The patient is a 44-year-old, overweightfemale who presented to her primaryhealthcare provider yesterday withcomplaints of recent episodes of shortness of breath that occur with minimal activity such as walking a flight of stairs or with increased stress. Her symptoms are relieved with rest.She denied any chest, arm or jaw pain butdid have some diaphoresis with one ortwo episodes.- She attributed her symptoms to hersmoking one pack per day for the past 20years and obesity.- She has gastroesophageal refluxcontrolled with ranitidine and has a historyof elevated cholesterol (252), HDL of 46,and LDL of 180.Her triglycerides were 140.- She drinks three to four caffeinatedbeverages per day and denies alcohol use.-In addition, she has a history of situational anxiety since her mother's death and hypertension controlled with atenolol.- Her surgical history includes totalabdominal hysterectomy six years ago and right carpal tunnel surgery two years ago.The patient's mother had a myocardialinfarction (MI) at age 56 and died at age66, secondary to complications of acoronary artery bypass graft.- Her oldest sister died at age 54 fromsudden cardiac death.- Her father is alive with a recent stroke and two younger brothers are alive and well.The patient and her husband have threehealthy children, ages 14-18, all living athome.- She is employed full-time as a paralegal.- The patient failed an exercise tolerancetest today with ST depression, shortnessof breath and a drop in BP.- She was admitted to the cardiac unit andan MI was ruled out with normal Troponin,CPK and Iso-Enzymes and ECG.She was then sent to the cardiaccatheterization lab for possible angioplasty and stent placement.- She was unable to have stent placementor angioplasty secondary to findings ofthree vessel disease and poor coronaryanatomy.- Thus, she was scheduled to have acoronary artery bypass graft (CABG) thefollowing day.The time is 1600 hours and the nurses are working the PM shift.-The cardiac catheterization RN has justreported to you that the patient wasmedicated with alprazolam 2mg at 1430hours.- She tolerated the procedure with nocomplications.- Her vital signs have been stable with aclean, dry, and intact left groin dressing.A sandbag is over the site and the head of the bed is flat.- The left lower extremity neurovascularstatus is intact and pulses are 2/4.- She is scheduled to have a CABGtomorrow and she is aware of this.1. Describe the pathophysiology ofcoronary artery disease.2. Discuss risk factors for coronary arterydisease and health promotion measures.3. What are the classic and non-classicsymptoms of chest pain? How are theydifferent in men and women?4. Discuss the following medications:nitroglycerin, morphine sulfate, aspirin,atenolol, aluminum hydroxide/magnesiumhydroxide, alprazolam, atorvastatincalcium. Include indications, actions,contraindications, side effects, normaldosage and nursing implications.5. Discuss the nursing and medicalmanagement of the patient post cardiacangiogram.6. Describe how to intervene and care forthe patient with chest pain and anxiety.7. Outline and discuss the preoperativeeducation plan for a patient and family forcoronary artery bypass graft surgery. Thisshould include preoperative education,instruction on the surgical procedure,postoperative course, and avoidance ofcomplications.8. Discuss the basic components ofcardiac rehabilitation.

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The underlying pathophysiologic processes for MI start with atherosclerosis, which develops and…

1. Describe the pathophysiology of coronary artery disease. 2. Discuss risk factors for coronary artery disease and health promotion measures. 3. What are the classic and non-classic symptoms of chest pain? How are they different in men and women?