Nursing Care Plans for Coronary Artery Disease – Best Nursing Care Plans(2022)

This article discusses Nursing Care Plans for Coronary Artery Disease plus its causes, symptoms, preventions, treatments, and interventions.

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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Introduction

Coronary artery disease (CAD) is a medical condition that 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 narrows 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.

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:

• Smoking
• High blood pressure
• High cholesterol diet
• Sedentary lifestyle
• Diabetes or insulin resistance

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 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

Complications of Coronary Artery Disease

• Arrhythmias – Abnormal heart rhythms such as atrial fibrillation may result from the decreased blood supply in the heart. Irregular heartbeats may result in the 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.

• Myocardial Infarction, acute coronary syndrome (ACS), or heart attack. Total blockage of a coronary artery may result to a lack of blood flow to the cardiac muscle.
• 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 the 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 are a more advanced version wherein 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 –reduces 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 a balloon and insertion of a stent to keep the blood vessel open.

Lifestyle changes

1. Smoking is one of the biggest risk factors for CAD. The nicotine in cigarettes facilitates 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.
2. Another lifestyle change is to commit to low cholesterol, and 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.
3. 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.
4. 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.

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Nursing Care Plans for Coronary Artery Disease Based on Diagnosis

Nursing Care Plan 1: Diagnosis – Acute Pain

May be related to:

• Decreased myocardial blood flow
• Increased cardiac workload/oxygen consumption

Possibly evidenced by

• Reports of pain varying in frequency, duration, and intensity (especially as the condition worsens)
• Narrowed focus
• Distraction behaviors (moaning, crying, pacing, restlessness)
• Autonomic responses, e.g., diaphoresis, blood pressure and pulse rate changes, pupillary dilation, increased/decreased respiratory rate

Desired Outcomes

• Report anginal episodes decreased in frequency, duration, and severity.
• Demonstrate relief of pain as evidenced by stable vital signs, absence of muscle tension and restlessness

Nursing Interventions	Rationale
Instruct patient to notify nurse immediately when chest pain occurs.	Pain and decreased cardiac output may stimulate the sympathetic nervous system to release excessive amounts of norepinephrine, which increases platelet aggregation and release of thromboxane A2. This potent vasoconstrictor 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.
Assess and document patient response to medication.	Provides information about disease progression. Aids in evaluating effectiveness of interventions, and may indicate need for change in therapeutic regimen.
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.
Observe for associated symptoms: dyspnea, nausea and vomiting, dizziness, palpitations, desire to micturate.	Decreased cardiac output (which may occur during ischemic myocardial episode) stimulates sympathetic and parasympathetic nervous system, causing a variety of vague sensations that patient may not identify as related to anginal episode.
Evaluate reports of pain in jaw, neck, shoulder, arm, or hand (typically on left side).	Cardiac pain may radiate. Pain is often referred to more superficial sites served by the same spinal cord nerve level.
Place patient at complete rest during anginal episodes.	Reduces myocardial oxygen demand to minimize risk of tissue injury.
Elevate head of bed if patient is short of breath.	Facilitates gas exchange to decrease hypoxia and resultant shortness of breath.
Monitor heart rate and rhythm.	Patients with unstable angina have an increased risk of acute life-threatening dysrhythmias, which occur in response to ischemic changes and/or stress.
Monitor vital signs every 5 min during initial anginal attack.	Blood pressure may initially rise because of sympathetic stimulation, then fall if cardiac output is compromised. Tachycardia also develops in response to sympathetic stimulation and may be sustained as a compensatory response if cardiac output falls.
Stay with patient who is experiencing pain or appears anxious.	Anxiety releases catecholamines, which increase myocardial workload and can escalate and/or prolong ischemic pain. Presence of nurse can reduce feelings of fear and helplessness.
Maintain quiet, comfortable environment. Restrict visitors as necessary.	Mental/emotional stress increases myocardial workload.
Provide light meals. Have patient rest for 1 hr after meals.	Decreases myocardial workload associated with work of digestion, reducing risk of anginal attack.
Provide supplemental oxygen as indicated.	Increases oxygen available for myocardial uptake and reversal of ischemia.
Administer antianginal medication(s) promptly as indicated:
Nitroglycerin: sublingual (Nitrostat), buccal, or oral tablets, metered-dose spray.	Nitroglycerin has been the standard for treating and preventing anginal pain for more than 100 yr. Today it is available in many forms and is still the cornerstone of antianginal therapy.
sublingual isosorbide dinitrate (Isordil)	Rapid vasodilator effect lasts 10–30 min and can be used prophylactically to prevent, as well as abort, anginal attacks.
Sustained-release tablets, caplets: (Nitrong, Nitro Cap T.D.), chewable tablets (Isordil, Sorbitrate), patches, transmucosal ointment (Nitro-Dur, Transderm-Nitro)	Long-acting preparations are used to prevent recurrences by reducing coronary vasospasms and reducing cardiac workload. May cause headache, dizziness, light-headedness, symptoms that usually pass quickly. If headache is intolerable, alteration of dose or discontinuation of drug may be necessary. Note: Isordil may be more effective for patients with variant form of angina. Reduces frequency and severity of attack by producing continuous vasodilation.
Beta-blockers: acebutolol (Sectral), atenolol (Tenormin), nadolol (Corgard), metoprolol (Lopressor), propranolol (Inderal)	Reduces angina by reducing the heart’s workload. Note: Often these drugs alone are sufficient to relieve angina in less severe conditions.
Calcium channel blockers: bepridil (Vascor), amlodipine (Norvasc), nifedipine (Procardia), felodipine (Plendil), isradipine (DynaCirc), diltiazem (Cardizem)	Produces relaxation of coronary vascular smooth muscle; dilates coronary arteries; decreases peripheral vascular resistance.
Analgesics:  acetaminophen (Tylenol)	Usually sufficient analgesia for relief of headache caused by dilation of cerebral vessels in response to nitrates.
Morphine sulphate (MS)	Potent narcotic analgesic may be used in acute onset because of its several beneficial effects, e.g., causes peripheral vasodilation and reduces myocardial workload; has a sedative effect to produce relaxation; interrupts the flow of vasoconstricting catecholamines and thereby effectively relieves severe chest pain. MS is given IV for rapid action and because decreased cardiac output compromises peripheral tissue absorption.
Monitor serial ECG changes.	Ischemia during anginal attack may cause transient ST segment depression or elevation and T wave inversion. Serial tracings verify ischemic changes, which may disappear when patient is pain-free. They also provide a baseline against which to compare later pattern changes.

Nursing Care Plan 2: Diagnosis – Deficient Knowledge: Absence or deficiency of cognitive information related to a specific topic.

May be related to

• Lack of exposure
• Inaccurate/misinterpretation of information
• Unfamiliarity with information resources

Possibly evidenced by

• Questions; statement of concerns
• Request for information
• Inaccurate follow-through of instructions

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Desired Outcomes

• Participate in learning process.
• Assume responsibility for own learning, looking for information and asking questions.
• Verbalize understanding of condition/disease process and potential complications.
• Verbalize understanding of /participate in therapeutic regimen.
• Initiate necessary lifestyle changes.

Nursing Interventions	Rationale
Discuss pathophysiology of condition. Stress need for preventing and managing anginal attacks.	Patients with angina need to learn why it occurs and what they can do to control it. This is the focus of therapeutic management to reduce likelihood of myocardial infarction and promote healthy heart lifestyle.
Review significance of cholesterol levels and differentiate between LDL and HDL factors. Emphasize importance of periodic laboratory measurements.	Although recommended LDL is ±160 mg/dL, patients with two or more risk factors (smoking, hypertension, diabetes mellitus, positive family history) should keep LDL ±130 mg/dL, and those with diagnosis of CAD need to keep LDL below 100 mg/dL. HDL below 35–45 is considered a risk factor; a level above 60 mg/dL is considered an advantage.
Encourage avoidance of situations that may precipitate anginal episode (stress, intense physical exertion, large heavy meals especially during bedtime, exposure to extreme temperatures).	Doing so would reduce the incidence or severity of ischemic episodes.
Assist patient and/or SO to identify sources of physical and emotional stress and discuss ways that they can be avoided.	This is a crucial step in preventing anginal attacks.
Review importance of weight control, cessation of smoking, dietary changes, and exercise.	Knowledge of the significance of risk factors provides patient with opportunity to make needed changes. Patients with high cholesterol who do not respond to 6-month program of low-fat diet and regular exercise will require medication.
Encourage patient to follow prescribed reconditioning program; caution to avoid exhaustion.	Fear of triggering attacks may cause patient to avoid participation in activity that has been prescribed to enhance recovery (increase myocardial strength and form collateral circulation).
Discuss impact of illness on desired lifestyle and activities, including work, driving, sexual activity, and hobbies. Provide information, privacy, or consultation, as indicated.	Patient may be reluctant to resume usual activities because of fear of anginal attack or death. Patient should take nitroglycerin prophylactically before any activity that is known to precipitate angina.
Demonstrate how to monitor own pulse and BP during and after activities, and to schedule activities, avoid strain and take rest periods.	Allows patient to identify those activities that can be modified to avoid cardiac stress and stay below the anginal threshold.
Discuss steps to take when anginal attacks occur, (cessation of activity, keeping “rescue” NTG on hand, administration of prn medication, use of relaxation techniques).	Being prepared for an event takes away the fear that patient will not know what to do if attack occurs.
Review prescribed medications for prevention of anginal attacks:	Angina is a complicated condition that often requires the use of many drugs given to decrease myocardial workload, improve coronary circulation, and control the occurrence of attacks.
Lipid-lowering agents: bile acid sequestrants, cholestyramine (Questran), colestipol (Colestid);	These drugs are considered first-line agents for lowering serum cholesterol levels. Note: Questran and Colestid may inhibit absorption of fat-soluble vitamins and some drugs such as Coumadin, Lanoxin, and Inderal.
nicotinic acid, and HMG-CoA reductase inhibitors: lovastatin (Mevacor), simvastatin (Zocor)	The HMG-CoA reductase inhibitors may cause photosensitivity.
Stress importance of checking with physician before taking OTC drugs.	OTC drugs may potentiate or negate effects of prescribed medications.
Discuss ASA and other antiplatelet agents as indicated.	May be given prophylactically on a daily basis to decrease platelet aggregation and improve coronary circulation.
Review symptoms to be reported to physician: increase in frequency of attacks, changes in response to medications.	May prolong survival rate of patients with unstable angina. Knowledge of expectations can avoid undue concern for insignificant reasons or delay in treatment of important symptoms.
Discuss importance of follow-up appointments.	Angina is a symptom of progressive coronary artery disease that should be monitored and may require occasional adjustment of treatment regimen.

Nursing Care Plan 3: Diagnosis – Anxiety

May be related to

• Situational crises
• Threat to self-concept (altered image/abilities)
• Underlying pathophysiological response
• Threat to or change in health status (disease course that can lead to further compromise, debility, even death)
• Negative self-talk

Possibly evidenced by

• Expressed concern regarding changes in life events
• Increased tension/helplessness
• Apprehension, uncertainty, restlessness
• Association of diagnosis with loss of healthy body image, loss of place/influence
• View of self as noncontributing member of family/society
• Fear of death as an imminent reality

Desired Outcomes

• Verbalize awareness of feelings of anxiety and healthy ways to deal with them.
• Report anxiety is reduced to a manageable level.
• Express concerns about effect of disease on lifestyle, position within family and society.
• Demonstrate effective coping strategies/problem-solving skills.

Nursing Interventions	Rationale
Explain purpose of tests and procedures: stress testing.	Reduces anxiety attributable to fear of unknown diagnosis and prognosis.
Promote expression of feelings and fears. Let patient/SO know these are normal reactions.	Unexpressed feelings may create internal turmoil and affect self-image. Verbalization of concerns reduces tension, verifies level of coping, and facilitates dealing with feelings. Presence of negative self-talk can increase level of anxiety and may contribute to exacerbation of angina attacks.
Encourage family and friends to treat patient as before.	Reassures patient that role in the family and business has not been altered.
Tell patient the medical regimen has been designed to limit future attacks and increase cardiac stability.	Encourages patient to test symptom control, to increase confidence in medical program, and to integrate abilities into perceptions of self.
Administer sedatives, tranquilizers, as indicated.	May be desired to help patient relax until physically able to reestablish adequate coping strategies.

Nursing Care Plan 4: Diagnosis – 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 Disease	Rationale
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.

Related FAQs

1. What are the three symptoms of coronary artery disease?

What are the symptoms of coronary artery disease?

• Chest pain or discomfort (angina)
• Weakness, light-headedness, nausea (feeling sick to your stomach), or a cold sweat.
• Pain or discomfort in the arms or shoulder.
• Shortness of breath.

2. What is coronary artery disease most commonly caused by?

Causes of coronary artery disease

The most common cause of CAD is vascular injury with cholesterol plaque buildup in the arteries, known as atherosclerosis. Reduced blood flow occurs when one or more of these arteries becomes partially or completely blocked.

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3. Can you be cured from coronary artery disease?

Treating coronary heart disease (CHD)

Coronary heart disease cannot be cured but treatment can help manage the symptoms and reduce the chances of problems such as heart attacks. Treatment can include: lifestyle changes, such as regular exercise and stopping smoking.

4. What does a blocked artery feel like?

The symptoms of an artery blockage include chest pain and tightness, and shortness of breath. Imagine driving through a tunnel. On Monday, you encounter a pile of rubble. There is a narrow gap, big enough to drive through.

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