Nursing Care Plan – Angina

Nursing Care Plan – Angina

Angina is a temporary chest pain that results from inadequate oxygen flow to the myocardium. It’s usually described as burning, squeezing, or a tight feeling in the substernal or precordial chest. This pain may radiate to the left arm, neck, jaw, or shoulder blade. Typically, the patient clenches his fist over his chest or rubs his left arm when describing the pain, which may also be accompanied by nausea, vomiting, fainting, sweating, and cool extremities.

Angina commonly occurs after physical exertion, but may also follow emotional excitement, exposure to cold, or a large meal. It may also develop during sleep, and symptoms may awaken the patient.

When assessing for anginal pain, older adults commonly have an increased tolerance for pain, and may be less likely to complain. Instead, they may compensate by slowing their activity levels. Older adults may not experience chest pain at all, but may report dyspnea, faintness, or extreme fatigue.

The person’s health history may suggest a pattern to the type and onset of pain. If the pain is predictable and relieved by rest or nitrates, it’s called stable angina. If it increases in frequency and duration and is more easily induced, it’s referred to as unstable angina or unpredictable angina. Unstable angina may occur at rest and generally indicates extensive or worsening disease that may progress to an MI. Variant or Prinzmetal’s angina is caused by coronary artery spasm, and commonly occurs at rest without initial increased oxygen demand.

NURSING CARE PLAN

ASSESSMENT	DIAGNOSIS	INFERENCE	PLANNING	INTERVENTION	RATIONALE	EVALUATION
SUBJECTIVE: The patient may report: ·         Chest pain, heaviness, or pressure that may radiate to the shoulders, arms, neck, jaw, or upper abdomen. OBJECTIVE: ·         Tachycardia ·         Elevated blood pressure ·         Jugular vein distention ·         Cool, clammy skin	Acute pain related to decreased myocardial blood flow.	Angina can result from any condition in which there’s a decrease in oxygen delivery by the coronary arteries, an increase in cardiac workload, or an increase in the myocardium’s oxygen requirements. The most common cause is atherosclerosis, but angina can result from aortic stenosis, mitral stenosis or insufficiency, hypotension, hyperthyroidism, anemia, ventricular arrhythmias, or hypertension.	After 8 hours of nursing intervention the patient will: ·         Remain free from pain ·         Maintain stable vital signs. ·         Maintain relaxed body posture.	·         Assess for vital signs and symptoms of pain such as facial grimacing, rubbing of neck or jaw, reluctance to move, increased blood pressure, and tachycardia. Note onset, duration, location, and pattern of pain. ·         Use a pain rating scale to assess the patient’s perception of the pain’s severity. ·         Administer sublingual nitroglycerin as ordered. ·         Instruct the patient to notify a nurse immediately when experiencing pain. Have the patient stop current activity, and place him on bed rest in a semi- to high Fowler’s position. ·         Administer oxygen as ordered. ·         Obtain a 12-lead ECG immediately during acute chest pain. ·         Stay with the patient during chest pain episodes.	·         To differentiate angina pain from pain related to other causes. ·         To monitor the effectiveness of medications given for pain relief. ·         To decrease myocardial oxygen demands through vasodilation, preload and after load reduction and decreased cardiac work load. ·         To minimize ischemia produced by increased myocardial work load. ·         To provide optimal oxygenation to the myocardium. ·         To document ischemic changes. ·         To decrease anxiety and promote comfort.	After 8 hours of nursing intervention the patient was free from pain, maintains stable vital signs, and relaxed body posture.