N 200 Atherosclerosis and CAD instructor 2022-202 CAP

CARE OF THE CLIENT WITH ATHEROSCLEROSIS AND CORONARY HEART DISEASE

Learning Outcomes

  • Pathophysiology: Understand the mechanisms involved in atherosclerosis and coronary heart/artery disease.

  • Nutritional Concepts: Learn nutritional strategies for managing atherosclerosis.

  • Medications: Identify various medications used to treat atherosclerosis.

  • Clinical Manifestations: Recognize the signs and symptoms of coronary heart/artery disease.

  • Diagnostic Testing: Differentiate types of diagnostic tests for coronary heart disease (CHD).

  • Nursing Process: Apply the nursing process in the care of clients with CHD.

Anatomy of the Artery

  • Layers of the Artery: Intima, Media, Adventitia (External).

    • Lumen: Inner space through which blood flows.

    • Tunica Interna: Endothelium and basement membrane.

    • Tunica Media: Muscular layer that regulates vessel diameter.

    • Tunica Externa: Connective tissue that provides structural support.

Understanding Atherosclerosis

  • Definition: A progressive disease characterized by fatty deposits on artery walls leading to hardening (arteriosclerosis).

  • Interchangeable Terms: Atherosclerotic heart disease, cardiovascular heart disease, ischemic heart disease.

  • Location: Frequently occurs in coronary arteries.

Causes of Coronary Artery Disease (CAD)

  • Common Causes:

    • Atherosclerosis

    • Coronary artery spasm

    • Embolus

    • Inflammation of vascular lumen

Atherosclerosis Details

  • Definition Breakdown: "Athero" means "gruel or paste", while "sclerosis" means "hardening".

  • Development: Begins with soft, fatty deposits that harden over time.

  • Preferred Location: Primarily affects coronary arteries.

Nutritional Aspects of Atherosclerosis

  • Cholesterol:

    • Manufactured by the liver based on genetics and diet.

    • Necessary for fat absorption and nerve conduction.

    • Intrinsic (body-made) cholesterol is sufficient; excess is derived from diet (extrinsic).

  • Lipoproteins:

    • HDL (High-Density Lipoprotein): "Good cholesterol"; higher protein than lipids; transports cholesterol to liver for excretion.

      • Desirable values: > 60 mg/dL is optimal, 40-60 mg/dL is acceptable.

    • LDL (Low-Density Lipoprotein): "Bad cholesterol"; carries cholesterol to tissues, associated with atherosclerosis progression.

      • Values: < 100 mg/dL is optimal; > 160 mg/dL is high risk.

  • Triglycerides: Produced in the liver; high levels associated with CAD, especially in diabetics.

    • Normal values: < 150 mg/dL; borderline high: 150-199 mg/dL.

Client Education on Lipid Profile

  • Frequency: Lipid profiles recommended every 4-6 years starting at age 20, unless family history exists.

  • Preparation: Fast for 8-12 hours before testing, no alcohol 24 hours prior, avoid medications impacting results.

Dietary Modifications for Atherosclerosis

  • Fat Intake: Total fat should be 20-35% of total calories; limit saturated fats (< 10% of total calories) and cholesterol (< 200 mg/day).

  • Healthy Choices:

    • Use olive or canola oil.

    • Increase fruit and vegetable intake (5+ servings daily).

    • Choose skinless poultry and fish; whole grains (6+ servings).

    • Limit sodium and alcohol consumption.

Lifestyle Modifications for Atherosclerosis and CAD

  • Behavioral Changes:

    • Smoking cessation.

    • Weight control.

    • Regular exercise (30 min/day).

    • Management of chronic conditions (hypertension, diabetes).

Pharmacotherapy for Atheroslcerosis

  • Main Classes of Medications:

    • Antilipidemic Agents:

      • Statins (e.g., Atorvastatin, Simvastatin): Decrease LDL and triglycerides by inhibiting cholesterol production.

      • Bile Acid Sequestrants (e.g., Cholestyramine): Increase cholesterol removal via conversion to bile acids.

      • Cholesterol Absorption Inhibitors (e.g., Ezetimibe): Decrease absorption of cholesterol across the intestinal wall.

  • Common Side Effects:

    • GI disturbances, headache, myopathy, liver dysfunction.

    • Report muscle pain, take statins in the evening, check liver enzymes biannually.

Pathophysiology of CAD

  • Progression: CAD is progressive and may remain asymptomatic until advanced stages with significant fatty streak formation and potential blockages leading to ischemia.

  • Risk Factors: Non-modifiable (age, gender, genetics) and modifiable (hyperlipidemia, smoking, stress).

Angina Pectoris Overview

  • Definition: Chest pain due to ischemia where oxygen demand exceeds supply.

    • Types:

      • Stable Angina: Predictable, relieved by rest.

      • Unstable Angina: Leads to acute coronary syndrome, occurs even at rest.

      • Variant Angina: Results from coronary artery spasm.

Assessment of CAD

  • Key Diagnostic Tools:

    • Electrocardiograms (ECGs) to assess electrical activity; laboratory tests for cardiac biomarkers including troponins and creatine phosphokinase (CK/CK-MB).

    • Stress testing (exercise or pharmacologic) to evaluate heart performance under stress.

    • Invasive procedures like coronary angiography to determine blockage and possible interventions such as stenting.

Nursing Process in CAD Management

  • Assessment: Gather client history using OPQRST for chest pain; perform physical exams including cardiovascular and respiratory assessments.

  • Planning and Implementation: Prioritize client problems and implement interventions aimed at improving tissue perfusion and pain relief.

  • Evaluation: Assess effectiveness of interventions, ensuring clients remain pain-free and understand their management plan.