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Case Study of Mrs G who has Coronary Artery Disease (CAD).

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INTRODUCTION In this case study I will present a client from my clinical placement that I will refer to as Mrs G for confidentiality reasons. Mrs G is an 81 year old woman and she was diagnosed with Coronary Artery Disease (CAD). I will be explaining the signs and symptoms commonly related to CAD and examine how this disease affected her health and how her body tried to compensate. I will also discuss how hypertension relates to CAD. I will examine diagnostic and pharmacological data while discussing nursing interventions in relation to her results. CLIENT'S PROFILE Mrs G has no past history of alcohol intake. She is an ex-smoker with 20 cigarettes per day, weighs 67kg and is 154cm in height. Mrs G's past medical history includes osteoporosis, (L) THJR, hypertension, Coronary Artery Disease (CAD) with a CABG in 1993. On admission, Mrs G's signs and symptoms consisted of chest pain, tachycardia, tiredness and shortness of breath (SOB). She said she began experiencing these symptoms earlier in the day but they had gotten worse at the time of admission. These are all consistent with CAD. PATHOPHYSIOLOGY The coronary arteries branch off from the base of the aorta and encircle the heart in the atrioventricular groove. ...read more.


In most instances, a Q wave is not obvious on the ECG of the normal heart. The Q wave change is minor; normally the Q wave is very small or absent. When there is inactive tissue under the electrode, the wave front must travel long distance around the inactive tissue. Abnormal Q waves reflect this delay. The larger and deeper the lesion, the larger the Q wave. Abnormal Q waves appear as early as 2 hours after the onset of chest pain and are usually fully developed within 9 hours. Although the electrocardiogram can detect evidence of coronary heart disease in asymptomatic persons and identify individuals at increased risk of future coronary events, having regular ECG's can be invasive procedure, especially for female patient. Therefore it is important as a nurse looking Mrs G to maintain as much dignity as possible by ensuring privacy while carry out the ECG. Calcium plays a significant role in the electrical excitation of cardiac cells and in the mechanical contraction of the myocardial and vascular smooth muscle cells. Calcium (Ca+) is an element within the body and participates in many biochemical reactions. These include the mechanisms for blood coagulation (clotting), nerve impulses, and muscle contractions including the cardiac muscle. ...read more.


Therefore taking Lactulose helps her with this. Lactulose is an osmotic laxative and is made up of sugar molecules, which are broken down by the bacteria that live in the lower part of the gut. This leads to the contents of the gut becoming more acidic. The acidification of the contents of the gut causes a reduction in the absorption of chemical called ammonia. The presence of ammonia in the gut causes water to be drawn into the lower bowel, which causes an increase in the water content and volume of the stools, therefore relieving constipation, though sometimes they may cause diarrhoea (New Ethicals Compendium, 2000). SUMMARY In order to maintain adequate care of Mrs G while she is experiencing signs and symptoms with Coronary Artery Disease, she needs regular head to toe assessments, ECG's to monitor her hearts activity, rate and rhythm and blood tests to monitor levels of cholesterol and calcium. Mrs G will require assistance with daily hygiene cares, and monitoring of pressure areas. She will need her vital signs taken and monitor her blood pressure. She will also need regular medication administration and monitoring of side effects. Further nursing interventions for long-term management of CAD would be to teach the client about the disease they have, about medications they will be taking, blood pressure monitoring, nutrition and the symptoms indicating the need for emergency care (Crisp & Taylor, 2001). ...read more.

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