Chest pain, or angina, represents a critical symptom that requires immediate nursing attention and careful assessment. This comprehensive guide explores the nursing diagnosis process, essential care plans, and evidence-based interventions for managing patients with chest pain.
Understanding Chest Pain and Angina
Angina occurs when the heart muscle doesn’t receive adequate oxygen-rich blood flow. This condition manifests through various symptoms, including:
- Squeezing or crushing chest discomfort
- Pain radiating to the jaw, neck, or arms
- Pressure sensation in the chest
- Burning or sharp pain
- Associated symptoms like shortness of breath and anxiety
Types of Angina
Healthcare providers recognize several distinct types of angina:
Stable Angina
- Predictable pattern
- Triggered by physical exertion or stress
- Responds to rest and nitroglycerin
Unstable Angina
- Occurs unpredictably
- May happen at rest
- Requires immediate medical attention
Variant (Prinzmetal) Angina
- Occurs during rest
- Most common during early morning hours
- Caused by coronary artery spasm
Risk Factors and Assessment
Key risk factors for angina include:
- Advanced age
- Hypertension
- Diabetes mellitus
- Smoking history
- High cholesterol levels
- Family history of heart disease
- Obesity
- Sedentary lifestyle
Clinical Assessment
Nurses must perform thorough assessments including:
- Vital signs monitoring
- Pain assessment using standardized scales
- Cardiac rhythm evaluation
- Observation for associated symptoms
- Review of medical history
Nursing Care Plans for Chest Pain
1. Acute Pain
Nursing Diagnosis: Acute Pain related to decreased myocardial blood flow as evidenced by verbal reports of chest pain, facial grimacing, and vital sign changes.
Related Factors:
- Myocardial ischemia
- Coronary artery disease
- Physical or emotional stress
- Decreased oxygen supply to heart muscle
Nursing Interventions and Rationales:
- Perform comprehensive pain assessment using PQRST method
Rationale: Enables accurate tracking of pain characteristics and response to interventions - Administer prescribed medications, including nitroglycerin
Rationale: Promotes vasodilation and improves myocardial perfusion - Position patient in semi-Fowler’s position
Rationale: Reduces cardiac workload and promotes comfort - Monitor vital signs every 15 minutes during acute episode
Rationale: Allows early detection of complications
Desired Outcomes:
- Patient reports pain reduction (pain scale ≤3/10)
- Demonstrates stable vital signs
- Identifies pain triggers and management strategies
2. Decreased Cardiac Output
Nursing Diagnosis: Decreased Cardiac Output related to altered myocardial contractility as evidenced by ECG changes and decreased peripheral perfusion.
Related Factors:
- Coronary artery disease
- Altered contractility
- Dysrhythmias
- Medication effects
Nursing Interventions and Rationales:
- Monitor cardiac rhythm continuously
Rationale: Enables early detection of potentially dangerous arrhythmias - Assess peripheral perfusion hourly
Rationale: Indicates adequacy of cardiac output - Maintain oxygen therapy as prescribed
Rationale: Improves myocardial oxygenation - Restrict activity during acute episodes
Rationale: Reduces cardiac workload
Desired Outcomes:
- Maintains stable cardiac rhythm
- Demonstrates adequate peripheral perfusion
- Reports improved activity tolerance
3. Anxiety
Nursing Diagnosis: Anxiety related to acute chest pain and fear of death as evidenced by expressed concerns and increased vital signs.
Related Factors:
- Fear of death
- Uncertainty about health status
- Previous cardiac events
- Lack of knowledge about the condition
Nursing Interventions and Rationales:
- Provide a calm, reassuring presence
Rationale: Reduces anxiety and promotes feeling of safety - Explain all procedures and interventions
Rationale: Increases sense of control and reduces fear - Teach relaxation techniques
Rationale: Provides a coping mechanism for anxiety management - Include family in education and support
Rationale: Strengthens support system and reduces isolation
Desired Outcomes:
- Demonstrates reduced anxiety levels
- Uses effective coping strategies
- Verbalizes understanding of condition and treatment
4. Risk for Ineffective Tissue Perfusion
Nursing Diagnosis: Risk for Ineffective Tissue Perfusion related to reduced coronary blood flow.
Related Factors:
- Atherosclerotic changes
- Coronary artery spasm
- Thrombosis
- Hypertension
Nursing Interventions and Rationales:
- Monitor oxygen saturation continuously
Rationale: Ensures adequate tissue oxygenation - Assess for signs of decreased perfusion
Rationale: Enables early intervention - Maintain prescribed anticoagulation therapy
Rationale: Prevents thrombus formation - Monitor laboratory values (cardiac enzymes)
Rationale: Indicates effectiveness of tissue perfusion
Desired Outcomes:
- Maintains adequate tissue perfusion
- Shows no signs of complications
- Demonstrates improved cardiac function
5. Knowledge Deficit
Nursing Diagnosis: Knowledge Deficit related to lack of information about angina management as evidenced by questions about self-care and medication regime.
Related Factors:
- Limited exposure to information
- Misinterpretation of health information
- Lack of experience with the condition
- Language or cultural barriers
Nursing Interventions and Rationales:
- Provide comprehensive education about the condition
Rationale: Increases understanding and compliance - Teach medication management
Rationale: Ensures proper use of prescribed treatments - Demonstrate proper use of nitroglycerin
Rationale: Promotes safe and effective medication administration - Review lifestyle modifications
Rationale: Helps prevent future episodes
Desired Outcomes:
- Demonstrates understanding of the condition
- Correctly uses prescribed medications
- Implements recommended lifestyle changes
Patient Education and Prevention
Effective patient education includes:
- Recognition of angina symptoms
- Proper use of medications
- Lifestyle modification strategies
- When to seek emergency care
- Risk factor management
- Activity guidelines
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Fuchs RM, Becker LC. Pathogenesis of angina pectoris. Arch Intern Med. 1982 Sep;142(9):1685-92. PMID: 7052007.
- Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O’Connor RE, Ross MA, Shaw LJ. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021 Nov 30;144(22):e368-e454. doi: 10.1161/CIR.0000000000001029. Epub 2021 Oct 28. Erratum in: Circulation. 2021 Nov 30;144(22):e455. doi: 10.1161/CIR.0000000000001047. Erratum in: Circulation. 2023 Dec 12;148(24):e281. doi: 10.1161/CIR.0000000000001198. PMID: 34709879.
- Noory, N., Westin, O., Maurer, M. S., Fosbøl, E., & Gustafsson, F. (2025). Chest pain and coronary artery disease in cardiac amyloidosis: Prevalence, mechanisms, and clinical implications. American Heart Journal, 280, 52-59. https://doi.org/10.1016/j.ahj.2024.11.004
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
