Clinical Learning Guide #4
The Client with Coronary Artery Disease
Coronary artery disease (CAD) is a type of blood vessel disorder that is included in the general category of atherosclerosis. CAD is the number one cause of death in the United States.
An acute myocardial infarction (AMI) occurs when ischemic intracellular changes become irreversible and necrosis results.
The student will prepare for the clinical assignment by reviewing:
a. the pathophysiology of atherosclerosis and of acute myocardial infarction (AMI).
b. the normal electrical conduction system of the heart and changes which occur due to ischemia and necrosis of tissue.
The student will obtain one nursing journal article related to a client with CAD. The student will present an outline of the article to the faculty during post-conference.
The student will be prepared to answer questions on the learning guide. Designated students will be prepared to lead the group in a discussion in post conference using the following questions as applied to the assigned clients;
Identify the stimuli (causes) of CAD.
List the major client behaviors (signs & symptoms) of an AMI.
List the diet ordered for your assigned patient by their physician? How will this diet support your patient’s current diagnosis?
Discuss in post conference, any and all laboratory tests, EKG changes, and rhythm disturbances that your patient confirm or rule out the diagnosis of AMI (i.e., CPK-MB, troponin and myoglobin, etc.).What is your interpretation of the cardiac labs? What does this mean for your client?
List 5 of the most important nursing interventions for your assigned patient and prioritize them from #1 being the highest priority to #5 as the lowest of the 5 interventions listed.
Develop a client teaching plan for a client with angina; with AMI; with heart failure. Please hand in teaching plan on the Wednesday following clinical.
List the medications that your patient was administered?
List the major maladaptive responses (complications) of AMI and at least one nursing/medical intervention for each including;
Discuss anticoagulant/thrombolytic therapy, comparing the similarities and differences of heparin, low-molecular weight heparins, Streptokinase, and Tissue Plasminogen Activator (tPa).
Discuss teaching a client receiving Digoxin, a beta blocker, Nitroglycerine, an antiarrhythmic, a calcium channel blocker, angiotension receptor blockers (ARB’s) and angiotension converting enzyme (ACE) inhibitors. You can use medication cards made last semester as resources for this.
Discuss in post conference, rehabilitation for a client following an AMI, including psychosocial, spiritual, and cultural aspects.
Discuss in post conference, your observations with assessment of the cardiovascular system in crisis (what and how did the nurses assess the patient?).
