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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Risk for Decreased Cardiac Output

Nursing Diagnosis

  • Decreased Cardiac Output

Risk factors may include

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  • Inotropic changes (transient/prolonged myocardial ischemia, effects of medications)
  • Alterations in rate/rhythm and electrical conduction

Desired Outcomes

  • Report/display decreased episodes of dyspnea, angina, and dysrhythmias.
  • Demonstrate increased activity tolerance.
  • Participate in behaviors/activities that reduce the workload of the heart.
Nursing InterventionsRationale
Maintain bed or chair rest in position of comfort during acute episodes.Decreases oxygen demand therefore reducing myocardial workload and risk of decompensation.
Monitor vital signs and cardiac rhythm.Tachycardia may be present because of pain, anxiety, hypoxemia, and reduced cardiac output. Changes may also occur in BP (hypertension or hypotension) because of cardiac response. ECG changes reflecting dysrhythmias indicate need for additional evaluation and therapeutic intervention.
Auscultate breath sounds and heart sounds. Listen for murmurs.S3, S4, or crackles can occur with cardiac decompensation or some medications (especially beta-blockers). Development of murmurs may reveal a valvular cause for chest pain (aortic stenosis, mitral stenosis) or papillary muscle rupture.
Provide for adequate rest periods. Perform self-care activities, as indicated.Conserves energy, reduces cardiac workload.
Stress importance of avoiding straining down, especially during defecation.Valsalva maneuver causes vagal stimulation, reducing heart rate (bradycardia), which may be followed by rebound tachycardia, both of which may impair cardiac output.
Encourage immediate reporting of pain for prompt administration of medications as indicated.Timely interventions can reduce oxygen consumption and myocardial workload and may minimize cardiac complications.
Monitor and documents effects or adverse response to medications, noting BP, heart rate, and rhythm.Desired effect is to decrease myocardial oxygen demand by decreasing ventricular stress. Drugs with negative inotropic properties can decrease perfusion to an already ischemic myocardium. Combination of nitrates and beta-blockers may have cumulative effect on cardiac output.
Assess for signs and symptoms of heart failure.Angina is only a symptom of underlying pathology causing myocardial ischemia. Disease may compromise cardiac function to point of decompensation.
Evaluate mental status, noting development of confusion, disorientation.Reduced perfusion of the brain can produce observable changes in sensorium.
Note skin color and presence and quality of pulses.Peripheral circulation is reduced when cardiac output falls, giving the skin a pale or gray color (depending on level of hypoxia) and diminishing the strength of peripheral pulses.
Administer supplemental oxygen as needed.Increases oxygen available for myocardial uptake to improve contractility, reduce ischemia, and reduce lactic acid levels.
Monitor pulse oximetry or ABGs as indicated.Determines adequacy of respiratory function and/or Otherapy.
Measure cardiac output and other functional parameters as indicated.Cardiac index, preload/afterload, contractility, and cardiac work can be measured noninvasively through various means, including thoracic electrical bioimpedance (TEB) technique. Useful in evaluating response to therapeutic interventions and identifying need for emergency care. Note: Evaluation of changes in heart rate, BP, and cardiac output requires consideration of patient’s circadian hemodynamic variability.
Administer medications as indicated:
  • Calcium channel blockers: diltiazem (Cardizem), nifedipine (Procardia), verapamil (Calan), bepridil (Vascor), amlodipine (Norvasc), felodipine (Plendil), isradipine (DynaCirc)
Although differing in mode of action, calcium channel blockers play a major role in preventing and terminating ischemia induced by coronary artery spasm and in reducing vascular resistance, thereby decreasing BP and cardiac workload.
  • Beta-blockers: atenolol (Tenormin), nadolol (Corgard), propranolol (Inderal), esmolol (Brevibloc);
These medications decrease cardiac workload by reducing heart rate and systolic BP. Note: Overdosage produces cardiac decompensation.
  • Acetylsalicylic acid (ASA), other antiplatelet agents: ticlopidine (Ticlid); glycoprotein IIb/IIa, abciximab (ReoPro), eptifibatide (Integrilin)
Useful in unstable angina, ASA diminishes platelet aggregation and clot formation. For patients with major GI intolerance, alternative drugs may be indicated. New antiplatelet medications are being used IV in conjunction with angioplasty. Oral forms are under investigation.
  • IV heparin
Bolus, followed by continuous infusion, is recommended to help reduce risk of subsequent MI by reducing the thrombotic complications of plaque rupture for patients diagnosed with intermediate or high-risk unstable angina. Note: Use of low-molecular-weight heparin is increasing because of its more efficacious and predictable effect with fewer adverse effects (less risk of bleeding) and longer half-life. It also does not require anticoagulation monitoring.
Monitor laboratory studies: PTT, aPTT.Evaluates therapy needs and effectiveness.
Discuss purpose and prepare for stress testing and cardiac catheterization, when indicated.Stress testing provides information about the health and strength of the ventricles.
Prepare for surgical intervention, angioplasty with/without intracoronary stent placement, valve replacement, CABG, if indicated.Angioplasty (also called percutaneous transluminal coronary angioplasty [PTCA]) increases coronary blood flow by compression of atheromatous lesions and dilation of the vessel lumen in an occluded coronary artery. Intracoronary stents may be placed at the time of PTCA to provide structural support within the coronary artery and improve the odds of long-term patency. This procedure is preferred over the more invasive CABG surgery. CABG is the recommended treatment when testing confirms myocardial ischemia as a result of left main coronary artery disease or symptomatic three-vessel disease, especially in those with left ventricular dysfunction. Note: Stent placement may also be effective for the variant form of angina where periodic vasospasms impair arterial flow.
Prepare for transfer to critical care unit if condition warrants.Prolonged chest pain with decreased cardiac output reflects development of complications requiring more emergency interventions.
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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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