CASE PRESENTATION

CASE PRESENTATION

BSN3 BLOCK 1 GROUP 1

Wesleyan University-PhilippinesCabanatuan City

CORONARY ARTERY DISEASE

CORONARY ARTERY DISEASE

Overview

It is the end result of the accumulation of atheromatous plaques within the walls of the coronary arteries that supply the myocardium (the muscle of the heart) with oxygen and nutrients. It is sometimes called coronary heart disease(CHD), although CAD is the most common cause of CHD.

CORONARY ARTERY DISEASE

CAD is the leading cause of death worldwide.

While the symptoms and signs of coronary artery disease are noted in the advanced state of disease, most individuals with coronary artery disease show no evidence of disease for decades as the disease progresses before the first onset of symptoms, often a "sudden" heart attack, finally arises. After decades of progression, some of these atheromatous plaques may rupture and (along with the activation of the blood clotting system) start limiting blood flow to the heart muscle.

CORONARY ARTERY DISEASE

The disease is the most common cause of sudden death, and is also the most common reason for death of men and women over 20 years of age.

As the degree of coronary artery disease progresses, there may be near-complete obstruction of the lumen of the coronary artery, severely restricting the flow of oxygen-carrying blood to the myocardium. Individuals with this degree of coronary artery disease typically have suffered from one or more myocardial infarctions (heart attacks), and may have signs and symptoms of chronic coronary ischemia, including symptoms of angina at rest and flash pulmonary edema.

Patient’s ProfileName: Patient XAddress: Purok 3 Maligaya, Science City of MunozBirthday: November 17, 1939Age: 71 years oldGender: MaleCivil Status: WidowOccupation: FarmerReligion: CatholicDate of Admission: January 18,2011Time of Admission: 3:15 pmAttending Physician: Dr. MontenegroDiagnosis: Coronary Artery Disease.Surgical Management: None

Patient’s History

History of Present Illness

One day prior to his admission to Wesleyan-University General Hospital and Cardiovascular Center, patient experienced difficulty of breathing and mild chest pain thus he scheduled to have a check up and angiography at Wesleyan-University General Hospital and Cardiovascular Center.

Patient’s HistoryPast Medical History

Last 2008, patient was admitted to Premiere General Hospital due to chest pain accompanied by difficulty of breathing. The patient was under observation for several weeks at the ICU of Premiere General Hospital. The patient was diagnosed at the same hospital with Coronary Artery Disease. The doctor prescribed the patient with maintenance medicines and was advised to maintain a healthy diet and proper exercise. But the patient wa s unable to comply to the doctor’s instructions. The patient was unable to perform regular exercise and consumed unhealthy foods such as 1-2 packs of chicharon a day. The patient also cannot quit smoking and alcohol consumption although he is aware that he is at risk for stroke like his father and brother.

Patient’s History

Family History

Paternal Maternal

Asthma (+) (-)

Heart Disease (+) (-)

Hypertension (+) (-)

Diabetes Mellitus (-) (-)

Kidney Disease (-) (-)

Patient’s History

Socio-Economic History

Patient worked as a farmer and mechanics for almost 40 years. He was married for 48 years, They have 4 children ages 15, 16, 20 and 24.He was able to finish high school. He is the 2nd child. He has 1 brother and 2 sisters, His brother had stroke for 5 times. He lives in a house made of concrete with 6 other occupants including his wife and 4 kids

Physical AssessmentBody Part Assessed

Technique Used Actual Findings

Normal Findings Interpretation Analysis

Skin InspectionGeneralized color

PalpationTemperature and moisture:feel with back of the hand

(-)jaundiceWarm to touchPink nail bed

In white skin: light to dark pinkIn dark skin: light to dark brown.warm and dryPink nail bed

Normal since the client has no yellow discolorationThe patient is only warm to touch not very warm that may indicate fever

The client has normal colorAnd warm to touch maybe related to his blood pressure that is above normal 130/80mmhg. And may indicate that there is adequate circulation

Eyes InspectConjunctiva and sclera

Blue white sclera and pinkish palpebral conjunctiva.light red retinal vessels ad smaller than veins

Palpebral conjunctiva is pink with no discharge; sclera is blue white

Normal Findings are NormalChanges in the blood vessels in the retina give clues to the presence and severity of high blood pressure ord iabetes

Physical AssessmentBody Part Assessed

Technique Used Actual Findings Normal Findings Interpretation Analysis

mouth Inspect buccal mucosa

Moist lips and buccal mucosa

Pink, moist Normal Normal

Neck Inspection and palpation

(-) jugular vein distentionPulsation height is 3cm

Smooth, controlled movement, symmetricalPulsation height is less than or equal to 1 inch(3cm)

normal It is normal since jvd is negative Bulging or swollen neck veins may be a sign of heart failure

heart AuscultationOf the apical pulse(left midclavicular line fifth intercostals space)

Apical pulse is normal and identical with radial pulse, no heart murmurs heard

Radial and apical pulse are normal Apical pulse is between 60 and 100

Normal Normal since the pulse is normal and no murmurs heardMurmurs may indicate heart problems

Physical AssessmentBody Part Assessed

Technique Used

Actual Findings Normal Findings

Interpretation Analysis

Lungs Auscultation

No abnormal breath sounds or crackling sounds heard

Lungs clear to auscultation on inspiration and expiration

Normal Listening to the lungs for abnormal breath sounds. Soft crackling sounds (crepitations or rales) may be a sign that heart failure has caused fluid to build up in the lungs.

Abdomen Inspection/ Auscultation

Globularly distendedNo bruits sounds heard

Rounded or flatNo bruits, no venous hums, no friction rub heard

Slightly normal Slightly normal since the client has globularly distended abdomenPurpose: An examination of the abdomen. Using a stethoscope, the doctor will listen to blood flow in the abdomen. Changes in the sounds of blood flow (bruits) may indicate a narrowed blood vessel in the abdomen. This is a sign of hardening of the arteries (atherosclerosis) in the large blood vessels that run through the abdomen.

Physical AssessmentBody Part Assessed

Technique Used

Actual Findings

Normal Findings

Interpretation Analysis

Extremities Inspection/palpation

(-) bipedal edema

Edema is present

Normal A check for swelling in the feet and legs (a sign of heart failure). Fluid buildup in the legs causes swelling (edema) and may be a sign of heart failure. To assess swelling in the legs, the doctor will press down on the skin over the lower leg bone. Edema is present if the pressure leaves a dent in the skin.

Anatomy and Physiology

Anatomy and Physiology

HEARTHeart is located in the

thoracic cavity between two pleural cavities which surrounds the lungs. The heart, trachea, esophagus and associated structures form a midline partition, the mediastinum. It consist of four chamber: The right atrium The left atrium The right ventricle The left ventricle

Anatomy and Physiology

Each of the five region is identified by a letter and the vertebrae within each region by numbers.

The heart is surrounded by its own pericardial cavity. It is formed by pericardium or pericardial sac, which surrounds the heart and anchors it with mediastinum.

Anatomy and Physiology

Four Major Functions of the Heat Generating Blood Pressure Routing Blood Ensuring One Way Blood flow Regulating Blood Supply

Anatomy and Physiology

Anatomy and PhysiologyIn human Anatomy, Cardiac Muscle wall of

the heart is thick and metabolically very active, Two coronary arteries supply blood to the wall of the heart. The coronary arteries originate from the base of the aorta, just above the aortic semilunar valve. The left coronary artery originate from the left side of aorta. It has three major branches: Arterior interventricular artery lies in the anterior interventricular sulcus, the circumflex artery extends inferiorly in the lateral wall of the left artery to the circumflex artery. The branches of left coronary artery supply much of the arterior wall of the heart and most of the left ventricle. The right coronary artery originate on the right side of the aorta.

Anatomy and Physiology

It extends around the coronary sulcus on the right to the posterior surface of the heart and give rise to the posterior interventricular artery which lies in the interventricular sulcus. The right marginal artery extends inferiorly along the lateral wall of the right ventricle. The right coronary artery and its branches supplymos of the wall of the right ventricle.

Affected part in Coronary Artery:

In coronary Artery Disease, the coronary arteries are the main affected, particularly the left coronary arteries that supple the left anterior descending coronary arteries, anterior wall of of the heart, the circumflex and the left lateral wall of the heart.

PathophysiologyRisk Factors:obesity, sedentary lifestyle, smoking, alcohol,

hypertension , family history, previous hospitalization, aging, male gender

Dietary Intake of Alcohol and Triglycerides

Chylomicrons absorbed in the

lymph and blood

liver synthesizes lipoprotein

HDL transport cholesterol from

cell to liver

LDL transport cholesterol to

the cells

Remnants left in the liver

Lipid Uptake by Adipose and

skeletal muscle cells

LDL attaches to LDL receptor in smooth muscle, endothelial tissue particularly the heart muscle

LDL accumulate to form plaque to left side of the heart

Dilated left ventricular and atrial free wall of the heart

Signs and Symptoms: difficulty of breathing, chest

pain

Diagnostic Tests (Hematology)

Components Results Normal Range Interpretation

RBC Count 4.22 4.5 – 6.0 x 10 12/L Decreased

Hematocrit 0.38 0.40 – 0.54 Decreased

Hemoglobin 127 120-170 g /L Normal

WBC Count 6.5 5-10 x 10 9 /L Normal

Segmenters 0.59 0.50 – 0.70 Normal

Lymphocyte 0.33 0.20 - 040 Normal

Platelet Count 225 150 – 450 x 10 9/L Normal

Monocyte 0.08 0 -0.07 Increased

Diagnostic Tests (Clinical Chemistry)

Test Results Normal Range Interpretation

Creatinine 1.4 0.9-1.3 mg/dl Increased

Sodium (Na) 136.6 135-148 Normal

Potassium (K) 4.36 3.5-5.3 Normal

Chloride (Cl) 109.2 98-107 Increased

Diagnostic Tests 2-D ECHOCARDIOGRAPHY AND COLOR DOPPLER STUDY

CHAMBER DIMENSION Normal Value

LVED (D) 6.02 cm 4.5-5.0

LVED (S) 4.84 cm

IVS (D) 1.12 cm 0.8-1.1

IVS (S) 1.27 cm

LVPW (D) 1.17 cm 0.8-1.1

LVPW (S) 1.68 cm

LA 4.33 cm 3-3.5

RA 3.48 cm

RV 3.44 cm

MVAn 3.56 cm

TVAn 3.17 cm

EPSS 2.14 cm <1.0

Diagnostic Tests

GREAT VESSEL SIZE Normal Value

Aorta 3.82 cm 3.4-4.0

AV Opening 2.24 cm

MPA 1.12 cm <3.5

IVC 1.27 cm

Diagnostic TestsLV VOLUME/ FUNCTION Normal Value

LVEDV 218 91 – 125

LVESV 114 ml

SV 71.3 ml

CO 5.87 L/min

EF S= 31.7T=39.4

55-75

FS 19.5 25-46%

LV MASS 297 gram

Diagnostic Tests

DIASTOLIC FUNCTION Normal Value

MV E/A 1-2

Dec time 135 160-240 m/sec

IVRT 101 70-90 m/sec

M-A Duration >PVA Duration

PV-A Duration 0.8-1.1

Diagnostic Tests

HEMODYNAMIC DATA Normal Value

ED PR Vel

Peak MR Vel

ED AR Vel

Index- MP

PA Pressure (PAT) 196m/s

QP:QS

PFO/ASD Vel

Diagnostic Tests

DOPPLER SPECTRAL DATA

Gradient

VALVES Maximum Velocity

(m/sec)

MITRAL 0.64 0.96 1.65 3.71

AORTIC 0.69 1.09 1.91 4.76

TRICUSPID 0.49 0.36 0.86 0.53

PULMONIC 0.63 1.60

Diagnostic Tests

IMPRESSION :Dilated left ventricular cavity size

with hypertrpied walls and with hypokinesia of the anterior left ventricular free wall, entire interventricular septum and inferior Left ventricular free wall from base to apex only the lateral segment contract adequate, the patient also has dilated left atrium.

Medical Management

Take your medications

Medications may be needed to help your heart work more efficiently and receive more oxygen-rich blood. The medications you are prescribed depend on you and your specific heart problem. Check the drug search to find out more about your medications.

It is important to know: the names of your medications what they are for how often and at what times to take your

medications

Medical Management

Angiotensin 2 receptor Antagonist

are medications that block the action of angiotensin II by preventing angiotensin II from binding to angiotensin II receptors on blood vessels. As a result, blood vessels enlarge (dilate) and blood pressure is reduced. Reduced blood pressure makes it easier for the heart to pump blood and can improve heart failure. In addition, the progression of kidney disease due to high blood pressure or diabetes is slowed. ARBs have effects that are similar to angiotensin converting enzyme (ACE) inhibitors, but ACE inhibitors act by preventing the formation of angiotensin II rather than by blocking the binding of angiotensin II to muscles on blood vessels

Medical Management

Hypolipidemic DrugsHypolipidemic agents, or anti-

hyperlipidemic agents, are a diverse group of pharmaceuticals that are used in the treatment of hyperlipidemias. They are called lipid-lowering drugs (LLD) or agents.

Medical Management

Beta Blockersor beta-adrenergic blocking

agents, beta-adrenergic antagonists, or beta antagonists, are a class of drugs used for various indications, but particularly for the management of cardiac arrhythmias cardioprotection after myocardial infarction (heart attack), and hypertension.

Doctor’s Order

Doctor’s Order Nurse’s Remarks

January 18,2011Please admit to ROC under Dr. MontenegroSecure consent TPR qshift and recordLow salt, low fat dietCBC, APC,UA,CREA,NA,KContinue Patient MedsInform CAT lab for coronary angiographyMonitor VS q 4 and readInform Ap of this admissionRefer

Admitted a 71 year old, ambulatory with written orders from Dr. Montenegro: for Coro-Angiography tomorrow at 2 pmBaseline Vital Signs taken and recorded as follows :BP 140/80 mmHg; PR:66bpm; RR 20bpm; Temperature 35.8 CConscious and coherentAttended by Dr Castillo with orders made and carried out.Attending Physician Dr. Montenegro is aware about the admission, still informed thru SMS; awaiting for response.CATH laboratory informedBrought to General ward per wheelchair accompanied by NOD Mr. Legaspi and relatives

Doctor’s OrderDoctor’s Order Nurse’s Remarks

January 18,2011 6:35 pmTelephone Order:

Insert PNSS 1L X 16 60cc /hrHydrocortisone 100 mg IV at 9 pmLight breakfast then NPOFor coronary angiography at 2:30 pmStand by medsHydrocortisone 50 mgDiazepam 5mg/ 1 tabDiphenhydramine 50 mg/ cap

3;39 pmIn from Emergency room per wheelchair accompanied by Mr. LegaspiConscious;coherentTransfer to bed safely; orient to hospital and ward policyReceived telephone order and carried outSafely ensuredLatest BP: 120/80mmHg

7-7 PMReceived sitting on the bedConscious and coherentIntravenous fluid of Plain NSS 1L connected via microset inserted aseptically at right metacarpal vein by RN Seeping using insyte gauge 20 then regulated at 20gtts/min.May have light breakfast then nothing per orem instructed to patient : well understood as claimedLatest BP : 120/80

Doctor’s Order

Doctor’s Order Nurse’s Remarks

January 19, 2011 9:40 amPurpose, Benefit, Indications ,Risks, possible complication explained thoroughly to patient & his daughterIncrease IVF rate to 100 cc/hourIVF to follow: PNSS 1L at 100 cc/hourShave both inguinal at 1:00 pmCoronary Angiography c/o Dr Neil Gomez

7-7AM

Received with IVF of PNSS 1L on around 600 ml and regulated at 20 gtts/minConscious and coherentNPO instructed and maintained; well understood as claimedExamined by Dr. Montenegro with orders made and carried outPresent IVF increased to 100 ml per hourConsent for the procedure signed by the patient

Drug Study

GENERIC NAME INDICATION ACTION CONTRAINDICATION

PRECAUTION/ ADVERSE

REACTION

NURSING CONSIDERATIO

N

TELMISARTANBRAND NAMEPritorDOSAGEAdult: 20-80mg daily, usual starting dose 40mg daily

Treatment of hypertension

Blocks the vasoconstrictive ans aldosterone-one-secreting effects of angiotensin II by selectively blocking the binding of angiotensin II to the ATI receptor in many tissues

•Hypersensitivity•Pregnancy•lactation Severe hepatic or renal impairment

PRECAUTION:Can cause death to the fetus if used on the 2nd trimester, safety in children not yet establishedADVERSE RXNDiarrhea and angioedema. Sinusitis, pharyngitis, upper resp. tract infection, back pain

>Assess pt’s condition before therapy. >Assess for heart failure.>Assess for obstructive jaundice.>Monitor for possible drug induced adverse rxn>Close monitoring of BP and pulse

Drug StudyGENERIC

NAME INDICATION ACTION CONTRAINDICATIONPRECAUTION/

ADVERSE REACTIONNURSING

CONSIDERATIONSIMVASTATINBRAND NAMEVidastat

Treatment of hyperlipidemia

inhibits HMG-CoAreductase, theenzyme thatcatalyzes the firststep in thecholesterolsynthesis pathway,resulting in adecrease in serumcholesterol, serumLDLs, and eitheran increase or nochange in serumHDLs.

Contraindicated with allergy tosimvastatin,fungal byproducts,pregnancy,lactation.

PRECAUTIONPast liver disease,alcoholism,severe acuteinfections,trauma, severemetabolicdisorders,electrolyteimbalances,elderly, renaldiseaseADVERSE REACTION Dizziness diarrhea, sinusitis, abdominal cramps and abdominal pain

>Assess nutrition: fat, protein, carbohydrates >Monitor bowel pattern daily >Monitor triglycerides,cholesterolbaselinethroughouttreatment

Drug StudyGENERIC

NAME INDICATION ACTION CONTRAINDICATION

PRECAUTION/ ADVERSE REACTION

NURSING CONSIDERATION

CARVEDILOLBRAND NAMEDilatrend

Treatment of mild to severe CHF of ischemic or cardiomyopathic origin with digitalis, diuretics, ACE inhibitors

Competitively blocks alpha-, beta-, and beta2-adrenergic receptors and has somesympathomimetic activity at beta2-receptors. Both alpha and beta blocking actionscontribute to the BP-lowering effect; beta blockade prevents the reflex tachycardia seenwith most alpha-blocking drugs and decreases plasma renin activity. Significantlyreduces plasma renin activity.

Contraindicated with decompensated CHF, bronchial asthma, heart block, cardiogenic shock, hypersensitivity to carvedilol, pregnancy, lactation. Use cautiously with hepatic impairment, peripheral vascular disease, thyrotoxicosis, diabetes, anesthesia, major surgery.

PRECAUTIONUse cautiously with hepatic impairment, peripheral vascular disease, thyrotoxicosis, diabetes, anesthesia, major surgery. ADVERSE REACTIONDizziness, vertigo, tinnitus, fatigue, Gastric pain, flatulence, constipation, bradycardia, orthostatic hypertension

>Consult with physician about withdrawing drug if patient is to undergo surgery (withdrawal is controversial). >Give with food to decrease orthostatic hypotension and adverse effects. >Monitor for orthostatic hypotension and provide safety precautions. >Monitor patient for any sign of liver dysfunction (pruritus, dark urine or stools, anorexia, jaundice, pain.

Drug StudyGENERIC

NAME INDICATION ACTION CONTRAINDICATIONPRECAUTION/

ADVERSE REACTION

NURSING CONSIDERATION

DIAZEPAM Symptomatic relief of anxiety, agitation, tension

Facilitates/ potentiates the inhibitory activity of GABA at the limbic system and reticular formation to reduce anxiety, promote calmness and sleep

Hypersensitivity. Dependence, withdrawal symptoms

PRECAUTION:Hypersensitivity: cardiorespiratory insufficiency, pregnancy, lactationADVERSE RXNDizziness, fatigue, blurred vision, dependence, withdrawal reactions

> inform pt. that drug may be taken with food>advice pt. not to abruptly discontinue drug after long term use>advice pt. to avoid driving and activities that require alertness bec, drug can cause drowsiness>inform pt. that smoking may decrease effect

Drug StudyGENERIC NAME INDICATION ACTION CONTRAINDICATION SIDE EFFECTS NURSING

CONSIDERATION

Diphenhydramine HCl

Hay fever, urticaria, vasomotor rhinitis, angioneurotic edema, drug sensitization, serum & penicillin reaction, contact dermatitis, atopic eczema, other allergic dermatoses, pruritus, food sensitivity, parkinsonism, motion sickness

Antihistamine that reduces allergic reactions, motion sickness and vertigo (dizziness and loss of balance), and Parkinson's disease

Premature & newborn infants; asthma attack; lactation

CV & CNS effects

Blood disorders

GI disturbances

Antimuscarinic effects

Allergic reactions

Special precaution for

History of bronchial asthma

increased intraocular pressure

hyperthyroidism

CV disease or hypertension.

Pregnancy. Avoid operating vehicles or machinery

Drug StudyGeneric Name Brand

NameAction Indication Side Effects Nursing Management

Hydrocortisone cortef Not clearly defined .Decreases inflammation mainly by stabilizing leukocyte lysosomal membranes; suppresses bone marrow; influences protein, fat and carbohydrate metabolism.

Severe inflammation adrenal insufficiency.

shock

CNS: insomnia, vertigo

EENT: glaucoma

Dermatologic: Impaired wound healingThin fragile skinPetechiae and ecchymosesKaposi’s sarcoma has been reported in patients receiving corticosteroid therapy.

Determine whether patient is sensitive to corticosteroids.

In patients on corticosteroid therapy subjected to unusual stress, increased dosage of rapidly acting corticosteroids before, drug, and after the stressful situation is indicated.

Drug StudyGeneric Name Brand Name Action Indication Side

EffectsNursing Management

Isosorbide Dinitrate Isosorbide 5 moninitrate

Apo-ISDN, Cedocard SRImdur, ISMO

Not completely known. Thought to reduce cardiac oxygen demand by decreasing preload and after load. Drug also may increase blood flow through collateral coronary vessels.

Acute angina attacks(S.L. isosorbide dinitrate only); to prevent situations that may cause angina attacks.

CNS : headache, weaknessCV : orthostatic hypotension, tachycardiaEENT : sublingual burning

Monitor BP and intensity and duration of drug response.

Drug may cause headaches at the beginning of therapy. Dosage may reduce temporarily but tolerance usually develops. Treat headache with aspirin or acetaminophen.

3Notify prescribing signs ofheart failure such as swelling ofhands and feet or SOB.4. Advise patient of the sideeffects of the drug.

Drug Study

Generic Name Brand Name Action Indication Side Effects Nursing Management

trimetazidine Vastarel MR -Anti-anginal - acute anginalattacks- prevent situationthat may causeanginal attacks

Nausea andVomiting,headache,edema

1. Check for doctor’s order2. Monitor blood pressure andpulse rate before and after givingthe meds.3. Notify prescribing signs ofheart failure such as swelling ofhands and feet or SOB.4. Advise patient of the sideeffects of the drug.

Nursing Care PlanASSESSME

NTNURSING

DIAGNOSISPLANNING INTERVENTI

ONRATIONALE EVALUATIO

N

SUBJECTIVE:“Medyo kinakabahan nga ako kasi hindi ko alam kung papano yung mga gagawin sakin”, as verbalized by the patient.

OBJECTIVE:V/s:T:36.8P:95R:33Bp:140/100

Anxiety r/t pain for surgery as manifested by verbal reports of pain and expressed concerns .

After 8 hours of nursing intervention, the client will be able to appear relax and report anxiety is reduced to a manageable level.

•Provide accurate information about the situation of the client and reasons for procedure.

•Observe client’s behavior.

•To know his own perception about the upcoming procedure

•.to identify client’s level of anxiety.

After 8hours of nursing intervention, the client was able to appear relax and reported anxiety is reduced to a manageable level.

Nursing Care PlanASSESSMENT NURSING

DIAGNOSISPLANNING INTERVENTION RATIONALE EVALUATION

Subjective:“Medyo sumasakit ang dibdib ko” as verbalized by the patient.Objective:-restlessness- Facial mask of pain-weakness-use of accessory muscle when breathing-guarding behaviorv/s:t:36.8p:95r:33bp:130/90

Acute pain related to biological agents possibly evidenced by verbal reports and facial mask of pain

After 8 hours of nursing intervention the patient will Verbalize relief/control of pain.

INDEPENDENT:- assess characteristics of chest pain, including location, duration, quality, intensity, presence of radiation, precipitating and alleviating factors, and associated symptoms, have client rate pain on a scale of1-10 and document findings in nurse’s notes.

Pain is indication of complication. assisting the client in quantifying pain may differentiate pre-existing and current pain patterns as well as identify complications

After 8 hours of nursing intervention the patient has verbalized relief/control of pain.

Nursing Care PlanASSESSMENT NURSING

DIAGNOSISPLANNING INTERVENTION RATIONALE EVALUATI

ON

-assess respirations, BP and heart rate with each episodes of chest pain.

- maintain bedrest during pain, with position of comfort,maintain relaxing environment topromote calmness.

•-prepare for the administration of medications, and monitor response to drug therapy. Notifyphysician if pain does not abate.

•respirations may be increased as a result of pain and associate anxiety.

•to reduce oxygen consumption and demand, to reduce competing stimuli and reduces anxiety.

•pain control is a priority, as it indicates ischemia.