Nursing Care Plan for Angina Pectoris - Nursing Diagnosis : Decreased Cardiac Output
Angina pectoris is chest pain often due to ischemia of the heart muscle, due in general to obstruction or spasm of the coronary arteries. The main cause of angina pectoris is improper contractivity of the heart muscle and coronary artery disease, due to atherosclerosis of the arteries feeding the heart.
Angina pectoris can be quite painful, but many patients with angina complain of chest discomfort rather than actual pain: the discomfort is usually described as a pressure, heaviness, tightness, squeezing, burning, or choking sensation. Apart from chest discomfort, anginal pains may also be experienced in the epigastrium (upper central abdomen), back, neck area, jaw, or shoulders. This is explained by the concept of referred pain, and is due to the fact that the spinal level that receives visceral sensation from the heart simultaneously receives cutaneous sensation from parts of the skin specified by that spinal nerve's dermatome, without an ability to discriminate the two. Typical locations for referred pain are arms (often inner left arm), shoulders, and neck into the jaw. Angina is typically precipitated by exertion or emotional stress. It is exacerbated by having a full stomach and by cold temperatures. Pain may be accompanied by breathlessness, sweating, and nausea in some cases. In this case, the pulse rate and the blood pressure increases. Chest pain lasting only a few seconds is normally not angina (such as precordial catch syndrome).
Decreased Cardiac Output
Related to :
- Inotropic changes, such as transient or prolonged myocardial ischemia and effects of medications;
- alterations in rate, rhythm, and electrical conduction.
- Cardiac Pump Effectiveness
- Demonstrate increased activity tolerance.
- Report or display decreased episodes of dyspnea, angina, and dysrhythmias.
- Participate in behaviors and activities that reduce the workload of the heart.
Nursing Intervention for Angina Pectoris
1. Monitor vital signs, eg heart rate, blood pressure.
Rationale: Tachycardia can occur because of pain, anxiety, hypoxemia, and decreased cardiac output. Changes also occur in blood pressure (hypertension or hypotension) due to cardiovascular response.
2. Record the color and the presence / quality of the pulse.
Rationale: decreased peripheral circulation when cardiac output falls, making skin color pale or gray (depending on the level of hypoxia) and decreased strength of peripheral pulses.
3. Maintain bed rest in a comfortable position during the acute episode.
Rationale: Lowering the oxygen consumption / demand, lowering employment and risk of myocardial decompensation.
4. Provide supplemental oxygen as needed
Rationale: Increase the supply of oxygen to the need to improve myocardial contractility, decrease ischemia, and lactic acid levels.
Source : http://nursingdiagnosis-nursinginterventions.blogspot.com/2011/07/nursing-diagnosis-and-nursing_8092.html