Coronary artery disease (CAD), sometimes called coronary heart disease, is a progressive condition in which the coronary arteries become narrowed or blocked by atherosclerotic plaque. This reduced blood flow deprives the heart muscle of oxygen, leading to angina, arrhythmias, myocardial infarction, or long-term heart failure.
For nurses and nursing students, learning how to apply a coronary artery disease nursing diagnosis is essential to providing safe and effective care. Accurate assessment, targeted nursing interventions, and patient-centered education form the foundation of improved outcomes.
Common Signs and Symptoms of CAD
Patients with CAD may present with:
- Substernal chest pain or tightness (angina), often triggered by exertion or stress
- Shortness of breath during activity or at rest
- Generalized fatigue or decreased stamina
- Irregular heartbeat or palpitations
- Dizziness or lightheadedness
- Nausea or diaphoresis
- Increased anxiety or restlessness
Because some individuals—especially older adults and those assigned female at birth—may present with atypical symptoms, nurses must conduct thorough and ongoing assessments.
Focused Nursing Assessment for CAD
Health History
- Current chest pain or dyspnea patterns
- Past history of cardiac disease or procedures
- Family history of cardiovascular disorders
- Risk factors (smoking, diabetes, hypertension, obesity, dyslipidemia)
- Current medication regimen
Physical Assessment
- Vital signs, heart and lung sounds
- Peripheral circulation (pulses, skin color, temperature, capillary refill)
- Level of consciousness and anxiety level
- Presence of edema, fatigue, or exercise intolerance
Diagnostic Tests Commonly Reviewed by Nurses
- 12-lead ECG for ST-T wave changes or arrhythmias
- Cardiac enzymes such as troponin to evaluate myocardial injury
- Lipid profile and blood glucose for risk factor management
- Chest X-ray for cardiac size and pulmonary status
- Echocardiogram and stress testing if ordered
Nursing Care Plans for Coronary Artery Disease
Nursing Care Plan 1: Decreased Cardiac Output
Nursing Diagnosis Statement:
Decreased cardiac output related to impaired myocardial contractility and altered conduction secondary to coronary artery disease as evidenced by fatigue, hypotension, and arrhythmias.
Related Factors/Causes:
Ischemic damage, reduced coronary perfusion, ventricular remodeling, and electrical abnormalities.
Interventions and Rationales:
- Monitor vital signs and hemodynamic trends frequently – detects early compromise.
- Assess tissue perfusion (skin, urine output, mental status) – identifies systemic effects of low output.
- Place patient in semi-Fowler’s position – decreases preload and eases breathing.
- Administer medications such as ACE inhibitors, beta-blockers, or diuretics as prescribed – improves contractility and workload.
Desired Outcomes:
Patient maintains stable BP and HR, demonstrates improved tolerance for ADLs, and shows signs of adequate organ perfusion.
Nursing Care Plan 2: Acute Pain (Angina)
Nursing Diagnosis Statement:
Acute pain related to myocardial ischemia as evidenced by chest pressure radiating to the arm and diaphoresis.
Related Factors/Causes:
Oxygen supply-demand imbalance, coronary artery spasm, physical exertion, or stress.
Interventions and Rationales:
- Assess chest pain characteristics (PQRST method) – ensures accurate evaluation.
- Administer nitroglycerin and reassess pain – relieves ischemia and vasodilates coronaries.
- Monitor vital signs before/after medications – evaluates therapy effectiveness and prevents hypotension.
- Provide calm environment, reduce anxiety – lowers myocardial workload.
Desired Outcomes:
Patient reports decreased chest pain (≤2/10) within 10 minutes of intervention and verbalizes understanding of angina management.
Nursing Care Plan 3: Activity Intolerance
Nursing Diagnosis Statement:
Activity intolerance related to insufficient oxygen supply during exertion as evidenced by dyspnea, fatigue, and increased HR with minimal activity.
Related Factors/Causes:
Reduced cardiac reserve, sedentary lifestyle, deconditioning, and oxygen transport deficits.
Interventions and Rationales:
- Assess tolerance to activity with vital signs and oxygen saturation – determines safe exertion levels.
- Plan care with built-in rest periods – prevents overexertion.
- Implement graded exercise program, collaborate with physical therapy – builds endurance safely.
- Educate on energy conservation techniques – allows safe performance of ADLs.
Desired Outcomes:
Patient completes light activities without significant dyspnea and demonstrates gradual improvement in stamina.
Nursing Care Plan 4: Anxiety
Nursing Diagnosis Statement:
Anxiety related to health status changes and threat of cardiac events as evidenced by restlessness, verbal concerns, and increased heart rate.
Related Factors/Causes:
Fear of death, uncertainty about treatment, and knowledge deficit regarding CAD.
Interventions and Rationales:
- Assess anxiety level regularly – monitors progress and needs for intervention.
- Provide clear, factual education about CAD and treatments – reduces fear of the unknown.
- Teach stress reduction techniques (deep breathing, guided imagery) – enhances coping.
- Include family in teaching and care discussions – provides support system.
Desired Outcomes:
Patient verbalizes reduced anxiety, uses coping strategies effectively, and shows stable vital signs.
Nursing Care Plan 5: Ineffective Health Management
Nursing Diagnosis Statement:
Ineffective health management related to complexity of treatment regimen and limited knowledge as evidenced by inconsistent adherence to medications and ongoing risk behaviors.
Related Factors/Causes:
Polypharmacy, lifestyle change challenges, inadequate understanding, or lack of resources.
Interventions and Rationales:
- Assess patient’s understanding of CAD and treatment plan – identifies knowledge gaps.
- Provide individualized teaching on medications and lifestyle modifications – enhances compliance.
- Simplify regimen when possible and encourage reminder systems – supports adherence.
- Refer to cardiac rehabilitation and community programs – builds long-term support.
Desired Outcomes:
Patient demonstrates correct medication use, engages in recommended lifestyle changes, and identifies when to seek medical help.
Patient Education & Discharge Priorities
- Medication safety: Teach nitroglycerin use, beta-blocker precautions, and importance of adherence.
- Lifestyle modifications: Smoking cessation, low-fat diet, weight management, regular exercise.
- Activity guidelines: Pace exertion and follow prescribed rehab programs.
- Risk factor management: Control blood pressure, blood glucose, and cholesterol.
- Emergency plan: Call EMS if chest pain persists >5 minutes after nitroglycerin.
Conclusion
Coronary artery disease is one of the most prevalent and serious cardiovascular conditions. By linking accurate nursing diagnoses with evidence-based interventions, nurses support both immediate stabilization and long-term management. For nursing students, mastering CAD care plans provides critical preparation for NCLEX exams and real-world practice.
References
- Smith, J., & Johnson, B. (2023). Current Approaches to Nursing Care in Coronary Artery Disease. Journal of Cardiovascular Nursing, 38(2), 112-124.
- Anderson, R.M., et al. (2023). Evidence-Based Nursing Interventions for Cardiac Patients. American Journal of Nursing, 123(4), 45-52.
- Williams, P.K., & Davis, S.L. (2023). Nursing Diagnosis in Cardiovascular Care: A Systematic Review. Heart & Lung, 52(1), 23-31.
- Brown, M.A., et al. (2023). Clinical Outcomes in CAD: Impact of Nursing Interventions. Cardiology Nursing Quarterly, 46(3), 178-189.
- Thompson, C.R., & Garcia, R.N. (2023). Best Practices in Cardiac Nursing Care. Critical Care Nursing Clinics, 35(2), 67-79.
- Martinez, L.K., & Lee, S.H. (2023). Patient Education Strategies in Coronary Artery Disease Management. Patient Education and Counseling, 106(4), 890-901.
