Which of the following lifestyle modifications should the nurse emphasize for a patient with stable coronary artery disease to prevent progression of the condition?

B) Engaging in regular physical exercise

A) Increasing dietary sodium intake

B) Engaging in regular physical exercise

D) Avoiding all forms of physical activity

A 56-year-old male patient is diagnosed with stable angina. Which of the following lifestyle modifications should the nurse emphasize to help manage this condition?

B) Engage in regular physical activity

A) Increase dietary sodium intake

B) Engage in regular physical activity

C) Avoid all forms of physical exercise

What is the primary purpose of conducting an exercise stress test for a patient with stable coronary artery disease?

B) To determine if the patient has developed heart failure

C) To evaluate kidney function under stress

D) To measure lung capacity during exercise

During a follow-up appointment, a patient with stable coronary artery disease reports an increase in the frequency of mild chest discomfort. What should be the nurse's initial action?

B) Advise the patient to use nitroglycerin at the onset of chest discomfort

A) Instruct the patient to increase physical activity to improve cardiovascular health

B) Advise the patient to use nitroglycerin at the onset of chest discomfort

C) Encourage the patient to rest and monitor the symptoms

D) Schedule an immediate visit with the cardiologist

What is the primary goal of the lifestyle modifications recommended to the patient with coronary artery disease?

B) To reduce cardiovascular risk factors

A) To completely eliminate cholesterol from the diet

B) To reduce cardiovascular risk factors

C) To cure coronary artery disease

D) To replace medication therapy

What is the primary goal of the patient's modified treatment plan for coronary artery disease?

B) To reduce the frequency and intensity of chest discomfort

A) To eliminate the need for medication

B) To reduce the frequency and intensity of chest discomfort

C) To increase the patient's heart rate

D) To lower the patient's respiratory rate

What is the most appropriate nursing action to prevent dizziness in a patient experiencing orthostatic hypotension?

A) Encourage the patient to rise slowly from a seated or lying position

B) Advise the patient to increase saturated fat intake

C) Suggest reducing daily fluid intake

D) Recommend the patient skip exercise sessions

A patient experiences occasional mild dizziness when standing up quickly, and an orthostatic blood pressure measurement reveals a drop in blood pressure from 124/78 mmHg lying down to 110/70 mmHg upon standing. What is the most appropriate nursing intervention to address this symptom?

B) Educate the patient to rise slowly from seated or lying positions.

A) Advise the patient to increase salt intake.

B) Educate the patient to rise slowly from seated or lying positions.

C) Recommend stopping all physical exercise.

D) Suggest avoiding all medications temporarily.

What does the minimal postural drop in blood pressure upon standing indicate about the patient's response to the recent medication adjustment?

A) The medication adjustment has effectively stabilized the patient's blood pressure.

B) The patient is experiencing orthostatic hypotension.

C) The medication has caused the patient to become hypertensive.

D) The patient is not adhering to the prescribed medication regimen.

What is the primary reason for assessing postural blood pressure changes in a patient with coronary artery disease?

A) To evaluate the risk of dizziness and falls

B) To determine fluid retention levels

C) To assess the effectiveness of dietary changes

D) To check for signs of infection

CAD - Nursing Case Study

Pathophysiology

• Primary mechanism: Atherosclerosis - Fatty deposits called plaques build up in the coronary arteries, narrowing them and reducing blood flow to the heart muscle. This can lead to chest pain (angina) or heart attacks.

• Secondary mechanism: Inflammation - Chronic inflammation in the arteries contributes to plaque formation and instability, increasing the risk of plaque rupture and subsequent clot formation, which can block blood flow.

• Key complication: Myocardial infarction - If a plaque ruptures and a blood clot forms, it can completely obstruct the coronary artery, leading to a heart attack due to the lack of oxygen to the heart muscle.

Patient Profile

Demographics:

56-year-old male, accountant

History:

• Key past medical history: Hypertension diagnosed 5 years ago, hyperlipidemia

• Current medications: Atorvastatin 20 mg daily, Lisinopril 10 mg daily, Aspirin 81 mg daily

• Allergies: No known drug allergies

Current Presentation:

• Chief complaint: Occasional chest discomfort during exertion

• Key symptoms: Mild chest pain that resolves with rest, no shortness of breath, no radiating pain

• Vital signs: Blood pressure 128/82 mmHg, heart rate 74 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F

Section 1

Initial Assessment Findings:

As the nursing team conducts an initial assessment of the patient, several key findings emerge. The patient, a 56-year-old male accountant, presents with stable vital signs: blood pressure remains at 128/82 mmHg, heart rate is a steady 74 bpm, and respiratory rate is 16 breaths per minute, with a temperature of 98.6°F. The patient reports occasional chest discomfort during exertion, which alleviates with rest. Upon further inquiry, the patient denies any shortness of breath, palpitations, or radiating pain, indicating that his symptoms align with stable angina rather than an acute coronary event.

During the physical examination, heart sounds are regular with no murmurs, rubs, or gallops detected. Breath sounds are clear bilaterally, and there is no jugular venous distention or peripheral edema noted, suggesting that heart failure is not present at this time. The patient’s skin is warm and well-perfused, further indicating stable hemodynamics. An electrocardiogram (ECG) is performed, showing normal sinus rhythm with no acute ischemic changes. The nursing assessment reveals that the patient’s condition is consistent with stable coronary artery disease, requiring routine monitoring and adherence to prescribed medication and lifestyle modifications to prevent progression.

These findings will guide the interdisciplinary team in reinforcing the importance of lifestyle changes, such as dietary adjustments and regular exercise, alongside strict adherence to the current medication regimen. The patient is educated on recognizing warning signs of worsening symptoms, such as increased frequency or severity of chest pain, which would necessitate immediate medical attention. The nursing team will continue to monitor the patient's symptoms and response to ongoing treatment, ensuring timely intervention should any changes in clinical status occur.

Section 2

A few weeks after the initial assessment, the patient returns for a follow-up appointment to evaluate his progress and response to the prescribed treatment plan for stable coronary artery disease. During this visit, the patient mentions compliance with the recommended lifestyle modifications, such as adopting a heart-healthy diet low in saturated fats and incorporating brisk walking into his daily routine. He reports feeling generally well but notes that he experiences mild chest discomfort more frequently, although it still resolves with rest.

The nursing team conducts a thorough assessment, noting that the patient’s vital signs remain stable: blood pressure is 126/80 mmHg, heart rate is 72 bpm, respiratory rate is 16 breaths per minute, and temperature is 98.4°F. Overall, the physical exam findings are consistent with previous assessments, showing no signs of heart failure or respiratory distress. Given the increased frequency of chest discomfort, the healthcare team decides to perform additional diagnostic tests to further evaluate the patient’s condition.

A repeat ECG is conducted, which continues to show normal sinus rhythm without acute ischemic changes. However, the cardiologist recommends an exercise stress test to assess the heart’s response to physical exertion more thoroughly. The stress test results reveal mild ischemia during peak exercise, indicating that while the patient’s condition is stable, there is a need to review and possibly adjust the current management plan. The interdisciplinary team considers optimizing medication, such as adjusting the dosage of anti-anginal drugs, to better control the symptoms and reduce the risk of future complications. The patient is educated about the importance of adhering to the modified treatment plan and is scheduled for another follow-up to monitor the effectiveness of these adjustments.

Section 3

Over the next few weeks, the patient adheres to the modified treatment plan, which includes an adjusted dosage of his anti-anginal medication. He continues with his heart-healthy lifestyle modifications, maintaining his low-saturated-fat diet and daily brisk walks. On his next follow-up appointment, the nursing team conducts a comprehensive assessment to evaluate his response to the interventions. The patient reports that his episodes of chest discomfort have decreased in frequency and intensity, suggesting a positive response to the medication adjustment. He feels more confident in managing his symptoms and is motivated to continue his lifestyle changes.

During the physical examination, the patient's vital signs remain stable: blood pressure is 124/78 mmHg, heart rate is 70 bpm, respiratory rate is 16 breaths per minute, and temperature is 98.6°F. The patient does not exhibit any signs of heart failure or respiratory distress. An updated lipid panel reveals improved cholesterol levels, with LDL decreased to 95 mg/dL and HDL increased to 50 mg/dL, reflecting the effectiveness of dietary changes and medication adherence. These findings indicate progress in the management of his coronary artery disease and a reduction in cardiovascular risk factors.

The interdisciplinary team is encouraged by these results but remains vigilant in monitoring the patient's condition. They reinforce the importance of continued adherence to the treatment plan and educate the patient on recognizing potential warning signs of worsening symptoms. The patient is scheduled for another follow-up in three months to ensure ongoing stability and to make any necessary adjustments to his management plan. This approach aims to sustain the positive trend in his health status and prevent future complications.

Section 4

As the patient continues with his treatment plan, the nursing team remains attentive to any subtle changes in his condition. During a routine follow-up visit, the patient mentions experiencing occasional episodes of mild dizziness, particularly when standing up quickly. Although these episodes are infrequent and short-lived, the nursing team decides to investigate further to rule out any potential issues. Upon reviewing his current medication regimen and lifestyle modifications, they suspect that the dizziness may be related to a slight drop in blood pressure, possibly due to improved cardiovascular health and the patient's strict adherence to his low-saturated-fat diet and exercise routine.

To confirm their suspicions, an orthostatic blood pressure measurement is conducted. The patient's blood pressure while lying down is recorded at 124/78 mmHg, similar to previous readings. However, upon standing, his blood pressure drops slightly to 110/70 mmHg, which could explain the episodes of dizziness. The nursing team educates the patient on the importance of rising slowly from a seated or lying position to minimize these symptoms. Additionally, they suggest monitoring his fluid intake to ensure adequate hydration, which can help maintain stable blood pressure levels.

With this new insight, the team decides to make a minor adjustment to the patient's medication dosage to prevent further episodes of dizziness and to ensure his comfort and safety. The patient is reassured that these adjustments are common as the body adapts to a healthier state, and he expresses relief that the issue has been addressed. The nursing team schedules a follow-up appointment in four weeks to assess the effectiveness of the intervention and to ensure that his condition remains stable, demonstrating a proactive approach to managing his coronary artery disease and overall well-being.

Section 5

The patient returns for his scheduled follow-up appointment four weeks later, and the nursing team is eager to evaluate his response to the recent medication adjustment. Upon arrival, the patient reports feeling more stable and experiencing no further episodes of dizziness. The nursing team conducts a thorough assessment, noting that the patient appears well-nourished and in no apparent distress. His vital signs are stable, with a blood pressure reading of 118/74 mmHg while seated and 112/72 mmHg upon standing. This minimal postural drop suggests that the intervention has been effective in managing his symptoms.

The team also reviews the patient's adherence to lifestyle modifications, and he proudly shares that he has maintained his exercise routine and continues to follow a heart-healthy diet. Laboratory results show that his lipid profile has improved further, with LDL cholesterol now at 95 mg/dL, HDL at 50 mg/dL, and total cholesterol at 175 mg/dL. These findings are consistent with his ongoing commitment to lifestyle changes and indicate an overall positive impact on his cardiovascular health.

Encouraged by these results, the nursing team reinforces the importance of continuing his current regimen and encourages him to remain vigilant about any new symptoms. They discuss the significance of routine monitoring and the potential need for future adjustments as his condition evolves. The patient expresses gratitude for the guidance and support he has received, understanding that his proactive approach plays a crucial role in managing his coronary artery disease. The team schedules another follow-up in three months, confident in the collaborative plan to maintain his stability and prevent any new complications.