4 Angina Pectoris (Coronary Artery Disease) Nursing Care Plans

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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:

  1. stable: precipitated by effort, of short duration, and easily relieved,
  2. 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.
  3. 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.

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Here are four (4) angina pectoris (coronary artery disease) nursing diagnosis and nursing care plans (NCP):

  1. Acute Pain
  2. Deficient Knowledge
  3. Anxiety
  4. Risk for Decreased Cardiac Output
  5. Other possible nursing care plans
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Deficient Knowledge

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

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  • Questions; statement of concerns
  • Request for information
  • Inaccurate follow-through of instructions

Desired Outcomes

  • 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.
Nursing InterventionsRationale
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.
  • nicotinic acid, and HMG-CoA reductase inhibitors: lovastatin (Mevacor), simvastatin (Zocor)
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.
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See also

Other recommended site resources for this nursing care plan:

Other nursing care plans for cardiovascular system disorders:

Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics. Finding help online is nearly impossible. His situation drove his passion for helping student nurses by creating content and lectures that are easy to digest. Knowing how valuable nurses are in delivering quality healthcare but limited in number, he wants to educate and inspire nursing students. As a nurse educator since 2010, his goal in Nurseslabs is to simplify the learning process, break down complicated topics, help motivate learners, and look for unique ways of assisting students in mastering core nursing concepts effectively.
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