Nursing intervention for chest pain (angina pectoris) Pain Management (NIC) Independent 1.

Instruct patient to notify nurse immediately when chest pain occurs. Rationale: Pain and decreased cardiac output may stimulate thesympathetic nervous system to release excessive amountsof norepinephrine, which increases platelet aggregationand release of thromboxane A2. This potentvasoconstrictor causes coronary artery spasm, which can precipitate, complicate, and/or prolong an anginal attack.Unbearable pain may cause vasovagal response,decreasing BP and heart rate. 2.Assess and document patient response/effects of medication. Provides information about disease progression. Aids inevaluating effectiveness of interventions, and mayindicate need for change in therapeutic regimen. 3.Identify precipitating event, if any; frequency, duration,intensity, and location of pain. Helps differentiate this chest pain, and aids in evaluating possible progression to unstable angina. (Stable anginausually lasts 315 min and is often relieved by rest andsublingual nitroglycerin (NTG); unstable angina is moreintense, occurs unpredictably, may last longer, and is notusually relieved by NTG/rest.) 4.Observe for associated symptoms, e.g., dyspnea,nausea/vomiting, dizziness, palpitations, desire tomicturate Decreased cardiac output (which may occur duringischemic myocardial episode) stimulatessympathetic/parasympathetic nervous system, causing avariety of vague sensations that patient may not identifyas related to anginal episode. 5..Evaluate reports of pain in jaw, neck, shoulder, arm, or hand (typically on left side). Cardiac pain may radiate, e.g., pain is often referred tomore superficial sites served by the same spinal cordnerve level. 6.Place patient at complete rest during anginal episodes. Reduces myocardial oxygen demand to minimize risk of tissue injury/necrosis. 7.Elevate head of bed if patient is short of breath. Facilitates gas exchange to decrease hypoxia and resultantshortness of breath. 8.Monitor heart rate/rhythm. Patients with unstable angina have an increased risk of acute life-threatening dysrhythmias, which occur inresponse to ischemic changes and/or stress. 9.Monitor vital signs every 5 min during initial anginalattack. Blood pressure may initially rise because of sympatheticstimulation, then fall if cardiac output is compromised.Tachycardia also develops in response to sympatheticstimulation and may be sustained as a compensatoryresponse if cardiac output falls

1o.Stay with patient who is experiencing pain or appearsanxious. RATIONALE .Anxiety releases catecholamines, which increasemyocardial workload and can escalate/prolong ischemic pain. Presence of nurse can reduce feelings of fear andhelplessness.