Student Name: Charleen Kahapea

Date Submitted:

Code status: Full

Medical Dx: Right 5th toe gangrene
Surgical Procedure and date:
11/11 Right 5th metatarsal amputation

History of Present Illness

11/8 Cc in ER infected sores Right foot.
Homeless & dressing on feet filthy. Missed
dialysis d/t pain that day. R foot very foul odor.
Lateral R foot necrotic tissue. Last drsg
change 3 days ago. Last adm 9/23-10/9 Left
foot cellulitis, had debridement done &
declined removal Right 5th toe.

Problem List:
DM2 w/ renal manifestations,
controlled
Cellulitis
ESRD on dialysis (chronic)
Peripheral artery disease
Toe gangrene
Diabetic foot ulcers

Age: 54
Male or Female: male
Religion: No religious preference
Ethnicity: Part-Hawaiian
Marital Status: single
Occupation: unemployed
Living condition: homeless/ kicked out of IHS

Skin/wound:
1. L knee old scab wound- OTA
2. R foot 1, 5th toe gangrene, lateral foot

Type of IV solution & Rate: none

Notify MD:
Temp >101.5F; HR <50 or >120; SBP <90 or >180; DBP <50 or >90; RR <10 or >29;
SaO2 <93%; UOP <240cc/shift; severe pain; abdominal distention; change in mental
status; respiratory depression.
*for Temp >101.5 do blood cultures x2 stat

Type of IV Access & Location:

1. 11/10 PIV R lateral forearm (SL)
2. (no date) Graft L upper arm (HD)

Interdisciplinary referrals
Nephrology for Hx ESRD on dialysis
Vascular surgery for gangrene toe w/ infection

Allergies:
Allergy: NKDA
Type of reaction:

Wound care BID: silver sulfadiazine 1% cream. Cover with Kerlix. Describe wound/body
part to right lateral foot.

Treatment:
-Glucose check before meals & bedtime
-Incentive spirometry none
-Flowtron none
-O2 none
-Daily Weight: none
-PT/OT when ok with Dr. Wong (vascular MD)
-Precautions: Falls r/t surgery
-Vitals Q4H
-Dailysis: Tu /Th /Sat Intermittent HD

D/c plan: back to HIS under circumstances:

1. Be able to get in/out of bed
2. Going to bathroom independently
3. Compliant with medications
4. Home health services to provide assist as
needed.
-pt is agreeable
-working w/ Ohana insurance to get home health
services

Dx tests & results (pre- and post- procedures nsg. implications later in CIS)
11/10 Wound R foot dorsum gram stain
No WBCs or organisms seen
11/10 R foot dorsum wound culture
Probably staph, diptheroids; 2+ growth proteus species probable
11/8 R AC blood culture
Organism: No growth 48hrs
11/10 X ray foot (AP & LAT)
h/o foot infection, necrosis, now worse, cellulitis
1. Moderate demineralization in the head of the 5th digit metatarsal, recommend
clinical correlation for osteomyelitis in the region.
2. Cortical break present in 5th digit proximal phalanx. This is only seen in 1 of 2
views. Recommend clinical correlation for fracture in this region.

Type of Diet: Renal: protein 60gm, Na 3g, K 2g, Phos 1g

Fluid Restriction: none
Enc. Fluids: none
Activity (ability to walk - gait): NWB R foot w/ MAX assist OOB
Type of activity:
Assistive device:

services

Non-Hospital List:

Weight: 77.6 kg (171 lb 1.2 oz)

Height: 165.1 cm (5 5)
Elimination (continent/incontinent): HD and inc BM
Foley/condom cath/ st. cath:
Last BM: 11/9 Lrg brown/black; liquid inc.
Last urine: 11/10 100ml

Benign hypertensive heart & kidney disease w/ heart failure & ESRD
Hx of CVA
Polysubstance abuse (chronic)
Alcohol abuse
Heart failure EF 50-55% earlier this yr. Lexiscan in Mar. w/ mild reversible ischemia suspicious for LAD.
Anemia in chronic kidney disease
Obstructive sleep apnea
Acute on chronic diastolic heart failure
Bilat Lower leg cellulitis
Hyperkalemia
Diabetic hypoglycemia
Acute uremia
Obstructive uropathy
Rhabdomyolysis
Metabolic encelaopathy
Protein calorie malnutrition
Unspecified Schizoprenia
Non ST elevated MI (NSTEMI) 9/11/14
Tinea pedis
Coronary artherosclerosis of native coronary artery
Hyposmolality and/or hyponatremia

Comprehensive 1st page good work.

General appearance and behavior:

1. Affect: appropriate responses
2. Mood: I think his mood was dysphoric, he was anxious and saying he was always in pain. When we
peeked in his room because he was moaning and yelling out in pain, he would be lying in bed and watching
tv. He stated he was lonely. When I was in the room he was fine and not yelling out in pain, except when
doing the dressing change. possibly
3. Thought Process No disturbances in thought process noted.
4. Thought Content His thought content was delusional on the second day aeb when I was in the room he
yelled out in pain, and I asked what happened that made him yell, he responded that the walkie talkie was
causing pain to his right foot. I asked him what he meant and he said that the radio frequency from the
walkie talkie was causing the pain to his right foot.
5. Cognitive Evaluation: He was A&O x4 for the most part. Except this one time he was awoken from his
sleep he asked where he was. But after being reoriented he was able to remember where he was when asked
throughout the shift.
6. Insight: He showed good insight as stating he was in the hospital because his legs were dirty and infected.
So he needed to get his toe amputated.
7. Judgment He showed good judgment I would say partially, when he asked for pain medications I told him
he could have his PO and we would save his IV for the dressing change and he agreed. But not too soon
after he got his PO meds he was asking for the IV pain meds. So when I reminded him I would give it to
him before the dressing change he was again agreeable. Then asking again later.
8. Level of Function He was limited to his bilateral lower leg cellulitis and 5th toe on right foot amputation.
9. Psychiatric status doctors note suggesting schizophrenia could be possible d/t substance induced. Pt had
hx for meth and marijuana and alcohol abuse. Homeless and kicked out of IHS (not sure why)
10. Psychotropic Medications none, pt says diagnosis of schizophrenia is wrong.

Psychosocial assessment:
1. Housing: Pt is homeless and was kicked out of HIS, sleeping at a bus shelter.
2. Transport pt does not drive
3. Financial pt receives $1000/mo SSD
4. Support Pts parents are deceased. He has a brother that lives in Waianae that he would like to live with if
he will agree.
5. Follow-up Pt needs personal aide services w/ Kamaaina health services for wound dressing changes and
IV antibiotics.

Good Mental Health Assessment!

Med/dose/frequency

Time

Mechanism
of action

Indication

Major Side effects

Nsg. Implications (prior to

admin)

Amlodipine tab 10mg PO

09

Antianginal,

Coronary artery
disease

Hypotension, palpitations, N/
V

-check BP & HR
-hold SBP <100

Atorvastatin 80 mg PO

09

Antilipidemic

cholesterol
levels

Abd cramps, diarrhea,

constipation, heartburn

-monitor lipids

Docusate sodium cap

100 mg PO

09
21

laxative

Prevent
constipation

Nausea, cramps, diarrhea

- Dont crush/ open capsule

- Give on empty stomach for
increased absorption, with
8 oz water

Gabapentin (Neurontin)
100mg PO

09
13
21

Anti
convulsant

Neuropathic
pain?

Confusion, seizures,
suicidal ideations,
leukopenia

-assess pain
-monitor labs
-monitor mental changes

Heparin syr 5,000 U SQ

Q12H

09
21

Prevention of
thrombi

DVT prophylaxis

Fever, rash, anaphylaxis,

pancytopenia

-check last time given

-check where last site given

Insulin aspart (Novolog

flexpen) 100 mg/ml AC
dose inj: TID w/ meals.
BG <70 or >400 call MD
<201 No insulin
201-250 2 units
251-300 4 units
301-350 6 units
351-400 8 units

07
11
16

antidiabetic

Hx DM2

Metoprolol tartrate
12.5mg

09
21

antianginal

Heart failure

Insomnia, palpitations,
hypotension, N/V

-Hold SBP <100 or HR <60

Pantoprazole DR EC
40mg tab

09

Proton pump
inhibitor

GI prophylaxis

Headace, diarrhea,
abdominal pain

-dont crush/ chew

Silver sulfadiazine
(SSD) 1% cream topical
BID

09
21

Topical
antiinfectives

cellulitis

Rash, urticaria, scaling,

redness

-apply to R lateral foot with

dressing changes

Acetaminophen (Tylenol)
650 mg tab

Q6H

Nonopioid
analgesic

Fever/pain, painmild

hepatotoxicity

(dont admin > 4g

acetaminophen a day)
-assess pain

Bisacodyl DR ec tab
5mg PO

daily

Laxative,
stimulant

constipation

Anorexia, cramps

Dont chew/crush. Give w/in 1h

of food/antacid

Fentanyl citrate (PF) inj

25-50 mcg

Q3H

Opioid
analgesic

Severe pain

Bradycardia, cardiac arrest,

delirium, respiratory
depression

-give over 1-2 mins

-assess IV site & pain
-check when last given

Guaifenesin (Tussin)
100mg/5ml liquid

Q4H

Expectorant

cough

Drowsiness, headache, N/V

-assess cough & sputum

bedtime

Herbal sleep
aid

sleep

Daytime drowsiness,
headache, dizziness

-assess sleeping issues or

need for sleep aid

Anaphylaxis, hypoglycemia, -rapid acting

lipodystrophy, blurred vision, Onset 10-20 mins
dry mouth
Peak 1-3 hr
Duration 3-5 hrs
-administer prior to beginning
of a meal
-check BG
-check last site given & rotate

PRN

Melatonin tab 3mg

Oxycodone imm release

tab 5 mg PO

Q4H

Opiate
analgesic

Mod pain

Sedation, constipation,
cramps

*high alert med

-assess pain

IV medications (research compatibility & infusion rate for each med.)

Med./dose/indication

Time

Infusion rate

Compat.

Piperacillin/tazobactam premix (Zosyn) 2.25g (Q12H)

-give pm dose after HD on HD days

10,22

2.25g/ 30 mins

Vancomycin 500mg after HD Tu, Th, Sa

16

No more than
10mg/min

Gulanick, PhD, APRN, FAAN, M., & Myers, RN, MSN, J. L. (2011). Nursing care plans: Diagnoses,
interventions, and outcomes Missouri: Elsevier Mosby.

Nursing Diagnosis (complete ONE nursing diagnosis of highest priority for the first day of clinical.(for Thursday) Also include
expectedLab
outcome
Nursing interventions
should
include assessment,
interventions
and teaching.
Tests and nursing
Normal interventions.
Range/
Date/
Date/
Date/ Result
Rationale
for abnormalities
Complete the 2nd plan ofUnit
careoffor
measure
the secondResult
day of clinicalResult
(Friday). Evaluate
(Clinical patients
Day
responsesspecific
duringtoclinical.
your client
(preclinical)
(Clinical
#2)
#1 Nursing dx: Pain r/t right foot 5th toe amputation
(POD3) aeb
moaning and frequently
requesting pain meds, stating pain 9/10.
Day #1)

Expected outcome:
Pain will be managed with
prn pain medications.
CBC
11/12
11/13
.
WBCInterventions
4-11
Nursing
Patient Responses to8.75
interventions 9.11
1. Assess
RBC pain
4-6
3.19 L
3.04 L

-anemia in chronic kidney disease

Hemoglobin
L foot wound.
9.3 LRequesting for pain meds
-anemia
in chronic
kidney
disease
Pt moaning and 14-18
verbalizing pain 9/10 to9.8
right
and states
only relief
when
both PO and IV pain
meds are given. Also states that just pill/ IV still too sore.
-anemia in chronic kidney disease
Hematocrit
40-50%
29.8 L
27.8 L
2. Ask the patient to identify a comfort-function goal, a pain level, on a self-report pain tool, that will allow the client to perform necessary or
desired
activities easily. 0.5-2
Reticulocytes
MCV

93.4
Pt states a 3/10 76-100
to be a comfortable level
for him.
3. Administer
opioids orally
or intravenously as ordered.
MCH
25-35
30.7

97.4
30.6

MCHCAdministered

31-35 @ 1800. RN administered

32.9
33.5IV at 2051 before dressing change.
2 Norco
dilaudid
4. Reassess
pain within 111.5-14.5
hour and with documentation.
After the PO pain meds, pt stated pain 6/10. After dressing change pain 3/10.
RDW
14.2
14.2
Evaluation of whether outcome(s) are met::
Platelet. Count

150-400

212

251

Yes.MPV
During dressing change,
after getting dilaudid patient was in a lot of pain during dressing change. After the dressing change, pt was lying
7.4-10.4
in bed watching tv with no further reports of pain.
Differential

Definitely a priority issue for him

Bands

0-6

Segmented
Neutrophils

34-72

#2 Nursing dx: Impaired tissue integrity r/t altered circulation aeb right 5th toe amputation d/t gangrene
Lymphocytes

12-44

Monocytes

0.0-12

Eosinophils

0.0-7.0

Expected Outcome: Pt will report any altered sensation or pain at site of impairment.
Nursing
Interventions 0.5-1
Patient Responses to interventions
Basophils
Assess site of skin impairment and determine etiology (e.g., acute or chronic wound, burn, dermatological lesion, pressure ulcer, skin tear)
NeutsPt(absolute)
had 5th toe on1.56-6.20x10(3)
right foot amputated 11/11, POD 3.
Monitor
site
of
skin
impairment
for color changes, redness, swelling, warmth, pain, or other signs of infection.
Right foot +cms. Pulses
Lymph (absolute)
heard with Doppler. Wound bed more pink from previous day. Scant purulent and serosang drainage mixed with silvadene noted on gauze.
Mono
(absolute)
Three
stitches
to right lateral upper foot intact.
Keep
area
clean
and dry. Dress wounds using appropriate wound covering.
Wound cleansed with NS. Wiped off previous silvadene.
Eos (absolute)
Cleansed surrounding tissue to toes with soap and water. All areas dried completely. Silvadene applied to wound. Wiped off cream to areas
beyond
Basothe
(absolute)
wound. Covered wound with folded gauze. Wrapped foot in kerlix and ace wrap.
Teach the use of pillows, foam wedges, and pressure-reducing devices to prevent pressure injury. Right leg elevated on 2 pillows at all times.
Heels kept off the bed. Pt able to self-reposition leg when falling off the pillows.
Evaluation
of whether outcome(s)
PT
11.4-14.2are met:
Yes and ongoing, pt verbalizing extreme pain on the previous day dressing change. 2nd day patient was in a more rested state and did not
PTT as much pain, dressing
25-35 changes was better tolerated the 2nd day. Both days pt was doing well after dressing change and
verbalize
administration
of dilaudid.2.0-3.0
INR
Good work!
Test
Lab

Normal Range

CHEM 25
Glucose, fasting

Date/ Result

Date/
Result

Date/ Result

Rationale for abnormalities specific

to your client

8/13
65-100

126 H

-DM2

BUN

6-23

51 H

-ESRD on dialysis, chronic kidney

disease

Creatinine

0.6-1.4

10.6 H

-ESRD on dialysis, chronic kidney

disease

BUN/Creatinine

10-20:1

Sodium

135-145

Potassium

3.5-5

4.6

Chloride

98-107

98 L

-heart failure

TCO2

23-27

20 L

-kidney disease

Magnesium

1.8-3.0

Phosphorus

2.5-4.5

Calcium

8.5-10.2

Albumin

3.5-5

8.0 H

-dehydration, kidney disease

Total protein

6.5-8.2

3.0 L

-kidney dx, hx of protein calorie

malnutrition

Globulin

2.3-3.5

127 L

-chronic kidney disease

9.0

A/G ratio
Bilirubin, total

0.3-1

Bilirubin, direct

<0.4

Bilirubin, indirect
Uric acid

2.5-7.8

Osmolality (Calc)

275-299

CPK

0-5

Digoxin Tx
BNP

<100

Troponin I

0.6-2.8

Troponin T

<0.1

LDH

100-190

AST (SGOT)

<35

ALT (SGPT)

10-35

GGTP

15-80

**
Glucose meter 11/12 1800 114H d/t DM
Toxicology urine- Neg to all tests

Lab Test

Normal
Range/ Unit of
measure

Date/ Result

Date/
Result

Date/ Result

Rationale for abnormalities

specific to your client

Alkaline
phosphatase,

44-147

Amylase

30-100

Lipase

<160

Cholesterol

<200

Triglycerides

80-150

Homocysteine
Others:
Lactic Acid

3-7

ABG
pH

7.35-7.45

PaCO2

28-42

Pao2

75-105

O2 saturation

80-100

HCO3

22-26

BE

+-2
Urinalysis

Color

Yellow

Appearance

Clear

Specific gravity

1.050-1.030

pH

4.6-8

Leukocytes

Neg.

Nitrites

Neg.

Protein

Neg.

Glucose

Neg.

Ketones

Neg.

Urobilinogen

0.1-1.0

Bilirubin

None

Erythrocytes

UA microscopic
WBC

0-5

RBC

0-2

Epithelial cells
Occult blood

<3

Bacteria

None

Mucus
Casts

None

Crystals

None

Yeast
Comments
Cultures and
sensitivities
Organism
Sensitivity for
ordered antibiotic
Sensitivity for
ordered antibiotic
Sensitivity for
ordered antibiotic
Other tests
Blood culture

Neg.

** Modify normal range according to the hospital standard

Clinical Day #1

VS @16 98.8F 66 20 134/69 98 RA

@20 98.5F 85 20 113/71 98 RA

Neurological/Mental Status
A&O x4: oriented to person, place, time and situation: Alert & oriented x 4
Pupils: pupils equal round and reactive to light bilaterally 1.5 sluggish
Sensory deficits for vision/ hearing/taste/smell: none
Speech: pt mumbled a little, but he had all teeth intact and no complications noted
Sensation: full sensation to all extremities
Motor & strength: full strength to all extremities, a little weak to right leg; he was able to move his leg on his own.
Other:
Psychosocial Assessment
Mental Status Exam
Respiratory System
Depth=unlabored, rate=20, rhythm=even
Cough: strong
Uses of accessory muscles/cyanosis: none
Sputum color, amount: none
Breath sounds: lung sounds clear to all lobes bilaterally
Use of O2: none
Pulse oximeter: 98 RA
Smoking: none
Chest tube: none
Other:
Cardiovascular System
Pulses: radial-palpable bilaterally, brachial- palpable bilaterally,
post tib and dorsal pedis bilateral pulses heard with doppler
Edema: trace to lower extremities
Heart sounds: S1 & S2 noted
Chest pain: none
Capillary refill: less than 3 seconds
Other

Gastrointestinal System
Abdomen: soft and non-distended
Bowel sounds: present in all 4 quadrants
NGT(suction, feeding): none

Last BM: 11/9 brown/black; liquid

Ostomy: none
Other:

Musculoskeletal System
Bones: Fx/dislocation: none
Affected extremity CMS (pulses, temperature, edema, movement, sensation) check: CMS+ to right foot
Use of cast, splint, neck collar, brace or traction (identify): none
Genitourinary System
Pain or burning sensation with urination: none
Urine: No output, HD pt
Foley, continent, incontinent, ostomy (identify): has urinal
Dialysis: Tu/Th/ Sa
Skin & Wounds good!
Color, turgor: pink, no tenting
Bruises/rash: none
Describe wounds (size, location): right foot 5th toe amputation, 3 stitches intact. Beefy red wound bed, with scant
purulent, serosang exudate, a little foul smelling. Old scab to left knee OTA
(forgot to measure) about 2 in length and 1 lateral of right foot.
Dressing: wound covered with sulfodiazine and gauze, wrapped in kerlix & ace wrap.
Wound vac: none
IV site (peripheral, PICC, TLC): peripheral IV to left forearm (11/10) clean, dry, & intact, no complications
Other: L upper arm AV fistula bruit & thrill positive. Covered with band aid, no complications noted

Circle the appropriate assessment if applicable and describe what you observe using medical terminology

Clinical Day #2

VS #1 98.0F 53 16 109/60 95 RA
VS #2 98.7 70 18 145/70 97 RA

Neurological/Mental Status
A&O x4: oriented to person, place, time and situation: When pt was woke up from sleep during beginning of shift,
he did not know where he was and had to reorient him. Later he was Alert & oriented x 4
Pupils: pupils equal round and reactive to light bilaterally 1.5 sluggish
Sensory deficits for vision/ hearing/taste/smell: none
Speech: pt mumbled a little, but he had all teeth intact and no complications noted
Sensation: full sensation to all extremities
Motor & strength: full strength to all extremities, a little weak to right leg; he was able to move his leg on his own.
Other: very sleepy but arousable for my shift
Psychosocial Assessment
Mental Status Exam
Respiratory System
Depth=unlabored, rate=16/18, rhythm=even
Cough: strong
Uses of accessory muscles/cyanosis: none
Sputum color, amount: none
Breath sounds: lung sounds clear to all lobes bilaterally
Use of O2: none
Pulse oximeter: 95/97 RA
Smoking: none
Chest tube: none
Other:
Cardiovascular System
Pulses: radial-palpable bilaterally, brachial- palpable bilaterally,
Left post tib and dorsal pedis pulses heard with Doppler (forgot to use Doppler to listen to right DP & PT pulses
during dressing change)
Edema: trace to lower extremities
Heart sounds: S1 & S2 noted
Chest pain: none
Capillary refill: less than 3 seconds
Other
Gastrointestinal System
Abdomen: soft and non-distended
Bowel sounds: present in all 4 quadrants
NGT(suction, feeding): none

Last BM: 11/9 brown/black; liquid

Ostomy: none
Other:

Musculoskeletal System
Bones: Fx/dislocation: none
Affected extremity CMS (pulses, temperature, edema, movement, sensation) check: CMS+ to right foot
Use of cast, splint, neck collar, brace or traction (identify): none
Genitourinary System
Pain or burning sensation with urination: none
Urine: No output, HD pt,
Foley, continent, incontinent, ostomy (identify): has urinal
Dialysis: Tu/Th/ Sa
Skin & Wounds
Color, turgor: pink, no tenting
Bruises/rash: none
Describe wounds (size, location): right foot 5th toe amputation, 3 stitches intact. wound bed more pink color than
yesterday, with scant purulent, serosang exudate, a little foul smelling. Old scab to left knee OTA
(forgot to measure) about 2 in length and 1 lateral of right foot.
Dressing: wound covered with sulfodiazine and gauze, wrapped in kerlix & ace wrap.
Wound vac: none
IV site (peripheral, PICC, TLC): peripheral IV to left forearm (11/10) clean, dry, & intact, no complications, saline
locked.
Other: Left upper arm AV fistula bruit & thrill positive. No band aid, no complications noted

Thorough assessments Char, good work.

Tends to develop in medium & large size arteries, mostly the

coronary, cerebral, carotid, femoral arteries & the aorta.

Coronary atherosclerosis
!
Trauma or irritation to the intima, injury stimulates
platelet aggregation & the inflammatory response.

Clinical Manifestations:

Medial smooth muscle proliferates & migrates into the

intima; LDL cholesterol leaks into vessel wall.

Leukocytes are drawn to the site, & along with

endothelial cells, they oxidize the lipids, producing
further damage to the vessel walls.

Disease manifestations: hypertension, renal disease, cardiac

disease, peripheral artery disease, & stroke
Lab assessments: lipids, cholesterol: LDL (good is <100
mg/dl- healthy people; <70 mg/dL- w/ cardiovascular
disease or diabetic) & HDL (good > 40 mg/dL).
Triglycerides >150 mg/dL & women >135 mg/dL.
Chest discomfort- tightness, aching, burning
Angina pectoris radiating to the arm, jaw, or back
Dyspnea
Palpitations or tachycardia
N/V
Weakness & inability to complete usual activities w/o chest
pain or dyspnea

Medical Treatment:
Platelets aggregate at the site of injury; the lesion
slowly grows to decrease vessel diameter

Formation of atherosclerotic plaque, primarily

composed of smooth muscle cells, lipoproteins, &
inflammatory debris.

LDL molecule bind with receptors on cell membranes,

allowing the molecule to be absorbed into the cell.
Excess cholesterol is stored & acts as a cellular irritant,
leading to endothelial injury & plaque formation.

While the plaques enlarge, the opening of the artery

decreases, the plaque can rupture, initiating thrombus
formation & acute loss of perfusion

Non-pharmacological: weight loss, cessation of smoking,

exercise regimen & low-fat diet.
Blood tests & cardiac enzymes Troponin I & T, CPK, & CKMB all elevated.
EKG
Cardiac Angiography-cardiac catherization (show whether
plaque is blocking your arteries and how severe the blockage
is)
X Ray (reveal signs of heart failure)
CT scan (show hardening & narrowing of large arteries)
Stress testing (can show changes in HR & BP, SOB or chest
pain, abnormal changes in heart rhythm)
Ankle-brachial index (This test compares the blood pressure
in your ankle with the blood pressure in your arm to see how
well your blood is flowing.)
Echocardiography (provides information about the size and
shape of your heart and how well your heart chambers and
valves are working) May show unstable angina, MI w/ Non
ST elevation, MI w/ ST elevation.

Occlusion of coronary arteries leads to myocardial

ischemia and infarction

Nursing Interventions (should be cited from the textbook):

-

Nutrition therapy: increase daily vegetables & decrease dairy food fats. Total fat intake <30% of caloric intake. Less than
300mg daily cholesterol intake. Use canola oil, safflower & sunflower oil instead of palm or coconut oil. Increasing fiber.
Drug therapy: Lipid lowering agents- statins total cholesterol when used for an extensive period. Other drugs help to inhibit
absorption of cholesterol through the small intestine or amt of cholesterol synthesis in the liver. Combination drugs help w/
patients taking multiple drugs.
Physical exam to monitor for decreased or absent pulse. Hearing a bruit when auscultating the heart can indicate poor blood
flow d/t plaque build-up.

Lifestyle changes:

Having cholesterol screening and checks done. Low risk people 20 yrs of age or older should check their serum cholesterol
levels once every 5 yrs. More frequent checks for those w/ multiple risk factors & older than 40 yrs old.
Avoiding or minimizing modifiable risk factors (smoking, weight management, exercise, nutrition)
Monitoring for hypertension.
Adhering to diet, nutrition, and drug therapy.
Following up with annual checkups.

References:

Copstead, L., & Banasik, J. (2013). Pathophysiology (5th ed). St. Louis, Mo.: Elsevier.
Ignatavicius, D. (2013). Medical-surgical nursing: Patient-centered collaborative care (7th ed.). St. Louis: Elsevier Saunders
What Are the Signs and Symptoms of Atherosclerosis? (n.d.). Retrieved November 16, 2014, from http://www.nhlbi.nih.gov/health/
health-topics/topics/atherosclerosis/signs.htm

Make sure you save your pathos! They are very comprehensive and informative. They offer
good review for future purposes!!!