GROUP 5 PRESENTATION

Group Members

1. Andrew Moyo

2. Alex Mbewe

3. Mtisunge Wandale

4. Monica Banda

5. Jacqualine Ntaba

6. Nelson Munthali

7. Rosella Munyenyembe

PRESENTS

ANGINA PECTORIS

BROAD OBJECTIVE

At the end of this presentation, learners should be able to manage the patient with angina pectoris.

OUTLINE1. Define and describe the classification of angina pectoris

2. Explain the etiology and pathophysiology of angina pectoris

3. Describe the clinical manifestation of angina pectoris

4. Describe the diagnostic evaluation of the angina pectoris

5. Explain the nursing assessment and its diagnosis

6. Explain the nursing management of angina pectoris

7. Explain the medical/ surgical management of angina pectoris

8. Outline the complications of angina pectoris

Definition

It is commonly called “angina” It is the chest pain that is due to ischemia of

the heart muscle, generally due to obstruction or spasm of the coronary arteries

TYPES OF ANGINA PECTORIS

The most three types of angina include: Stable angina- It is triggered by a predictable degree of physical exertion or

motion but can be improved after rest.- It is the most common type of angina Unstable angina- It is triggered by unpredictable degree which may occur at

night- It is more dangerous and requires emergency treatment and is

often a sign that heart attack can occur soon Variant angina- this is a rare form that is caused by a spasm in coronary artery

ETIOLOGY AND PATHOPHYSIOLOGY

Angina pectoris is as a result of ischemia of the heart which is due to antherosclerosis of the coronary arteries which restricts blood flow to the myocardium.

Due to myocardium ischemia, the myocardial tissues are deprived of oxygen and nutrients for the aerobic metabolism.

As a result there is an inclusion of anaerobic metabolism which leads to accumulation of lactic acid

Due to increase of lactic acid, myocardial nerve fibers are irritated and this transmit a pain message to the cardiac nerves and upper thoracic posterior nerve roots

And all this leads to cardiac pain which is the angina pectoris

CLINICAL MANIFESTATION

Dyspnea Sweating/ diaphoresis Faintness Palpitations Dizziness Indigestive disturbances

DIAGNOSTIC EVALUATION

Electrocardiography (ECG)- an ECG recorded in the presence of pain may record

transient ischemic attacks.- it also suggest coronary artery’s involvement and the

extent of the myocardium affected by the ischemic event Exercise electrocardiography- This involves the client exercising on a treadmill or

stationery bicycle until reaching a maximum of 85% heart rate.

If any change in the ECG or vital signs may indicate the presence of ischemia

Radioisotope- this involves the use of different nuclear imaging

techniques to evaluate heart muscles.- regions of ischemia appear as areas of

diminished activity Ultrafast computed tomography- it enables detection of the amount of calcium in

the coronary arteries. High coronary calcium rate is associated with obstructive coronary disease.

Coronary angiography- it detect the percentage of blockage in

coronary artery- it remains the most accurate test Chest x-ray- it allows the detection of cardiomegaly and

non cardiac causes of chest pain e.g pneumonia

NURSING ASSESSMENT

SUBJECTIVE DATA

Past health history- previous history of cardiac artery disease, angina, myocardial

infarction, anemia and heart failure

Medications- use of aspirin, calcium channel blockers and antihypertensive

Family history- history of heart disease, tobacco use

Nutritional history- heart burn, nausea, vomiting

Coping stress mechanism- anger, anxiety, depression and stressful life style

OBJECTIVE DATA

General

- anxiety, fear, restlessness

Integumentary

- cool, clammy, pale skin

Cardivascular

- tachycardia or bradycardia, dysrhythmias, low Bp or hypertension

Possible findings

- increase in white blood cell count, positive exercise stress test, ST segment and T wave abnormalities on ECG, cardiac enlargement, pulmonary congestion on chest x-ray and positive coronary angiography.

NURSING DIAGNOSIS Acute pain related to myocardial ischemia as

evidenced by severe chest pain and tightness Ineffective tissue perfusion related to myocardial

injury as evidenced by dyspnea, decrease in Bp. Anxiety related to perceived or actual threat of death,

pain and possible life style changes as manifested by restlessness and patient asking too much questions

Activity intolerance related to fatigue secondary to decreased cardiac output and poor lung and tissue perfusion as manifested by increased heart rate

Ineffective therapeutic regimen management related to lack of knowledge of disease process as evidenced by frequent questioning about the illness and management after discharge

NURSING MANAGEMENT

- evaluate chest pain e.g location in order to accurately evaluate, treat and prevent further ischemia

- promote bed rest in semi fowlers position, it relaxes the muscles of the chest cavity

- monitor vital signs after every 5 minutes on each attack to review the effectiveness of the care given

- Monitor fluid balance (e.g. monitor input and output, daily weight ) to monitor renal perfusion and observe for fluid retention

- Provide factual information concerning the disease process to decrease fear of the unknown

- administer prescribed medication to relieve pain and ischemia to decrease anxiety and cardiac workload e.g. Nitroglycerin-which dilates the coronary arteries and increases the supply of oxygen to the myocardium

MEDICAL MANAGEMENT It focuses on three goals

1. Relief of the acute pain. The major drugs used to reduce acute pain are opioid analgesics e.g nitroglycerin

2. Restore coronary blood flow. Administer vasodilators e.g propanolol, calcium channel blockers such as felodipine.

3. Prevent further attacks-this is done through education and counselling regarding modification of risk factors of the disease.

This reduce the progression of coronary heart disease.

Complications of Angina Pectoris Angina pectoris can lead to:-• Heart failure• Acute renal failure• Myocardial infarction• Cardiac arrest• Death

References

1. Black J. M. and Hawks J (2009) Medical –surgical Nursing, Clinical Management for positive outcomes (8th edition) saunders, Elsevier

2. Lewis S. M., Heitkemper M. M and Dirksen S. R (2007) Medical /Surgical Nursing. Assessment and management of clinical problems. (7th edition) St Louis: C.V. Mosby

3. http://www.servier.co.uk

A BENGO TADZUKANI!!!!!!!!