Primary Nursing Diagnosis

Altered tissue perfusion (myocardial) related to narrowing of the coronary artery(ies) and associated with atherosclerosis, spasm, or thrombosis

OUTCOMES. Cardiac pump effectiveness; Circulation status; Comfort level; Pain control behavior; Pain level; Tissue perfusion: Cardiac

INTERVENTIONS. Cardiac care; Cardiac precautions; Oxygen therapy; Pain management; Medication administration; Circulatory care; Positioning

H PLANNING AND IMPLEMENTATION Collaborative

For any patient who is experiencing an acute anginal episode, pain management is the priority, not only for patient comfort but also to decrease myocardial oxygen consumption. The physician orders selected therapies that either decrease myocardial oxygen demand or increase coronary blood and oxygen supply. These therapies may include short-term bedrest; oxygen therapy;

80 Angina Pectoris cardiac monitoring to prevent potential complications; and small, frequent, easily digested meals. Surgical and other invasive options are discussed under Coronary Artery Disease.

DIET. A collaborative effort among the patient, dietitian, physician, and nurse plans for a diet low in cholesterol, fat, calories, and sodium. Drinks in the coronary care unit or step-down unit are usually decaffeinated and not too hot or cold.

VITAL SIGNS. During unstable periods, the nurse and physician closely monitor the patient's vital signs and her or his response to pain-relieving therapies (narcotics, nitrates). Often the patient is placed on a cardiac monitor to determine if life-threatening dysrhythmias occur during an anginal episode, particularly if the angina may be a symptom that the patient is having an MI.

Pharmacologic Highlights

Medication or Drug Class

Dosage

Description

Rationale

Nitroglycerin (NTG)

0.3-0.6 mg prn SL for stable

Nitrate

Relieves ischemic symptoms

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