Atherosclerosis Nursing Care Plans Diagnosis and Interventions
Atherosclerosis NCLEX Review and Nursing Care Plans
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.
- Arrhythmias. 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
Nursing Care Plan for Atherosclerosis 1
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.
|Atherosclerosis Nursing Interventions||Rationale|
|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 Care Plan for Atherosclerosis 2
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.
|Atherosclerosis Nursing Interventions||Rationale|
|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.|
Nursing Care Plan for Atherosclerosis 3
Nursing Diagnosis: Activity Intolerance related to imbalanced oxygen supply and demand secondary to atherosclerosis as evidenced by marked weakness, fatigue, and changes in vital signs
Desired Outcome: The patient will be able to participate in desired activities within limits with marked evidence of reduced fatigue and normalization of vital signs within allowed levels during activity.
|Atherosclerosis Nursing Interventions||Rationale|
|Evaluate the patient’s vital signs prior to and during activity especially if the patient is on vasodilators, diuretics, or beta-blockers.||Patients on vasodilators, diuretics, and beta-blockers are prone to develop orthostatic hypotension as an aftereffect of these medications such as vasodilation, fluid shifts, and altered pumping mechanism of the heart.|
|Record cardiopulmonary strength and vigor while doing activities. Keep watch for the presence of tachycardia, dysrhythmias, pallor, diaphoresis, or dyspnea.||Alterations in the myocardium, restricted blood flow in the blood vessels, resulting to failure to increase stroke volume while in activities will cause sudden elevations in oxygen demand and heart rate, thus worsening the latent weakness of the patient.|
|Evaluate and watch out for other reasons for patient fatigue such as the presence of pain, due to medication regimen, or therapeutic management, etc.||Some medications such as beta-blockers and sedatives have fatigue as one of their marked side effects. Stressful situations or procedures may also lower a patient’s energy levels thereby compounding the current fatigue of the patient.|
|Recognize factors that could possibly influence the patient’s desired activity and motivation levels.||Factors such as age, pain levels, sensory deficits (e.g., hearing problems), functional decline, etc. may hinder the employed interventions that are utilized in order to improve tolerance levels. Fatigue influences both the actual and perceived ability to accomplish activities.|
|Observe and record the patient’s response with regard to activities.||Vital signs and oxygen levels should be observed before, during, and immediately after activity in order to analyze the limits of the patient. A normal heart response to activity would be the normalization of heart rate within 3 minutes after completion. In the instance that the patient is able to tolerate activity, utilize that data to formulate health goals that may lead to better activity performance.|
|Determine the use of the 6-minute walk test (6MWT) in evaluating the patient’s physical ability.||6MWT is an exercise test developed to evaluate the patient’s cardiopulmonary health by having the individual walk a certain distance within a time frame of 6 minutes.|
|Assess the patient when accelerating activity intolerance.||This may mean elevating myocardial decompensation and not simply overactivity itself. Exercise risks of an individual are affected by these three factors: age, presence of heart disease, and exercise intensity. Episodes of sudden cardiac death while doing exercise is rare for healthy individuals. However, patients with heart conditions are at greater risk for immediate cardiac arrest during strenuous exercise when compared to healthy individuals.|
|Help the patient in fulfilling self-care activities as needed. Allow independence as tolerated by the patient.||Helping the patient accomplish ADLs would ensure that his needs are met without putting cardiac health at risk. As much as possible and if tolerated, include the patient to actively participate in order to promote self-reliance and reduce helplessness.|
|Do patient care activities slowly, ensuring that adequate rest periods are maintained before activities and after exertion efforts. (e.g., bathing, exercise, etc.)||Letting the patient ample time to do ADLs will help in reducing fatigue, especially for geriatric patients. Older patients are susceptible to falls and injuries due to limited muscle strength which may further be compounded during episodes of fatigue.|
|Schedule nursing care actions to allow rest periods.||Employing rest periods in between activity periods through a schedule will promote pacing and prioritization in order to meet the personal care needs of the patient without compromising cardiac health.|
|Allow the patient to take an active role in doing a range of motion exercises. Involve the patient in scheduling activities in order to increase endurance.||Exercise facilitates maintaining muscle integrity, joint stability, and activity tolerance. Patients who are bedridden would need these conditioning exercises for them to regain lost strength and endurance, that they will need for doing activities of daily living.|
|Educate the patient and relative on the clinical manifestations of overexertion.||Awareness in recognizing overexertion while doing activities will ensure that the patient is able to safely enact actions without compromising his health.|
Nursing Care Plan for Atherosclerosis 4
Nursing Diagnosis: Ineffective Breathing Pattern related to fatigue secondary to atherosclerosis as evidenced by generalized weakness, tachypnea, and pursed lip breathing.
Desired Outcome: The patient will be able to establish normal and effective respiratory pattern, free from fatigue.
|Atherosclerosis Nursing Interventions||Rationale|
|Ensure to establish rapport with the patient by using open-ended questions and exploring the patient’s feelings about having atherosclerosis.||The patient having trouble breathing would often feel apprehensive and stressed out, which could further complicate efforts. The nurse establishing rapport will help the patient trust the healthcare team during his most vulnerable moments, thus allowing for better compliance towards therapeutic goals.|
|Take note and record the patient’s vital signs, particularly the respiratory rate and oxygen saturation.||Monitoring the patient’s vital signs will help the healthcare team establish baseline data of the patient. Having baseline data would help the healthcare team determine the effectiveness of employed interventions or the worsening of latent clinical manifestations.|
|Assess the patient’s thorax for symmetry when breathing.||Equal chest expansion would mean that breathing is adequate for proper oxygenation of the body. An unequal chest expansion would mean respiratory compromise that would necessitate timely intervention to prevent untoward complications that may progress to respiratory failure.|
|Examine the patient for manifestations of compromised respiratory health such as shortness of breath, nasal flaring, pursed-lip breathing, use of accessory muscles of breathing, and extended expirations.||Signs and symptoms of compromised breathing include observations of shortness of breathing, use of accessory muscles, and pursed lip breathing to name a few. Early recognition of these signs will help the healthcare team to identify beginning respiratory failure for corrective interventions to be done.|
|Determine the patient’s tidal volume and vital capacity.||Knowing both the tidal volume and vital capacity of the patient’s lungs would indicate the amount and volume of air that passes through in and out of the lungs. It can help determine the next therapeutic intervention that the healthcare team will utilize in order to address a worsening condition or the shifting to lesser invasive therapies as a sign of patient improvement.|
|Evaluate the emotional response of the patient in light of the condition, the therapies rendered, etc.||The emotional response of a patient can either improve or worsen the patient’s dyspnea. Furthermore, evaluating emotional reaction will detect the use of hyperventilation as a cause of dyspnea so that other therapies can be utilized to address this.|
|Assist the patient to a comfortable position. Consider putting the patient on semi-Fowler’s position.||Placing the patient in a comfortable position promotes patient comfort that could reduce feelings of apprehension and stress. Positioning into the semi-Fowler’s position would promote for better chest expansion, therefore improving patient respiration and reducing dyspnea episodes.|
|Encourage the patient the use of relaxation methods.||Relaxation methods assist by reducing muscle tension in the body. It also limits respiratory effort by allowing the patient to refocus attention on relaxation and away from the stress of dyspnea.|
|Promote frequent small feedings, especially during dyspneic episodes.||Small frequent feedings are ideal for patients with dyspnea for it reduce energy consumption with the activity. Furthermore, it promotes patient safety by limiting aspiration risk due to the effort it takes to eat and breathe simultaneously.|
|Remain with the patient, especially during episodes of dyspnea or respiratory distress.||Dyspnea is a debilitating condition that can also cause emotional instability and anxiety to the patient. Letting the patient know that a healthcare provider is within reach during dyspneic episodes enforces a sense of comfort and security that will make the experience less daunting.|
Nursing Care Plan for Atherosclerosis 5
Nursing Diagnosis: Impaired Gas Exchange related to alveolar edema secondary to atherosclerosis and increased ventricular pressure as evidenced by difficulty in breathing, shortness of breath, fatigue, and circumoral cyanosis.
Desired Outcome: The patient will be able to show improvement in gas exchange as indicated by normal breath sounds, SpO2 levels of 95% and above, normal skin color, and evidence of eupnea.
|Atherosclerosis Nursing Interventions||Rationale|
|Evaluate the patient’s respiratory rate, including the presence of lung excursion, use of accessory muscles, cyanosis, manifestations of air hunger, and marked changes in vital signs.||Warning signs of impending respiratory distress are characterized by the use of accessory muscles, signs of air hunger, and cyanosis to enumerate a few. Recognizing these early would prevent unnecessary complications and reduce mortality and morbidity rates.|
|Auscultate the patient’s chest to evaluate for the presence of crackles.||The presence of crackles upon chest auscultation would mean retention of fluid or alterations in ventilation. Furthermore, it is a sign of fluid congestion in the alveoli that will result in a decrease in breath sounds. Wheezing heard upon auscultation would mean that the patient has asthma or bronchitis.|
|Monitor and take note of oxygen saturation and ABG results.||Oxygen saturation arterial blood gasses are good indicators for determining the adequacy of oxygenation in the body. A reading of 92% or less in the pulse oximeter and reduced PaO2 and elevated PaCO2 in ABG result would indicate respiratory distress and decreasing oxygen levels.|
|Examine the patient’s skin color, nail beds, and mucus membranes. Observe for the presence of peripheral discoloration or cyanosis.||Cyanosis for these patients may be observed in the presence of vasoconstriction, or the limitation of circulating blood in the body brought about by plaque formation in the blood vessels.|
|Place the patient on High Fowler’s, ensuring that the head of the bed is at 90 degrees.||The high fowler’s position assists in patient breathing by enhancing lung expansion during inspiration. It also promotes the expectoration of secretions to enhance ventilation efforts.|
|Render oxygen supplementation as ordered.||Patients encountering difficulty in breathing and maintaining good oxygen saturations would require supplementation to address inherent hypoxia and hypoxemia episodes.|
|Anticipate administration of medications as ordered: |
ACE (angiotensin-converting enzyme) inhibitors
Cholesterol-lowering drugs or statins
These medications are administered for certain issues in patients with atherosclerosis. It acts on the renin-angiotensin system by reducing angiotensin II thereby facilitating limited aldosterone supply. With these, it lowers inherent hypertension thereby reducing the workload of the heart.
These medications block the effect of adrenaline thereby causing the heart to beat more slowly and with a lesser force which in turn reduces blood pressure.
These medications help in lowering and controlling blood cholesterol levels in the body, thus limiting the blood vessel blockages associated with atherosclerosis.
These drugs prevent unnecessary blood clotting that could potentially clog blood vessels in the presence of atherosclerosis.
|Anticipate airway management for patients with uncontrolled breathing or impaired oxygen saturation levels.||These patients are at risk in developing breathing and heart complications that would need advanced management techniques to address the issues.|
|Assist the patient in doing deep breathing exercises and modulated coughing techniques. Let the patient inhale deeply, hold his breath for a few seconds, and cough 2 or 3 times with an open mouth, all of this done while controlling the abdominal muscles as able.||This method can assist the patient in increasing sputum expectoration while reducing cough spasms. The controlled coughing method focuses on using the diaphragm, with the goal of making the cough more compelling and efficient.|
|Educate the patient and family on the complications of the case, the importance of compliance with the treatment regimen, and the need to ask for further medical intervention.||Giving useful information to the patient and relatives regarding atherosclerosis will promote a better understanding of their roles and impact on the patient’s general well-being. It also promotes improvement in health choices that would be crucial towards achieving the health goals of the patient.|
More Atherosclerosis Nursing Diagnosis
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. (2022). 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. (2020). 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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