Ihd

GENERAL OBJECTIVE

At the end of the presentation, students are expected to gain the necessary information regarding Ischemic Heart Disease for them to determine the appropriate nursing care management they should provide to those patients having this kind of illness

The students will be able to:  Understand the nature of Ischemic Heart Disease  Distinguishes its clinical manifestations and predisposing factors.  Outline the Anatomy and Physiology of the disease or condition.  Demonstrate the Pathophysiology of the disease.

 Determine the health status

of the

patient through: Knowing the past history and present illnesses of the patient as well as their family health history. Conducting physical examination. Analyzing the laboratory examination done and correlate it to the present condition of the patient.

 Determine the appropriate nursing care

that should be provided to the client.  Understand the different drugs that the client is taking and determine how it will benefit the client as well as the possible adverse effect it may give.  Create a good and therapeutic nursepatient interaction.  Teach the client’s relatives on how to minimize the risk of developing Ischemic Heart Disease.

Ischemic Heart Disease, otherwise known as Coronary Artery Disease, is a condition that affects the supply of blood to the heart. The blood vessels are narrowed or blocked due to the deposition of cholesterol plaques on their walls. This reduces the supply of oxygen and nutrients to the heart musculature, which is essential for proper functioning of the heart. This may eventually result in a portion of the heart being suddenly deprived of its blood supply leading to the death of that area of heart tissue, resulting in a heart attack.

As the heart is the one that supplies oxygenated blood to the various vital organs like the brain, kidneys etc. this leads to the death of tissue within these organs and their eventual failure or death. Ischemic heart Disease is the most common cause of death in several countries around the world. Coronary artery disease the condition in which fatty deposits (atheroma) accumulates in the cells lining the wall of the coronary arteries. These fatty deposits build up gradually and irregularly in the large branches of the two main coronary arteries which encircle the heart and are the main source of its blood supply.

This process is called atherosclerosis which leads to  narrowing or hardening of the blood vessels supplying blood to the heart muscle (the coronary arteries ). This  results in ischemia ( inability to provide adequate oxygen) to heart muscle and this can cause damage to the heart muscle . Complete occlusion of the blood vessel leads to a heart attack (myocardial infarction).

 Severe chest pain of Myocardial Infarction

which may be fatal.  Angina Pectoris- pain over the central chest that may sometimes radiate down the left arm, jaw or the back.  Pain may be accompanied by sweating.  The presence of anginal episodes is virtually diagnostic of Ischemic Heart Disease

Other signs that can be observed on clinical examination:  Presence of tendon Xanthomas  Thickening of the Achilles Tendon and Arcus Lipidus in young patients.

Risk factors:  Fatty diet  Smoking  Sedentary lifestyle  Stress These are the main areas of focus in prevention. Avoiding foods rich in saturated fats is vital to reduce lipid levels in the blood and to prevent atherosclerosis. Adequate regular exercise is also essential. DM and hypertension should be kept under good control with proper treatment

Various treatments are offered in people deemed to be high at risk of CAD. These include:  Control of cholesterol levels in those with known high cholesterol.\  Smoking cessation  Control of high blood pressure. The degree to which IHD affects each individual depends on a varietyof factors including:  Age  Genetics  Diet  Exercise habits  smoking

Drug therapy with Nitrates, which dilate the diseased coronary arteries, administered sublingually are very effective in relieving the pain in a few minutes. Drugs such as Isosorbide Dinitrate and Isosorbide Mononitrate belong to the category of Nitrates. These drugs are also used as a prophylactic to prevent the pain from occurring. Beta-blockers like Propranolol are also highly effective in relieving pain by reducing myocardial oxygen demand, mainly by decreasing the heart rate. Calcium channel antagonists produce vasodilatation and relieve the symptoms by reducing the excitability and conductivity of cardiac muscle and by reducing blood pressure. For patients with hypercholesterolaemia, drugs may be used to lower cholesterol levels.

Angioplasty is the technique of mechanically widening a narrowed or obstructed blood vessel; typically as a result of atherosclerosis. Tightly folded balloons are passed into the narrowed locations and then inflated to a fixed size using water pressures some 75 to 500 times normal blood pressure (6 to 20 atmospheres).  Coronary artery bypass surgery, also

coronary artery bypass graft surgery, and colloquially heart bypass or bypass surgery is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease. 

Arteries or veins from elsewhere in the patient's body are grafted to the coronary arteries to bypass atherosclerotic narrowing’s and improve the blood supply to the coronary circulation supplying the myocardium (heart muscle). This surgery is usually performed with the heart stopped, necessitating the usage of cardiopulmonary bypass; techniques are available to perform CABG on a beating heart, so-called "off-pump" surgery.

Current approaches to the treatment of ischemic heart disease (such as CABG surgery and angioplasty techniques) often result in incomplete revascularization because of the frequent presence of diffuse coronary artery disease extending into small peripheral vessels. As an alternative to these techniques, recent attention has been directed toward harnessing the body's ability to generate new blood vessels (natural angiogenesis).

This report documents the results of animal and clinical studies that evaluated the ability of fibroblast growth factor (FGF-1), produced using genetic engineering techniques, to induce angiogenesis. After production, purification, and demonstration of the potential for triggering angiogenesis in animal models with FGF-1, a clinical study was performed in 40 patients with multivessel coronary artery disease referred for CABG. All patients had proximal disease of the left anterior descending artery (LAD) as well as disease in the distal one third of the LAD or at the origin of one of its branches.

 The mean ejection fraction was 50 percent.

Between three and four bypass grafts were placed in each patient. FGF-1 was injected into the myocardium distal to the proximal LAD anastomoses in 20 patients. The remaining 20 patients had heat-denatured FGF-1 substituted for FGF-1. After 12 weeks, coronary angiograms revealed the presence of a capillary network sprouting out of the LAD into the myocardium in all 20 patients who received active FGF-1. In the control group, there was no evidence of new vessel formation.

 Name:

MR. OR  Address: Purok I Brgy. Talao-Talao Dalahican Lucena City  Date of Birth: APRIL 28, 1928  Age: 81  Sex: MALE  Nationality: Filipino  Religion: Roman Catholic  Attending Physician: DR. ROY ROXAS

PRESENT CONDITION:  Patient is experiencing chest pain. PAST HEALTH HISTORY: General health: The patient is weak in appearance upon admission. Childhood Illness: The only illness she experienced was common colds, cough, and fever.

Immunization Complete immunization.  Hospitalization  The patient was hospitalized thrice prior to

the prensent hospitalization.

 Current Medication  His current medications are: Isodril,

Catapres, Lanoxin, Norvasc, Imdur, Capoten.

 Allergies  No known allergies.  Habits  Patient enjoys daily walk routine.

 Family Health History

MR. OR

FATHE R Asthma, Hypertension,

MOTHE R Ulcer, Hypertension, CVA

 Nutritional Metabolic Pattern  Patient has a poor appetite.

 His usual daily menu is consist of rice,

pork and vegetables.

 Elimination Pattern  The patient defecates once a day.  The patient voids thrice a day.  Activity-Exercise pattern  The patient can perform ADL.  The patient is not in respiratory

distress.

General Appearance Body built is appropriate to age Pale and weak in appearance Conscious and coherent Not in respiratory distress Skin Pallor skin Good skin turgor No lesions

HAIR  Equally distributed on scalp  Black, short hair  Without tenderness or lesion on scalp Nails \  With long finger and toe nails Skull and Face  Skull is proportionate to body size  Symmetrical skull  Without masses or nodules  Symmetrical facial grimace EYES  Eyebrows and eyelashes evenly distributed  With pale conjunctiva

 No lesion in lacrimal glands  Symmetric eyeballs, with equal size of

pupils and white

SCLERA  Pupils equally dilated reacted to light  Ears  With symmetrical auricle position and size  With elastic auricle  Without discharge NOSE  Symmetrical  Without nasal secretions  Without tenderness

MOUTH  With slightly dry lips  With permanent teeth NECK  Neck muscle proportionate to body size  With normal range  With palpable lymph nodes Neck  Neck muscle proportionate to body size  With normal range  With palpable lymph nodes

Chest  With symmetrical chest wall expansion  Not in respiratory distress  With normal breath sounds  With normal heart sounds Abdomen  With flabby soft abdomen upon palpation

 Your heart is located under the ribcage in

the center of your chest between your right and left lung. It’s shaped like an upside-down pear. Its muscular walls beat, or contract, pumping blood continuously to all parts of your body.  The size of your heart can vary depending on your age, size, or the condition of your heart. A normal, healthy, adult heart most often is the size of an average clenched adult fist. Some diseases of the heart can cause it to become larger.

 The heart is the muscle in the lower half of

the picture. The heart has four chambers. The right and left atria (AY-tree-uh) are shown in purple. The right and left ventricles (VENtrih-kuls) are shown in red.  Connected to the heart are some of the main blood vessels—arteries and veins—that make up your blood circulatory system.  The ventricle on the right side of your heart pumps blood from the heart to your lungs. When you breathe air in, oxygen passes from your lungs through blood vessels where it’s added to your blood. Carbon dioxide, a waste product, is passed from your blood through blood vessels to your lungs and is removed from your body when you breathe air out.  The atrium on the left side of your heart receives oxygen-rich blood from the lungs. The pumping action of your left ventricle sends this oxygen-rich blood through the aorta (a main artery) to the rest of your body.

 The superior and inferior vena cavae are in blue to

the left of the muscle as you look at the picture. These veins are the largest veins in your body. They carry used (oxygen-poor) blood to the right atrium of your heart. “Used” blood has had its oxygen removed and used by your body’s organs and tissues. The superior vena cava carries used blood from the upper parts of your body, including your head, chest, arms, and neck. The inferior vena cava carries used blood from the lower parts of your body.  The used blood from the vena cavae flows into your heart’s right atrium and then on to the right ventricle. From the right ventricle, the used blood is pumped through the pulmonary (PULL-mun-ary) arteries (in blue in the center of picture) to your lungs. Here, through many small, thin blood vessels called capillaries, your blood picks up oxygen needed by all the areas of your body.  The oxygen-rich blood passes from your lungs back to your heart through the pulmonary veins (in red to the left of the right atrium in the picture).

 Oxygen-rich blood from your lungs passes

through the pulmonary veins (in red to the right of the left atrium in the picture). It enters the left atrium and is pumped into the left ventricle. From the left ventricle, your blood is pumped to the rest of your body through the aorta.  Like all of your organs, your heart needs blood rich with oxygen. This oxygen is supplied through the coronary arteries as it’s pumped out of your heart’s left ventricle. Your coronary arteries are located on your heart’s surface at the beginning of the aorta. Your coronary arteries (shown in red in the drawing) carry oxygen-rich blood to all parts of your heart.

 The right and left sides of your heart are

divided by an internal wall of tissue called the septum. The area of the septum that divides the two upper chambers (atria) of your heart is called the atrial or interatrial septum. The area of the septum that divides the two lower chambers (ventricles) of your heart is called the ventricular or interventricular septum.

 The picture shows the inside of your heart

and how it’s divided into four chambers. The two upper chambers of your heart are called atria. The atria receive and collect blood. The two lower chambers of your heart are called ventricles. The ventricles pump blood out of your heart into the circulatory system to other parts of your body.

 The picture shows your heart’s four

valves. Shown counterclockwise in the picture, the valves include the aortic (ay-OR-tik) valve, the tricuspid (triCUSS-pid) valve, the pulmonary valve, and the mitral (MI-trul) valve.

 The arrows in the drawing show the direction

that blood flows through your heart. The light blue arrows show that blood enters the right atrium of your heart from the superior and inferior vena cavae. From the right atrium, blood is pumped into the right ventricle. From the right ventricle, blood is pumped to your lungs through the pulmonary arteries.  The light red arrows show the oxygen-rich blood coming in from your lungs through the pulmonary veins into your heart’s left atrium. From the left atrium, the blood is pumped into the left ventricle, where it’s pumped to the rest of your body through the aorta.

 For the heart to function properly, your blood

flows in only one direction. Your heart’s valves make this possible. Both of your heart’s ventricles has an “in” (inlet) valve from the atria and an “out” (outlet) valve leading to your arteries. Healthy valves open and close in very exact coordination with the pumping action of your heart’s atria and ventricles. Each valve has a set of flaps called leaflets or cusps, which seal or open the valves. This allows pumped blood to pass through the chambers and into your arteries without backing up or flowing backward.

Blood Flow SVC RA

TV

RV

PV

PA

MV

LA

LUNGS IVC Diffirent systen

Aorta

LV

PV

RISK FACTORS: Smoking, DM, Hypertensio n, Sedentary Lifestyle, Obesity

Family history of CAD (HEREDITY)

CHOLESTE ROL

FOAM CELLS OXIDIZED LDL PLAQUE FORMATION

BLOOD VESSELS ARE BLOCKED

AFFECTS THE SUPPLY OF BLOOD TO THE HEART REDUCES OXYGEN AND NUTRIENTS IN THE HEART AND AFFECTS THE SUPPLY OF OXYGEN TO THE VITAL ORGANS DEATH OF TISSUE WITHIN THESE ORGANS AND THEIR EVENTUAL FAILURE HEART ATTAC K

DEAT H

 The patient was admitted last July 13,

2009 to the ICU of Mount Carmel Diocesan General Hospital under Dr. Roxas attending to the chief complaint of chest pain. The following orders were given: low salt diet, for CBC, allergies and RBC.  On July 14, 2009 at 7:30 AM, the ROD ordered that the patient is for transfer to private room, for FBS, urine, cholesterol, BUN, creatinine, Catapress given 150mg 1 tablet BID, Lasix 60mg IV now. At 2:30PM the ROD ordered to continue Isoket drip.

 At 6:30PM, a telephone order was given by Dr.

Roxas to R. Llerado. He ordered an IVF of Plain NSS 500cc x KVO to follow on right arm.  On July 15, 2009, a verbal order of Dr. Roxas to NOD was made. The orders were as follows:for repeat hemoglobin, hematocrit now,if negative chest pain, may decrease Isoket drip to 10 mgtts per minute and may discontinue IVF at left arm.  At 4:35PM, received phone order from Dr. Roxas by CI: Mr. Noel Ayala. The patient’s RBS is 344mg/dl. He ordered to start RBS monitoring 5AM-5PM and to start Melformin 500mg/tablet TID.

 At 6:33PM, the patient’s hemoglobin is

8.3. Telephone order of Dr. Roxas to NOD Mark Tan for blood typing  At 7:25PM, verbal order of Dr. Roxas to NOD Mark Tan. The orders were to give Lasix 60mg IV now, ½ ampule Lanox every 8 hours and to transfuse 3 units PRBC after properly typed and cross matched.  At 11:25PM, patient’s BP is 219/96 mmHg. Telephone of Dr. Greys to NOD. He ordered to start Nicardipine drip ( 1 ampule Nicardifine plus 90cc Plain NSS at 10mgtts per min).

ASSESSMEN T S: “Gusto niyang humiga , hinahapo kasi siya” as verbalized by the pt’s SO.

DIAGNOSIS

Activity intolerance as r/t to general weakness as evidenced by lack of interest in activity, bed O: rest and •Heart rate: abnormal 43 heart rate •Respiration and BP as : 11 response to •BP: 180/100 •Discomfort activity when performing ADL

PLANNING At the end of the nursing interventi on and collaborati ve medical manageme nt the patient will demonstra te a decrease in physiologi cal signs of intoleranc

INTERVENTIO N • Note presence of factors contributing to fatigue (e.g. acute or chronic illness, heart failure • Note client factors of weakness, fatigue, pain,diffulcty accomplishing task and insomnia.

EVALUATION Goal met, the patient : • Lessen report of fatigue and discomfort • Can ambulate with assistance • can manage body weakness • Have interest on specific activity.

ASSESSMEN DIAGNOSIS T S: “Hindi Impaired siya adjustment masyadong related to nag-iiimik sa negative una”, as attitude verbalized healthy by thr behaviors, patient’s lack of SO. motivation/c O: hange in demonstrati behavior as on of nonevidenced acceptance by absence of health of social status support for change change Irritability behavior, beliefs and practices.

PLANNING At the end of the nursing interventi ons and collaborati ve medical manageme nts, the patient will initiate lifestyle changes that will permit adaptation to current life situation, identify and use

INTERVENTIO N •Acknowledge

EVALUATION

Goal met. client’ efforts The patient to now can: adjust:exampl •Adjust on e “Have you his done your environment best”, to . lessen •No feelings of irritability blame/guilt noted. and defensive •Can response. motivate •Provide an and open socialize. environment •Share encouraging communicatio interest and beliefs to n so that expression of others feelings concerning to impaired functions can be dealt

ASSESSMEN T

DIAGNOSIS

PLANNING appropriat e support system, demonstra te increasing interest/pa rticipation in selfcare and develop ability to assume responsibil ity for personal needs when possible.

INTERVENTIO N •Provide feedback during and after learning experience to enhance attention, skills, and confidence. •Explain disease classes/causat ive factors and prognosis as appropriate and promote questioning to enhance understandin g.

EVALUATION

ASSESSMEN DIAGNOSIS T S: “Ah! Acute pain Aray!” as related to verbalized unrelieved by patient. pain O: sleep (beyond disturbance tolerance) Restlessnes as s evidenced BP:180/100 by With expressive moderate behavior pain (scores (moaning, 7 in the pain irritability, scale) sighing, restlessness )

PLANNING At the end of the nursing interventi ons and collaborati ve medical manageme nt, the patient will have an expected pain manageme nt, accept level of pain and have a descriptio n of response to pain.

INTERVENTIO N •Note when

EVALUATION

Goal met. pain occurs to The patient: •Now can medicate prophylactical describe the ly as level of appropriate. pain. •Encourage •Can adequate rest manage it at periods to the same prevent time. •Lessen fatigue. •Review ways reports of to lessen paiun. •Not restless pain, •Absence of including techniques irritabily. such as BP:140/100 therapeutic touch.

ASSESSMEN T S: “May mga oras na kung minsan ay nahihirapan akong huminga”, as verbalized by the patient. O: Altered heart rate HR:46 Shortness of breath/dysp nea Variation in blood pressure readings;inc reased/decr eased

DIAGNOSIS

PLANNING

Decreased cardiac output related to altered heart rate as evidenced by restlessness s.

At the end of the nursing interventi ons and collaborati ve medical manageme nt, the patient will have a hemodyna nmic stability e.g. blood pressure, cardiac output, etc. report/de monsrtrae

INTERVENTIO N vital •Monitor signs frequently to promote response to activity. •Restrict or administer fluid as indicated. •Provide adequate fluid/free running water, depending on client needs, assess hourly urinary output/noting total fluid balance to allow timely alteration in

EVALUATION Goal partially met: •The patient now participate in activity. •Not in respiratory distress. •BP reading is not stable BP:140/100160/100

ASSESSMEN T

DIAGNOSIS

PLANNING decrease episodes of dyspnea, participate in activities that reduce the workload of the heart, demonstra te an increase in activity tolerance.

INTERVENTIO N quiet •Provide environment to promote adequate rest. •Alter environment to maintain adequate body temperature in near normal range. •Encourage relaxation techniques to reduce anxiety.

EVALUATION

LAB TEST

RESULT

NORMAL RANGE

INTERPRETATIO N

13.10

13.5 - 18

NORMAL

Hct

0.36

0.4 – 0.48

NORMAL

FLUID SERUM: Glucose

103

74 - 106

NORMAL

Urea Nitrogen

25

9 - 20

Creatinine

4.3

.7 – 1.2

(HIGHER) Excessive protein intake (HIGHER) Heart

HGB, HCT: Hgb

Failure Cholesterol

415

0 - 200

Triglycerides

367

0 - 150

(HIGHER)Hyperch olesteremia, Hypertension, Myocardial Infarction, uncontrolled DM, (HIGHER) Hyperlipidemia

Hypertension

LAB TEST

RESULT

NORMAL RANGE

INTERPRETATIO N

6.0

3.5 - 7

NORMAL

CBC, PLATELET COUNT: RBC

2.65

4.5 – 5.5

WBC

4.56

5 - 10

(LOWER) Anemia, Leukemia, Multiple Myeloma, (LOWER) Bone hemorrhage, marrow failure, Chemotheraphy , Drug Toxicity

Segmente

0.68

.56 - .65

Lymphocyte

0.32

.25 - .35

MCV

89.40

82 - 92

MCH

31.30

27 - 32

Uric Acid

(HIGHER) Cushing’s Syndrome, Eclampsia, Gout, NORMAL Inflammatory NORMAL diseases NORMAL

LAB TEST

RESULT

NORMAL RANGE

INTERPRETATIO N

35

32 - 36

NORMAL

Hgb

8.30

13.5 - 18

Hct

0.23

.4 - .48

Platelet Count

184

150 - 400

MCHC

TROPONIN RBS

Negative 344, 314, 117, 97, 91, 133

(LOWER) hemolytic reactions, Hemorrhage, iron Deficiency (LOWER) Anemia Anemia, bone marrow dysfunction, Hemorrhage, Malnutrition NORMAL NORMAL

70 - 125

(HIGHER) High blood glucose level, excess production of growth

LAB TEST

RESULT

NORMAL VALUE

INTERPRETATIO N

++

NEGATIVE

(HIGHER +)CHF, Multiple myeloma

+++

NEGATIVE

7.0

4.6 – 8.0

(HIGER +)Cushing syndrome, DM NORMAL

1.025

1.010 – 1.025

NORMAL

Pus cells

0 -2

0-2

NORMAL

RBC

0-2

NEGATVE

URINALYSIS: Color

Light yellow

Transparency

Sl. Turbid

Protein

Sugar pH Sp. Gravity

Hematuria

NAME OF DRUG

ACTION

ROSUVA LOWER SELEVATED TATIN LIPID LEVEL

IMDUR

•MAY REDUCE CARDIAC OXYGEN DEMAND BY DECREASING DIALOSTOLI C • RELIEVES ANGINA

INDICATIO N

DOSAGE

ADVERSE REACTION

NURSING RESPONSIBILI TY

HYPERLIPI DE-MIA

1O mg 1 tab OFTEN DINNER

BILE SEQUESTERI NGDRUG MAY CAUSED BLOATING AND CONSTIPATI ON

• MONITOR FASTING LIPID PROFILE • CHEAK CK LEVEL IN A PATIET WHO COMPLAINTS OF MUSCLE PAIN AND WEAKNESS

ACUTE ANGINA, PROOHYLA XIS IN SITUATION LIKELY TO CAUSE ANGINA

60mG 1 tab OD

DIZZINESS HEADACHE WEAKNESS NAUSEA VOMITTING FLUSHING AND HYPOTENSI ON

MONITOR BLOOD PRESSURE, HEART RATE, RHYTM, ITENSITY AND DURATION OF DRUG RESPONCE

NAME OF DRUG LASIX

ACTION

INDICATION

INHIBITS SODIUM AND CHLORIDE REABSORTIO N

HYPERTENSI ON

•TREAT HPN •CHRONIC STABLE AGINA

NORVAS DECREASE C MTOCARDIAL CONTRACTILI TY

DOSAGE

ADVERSE REACTION

NURSING RESPONSIBILI TY

60 mg IV (STAT)

DIZZINESS, FEVER, HEADACHE, RESTLESSN ESS, WEAKNESS, ABDOMINAL DISCOMFOR T AND VOMITTING

10ml 1 tab OD

HEADACHE, FATIGUE, NAUSEA, DIZZINESS, SLEEP DISTURBAN CE,DRY

•ASSESS PATIENT UNDERLYING CONDITION BEFORE STRATING THERAPY (MONITOR WEIGHT, PERIPHERAL EDEMA, BREATH SOUND, BP, FLUID, INTAKE AND OUTPUT, ELECTROLYCE S GLUCOSE BUN •AND DO NOT CONFUSE NORVASC WITH NA VANE

NAME OF DRUG

ACTION

INDICATION

CATAPRE SS

ANTI HYPERTENSI VE

TREAT MILD TO MODERATE HYPERTENSI ON

LANOXIN

•FOR MYOCARDIA L CONTRACTIO N

CONTROL OF RAPID VETRICULAR CONSTIPATI ON

DOSAG E

ADVERSE REACTION

NURSING RESPONSIBILI TY

•DO NOT CONFUSE CATAPRESS WITH CATAFLAM (NSAID) • DONOT CHANGE REGIMEN OR DISCONTINUE DRUG ABRUPTLY TO PREVENT REBOUND •MEASURE 0.25mg MUSCLE ,½ WEAKNESS, HYPERTENSIO LIQUIDS amp. IV HYPOKALEM N PRECISELY, PUSH IA, USING A OD HYPOTENSI CALIBRATED ON, DROPER OR RESPIRATO SYRINGE RY DISTRESS 150ml/t MAY ab BID INTERFERE ABILITY TO WORK

 Teach the pt. to understand the symptom

complex and avoid activities known to cause anginal pain.  Avoid exertion, exposure to cold, tobacco, eat regularly but lightly, maintain prescribed weight.  Teach pt. to maintain an unhurried pace throughout the day.  Discourage over-the-counter drugs e.g. diet pills, nasal decongestants, or drugs that increase heart rate And blood pressure.

1. Explain to the pt the importance of

anxiety reduction in control of angina. Teach relaxation techniques. 2. Advise the pt on activity level to prevent angina  Begin a regular regimen of exercise as directed by health care provider.  Avoid lifestyles that may cause IHD/CHDsmoking, drinking, inadequate rest and sleep.

 Avoid activities known to cause anginal

pain- sudden exertion, walking against wind, extremes of temperature, high altitude, emotional stressful situations, may accelerate heart rate, raise blood pressure and increase cardiac work.  Refrain from physical activity for 2 hrs. after meals. Rest after each meal if possible.

 Take home medsto decrease the oxygen

demands of the myocardium and increase the oxygen supply through pharmacologic theraphy and risk factor control:  Nitrates remain the mainstay of theraphy NTG.  Beta-andrenergic blockers (Inderal)  Calcium-ion antagonists/channel blockers (Procardia, Isoptin, Calan)