She attributed her symptoms to her
smoking one pack per day for the past 20
years and obesity.
- She has gastroesophageal reflux
controlled with ranitidine and has a history
of elevated cholesterol (252), HDL of 46,
and LDL of 180.
Her triglycerides were 140.
- She drinks three to four caffeinated
beverages per day and denies alcohol use.
-In addition, she has a history of situational anxiety since her mother's death and hypertension controlled with atenolol.
- Her surgical history includes total
abdominal hysterectomy six years ago and right carpal tunnel surgery two years ago.
The patient's mother had a myocardial
infarction (MI) at age 56 and died at age
66, secondary to complications of a
coronary artery bypass graft.
- Her oldest sister died at age 54 from
sudden cardiac death.
- Her father is alive with a recent stroke and two younger brothers are alive and well.
The patient and her husband have three
healthy children, ages 14-18, all living at
home.
- She is employed full-time as a paralegal.
- The patient failed an exercise tolerance
test today with ST depression, shortness
of breath and a drop in BP.
- She was admitted to the cardiac unit and
an MI was ruled out with normal Troponin,
CPK and Iso-Enzymes and ECG.
She was then sent to the cardiac
catheterization lab for possible angioplasty and stent placement.
- She was unable to have stent placement
or angioplasty secondary to findings of
three vessel disease and poor coronary
anatomy.
- Thus, she was scheduled to have a
coronary artery bypass graft (CABG) the
following day.
The time is 1600 hours and the nurses are working the PM shift.
-The cardiac catheterization RN has just
reported to you that the patient was
medicated with alprazolam 2mg at 1430
hours.
- She tolerated the procedure with no
complications.
- Her vital signs have been stable with a
clean, dry, and intact left groin dressing.
A sandbag is over the site and the head of the bed is flat.
- The left lower extremity neurovascular
status is intact and pulses are 2/4.
- She is scheduled to have a CABG
tomorrow and she is aware of this.
1. Describe the pathophysiology of
coronary artery disease.
2. Discuss risk factors for coronary artery
disease and health promotion measures.
3. What are the classic and non-classic
symptoms of chest pain? How are they
different in men and women?
4. Discuss the following medications:
nitroglycerin, morphine sulfate, aspirin,
atenolol, aluminum hydroxide/magnesium
hydroxide, alprazolam, atorvastatin
calcium. Include indications, actions,
contraindications, side effects, normal
dosage and nursing implications.
5. Discuss the nursing and medical
management of the patient post cardiac
angiogram.
6. Describe how to intervene and care for
the patient with chest pain and anxiety.
7. Outline and discuss the preoperative
education plan for a patient and family for
coronary artery bypass graft surgery. This
should include preoperative education,
instruction on the surgical procedure,
postoperative course, and avoidance of
complications.
8. Discuss the basic components of
cardiac rehabilitation.
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- The patient denied hematemesis. What question did the doctor ask the patient regarding this term?
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