Coronary Artery Disease Part 2 NCLEX Review

This is an NCLEX review for coronary artery disease. Patients who have coronary artery disease have developed fatty plaques due to atherosclerosis in the arteries that provide the heart muscle with a vital blood supply. CAD can lead to heart muscle damaged or death. In part 1 of this series, I will cover the patho, signs and symptoms, risk factors, and treatments for CAD.

When taking care of a patient with coronary artery disease, it is very important the nurse knows how to recognize the typical signs and symptoms seen in this condition, how it is diagnosed, nursing interventions, and patient education.

Don’t forget to take the coronary artery disease quiz.

In this NCLEX review for coronary artery disease, you will learn the following:

• Nursing interventions for patients with CAD
• Medications used in coronary artery disease

Lecture Part 2 on Coronary Artery Disease

Nursing Interventions for CAD

Goal:  prevent further progression of CAD

Educating patient about treatment, preventive measure, medications, and management

• Educate the patient about the significance and complications of CAD (discussed in part 1 of this series)
• Modifying lifestyle:
  • How to manage with diet (low fat, low calorie)
  • Exercise program
  • Smoking cessation and why it is important
  • Weight loss
• Monitoring heart rate and blood pressure
• Signs and symptoms and when to seek help
• Education about procedures: EKG, stress test, heart cath, lipid profile blood test

Medications for CAD

Antiplatelet meds: prevent clots from forming or growing which decrease the chances of ischemia

• Aspirin: watching for GI bleeding.
• Plavix: for patients who can’t tolerate Aspirin or just had a stent placed
  • Monitor for:
    • Thrombotic Thrombocytopenic Purpura (TTP): clotting disorder where clots form in blood vessels in the body which causes decreased blood flow to vital organs…low platelet count, neuro changes, bruising, anemia, renal failure, fever
    • **will need to discontinue medication for 5-7 days before a planned surgical procedure because of the increase chance of hemorrhage while taking this drug. Patients need to let their surgeon know they are taking Plavix because they will be switched to another blood thinner prior to the surgery. Plavix takes a while to clear in the body’s system.

Nitrates:

• Nitroglycerin: dilates vessels to allow more blood to get the heart muscle
  • Educate about how to take: sublingual (underneath the tongue)
    • Take right when having chest pain
    • Place one tab or one spray under the tongue
      • Patient may feel dizzy or hot flushing after taking Nitro. As the nurse, you will need to monitor their blood pressure because Nitro causes hypotension
    • If not relieved in 5 minutes take another dose of Nitro a 2nd dose and
    • If not relieved in 5 minutes take another one for a 3rd dose. The patient is NOT to take more than 3 total doses. If not relieved with the 3rd dose of Nitro the patient needs to  call 911.

Cholesterol lowering medication:

• Statins “Lipitor, Crestor, Zocor” (goal: LDL less than 100 mg/dL) helps lower LDL, total cholesterol, lower triglycerides, and increase HDL.
  • Educate not to replace diet and exercise
  • Notify doctor if they develop muscle pain or tenderness
  • Monitor CPK (creatine kinase) levels…. which if elevated it can cause muscle problems
  • Monitor liver function because statins act on the liver to block it from producing too much cholesterol.

Beta blockers:

• end in “lol” Propranolol, Metoprolol
• lowers heart rate and blood pressure which reduces work load on the heart. This will help decrease episodes of chest pain
  • side effects: mask hypoglycemia signs and symptoms like sweating and tachycardia in diabetics, bradycardia, breathing problems in patients with COPD or asthma, don’t take with grapefruit juice

ACE inhibitors:

• end in “pril” Lisinopril
• blocks the conversion of angiotensin I to angiotensin II which caused vasodilation….lowers blood pressure…this decreases the workload on the heart.
• Side effect: nagging dry cough

Learn more about CAD in part 1.

References: