Question

The nurse is working with a new client at the community clinic. The client is a 59-year-old African American female. The client’s mother was diagnosed with coronary artery disease at the age of 60. The client has a sedentary job but walks for 30 minutes every day on the weekend. Her waist circumference is 38 inches (96.52cm). Her blood pressure on this visit is 140/90 mm Hg. She stopped smoking six months ago.

Laboratory results are:

• Triglycerides 250 mg/dL
• HDL 45 mg/dL
• LDL 150 mg/dL
• Total cholesterol 300 mg/dL

The nurse establishes a NANDA -I nursing diagnosis of Deficient Knowledge related to coronary artery disease.

Initial Discussion Post:

Develop a teaching plan that addresses one of the client’s risk factors for coronary artery disease.

The teaching plan should consider cultural influences and must include:

• a measurable patient centered outcome.
• two (2) nursing interventions to help the client achieve the outcome.
• an explanation of how each intervention will help the client achieve the outcome

Answer 1

Teaching plan;

Physical activity

Improve the function of your heart and lungs

Improve your HDL cholesterol and triglycerides

Lower your blood pressure

Help you achieve a healthier body weight

Improve your muscle tone and bone density

Increase your endurance and improve your confidence

Improve your ability to cope with stress and decrease anxiety and depression.

How to increases your physical activity

A balance of rest and activity should still be maintained to allow for continued healing and to conserve your energy.Activity should be increased gradually. Everyone recovery is different .The rate at which you progress will depend on the severity of your cardiac event and your previous Activity level.After four to six weeks you should be back to performing your regular activities.

Walking is one of the earliest activities you are allowed to resumes and it is one of the best exercise for improving your health. We have given you a walking guide below to help get you started.

Exercise;

Walk on flat ground initially. It hills are unavoidable.

It is best to wait about an hour after a meal before you exercise as extra energy is required for digestion.

It is important to Start exercising for short periods of time and at a slow walking pace.gradually increase the length of your walks before you increase the speed.

If you are feeling well enough you may exercise twice per day.

You should be back to your pre walk or resting state within 10 mint's of completing exercise.

If you feel tired shorten your walking times.

Avoid exercise in extreme temperatures.

A stationary bicycle can also be very valuable. Especially if you have joint problems which make walking more difficult. Make sure a slow speed.

Avoid exercise where you hold your breath or breath down.

TRest and sleep;

Try to get 8 hourse sleep every day.

Minimizes Activity After meals.

Avoid smoking helps to reduce blood pressure

control your blood pressure

Follow nutrition plan

Maintain a healthy body weight

Stress management techniques that work for you

Take your medications as prescribed

Smoke free

Participate in cardiac rehabilitation

Aspirin

Beta blockers

Calcium channel blocker

Ranolazine

Nitroglycerin

Angiotensin converting enzyme inhibitor.

Nursing interventions;

Knowledge deficit related to diseases condition as evidenced by frequent asking questions.

Goal;

Patient get relive from fear

Interventions;

Define and state the limit s of desired blood pressure

Explain hypertension and it's effect on the heart,brain,blood vessel

Assist the patient in identifying modifiable risk factors like cholesterol, high in sodium

Reinforce the importance of adhering to treatment regimen and keeping follow up appointment.

Frequent position changes,leg exercise when lying down.

Altered tissue perfusion related to narrowing of the coronary artery as evidenced by chest pain.

Goal :

Patient get relief from pain.

Interventions;

Monitor blood pressure, apical pulse rate noted

Maintain continuous ECG monitoring

Place patient comfortable position and administer oxygen

Identify specific activities patient may engage in that are below the level at which anginal pain occur.

Reduce patient anxiety

Teach the patient relaxation techniques

Acute pain in the chest related to decreased myocardial blood flow as evidence by pain scale score.

Goal; patient get relief from pain.

Interventions;

Assess character of pain

Monitor vital signs

Provide comfortable position.

Patient at complete rest during angina episode.

Use relaxation techniques.

Maintain quit ,comfortable environment.

Provide light meals.

Provide supplemental oxygen.

Administrator medication.

Activity intolerance related to imbalance between oxygen supply and demand and the presence of necrotic tissue in myocardial ischemia.

Risk for decreased cardiac output related to changes in the rate ,rhythm and the presence of necrotic tissue in myocardial infarction.