Nursing care plan

Nursing Care Plan for Coronary Artery Disease (CAD)

Also searched as: CAD, coronary heart disease, ischemic heart disease

Plaque made of fat, cholesterol, calcium and other material builds up inside the coronary arteries and narrows them, so the heart muscle gets less oxygen-rich blood. It is the most common type of heart disease in the United States. Some people have no symptoms until a heart attack; others get chest pain, pressure or shortness of breath with exertion or stress that goes away with rest. Nursing care assesses and relieves chest pain, recognizes pain that may be a heart attack, supports the medicines and procedures the provider orders, and teaches the risk-factor changes that slow the disease.

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What do you assess in the Coronary Artery Disease care plan?

• Subjective: chest pain, pressure, squeezing, tightness or burning that may spread to the shoulders, arms, neck, jaw or back; shortness of breath with activity; unusual tiredness; what brings symptoms on and what relieves them; smoking, diet, activity, and a family history of early heart disease
• Objective: vital signs during and after chest pain, ECG findings and heart rhythm, cholesterol and blood glucose results, blood pressure and weight trends; women are more likely than men to have dizziness, extreme tiredness, nausea or stomach pain instead of chest pain during a heart attack

Which nursing diagnoses apply to Coronary Artery Disease?

What are the goals and expected outcomes for Coronary Artery Disease?

Each goal below follows the SMART format: specific, measurable, achievable, relevant, time-bound.

• The patient will report any chest discomfort right away, and each episode will be relieved with rest and prescribed medicine or escalated immediately if it occurs at rest or does not go away.
• The patient will complete the activity agreed with the care team (for example, walking in the hallway three times a day) without chest pain or shortness of breath before discharge.
• Before discharge, the patient will name two personal risk factors to change, how to take each heart medicine, and which symptoms mean calling 911.

What are the nursing interventions for Coronary Artery Disease, and why?

Intervention	Rationale
Assess every episode of chest pain (location, quality, spread, severity, trigger and what relieves it), record vital signs, and obtain an ECG as ordered.	Chest pain that does not go away or that occurs at rest may be a heart attack, and an ECG shows the heart's rhythm and signs of low blood flow.
Give heart medicines as prescribed (nitrates such as nitroglycerin, beta blockers, ACE inhibitors or ARBs, calcium channel blockers, statins, antiplatelet therapy), checking blood pressure and heart rate before doses.	Nitrates widen the coronary arteries and relieve angina, blood pressure medicines reduce how hard the heart works, statins slow plaque buildup, and antiplatelet therapy helps prevent clots.
Pace activity: plan rest periods, increase walking step by step, and stop for chest pain, shortness of breath or dizziness.	Symptoms usually start with exertion or stress and go away with rest, so pacing keeps oxygen demand within what the narrowed arteries can supply.
Teach heart-healthy changes: quit smoking, eat fruits, vegetables and whole grains with less saturated fat, salt and added sugar, stay active at the level the provider allows, and keep blood pressure, cholesterol and glucose in range.	These risk factors drive plaque buildup, and NHLBI lists heart-healthy lifestyle changes as the first part of treatment.
Ask the provider about a cardiac rehabilitation referral and explain what the program involves.	Cardiac rehabilitation is a medically supervised exercise program, and studies show it lowers the risk of hospitalization and death.
Teach when to call 911: chest pain at rest, chest pain that does not go away, or heart attack symptoms such as cold sweats, nausea, shortness of breath or lightheadedness.	Calling 911 lets emergency staff begin treatment on the way to the hospital.

How do you evaluate the Coronary Artery Disease care plan?

• Chest pain episodes reported, assessed and relieved, or escalated without delay
• Agreed activity completed without angina or shortness of breath
• Patient names personal risk factors, the medicine schedule and when to call 911
• Cardiac rehabilitation referral discussed with the provider

Where do these Coronary Artery Disease recommendations come from?

• NHLBI: What Is Coronary Heart Disease?
• NHLBI: Coronary Heart Disease Treatment
• MedlinePlus: Coronary Artery Disease