Coronary artery disease (CAD) represents a spectrum of conditions impacting the arteries responsible for delivering vital nutrients, blood, and oxygen to the heart muscle. Atherosclerosis, a primary driver of CAD, is characterized by the accumulation of lipid deposits within arterial walls. These plaques lead to arterial narrowing, impeding blood flow and significantly elevating the risk of angina and myocardial infarction.
CAD is a progressive condition that unfolds gradually over time. Often, the disease reaches an advanced stage before noticeable symptoms such as angina, shortness of breath, and fatigue manifest. When blood flow through the coronary arteries is compromised, either partially or entirely, it triggers ischemia and infarction within the heart muscle. This insufficient supply of blood and oxygen (ischemia) to the myocardium results in decreased tissue perfusion and necrosis (infarction), necessitating prompt medical intervention.
In managing CAD, a crucial aspect involves modifying risk factors to both prevent and slow down the disease’s progression. Given that symptoms may not always be apparent early on, identifying individuals at risk for CAD is paramount. Nurses play a vital role in health promotion, focusing on controlling modifiable risk factors for CAD. Educating patients about the disease process, its progression, and the importance of necessary lifestyle adjustments is key in CAD prevention.
For patients exhibiting symptoms like chest pain or dyspnea, medical or surgical interventions may be warranted. Medications such as aspirin and cholesterol-lowering agents are commonly prescribed to prevent blood clots, reduce the risk of heart attacks, and minimize plaque buildup in the arteries. Surgical procedures like coronary angioplasty and stent placement might be indicated to alleviate blockages, widen arteries, and restore adequate blood flow to the heart. Coronary artery bypass grafting (CABG) is typically considered for patients with multiple significantly narrowed coronary arteries.
Nursing Assessment
The cornerstone of nursing care begins with a thorough nursing assessment. This process involves gathering comprehensive physical, psychosocial, emotional, and diagnostic data. This section will delve into both subjective and objective data pertinent to coronary artery disease.
Review of Health History
1. Elicit General Symptoms: Begin by inquiring about the patient’s overall symptoms, noting complaints such as:
- Chest pain
- Shortness of breath (dyspnea), both at rest and during exertion
- Rapid breathing (tachypnea)
- Difficulty breathing while lying down or sitting (orthopnea)
- Fainting spells (syncope)
- Palpitations
- Lower extremity edema
- Pain in the lower extremities
- Reduced ability to perform physical activities
2. In-depth Chest Pain Investigation: Thoroughly explore the characteristics of chest pain:
- Chest tightness
- Squeezing sensation
- Heaviness
- Burning discomfort
- Pain triggered by physical activity
- Identifying triggers like stress or substance use
- Pain radiating to the jaw, neck, left arm, or back
3. Risk Factor Assessment:
Non-modifiable Risk Factors:
- Age: Arterial damage and narrowing are more likely with advancing age.
- Gender: Men generally face a higher risk, although women’s risk escalates post-menopause.
- Family History of Ischemic Heart Disease: Increased risk is indicated if a male relative (father or brother) developed heart disease before age 55, or a female relative (mother or sister) before age 65.
- Race/Ethnicity: Certain minority groups, including Hispanics and Blacks, exhibit a higher incidence of CAD.
Modifiable Risk Factors:
- Hypertension: Uncontrolled high blood pressure can lead to stiff and rigid arteries, potentially slowing blood flow due to coronary artery narrowing.
- Hyperlipidemia/Hypercholesterolemia: Elevated levels of “bad” cholesterol (low-density lipoprotein – LDL) or decreased “good” cholesterol (high-density lipoprotein – HDL) significantly increase the risk of atherosclerosis.
- Diabetes Mellitus or Insulin Resistance: Diabetes or insulin resistance contributes to the hardening of blood vessels and the buildup of fatty plaques.
- Kidney Disease: Kidney disease impairs the kidneys’ role in blood pressure regulation.
- Tobacco Use: Both firsthand and secondhand smoke promote blood vessel constriction.
- Obesity: Obesity elevates cholesterol levels, contributing to plaque formation and narrowing of blood vessels.
- Physical Inactivity: Lack of exercise elevates blood cholesterol levels.
- Diet: Diets high in saturated fats increase LDL “bad” cholesterol.
- Stress: Stress elevates inflammatory markers, potentially narrowing blood vessels.
- Alcohol Use: Excessive alcohol consumption can weaken the heart muscle and disrupt blood clot formation, leading to vessel obstruction.
- Sleep Deprivation: Poor sleep habits and insomnia elevate stress levels, resulting in blood vessel constriction.
4. Medication and Treatment History Review: Certain medications (e.g., anthracyclines, anabolic steroids) and prior vascular surgeries can compromise blood vessel integrity.
Physical Assessment
1. Vital Sign Monitoring: Due to reduced oxygenated blood supply to the heart, vital signs, particularly pulse rate and blood pressure, are likely to be elevated or altered.
2. EKG and Telemetry Monitoring: An EKG should be performed immediately when a patient reports chest pain to assess for dysrhythmias. Continuous telemetry monitoring is appropriate for patients with a known cardiac history.
3. Systemic Assessment:
- Neck: Observe for distended jugular veins.
- Central Nervous System (CNS): Assess for acute distress, dizziness, lightheadedness, syncope, and lethargy.
- Cardiovascular: Note tachycardia, chest pain, abnormal heart sounds (murmur at the apex or bruit on carotid artery), and irregular heartbeats (arrhythmias).
- Circulatory: Evaluate for decreased peripheral pulses.
- Respiratory: Assess for dyspnea, tachypnea, orthopnea, and abnormal lung sounds (crackles).
- Gastrointestinal: Inquire about nausea and vomiting.
- Lymphatic: Check for peripheral edema.
- Musculoskeletal: Assess for pain in the neck, arm, back, jaw, and upper body, as well as fatigue.
- Integumentary: Observe for cyanotic or pale skin and excessive sweating.
4. ASCVD Risk Score Calculation: Calculate the patient’s Atherosclerotic Cardiovascular Disease (ASCVD) risk score. A low score is ideal (<7.5%). This score considers:
- Age
- Gender
- Race
- Blood pressure
- Cholesterol levels
- Medication history
- Diabetes status
- Smoking history
Diagnostic Procedures
1. Arrhythmia Detection: CAD-related obstruction of blood flow can cause arrhythmias or disruptions in the heart’s electrical activity. Monitor for ST segment changes on ECG, which may indicate cardiac ischemia. Other arrhythmias like atrial fibrillation, bundle branch blocks, and supraventricular tachycardia may also be present.
2. Blood Work Analysis: Analyze the results of the following blood tests:
- Complete Blood Count (CBC) with differential: To assess for underlying infection (WBC count), blood clotting response (platelet count), and signs of anemia (low RBC levels).
- B-type Natriuretic Peptide (BNP): To detect volume overload of cardiac origin. Note that BNP can be falsely elevated in kidney conditions and lower in obese individuals.
- Cardiac Enzymes: Troponin and CK levels provide insights into acute myocardial ischemia.
- Lipid Panel: To monitor for hypercholesterolemia.
- Ultra-sensitive C-reactive protein (us-CRP) or High-sensitivity CRP: To assess vascular inflammation, a risk factor for CAD.
- Liver Function Tests (LFTs): To evaluate liver function, especially in conditions like hemochromatosis (iron overload, a CAD complication), and to monitor liver function due to cholesterol medication use.
3. Stress Testing: Stress testing is a non-invasive method to evaluate CAD by assessing the heart’s response to physical activity.
4. Cardiac Catheterization Preparation: Cardiac catheterization or angiography is the most accurate method for visualizing heart blood vessels. Be aware of the risks associated with this invasive procedure, including contrast dye use.
5. Further Investigations:
- Echocardiogram: To visualize heart structure and valve function, aiding in diagnosing valve abnormalities or underlying conditions like heart failure.
- Exercise Treadmill Test: For patients with a normal resting ECG who are physically capable of exercise.
- Nuclear Stress Test: Combines ECG recordings with images of blood flow to the heart muscle at rest and during stress, useful when exercise ECG is insufficient.
- Stress Imaging: For patients who have undergone revascularization, have ECGs difficult to interpret, or cannot exercise due to physical limitations.
- Cardiac CT Scans: To detect calcium buildup and blockages in heart arteries.
- CT Coronary Angiogram: Similar to cardiac CT scan but uses contrast dye for more detailed visualization.
Nursing Interventions
Nursing interventions and comprehensive care are crucial for patient recovery and management of CAD. The following sections outline key nursing interventions for patients with coronary artery disease.
Promoting Perfusion
1. Reduce Cholesterol Plaque Buildup: Administer cholesterol-lowering medications such as statins, fibrates, niacin, and bile acid sequestrants as prescribed. These medications help reduce “bad” cholesterol levels and minimize plaque formation in arteries.
2. Prevent Blood Clot Formation: Administer aspirin to thin the blood and prevent clot formation. Daily low-dose aspirin therapy is a primary preventive measure against CAD. Anticoagulant medications might be added for patients at higher risk.
3. Address Blocked Arteries:
- Coronary Angioplasty and Stent Placement (Percutaneous Coronary Intervention – PCI): This procedure opens clogged heart arteries using a balloon and often involves placing a stent to maintain artery patency.
- Coronary Artery Bypass Graft Surgery (CABG): CABG creates new pathways for blood flow around blocked coronary arteries. It is indicated for patients with multi-vessel CAD.
4. Cholesterol Level Monitoring: Regularly monitor cholesterol levels, especially in high-risk patients, to facilitate early CAD detection and management.
Symptom Management
1. Blood Pressure Control: Administer medications to manage blood pressure in CAD patients:
- Beta-blockers: To slow heart rate and lower blood pressure.
- Calcium Channel Blockers: As an alternative if beta-blockers are contraindicated or not tolerated.
- Angiotensin-Converting Enzyme (ACE) Inhibitors and Angiotensin II Receptor Blockers (ARBs): To reduce blood pressure.
2. Chest Pain Relief: Nitroglycerin is commonly used to dilate veins, improve blood flow, and alleviate chest pain (angina), a prevalent symptom of CAD.
3. Angina Trigger Identification: Educate patients to track angina triggers, such as physical activity, stress, meals, or rest. This helps in planning tailored interventions.
4. Ischemic Angina Management: Ranolazine can be used to treat chronic and ischemic angina, often in combination with:
- Antihypertensive medications (ACE inhibitors, ARBs, calcium channel blockers, beta-blockers)
- Nitrates
- Antiplatelets
- Lipid-lowering medications
5. Blood Pressure Maintenance: Advise patients with CAD to maintain blood pressure below 140/90 mmHg. Caution against excessively low diastolic blood pressure (below 60 mmHg), as it can worsen angina in CAD patients.
Cardiac Rehabilitation
1. Cardiac Rehabilitation Program Adherence: Emphasize the importance of adhering to individualized cardiac rehabilitation programs, which include support, exercise, and education tailored to each patient’s needs and promote long-term lifestyle changes.
2. Complication Prevention: Cardiac rehabilitation aids in recovery after CAD events and reduces the risk of complications and hospital readmissions.
3. Home and Community Health Services Referral: Ensure continuity of care by referring patients to home health or community-based cardiac rehabilitation programs post-discharge. These programs typically last 6 to 10 weeks.
4. Patient Motivation and Adherence: Motivate patients to actively participate in and adhere to cardiac rehabilitation plans. Adherence is strongly linked to positive outcomes, including reduced mortality, improved exercise capacity, better BMI, improved lipid profiles, enhanced psychological well-being, and improved quality of life.
Risk Reduction: Prevention Strategies
1. Promote Physical Activity: Encourage regular physical activity and exercise. Aim for at least 150 minutes of moderate-intensity exercise per week, incorporating aerobic and strength training.
2. Maintain Ideal Body Mass Index (BMI): Educate patients about the risks of overweight and obesity, as excess weight can lead to fatty deposits in arteries. Weight loss can improve blood pressure, cholesterol levels, and metabolic health.
3. Patient Education: Comprehensive patient education is crucial for improving medication and treatment adherence. It promotes patient-centered care and continuity, enhancing CAD management and prevention through increased patient motivation and engagement.
4. Stress Management: Instruct patients in stress-reduction techniques such as yoga, guided imagery, deep breathing, and meditation. Stress elevates heart rate and blood pressure, constricts blood vessels, and increases CAD risk through inflammatory responses.
5. Comorbidity Management: Effective management of comorbidities like diabetes and hypertension is essential for long-term survival, complication prevention, and symptom control in CAD patients.
6. Recognize When to Seek Medical Attention: Instruct patients to seek immediate medical attention if they suspect heart attack or stroke symptoms. Patients with angina should seek help if chest pain is unresponsive to nitroglycerin.
7. Lifestyle Modification Education: Emphasize the importance of lifestyle modifications for CAD prevention and management. Encourage:
- Regular exercise
- Heart-healthy diet
- Smoking cessation and avoidance of secondhand smoke
- Limiting alcohol intake
- Stress management
- Management of depression
8. Omega-3 Fatty Acids: Discuss the potential benefits of omega-3 fatty acids, found in fish, flaxseeds, and soybeans, or through fish oil supplements, in reducing inflammation and CAD risk.
9. Alternative Medicine Considerations: Advise patients to consult healthcare providers before using herbal supplements, as they may interact with prescribed medications. Some herbs like garlic, barley, oats, and psyllium are known to potentially lower cholesterol and blood pressure.
10. Cardiologist Follow-up: Recommend regular follow-up visits with a cardiologist and routine testing and blood work to ensure treatment effectiveness. Typically, cardiologist visits are recommended every three to six months for diagnosed CAD patients.
Ensuring Safety
1. Caution with Blood Thinners: Management of CAD often includes anticoagulant therapy. Educate patients about the increased bleeding risk associated with these medications.
2. Bleeding Precautions Implementation: Instruct patients on bleeding precautions:
- Use a soft-bristled toothbrush
- Use electric razors for shaving
- Avoid forceful nose blowing
- Prevent constipation and straining during bowel movements
- Avoid contact sports
3. Medical Identification: Recommend that patients wear medical identification (bracelet, necklace, or ID tag) indicating their CAD history, potential risk of heart attack and stroke, and anticoagulant use, to alert emergency responders.
Nursing Care Plans
Once nursing diagnoses are identified for coronary artery disease, nursing care plans are essential for prioritizing assessments and interventions for both short-term and long-term care goals. Examples of nursing care plans for coronary artery disease are detailed below.
Acute Pain
CAD can cause chest pain, known as angina, due to reduced blood supply to the heart muscle from blocked arteries. Patients often describe angina as pressure or tightness, feeling like “something sitting on my chest.”
Nursing Diagnosis: Acute Pain
Related to:
- Increased cardiac workload
- Decreased blood flow to the myocardium
As evidenced by:
- Reports of chest pain or tightness (duration, frequency, intensity)
- Diaphoresis
- Distraction behaviors
- Facial grimacing
- Guarding or protective posture
- Positioning to alleviate pain
- Altered vital signs
Expected Outcomes:
- Patient will report pain relief, demonstrated by absence of pain behaviors and stable vital signs.
- Patient will verbalize appropriate actions when chest pain occurs and when to seek emergency care.
Assessments:
1. Vital Sign Monitoring: Assess and monitor vital signs regularly. Pain can alter vital signs, potentially causing initial tachycardia and hypertension, followed by hypotension, hypoxemia, and bradycardia with worsening cardiac output.
2. Pain Characteristics Assessment: Rapidly assess pain characteristics, differentiating chest pain from other causes like heartburn or indigestion. Unstable angina is typically more intense, unpredictable, prolonged, and less responsive to rest or sublingual nitroglycerin compared to stable angina.
3. Diagnostic Study Review: Review ECG results to identify the presence and location of infarction or angina. ECG changes during angina may include ST depression or T-wave inversion. Infarction may be indicated by ST-elevation MI, non-ST-elevation MI, or abnormal Q waves.
Interventions:
1. Supplemental Oxygen Administration: Provide supplemental oxygen as needed to maintain arterial oxygen saturation at 90% or higher. Administer oxygen only if SpO2 is below normal limits, as it can be counterproductive otherwise.
2. Prompt Medication Administration: Administer prescribed medications promptly. Nitroglycerin dilates coronary arteries, improving blood flow. Morphine sulfate may be ordered for comfort, smooth muscle relaxation, and reduced myocardial oxygen demand. Beta-blockers decrease cardiac workload.
3. Head-of-Bed Elevation: Elevate the head of the bed to promote comfort and reduce myocardial oxygen demand. This position facilitates gas exchange and minimizes hypoxia and associated shortness of breath.
4. Quiet and Comfortable Environment: Maintain a calm and comfortable environment to reduce anxiety and chest pain. Mental and emotional stress can increase myocardial workload and pain.
5. Trigger Identification Assistance: Help the patient identify angina triggers, often related to stress, emotional events, or exercise. Stopping the triggering activity can help determine if further assessment is needed.
Anxiety
Anxiety is a normal response to stressful events like cardiac issues but can be detrimental if excessive. Timely identification and management of anxiety alongside CAD are crucial.
Nursing Diagnosis: Anxiety
Related to:
- Situational crisis or stressors
- Pain
- Underlying pathophysiological response
- Perceived threat to health status
As evidenced by:
- Expressions of distress and insecurity
- Awareness of physiological symptoms
- Feelings of helplessness
- Heart palpitations
- Nausea
- Fear of death
- Physiological manifestations: altered respiratory pattern, facial flushing, increased BP, increased heart rate, sweating
Expected Outcomes:
- Patient will verbalize awareness of anxiety and healthy coping mechanisms.
- Patient will demonstrate two effective relaxation strategies.
- Patient will report reduced anxiety to a manageable level.
Assessments:
1. Stress Level Assessment: Assess the patient’s stress levels, as stress can exacerbate CAD by increasing blood pressure and cardiac workload.
2. Vital Sign Monitoring: Monitor vital signs, distinguishing between medical and emotional responses. Both can manifest as rapid pulse, diaphoresis, and hyperventilation.
Interventions:
1. Encourage Expression of Feelings: Encourage the patient to express feelings and fears. Unexpressed emotions can intensify anxiety and worsen health conditions like CAD.
2. Reassurance Provision: Offer reassurance to alleviate anxiety. Reiterate patient safety and present a calm demeanor to instill a sense of control.
3. Medication Administration: Administer prescribed anxiolytics like benzodiazepines (e.g., alprazolam) to aid relaxation until the patient can develop effective coping strategies.
4. Accurate Disease Information: Provide accurate information about CAD to enhance understanding and reduce anxiety. Patient education empowers active participation in treatment.
5. Relaxation Coping Methods: Encourage and guide patients in practicing relaxation techniques like breathing exercises, meditation, distraction, and positive self-talk.
Decreased Cardiac Output
CAD can lead to decreased cardiac output, resulting in inadequate oxygenation and perfusion to meet bodily demands.
Nursing Diagnosis: Decreased Cardiac Output
Related to:
- Inotropic changes (myocardial ischemia)
- Altered heart rate and rhythm
As evidenced by:
- Tachycardia
- ECG changes
- Angina
- Activity intolerance
- Fatigue
- Restlessness
Expected Outcomes:
- Patient will report fewer episodes of angina, dyspnea, and dysrhythmias.
- Patient will engage in activities that reduce cardiac workload.
Assessments:
1. Heart Rate, BP, and Rhythm Assessment: Assess heart rate, blood pressure, and cardiac rhythm. Tachycardia may be present due to pain, hypoxemia, anxiety, or reduced cardiac output. Blood pressure changes can also occur.
2. Breath and Heart Sounds Auscultation: Auscultate breath and heart sounds. Crackles in lungs may indicate cardiac decompensation. Abnormal heart rhythms or sounds (gallop, S3 or S4) may signal heart failure.
3. Skin Color and Pulse Assessment: Assess skin color and peripheral pulses. Compromised cardiac output can reduce peripheral circulation, leading to pallor, cyanosis, and diminished pulses.
Interventions:
1. Adequate Rest Periods: Ensure adequate rest periods to decrease oxygen consumption and demand, reduce decompensation risk, and minimize myocardial workload.
2. Valsalva Maneuver Avoidance: Stress the importance of avoiding Valsalva maneuvers (straining), which can cause vagal stimulation, reducing heart rate followed by rebound tachycardia, both impairing cardiac output.
3. Medication Administration: Administer inotropic medications like digoxin as prescribed to enhance cardiac output by strengthening heart contractions.
4. Test and Procedure Preparation: Prepare patients for diagnostic tests and procedures like echocardiograms (to assess heart structure and function) and cardiac catheterizations (to visualize blockages).
Ineffective Tissue Perfusion
Ineffective tissue perfusion in CAD is often due to plaque formation, leading to narrowed or obstructed arteries and reduced blood flow to tissues and organs.
Nursing Diagnosis: Ineffective Tissue Perfusion
Related to:
- Plaque formation
- Narrowed/obstructed arteries
- Unstable plaque rupture
- Coronary artery vasospasm
- Ineffective cardiac muscle contraction
- Conditions compromising blood supply
- Difficulty of heart muscle to pump
- Increased workload
- Inadequate blood supply to the heart
As evidenced by:
- Hypotension
- Decreased peripheral pulses
- Increased central venous pressure (CVP)
- Tachycardia
- Dysrhythmias
- Decreased oxygen saturation
- Chest pain (angina)
- Dyspnea
- Orthopnea
- Tachypnea
- Altered level of consciousness
- Restlessness
- Fatigue
- Activity intolerance
- Cold, clammy skin
- Prolonged capillary refill
- Pallor or cyanosis
- Edema
- Claudication complaints
- Numbness
- Lower extremity pain
Expected Outcomes:
- Patient will exhibit palpable peripheral pulses and normal capillary refill time.
- Patient will have warm, non-edematous skin.
- Patient will maintain alertness, consciousness, and coherence.
Assessments:
1. Vascularization Status Determination: Assess the patient’s vascularization status, as reduced blood flow impairs tissue perfusion. Chronic conditions like peripheral vascular disease can further compromise lower extremity circulation.
2. Ankle-Brachial Index (ABI) Calculation: Calculate ABI to assess blood flow in the legs by comparing blood pressure in arms and ankles.
3. Skin, Capillary Refill, and Sensation Assessment: Assess skin color, capillary refill, and sensations, noting signs like edema, poor ulceration/wound healing, skin color changes (pale/cyanotic), temperature, hair loss, thickened nails, absent/weak pulses, pain, dulled sensations, and claudication.
4. Doppler Ultrasound Use: Use Doppler ultrasound to non-invasively assess blood flow and tissue perfusion, especially in lower extremities, by reflecting sound waves off red blood cells.
Interventions:
1. Blood Flow Improvement Medications: Administer vasodilators (e.g., nitroglycerin, hydralazine) as prescribed to enhance tissue perfusion by widening blood vessels.
2. Surgical Procedure Preparation: Prepare patients for potential surgical procedures to improve blood flow:
- Percutaneous Coronary Intervention (PCI) with stent placement
- Coronary Artery Bypass Grafting (CABG)
3. Aspirin Therapy Initiation: Initiate aspirin therapy as ordered. Aspirin, a blood thinner, reduces plaque rupture and clotting risks, improving blood flow.
4. Mobility and Activity Contraindication Education: Educate patients to avoid prolonged sitting, leg crossing, and constrictive clothing to prevent venous return impairment. Encourage active/passive ROM exercises and ambulation as tolerated. Elevate legs when sitting to promote venous return.
5. Cardiac Rehabilitation Referral: Refer patients to cardiac rehabilitation to improve risk factors, exercise tolerance, medication adherence, and diet control post-PCI or CABG.
Risk for Unstable Blood Pressure
Risk for unstable blood pressure in CAD arises from plaque formation leading to narrowed/obstructed arteries and reduced blood flow, causing BP instability.
Nursing Diagnosis: Risk for Unstable Blood Pressure
Related to:
- Plaque formation
- Narrowed/blocked arteries
- Unstable plaque rupture
- Coronary vasospasm
- Ineffective cardiac muscle contraction
- Conditions compromising blood supply
- Difficulty of heart muscle to pump
- Increased workload
- Inadequate blood supply to heart
- Impaired contractility and relaxation
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred; interventions are preventative.
Expected Outcomes:
- Patient will maintain blood pressure within ordered parameters.
- Patient will tolerate sitting or standing without significant BP fluctuations.
- Patient will avoid complications of unstable BP, such as myocardial ischemia or cerebrovascular accident.
Assessments:
1. Blood Pressure Monitoring: Track blood pressure regularly. Hypertension can worsen CAD, damage vessels, and cause plaque rupture.
2. Symptom Assessment: Assess for signs and symptoms of unstable BP. Initial symptoms may be subtle (e.g., tachycardia during exercise). As arteries narrow, symptoms like angina, dyspnea, fatigue, and dizziness may worsen.
3. Risk Factor Determination: Determine risk factors for hypertension, such as high blood sugar, inactivity, high triglycerides, high sodium diets, and excessive alcohol intake.
4. Body Fat Assessment: Assess body fat, as excess weight and obesity are linked to hypertension due to increased visceral and retroperitoneal fat compressing kidneys and excessive fat buildup around kidneys.
Interventions:
1. Caution with Exertional Activities: Advise caution with exertion, as obstructed arteries can cause BP increases during stress or exercise due to increased cardiac workload.
2. Medication Administration: Administer prescribed medications like beta-blockers and ACE inhibitors to reduce BP and cardiac workload. Antiplatelet or anticoagulant medications may be needed to lower complication risks in atherosclerosis.
3. Blood Pressure Control Education: Educate patients on the importance of BP control to prevent heart attacks and strokes, common consequences of atherosclerosis and hypertension.
4. Lifestyle Modification Emphasis: Emphasize lifestyle modifications (diet, exercise, smoking cessation) as primary steps in treating atherosclerosis and lowering BP.
5. Stress Testing Assistance: Assist with stress testing to evaluate exertional hypotension or hypertension, monitoring BP response during exercise.
References
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