Atherosclerosis NCLEX Review Care Plans
Nursing Study Guide – Atherosclerosis
Atherosclerosis is the buildup of fatty material called plaque or atheroma, in the lining of the artery walls.
This buildup causes the narrowing of the affected arteries. When the arteries are narrowed, blood cannot go through it easily. This can lead to reduced delivery of oxygen and nutrients to the cells of the body.
When atherosclerosis affects the coronary artery, it can lead to coronary heart disease and eventually, myocardial infarction otherwise known as heart attack.
In the U.S. and many other countries, atherosclerosis is common in people age 65 and above, as well as those with a family history of heart diseases.
Signs and Symptoms of Atherosclerosis
- Pain – can be on the chest (if coronary artery is affected) or the limbs (if peripheral arteries are affected) especially the legs
- Shortness of breath
- Weakness or myalgia
Causes of Atherosclerosis
Atherosclerosis happens when cholesterol-containing deposits or “plaques” develop on the artery walls.
There are several risk factors that may promote the buildup of plaque in an artery. These include smoking, high blood pressure, high cholesterol diet. sedentary lifestyle, diabetes or insulin resistance.
Complications of Atherosclerosis
- Coronary artery disease (CAD), Myocardial Infarction, acute coronary syndrome (ACS), or heart attack. Atherosclerosis may cause total blockage of a coronary artery, which may result to the lack of blood flow to the cardiac muscle.
- Heart Failure. Since the coronary arteries supply the heart with oxygen- and nutrient-rich blood, blockage in them may weaken the heart. This eventually leads to failure of the heart to supply blood to the rest of the body tissues.
- Peripheral vascular disease (PVD). Blockage of a peripheral artery may lead to reduced blood flow to the limbs, usually the legs. This can manifest as leg weakness and pain and can affect the mobility of the patient.
- Arrythmias. Abnormal heart rhythms such as atrial fibrillation may result from the decreased blood supply in the heart. Irregular heartbeats may result to formation of more blood clots. These thrombi can travel to other parts of the body and become embolus/ emboli. When the embolus reaches the brain, the patient may suffer from transient ischemic attack (TIA) or stroke.
Diagnostic Tests for Atherosclerosis
- Vital signs – decreased blood pressure on the affected limb; whooshing sound or bruit over the arteries upon auscultation
- Blood tests – to measure cholesterol levels by total lipid profile (fasting for 10 to 12 hours), lipoprotein blood test (non-fasting), and glucose testing
- Doppler Ultrasound – to measure the blood pressure on different sites of the arm or leg in order to check for the speed of the arterial blood flow, and any blockage
- Ankle-brachial index – to compare the blood pressure level in the arm versus that in the ankle
- Electrocardiogram (ECG)
- Echocardiogram – utilizes sound waves to create images of the heart
- Exercise stress test – use of ECG while the patient is on a treadmill or a stationary bike
- Cardiac catheterization and angiogram
- Cardiac CT scan
Treatment for Atherosclerosis
- Medications. The following drugs may be used to treat atherosclerosis:
- Anti-cholesterol drugs (e.g. statins) – to reduce the deposits on the arterial walls
- Blood thinning agents such as Aspirin – to reduce the ability of the blood to clot, so that the blood flows easier through the narrowed arteries.
- Nitrates – to relax the blood vessels.
- Beta blockers – to decrease the cardiac demand for oxygen by means of lowering the heart rate and blood pressure levels
- Calcium channel blockers – used in combination with beta blockers
- Diuretics – to reduce blood pressure
- Ranolazine – to treat angina
- Surgery. Surgical interventions are required if the medical team believes that an urgent, more aggressive treatment for the complications of atherosclerosis (such as CAD and PVD) is needed. These surgeries include:
- Coronary artery bypass surgery – creation of a graft to reroute the blood flow away from the diseased artery
- Fibrinolytic therapy – usage of a clot-dissolving drug to dissolve the atheroma
- Endarterectomy – surgical removal of atheroma from the narrowed arteries
- Lifestyle changes. A low cholesterol, low sugar diet to control cholesterol and blood glucose levels is needed for a patient with atherosclerosis. Foods rich in omega-3 fatty acids such as fish, soybeans, and flaxseeds are recommended Smoking is another risk factor of atherosclerosis and CAD. Increased physical activity by doing at least 150 minutes of moderate aerobic exercises will help promote an active lifestyle.
Nursing Care Plans for Atherosclerosis
- Decreased cardiac output secondary to increased vascular resistance as evidenced by high blood pressure level of 170/89, fatigue and inability to do ADLs as normal
Desired outcome: The patient will be able to maintain adequate cardiac output.
|Assess the patient’s vital signs and characteristics of heartbeat at least every 4 hours. Assess heart sounds via auscultation. Observe for signs of decreasing peripheral tissue perfusion such as slow capillary refill, facial pallor, cyanosis, and cool, clammy skin.||To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment. Heart murmur sounds is an important sign of endocarditis. The presence of signs of decreasing peripheral tissue perfusion indicate deterioration of the patient’s status which require immediate referral to the physician.|
|Administer prescribed medications for atherosclerosis.||Aspirin – to reduce the ability of the blood to clot, so that the blood flows easier through the narrowed arteries. Nitrates – to relax the blood vessels. Anti-cholesterol drugs (e.g. statins) – to reduce the deposits on the arterial walls Beta blockers – to decrease the cardiac demand for oxygen by means of lowering the heart rate and blood pressure levels Calcium channel blockers – used in combination with beta blockers Ranolazine – to treat angina|
|Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.||To increase the oxygen level and achieve an SpO2 value within the target range.|
|Educate patient on stress management, deep breathing exercises, and relaxation techniques.||Stress causes a persistent increase in cortisol levels, which has been linked to people with cardiac issues. Chronic stress may also cause an increase in adrenaline levels, which tend to increase the heart rate, respiratory rate, and blood sugar levels. Reducing stress is also an important aspect of dealing with fatigue.|
- Nursing Diagnosis: Acute Pain related to decreased myocardial blood flow as evidenced by pain score of 10 out of 10, verbalization of pressure-like/ squeezing chest pain (angina), guarding sign on the chest, blood pressure level of 180/90, respiratory rate of 29 bpm, and restlessness
Desired Outcome: The patient will demonstrate relief of pain as evidenced by a pain score of 0 out of 10, stable vital signs, and absence of restlessness.
|Administer prescribed medications that alleviate the symptoms of pain (chest pain or angina, or leg/limb pain)||Aspirin may be given to reduce the ability of the blood to clot, so that the blood flows easier through the narrowed arteries. Nitrates may be given to relax the blood vessels. Other medications that help treat angina include anti-cholesterol drugs (e.g. statins), beta blockers, calcium channel blockers, and Ranolazine.|
|Assess the patient’s vital signs and characteristics of pain at least 30 minutes after administration of medication.||To monitor effectiveness of medical treatment for the relief of pain. The time of monitoring of vital signs may depend on the peak time of the drug administered.|
|Elevate the head of the bed if the patient is short of breath. Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.||To increase the oxygen level and achieve an SpO2 value within the target range.|
|Place the patient in complete bed rest when in severe pain. Educate patient on stress management, deep breathing exercises, and relaxation techniques.||Stress causes a persistent increase in cortisol levels, which has been linked to people with cardiac issues. The effects of stress are likely to increase myocardial workload.|
Other nursing diagnoses:
- Activity Intolerance
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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