Coronary artery disease (CAD) is a condition in which plaque builds up inside the coronary arteries. Coronary arteries are arteries that supply the 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 the coronary arteries are narrowed or blocked, oxygen-rich blood can’t reach the heart muscle. This can cause angina or a heart attack. Without quick treatment, a heart attack can lead to serious problems and even death.
The classic symptom of coronary artery disease (CAD) is angina—pain caused by loss of oxygen and nutrients to the myocardial tissue because of inadequate coronary blood flow. In most but not all patients presenting with angina, CAD symptoms are caused by significant atherosclerosis. Unstable angina is sometimes grouped with MI under the diagnosis of acute coronary syndrome.
Angina has three major forms:
- stable: precipitated by effort, of short duration, and easily relieved,
- unstable: longer lasting, more severe, may not be relieved by rest or nitroglycerin; may also be new onset of pain with exertion or recent acceleration in severity of pain.
- variant: chest pain at rest with ECG changes due to coronary artery spasm.
Nursing Care Plans
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 arteries.
- Acute Pain
- Deficient Knowledge
- Risk for Decreased Cardiac Output
- Other possible nursing care plans
Deficient Knowledge: Absence or deficiency of cognitive information related to specific topic.
May be related to
- Lack of exposure
- Inaccurate/misinterpretation of information
- Unfamiliarity with information resources
Possibly evidenced by
- Questions; statement of concerns
- Request for information
- Inaccurate follow-through of instructions
- Participate in learning process.
- Assume responsibility for own learning, looking for information and asking questions.
- Verbalize understanding of condition/disease process and potential complications.
- Verbalize understanding of /participate in therapeutic regimen.
- Initiate necessary lifestyle changes.
|Discuss pathophysiology of condition. Stress need for preventing and managing anginal attacks.||Patients with angina need to learn why it occurs and what they can do to control it. This is the focus of therapeutic management to reduce likelihood of myocardial infarction and promote healthy heart lifestyle.|
|Review significance of cholesterol levels and differentiate between LDL and HDL factors. Emphasize importance of periodic laboratory measurements.||Although recommended LDL is ±160 mg/dL, patients with two or more risk factors (smoking, hypertension, diabetes mellitus, positive family history) should keep LDL ±130 mg/dL, and those with diagnosis of CAD need to keep LDL below 100 mg/dL. HDL below 35–45 is considered a risk factor; a level above 60 mg/dL is considered an advantage.|
|Encourage avoidance of situations that may precipitate anginal episode (stress, intense physical exertion, large heavy meals especially during bedtime, exposure to extreme temperatures).||Doing so would reduce the incidence or severity of ischemic episodes.|
|Assist patient and/or SO to identify sources of physical and emotional stress and discuss ways that they can be avoided.||This is a crucial step in preventing anginal attacks.|
|Review importance of weight control, cessation of smoking, dietary changes, and exercise.||Knowledge of the significance of risk factors provides patient with opportunity to make needed changes. Patients with high cholesterol who do not respond to 6-month program of low-fat diet and regular exercise will require medication.|
|Encourage patient to follow prescribed reconditioning program; caution to avoid exhaustion.||Fear of triggering attacks may cause patient to avoid participation in activity that has been prescribed to enhance recovery (increase myocardial strength and form collateral circulation).|
|Discuss impact of illness on desired lifestyle and activities, including work, driving, sexual activity, and hobbies. Provide information, privacy, or consultation, as indicated.||Patient may be reluctant to resume usual activities because of fear of anginal attack or death. Patient should take nitroglycerin prophylactically before any activity that is known to precipitate angina.|
|Demonstrate how to monitor own pulse and BP during and after activities, and to schedule activities, avoid strain and take rest periods.||Allows patient to identify those activities that can be modified to avoid cardiac stress and stay below the anginal threshold.|
|Discuss steps to take when anginal attacks occur, (cessation of activity, keeping “rescue” NTG on hand, administration of prn medication, use of relaxation techniques).||Being prepared for an event takes away the fear that patient will not know what to do if attack occurs.|
|Review prescribed medications for prevention of anginal attacks:||Angina is a complicated condition that often requires the use of many drugs given to decrease myocardial workload, improve coronary circulation, and control the occurrence of attacks.|
||These drugs are considered first-line agents for lowering serum cholesterol levels. Note: Questran and Colestid may inhibit absorption of fat-soluble vitamins and some drugs such as Coumadin, Lanoxin, and Inderal.|
||The HMG-CoA reductase inhibitors may cause photosensitivity.|
|Stress importance of checking with physician before taking OTC drugs.||OTC drugs may potentiate or negate effects of prescribed medications.|
|Discuss ASA and other antiplatelet agents as indicated.||May be given prophylactically on a daily basis to decrease platelet aggregation and improve coronary circulation.|
|Review symptoms to be reported to physician: increase in frequency of attacks, changes in response to medications.||May prolong survival rate of patients with unstable angina. Knowledge of expectations can avoid undue concern for insignificant reasons or delay in treatment of important symptoms.|
|Discuss importance of follow-up appointments.||Angina is a symptom of progressive coronary artery disease that should be monitored and may require occasional adjustment of treatment regimen.|
Recommended nursing diagnosis and nursing care plan books and resources.
- Nursing Care Plans: Nursing Diagnosis and Intervention (10th Edition)
An awesome book to help you create and customize effective nursing care plans. We highly recommend this book for its completeness and ease of use.
- Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
A quick-reference tool to easily select the appropriate nursing diagnosis to plan your patient’s care effectively.
- NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023 (12th Edition)
The official and definitive guide to nursing diagnoses as reviewed and approved by the NANDA-I. This book focuses on the nursing diagnostic labels, their defining characteristics, and risk factors – this does not include nursing interventions and rationales.
- Nursing Diagnosis Handbook, 12th Edition Revised Reprint with 2021-2023 NANDA-I® Updates
Another great nursing care plan resource that is updated to include the recent NANDA-I updates.
- Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5(TM))
Useful for creating nursing care plans related to mental health and psychiatric nursing.
- Ulrich & Canale’s Nursing Care Planning Guides, 8th Edition
Claims to have the most in-depth care plans of any nursing care planning book. Includes 31 detailed nursing diagnosis care plans and 63 disease/disorder care plans.
- Maternal Newborn Nursing Care Plans (3rd Edition)
If you’re looking for specific care plans related to maternal and newborn nursing care, this book is for you.
- Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care (7th Edition)
An easy-to-use nursing care plan book that is updated with the latest diagnosis from NANDA-I 2021-2023.
- All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health (5th Edition)
Definitely an all-in-one resources for nursing care planning. It has over 100 care plans for different nursing topics.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other nursing care plans for cardiovascular system disorders:
- Angina Pectoris (Coronary Artery Disease) | 4 Care Plans
- Cardiac Arrhythmia (Digitalis Toxicity) | 3 Care Plans
- Cardiac Catheterization | 4 Care Plans
- Cardiogenic Shock | 5 Care Plans
- Congenital Heart Disease | 5 Care Plans
- Heart Failure | 18 Care Plans
- Hypertension | 6 Care Plans
- Hypovolemic Shock | 4 Care Plans
- Myocardial Infarction | 7 Care Plans
- Pacemaker Therapy | 7 Care Plans