Chest Pain Nursing Diagnosis and Nursing Care Plan

Chest Pain also called Angina is a medical condition which involves chest pain due to the decrease in the blood supply to the heart.

It is one of the definitive symptoms of coronary heart disease, and can also be a symptom for other cardiac issues.

Chest Pain also known as angina pectoris (which means it is located in the chest), angina is a type of pain that can be described as heaviness, tightness, squeezing or pressured, as if something heavy is lying on the chest.

There are several types of angina, which include stable, unstable, variant/ prinzmetal angina, and microvascular angina.

Long-term chest pain may be diagnosed as refractory angina.

It may be hard to distinguish angina from other types of chest pain such as heartburn due to indigestion. Urgent medical attention is needed for any unexplained or new chest pain.

Signs and Symptoms of Chest Pain

Pain in the chest
Chest pain may radiate to the neck, shoulders, jaw, back, or arms
Shortness of breath
Nausea
Dizziness
Fatigue

Symptoms of angina in women may also include abdominal pain and stabbing pain instead of a pressure feeling on the chest.

Symptoms of angina may also differ depending on the specific type.

Stable Angina – most common form of angina

Triggered by exertion, such as climbing the stairs or exercise
Last for a short period, usually less than 5 minutes
Relieved by rest or by administration of angina medication
Usually predictable if the patient has had the same type of chest pain before

Unstable Angina – considered a precursor to myocardial infarction or heart attack

Happens even if the patient is at rest
Not relieved by angina medication
Lasts longer than stable angina, usually 30 minutes or longer
Unpredictable / unexpected
Different from the usual pattern of chest pain

Prinzmetal or Variant Angina – rare; results from the spasm of coronary arteries due to temporary lack of blood flow

Occurs at rest
Severe
May be alleviated by angina medication

Microvascular angina – common symptom of coronary microvascular disease (MVD), which involves the damage of the tiny branches of a coronary artery.

May last from 10 minutes to longer than 30 minutes
May occur overnight and associated with sleeping problems

Causes of Chest Pain

Atherosclerosis, or the buildup of cholesterol-containing deposits called plaques in the arterial walls is the common cause of the narrow of the coronary arteries. This results to the reduction of blood flow in the heart, a cardiac condition known as coronary artery disease (CAD).

When there is a decreased blood supply to the cardiac muscle, the heart does not receive enough oxygen. The patient may not have chest pain at rest, but when he/she starts to exert effort such as doing exercise or climbing up the stairs, the demand for oxygenated blood in the heart increases.

Since the blocked coronary arteries cannot supply this additional demand, stable angina happens. Angina can also be referred to as ischemic chest pain because it involves the ischemia of the heart, or lack of oxygenated blood supply.

Unstable angina may result from the sudden blockage (partial or total) of the coronary artery due to the rupture of plaques or formation of blood clot. Usual angina medications do not improve blood flow, thus, the patient needs emergency treatment.

Variant or prinzmetal angina is rare and is particularly caused by the sudden spasm of a narrowed coronary artery. This usually occurs overnight and is mainly triggered by emotional stress, vasoconstrictor drugs, or smoking.

Risk Factors for Chest Pain

There are many risk factors for angina. These include smoking, diabetes or poor diabetic management, high blood pressure, high cholesterol (LDL) levels, old age (Men: 45 years old and above, Women: 55 years old and above), sedentary lifestyle, lack of exercise, stress, obesity, and family history of heart disease.

Complications of Chest Pain

Angina is an important sign of heart attack. Along with chest pain, the patient may experience shortness of breath, radiating pain to the shoulder, arm, jaw, back, and even the teeth.

Abdominal pain may also occur, as well as nausea and vomiting. The patient may feel an impending sense of doom and may also faint.

Diagnostic Tests for Chest Pain

Blood tests – Cardiac enzymes such as Troponin T and Troponin I as well as proteins such as creatinine phosphokinase (CPK) and myoglobin may leak into the blood stream when the cardiac blood vessels are damaged.
Electrocardiogram
Stress test – walking on a treadmill or pedaling a stationary bike while connected to the ECG
Echocardiogram – to visualize the heart
Nuclear stress test –the injection of a radioactive substance to measure the blood flow to the heart, both when the patient is at rest and when inducing stress through exercise.
Chest X-ray – to see if there is any enlargement of the heart
Coronary angiography- injection of a dye before taking images
Cardiac computerized tomography (CT) scan
Cardiac MRI

Treatment for Chest Pain

Medications. The following drugs may be used to treat angina:

Nitrates – to relax the blood vessels in order to increase the blood flow to the heart. Nitroglycerin sublingual tablets are the most common form of nitrates used.
Anticoagulants such as clopidogrel and ticagrelor – to prevent the formation of blood clot
Blood thinning agents such as aspirin – to reduce the ability of the blood to clot, so that the blood flows easier through the narrowed arteries.
Statins such as atorvastatin – also called as anti-cholesterol drugs used to reduce the deposits on the arterial walls
Beta blockers – to decrease the cardiac demand for oxygen by means of lowering the heart rate and blood pressure levels
Calcium channel blockers – to widen the blood vessels by vasodilation
Ranolazine – to treat angina, on its own or in combination with beta blockers, calcium channel blockers, and nitrates

Surgery. Surgical interventions are required if the medical team believes that an urgent, more aggressive treatment for CAD-related angina is needed. These surgeries include:

Coronary artery bypass surgery – creation of a graft to reroute the blood flow away from the diseased artery)
Angioplasty with stent placement – also known as percutaneous coronary revascularization which involves the insertion of a catheter into the affected artery followed by inflation of balloon and insertion of a stent to keep the blood vessel open.

External counterpulsation (ECP) – the use of multiple blood pressure-like cuffs on the pelvis, thighs, and calves to improve the blood flow to the cardiac muscle.

Lifestyle changes.

Smoking is one of the biggest risk factors of angina and CAD. The nicotine in cigarettes facilitates the constriction of blood vessels, which then increases the cardiac workload. This eventually damages the lining of the coronary arteries, as well as other blood vessels.
Having a low cholesterol, low sugar diet to control cholesterol and blood glucose levels. Foods rich in omega-3 fatty acids such as fish, soybeans, and flaxseeds are recommended.
Taking prescribed blood pressure medications helps control hypertension.
Increasing physical activity by doing at least 150 minutes of moderate aerobic exercises will help promote an active lifestyle
Learning stress management techniques is helpful in lowering the risk for angina and CAD.
Some alternative medicine may help, including fish oil, flaxseed oil, canola oil, and soybean oil.

Nursing Diagnosis for Chest Pain

Nursing Care Plan for Chest Pain 1

Decreased cardiac output related to the disease process of coronary artery disease (CAD) as evidenced by angina, patient’s verbalization of heavy and tight chest pain, sweating, nausea, and heart rate of 150 bpm and blood pressure of 85/50

Desired outcome: The patient will be able to maintain adequate cardiac output.

Nursing Interventions for Chest Pain	Rationale
Assess the patient’s vital signs and characteristics of heart beat at least every 4 hours. Assess heart sounds via auscultation. Observe for signs of decreasing peripheral tissue perfusion such as slow capillary refill, facial pallor, cyanosis, and cool, clammy skin.	To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment. The presence of signs of decreasing peripheral tissue perfusion indicates deterioration of the patient’s status which require immediate referral to the physician.
Administer prescribed medications for coronary artery disease and angina.	Nitrates – to relax the blood vessels in order to increase the blood flow to the heart. Anticoagulants such as clopidogrel and ticagrelor – to prevent the formation of blood clots. Blood thinning agents such as aspirin – to reduce the ability of the blood to clot. Statins such as atorvastatin – also called as anti-cholesterol drugs used to reduce the deposits on the arterial walls Beta blockers – to decrease the cardiac demand for oxygen by means of lowering the heart rate and blood pressure levels. Calcium channel blockers – to widen the blood vessels by vasodilation. Ranolazine – to treat angin
Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.	To increase the oxygen level and achieve an SpO2 value of at least 94%.
Educate patient on stress management, deep breathing exercises, and relaxation techniques.	Stress causes a persistent increase in cortisol levels, which has been linked to people with cardiac issues. Chronic stress may also cause an increase in adrenaline levels, which tend to increase the heart rate, respiratory rate, and blood sugar levels. Reducing stress is also an important aspect of dealing with fatigue.

Nursing Care Plan for Chest Pain 2

Nursing Diagnosis: Acute Pain related to decreased myocardial blood flow as evidenced by pain score of 10 out of 10, verbalization of pressure-like/ squeezing chest pain (angina), guarding sign on the chest, blood pressure level of 180/90, respiratory rate of 29 cpm, and restlessness

Desired Outcome: The patient will demonstrate relief of pain as evidenced by a pain score of 0 out of 10, stable vital signs, and absence of restlessness.

Nursing Interventions for Chest Pain	Rationale
Administer prescribed medications that alleviate the symptoms of angina.	Aspirin may be given to reduce the ability of the blood to clot, so that the blood flows easier through the narrowed arteries. Nitrates may be given to relax the blood vessels. Other medications that help treat angina include anti-cholesterol drugs (e.g. statins), beta blockers, calcium channel blockers, and Ranolazine.
Assess the patient’s vital signs and characteristics of pain at least 30 minutes after administration of medication.	To monitor effectiveness of medical treatment for the relief of angina. The time of monitoring of vital signs may depend on the peak time of the drug administered.
Elevate the head of the bed if the patient is short of breath. Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.	To increase the oxygen level and achieve an SpO2 value of at least 94%.
Place the patient in complete bed rest during angina attacks. Educate patient on stress management, deep breathing exercises, and relaxation techniques.	Stress causes a persistent increase in cortisol levels, which has been linked to people with cardiac issues. The effects of stress are likely to increase myocardial workload.

Nursing Care Plan for Chest Pain 3

Nursing Diagnosis: Activity intolerance related to reduced oxygen supply to the heart, as evidenced by fatigue, overwhelming lack of energy, verbalization of tiredness, generalized weakness, and shortness of breath upon exertion

Desired Outcome: The patient will demonstrate active participation in necessary and desired activities and demonstrate increase in activity levels.

Nursing Interventions for Chest Pain	Rationales
Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.	To create a baseline of activity levels and mental status related to fatigue and activity intolerance.
Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with 60-90 minutes of undisturbed rest.	To gradually increase the patient’s tolerance to physical activity. To avoid triggering angina by allowing the patient to pace activity versus rest.
Teach deep breathing exercises and relaxation techniques.	To allow the patient to relax and to facilitate effective stress management.
Refer the patient to physiotherapy / occupational therapy team as required.	To provide a more specialized care for the patient in terms of helping him/her build confidence in increasing daily physical activity.

Nursing Care Plan for Chest Pain 4

Nursing Diagnosis: Deficient Knowledge related to new diagnosis of angina as evidenced by patient’s verbalization of “I want to know more about my new diagnosis and care”

Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of angina and its management.

Nursing Interventions for Chest Pain	Rationales
Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g. denial of diagnosis or poor lifestyle habits).	To address the patient’s cognition and mental status towards the new diagnosis of angina and to help the patient overcome blocks to learning.
Explain what angina (specific to the type of angina that the patient is diagnosed with) and its treatment and management. Avoid using medical jargons and explain in layman’s terms.	To provide information on angina, its pathophysiology, and management in the simplest way possible.
Educate the patient about lifestyle changes that can help manage angina, particularly the cessation of smoking, low cholesterol diet, blood pressure control, stress management, and increased physical activity/ exercise. Refer to smoking cessation team if patient gives consent.	Smoking cessation, low cholesterol diet, blood pressure control, stress management, and increased physical activity/ exercise may prevent angina episodes and lower the risk for the development of coronary artery disease (CAD). A smoking cessation team can provide further help and advice on how to stop smoking and can also monitor the patient’s progress when he/she is back in the community.
Inform the patient the details about the prescribed medications (e.g. drug class, use, benefits, side effects, and risks) to treat angina. Ask the patient to repeat or demonstrate the self-administration details to you.	To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, adverse events, and self-administration details.
Educate the patient about deep breathing exercises and relaxation techniques.	To reduce stress levels and promote client comfort.

Nursing Care Plan for Chest Pain 5

Nursing Diagnosis: Anxiety related to situational crisis due to angina episode as evidenced by fatigue, overwhelming lack of energy, verbalization of helplessness, restlessness, and expression of fear of death

Desired Outcome: The patient will verbalize awareness of anxiety and will be able to demonstrate effective coping strategies.

Nursing Interventions for Chest Pain	Rationales
Assess the patient’s level of anxiety by using open-ended questions such as “How are you feeling about your new diagnosis and treatment?”	To allow the patient to openly express their concerns about diagnosis and treatment.
Encourage the patient to express any concerns, feelings, and fears. Advice the next-of-kin/ significant others to practice active listening when communicating with the patient.	Verbal expression of feelings and fears can help avoid internal emotional turmoil and negative-self talk. Family and significant others can provide adequate emotional support to the patient by active listening.
Teach deep breathing exercises and relaxation techniques such as guided imagery.	To allow the patient to relax and to facilitate effective stress management.
Refer the patient to a psychologist if the patient gives consent.	To provide a more specialized care for the patient in terms of helping him/her develop effective coping strategies to combat anxiety.

Nursing Care Plan for Chest Pain 6

Nursing Diagnosis: Fatigue related to decreased oxygen supply to the heart as evidenced by overwhelming lack of energy, verbalization of tiredness, generalized weakness, and shortness of breath upon exertion

Desired Outcome: The patient will establish adequate energy levels and will demonstrate active participation in necessary and desired activities.

Nursing Interventions for Chest Pain	Rationales
Ask the patient to rate fatigue level (mild, moderate, or severe fatigue). Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.	To create a baseline of activity levels, degree of fatigability, and mental status related to fatigue and activity intolerance.
Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with rest and sleep.	To gradually increase the patient’s tolerance to physical activity. Sedentary lifestyle is a risk factor to develop coronary artery disease related to angina.
Encourage the patient to follow a low cholesterol, high caloric diet. Refer to the dietitian as needed.	To increase energy levels while promoting a lower risk for angina and coronary artery disease.
Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room.	To allow the patient to relax while at rest. To allow enough oxygenation in the room.
Refer the patient to physiotherapy / occupational therapy team as required.	To provide a more specialized care for the patient in terms of helping him/her build confidence in increasing daily physical activity.

Nursing Care Plan for Chest Pain 7

Nursing Diagnosis: Powerlessness related to chronic illness and hospitalizations due to angina episodes

Desired Outcome: The patient will express a sense of control in terms of physical, mental, and emotional health, as well as self-care.

Nursing Interventions for Chest Pain	Rationales
Assess the factors that contribute to the patient’s sense of powerlessness. Observe for signs of depression, hopelessness, and apathy.	To identify the factors that give rise to the patient’s sense of powerlessness. To check the patient’s mental health.
Encourage the patient to express any concerns regarding health management as well as any feelings of powerlessness. Advice the next-of-kin/ significant others to practice active listening when communicating with the patient.	Verbal expression of feelings and fears can help avoid internal emotional turmoil and negative-self talk. Family and significant others can provide adequate emotional support to the patient by active listening.
Refer to the community nursing team and social health team as needed.	Powerlessness may involve the inability of the patient to take angina medications properly, thus there may be a need for a community health nurse to monitor the patient’s pharmacologic therapy. It may also affect the patient’s activities of daily living, so a social health care worker may be required.
Refer the patient to a psychologist if the patient gives consent.	To provide a more specialized care for the patient in terms of helping him/her develop effective coping strategies that help the patient regain a sense of personal control.

Angina can be an overwhelming medical condition to the client, so effective nursing care is required to combat activity intolerance, fatigue, lack of knowledge, and feelings of anxiety and powerlessness.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon