Coronary artery disease is plaque buildup in the arteries that feed the heart muscle. Narrow arteries can cause chest pain and raise the risk of a heart attack. Your priorities are managing chest pain, improving activity tolerance, and teaching risk factor changes.
A · AssessmentD · DiagnosisP · PlanningI · InterventionE · Evaluation
Each care plan below follows the nursing process (ADPIE).
CARE PLAN 1 · NURSING DIAGNOSIS
PLANNING · EXPECTED OUTCOMES
ASSESSMENT
Acute Pain
Related to
- Reduced blood flow to the heart muscle
- Imbalance between oxygen supply and demand
As evidenced by
- Client reports chest pressure or tightness
- Pain with exertion that eases with rest or nitroglycerin
- Tachycardia and anxiety
Short-term goals
- Client reports chest pain relief within 15 minutes of treatment
Long-term goals
- Client has fewer angina episodes and knows how to manage them
- Pain location, quality, severity, and duration
- Vital signs before and after nitroglycerin
- 12-lead ECG with chest pain
- Triggers for pain
| INTERVENTION | RATIONALE |
|---|---|
| Stop activity and have the client rest | Rest lowers the heart's oxygen demand. |
| Give nitroglycerin as ordered, checking BP first | Nitroglycerin widens blood vessels but can drop BP. |
| Give oxygen if SpO2 is below the ordered goal | Oxygen helps when saturation is low. |
| Obtain a 12-lead ECG during pain as ordered | The ECG can show ischemia while it is happening. |
EVALUATION
- Client reports pain relief
- BP stays stable after nitroglycerin
- Client states triggers to avoid
CARE PLAN 2 · NURSING DIAGNOSIS
PLANNING · EXPECTED OUTCOMES
ASSESSMENT
Activity Intolerance
Related to
- Reduced oxygen supply to the heart
- Deconditioning
As evidenced by
- Fatigue with activity
- Shortness of breath on exertion
- Chest pain with exertion
Short-term goals
- Client completes self-care without chest pain by discharge
Long-term goals
- Client takes part in cardiac rehab and gradually increases activity
- Heart rate, BP, and SpO2 before and after activity
- Signs of intolerance like chest pain, dizziness, or dyspnea
| INTERVENTION | RATIONALE |
|---|---|
| Increase activity gradually as ordered | Slow increases build tolerance without overworking the heart. |
| Plan rest periods between activities | Rest prevents fatigue and angina. |
| Refer to cardiac rehab as ordered | Supervised exercise improves heart health and confidence. |
| Teach risk factor changes like quitting smoking and eating heart healthy | These slow plaque buildup. |
EVALUATION
- Client completes self-care without chest pain
- Vital signs stay within limits during activity
- Client states plans for cardiac rehab
Quick answers
How should a client take sublingual nitroglycerin for chest pain?
Take 1 tablet under the tongue and call 911 if pain is not better or is worse 5 minutes after the first dose, then follow the provider's instructions for more doses.
Which lab is a major risk factor for CAD?
High LDL cholesterol. Lowering LDL with diet and statins slows plaque buildup.
For learning only. Individualize every care plan to your client, and follow your program, current guidelines, provider orders, and facility policy.