5 Coronary Artery Disease Nursing Care Plans

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Coronary-Artery-Disease-NCP

Definition & Pathophysiology

Coronary Artery Disease (CAD) is a condition in which plaque builds up inside the coronary arteries. Coronary arteries are arteries that supply your heart muscle with oxygen-rich blood. Plaque is made up of fat, cholesterol, calcium, and other substance found in the blood.  Plaque narrows the arteries and reduces blood flow to your heart muscle. It also makes it more likely that blood clots will form in your arteries. Blood clots can partially or completely block blood flow. When your coronary arteries are narrowed or blocked, oxygen-rich blood can’t reach your heart muscle. This can cause angina or a heart attack. Without quick treatment, a heart attack can lead to serious problems and even death.

CAD is the most common type of heart disease. Lifestyle changes, medicines, and/or medical procedures can effectively prevent or treat CAD in most people. Other names for Coronary Artery Disease are Atherosclerosis, Coronary heart disease, Hardening of the arteries, Heart disease, Ischemic heart disease, and Narrowing of the arteries.

Nursing Care Plans

Here are 5 Coronary Artery Disease Nursing Care Plans

Decreased Cardiac Output

NDx: Decreased cardiac output r/t increased vascular resistance

CAD causes narrowing of blood vessels. This condition leads to intense pressure exerted on the walls of the blood vessels. The body’s compensatory mechanism is to increase the workload of the heart and thus the patient has decreased cardiac output.

Assessment Planning Nursing interventions Rationale Expected outcome
S= ∅

O=The patient may manifest:

  • restlessness
  • increased bp
  • cold clammy skin
  • decreased peripheral pulses
Short term:

After 2-3 hours of nursing interventions, the patient will verbalize understanding of disease process.

Long term:

After two days of nursing interventions the patient will participate in activities to decrease in the heart’s workload

  1. assess patient’s condition
  2. monitor and record vital signs
  3. encourage patient to verbalize concerns
  4. encourage patient to change position every two hours
  5. encourage patient to do relaxation techniques
  6. encourage patient to engage in diversional activities such as chatting with family and friends.
  7. reinforced low salt and low fat diet
  1. to determine possible problems
  2. for baseline data
  3. to make client express his feelings
  4. to improve venous return
  5. to reduce stress
  6. to divert attention and help patient lessen experienced pain and anxiety
  7. to prevent further complications of the disease
Short term:

The patient shall have verbalized understanding of disease process.

Long term:

The patient shall have participated in activities to decrease in the heart’s workload

Ineffective Tissue Perfusion

Ineffective tissue perfusion r/t decreased cardiac output

The oxygen content of arterial blood is almost all bound to hgb. In anemia, the oxygen content will therefore fall in proportion to the reduction in hgb concentration, even though the po2 is normal. The normal compensatory to restore oxygen delivery is an increase in cardiac output.

Assessment Objectives Nursing interventions Rationale Expected outcome
S o

O the patient manifested the following:

  • shortness of breath
  • fatigue
  • The pt. May manifest:
  • pallor
  • cool temperature
  • decrease pulse
  • decrease urine output
Short term:

After 3 hours of ni, the pt. Will be able to demonstrate behaviors on how to have effective airways.

Long term:

After 1- 2 days of ni, the patient will free from shortness of breath.

  1. assess pt.’s condition.
  2. monitor and record v/s.
  3. note color and temperature of the skin.
  4. monitor peripheral pulse.
  5. provide a warmth environment.
  6. encourage active rom.
  7. monitor urine output.
  1. to have baseline data.
  2. to have baseline data and this are usually altered in the condition.
  3. cool, pale skin is indicative of decrease peripheral tissue perfusion.
  4. decrease pulse is indicative of decreased tissue perfusion from vasoconstriction of the vessels.
  5. a warm environment promotes vasodilation which decreases preload and promotes tissue perfusion.
  6. rom helps decreases venous pooling and promotes tissue perfusion.
  7. decreased tissue perfusion to the kidneys may result in oliguria.
Short term:

The pt. Shall have demonstrated behaviors on how to have effective airways.

Long term:

The patient shall be free from shortness of breath.

Acute Pain

Coronary artery disease (CAD) is caused by a narrowing of the arteries that supply the heart muscle with blood. When the arteries narrow, blood flow is reduced. The reduced blood flow causes the heart muscle to receive less oxygen than it needs to function properly. When ischemia occurs patients typically develop angina or chest pain originating from the heart. It has been described as chest pain or discomfort that has a squeezing or pressure-like quality, usually felt behind the breastbone (sternum), but sometimes felt in the shoulders, arms, neck, jaws, or back.

Assessment Objectives Nursing interventions Rationale Expected outcome
S o

O the pt. May manifest:

  • restlessness
  • pain scale of 9/10
  • chest pain
  • irritability
  • (+) guarded behavior
  • (+) facial grimaces
  • crying
  • v/s change
  • diaphoresis
  • sleep disturbance
  • increase rr and pulse
Short Term:After 3 hours of ni, the pt. Will verbalize understanding of pt’s condition and health teachings given to provide comfort and relieve of pain.

Long term

After 2 days of ni, the pt. Will demonstrate behavior of being relieved from pain and will be free from the complications of the condition.

  1. assess pt.’s condition.
  2. monitor and record v/s.
  3. assess pains location and intensity/severity arising with.
  4. provide comfort measures like stretching of linens and assisting in position.
  5. provide diversional activities like having conversation w/ the pt.
  6. stress to pt the importance of providing adequate rest period to the pt.
  7. administer meds as ordered.
  1. to have baseline data.
  2. to have baseline data and this are usually altered in the condition.
  3. to have baseline data for planning and interventions.
  4. to provide non-pharmacological Pain management.
  5. to divert pt.’s attention.
  6. to prevent fatigue.
  7. to reduce pain.
The pt.’s so will verbalize understanding of pt’s condition and health teachings given to provide comfort and relieve of pain and pt.

 

Will demonstrate behavior of being relieved from pain and will be free from the complications of the condition.

Activity Intolerance

Due to the disease condition, the patient lost the energy reserve and has increased need to adapt to the pain of angina. Because of that she has limited movement. The inability to perform activities of daily living is also due to fatigue.

Assessment Objectives Interventions Rationale Outcomes
Weakness Short term:

After 4 hours of nursing interventions and health teachings, the patient will be able to use identified techniques to enhance activity intolerance.

Long term

After 2-4 days of nursing interventions, the patient will be able to participate willingly in necessary activities.

  1. monitor and record vital signs
  2. teach method to increase activity level
  3. plan care with rest periods between activities
  4. provide positive atmosphere
  5. assist with activities
  6. promote comfort measures
  7. encourage participation and diversion of activities
  1. for baseline data
  2. to conserve energy
  3. to reduce fatigue
  4. to minimize frustrations
  5. to protect from injury
  6. to reduce pain
  7. to minimize pain
Short term:

The patient shall have identified and used techniques to enhance activity intolerance.

Long term:

The patient shall have participated willingly in necessary activities.

Fatigue

Fatigue is a overwhelming sense of exhaustion resulting to decreased capacity to perform activities at the usual level. This is due to the patient’s poor physical condition brought about by the disease condition.

Assessment Objectives Interventions Rationale Outcomes
S= ø

O=

the patient may manifest:

  • verbalization of overwhelming lack of energy;
  • compromised libido;
  • lethargy or listless
  • drowsiness
  • disinterest in surroundings
  • decreased performance
  • weight gain
Short term:

After 2 hours of nursing interventions, the patient will be able to verbalize understanding of condition and causative factors.

Long term:

After 3 days of nursing interventions, the patient will be able to perform adls and participate in desired activities/level of activity.

  1. monitor vital signs
  2. determine ability to participate in activities/level of mobility.
  3. establish realistic activity goals with client
  4. plan care to allow individually adequate rest periods, schedule activities for periods when client has the most energy
  5. provide environment conducive
  6. give medication as doctors ordered
  1. to provide baseline data
  2. to enhances commitment to promoting optimal outcomes
  3. to maximize participation
  4. to encourage patient’s cooperation
  5. to maintain/increase strength and muscle tone and to enhance sense of well-being.
  6. to lessen fatigue
Short term:

The patient shall have verbalized understanding of condition and causative factors.

Long term:

The patient shall have performed adls and participate in desired activities/level of activity.

10 COMMENTS

  1. I am a currently a nursing student and almost ready to give up! So overwhelming. I have used this site before and yes… It has helped. Thank you :-) is there anywhere I can find rational to interventions for care plans?? Pls help

  2. Wow, I am so encouraged by this wsbtiee!I am 55 yrs old. On Sept. 9, 2011 I had a weird back/and chest pain. After an angiogram I was diagnosed with SCAD, my RCA had a dissection in the smaller vessel so couldn’t be stinted.Upon getting ready for work one morning, I developed back/chest pain’ that lasted 40 min. It radiated from my upper back to my upper sternum. Being diagnosed with SCAD leaves me feeling alone’ as little is known about SCAD and most Dr’s have never heard of it. My Cardiologist has me on 81 mg aspirin and 75 mg Plavix, and wants another angiogram in 6 mos. He advised no lifting nor exercise for several months. Bummer! ( this has been hard and depressing). I am an avid walker/hiker, don’t smoke nor drink and my angiogram showed a healthy heart, I don’t have high BP, eat healthy (for the most part!) and am not overweight 5’4 110 pounds.’This is so disappointing and all my friends say and you’re so healthy!’ I feel like a walking time bomb’ as no one knows what can prevent this. Therefore I am very interested in this study.I have concerns over having another angio. Do yo think this is necessary? I would like to have a less invasive test. My Dr. still wants to go ahead and sched. one for Feb.I want to mention that in 2010 I had a routine vag. hysterectomy w/ A&P repair, of which I had 3 spontaneous hemorrhages from each site in the 4th ,5th and 6th week post op. I saw many Doctors and ended up in Loma Linda Med Ctr. in CA. This was extremely frightening and almost died of blood loss. The specialists told me I was very rare’, strange and unheard of’. My vessels from each incision had to be cauterized wondering if there is any relationship in regards to my vessel tenacity/turgor along with fluctuating hormones. The Drs were so puzzled and still are. I am continually haunted, emotionally over this. Now I am again told, with SCAD, that this is very rare’ ..I am looking forward to what will be learned in this study, and hope I can be of some use!Thank youElaine

  3. I am 51 yrs old and I’ve had two SCAD’s in the last year. One on the inferal larteal branch of the circumflex coronary artery in October 2010 and one on the left anterior descending coronary artery September 2011. I’m in Oregon for those others here After the first one, they put me on a statin, plavix and metoprolol. I also took CoQ10 and calcium and magnesium at the recommendation of a naturopath. I stopped taking the statin after I talked to the naturopath, my pharmacist and a physical therapist I know. I was also reading Dean Ornish’s book on Reversing Heart Disease and they all held similar opinions about statins for people without family history of high cholesterol. I started eating more vegetables and fruit, less rice, bread and pasta and less refined sugar. I added dried fruits and nuts to my diet and lost 15lbs. I felt good! I was so excited to be released from the Plavix in July 2011 after the October 2010 heart attack. I was getting goose eggs everytime I bumped into anything. In late August I walked the Portland to Coast Relay and in early September I had the second dissection. There has been no cardiac follow up yet. I don’t think they know what to say. And when they told me in the hospital that it didn’t matter what I did, I got depressed. Doctors should never say things like that. The connection between body and mind is too strong. So, I made an appointment with a therapist and I signed up for cardiac rehab, if that’s all they’ve got for me then I’m going for it. At least then I can feel like I’m doing something. I know I can’t control this, but I can do the best I can at being healthy and engaged in life.

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