Aclient comes to the cardiovascular intensive care unit (cvicu) directly after a three-vessel coronary artery bypass graft (cabg). the client's orders state "maintain systolic blood pressure > 90 but < 120." how does this order affect the monitoring of the client's blood pressure?
a. the nurse will assess blood pressure more frequently to ensure that it does not go beyond the ordered limits
b. monitoring blood pressure once every hour is sufficient for this client
c. monitoring blood pressure every 4 hours is sufficient for this client
d. the nurse can delegate monitoring of the client's blood pressure to the patient care assistant

A. The nurse will assess blood pressure more frequently to ensure that it does not go beyond the ordered limits

Explanation:

Systolic blood pressure, also known as “maximal pressure”, is the blood pressure at the time of cardiac systole, in other words, at the time of contraction of the heart, causing the blood to thrust into the arteries. Systolic blood pressure is the pressure exerted by the blood against the artery wall, that is, the more the heart contracts with emphasis, the more the systolic pressure will increase. However, when systolic blood pressure rises too much, it becomes very dangerous that can result in serious patient problems.

For this reason, in the case described above, the nurse should assess blood pressure more often to ensure that she does not exceed the prescribed limits.

    however, coronary heart disease , or chd, is actually a result of coronary artery disease, or cad, said edward a. fisher, m.d., ph.d., m.p.h., an american heart association volunteer who is the leon h. charney professor of cardiovascular medicine and also of the marc and ruti bell vascular biology and disease program at the nyu school of medicine.

  with coronary artery disease, plaque first grows within the walls of the coronary arteries until the blood flow to the heart’s muscle is limited. view an illustration of coronary arteries. this is also called ischemia. it may be chronic, narrowing of the coronary artery over time and limiting of the blood supply to part of the muscle. or it can be acute, resulting from a sudden rupture of a plaque and formation of a thrombus or blood clot.

    the traditional risk factors for coronary artery disease are high ldl cholesterol, low hdl cholesterol, high blood pressure, family history, diabetes, smoking, being post-menopausal for women and being older than 45 for men, according to fisher. obesity may also be a risk factor.

    “coronary artery disease begins in childhood, so that by the teenage years, there is evidence that plaques that will stay with us for life are formed in most people,” said fisher, who is former editor of the american heart association journal, atvb. “preventive measures instituted early are thought to have greater lifetime benefits. healthy lifestyles will delay the progression of cad, and there is hope that cad can be regressed before it causes chd.”

  living a healthy lifestyle that incorporates good nutrition, weight management and getting plenty of physical activity can play a big role in avoiding cad.

    “coronary artery disease is preventable,” agreed johnny lee, m.d., president of new york heart associates, and an american heart association volunteer. “typical warning signs are chest pain, shortness of breath, palpitations and even fatigue.” if you feel any of these symptoms, don’t delay — call 9-1-1.