Angina Pectoris (CAD) Nursing Care Plan

1. Immediate management of the anginal episode

• Stop all activity and place the patient at rest with the head of bed elevated — reducing demand is the fastest intervention available.
• Obtain a 12-lead ECG during the pain, since ischemic changes may disappear once it resolves.
• Give sublingual nitroglycerin every 5 minutes up to three doses, checking blood pressure before each; hold for systolic pressure below about 90 mmHg.
• Administer oxygen only if saturation is below 90% or the patient is dyspneic; routine oxygen in normoxic patients offers no benefit.
• Give aspirin to chew for suspected acute coronary syndrome unless contraindicated.
• Establish IV access, place on continuous cardiac monitoring and draw serial troponins.
• Stay with the patient and provide calm reassurance; anxiety raises heart rate and worsens the ischemia.
• Report pain unrelieved after three nitroglycerin doses, changing ECG or rising troponin immediately — this is infarction until proven otherwise.

2. Reducing myocardial oxygen demand

• Maintain bed or chair rest during pain and progress activity gradually with monitored response.
• Space activities and meals to avoid stacking demands; a large meal diverts blood flow to digestion.
• Keep the room comfortably warm and avoid cold exposure, which causes vasoconstriction.
• Manage constipation to avoid straining, which triggers a Valsalva response and a sudden change in cardiac load.
• Control heart rate, blood pressure, fever, anemia and hypoxemia, all of which shift the supply–demand balance.

3. Pharmacologic therapy

• Nitrates dilate veins and coronary arteries, reducing preload and improving supply; expect headache, flushing and dizziness, and teach the patient to sit or lie before taking a dose.
• Beta blockers lower heart rate, contractility and blood pressure and are first-line for chronic stable angina; hold for bradycardia or hypotension and never stop abruptly because of rebound ischemia.
• Calcium channel blockers are the drug of choice for Prinzmetal spasm and an alternative when beta blockers are contraindicated.
• Antiplatelet therapy — aspirin, with clopidogrel or ticagrelor added after stenting — reduces thrombotic occlusion; teach bleeding precautions and never to stop dual therapy without cardiology approval.
• High-intensity statins are given regardless of baseline cholesterol for plaque stabilization; monitor liver enzymes and report unexplained muscle pain.
• ACE inhibitors or ARBs are added for hypertension, diabetes, or reduced ejection fraction; monitor potassium, renal function and cough.
• Screen every patient for phosphodiesterase inhibitor use before giving any nitrate.

4. Monitoring for progression to infarction

• Compare each episode to the patient's baseline pattern; more frequent, longer or rest pain marks an unstable trajectory.
• Repeat ECGs with each new episode and follow serial troponins over hours rather than relying on a single value.
• Watch for signs of failing pump function: new crackles, S3, hypotension, falling urine output, cool extremities.
• Monitor continuously for dysrhythmias, particularly ventricular ectopy during ischemia.
• Prepare the patient for cardiac catheterization: NPO status, contrast and shellfish allergy history, renal function, and post-procedure site and pulse checks.

5. Risk-factor modification and cardiac rehabilitation

• Address smoking directly at every contact, offering pharmacologic aids and referral — cessation lowers cardiac risk more than any single medication.
• Teach a Mediterranean-style pattern emphasizing vegetables, fruit, whole grains, fish, olive oil and nuts, with reduced sodium, saturated fat and added sugar.
• Set concrete activity goals such as 30 minutes of moderate aerobic activity most days, built up gradually and stopped for chest pain or severe dyspnea.
• Coordinate diabetes and blood pressure control, since both accelerate coronary disease.
• Refer to a structured cardiac rehabilitation program, which improves both symptoms and survival.
• Discuss stress management, adequate sleep and screening for depression, which independently worsens cardiac outcomes.
• Talk openly about resuming sexual activity — generally safe when the patient can climb two flights of stairs without symptoms — and about the nitrate interaction.

What are the nursing diagnoses for Angina Pectoris?

Priority nursing diagnoses for Angina Pectoris: Acute pain; Decreased cardiac output; Anxiety; Deficient knowledge.

What are the nursing interventions for Angina Pectoris?

Stop all activity and place the patient at rest with the head of bed elevated — reducing demand is the fastest intervention available. Obtain a 12-lead ECG during the pain, since ischemic changes may disappear once it resolves. Give sublingual nitroglycerin every 5 minutes up to three doses, checking blood pressure before each; hold for systolic pressure below about 90 mmHg. Administer oxygen only if saturation is below 90% or the patient is dyspneic; routine oxygen in normoxic patients offers no benefit. Give aspirin to chew for suspected acute coronary syndrome unless contraindicated. Establish IV access, place on continuous cardiac monitoring and draw serial troponins.

What are the nursing care goals for Angina Pectoris?

The client will report chest pain relieved within minutes of intervention and will remain pain free at rest. The client will maintain stable vital signs, adequate perfusion and no dysrhythmia. The client will demonstrate correct sublingual nitroglycerin technique and state when to call emergency services. The client will identify personal triggers and describe two ways to reduce cardiac workload. The client will verbalize a specific plan for smoking cessation, diet, activity and medication adherence. The client will report anxiety at a manageable level.

What should you assess in a patient with Angina Pectoris?

Chest pressure, squeezing, tightness or heaviness — often described with a fist over the sternum; Radiation to the left arm, jaw, neck, shoulder or back; Associated dyspnea, nausea, indigestion-like discomfort or sudden fatigue; What provoked it, how long it lasted and what relieved it; Fear of dying and a sense of impending doom; ECG changes during pain: ST depression and T-wave inversion in ischemia; transient ST elevation in spasm; Troponin values — normal in angina, rising in infarction; Tachycardia or bradycardia, blood pressure changes, new S3, S4 or murmur; Diaphoresis, pallor, cool clammy skin, restlessness; Dysrhythmias on continuous monitoring; Lipid panel, glucose, hemoglobin A1c and body mass index for risk profiling