Caring for Person S with Angina Pectoris

Caring for Person’s

With

“Angina Pectoris”

This diagram is from the copyright-free collection, The Sourcebook of Medical Illustration, edited by Peter Cull (Park Ridge, NJ: Parthenon, 1989).

Caring for Person’s with Angina Pectoris

Course Title: Caring for Persons with Angina Pectoris

Course Number: A102

Continuing Education Credit: 1.0 contact hour(s) = 1.0 CEU

Author/Instructor: Leauretta Boulding LVN

Course Objectives:

By the end of this course, the nursing assistant will be able to…

1. Define Angina Pectoris

2. Explain briefly the affects of angina pectoris on the heart.

3. Identify three signs/symptoms associated with angina pectoris.

4. Describe methods of treatment for angina pectoris.

5. Describe nursing assistant measures used when caring for persons with angina pectoris.

6. Explain the purpose of cardiac rehabilitation.

Course Outline:

· Introduction

· Review of the structures and functions of the heart

· Causes/Risk factors

· What are the Signs and Symptoms?

· Treatment for Angina Pectoris.

· Guidelines for nursing assistant care for persons with angina pectoris.

Teaching methods:

· Audio lecture

· Illustrations

· Power-point presentation

· Questions/Answers

Caring for Person’s

With

“Angina Pectoris”

Introduction:

In the United States alone, more than 7,000,000 people have been diagnosed with angina pectoris. Each year, approximately 400, 000 new diagnoses are made, according to an article posted earlier this year. Angina Pectoris is an indication of an underlying problem of the heart. It presents itself in two forms; stable or unstable.

In order to provide quality of care to patients/residents with various types of heart disease, it is first crucial to have a basic understanding of the body system most affected. So we will briefly review the circulatory system. Here is a little exercise to complete prior to the review of the circulatory system. In the table below, match the term with the correct description.

Individual Activity: “Matching Exercise”

Terminology / Description
1. heart
2. capillaries
3. blood vessels
4. blood
5. arteries
6. veins
7. valves / A. sends oxygenated blood away from the heart.
B. comprised of muscle; size of a fist
C. separate chambers of the heart
D. send blood back to the heart
E. aide in blood circulated throughout the heart.
F. comprised of plasma and cells
G. carry food and nutrients to cells

Answers to the matching exercise above are listed below…

B, 2. G, 3. E, 4. F, 5. A, 6. D. 7. C

Review of the structures and functions of the heart:

Question: Can you give another name for the circulatory system?

Answer: Another name for the circulatory system is the “cardiovascular system”.

Let us begin to take a brief review of the circulatory system. The circulatory system is also known as the “cardiovascular system”. Major structures within this system are the heart, blood vessels and blood. This system has numerous functions.

The heart (a muscle), the major organ of this system, is responsible for pumping blood throughout the body. It is located at the lower end of the left side of the chest and is approximately the size of your fist. The heart is divided into four chambers. The two upper chambers of the heart are the atria and the two lower chambers are called the ventricles. The atria is separated by the tricuspid valve; making up the left and right atrium of the heart. The mitral valve lies between the two lower chambers of the heart; making up the left and right ventricles. Moving blood in only one direction, the valves help to prevent the ventricles from sending blood back up into the atria.

The blood vessels are the means in which blood is pumped from the heart is able to travel throughout the human body. The three groups of blood vessels are: arteries (are responsible for moving oxygenated blood from the heart); capillaries (carry food and nutrients to cells); and veins (send blood back to the heart).

The blood is responsible for carrying out the following duties as a part of the circulatory system. It makes up less than 10% of the body’s weight; the body containing a little over five liters. Made up of plasma and cells; blood gets rid of waste products from cells; helps maintain fluid balance in the body, and supplies the cells with necessary food and nutrients. Also, blood carries oxygen to the body’s cells while at the same time removing carbon dioxide from the body.

By having a basic understanding of the circulatory systems structures and their functions; enable us to carry out our job duties carefully and efficiently; for persons with various types of heart disease. In today’s lesson, we will discuss Angina Pectoris.

Causes/Risk factor…

Like many medical conditions, there are factors that may increase you chance of having angina pectoris. Some of these risk factors are out of your control such as: your age gender and a family history of coronary artery disease. However, there are many contributors in which you can exercise some control that may directly impact your health; increasing your risk for angina pectoris. These include: smoking and/or exposure to smoke; hypertension and diabetes; lack of exercise and problems with obesity.

Angina Defined…

A basic working definition for “angina pectoris” is pain occurring in the chest. There are two classifications for angina. We will take a look at both types. They are “stable” and “unstable angina”.

With stable angina, the signs and symptoms of angina pectoris happens in more predictable intervals; whereas unstable angina is unpredictable and may not be a result of anything the person is doing or not doing throughout the course of their day. In other words, it may occur without a cause or reason. Unstable angina is considered to be the more serious type. Whether unstable or stable this form of heart disease; characterized by pain in the chest. This type of pain in the chest occurs when blood flow to the myocardium (heart muscle) is decreased and the heart doesn’t receive sufficient amounts of oxygen needed for the heart to function properly.

Diagnosing angina pectoris is mostly reflective of the person’s physical history, reported current signs and symptoms and risk factors. The physician may make inquires regarding the characteristics of the complaints of pain; pain duration and noticeable times of the occurrence of the pain. If the doctor suspects angina pectoris, (or something more serious) an electrocardiogram (EKG) of the heart may be ordered; along with a stress test to rule out coronary artery disease.

For people with angina pectoris, the heart has to work harder to perform during instances such as: overeating, overexertion from exercise, smoking and extreme weather conditions; all which may exacerbate the signs and symptoms of angina pectoris.

What are the Signs and Symptoms?

Angina pectoris is characterized by pain in the chest described as being; pressure exerted on the chest; forceful tightening (feeling as if someone or something is sitting on the chest) squeezing the chest. Signs and symptoms associated with angina pectoris include; radiating pain from the jaw and down into the neck or back. In addition, the person may become diaphoretic, faint and complain of difficulty or pain when breathing (dyspnea). Nausea, vomiting and indigestion are also signs and symptoms associated with angina pectoris.

Treatment for Angina Pectoris…

So the question at hand is how is it treated? An episode of angina pectoris may be as short-lived as three minutes but as long as fifteen minutes. Relief may occur when the person ceases whatever may be causing the chest pain. However, there are times when rest alone is not enough to alleviate angina pectoris. In this case, the strict rest may be implemented as a part of the person’s care plan. In addition to rest, the person takes nitroglycerin by mouth. This nitroglycerin tab is simply placed under the tongue (sublingual) which allows for rapid absorption of the medicine. As a precautionary measure, the person needs to have the nitroglycerin tablet within their reach at all times. The person self-administers the tablets and once taken, they report immediately to the nurse. In an instance in which the tablet form of the nitroglycerin may not be feasible, the doctor may prescribe the medicine in the form of a patch. This patch is applied directly to the skin by the nurse. When it is time to be removed; this is the task of the nurse.

Angina pectoris that is not relieved with medicine and rest may be a signal of a health issue that is more life-threatening. This may indicate a heart attack (myocardial infarction) in which emergency medical care is needed immediately. As the nursing assistant, it is your job to report to your charge nurse immediately should such an incident occur. Follow your agencies protocol for responding to medical emergencies.

Treatment goals for angina pectoris include:

· Pain management

· Avoiding disease aggravating activities

· Preventing damage to the heart.

Nursing Assistant Care:

Goals are achieved when care measures are implemented to decrease the heart’s need for more oxygen. Here are some things you can do as a nursing assistant to aide in minimizing the occurrence of angina pectoris. Encourage the person to take frequent rest periods if needed if the person in your care is ambulatory; sitting down in a chair if they become tired. Be sure to observe for signs and symptoms of painful or difficulty breathing. An assessment of the persons pulse, respirations and blood pressure may be performed before and after ambulating; fluctuations may indicate possible signs of overexertion.

Also, provide the appropriate amount of assistance with all activities of daily living; again, monitoring for signs of overexertion; while assisting with transfers, repositioning and even bathing. Monitor the person’s weight according to their written plan of care and assist with prescribed exercises as needed.

During meal times, be sure to monitor/report consumption and intake measurements. The patient/resident should adhere to their prescribed diet. Patients/Residents with angina pectoris should be reminded to avoid overeating and heavy meals during mealtimes; for these things may increase the likeliness of an angina pectoris attack.

Extreme spikes or drastic decreases in weather conditions bring about an angina pectoris attack. As the nursing assistant, you are responsible in assisting residents to dress and undress. Be sure to assist the person in making appropriate choices when assisting with such a task like dressing and undressing. A sweater and/or jacket may be necessary when the weather is cold; light clothing may be needed when the weather is hot.

It may be necessary for the person with angina pectoris to receive cardiac rehabilitation. The focus of cardiac rehabilitation consists of training to include: physical exercise, education on heart disease and lifestyle changes and counseling. The person learns exercises that aide them in improving their strength, physical endurance and improving muscle tone. In addition, they are taught how to exercise while maintaining their personal safety. The person’s physical ability, holistic needs and individual interests are taken into consideration.

Education and, counseling and training includes: lowering risks for complications associated with heart disease; dealing with fears regarding their current health status and learning more about their medical condition. The cardiac team is comprised of various health care team members with the patient as the focus. Members of the cardiac rehabilitation team include: physicians, cardiac specialists, heart surgeons, physical and occupational therapists, nurses, dieticians and you.

Summary:

The quality of care you administer to your patients/residents should always be in the best interest of the patient/resident. Your primary goal is to utilize the skills and training you possess to improve the over-all well being of the patient/resident. This is accomplished when you understand the individual’s disease process; provide care safely and know what signs and symptoms pose a threat to the person’s health. Be watchful; be careful and attentive to the needs of your person diagnosed with angina pectoris. Report changes in condition to your charge nurse accurately and promptly. Provide assistance with activities of daily living according to the person’s plan of care and promote independence.

Summary:

So as you carry out your role as a nursing assistant, remember the importance of having a solid foundation and basic understanding regarding various diseases and disorders. In such cases of angina pectoris, your actions or lack there of; can mean the difference between care that is of optimal quality or that ends in a fatality. Angina pectoris is manageable with the proper care; but if unrelieved, it can prove to be life-threatening.