VI. Nursing Diagnosis
• Ineffective, cardiac tissue perfusion secondary to CAD, as evidenced by chest pain or equivalent symptoms
• Death anxiety
• Deficient knowledge about the underlying disease and methods for avoiding complications
• Noncompliance, ineffective management of therapeutic regimen related to failure to accept necessary lifestyle changes.
VII. Nursing Management
• The nurse directs 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.
• Continue to assess the patients, measuring vital signs and observing for signs of respiratory distress.
• Exploring the implications that the diagnosis has for the patient and providing information about the illness.
• The nurse reviews the assessment findings, identifies the level of activity that causes the patient’s pain and plans the patient’s activities accordingly.
• Balancing activity and rest is an important aspect of the educational plan for the patient and family.
• Exploring what the patient and family see as their priorities in managing the disease and developing a plan based on those priorities can assist with patient adherence to the therapeutic regimen.
• The goals of the educational program are to reduce the frequency and severity of angina attacks to delay the progress of the underlying disease if possible and to prevent complications.
• Administer oxygen as ordered to relieve dyspnea and prevent arrhythmias
• Provide bed rest with semi-Fowler’s position to decrease cardiac workload
• Monitor ECG and hemodynamic procedures
• Administer arrhythmias as ordered
• Perform complete lung/cardiovascular assessment
• Monitor urinary output and report output of less than 30 ml/hr; indicates decreased cardiac output
• Maintain full liquid diet with gradual increase to soft; low sodium
• Maintain quiet environment
• Administer stool softeners as ordered to facilitate bowel evacuation and prevent straining
• Administer coagulants, as ordered
• Provide client teaching and discharge planning:
o Reduce the probability of an episode of angina plan by balancing rest and activity.
o Avoid using medications or any over-the-counter substances (diet pills, nasal decongestants) that can increase the heart rate and blood pressure without first discussing with a health care provider.
o Stop smoking and other use of tobacco, and avoid second-hand smoke (because smoking increase the heart rate, blood pressure and blood carbon monoxide levels)
o Eat a diet low in saturated fat, high in fiber and if indicated, lower in calories.
o Achieve and maintain normal blood pressure.
o Achieve and maintain normal blood glucose level.
o Take medications, especially aspirin and beta-blockers as prescribed.
o Carry nitroglycerin at all times; state when and how to use it; identify its side effects