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Angina Pectoris Nursing Care Plan Management
Angina Pectoris Nursing Care Plan Management
Description
1. Angina is chest pain resulting from myocardial ischemia caused by inadequate myocardial blood
and oxygen supply.
3. Causes include obstruction of coronary blood flow because of atherosclerosis, coronary artery
spasm, and conditions increasing myocardial oxygen consumption.
4. The goal of treatment is to provide relief of an acute attack, correct the imbalance between
myocardial oxygen supply and demand, and prevent the progression of the disease ad further
attacks to reduce the risk of MI.
Patterns of angina
1. Stable angina
▪ Stable angina occurs with activities that involve exertion or emotional stress and is relieved with
rest or nitroglycerin.
▪ Stable angina usually has a stable pattern of onset, duration, severity, and relieving factors.
2. Unstable angina
▪ Unstable angina occurs with an unpredictable degree of exertion or emotion and increases in
occurrence, duration, and severity over time.
3. Variant angina
5. Pre-infarction angina
6. Post-infarction angina occurs after an MI, when residual ischemia may cause episodes of
angina.
Risk Factors
▪ Atherosclerosis
▪ Hypertension
▪ Diabetes Mellitus
▪ Thromboangitis Obliterans
▪ Polycythemia Vera
▪ Aortic Regurgitation
Assessment
1. Pain
d. Pain may radiate to the shoulders, arms, jaw, neck, and back.
e. Pain usually lasts less than 5 minutes, however, pain can last up to 15 to 20 minutes.
2. Dyspnea
3. Pallor
4. Sweating
5. Palpitations and tachycardia
6. Dizziness and faintness
7. Hypertension
8. Digestive disturbances
Diagnostic Evaluation
1. Electrocardiogram: Readings are normal during rest, with ST depression or elevation and/or T
wave inversion during an episode of pain.
2. Stress test: Chest pain or changes in the electrocardiogram or vital signs during testing may
indicate ischemia.
▪ Altered tissue perfusion (myocardial) related to narrowing of the coronary artery(ies) and
associated with atherosclerosis, spasm, or thrombosis
Other Diagnoses that may occur in Nursing Care Plans For Angina
▪ Acute pain
▪ Anxiety
▪ Deficient knowledge (Learning Need) regarding condition, treatment plan, self-care, and
discharge needs
Medical Management
The goals of medical management are to decrease the oxygen demands of the myocardium and
to increase the oxygen supply through pharmacologic therapy and risk factor control.
Surgical Management
Frequently, therapy includes a combination of medicine and surgery. Surgically, the goals of
management include revascularization of the blood supply to the myocardium.
▪ Coronary artery bypass surgery or minimally invasive direct coronary artery bypass (MIDCAB)
Pharmacologic Intervention
▪ Calcium ion antagonists and calcium-channel blockers (amlodipine [Norvase] and diltiazem
[Cardizem])
▪ Oxygen therapy
Nursing Intervention
Immediate management
1. Assess pain.
4. Administer nitroglycerin as prescribed to dilate the coronary arteries, reduce the oxygen
requirements of the myocardium and relieve the chest pain.
1. Instruct the client regarding the purpose of diagnostic medical and surgical procedures and the
pre-procedure and post-procedure expectations.
3. Instruct the client to stop activity and rest if chest pain occurs and to take nitroglycerin as
prescribed.
6. Provide diet instructions o the client, stressing that dietary changes are not temporary and must
be maintained or life.
8. Assist the client to set goals that will promote changes in lifestyle to reduce the impact of risk
factors.
9. Assist the client to identify barriers to compliance with therapeutic plan and to identify methods
to overcome barriers.
10. Provide community resources to the client regarding exercise, smoking reduction, and stress
reduction.
Documentation Guidelines
▪ Description of pain: Onset (sudden, gradual), character (aching, sharp, burning, pressure),
precipitating factors, associated symptoms (anxiety, dyspnea, diaphoresis, dizziness, nausea,
cyanosis, pallor), duration, and alleviating factors of the anginal episode
▪ PREVENTION. Teach the patient factors that may precipitate anginal episodes and the
appropriate measures to control episodes. Teach the patient the modifiable cardiovascular risk
factors and ways to reduce them. Manage risk factors, including hypertension, diabetes mellitus,
obesity, and hyperlipidemia.
▪ ACTIVITY. Each person has a different level of activity that will aggravate anginal symptoms.
Most patients with stable angina can avoid symptoms during daily activities by reducing the
speed of any activity.
▪ MEDICATIONS. Be sure the patient understands all medications, including the dose, route,
action, and adverse effects. If the patient’s physician prescribes sublingual nitroglycerin (NTG),
instruct the patient to lie in semi-Fowler position and take up to three tablets 5 minutes apart to
relieve chest discomfort. Instruct the patient that if relief is not obtained after ingestion of the
three tablets, he or she should seek medical attention immediately. Remind the patient to check
the expiration date on the NTG tablets and to replace the bottle, once it is opened, every 3 to 5
months.
▪ COMPLICATIONS. Teach the patient the importance of not denying or ignoring angina episodes
and of reporting them to the healthcare provider immediately.