Coronary Atherosclerosis OR Coronary artery disease (CAD).pptx

Coronary atherosclerosis /CAD is characterized by accumulation of fatty deposits along the inner most layer of the coronary arteries.

The topic coronary atherosclerosis is summarized by introduction, definition, etiology, risk factors, clinical manifestation, pathophysiology, diagnostic evaluation, complications, preventions, management, nursing diagnosis.

1. CORONARY ATHEROSCLEROSI (CAD) PRESENTED BY:- JITENDRA KUMAR DAS MSC NURSIBG 1 ST YEAR COLLAGE OF NURSING, VIMSAR , BURLA, SAMBALPUR

2. INTRODUCTION:- The main function of heart is pumps blood through a system of blood vessels, called the circulatory system. There are three main types of blood vessels- Arteries- carry oxygen and nutrients with blood to the body’s tissues. Veins-take oxygen poor or deoxygenated blood to the heart from body’s tissues. Capillaries-these are thin and small blood vessels of arteries and veins. The blood vessels connected to the heart are:- aorta, superior vena cava, inferior vena cava, pulmonary artery, pulmonary vein and the coronary arteries.

3. Cont…. Coronary arteries:- these are the arteries which transports blood into and out of the cardiac muscle and provide oxygen, nutrients to the heart. There are left and right coronary arteries which are originated from aorta.

4. Cont… Due to the abnormal accumulation of the lipid or fatty substance in the coronary arteries, the blood flow to the heart is reduced and leads to heart disease like coronary atherosclerosis/coronary artery disease. Atherosclerosis:- is an abnormal accumulation of the lipid or fatty substances and fibrous tissue in vessel wall

5. Cont… Arteriosclerosis:- is referred to as hardening of the arteries.

6. CORONARY ATHEROSCLEROSIS/CORONARY ARTERY DISEASE:- Coronary atherosclerosis /CAD is characterized by accumulation of fatty deposits along the inner most layer of the coronary arteries. The enlarged lesion can cause a critical narrowing of the coronary artery lumen, resulting in a decrease in coronary blood flow and an inadequate supply of oxygen to the heart muscle.

7. ETIOLOGY/CAUSESA:- Damage, injury to the inner wall of coronary artery and hardening of coronary artery by accumulation of lipid or fatty substance. This damage or hardening of coronary artery may be caused by various factors such as:- Smoking High blood pressure High cholesterol Diabetes Sedentary life style

8. RISK FACTORS:- Modifiable risk factors:- High blood cholesterol level (hyper lipidemia ) Cigarette smoking, tobacco use Hypertension Diabetes mellitus Physical inactivity Obesity stress Non modifiable risk factors:- Family history of coronary heart disease. Increasing age Gender

9. SIGN AND SYMPTOMS/CLINICAL MANIFESTATION:- Chest pain Inadequate cardiac out put Diaphoresis Palpitation Syncope Excessive fatigue Changes on the ecg Pain in the arm, neck, jaw Nausea Dysrhythmias Angina pectoris Myocardial infraction Congestive heart failure Sudden cardiac death

10. PATHOPHYSIOLOGY:-

11. CONT….

12. collateral circulation

13. DIAGNOSTIC EVALUATION:- Electrocardiogram (ECG) Treadmill testing Nuclear perfusion imaging CT coronary angiography Echocardiogram Positron emission tomography (PET) Bloods test

14. COMPLICATIONS OF CORONARY ATHEROSCLEROSIS/CAD:- Chest pain Irregular heart beat Limited blood flow to vital organs, and hands and legs, thus affecting the efficient functioning of the different parts of the body. Heart attack Heart failure Sudden death

15. PREVENTIVE MEASURES FOR CA/CAD:- Regular check up (blood test) Aim for healthy weight Avoid cigarette smoking Limit alcohol intake Eat smart avoid fat Exercise regularly Manage the stress level

16. TREATMENT/MANAGEMENT OF CORONARY ATHEROSCLEROSIS:- Medical management:- Non pharmacologic intervention:- Lifestyle modification Stop smoking and tobacco taking Daily and regular exercise A healthy diet lowing cholesterol, fat and sugar and high fiber diet Weight control

17. CONT…. Pharmacological intervention:- Antiplatelets and anticoagulant:- ex- aspirin and clopidogre , ticlopidine and heparin Antiangianal agent:- ex- calcium channel blocker, nitrates and B-blocker lipid lowering drug:- ex- stafins and clofibrate

18. Surgical management:- PTCA ( Percutaneous transluminal coronary angioplasty):- compress the plaque against the wall of the artery and dilate the vessel.

19. CONT… VASCULAR STENT:- prevent the artery from closing and prevent restenosis .

20. CONT…. CABG(coronary artery bypass grafting):- recommended for patient with left main coronary artery disease, triple or two vessel disease.

21. CONT…. ATHERECTOMY:- removing atherosclerosis from blood vessel. Surgical revascularization of affected artery:- BY- EMBOLECTOMY- removal of blood clots from artery. THROMECTOMY- removal of thrombus from the artery. ENDARTERECTOMY- removal of atherosclerotic plaque from the artery.

22. NURSING MANAGEMENT:- Instruct the patient regarding the purpose of diagnostic medical and surgical procedures and the pre and post procedure expectations. Assist the patient to identify risk factors that can be modified and set goals that will promote changes in life style to reduce the impact of risk factor. Instruct the patient to follow a low calorie, low sodium, low cholesterol, low fat and high fiber diet.

23. CONT …. Keep nitroglycerin available for immediate use. Monitor blood pressure and heart rate during the episodes. Patient when posted for coronary angiogram or surgery explain the procedure to the patient and relatives. Stress the patient to follow prescribed drug regimen and regular follow ups.

24. NURSING DIAGNOSIS:- 1.Acute pain related to decreased myocardial blood flow as evidenced by reports of pain and distraction behaviors. Nursing intervention:- Assess reports of pain in jaw, neck, shoulder, arm or hand. Place patient at complete bed rest. Elevate head of bed if patient is short breath. Monitor heart rate and blood pressure. Maintain calm and comfortable environment. Provide supplementary oxygen as indicated. Administered antianginal medication as indicated

25. CONT 2.Decreased cardiac output, by the heart to meet metabolic demands of the body related to alterations in rate /rhythms as evidenced by reduced heart rate. Nursing intervention:- Monitor vital signs and cardiac rhythm. Asucultate breath sounds and heart sounds listen for murmur. Provide adequate rest period. Encourage immediate reporting of pain for prompt administration of medications. Administer supplemental oxygen as needed.

26. CONT…. 3.Anxiety related to situational crises as evidenced by increased tension. Nursing intervention:- Let patient know these are normal reactions. Tell patient the medical regimen has been designed to limit future attack and increase cardiac stability. Administer sedatives, tranquilizers as indicated.

27. CONT… 4.Knowledge deficiency related to lack of exposure as evidenced by asking questions about his disease condition and request for information. Nursing intervention:- Discuss the pathophysiology of condition. Review significance of cholesterol level. Explain importance of weight control. Demonstrate how to monitor own pulse and blood pressure.

28. The topic coronary atherosclerosis is summarized by introduction, definition, etiology, risk factors, clinical manifestation, pathophysiology , diagnostic evaluation, complications, preventions, management, nursing diagnosis.

29. What is CAD, describe the management of coronary atherosclerosis with nursing care plan?

30. Coronary atherosclerosis is a chronic heart disease. Chronic atherosclerosis can be prevented by life style modification and home remedies by eating healthy low fat diet. It is a preventable and treatable condition.

31. Brunner and Suddarth’s .(2016), Text book of medical surgical nursing; 12 th edition: publish by. Lippincott Williums and wilkins , page no. Javed Ansari and Davinden kaur .(2011), Text book of medical surgical nursing volume-ii; 1 st edition: publish by pee vee , page no. 427-430 Lewis.Bucher , Heitkempeer , Harding, Kwong .(2017), Roberts medical surgical nursing, assessment and management of clinical problems; 3 rd south asia edition: publish by RELX India pvt.ltd , new delhi ; page no. 657-666