Question

Discussion: Perfusion

Coronary Artery Disease

1. Identify the most important client concerns for this condition.
2. Discuss three priorities for nursing care of this client, with these client concerns in mind.
   1. Explain how you arrived at the order of importance (Nursing Process, Maslow’s Hierarchy, ABCs, etc.)
3. Use the Nightingale library and the CINAHL search system to find an article from a peer-reviewed journal published in the last 5 that supports the priorities of nursing care you identified.   
4. In your peer replies, compare how other classmates arrived at their order of importance.
   1. What new methods did you learn?
   2. What can you teach others?

Answer 1

Before discussing the answers let us first know what is Coronary Artery Disease.Coronary artery disease (CAD) causes changes in both structure and function of the blood vessels. Atherosclerotic processes cause an abnormal deposition of lipids in the vessel wall, leukocyte infiltration and vascular inflammation, plaque formation and thickening of the vessel wall. These changes lead to a narrowing of the lumen (i.e., stenosis), which restricts blood flow. There are also subtle, yet functionally important changes that can occur before overt changes in structure are observed. Early in the disease process, the endothelial cells that line the coronary arteries become dysfunctional. Because the endothelium produces important substances such as nitric oxide and prostacyclin that are required for normal coronary function, endothelial dysfunction can lead to coronary vasospasm, impaired relaxation, and formation of blood clots that can partially or completely occlude the vessel.

So the most important client concerned for this disease may be Age and gender, ethnicity or family history. Heart disease may run in the family. According to the World Heart Federation, your heart disease risk increases if a close family member has heart disease. Your risk is further increased if your father or a brother received a diagnosis of heart disease before age 55, or if your mother or a sister received a diagnosis before age 65. Smoking, abnormal cholesterol levels, high blood pressure, physical activity, being overweight and diabetes mellitus.

Let's talk about ACS to find the answe.ACS is a common, life-threatening condition and, in our ageing population, its incidence is likely to rise. Nurses have a crucial role in the clinical management of patients with ACS, by helping them understand their condition and care, and promoting secondary prevention.  three priorities for nursing care of this client are Acute hospital admission,General priorities for patients with ACS are haemodynamic monitoring and close observation of vital signs and elements of nursing care include ongoing management of IV cannulas, central venous pressure lines,urinary catheters and wounds and dressings.

The arrival at the order of importance is Resting ECG may show left ventricular hypertrophy, ST-T changes, arrhythmias, and possible Q waves.Exercise stress testing with or without perfusion studies shows ischemia.Cardiac catheterization shows blocked vessels.Position emission tomography may show small perfusion defects.Radionuclide ventriculography shows wall motion abnormalities and ejection fraction.Fasting blood levels of cholesterol, low density lipoprotein, high density lipoprotein, lipoprotein A, homocysteine, and triglycerides may be abnormal.Coagulation studies, hemoglobin level, fasting blood sugar as baseline studies. Primary nursing diagnosis can be altered tissue perfusion (myocardial) related to narrowing of the coronary artery(ies) associated with atherosclerosis, spasm, and/or thrombosis.Acute pain,Risk for decreased cardiac output ,Anxiety andDeficient knowledge (Learning Need) regarding condition, treatment plan, self-care, and discharge needs can also be signs. Health Care Management Review is a journal where you can find support to the priorities of nursing care I identified.