Cardiovascular Final Case Study Valencia Howard South University Advanced Nursing Practice 1

Running head: CARDIOVASCULAR FINAL CASE

STUDY 1

Cardiovascular Final Case Study Valencia Howard South University Advanced Nursing Practice 1

Dr. Karen Hartman October 17, 2015

CARDIOVASCULAR FINAL CASE STUDY 2

Cardiovascular Final Case Study

The heart is one of the most powerful organ within the body and is responsible for a large population percentage of heart disease worldwide. The most common type of heart disease is the coronary artery disease (CAD) (ICD-10-CM code I25.10), ("ICD10 Data," 2015) which affects the blood flow to the heart. (CDC, 2015, para. 1). “For some people, the first sign of CAD is a heart attack, in which their health care team can be able to help one’s reduce their risk for CAD” (CDC, 2015). The cardiovascular system was chosen as a favorite out of the pulmonary, gastrointestinal, genitourinary, or musculoskeletal systems because of a special interest of the flow of blood through the heart. The cardiac cycle knowledge is imperative in order for the advanced nurse to effectively care for the patient. This plan of care is based on analytical assessment, published ground rules, standards set for individualized specialties, and other studies depending of evidence-based literature for a 52-year old male from an Irish decent.Analyzation of Cardiovascular System

CAD is initialized by causing a formation of plaque, which are also called aretheromas, in the lining of the artery. (Mandal, 2014). The formation of plaque thickens in the arterial wall causing a narrowed arterial space. The blood has to move through this narrowed area to reach the heart. This blood reaches the heart supplying oxygen and nutrients to the heart muscle. This reduction of blood flow causes atheromas. (Mandal, 2014). “The formation of plaque in the artery is called atherosclerosis and the plaque is called an atheroma” (Mandal, 2014, para. 2).The presence of plaques in the narrowed arteries may lead to angina or chest pain because the heart muscles have a deprivation of oxygen. (Mandal, 2014). As the plaque increases within the arterial wall, the vessels become more narrowed leading to a possible heart attack.

CARDIOVASCULAR FINAL CASE STUDY 3

Symptoms that may occur as the arteries narrow are chest pain brought on by physical activity, emotionally upset, or just maybe from eating a meal. (Mandal, 2014, para. 3).Sometimes there may be a blockage in the artery that may not produce any symptoms unless the plaques developed in severe. Other signs and symptoms include dyspnea or intense fatigue on exertion causing the heart to not pump enough blood to meet the body’s needs. ("CAD," 2014).These signs and symptoms are observed in Mr. M. J.One of the crucial mechanism that intervene with the increase and advancement of CAD and its complications is an inflammation. (Buttaro, Trybulski, Bailey, & Sandberg-Cook, 2013).Inflammatory trajectory have connected with the early progression of atherosclerotic disease with plaque formation in coronary arteries, producing CAD. (Buttaro et al., 2013). Inflammation and plaque formation have significantly displays the acute plaque rupture, a cause of acute myocardial infarction. (Buttaro et al., 2013).If a heart disease is suspected, a coronary angiogram may be performed to assess the state of the coronary arteries. This test would require a special dye inserted into the artery to visualize the heart and any blocked areas in the coronary artery. Other diagnostic tests encompass treadmill exercise to assess ischemia and functional capacity. Exercise myocardial perfusion imaging, cardiac magnetic resonance imaging (MRI), and exercise radionuclide angiography are other pertinent test to include for the patient’s diagnostic tests. (Buttaro et al., 2013).CAD Differentiated from Normal Development

The heart muscle is required to receive oxygen-rich blood in order to survive. The responsibility of the coronary circulation is to carry blood from and to the heart. The greatest supplier of the heart is held in the aorta which “branches off into two main coronary blood vessels, which is also called arteries” ("Coronary artery," 2015, para. 2). “These coronary arteries

CARDIOVASCULAR FINAL CASE STUDY 4

branch off into smaller arteries, which supply oxygen-rich blood to the entire heart muscle” (“Coronary Artery”, para. 2). “The right coronary supplies blood mainly to the right side of the heart, which is smaller because it only pumps blood to the lungs. The left coronary artery is the supplier of blood into the left side of the heart” (“Coronary Artery,” 2015, para. 3-4). The left side of the heart is muscular and the normal coronary artery consist of a large lumen without any narrowing by plaque.In the case of coronary artery disease (CAD), the lumen becomes narrowed by atherosclerotic plaque. This narrowing prevents normal blood flow which will result in hypo perfusion of the myocardium. The first diastolic leading to the systolic dysfunction has the characteristic of chest pain. The electrocardiogram (EKG) will display a late ischemic cascade in demonstrated from the ST-segment and T-wave changes. (Buttaro et al., 2013). When the coronary artery displays an inflammation, this would cause plaque formation leading to the progression of the artery to cause CAD driving toward a myocardial infarction. (Buttaro et al.,

2013).

Demands of CAD on the Patient and Family

The physical demands of Mr. M. J. would require changes in his diet and physical activities. He usually does not eat breakfast, as well as, fast foods for lunch but mostly rely on his wife’s cooking consisting of meats and pastas for dinner rarely eating fruits or vegetables.Mr. M. J. is an Irishman and his culture eat a lot of bacon, sausages, and potatoes. In terms of their dairy products, the Irish culture include large quantities of butter, cheese, and milk. His culture eats corned beef and cabbage on Easter Sunday. (Rapple, n.d.). Knowledge of his culture requires extensive support from the nursing professional and the dietician for change in dietary habits. The dietician would include Mr. M. J. and his wife in his food choices to benefit his taste