Coronary Artery Disease Nursing Diagnosis and Nursing Care Plan

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Coronary Artery Disease Nursing Care Plans Diagnosis and Interventions

Coronary Artery Disease NCLEX Review and Nursing Care Plans

Coronary artery disease (CAD) is a medical condition which involves damage to the major blood vessels that provide the heart with oxygen and nutrients. CAD is usually caused by cholesterol deposits called plaques that cause inflammation and narrowing of the coronary arteries.

The buildup of plaque on the arterial walls narrow the coronary arteries, thereby decreasing the blood flow to the heart. When one of the coronary arteries is completely blocked, the person is likely to experience a heart attack. The classic sign of CAD is chest pain called angina.

Signs and Symptoms of Coronary Artery Disease

  • Angina – pain or discomfort located on the middle or left side of the chest. The patient will describe a CAD angina as: “tight”, “crushing”, or “heavy”. The patient may also verbalize that it feels like someone is standing on their chest, or that there is a feeling of pressure. This may be triggered by emotional or physical stress. The pain may radiate to the neck, shoulder, back, arm., or jaw.
  • Shortness of breath
  • Tachycardia
  • Hypertension
  • Tachypnea
  • Palpitations
  • Nausea (especially in women)
  • Dizziness
  • Sweating
  • Restlessness

Causes of Coronary Artery Disease

Coronary artery disease starts when there is injury or damage to the inner layer of coronary arteries. Cholesterol-containing deposits or “plaques” clump the site of damage.

The medical term for plaque buildup is atherosclerosis. When there is a rupture or break in the plaque, platelets arrive at the injury site in an attempt to repair that part of the artery. The clump of platelets called thrombus may block the artery, causing an obstruction of blood flow. This eventually results into myocardial infarction (M.I.), also known as heart attack.

There are several risk factors that may promote the buildup of plaque in a coronary artery. These include:

Complications of Coronary Artery Disease

  1. Arrythmias. Abnormal heart rhythms such as atrial fibrillation may result from the decreased blood supply in the heart. Irregular heartbeats may result to formation of more blood clots. These thrombi can travel to other parts of the body and become embolus/ emboli. When the embolus reaches the brain, the patient may suffer from stroke.
  2. Myocardial Infarction, acute coronary syndrome (ACS), or heart attack. Total blockage of a coronary artery may result to the lack of blood flow to the cardiac muscle.
  3. Heart Failure. Since the coronary arteries supply the heart with oxygen- and nutrient-rich blood, blockage in them may weaken the heart. This eventually leads to failure of the heart to supply blood to the rest of the body tissues.

Diagnostic Tests for Coronary Artery Disease

  • Blood tests – total lipid profile (fasting for 10 to 12 hours) and lipoprotein blood test (non-fasting) to determine the risk for CAD
  • Electrocardiogram (ECG)
  • Echocardiogram – utilizes sound waves to create images of the heart
  • Exercise stress test – use of ECG while the patient is on a treadmill or a stationary bike. This may also be used with an echo. Nuclear stress tests is a more advanced version where in a tracer is injected into the bloodstream for the cameras to create images.
  • Cardiac catheterization and angiogram
  • Cardiac CT scan

Treatment of Coronary Artery Disease

Medications. The following drugs may be used to treat coronary artery disease, as well as the accompanying chest pain (angina):

  • 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.
  • Nitrates – to relax the blood vessels.
  • Anti-cholesterol drugs (e.g. statins) – 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 – used in combination with beta blockers
  • Ranolazine – to treat angina

Surgery. Surgical interventions are required if the medical team believes that an urgent, more aggressive treatment for CAD 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.

Lifestyle changes. Smoking is one of the biggest risk factors of CAD. The nicotine in cigarettes facilitate 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.

Another lifestyle change is to commit to 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.

Regular taking of prescribed blood pressure medications also helps control hypertension. Increasing physical activity by doing at least 150 minutes of moderate aerobic exercises will help promote an active lifestyle.

Lastly, learning stress management techniques is helpful in lowering the risk for CAD. Some alternative medicine may help, including fish oil, flaxseed oil, canola oil, and soybean oil.

Coronary Artery Disease Nursing Diagnosis

Coronary Artery Disease Nursing Care Plan 1

Decreased cardiac output related to the disease process of coronary artery disease (CAD) as evidenced by fatigue and inability to do ADLs as normal

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

Nursing Interventions Coronary Artery DiseaseRationale
Assess the patient’s vital signs and characteristics of heartbeat 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. Heart murmur sounds is an important sign of endocarditis. The presence of signs of decreasing peripheral tissue perfusion indicate deterioration of the patient’s status which require immediate referral to the physician.
Administer prescribed medications for coronary artery disease.    Aspirin – to reduce the ability of the blood to clot, so that the blood flows easier through the narrowed arteries. Nitrates – to relax the blood vessels. Anti-cholesterol drugs (e.g. statins) – 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 – used in combination with beta blockers Ranolazine – to treat angina
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.

Coronary Artery Disease Nursing Care Plan 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 bpm, 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 Coronary Artery DiseaseRationale
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.

Coronary Artery Disease Nursing Care Plan 3

Altered Tissue Perfusion (Myocardial)

Nursing Diagnosis: Altered Tissue Perfusion (Myocardial) related to decreased arterial flow due to occlusion, secondary to coronary artery disease (CAD), as evidenced by abnormal vital signs, pallor, pain, weak pulses, and abnormal heart rate

Desired Outcome: The patient will demonstrate adequate perfusion as evidenced by normal temperature, distal pulses, and skin color in the extremities.

Nursing Interventions Coronary Artery DiseaseRationale
Monitor the patient’s blood pressure, respiration, and heart rate changes. Note any indicators of an impending anginal attack such as dyspnea, palpitations, nausea, and vomiting.  Significant findings include variations in BP, HR, and respiratory rate. Other subjective symptoms involve changes in the skin pallor, decreased amplitude of pulses, and skin coolness. These symptoms are an early indicator of reduced cardiac output, which occurs during an ischemia myocardial episode. Increasing HR and BP indicate an increase in oxygen demand, necessitating immediate medical attention. Additionally, monitoring the patient’s vital signs may be important if the patient is asymptomatic or experiencing vague sensations that could mask the anginal episode.
Perform cardiac stress test.Stress testing is a non-invasive cardiac examination that evaluates the coronary arteries’ integrity and the presence of fatty deposits. It evaluates arterial blood flow, valve function, and aberrant wall motion. Additionally, conducting a cardiac stress test assists in determining the risk of developing cardiac disease and identifies any other tests that may be required.
Monitor the patient’s cardiac rhythm, ECG, and ST elevations.These tests show evidence of angina pectoris secondary to CAD. Moreover, ECG findings can identify localized hyperkalemia (heart block) and myocardial infarction.
Administer supplemental oxygen if necessary and shift the patient to a supine position to improve oxygenation of the myocardium.Reduced perfusion is a common cause of hypoxia. It also puts additional strain on the myocardium. Supplemental oxygen delivery may be indicated in patients with coronary artery disease to compensate for decreased oxygen supply and supply oxygen to the myocardium.
Allow no more than 30 degrees of head elevation if cardiac catheterization is in the temporal artery.Bed rest is typically indicated for individuals with cardiovascular disease, as reduced tissue perfusion caused by occlusion results in pain complaints. Repositioning the head of the bed (HOB) facilitates optimum excursion by relieving pressure on the lungs at low risk and cost. Moreover, acute hip joint flexion, which might impair blood flow, is prevented by this technique.
Assess changes in respirations (e.g., depth, rate, sounds) and increased work of breathing.Respiratory distress and breathing difficulties can occur due to low oxygen supply. At the same time, the presence of dysrhythmias can be an indication of heart ischemia.
Prompt smoking cessation.Smoking is one of the many risk factors for coronary artery disease (CAD), and avoiding it is a critical preventative measure. Its association can be derived from the harmful effects of nicotine in the vascular epithelium of coronary arteries, which leaves it susceptible or damaged. The artery wall can become occluded due to calcium deposition (atheroma) caused by smoking. Smoking also raises serum low-density lipoprotein (LDL) and triglycerides and decreases high-density lipoprotein (HDL) cholesterol in the blood, which further promotes atherosclerosis.
Recommend dynamic or passive leg routines rather than isometric exercises.Isometric exercises can increase oxygen consumption and myocardial workload. Rather than performing vigorous workouts, it is recommended to perform passive exercise routines to increase venous return and decrease venous stasis.
Explain and prepare for surgical interventions such as stent placement, percutaneous transluminal angioplasty, and coronary artery bypass graft (CABG) if one is planned.Patients with incapacitating claudication may require surgical intervention to open an obstructed artery or bypass the vessel in order to enhance distal circulation.  Coronary artery bypass graft or CABG reroutes blood around the occluded artery in the heart. Angioplasties enhance blood flow in an obstructed coronary artery by compressing atheromatous plaques and dilating the vascular lumen. In addition to PTA, intracoronary stents may be implanted to increase the likelihood of long-term patency. Stent placements are preferred over invasive CABG surgery; however, the latter is the favorable treatment option if myocardial ischemia is confirmed by testing.
Administer thrombolytics as prescribed.To dissolve the clot and restore blood circulation. Thrombolytics partially unblock the occluded artery to prevent complete obstruction by plague or embolus.

Coronary Artery Disease Nursing Care Plan 4

Deficient Knowledge

Nursing Diagnosis: Deficient Knowledge related to unfamiliarity with disease pathophysiology and treatment, secondary to coronary artery disease (CAD), as evidenced by avoidance behavior, difficulty complying with instructions, frequent questions, and requests for information.

Desired Outcomes:

  • The patient will take an active role in the learning process and take responsibility for his or her own learning.
  • The patient will verbalize comprehension of the condition, its complications, and risk factors.
Nursing Interventions Coronary Artery DiseaseRationale
Review the relevant risk factors for CAD with the patient.  Risk factor identification assists with managing and modifying the care plan, such as: adjusting diet to reduce cholesterol, smoking cessation, and scheduling regular exercises. Additionally, it aids in treatment progression and reveals the need for pharmacologic intervention in the event that risk factor management is unsuccessful.
Identify communication barriers (e.g., impaired speech, disability, avoidance behavior, language barriers, noncompliance).Communication barriers can limit a patient’s ability to comprehend information.  
Educate the patient about the disease process, therapeutic regimen, and complications. Emphasize the need for stress management to prevent and manage anginal episodes.One of the main focuses of therapeutic management is promoting a healthy lifestyle and reducing the likelihood of myocardial infarction through awareness and communication. Explaining the pathophysiology of CAD helps enhance patients’ literacy of their condition. It prevents fear of uncertainty and brings them a sense of control. Moreover, patients who are knowledgeable about the purpose of intervention and regimen are more likely to adhere to the planned care plan.
Explain the effect of CAD on the desired lifestyle. Provide support, consultation, and privacy as needed.When a patient is fearful of the condition, hesitancy and noncompliance can be observed. Increasing the patient’s awareness of his or her health status and expressing support can satisfy the patient’s interest in making lifestyle modifications and transitions to reducing debilitating habits.
Evaluate the patient’s knowledge of the catheterization procedure.Catheterization is usually performed to diagnose and treat cardiovascular diseases, including arterial occlusion. Assessment of the patient’s level of understanding helps nurses meet expected outcomes and confirm that knowledge of the complication has been delivered.
Allow the patient to practice and perform techniques (e.g., deep breathing, Valsalva’s maneuver) that will be employed during the cardiac catheterization.Due to their familiarity with the approach, the patient is more likely to follow preoperative instructions and make fewer errors. Apart from enhancing coordination, it also alleviates anxiety and hyperventilation connected with the procedure, which might aggravate angina episodes or chest pain.
Instruct the patient to be vigilant for indications of fatigue, respiratory distress, and sexual dysfunction and promptly contact the health care provider if any of these signs or symptoms are noticed.Patients taking drugs may experience adverse effects such as hypotension. They must also be aware of the potential for rebound tachycardia if the medication is discontinued.
Discuss the relevance and process of monitoring one’s HR and BP during and after scheduled activities.It helps the patient determine which activities should be modified to alleviate cardiac stress.  
Review cholesterol levels, LDL, and HDL levels. Instruct the patient to report any changes in drug tolerance or the frequency of angina attacks.An LDL concentration of 160 mg/dL is considered normal for patients who are not predisposed to any risk factors. Whereas LDL cholesterol levels below 100 mg/dL and HDL cholesterol levels below 35 necessitate rapid intervention. Subjective reports can ameliorate mortality and prevent hyperventilation to the treatment regimen.
Encourage the patient to avoid triggering factors that may provoke an anginal episode.Strenuous physical activity, temperature extremes, stress, and late-night heavy meals can increase the risk of myocardial infarction, ischemic attack, and stroke. Avoidance of precipitating factors is usually indicated in patients with CAD since it can reduce the incidence of ischemic episodes.
Remind the patient to always consult his/her handling physician before taking any over-the-counter medications.Certain supplements and herbal drugs, including ginseng, are contraindicated due to their potential to cause hypotension. Coadministration with other drugs may potentially impair efficacy and raise the risk of recurrence of hypertension and dysrhythmias. OTC medications may augment or cancel out the effects of prescribed medications.
Explain the significance of follow-up appointments.Stenosis can form outside the operative area if the patient has had CABG, implantation, or catheterization. Emotional aspects are also taken into account. Referral to a cardiologist may also be recommended if symptomatic alleviation, implementation of therapies, and measures do not result in an improvement in prognosis.

Coronary Artery Disease Nursing Care Plan 5

Anxiety

Nursing Diagnosis: Anxiety related to the threat of illness, secondary to coronary artery disease (CAD), as evidenced by fear, restlessness, unease, poor self-perception, powerlessness, diminished self-esteem, and concern over potential changes in life conditions

Desired Outcomes:

  • The patient will communicate fear and concerns effectively
  • The patient will express knowledge of anxiety and demonstrate healthy coping mechanisms.
Nursing Interventions Coronary Artery DiseaseRationale
Assess the level of anxiety using the following indicators:

Mild: Presence of restlessness, hyper-focusing, irritability

Moderate: Verbalization of concerns, insomnia, increased heart rate, inability to focus

Severe: Hallucinations, tachypnea, and inability to focus or converse

Panic: Fearful expressions, poor eye contact, tremors, hyperventilation, poor eye contact, tachycardia, nausea, and preoccupation with the past
Establishing the patient’s anxiety level helps nurses identify and personalize interventions that match the patient’s individual needs.  
Monitor and report significant findings such as chest pain and an irregular heart rate.Anxiety is a risk factor for developing cardiovascular diseases, most notably heart failure and coronary artery disease (CAD). Chest pain is frequently the result of a panic attack or heightened response, and it can be fatal if not handled appropriately.
Provide orientation and education to the patient regarding the stress test and its processes.  By explaining the processes to the patient, anxiety associated with fear of an unknown diagnosis and prognosis is reduced. Understanding the therapeutic regimen’s purpose alleviates tension, provides a sense of control and increases compliance with the treatment plan or therapy.
Explain the pathophysiology of the condition using plain language. Inform the patient about the surgical procedure and the post-operative equipment that will be used. Provide support and understanding.Patient education and awareness is the most effective method of reducing anxiety. Anxiety causes the release of catecholamines, which increases myocardial workload, prolongs ischemic discomfort, and increases the risk of sudden cardiac arrest.
Validate the patient’s feelings and fears. Reassure him/her that feeling anxious is completely normal.Acknowledging and validating feelings promotes therapeutic communication, verifies nursing assessment, and alleviates fear and stress. Additionally, it improves their capacity for coping by facilitating the expression of emotions. Negative sentiments should be avoided at all costs, as they might contribute to fear and anxiety, aggravating angina attacks.
Allow the patient to practice and perform techniques (e.g., deep breathing, Valsalva’s maneuver) that will be employed during the cardiac catheterization.Due to their familiarity with the approach, the patient is more likely to follow preoperative instructions and make fewer errors. Apart from enhancing coordination, it also alleviates anxiety and hyperventilation connected with the procedure, which might aggravate angina episodes or chest pain.
Collaborate with other health care team members to determine the most effective drug therapy for patients suffering from disabling anxiety.Severe panic episodes or anxiety can interfere with a patient’s day-to-day life. If it reaches chronic levels, medication may be necessary to ease its symptoms. However, the possibility of adverse effects and aggravation is always present.
Advise family and significant other/s to continue treating the patient in the same manner as before.It helps the patient maintain their sense of self-worth by assuring them that their place in the family and at work has not changed. Reassurance helps the patient respond to a healthcare consultation with less fear and concern.
Administer sedatives or tranquilizers if necessary.Conscious sedation may be necessary to increase comfort and tolerance and relieve anxiety. It works by reducing brain activity, hence promoting relaxation. After reestablishing relaxation, it is possible to strengthen coping skills. It also aids in the alleviation of stress and anxiety, which can precipitate angina.
Administer vasodilators as prescribedThese are antianginal drugs that lower blood pressure and reduce work in the left ventricle. Since ischemic heart disease obstructs the artery and affects blood flow, hypoxia is a resulting outcome. This medication can also reduce heart load and relieve hypoxic conditions and hyperventilation.

More Coronary Artery Disease Nursing Diagnosis

Coronary Artery Disease Practice Quiz 5 Questions with Rationales – Randomized

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#1. A 52-year old male patient arrives in the cardiac unit and is diagnosed with congestive heart failure. The cardiologist prescribes hydrochlorothiazide for him. Which of the following statements show that the patient understands your teaching about this medication?

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Answer: A

Rationale: Hydrochlorothiazide is a diuretic drug that is indicated for hypertension, heart failure, and kidney diseases. Dizziness is the most common side effect of hydrochlorothiazide. Quick changes of position may trigger dizziness, lightheadedness or even fainting. Other common side effects include headache and stomach upset.

#2. . A 47-year old female patient who has a recent history of anterior wall myocardial infarction presents in the emergency unit with difficulty of breathing. Upon auscultation, the nurse hears crackles in the lungs. Which of the following medical conditions is associated to this sign?

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Answer: B

Rationale: Crackles are usually heard in the lungs of patients with left-sided heart failure. A patient with AWMI may have decreased left ventricular function, causing the fluid to accumulate in the alveolar and interstitial spaces of the lungs.

#3. A 74-year old female patient is admitted to the cardiac unit and is suspected to have heart failure. The nurse hears murmurs upon auscultation of the patient’s chest. This may indicate:

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Answer: A

Rationale: Heart murmurs may indicate valvular incompetence. Reduced cardiac pumping action may be manifested by weak S1 and S2 sounds. Gallop rhythms of S3 and S4 sounds may indicate noncompliant heart chambers.

#4. A 72-year old patient came to the cardiac unit and is diagnosed with anterior wall myocardial infarction (AWMI). The nurse looking after this patient understands that the anterior cardiac wall is supplied with blood by which of the following arteries?

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Answer: B

Rationale: The left anterior descending artery is responsible for the blood supply of the anterior wall of the heart. AWMI occurs when there is a lesion near the left anterior descending artery.

#5. A 64-year old female patient comes into the emergency room with a chief complaint of severe chest pain. To assess myocardial damage, the nurse should expect the doctor to order which of the blood tests?

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Answer: B
Rationale: Within one hour of myocardial damage, rapid elevation of the Troponin I levels can be detected. A person with no heart injury has no detectable Troponin I level. LDH is also helpful in the diagnosis of cardiac damage; however, LDH is also found in other body tissues and not specific to cardiac muscles.

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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. (2018). 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

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The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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