1. What are H.C.’s risk factors for CAD?

2. What symptoms should lead the nurse to suspect the pain may be angina?

3. What nursing actions should be taken for H.C.’s discomfort?

4. What kind of ECG changes would indicate myocardial ischemia?

5. What information should the nurse provide for H.C. before the treadmill testing

6. Priority Decision: What are the priority nursing measures that should be instituted to help H.C.
decrease her risk factors?

7. Should H.C.’s angina become chronic stable angina, explain the treatment that would be used using
the mnemonic A, B, C, D, E, and F. 8. Priority Decision: Based on the assessment data presented, what
are the priority nursing diagnoses? Are there any collaborative problems?

1. The risk factors that associated with H.C are Diabetes mellitus, smoking history, obesity, physical
inactivity, and stress response.

2. The symptoms that could lead the nurse to suspect the pain may be angina are the Anxiousness with
fist clutching; radiation of the burning from epigastric area into the sternum; and prior episodes of chest
pain with activity, relieved by rest.

3. The nursing actions should be taken for H.C.’s discomfort are to provide emotional support as well as
an explanation of both interventions and procedures. Place her straight, inject oxygen via a nasal
cannula, take vital signs, start continuous ECG monitoring, auscultate pulse and breath sounds, diagnose
pain with PQRST, medicate as directed, and obtain baseline laboratory values and a chest x-ray.

4. The kind of ECG changes would indicate myocardial ischemia are Depressed ST segment and T wave
inversion.

5. The nurse should tell H.C. that she will be subjected to constant cardiac testing while walking on a
treadmill with increasing speed and acceleration to assess the impact of exercise on her heart's blood
flow. Her breathing, respiration, blood pressure, and heart rate will be monitored as she walks and
during the exercise before they return to normal, and the cardiac monitor will be used after the test
until an abnormality is detected.

6. This patient does not seem to be inspired to take responsibility for her welfare and, in the absence of
complications, does not appear to be motivated to make behavioral improvements. First, the nurse
should help her define her personal beliefs. The nurse can then assist her in recognizing her
susceptibility by describing the symptoms associated with her risk factors and helping her recognise her
specific vulnerability to different risks. Also, Assist the patient in setting specific targets and allowing her
to select which risk factor to address first.

7. A: Antiplatelet, antianginal, and ACE inhibitor or ARB therapy B: β-adrenergic blocker and blood
pressure control C: Cigarette smoking cessation, cholesterol management, calcium channel blockers, and
cardiac rehabilitation D: Diet for weight management, diabetes management, and depression screening
E: Education and exercise F: Flu vaccination Many of these measures can be used now to help the
patient better manage her current health if she is motivated to do so.
8. Nursing diagnoses:

• Acute pain related to imbalance between myocardial oxygen supply and demand

• Anxiety related to possible diagnosis and uncertain future

• Ineffective denial related to reluctance to receive medical care or change lifestyle

• Ineffective coping related to lack of effective coping skills

• Imbalanced nutrition: more than body requirements related to intake of calories in excess of calorie
expenditure

• Ineffective health maintenance related to lack of health insurance and motivation Collaborative
problems: Potential complications: myocardial infarction, cardiac dysrhythmias

Assessme Diagnosi Rationale Planning Intervention Rationale Evaluation

nt s
Subjective Ineffecti Inability Short Independent: Short
: ve to form a Term: 1. Assess 1. The Term:
“Expresse coping valid for the patient’s Goal was
s related appraisal After 1 day influen coping partially
frustratio to lack of the of nursing met,
ce of behavior
n with of stressors, interventio After 1 day
cultura may be
physical effective inadequa n, the of nursing
problems coping te patient will l based on interventio
” skills choices Verbalize beliefs, cultural n, the
As of ability to norms, percepti patient
Objective: evidenc practiced cope and and ons of able to
Physical ed by response asks for values normal Verbalize
Examinati the s, and/or help when on the and ability to
on • patient inability needed. patient’ abnorma cope and
Anxious, expresse to use asks for
s l coping
clutching s available help when
percep behavior.
fists frustrati resource Long term: needed.
• Appears on with s. After 1 tions of 2. Situational
overweig physical week of effectiv factors
ht and problem nursing e must be Long term:
withdraw s interventio coping. identified Goal was
to gain an
n n, the 2. Observe partially
patient will understan met,
for
Discuss ding of the After 1
causes
how recent patient’s week of
of
life current nursing
ineffecti
stressors situation interventio
ve
have and to aid n, the
coping
overwhelm patient patient
such as
ed normal with able to
poor
coping self- coping discuss
strategies. concept, effectively how recent
grief, . life
lack of 3. Accurate stressors
problem appraisal have
-solving can overwhelm
skills, facilitate ed normal
lack of developm
support, ent of
or appropriat
recent e coping
change strategies.
in life Because a
situatio patient
n. has an
3. Identify altered
specific health
stressor status
s. does not
4. Encour mean the
age coping
patient difficulties
he or she
to
exhibits
make
are only (if
choices at all)
and related to
partici that.
pate in Persistent
planni stressors
ng of may
care exhaust
the
and
patient’s
schedu
ability to
led maintain
activiti effective
es. coping.
5. Provide 4. Participa
informa tion
tion the gives a
patient feeling of
wants
control
and
and
needs.
Do not increases
give self-
 more esteem.
than the 5. Patients
patient who are
can coping
handle. ineffective
Dependent: ly have
1. Refer to reduced
outside ability to
resources absorb
and/or informatio
professional n and may
therapy as need
indicated/order more
ed guidance
initially
Collaborative: Dependent:
1. Refer to 1. For
medical social treatmen
services for t
evaluation and
Collaborative:
counseling.
1. This will
promote adequate
coping as part of
the medical plan
of care.