Siena College

Taytay, Rizal
COLLEGE OF NURSING
NCM 103

ATHEROSCLEROSIS

A Case Study of:

Ms. M t
Name of the Patient

As Partial Requirement for NCM-RLE- 103

Submitted by:
Leynes, Paolo

Group B-1

May 7 2010
 TABLE OF CONTENTS

I. Introduction

a. Background of study
b. Objectives
c. Significance of the study
d. Scope and delimitations
e. Theoretical framework
II. Nursing Assessment
a. Patient’s profile
b. Physical Assessment
c. Gordon’s functional health pattern
d. Laboratory Results
III. Anatomy and physiology
IV. Pathophysiology
V. Drug study
VI. Nursing Management : Nursing care Plan
VII. Evaluation
I. INTRODUCTION
A..Background of the study

Atherosclerosis (also known as arteriosclerotic vascular disease or ASVD) is the

condition in which an artery wall thickens as the result of a build-up of fatty materials
such as cholesterol. It is a syndrome affecting arterial blood vessels, a chronic
inflammatory response in the walls of arteries, in large part due to the accumulation of
macrophage white blood cells and promoted by low-density lipoproteins (plasma proteins
that carry cholesterol and triglycerides) without adequate removal of fats and cholesterol
from the macrophages by functional high density lipoproteins (HDL). It is commonly
referred to as a hardening or furring of the arteries. It is caused by the formation of
multiple plaques

The atheromatous plaque is divided into three distinct components:

1. The atheroma ("lump of gruel", from ἀθήρα, athera, gruel in Greek,), which
is the nodular accumulation of a soft, flaky, yellowish material at the center
of large plaques, composed of macrophages nearest the lumen of the artery
2. Underlying areas of cholesterol crystals
3. Calcification at the outer base of older/more advanced lesions.

Prevalance of Atherosclerosis is 17 per 1000 people Prevalance Rate: Deaths from

Atherosclerosis is 14,979 deaths reported in USA 1999 (NVSR Sep 2001); contributes to other
causes rather than direct cause of death; 71,926 deaths for Atherosclerotic CVD (NHLBI 1999).
Death rate extrapolations for USA for Atherosclerosis is 14,979 per year, 1,248 per month, 288
per week, 41 per day, 1 per hour, 0 per minute, 0 per second. Note: this extrapolation
calculation uses the deaths statistic: 14,979 deaths reported in USA 1999 (NVSR Sep 2001);
contributes to other causes rather than direct cause of death; 71,926 deaths for Atherosclerotic
CVD (NHLBI 1999).

approx 1 in 58 or 1.70% or 4.6 million people in USA

Signs and symptoms of athersclerosis often include but not limited to:
 Chest pain
 Difficulty of breathing
 Dizziness
 Easily fatigued
 Heart attack
  Sudden cardiac death

B.OBJECTIVES

Knowledge
The researchers seek deeper understanding regarding the subject matter by:
• Broadening the researches and patient’s knowledge concerning atherosclerosis
• Providing sufficient knowledge about the definition, nature, risks factors and
sings and symptoms of atherosclerosis
• Informing the client about the prevalence of the disease together with its proper
management.

Skills
The researchers wanted to improve the client’s competence by:
• Providing simple and effective ways on the managing care for atherosclerosis
through health teachings.
• Teaching the importance of health monitoring through an intensive and confident
demonstrations of particular procedure.

Attitude
The researches wanted to nurture the client’s behavior by:
• Showing empathy and concern to the client
• Providing a genuine care for the client
• Attending and providing client’s need

C.SIGNIFICANCE OF THE STUDY

To the patient with atherosclerosis:

 For them to acquire necessary knowledge related to their health condition.
 For them to be able to manage themselves when pain or abnormalities related to
the disease occurs.
 For them to be able to understand what are the treatments the health care
providers offer in their recovery process.
 To promote prevention of the disease.

To the Staff Nurses:

 For them to properly identify the needs of the patient.
 For them to be able to render nursing care and information to the patient through
the application of the nursing skills.
  For them to apply their knowledge and skills when caring to the patient with
ashd.

To the Nursing Students:

 For them to properly assess patients who are manifesting the disease.
 For them to be knowledgeable enough in the treatments that they are providing
them.
 For them to be able to provide more health teachings in the prevention of the
disease.

D. SCOPE AND DELIMITATIONS

We had our duty in University of Santo Tomas Hospital last May 11, 12, and 13
2010 in MICU SICU and ER. WE were able to assess our patient’s condition. We had
gathered data through our own keen observation and through the patient’s chart. The
study last for about 8 hours of exposure with the patient. Our patient, MT, is suffering
from atherosclerosis which we will be dealing with this study. This also includes the
cause of this illness and how we can prevent it for the wellness of our patient.
E. THEORETICAL FRAMEWORK

DOROTHEA OREM’S THEORY OF SELF CARE

SELF CARE
Universal development
and health Deviation

SELF CARE DEFICIT

Limitations that do not
allow them to meet their
self care needs

NURSING SYSTEM
Wholly, Partly and
Supportive-educative

Self Care Theory

 Self care is the ability to perform activities and meet personal needs with the goal
of maintaining health and wellness of mind, body and spirit.
 3 components: universal self care needs, developmental self care needs and
health deviation.

Universal Self Care

 These includes activities which are essential to health and vitality

 8 elements: identified these include: air, water, food , elimination, activity and
rest, solitude and social interactions, prevention of harm, and promotion of
normality
Developmental Self Care Needs
 These include the interventions and teachings designed to return a person to or
sustain a level of optimal health and well being.

Health Deviation Self Care

 This encompasses the variations in self care which may occur as a result of
disability, illness or injury.
 In other words the person with variation is meeting self care and maintaining
health and wellness in more individualize meaning.

Self Care Deficit Theory

 A person benefits from nursing intervention when a health situation inhibits their
ability to perform self care or creates a situation where their abilities are not
sufficient to maintain own health and wellness.
 The nursing action focuses on identification of limitation/deficit and
implementing appropriate intervention to meet the needs of person.

Theory of Nursing System

 The ability of the nurse to aid the person in meeting current and potential self care
demands.
 3 support modalities identified in theory including: total compensatory, partial
compensatory and educative/supportive compensatory.

3 Modalities
 Whole Compensatory system – encompasses total nurse care, client unable to do
for themselves
 Partially compensatory system – involves both the nurse and the client sharing the
self care requirement.
 Educative support compensatory – elicit the help of the nurse solely as consultant,
teacher or resource person

II. Nursing Assessment

A. Patients Profile

Client’s Name: Ms. MT

Age: 80
Birthday: 03/21/1930

Address: manila

Civil Status: married

Sex: Female

Nationality: Chinese-Filipino

Religion: Roman Catholic

Date of admission: May 8, 2010

Time of admission: 3:00 PM

Chief complaint: dob w/ radiating chest pain

Admitting diagnosis: ASHD (arteriosclerotic heart disease)

Attending physician: Dr. Ramirez

B. Physical assessment
Ears Symmetrical to the Symmetrical Normal
head
General Appearance

Nose Midline and Symmetrical to the Normal

symmetrical head
Skin Should be good Poor skin turgor due normal
turgor, not dry to old age

Mouth and lips Pinkish and moist, Dry lips Because of inadequate
symmetrical, lip oral fluid intake
Lymph nodes No Inflammation
margin well defined, No sign of normal
smooth and moist inflammation

Neck Symmetrical to the Symmetrical normal

body

Chest Symmetrical color of Symmetrical color of Normal

the skin same with the the skin same with
abdomen, no abdomen, no mass no
retraction, no area of tenderness
dimpling, no mass, or
lump, no areas of
tenderness
Heart With cardiac rate of Cardiac rate of 87 normal
60-100 BPM BPM

Abdomen Symmetrical, flat, There no tenderness Inflammatory action

soft, no contractions upon palpation indicates presence of
infection
Pattern Before hospitalization During hospitalization
I.Health perception- Feeling of tiredness and The patient is feeling
health management stress due to household better , no signs of stress
pattern work or fatigue
Household chores Household chores
Headache, cough cold, takes medication as
treated with over the prescribed by the
counter drugs pediatrician like
cefuroxime etc
Chief complaints chest Chief complaints of
pain and DOB chest pain and DOB
expects to be relieved of
physical discomforts in a
day or two
II.Nutritional-Metabolic Regular appetite Regular appetite
pattern
Usual eating pattern is 4 Usual eating pattern is 4
times a day times a day

Normal skin turgor with Normal skin turgor

dry lips
III.Elimination Pattern Increased frequency of Increased frequency of
urine and stool urine and stool

Yellow urine Yellow urine

IV. Activity / Exercise Household chores Household chores
V.Sleep and Rest pattern 5 hours of sleep at night 8 hours of sleep at night
including naps at day including naps at day
VI. Cognitive Perceptual Pupils black in color,
pattern equally rounded
Eyes symmetrical:
pinkish conjunctiva
ears .
Resposive.
C. GORDON’s Functional Health Pattern
Name: ms.mT
Address: blumentritt manila
Age: 1month old Gender: F Civil statis: single date of birth:03/11/2010
Place of birth: Morong rizal Nationality: Filipino Ethnic origin: tagalog

D.LABORATORY RESULTS
URINALYSIS :May 9 2010
Components Results Normal Values Interpretation
Color Yellow Yellow Normal
transparency turbid turbid Normal
Reaction Acidic acidic Normal
Specific gravity 1.000 1.000-1.005 Normal
bacteria +++ negative Presence of bacteria
maybe due to
infection

Blood chem: may 10 2010

Components Results Normal Values Interpretation
potassium 3.22L 3.8-5 Slightly decrease
due to increased
frequency of urine
troponin 0.50 0-0.05 High, because
troponin is one of
the cardiac markers

III.ANATOMY AND PHYSIOLOGY

Atherosclerosis (also known as arteriosclerotic vascular disease or ASVD) is the

condition in which an artery wall thickens as the result of a build-up of fatty materials
such as cholesterol. It is a syndrome affecting arterial blood vessels, a chronic
inflammatory response in the walls of arteries, in large part due to the accumulation of
macrophage white blood cells and promoted by low-density lipoproteins (plasma proteins
that carry cholesterol and triglycerides) without adequate removal of fats and cholesterol
from the macrophages by functional high density lipoproteins (HDL), (see apoA-1
Milano). It is commonly referred to as a hardening or furring of the arteries. It is caused
by the formation of multiple plaques within the arteries.[1]

The atheromatous plaque is divided into three distinct components:

1. The atheroma ("lump of gruel", from ἀθήρα, athera, gruel in Greek,), which is
the nodular accumulation of a soft, flaky, yellowish material at the center of large
plaques, composed of macrophages nearest the lumen of the artery
2. Underlying areas of cholesterol crystals
3. Calcification at the outer base of older/more advanced lesions.

The following terms are similar, yet distinct, in both spelling and meaning, and can be
easily confused: arteriosclerosis, arteriolosclerosis, and atherosclerosis. Arteriosclerosis
is a general term describing any hardening (and loss of elasticity) of medium or large
arteries (from the Greek arteria, meaning artery, and sclerosis, meaning hardening);
arteriolosclerosis is any hardening (and loss of elasticity) of arterioles (small arteries);
atherosclerosis is a hardening of an artery specifically due to an atheromatous plaque.
The term atherogenic is used for substances or processes that cause atherosclerosis.

Atherosclerosis, though typically asymptomatic for decades, eventually produces two

main problems: First, the atheromatous plaques, though long compensated for by artery
enlargement (see IMT), eventually lead to plaque ruptures and clots inside the artery
lumen over the ruptures. The clots heal and usually shrink but leave behind stenosis
(narrowing) of the artery (both locally and in smaller downstream branches), or worse,
complete closure, and, therefore, an insufficient blood supply to the tissues and organ it
feeds. Second, if the compensating artery enlargement process is excessive, then a net
aneurysm results.

These complications of advanced atherosclerosis are chronic, slowly progressive and

cumulative. Most commonly, soft plaque suddenly ruptures (see vulnerable plaque),
causing the formation of a thrombus that will rapidly slow or stop blood flow, leading to
death of the tissues fed by the artery in approximately 5 minutes. This catastrophic event
is called an infarction. One of the most common recognized scenarios is called coronary
thrombosis of a coronary artery, causing myocardial infarction (a heart attack). Even
worse is the same process in an artery to the brain, commonly called stroke. Another
common scenario in very advanced disease is claudication from insufficient blood supply
to the legs, typically due to a combination of both stenosis and aneurysmal segments
narrowed with clots. Since atherosclerosis is a body-wide process, similar events occur
also in the arteries to the brain, intestines, kidneys, legs, etc. Many infarctions involve
only very small amounts of tissue and are termed clinically silent, because the person
having the infarction does not notice the problem, does not seek medical help or when
they do, physicians do not recognize what has happened.
 VI. NURSING MANAGEMENT

V.DRUG STUDY
Drug Name Action Indication Nursing consideration
Enoxaparin blood formers,
Lovenox coagulators, and Parenteral use
0.4ml /sc x 5 anticoagulants; low restricted to Assessment & Drug
days molecular weight treatment of Effects
heparin serious infections
of GI • Lab tests: Baseline
coagulation
studies; periodic
CBC, platelet
count, urine and
stool for occult
blood.
• Monitor platelet
count closely.
Withhold drug and
notify physician if
platelet count less
than 100,000/mm3.
• Monitor closely
patients with renal
insufficiency and
older adults who
are at higher risk
for
thrombocytopenia.
• Monitor for and
report immediately
any sign or
symptom of
unexplained
bleeding.
Drug Name Action Indication Contraindication Nursing
consideration
Ampicillin Anti- Contraindicated
infective:interferes Bacterial Assess history
with cell wall infections to patients with of previous
synthesis of hypersensitivity sensitivity
susceptible reactions to
to penicillin
organisms, penicillin or
preventing other
bacterial cephalosporin.
multiplication >obtain
patient’s
history of
infection
before and
during therapy
to assess
response

Drug Name Action Indication Nursing

consideration
Ranitidine Potent anti-ulcer drug Short-term
150mg/ 1 tab that competitively and treatment of active Assess history of
reversibly inhibits duodenal ulcer; previous
histamine action at maintenance therapy sensitivity
H2-receptor sites on for duodenal ulcer reactions the
parietal cells, thus patient after healing drug
blocking gastric acid of acute ulcer;
secretion. Indirectly treatment of
reduces pepsin gastroesophageal
secretion but appears reflux disease;
to have minimal effect short-term treatment
on fasting and of active, benign
postprandial serum gastric ulcer;
 gastrin concentrations treatment of
or secretion of gastric pathologic GI
intrinsic factor or hypersecretory
mucus conditions (e.g.,
Zollinger-Ellison
syndrome, systemic
mastocytosis, and
postoperative
hypersecretion);
heartburn.

VII. Evaluation :Health Teaching and Discharge Plan

Medication- Continuation of medicine as prescribed by the physician

Exercise- encourage patient to exercise daily

Treatment- Replaces lost fluid and electrolytes. Oral Rehydration is the preffered
treatment of fluid and electrolyte losses caused by diarrhea in children with mild to
severe dehydration

Health teaching- instruct the client to monitor her VS and ask assistance from her
family members when she needs help

Outpatient- instruct the client that they should return to the out patient department for
a follow check up

Diet – low sodium low fat diet

Spiritual- teaches the client a simple prayer.

IV.Pathophysiology of atherosclerosis
Predisposing Factors: Precipitating Factors
Age Nutrition
Genes lifestyle
Gender