Nursing Process- Angina Pectoris

NURSING PROCESS: ANGINA PECTORIS

Assessment 
Gather information about the patient’s symptoms and activities, especially those that precede and precipitate attacks of angina pectoris. In addition, assess the
patient’s risk factors for CAD, the patient’s response to angina, the patient’s and family’s understanding of the diagnosis, and adherence to the current treatment plan.

Diagnosis 

Nursing Diagnoses 

• Ineffective cardiac tissue perfusion secondary to CAD as evidenced by chest pain or other prodromal symptoms 
• Death anxiety 
• Deficient knowledge about underlying disease and methods for avoiding complications 
• Noncompliance, ineffective management of therapeutic regimen related to failure to accept necessary lifestyle changes.

Planning and Goals 

Goals include immediate and appropriate treatment when angina occurs, prevention of angina, reduction of anxiety, awareness of the disease process and understanding of the prescribed care, adherence to the self-care program, and absence of complications.

Nursing Interventions 
Treating Angina 

• Take immediate action if the patient reports pain or if the person’s prodromal symptoms suggest anginal ischemia
• Direct the patient to stop all activities and sit or rest in bed in a semi-Fowler’s position to reduce the oxygen requirements of the ischemic myocardium.
• Measure vital signs and observe for signs of respiratory distress.
• Administer nitroglycerin sublingually and asses the patient’s response (repeat up to three doses). Administer oxygen therapy if the patient’s respiratory rate is increased or if the oxygen saturation level is decreased. 
• If the pain is significant and continues after these interventions, the patient is further evaluated for acute MI and may be transferred to a higher-acuity nursing unit. 

Reducing Anxiety 

• Explore the implications that the diagnosis has for the patient.
• Provide essential information about the illness and methods of preventing progression. Explain the importance of following prescribed directives for the ambulatory patient at home.
• Explore various stress reduction methods with the patient. 

Preventing Pain

• Review the assessment findings, identify the level of activity that causes the patient’s pain or prodromal symptoms, and plan the patient’s activities accordingly.
• If the patient has pain frequently or with minimal activity, alternate the patient’s activities with rest periods. Balancing activity and rest is an important aspect of the educational plan for the patient and family.

Teaching Patients Self-Care

• The teaching program for the patient with angina is designed so that the patient and family understand the illness, identify the symptoms of myocardial ischemia, state the actions to take when symptoms develop and discuss methods to prevent chest pain and the advancement of CAD.
• The goals of education are to reduce the frequency and severity of anginal attacks, to delay the progress of the underlying disease if possible, and to prevent complications. • Collaborate on a self-care program with patient, family, or friends.
• Plan activities to minimize angina episodes.
• Teach the patient that any pain unrelieved within 15 minutes by the usual methods, including nitroglycerin, should be treated at the closest emergency center. 

Evaluation 
Expected Patient Outcomes

• Reports that pain is relieved promptly 
• Reports decreased anxiety 
• Understands ways to avoid complications and demonstrates freedom from complications 
• Complies with self-care program