What is the common presentation of coronary heart disease?
Left arm and chest pain that stops with rest
What is the common presentation of heart failure?
- Progressive fatigue
- Increasing shortness of breath
- Cough
- Paroxysmal nocturnal dyspnoea
- Weight changes
- Dyspnoea
- Tachycardia
- Oedema
- Nocturia
- Skin changes
- Behavioural changes
What are risk factors of coronary heart disease?
- Elevated LDL and triglycerides
- Hypertension
- High fat, high salt diet
- Obesity
- Ethnicity
- Family history of HF
What are risk factors of heart failure?
- History of CAD
- History of myocardial infarction
What are functional health patterns of coronary heart disease?
- Health perceptions and health management
- Nutrition
- Roles and relationships
- Cognition – perceptual
- Activity and exercise
What are functional health patterns of heart failure?
- Health perceptions and health management
- Coping and stress tolerance
- Activity and exercise
- Roles and relationships
What are nursing interventions for coronary heart disease?
- Physical activity
- Nutrition therapy
- Support with medication management
- Reduce effects of risk factors
- Engage family and whanau when developing plans of care
- Help identify precipitating factors of angina
- Teach clients signs of acute cardiac event and what to do
- Encourage annual flu and 5 year pneumonia vaccines
- Use to medications to proactively prevent angina
- Identify stressors and effective coping strategies
- Activity modification
- Support engagement with cardiac rehab
What are nursing interventions for heart failure?
- Physical activity
- Planned periods of rest
- Identify stressors and effective coping strategies
- Support with medication management
- Nutritional therapy (Recognise high fat high sodium foods, know fluid limits, daily weights to monitor fluid retention, recognise side effects of diuretics)
- Teach clients to recognise signs of worsening and what to do
- Encourage annual flu and 5 year pneumonia vaccines
- Reduce effects of risk factors
- Engage family and whanau when developing plans of care
Medications to manage lipid levels?
Lipid lowering agents such as ‘statins’
Medications to increase cardiac output?
Positive inotropes
Medications to lower blood pressure?
Beta-blockers, calcium channel blockers, ACE inhibitors, thiazide diuretics, vasodilators
Medications to manage arrhythmias?
Beta-blockers, calcium channel blockers
Medications to manage clotting?
Antiplatelets, anticoagulants
Medications to manage chest pain?
Vasodilators, beta blockers
Medications to reduced fluid volume?
Diuretics taken during the day to avoid sleep disruption, ACE inhibitors, ARBs
Medications to decreased preload?
Diuretics, vasodilators
Medications to decreased after-load?
Vasodilators
What is the difference between congestive heart failure and heart failure?
Congestive heart failure has resulting oedema
What are modifiable risk factors of coronary artery disease?
- Hypertension
- Elevated serum lipids
- Tobacco use
- Alcohol intake
- Physical inactivity
- Psychological state
- Obesity
- Nutrition
- DM2
- Use of illicit drugs
What are non-modifiable risk factors of coronary artery disease?
- Male over 60 years
- Ethnicity
- Genetic predisposition
- Family history
What is the progression of coronary artery disease?
1) Asymptomatic (chronic artery endothelial injury)
2) Asymptomatic (arterial fatty streak and fibrous plaques)
3) Complicated lesions (plaque rupture, thrombus or complete narrowing of artery
4) Chronic stable angina, acute coronary syndrome
What is the progression of heart failure?
1) No limitation of physical activity. Asymptomatic
2) Slight limitation. Ordinary physical activity causes symptoms.
3) Marked limitation. Less than ordinary physical activity causes symptoms.
4) Inability to carry on any physical activity without discomfort. Symptoms at rest.
What to monitor for coronary heart disease?
- Blood pressure
- Levels of activity
- Blood tests
- Sodium and fat intake
- Watching weight
What to monitor for heart failure?
- Blood pressure
- Levels of activity
- Blood tests
- Sodium and fat intake
- Watching weight
- Watching fluid intake
