- Acute Pain related to Myocardial injury and ischemia as evidenced by Expressions of chest pain tightness/etc and facial expression of pain
- Anxiety related to the potential threat of death and threat to change in health status as evidenced by expresses panic and Palpitations
- Decreased Cardiac Output related to Ineffective cardiac muscle contraction and difficulty of the heart muscle to pump as evidenced by dysrhythmias and difficulty breathing
| Assessment | Nursing Diagnosis | Planning/Outcomes | Intervention | Evaluation |
| Subjective data: -Verbal reports from the patient -Expressions of pain, such as crying -Unpleasant feeling Objective data: -Significant changes in vital signs -Changes in appetite or eating patterns -Changes in sleep patterns -Guarding or protective behaviors | Acute Pain related to Myocardial injury and ischemia as evidenced by Expressions of chest pain tightness/etc and Facial expression of pain | Patient will demonstrate the resolution of chest pain. Patient will identify potential causes of chest pain. | 1. Administer pain medications as indicated. Drug therapy for chest pain aims to promote pain relief and reduce the risks of myocardial infarction and death. Medications like short-acting nitrates, angiotensin-converting enzyme inhibitors, analgesics, and calcium channel blockers are given to promote myocardial perfusion. 2. Provide oxygen supplementation if necessary. Supplemental oxygen is provided to increase oxygenation to the myocardium. If oxygenation levels are normal, this may not be necessary. 3. Prepare for further testing. Stress tests, echocardiograms, and CTAs assess the need for further treatment. These tests can visualize blockages within coronary arteries. 4. Provide patient education. Ensure the patient understands how to recognize and treat stable angina. Offer education on administering nitro-glycerine tablets and when to seek further assistance. | Patient demonstrated the resolution of chest pain. Patient identified potential causes of chest pain. |
| Subjective Data: Feeling nervous Verbalizing a sense of impending danger -Difficulty controlling one’s worrying Objective data: -Restlessness and tense appearance -Tachycardia -Tachypnoea -Hyperventilation -Diaphoresis -Trembling/tremors | Anxiety related to the potential threat of death and threat to change in health status as evidenced by expresses panic and Palpitations | Patient will verbalize strategies to cope with fear and anxiety related to chest pain. Patient will verbalize a sense of safety and feelings of decreased fear. | 1. Provide verbal and physical reassurance of safety. Providing support and reassurance while the patient verbalizes fear and emotions can help reduce the patient’s anxiety levels. The nurse may also calmly rub the patient’s back or hold their hand to offer physical support. 2. Explore positive coping mechanisms with the patient. Chest pain, dyspnea, and other symptoms can be alarming. Teach the patient strategies to calm themselves such as breathing exercises or distraction. 3. Administer anti-anxiety medications. Fear and anxiety can be disruptive to the body and worsen outcomes. Administer benzodiazepines if necessary to promote relaxation and reduce fear. 4. Arm with knowledge. A patient who is confident in monitoring and managing their health will experience less fear and anxiety. Discuss the patient’s chest pain, symptoms, and treatment once the threat has resolved so they feel in control. | Patient verbalized strategies to cope with fear and anxiety related to chest pain. Patient verbalized a sense of safety and feelings of decreased fear. |
| Subjective Data: Feeling nervous Verbalizing about chest discomfort Objective data: -Increased central venous pressure (CVP) -Tachycardia -Dysrhythmias -Decreased oxygen saturation -Chest pain (angina) -Rapid breathing -Alteration in the level of consciousness -Inadequate tolerance in activities | Decreased Cardiac Output related to Ineffective cardiac muscle contraction and difficulty of the heart muscle to pump as evidenced by dysrhythmias and difficulty breathing | Patient will manifest adequate cardiac output as evidenced by normal sinus rhythm on ECG. Patient will demonstrate hemodynamic stability by vital signs (particularly the heart rate) within the normal range. Patient will not experience dyspnoea, restlessness, or fatigue from reduced cardiac output. | 1. Treat the underlying cause. Non-cardiac factors, non-ischemic cardiac disease, and ischemic cardiac disease can produce chest pain, resulting in an imbalance between the heart’s oxygen supply and demand. Non-cardiac causes include lung disease, musculoskeletal issues, anxiety/panic attacks, and gastric reflux disease. Pericardial disease is a possible non-ischemic cardiac cause. Coronary artery atherosclerosis and myocardial infarction are common causes of cardiac ischemia. 2. Risk factor management. Blood pressure, cholesterol, and blood sugar are controllable risk factors. Educate patients on medications and lifestyle modifications to reduce their individual risks. 3. Encourage participation and adherence to lifestyle modification. Lifestyle modifications reduce further plaque buildup and lessen blood vessel damage to maintain patent blood flow and supply. Regular exercise, maintaining a healthy weight, and quitting smoking are lifestyle changes that should be included in the patient’s education. 4. Administer medications as ordered. Antianginal medications such as nitro-glycerine provide immediate relief of angina. The general goal of symptomatic control is to reduce myocardial oxygen demand. 5. Control the heart rate. Three angina medications—beta-blockers, ivabradine, and non-dihydropyridine calcium channel blockers—reduce symptoms by lowering the heart rate. Calcium channel blockers should not be given in patients with a low ejection fraction and left ventricular failure. | Patient manifested adequate cardiac output as evidenced by normal sinus rhythm on ECG. Patient demonstrated hemodynamic stability by vital signs (particularly the heart rate) within the normal range. Patients’ dyspnoea, restlessness, or fatigue by reduced cardiac output. |