ANGINA PECTORIS B S N 3 A JOAN BOMBITA JEREMY CABALQUINTO MARIANE CASAIS SHEILA MARIE GAN DANICA ORO OVERVIEW OF CARDIOVASCULAR SYSTEM CARDIOVASCULAR SYTEM Transportation system of the body Carries oxygen and nutrients Also carries substances called hormones, which control body processes Antibodies to fight invading germs Gets rid of waste materials (CO2) 3 KINDS OF CIRCULATION SYSTEMIC CIRCULATION The largest part of the circulatory system in which oxygenrich blood flows to all organs and body tissues, except the heart, and lungs. CORONARY CIRCULATION Movement of blood through the tissues of the heart (cardiac muscle only). PULMONARY CIRCULATION Movement of blood from the heart, to the lungs, and back to the heart again MAJOR PARTS OF CARDIOVASCULAR SYTEM HEART BLOOD VESSELS BLOOD HEART Size of your fist Serve as a muscular pump propelling blood into and through vessels to and from all parts of the body Hollow, muscular organ located in the left center of the chest and protected by the sternum Divided into 4 chambers HEART Atria (atrium): chambers in the top of the heart which receive blood from other areas of the body Ventricles bottom parts of the heart, pump blood to different parts of the body Pumps about 4-5 liters of blood per minute about 9,000 liters a day It beats between 60-160 beats per minute BLOOD VESSELS Hollow tubes that circulate your blood 3 KINDS ARTERIES Carry blood AWAY from the heart Main artery called the aorta is the largest artery VEINS Carry blood back to the heart Largest vein is the Vena Cava CAPILLARIES smallest of the blood vessels Where exchange of oxygen, waste and other transfers occur between the blood vessels and the tissue BLOOD Carries nutrients, water, oxygen and waste products to and from your body cells There is about 5 liters of blood in the average size adult human body PLASMA liquid part of the blood made up of mostly water PLATELETS blood cells that help stop bleeding WHITE BLOOD CELLS Defend body against bacteria, viruses, foreign substances RED BLOOD CELLS Contain hemoglobin that helps the RBC to carry oxygen to all parts of body Takes carbon dioxide and transports it back to the lungs ANGINA PECTORIS ANGINA PECTORIS clinical syndrome characterized by episodes of paroxysms of pain or pressure in the anterior chest chest pain or discomfort that occurs when a part of your heart doesn't get enough blood and oxygen caused by insufficient coronary blood flow resulting to decreased oxygen supply when there is an increased myocardial demand for oxygen in response to physical exertion or emotional stress the needs for oxygen exceeds the supply types of angina STABLE ANGINA UNSTABLE ANGINA predictable and consistent pain that occurs on exertion and is relieved by rest and/or nitroglycerin symptoms increase in frequency and severity; may not be relieved with rest or nitroglycerin VARIANT ANGINA - pain at rest with reversible ST-segment elevation; thought to be caused by coronary artery vasospasm - also called Prinzmetal’s angina INTRACTABLE OR REFRACTORY ANGINA severe incapacitating chest pain SILENT ISCHEMIA objective evidence of ischemia (such as electrocardiographic changes with a stress test), but patient reports no pain Who are at risk for angina pectoris? Physical activity Emotional stress Extreme cold or heat Who are at risk for angina pectoris? Heavy meals Drinking too much alcohol Cigarette smoking CLINICAL MANIFESTATIONS Ischemia of the heart muscle may produce pain or other symptoms, varying in severity from mild indigestion to a choking or heavy sensation in the upper chest that ranges from discomfort to agonizing pain accompanied by severe apprehension and a feeling of implementing death. Pain often in the chest behind sternum (pain or discomfort is poorly localized and may radiate to the neck, jaw, shoulders, and inner aspects of the arm (left arm)) Tightness / heavy choking/ strangling sensation Feeling of weakness or numbness in: -arm -wrists -hands clinical manifestations Shortness of breath Pallor Diaphoresis clinical manifestations Dizziness Nausea Vomiting clinical manifestations Patient with diabetes mellitus may not have severe pain with angina Women may have different symptoms than men An important characteristic of angina is that it subsides with rest or administering nitroglycerin Patients with angina symptoms follow a stable, predicament pattern Unstable angina is characterized by attacks that increase in frequency and severity and are not relieved by rest and administering nitroglycerin Pathophysiology: Angina Pectoris MANAGEMENT MEDICAL MANAGEMENT Several medications can improve angina symptoms, including: Beta Blockers Aspirin Reduce the ability ofthe blood to clot, making it easier for blood to flow through narrowed heart arteries Nitrates Relax and widen the blood vessels, allowing more blood to flow to your heart muscle. Nitrates in pills or sprays act quickly to relieve pain during an event. There are also long-acting nitrate pills and skin patches Block the effects of the hormone epinephrine, also known as adrenaline. Help the heart beat more slowly and with less force, decreasing the effort the heart makes and easing the angina pain MEDICAL MANAGEMENT Statins Lower blood cholesterol by blocking a substance your body needs to make cholesterol Help your body reabsorb cholesterol that has accumulated in the buildup of fats (plaques) in the artery walls, helping prevent further blockage in the blood vessels Ranolazine (Ranexa Calcium channel blockers Also called calcium antagonists These drugs relax and widen blood vessels by affecting the muscle cells in the arterial walls. This increases blood flow in the heart, reducing or preventing angina. This anti-angina medication might be prescribed with other angina medications, such as beta blockers. It can also be used as a substitute if your symptoms don't improve with the other medications PROCEDURES Angioplasty and stent placement Angioplasty, also known as percutaneous coronary intervention, increases blood flow through a blocked artery and decreases angina. During an angioplasty (AN-jee-o-plas-tee), your doctor threads a tiny, deflated balloon attached to special tubing up through an artery, generally in your groin, to your narrowed coronary artery. Your doctor inflates the balloon to widen the artery. He or she might then insert a small metal tube (stent) to keep the artery open. This procedure can take 30 minutes to several hours, and you'll probably remain in the hospital at least overnight. You can generally return to work or your normal routine soon after the angioplasty and stent procedure. Angioplasty and stenting involve some risks, including a risk of the blockage reforming. A stent coated with medication can help prevent this. PROCEDURES Enhanced external counterpulsation (EECP) therapy EECP therapy might be recommended for some people whose angina doesn't improve with other treatments. For this therapy, large cuffs are wrapped around your legs. Air pressure causes the cuffs to inflate and deflate in time to your heartbeat. This typically requires getting five one-hour treatments a week for seven weeks. LIFESTYLE CHANGES Regardless of which angina treatment you choose, your doctor will recommend that you make hearthealthy lifestyle changes. You can reduce or prevent angina by reducing your heart disease risks factors, including: Smoking If you smoke, stop. If you need help quitting, talk to your doctor about smoking cessation therapies Poor diet Eat a healthy diet with limited amounts of saturated fat, trans fat, salt and sugar. Lack of physical activity Talk to your doctor about starting a safe exercise plan. If your angina is brought on by exertion, pace yourself and take rest breaks. Excess weight If you're overweight, find a way to achieve and maintain a healthy weight by balancing what and how much you eat with how much physical activity you get. Ask your doctor what a healthy weight is for you. LIFESTYLE CHANGES Regardless of which angina treatment you choose, your doctor will recommend that you make hearthealthy lifestyle changes. You can reduce or prevent angina by reducing your heart disease risks factors, including: Medical conditions Get treatment for conditions that can increase your risk of angina, such as diabetes, high blood pressure and high blood cholesterol. Stress Avoiding stress is easier said than done, but try to find ways to relax. Talk with your doctor about stress-reduction techniques. NURSING CARE PLAN CASE STUDY Maria, a 56 years old farmer from Quinastillojan Tabaco City, Albay was admitted to Dr. Lorenzo P. Ziga Memorial District Hospital because she felt severe chest pains that lasts for at least 5-15 minutes, “Marauton sa pagmati,dae ko na kaya ang kulog garo ako tig tu-tuok buda mina kanap ang kulog sa may panga buda sa wala na kamot” as she stated . She also stated that she felt the chest pains for at least 1 week now, but did not consult the hospital because she thought that it is just fatigue from working in rice fields from morning to afternoon. Within further questioning, we learned that Maria is also an active smoker and a drunkard, at night, she likes to sleep on the floor which she stated that it helps her reduce her electric fan bill at night. Vital signs taken as follows: BP: 140/90 mmHg HR: 125 bpm RR: 42/min Temp: 37.6ºC Patient has no record of previous hospitalization and previous surgical procedures done. There is no significant family history. Subjective: “Marauton sa pagmati, dae na kaya ang kulog garo ako tigtu-tuok buda mina kanap ang kulog sa may panga buda sa wala na kamot. Halos 1 week ko na daa namamatian dae ko man aram kung nano ine, panghuna ko napagal lang ako dahil sa trabaho ” as stated by the patient. Objective: Vital signs BP- 140/90 mmHg HR- 125 bpm RR- 42 breaths per minute Temp: 37.6℃ NURSING DIAGNOSIS Deficient knowledge related to lack of information and education as evidence by continued chest pain for a week. Goal PLANNING Short term: After 2 hours of nursing intervention the patient will verbalize understanding of condition/disease through health teaching. Long term: After days of treatment the patient will initiate necessary changes in lifestyle. Desired/ Expected Outcome (s) Participate in learning process Verbalize understanding of conditon/disease process and potential complications Verbalize understanding of or participate in therapeutic regimen Initiate necessary lifestyle changes Perform health teaching INTERVENTION Independent Establish rapport Determine client ability to learn and provide factual information relevant to the situation. Discuss pathophysiology of condition Encourage avoidance of situations that may precipitate anginal episode like stress, intense physical exertion, large heaving meals during bedtime and exposure to elevated temperature. Discuss the importance of weight control, cessation of smoking, dietary changes and exercise. Discuss the importance of medical regime INTERVENTION Dependent Stress is important when checking with a physician before taking OTC drugs. Discuss the side effects of the prescribed medication by the physician Collaborative Collaborate with patient family or caretakers to support the client and to avoid the client getting anxiety. Instruct the family and educate them on the importance of medical regime and when to call the physician. EVALUATION After 2 hours of nursing intervention the short term was the patient coped up and was able to verbalize and understand the agina pectoris. After 2 days of the treatment, the patient initiated necessary changes in lifestyle and successfully recovered .
