Understanding Angina Pectoris as a Symptom of Coronary Artery Disease
Understanding Angina Pectoris as a Symptom of Coronary Artery Disease
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CAD Nursing Diagnosis: Angina Pectoris Nursing Care Plan | Nurseslabs

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Understanding Chest Pain (Angina Pectoris) in CAD Patients

Angina pectoris, commonly known as chest pain, is not a disease itself but a significant symptom, particularly in patients with Coronary Artery Disease (CAD). It arises from myocardial ischemia, a condition where the heart muscle doesn’t receive enough oxygen-rich blood. This comprehensive guide, tailored for nurses and healthcare professionals, delves into the nursing care plan and management of angina, focusing on accurate CAD nursing diagnosis and effective interventions. Understanding angina is crucial in managing CAD, as it often signals underlying cardiac issues requiring immediate attention and specialized nursing care.

Angina is typically triggered by a blockage or spasm in a coronary artery, disrupting the myocardial blood supply. This oxygen deprivation leads to myocardial ischemia, manifesting as discomfort, pressure, or pain in the chest. While angina can be felt in various areas like the chest, neck, arms, or back, it’s most frequently described as pain or pressure behind the sternum. The pain often radiates to the left arm but can also extend to both arms, back, shoulder, jaw, or neck. For nurses, recognizing these patterns is vital for prompt and accurate nursing diagnosis in CAD patients presenting with chest pain.

Types of Angina in CAD

Angina associated with CAD is categorized into three main types, each requiring distinct nursing considerations and management strategies:

  • Stable Angina: This type of chest pain occurs predictably during exertion and is a common symptom of stable plaque buildup in the coronary arteries. For patients with stable angina, nursing diagnosis focuses on managing triggers and educating on lifestyle modifications to prevent exacerbations.

  • Variant (Prinzmetal’s) Angina: A less common form, variant angina is characterized by chest pain episodes occurring at rest. Unlike stable angina, it’s caused by coronary artery vasospasms, leading to increased myocardial oxygen demand and transient ST-segment elevation. CAD nursing diagnosis in variant angina involves identifying and managing vasospasms and differentiating it from other types of angina.

  • Unstable Angina: This is a more serious form of angina, with pain occurring more frequently and unpredictably, even at rest or with minimal exertion. Unstable angina is a critical indicator of potential acute coronary syndrome and demands immediate medical attention. In CAD nursing diagnosis, unstable angina is a high-priority concern, often requiring intensive monitoring and intervention to prevent myocardial infarction.

Coronary Artery Disease (CAD) is the most frequent underlying cause of angina. CAD involves plaque buildup within the coronary arteries, the vessels responsible for supplying the heart muscle with oxygen-rich blood. This plaque, composed of fat, cholesterol, calcium, and other blood substances, narrows the arteries, reducing blood flow to the heart muscle. The narrowed arteries also increase the risk of blood clot formation, which can further obstruct blood flow. When coronary arteries are compromised by CAD, the resulting oxygen shortage to the heart muscle leads to angina and increases the risk of a heart attack (myocardial infarction). Without timely intervention, a heart attack can have severe consequences, including death. Therefore, understanding the link between CAD and angina is paramount in nursing diagnosis and patient care.

For a deeper understanding of the pathophysiology and medical management of angina, refer to Angina Pectoris.

Understanding Angina Pectoris as a Symptom of Coronary Artery DiseaseUnderstanding Angina Pectoris as a Symptom of Coronary Artery Disease

Nursing Care Plan and Management for CAD-Related Angina

Effective nursing care for chest pain, especially in the context of CAD, necessitates rapid assessment, efficient pain management, and vigilant monitoring of vital signs. This ensures prompt intervention and promotes patient well-being. This section focuses on the nursing care management specifically for patients experiencing angina pectoris due to CAD. The emphasis is on applying CAD nursing diagnosis principles to guide care.

Nursing Problem Priorities in CAD Angina

The primary nursing priorities for patients with chest pain related to CAD include:

  1. Relieving Acute Pain: Addressing chest pain and discomfort associated with angina is the immediate priority.
  2. Improving Cardiac Blood Flow: Enhancing myocardial oxygen supply to reduce ischemia.
  3. Reducing Anxiety: Providing emotional support and alleviating anxiety related to chest pain and CAD.
  4. Preventing Myocardial Complications: Monitoring for and preventing complications such as myocardial infarction and dysrhythmias.
  5. Patient Education: Equipping patients with knowledge for lifestyle modifications and self-management to control angina and CAD progression.

Nursing Assessment for CAD Angina

Comprehensive nursing assessment is crucial for patients with chest pain to identify the cause, evaluate symptom severity, and determine appropriate interventions. This assessment is fundamental to formulating an accurate CAD nursing diagnosis and planning effective care for optimal patient outcomes.

Assess for the following subjective and objective data:

  • Subjective Data:

    • Patient reports of pain: Varying in frequency, duration, intensity, and location, especially with worsening CAD.
    • Description of pain: Pressure, tightness, squeezing, burning, or heaviness in the chest.
    • Provoking factors: Exertion, stress, cold weather, heavy meals.
    • Relieving factors: Rest, nitroglycerin.
    • Associated symptoms: Shortness of breath, nausea, dizziness, sweating.
    • Anxiety or fear related to chest pain.

  • Objective Data:

    • Pain behaviors: Narrowed focus, distraction behaviors (moaning, crying, pacing, restlessness).
    • Autonomic responses: Diaphoresis, changes in blood pressure and pulse rate, pupillary dilation, increased or decreased respiratory rate.
    • Cardiovascular assessment: Heart rate and rhythm abnormalities, abnormal heart sounds (S3, S4 murmurs).
    • Respiratory assessment: Shortness of breath, increased respiratory rate, abnormal breath sounds.
    • Skin assessment: Pallor, cyanosis, diaphoresis.
    • Vital Signs: Elevated or decreased blood pressure, tachycardia or bradycardia, increased respiratory rate.
    • ECG changes: ST-segment depression or elevation, T-wave inversion (during pain episode).

Assess for factors related to CAD and chest pain:

  • History of Coronary Artery Disease or risk factors (hypertension, hyperlipidemia, smoking, diabetes, family history).
  • Decreased myocardial blood flow due to atherosclerosis or vasospasm.
  • Increased cardiac workload and oxygen consumption (exertion, stress).
  • Myocardial tissue ischemia evidenced by ECG changes or symptoms.

CAD Nursing Diagnosis for Angina

Based on a thorough assessment, a nursing diagnosis is formulated to address the challenges associated with chest pain (angina) in the context of CAD. These diagnoses guide the nursing care plan and interventions. While specific nursing diagnostic labels may vary in real-world clinical use, the underlying principles of addressing patient needs and prioritizing care remain crucial. The nurse’s clinical judgment is paramount in tailoring the care plan to meet each patient’s unique health condition and priorities.

Common Nursing Diagnoses for CAD Angina:

  1. Acute Pain related to myocardial ischemia secondary to coronary artery disease as evidenced by patient report of chest pain, changes in vital signs, and restlessness.
  2. Decreased Cardiac Output related to altered myocardial contractility secondary to myocardial ischemia as evidenced by changes in blood pressure, heart rate, ECG changes, and symptoms of heart failure.
  3. Ineffective Tissue Perfusion (Cardiopulmonary) related to reduced arterial blood flow secondary to coronary artery disease as evidenced by chest pain, ECG changes, and shortness of breath.
  4. Anxiety related to chest pain, fear of myocardial infarction, and uncertain prognosis as evidenced by patient report of anxiety, restlessness, and changes in vital signs.
  5. Deficient Knowledge regarding management of angina, risk factors for CAD, and lifestyle modifications as evidenced by patient questions and expressed misconceptions.
  6. Risk for Decreased Cardiac Tissue Perfusion related to coronary artery disease.

Nursing Goals for CAD Angina Patients

The goals and expected outcomes for nursing care of patients with CAD angina include:

  • Patient will report a decrease in frequency, duration, and severity of anginal episodes.
  • Patient will demonstrate relief of pain as evidenced by stable vital signs, absence of muscle tension and restlessness, and pain score within acceptable range.
  • Patient will verbalize understanding of their CAD and angina, therapeutic regimen, management strategies, and potential complications.
  • Patient will initiate necessary lifestyle changes to reduce cardiac risk factors and prevent potential myocardial complications of chest pain.
  • Patient will demonstrate reduced anxiety and improved coping mechanisms related to their cardiac condition.

Nursing Interventions and Actions for CAD Angina

Nursing interventions for CAD angina are focused on managing acute pain, improving cardiac blood flow, decreasing oxygen demand, preventing complications, providing emotional support, and educating patients for self-management.

1. Managing Acute Chest Pain and Discomfort in CAD Angina

Angina pectoris in CAD results from myocardial ischemia due to narrowed coronary arteries and reduced blood flow. Nursing interventions aim to alleviate pain, improve oxygen supply, and reduce myocardial workload.

Nursing Interventions:

  1. Perform Pain Assessment:

    • Identify precipitating factors, frequency, duration, intensity, location, and quality of pain.
    • Use a pain scale (e.g., 0-10) to quantify pain intensity.
    • Differentiate between stable and unstable angina characteristics.
    • Rationale: Detailed pain assessment helps in diagnosis, monitoring progression, and evaluating intervention effectiveness. Changes from stable to unstable angina are critical and require immediate attention.

  2. Assess and Document Medication Response:

    • Monitor and document the patient’s response to pain medications, especially nitroglycerin.
    • Evaluate effectiveness and any adverse effects.
    • Rationale: Provides data on disease progression and medication effectiveness. May indicate need for regimen adjustments. Microvascular spasm angina may be less responsive to nitrates, requiring alternative management strategies.

  3. Monitor Vital Signs Frequently:

    • Monitor vital signs (BP, HR, RR, SpO2) every 5 minutes during initial anginal attack and regularly thereafter.
    • Assess for tachycardia, bradycardia, hypertension, hypotension, and irregular heart rhythms.
    • Rationale: Vital sign changes are indicators of cardiac status and response to ischemia. Tachycardia is common, and heart rate irregularities may signal dysrhythmias. Hypotension can indicate hemodynamic compromise.

  4. Auscultate Heart Sounds:

    • Monitor heart rate, rhythm, and heart sounds.
    • Assess for S3, S4 gallops, and murmurs.
    • Rationale: S4 gallop is an early finding in angina. S3 indicates reduced left ventricular function. Murmurs may suggest complications like mitral regurgitation or ventricular septal defect.

  5. Position Patient for Comfort and Optimal Breathing:

    • Elevate the head of the bed if the patient is short of breath or during nitrate administration (unless contraindicated by hypotension).
    • Maintain a recumbent position with head of bed no higher than 30 degrees during angina episodes.
    • Rationale: Elevating the head facilitates gas exchange and reduces shortness of breath. Recumbent position promotes blood return to the heart and brain, minimizing headache and hypotension, especially with nitrates.

  6. Encourage Prompt Pain Reporting:

    • Instruct patient to immediately report chest pain or discomfort.
    • Ensure timely administration of prescribed medications.
    • Rationale: Prompt intervention reduces oxygen consumption and myocardial workload, minimizing cardiac complications. Angina relief with rest or nitrates is a key characteristic.

  7. Monitor Medication Effects and Adverse Reactions:

    • Document effects and side effects of medications, noting BP, heart rate, and rhythm.
    • Assess for hypotension, headache, dizziness, and other adverse reactions.
    • Rationale: Desired effect is decreased myocardial oxygen demand. Monitor for potential adverse effects, especially hypotension with nitrates and beta-blockers, which can compromise myocardial perfusion.

2. Administering Medications and Providing Pharmacologic Interventions for CAD Angina

Nurses are crucial in medication management for CAD angina, ensuring accurate administration, monitoring patient responses, and providing essential education.

Medications Commonly Used:

  1. Nitrates (Nitroglycerin, Isosorbide):

    • Administer sublingual, buccal, oral tablets, metered-dose spray, or IV as prescribed.
    • Monitor for hypotension, headache, and dizziness.
    • Rationale: Nitroglycerin is the standard for immediate angina relief and prevention. It vasodilates coronary arteries and reduces pain. Isosorbide dinitrate has a rapid effect and can be used prophylactically.

  2. Long-Acting Nitrates:

    • Administer sustained-release tablets, patches, or transmucosal ointment as prescribed for prevention.
    • Educate patient on potential headaches, dizziness, and lightheadedness, which usually subside.
    • Rationale: Long-acting nitrates prevent angina recurrences by reducing vasospasms and cardiac workload.

  3. Beta-Blockers (Metoprolol, Atenolol):

    • Administer oral or IV beta-blockers as prescribed.
    • Monitor heart rate and blood pressure.
    • Rationale: Beta-blockers reduce angina by decreasing heart rate and contractility, thus reducing myocardial oxygen demand.

  4. Calcium Channel Blockers (Amlodipine, Diltiazem):

    • Administer oral calcium channel blockers as prescribed.
    • Monitor blood pressure and heart rate.
    • Rationale: Calcium channel blockers relax coronary vascular smooth muscle, dilate coronary arteries, and reduce peripheral vascular resistance, improving myocardial oxygen delivery.

  5. Analgesics (Morphine Sulfate):

    • Administer IV morphine sulfate for severe, unrelieved angina pain as prescribed.
    • Monitor respiratory rate, blood pressure, and pain relief.
    • Rationale: Morphine relieves severe pain, reduces anxiety, and decreases myocardial oxygen demand in acute angina. Monitor for respiratory depression and hypotension.

  6. Lipid-Lowering Agents (Statins, Bile Acid Sequestrants):

    • Administer lipid-lowering agents as prescribed to manage hyperlipidemia, a CAD risk factor.
    • Monitor liver function tests and cholesterol levels.
    • Rationale: Lowering serum cholesterol levels reduces plaque formation in coronary arteries, addressing the underlying cause of CAD and angina.

  7. Antiplatelet Agents (Aspirin, Clopidogrel):

    • Administer aspirin and/or other antiplatelet agents as prescribed.
    • Monitor for bleeding tendencies.
    • Rationale: Antiplatelet agents reduce platelet aggregation and clot formation, preventing thrombus formation in narrowed coronary arteries, crucial in unstable angina and post-angioplasty.

  8. Anticoagulants (Heparin):

    • Administer IV heparin for unstable angina as prescribed, followed by continuous infusion.
    • Monitor PTT and aPTT levels to maintain therapeutic range.
    • Rationale: Heparin reduces the risk of myocardial infarction by preventing thrombus formation in unstable angina. Low-molecular-weight heparin may be used for its efficacy and ease of administration.

3. Decreasing Oxygen Demand and Managing Decreased Cardiac Output in CAD Angina

Reducing myocardial oxygen demand and improving cardiac output are key nursing goals in managing CAD angina.

Nursing Interventions:

  1. Administer Supplemental Oxygen:

    • Apply supplemental oxygen as prescribed, usually 2-4 L/min via nasal cannula, especially during acute episodes.
    • Monitor oxygen saturation (SpO2) and adjust flow rate to maintain SpO2 > 95%.
    • Rationale: Increases available oxygen for myocardial uptake, reversing ischemia. Hypoxia is common due to reduced perfusion, adding stress to the heart.

  2. Assess Associated Symptoms:

    • Monitor for dyspnea, nausea, vomiting, dizziness, palpitations, and urge to urinate.
    • Document associated symptoms and report significant changes.
    • Rationale: Decreased cardiac output during ischemia can stimulate the autonomic nervous system, causing various symptoms that may not be immediately recognized as angina-related.

  3. Provide Cardiac-Healthy Diet:

    • Offer light meals, low in saturated fats, cholesterol, sodium, and refined sugars.
    • Advise patient to rest for one hour after meals.
    • Rationale: Reduces myocardial workload associated with digestion. Dietary modifications reduce CAD risk factors.

  4. Continuously Monitor Vital Signs and Cardiac Rhythm:

    • Monitor vital signs and ECG continuously.
    • Assess for tachycardia, bradycardia, hypertension, hypotension, and dysrhythmias.
    • Rationale: Detects changes in cardiac status. Tachycardia increases myocardial oxygen demand. ECG changes indicate ischemia or dysrhythmias requiring intervention.

  5. Auscultate Breath and Heart Sounds Regularly:

    • Assess breath sounds for crackles or wheezes.
    • Assess heart sounds for S3, S4, or new murmurs.
    • Rationale: S3, S4, or crackles can indicate cardiac decompensation. New murmurs may suggest valvular issues or papillary muscle rupture.

  6. Observe Skin Color and Pulses:

    • Assess skin color (pallor, cyanosis).
    • Palpate peripheral pulses for strength and quality.
    • Rationale: Reduced cardiac output decreases peripheral circulation, causing pallor and weak pulses.

  7. Monitor Pulse Oximetry and ABGs:

    • Monitor pulse oximetry continuously or as needed.
    • Obtain arterial blood gases (ABGs) if indicated.
    • Rationale: Evaluates oxygenation status and effectiveness of oxygen therapy.

  8. Monitor Laboratory Studies:

    • Monitor PTT and aPTT for heparin therapy.
    • Monitor cardiac enzymes (troponin, CK-MB) to rule out myocardial infarction, especially in unstable angina.
    • Rationale: Guides heparin dosage. Cardiac enzymes help differentiate angina from myocardial infarction.

  9. Measure Cardiac Output (If Applicable):

    • If available, measure cardiac output and other hemodynamic parameters.
    • Assess trends and responses to interventions.
    • Rationale: Provides detailed information on cardiac function and response to therapy, especially in critical care settings.

  10. Ensure Rest During Anginal Episodes:

    • Instruct patient to stop activity and rest immediately upon chest pain onset.
    • Maintain bed or chair rest during acute episodes.
    • Rationale: Reduces myocardial oxygen demand, minimizing ischemia and risk of myocardial injury.

  11. Provide Adequate Rest Periods:

    • Schedule rest periods between activities.
    • Assist with self-care activities as needed to conserve energy.
    • Rationale: Conserves energy and reduces cardiac workload, preventing angina triggers.

  12. Avoid Valsalva Maneuver:

    • Educate patient on avoiding straining during bowel movements and breath-holding.
    • Administer stool softeners as needed.
    • Rationale: Valsalva maneuver can cause vagal stimulation, leading to bradycardia and rebound tachycardia, impairing cardiac output.

  13. Prepare for Stress Testing and Cardiac Catheterization:

    • Explain the purpose and procedure for stress testing and cardiac catheterization if planned.
    • Provide pre-procedure and post-procedure care as needed.
    • Rationale: Stress testing assesses ventricular function and ischemia. Cardiac catheterization (angiography) is the gold standard for diagnosing CAD and determining the extent of coronary artery blockage.

4. Monitoring and Preventing Potential Myocardial Complications in CAD Angina

Preventing complications like myocardial infarction, heart failure, and dysrhythmias is a crucial aspect of nursing care for CAD angina patients.

Nursing Interventions:

  1. Evaluate Pain Reports Carefully:

    • Assess reports of pain in jaw, neck, shoulder, arm, or hand, especially on the left side.
    • Recognize atypical angina presentations.
    • Rationale: Cardiac pain can radiate to these areas. Prompt recognition of pain patterns is crucial for timely intervention.

  2. Monitor Serial ECG Changes:

    • Obtain serial ECGs as ordered, especially during and after chest pain episodes.
    • Monitor for ST-segment changes, T-wave inversions, and new Q waves.
    • Rationale: ECG changes indicate myocardial ischemia or infarction. Serial tracings help track changes and establish a baseline.

  3. Instruct Patient to Immediately Report Chest Pain Changes:

    • Educate patients to report any change in chest pain frequency, intensity, duration, or relieving factors immediately.
    • Emphasize that “pressure” or “heaviness” can also be angina equivalents.
    • Rationale: Early reporting allows for prompt evaluation and intervention, preventing progression to myocardial infarction.

  4. Assess for Heart Failure Signs and Symptoms:

    • Monitor for shortness of breath, edema, fatigue, and persistent cough.
    • Assess for jugular venous distention and abnormal breath sounds.
    • Rationale: Angina can be a symptom of underlying CAD that may compromise cardiac function, leading to heart failure.

  5. Administer Antianginal Medications Promptly:

    • Administer prescribed nitrates, beta-blockers, and calcium channel blockers as per schedule and PRN orders.
    • Ensure timely administration during acute episodes.
    • Rationale: Prompt medication administration is crucial for managing angina and preventing complications.

  6. Closely Monitor Cardiac Monitor:

    • Continuously monitor ECG for dysrhythmias and silent ischemia.
    • Be vigilant for ST-segment changes even without reported pain (silent ischemia).
    • Rationale: Dysrhythmias and silent ischemia are potential complications of CAD angina requiring immediate attention.

  7. Prepare for Surgical or Interventional Procedures:

    • Prepare patients for procedures like angioplasty (PTCA) with or without stent placement, valve replacement, or CABG if indicated.
    • Provide pre- and post-procedure nursing care.
    • Rationale: These interventions improve coronary blood flow and are indicated for severe CAD and angina unresponsive to medical management.

  8. Prepare for Critical Care Transfer if Needed:

    • If angina is prolonged, unrelieved, or associated with hemodynamic instability, prepare for transfer to a critical care unit.
    • Ensure continuous monitoring and advanced interventions in critical care.
    • Rationale: Prolonged chest pain and hemodynamic instability indicate serious complications requiring intensive care.

5. Providing Emotional Support and Reducing Anxiety in CAD Angina

Angina and CAD can cause significant anxiety and fear. Nursing interventions focus on providing emotional support, reducing anxiety, and improving coping.

Nursing Interventions:

  1. Maintain Calm Environment and Stay with Anxious Patient:

    • Create a calm and reassuring environment.
    • Stay with the patient during pain episodes or when anxiety is high.
    • Rationale: Anxiety increases myocardial workload. Nurse’s presence reduces fear and helplessness.

  2. Assess Patient and Family Understanding:

    • Evaluate patient’s and family’s understanding of the CAD and angina diagnosis, treatment plan, and prognosis.
    • Address misconceptions and provide clear, accurate information.
    • Rationale: Understanding reduces anxiety and promotes informed participation in care.

  3. Observe and Monitor Physical Responses to Anxiety:

    • Assess for restlessness, vital sign changes, repetitive movements, and verbal cues of anxiety.
    • Note congruence between verbal and nonverbal communication.
    • Rationale: Physical responses indicate anxiety level and coping mechanisms.

  4. Identify Coping Strengths:

    • Identify patient’s and family’s previous coping strategies and current strengths.
    • Reinforce positive coping mechanisms.
    • Rationale: Focuses on patient’s capabilities and enhances sense of control.

  5. Explain Tests and Procedures:

    • Explain the purpose and process of diagnostic tests and procedures (e.g., stress test, cardiac catheterization).
    • Answer questions honestly and clearly.
    • Rationale: Reduces anxiety related to the unknown and promotes cooperation with diagnostic process.

  6. Promote Expression of Feelings and Fears:

    • Encourage patient and family to express feelings and fears.
    • Validate their feelings as normal reactions to a cardiac diagnosis.
    • Rationale: Verbalizing concerns reduces tension and facilitates coping.

  7. Provide Opportunities for Questions:

    • Create a safe space for patient and family to ask questions.
    • Provide honest and understandable answers.
    • Rationale: Builds trust and reduces misinformation.

  8. Encourage Normal Social Interactions:

    • Encourage family and friends to interact with the patient as they normally would.
    • Reassure patient that their roles and relationships are valued.
    • Rationale: Maintains social support and prevents feelings of isolation or altered self-image.

  9. Reinforce Medical Regimen Purpose:

    • Explain that the medical regimen is designed to control angina and improve cardiac stability.
    • Encourage adherence to treatment plan.
    • Rationale: Builds patient confidence in the treatment plan and promotes adherence.

  10. Encourage Stress Reduction and Relaxation Techniques:

    • Teach and encourage stress reduction techniques like deep breathing, guided imagery, and progressive muscle relaxation.
    • Explore music therapy or other relaxation methods.
    • Rationale: Reduces stress and anxiety, which can trigger angina.

  11. Involve Patient in Decision-Making:

    • Include the patient and family in care decisions whenever possible.
    • Promote a sense of control and autonomy.
    • Rationale: Increases patient engagement and reduces feelings of helplessness.

  12. Refer to Spiritual Counselor if Desired:

    • Offer referral to a spiritual counselor or chaplain if desired by the patient and family.
    • Support patient’s religious or spiritual practices.
    • Rationale: Addresses spiritual needs and provides additional comfort and support.

6. Providing Patient Education and Teachings for Lifestyle Changes in CAD Angina

Patient education is vital for managing CAD angina long-term. It focuses on disease understanding, symptom recognition, action plans, and lifestyle modifications.

Patient Education Points:

  1. Assess Readiness to Learn and Cultural Needs:

    • Evaluate patient’s readiness and ability to learn, considering cultural background and specific needs.
    • Tailor education to the patient’s level of understanding and cultural context.
    • Rationale: Ensures effective learning and culturally sensitive care.

  2. Discuss Nonmodifiable Risk Factors:

    • Discuss nonmodifiable CAD risk factors (age, family history).
    • Focus education on modifiable risk factors and lifestyle changes.
    • Rationale: While nonmodifiable risks cannot be changed, understanding them provides context for focusing on modifiable factors.

  3. Review Cholesterol Levels and Lipid Management:

    • Explain the significance of cholesterol levels, LDL, and HDL.
    • Emphasize the importance of periodic lipid level monitoring and prescribed lipid-lowering therapy.
    • Rationale: Managing cholesterol is crucial in CAD management.

  4. Explain Pathophysiology of CAD and Angina:

    • Educate patient on the pathophysiology of CAD and how it leads to angina.
    • Stress the importance of preventing and managing anginal attacks to reduce MI risk.
    • Rationale: Understanding the disease process enhances motivation for self-management and lifestyle changes.

  5. Identify and Manage Stressors:

    • Help patient identify physical and emotional stressors that trigger angina.
    • Discuss stress management techniques and avoidance of triggers.
    • Rationale: Stress management is a key component in angina prevention.

  6. Avoid Angina-Precipitating Situations:

    • Advise patient to avoid situations that can trigger angina (exertion, stress, heavy meals, extreme temperatures).
    • Provide strategies for modifying activities to prevent angina.
    • Rationale: Reduces incidence and severity of anginal episodes.

  7. Educate Women on Angina Symptoms:

    • Specifically educate female patients about atypical angina symptoms (shortness of breath, fatigue, nausea, lightheadedness).
    • Highlight the importance of recognizing these symptoms promptly.
    • Rationale: Women often present with atypical angina symptoms, which are frequently under-recognized.

  8. Review Lifestyle Modifications:

    • Emphasize the importance of weight control, smoking cessation, dietary changes, and regular exercise in CAD management.
    • Provide resources and support for lifestyle changes.
    • Rationale: Lifestyle modifications are foundational in reducing CAD risk and angina frequency.

  9. Encourage Cardiac Rehabilitation Program:

    • Recommend participation in a cardiac rehabilitation program.
    • Caution against overexertion and exhaustion during exercise.
    • Rationale: Cardiac rehabilitation provides structured exercise, education, and support for recovery and lifestyle changes.

  10. Discuss Impact on Lifestyle and Activities:

    • Address the impact of CAD and angina on work, driving, sexual activity, hobbies, and desired lifestyle.
    • Provide guidance on safe activity levels and prophylactic nitroglycerin use.
    • Rationale: Helps patients adapt to lifestyle changes and safely resume activities.

  11. Demonstrate Pulse and BP Monitoring:

    • Teach patient how to monitor their pulse and blood pressure during and after activities.
    • Guide them in scheduling activities to avoid cardiac stress.
    • Rationale: Empowers patients to monitor their cardiac response to activity and adjust accordingly.

  12. Action Plan for Anginal Attacks:

    • Educate patient on steps to take during an anginal attack: stop activity, use nitroglycerin, rest, and when to seek emergency care.
    • Instruct on proper nitroglycerin storage and administration.
    • Rationale: Prepares patients to manage angina attacks effectively and reduces anxiety about what to do if pain occurs.

  13. Caution Against Herbal Remedies and Medications:

    • Advise against using certain herbal supplements and medications that can interact with cardiac medications or worsen CAD.
    • Provide specific examples like Ginseng and St. John’s Wort.
    • Rationale: Prevents harmful interactions and ensures medication effectiveness.

  14. Promote Smoking Cessation:

    • Emphasize the critical importance of smoking cessation for CAD management.
    • Provide resources and support for quitting smoking.
    • Rationale: Smoking cessation is the most effective preventive measure in CAD.

  15. Review Prescribed Medications:

    • Thoroughly review all prescribed medications, including purpose, dosage, administration, side effects, and importance of adherence.
    • Ensure patient understands their medication regimen.
    • Rationale: Medication adherence is crucial for angina control and CAD management.

  16. Discuss Aspirin and Antiplatelet Agents:

    • Explain the role of aspirin and other antiplatelet agents in preventing clot formation.
    • Instruct on proper use and potential side effects.
    • Rationale: Antiplatelet therapy is essential in reducing cardiovascular events in CAD.

  17. Symptoms to Report to Healthcare Provider:

    • Educate patient on symptoms that require immediate reporting to their healthcare provider: increased angina frequency, changes in pain pattern, or lack of medication response.
    • Emphasize the importance of prompt medical attention for worsening symptoms.
    • Rationale: Early reporting of worsening symptoms can prevent serious complications.

  18. Importance of Follow-Up Appointments:

    • Stress the necessity of regular follow-up appointments for monitoring CAD and adjusting treatment as needed.
    • Encourage participation in cardiac rehabilitation and support groups.
    • Rationale: Ongoing monitoring and support are vital for long-term CAD management.

Evaluation of CAD Angina Care

Patient outcomes are evaluated based on the achievement of nursing goals.

Expected Patient Outcomes:

  • Patient reports relief of chest pain and reduced frequency of anginal episodes.
  • Patient demonstrates reduced anxiety and improved emotional coping.
  • Patient understands CAD, angina management, and prescribed therapeutic regimen.
  • Patient initiates and adheres to lifestyle modifications for CAD risk reduction.
  • Patient experiences no myocardial complications.

Discharge and Home Care Guidelines for CAD Angina

Discharge planning focuses on ensuring patients can manage their angina and CAD at home, preventing complications, and promoting long-term health.

Discharge Instructions:

  • Angina Management: Provide detailed instructions on managing anginal attacks at home, including rest, nitroglycerin use, and when to seek emergency care.
  • Follow-up Monitoring: Schedule follow-up appointments with cardiologist and primary care physician. Remind patient about necessary blood laboratory testing and ECGs.
  • Medication Compliance: Emphasize the importance of medication adherence and provide a medication schedule if needed. Ensure patient understands how to refill prescriptions.
  • Lifestyle Modifications: Reinforce recommended lifestyle changes: diet, exercise, smoking cessation, and stress management. Provide resources for support.
  • Emergency Plan: Develop an emergency plan with the patient, including when to call emergency services (911 or local emergency number).
  • Home Care Referral: Consider home care nursing referral for ongoing monitoring, medication management, and support, especially for patients with complex needs or limited self-management abilities.

Documentation Guidelines for CAD Angina Nursing Care

Accurate and thorough documentation is essential for effective communication and continuity of care.

Documentation Should Include:

  • Detailed Pain Assessment: Characteristics of pain (location, intensity, duration, quality, precipitating factors, relieving factors).
  • Effect of Angina on Lifestyle: Impact on ADLs, work, and quality of life.
  • Vital Signs and Cardiovascular Assessments: BP, HR, rhythm, heart sounds, peripheral pulses, ECG findings.
  • Patient’s Emotional and Psychological Status: Anxiety level, coping mechanisms, emotional responses to diagnosis.
  • Medication Administration and Response: Medications given, dosage, route, time, and patient response, including pain relief and any adverse effects.
  • Patient Education: Topics taught, patient’s understanding, and any educational materials provided.
  • Patient’s Adherence to Treatment Plan: Compliance with medications, diet, lifestyle modifications.
  • Progress Towards Goals and Outcomes: Evaluation of patient’s progress and attainment of expected outcomes.
  • Discharge Planning: Discharge instructions given, follow-up appointments scheduled, home care referrals, and emergency plan.

Recommended Resources for CAD Angina Nursing Care

Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care

Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health

Nursing Diagnosis Manual: Essential resource for planning, individualizing, and documenting CAD angina patient care, emphasizing accurate nursing diagnosis.

See also

Other resources for cardiovascular nursing care:

  • Nursing Care Plans for Cardiovascular System Disorders

References and Sources

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