1. Identify (3) priority nursing diagnoses from the scenario overview.
*Note: Please use the format on the attached page and complete one of your listed diagnoses in full
including goals, outcome criteria, intervention
...
1. Identify (3) priority nursing diagnoses from the scenario overview.
*Note: Please use the format on the attached page and complete one of your listed diagnoses in full
including goals, outcome criteria, interventions, rationale, etc.*
• Acute pain related to imbalance between myocardial, oxygen supply and demand evidenced by patient
complaints of chest discomfort.
• Imbalanced nutrition more than body requirements related to food intake evidenced by HDL level 32, BMI
of 30, and uncontrolled glucose level of 246.
• Deficient knowledge related to lack of information to lower risk of cardiac disease evidendenced by lifestyle
habits of smoking 2 packs of cigarettes a day and consumption of a high fat diet.
Identify the (3) top nursing assessments for this patient.
• Family history of hyperlipidemia
• Nutrition-High fat diet and sedentary lifestyle, smoking 2 packs of cigarettes a day.
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• Monitoring vital signs such as Pain, ECG, blood pressure, respirations, and heart rate.
Identify (2 - 3) priority orders for this patient.
• HCP prescribes lovastatin to help control cholesterol.
• After interpreting ECG, the HCP diagnosed the patient with stable angina and prescribed nitroglycerin
2. Students treat the case study as your clinical patient for the day and answer the following questions:
a. What is the pathophysiology of the patient’s diagnosis & current treatment recommendations?
Pathophysiology:
Harding et al (2020) describes coronary artery disease as a disease that progresses in three stages over the
years that the patient is suffering the disorder. The first stage is fatty streak, where yellow traced streaks of fat
begin to appear and develop within smooth muscle cells. These fatty streaks can be seen in an individual's coronary
arteries as young as 20 years old, which increases on the surface areas of the coronary arteries as the patient ages.
The second stage is fibrous plaque, which starts the progressive changes on the endothelium of arterial wall. These
progressive changes will start to appear at 30-years-old and increase with age. The endothelium is unable to repair
itself; the arterial wall is thickened by LDLs and platelets’ growth factors. Plaque begins to form on the artery due
transport of cholesterol, narrows the vessel lumen and reduces blood flow to the distal tissues. The third and final
stage is called complicated lesion, where the arthosclerotic lesion begins to develop. As the fibrous plaque begins
with growing, inflammation can cause the plaque to become unstable, development of ulcers, and rupturing. Once
the arterial wall is compromised, a thrombus develops and binds to the wall, which leads to an occlusion of the
artery. The thrombus becomes enlarged as many platelets begin to aggregate and adhere onto the thrombus.
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