- Acute Pain related to Increased cardiac workload and decreased blood flow to the myocardium as evidenced by reports of chest pain or tightness varying in duration, frequency, and intensity
- Anxiety related to situational crisis or stressors and Underlying pathophysiological response as evidenced by Expression of distress and insecurity and fear of death as an impending reality
- Decreased Cardiac Output related to Inotropic changes like transient or prolonged myocardial ischemia as evidenced by Angina and Activity intolerance
| Assessment | Nursing Diagnosis | Planning/Outcomes | Intervention | Evaluation |
| Subjective data: -Verbal reports from the patient -Expressions of pain, such as crying -Unpleasant feeling (such as a prick, burn, or ache) 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 Increased cardiac workload and decreased blood flow to the myocardium as evidenced by reports of chest pain or tightness varying in duration, frequency, and intensity | Patient will demonstrate pain relief as evidenced by the absence of pain behaviors and stable vital signs. Patient will verbalize what to do when chest pain occurs and when to seek emergency assistance. | 1. Provide supplemental oxygen as needed. Supplemental oxygen can help maintain arterial oxygen saturation of 90% or higher. Oxygen should only be administered if SpO2 levels are below normal limits, as it can have a counterproductive effect. 2. Administer medications promptly as indicated. Nitroglycerin dilates coronary arteries to increase blood flow. Morphine sulfate may be ordered to promote comfort, relax smooth muscles, and decrease myocardial oxygen demand. Beta-blockers reduce the workload of the heart. 3. Raise the head of the bed. This position promotes comfort and reduces myocardial oxygen demand. Raising the head of the bed will facilitate gas exchange to minimize hypoxia and resultant shortness of breath. 4. Maintain a quiet and comfortable environment. This can help reduce anxiety and reduce chest pain. Mental and emotional stress can increase myocardial workload and pain. 5. Help the patient recognize triggers. Chest pain is often precipitated by a stressful or emotional event or exercise. Stopping the activity that is causing the chest pain can help the patient identify if the chest pain requires further assessment. | Patient demonstrated pain relief as evidenced by the absence of pain behaviors and stable vital signs. Patient verbalized what to do when chest pain occurs and when to seek emergency assistance. |
| Subjective data: -Feeling nervous -Verbalizing a sense of impending danger -Difficulty controlling one’s worrying Objective data: -Restlessness and tense appearance -Tachycardia -Tachypnea -Hyperventilation -Diaphoresis -Trembling/tremors -Weakness or tiredness -Difficulty concentrating -Difficulty sleeping -GI distress | Anxiety related to situational crisis or stressors and Underlying pathophysiological response as evidenced by Expression of distress and insecurity and fear of death as an impending reality | Patient will verbalize awareness of feelings of anxiety and healthy ways to cope with them. Patient will demonstrate two effective relaxation strategies. Patient will report that anxiety has been reduced to a manageable level. | 1. Encourage the patient to express feelings and fears. Unexpressed feelings and fears tend to develop into anxiety, affecting the patient’s overall health and aggravating existing health conditions like CAD. 2. Provide reassurance to the patient. Reassuring the patient can help relieve anxiety. Reiterate that they are safe. Present a calm presence to invoke a sense of control. 3. Administer medications as indicated. Benzodiazepines like alprazolam can help the patient relax until physically able to rebuild adequate coping strategies. 4. Provide accurate information about the disease. Patient education is vital because it allows the patient to understand what is happening and what to expect. It will also allow the patient to actively participate in the treatment regimen. 5. Encourage coping methods for relaxation. Remind and encourage the patient to practice coping strategies to decrease anxiety such as breathing exercises, meditation, distraction, and positive talk. | Patient verbalized awareness of feelings of anxiety and healthy ways to cope with them. Patient demonstrated two effective relaxation strategies. Patient reported that anxiety has been reduced to a manageable level. |
| Subjective data: -Feeling tired -Verbalizing a sense of impending danger Objective data: -Tachycardia -EKG changes -Angina -Activity intolerance -Fatigue -Restlessness | Decreased Cardiac Output related to Inotropic changes like transient or prolonged myocardial ischemia as evidenced by Angina and Activity intolerance | Patient will report decreased episodes of angina, dyspnea, and dysrhythmias. Patient will participate in activities that reduce the workload of the heart. | 1. Allow adequate rest periods. Rest periods decrease oxygen consumption and demand, reduce the risk of decompensation, and minimize myocardial workload. 2. Stress the importance of avoiding bearing down or straining. Valsalva maneuver can cause vagal stimulation which reduces heart rate and is followed by rebound tachycardia; both of these can impair cardiac output. 3. Administer medications as indicated. Inotropic medications like digoxin can raise cardiac output by making heart contractions stronger. 4. Prepare for tests and procedures. Echocardiograms show how blood moves through the heart and valves and can identify weak areas. Cardiac catheterizations or angiograms use guided catheters and dye to visualize blockages. | Patient reported decreased episodes of angina, dyspnea, and dysrhythmias. Patient participated in activities that reduce the workload of the heart. |