Angina Nursing Diagnosis & Care Plan

Angina is chest pain or discomfort that occurs when the heart muscle does not get enough oxygen-rich blood. It is a common symptom of underlying heart disease, usually coronary artery disease (CAD). People often describe angina as pressure, heaviness, squeezing, or tightness in the chest. The discomfort may also spread to the shoulders, arms, neck, jaw, or back.

For nurses, recognizing and responding quickly to angina is critical. Early assessment and intervention can reduce the risk of heart attack, improve patient comfort, and prevent complications.

Causes & Pathophysiology

The heart needs a constant supply of oxygen. Angina occurs when the heart’s demand for oxygen is greater than the supply delivered through the coronary arteries. This mismatch is often caused by:

Atherosclerosis – Plaque buildup that narrows the arteries.
Coronary artery spasm – Temporary narrowing caused by tightening of the artery wall.
Anemia – Low red blood cell count reducing oxygen delivery.
Uncontrolled hypertension – Increases heart workload.

Types of Angina

Stable Angina: Predictable pain with exertion or stress; relieved by rest or nitroglycerin.
Unstable Angina: Unpredictable, occurs even at rest; more severe and longer lasting; a medical emergency.
Variant (Prinzmetal’s) Angina: Caused by artery spasm; often occurs at rest, usually in early morning.

Signs & Symptoms

Common

Pressure, squeezing, or heaviness in the chest
Pain radiating to arm, neck, jaw, or back
Shortness of breath
Fatigue or weakness
Sweating, nausea, or dizziness

Emergency

Chest pain at rest or lasting longer than usual
Pain not relieved by nitroglycerin
Increasing frequency or severity of symptoms
Severe shortness of breath, pale or clammy skin, or faintness

Nursing Assessment

Subjective (Patient Reports):

Description of chest pain (location, severity, quality, duration)
Activities or events before onset
Factors that relieve pain (rest, nitroglycerin)
Associated symptoms (shortness of breath, nausea, dizziness)
Past medical and family history

Objective (Nurse Observes):

Patient appearance (distress, sweating, anxiety)
Vital signs (BP, HR, RR, oxygen saturation)
Heart and lung sounds
ECG changes
Skin color and temperature

Nursing Diagnoses (NANDA-I 2024–2026)

Acute Pain related to decreased coronary blood flow and myocardial ischemia as evidenced by patient’s report of chest pressure 8/10 radiating to left arm, diaphoresis, and anxiety.
Decreased Cardiac Output related to impaired myocardial contractility secondary to ischemia as evidenced by hypotension, tachycardia, weak pulses, and reduced urine output.
Activity Intolerance related to imbalance between oxygen supply and demand during exertion as evidenced by chest pain and shortness of breath with minimal activity.
Anxiety related to threat of serious illness and unfamiliar hospital environment as evidenced by verbal expressions of fear, restlessness, and elevated heart rate.
Deficient Knowledge related to lack of prior education about angina management as evidenced by inability to describe medication use or identify lifestyle changes.

Goals & Expected Outcomes

Short-term Goals:

Pain relieved within minutes of intervention.
Stable vital signs during and after angina episodes.
Reduced anxiety reported by patient.

Long-term Goals:

Patient describes angina, treatment steps, and warning signs.
Improved activity tolerance without symptoms.
Lifestyle modifications adopted to reduce recurrence.

Nursing Care Plans

1. Acute Pain

Nursing Diagnosis: Acute Pain related to decreased coronary blood flow and myocardial ischemia as evidenced by patient’s report of chest pressure 8/10 radiating to left arm, diaphoresis, and anxiety.

Goals/Outcomes:

Pain reduced to 0–1/10 within 5 minutes of nitroglycerin.
Vital signs remain stable during pain episodes.
Patient expresses comfort and relief.

Interventions with Rationales:

Assess pain characteristics – Helps determine severity, location, and triggers to guide treatment.
Administer nitroglycerin as prescribed – Dilates coronary arteries, improving blood flow to heart muscle.
Provide supplemental oxygen if O₂ sat <94% – Increases oxygen supply to ischemic tissue.
Position in semi-Fowler’s and encourage rest – Reduces heart workload and improves breathing.
Stay with the patient and provide reassurance – Reduces anxiety, lowering oxygen demand.
Monitor vital signs and ECG – Detects changes indicating worsening ischemia or arrhythmias.

Evaluation: Pain subsided to 0/10, BP and HR stable, patient appears relaxed.

2. Decreased Cardiac Output

Nursing Diagnosis: Decreased Cardiac Output related to impaired myocardial contractility secondary to ischemia as evidenced by hypotension, tachycardia, weak pulses, and reduced urine output.

Goals/Outcomes:

Maintain BP and HR within normal limits.
Adequate urine output (≥30 mL/hour).
Warm skin with strong peripheral pulses.

Interventions with Rationales:

Monitor vitals, mental status, and cardiac rhythm – Detects early signs of low output or arrhythmias.
Assess skin temperature, pulses, and urine output – Identifies poor tissue perfusion.
Limit activity during acute episodes – Reduces oxygen demand on the heart.
Administer cardiac medications as ordered – Improves heart pumping ability, reduces workload, or opens blocked arteries.
Prepare for advanced interventions if needed – Ensures rapid response to worsening status.

Evaluation: BP, HR, and perfusion within target range, no signs of hypoperfusion.

3. Activity Intolerance

Nursing Diagnosis: Activity Intolerance related to imbalance between oxygen supply and demand during exertion as evidenced by chest pain and shortness of breath after minimal activity.

Goals/Outcomes:

Patient performs ADLs without pain or excessive fatigue.
Gradual increase in activity tolerance without symptoms.

Interventions with Rationales:

Assess baseline activity tolerance – Establishes safe starting point for activity.
Schedule rest periods and assist with ADLs – Conserves energy and prevents angina episodes.
Teach patient to stop activity at onset of symptoms – Prevents worsening ischemia.
Gradually increase activity under supervision – Builds endurance safely.
Provide assistive devices as needed – Reduces energy use during movement.

Evaluation: Patient completes ADLs without symptoms; vitals remain stable.

4. Anxiety

Nursing Diagnosis: Anxiety related to threat of serious illness and unfamiliar hospital environment as evidenced by verbal expressions of fear, restlessness, and elevated heart rate.

Goals/Outcomes:

Patient reports decreased anxiety within 30 minutes of intervention.
Demonstrates at least two relaxation techniques by discharge.

Interventions with Rationales:

Stay with patient and speak calmly – Provides reassurance and safety.
Encourage expression of feelings – Reduces emotional tension.
Teach deep breathing and relaxation techniques – Slows heart rate and lowers oxygen demand.
Reduce environmental stressors – Minimizes factors that worsen anxiety.
Give clear explanations about care – Increases understanding and control.

Evaluation: Patient verbalizes reduced anxiety, uses relaxation techniques independently.

5. Deficient Knowledge

Nursing Diagnosis: Deficient Knowledge related to lack of prior education about angina management as evidenced by inability to describe medication use or identify lifestyle changes.

Goals/Outcomes:

Patient explains angina, medication use, and warning signs.
Lists at least three lifestyle changes to reduce episodes.

Interventions with Rationales:

Assess current knowledge level – Identifies learning needs.
Explain angina in simple terms – Improves understanding of cause and prevention.
Teach proper nitroglycerin use – Ensures effective self-management during episodes.
Discuss lifestyle modifications – Reduces risk factors (diet, exercise, smoking cessation, stress control).
Provide written instructions and resources – Reinforces teaching after discharge.

Evaluation: Patient demonstrates correct medication use and names lifestyle changes they will implement.

Patient Education & Self-Care Tips

Recognize personal triggers and avoid them when possible.
Carry nitroglycerin at all times; use at first sign of pain.
Stop smoking and avoid secondhand smoke.
Eat a heart-healthy, low-fat, low-salt diet.
Exercise regularly with medical approval.
Manage stress with relaxation techniques.
Seek emergency help for new, worsening, or unrelieved chest pain.

References

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