- Decreased Cardiac Output related to Atherosclerotic plaque in the coronary vessels and decreased myocardial oxygenation as evidenced by Palpitations and activity intolerance
- Ineffective Adherence related to poor understanding of treatment plan and Cultural influences on lifestyle as evidenced by Inability to decrease intake of saturated fats and no progress to quit smoking
- Ineffective Tissue Perfusion related to Plaque formation causing decreased perfusion as evidenced by Stroke symptoms: weakness, slurred speech, vision changes and High LDL levels
| Assessment | Nursing Diagnosis | Planning/Outcomes | Intervention | Evaluation |
| Subjective data: Verbalizes having chest pain with rest or activity Objective data: -Angina -Exertional dyspnoea -Syncope -Palpitations -Tachypnoea -Jugular vein distension -Carotid bruit -Abnormal heart sounds (S3 and S4) -Fatigue -Activity intolerance | Decreased Cardiac Output related to Atherosclerotic plaque in the coronary vessels and decreased myocardial oxygenation as evidenced by Palpitations and activity intolerance | Patient will not experience chest pain with rest or activity. Patient will not experience heart failure, myocardial infarction, or stroke. Patient will maintain a normal sinus rhythm on EKG. | 1. Educate on cardiovascular screenings. Patients with hyperlipidaemia are at risk for cardiovascular disease. Adults should have their lipid profile assessed every 5 years. If cholesterol numbers are abnormal, this screening increases to every 1-2 years. Blood pressure monitoring and diabetes screenings are also necessary to monitor cardiovascular risk. 2. Administer medications as indicated. Diuretics promote diuresis and reduce blood pressure. Vasodilators dilate blood vessels to reduce filling pressure and cardiac workload. Nitro-glycerine causes coronary arterial and venous dilation reducing afterload, preload, and myocardial oxygen demand and increasing oxygen delivery. This medication is used to relieve chest pain. Inotropic drugs improve heart contractility. Aspirin prevents platelet aggregation, clumping, and activation that leads to thrombus formation in coronary arteries leading to acute coronary syndrome 3. Assist the patient in diagnostic studies and revascularization. Severe cases of ischemic coronary heart disease due to atherosclerosis may necessitate cardiac catheterization. Revascularization through the use of stents or balloons can restore blood flow to the coronary arteries during cardiac catheterization. 4. Instruct on supplements. Along with prescribed medications, omega-3 fatty acids may lower triglyceride levels and reduce the risk of heart attack and stroke. | Patient relieved from chest pain with rest or activity. Patient relieved from experience of heart failure, myocardial infarction, or stroke. Patient maintained a normal sinus rhythm on EKG. |
| Subjective data: Expression of disinterest, distrust, or denial Expression of frustration, barriers or hopelessness Objective data: -Failure to keep appointments -Signs of poor adherence: worsening health, failure to make progress, worsening lab results, exacerbation of chronic conditions -Frequent preventable hospitalizations -Refusing medications or treatments | Ineffective Adherence related to poor understanding of treatment plan and Cultural influences on lifestyle as evidenced by Inability to decrease intake of saturated fats and no progress to quit smoking | Patient will not miss any doses of statin medication for 2 weeks. Patient will verbalize one reason to decrease cholesterol. Patient will decrease smoking to less than a pack per day. | 1. Implement motivational interviewing. The nurse provides education and can assist the patient in making positive changes through motivational interviewing. The Stages of Change Model can help the nurse determine where the patient is in the cycle of changing their health. 2. Instruct on medication strategies. The nurse can recommend strategies to increase medication adherence. This can be delivery of their medications from the pharmacy to their home, setting timers as a reminder, keeping medications in a pillbox to be filled by a competent family member, and keeping medications visible such as on the nightstand to take before bed. (Statin medications are usually prescribed to take at night.) 3. Establish manageable goals. Changing lifestyle behaviors can be difficult. Quitting smoking, losing weight, and changing eating habits doesn’t happen overnight but over time. Help the patient establish graduated goals such as smoking 1 less cigarette per day. 4. Help the patient understand consequences. Stressing the importance of adherence can include consequences for not doing so. Providing education on how high cholesterol leads to serious conditions such as heart attacks and strokes may aid in making better choices. | Patient did not miss any doses of statin medication for 2 weeks. Patient verbalized one reason to decrease cholesterol. Patient decreased smoking to less than a pack per day. |
| Subjective data: Altered skin sensations Claudication Peripheral pain Numbness and tingling Objective data: -Weak or absent peripheral pulses -Cool skin temperature -Thickened nails -Skin discoloration: pallor when legs are raised and rubor when dependent | Ineffective Tissue Perfusion related to Plaque formation causing decreased perfusion as evidenced by Stroke symptoms: weakness, slurred speech, vision changes and High LDL levels | Patient will not experience a heart attack or stroke. Patient will verbalize understanding of reducing cholesterol through lifestyle changes, chronic disease management, and medication. | 1. Know your numbers. The patient should be educated on their cholesterol numbers. The goal is <130 mg/dL for low density lipoprotein (LDL), 100-199 mg/dL total cholesterol for adults, >45 mg/dL for high density lipoprotein (HDL), and <150 mg/dL for triglycerides. 2. Educate on dietary changes. A heart-healthy diet requires lowering the intake of saturated and trans fats. Reduce red meats, dairy products, and fried foods. Increase fruits, vegetables, whole grains, and fish. 3. Educate on statin medication. Patients who cannot reduce their cholesterol levels through lifestyle changes require statin medication. Changes in diet, exercise, and smoking should still be encouraged. 4. Obtain echo, ultrasound, or angiography. An echocardiogram shows the heart’s valves and how well it is pumping. Ultrasounds visualize the arteries and can show hardening or narrowing. Angiography can locate and measure blockages in the arteries. These tests can diagnose atherosclerosis and help plan treatment to prevent heart attacks and stroke. | Patient relieved from experiences of a heart attack or stroke. Patient verbalized understanding of reducing cholesterol through lifestyle changes, chronic disease management, and medication. |