Nursing Process: The Patient With Angina Pectoris - PDF

1/16/24, 10:23 PM Realizeit for Student NURSING PROCESS The Patient With Angina Pectoris Assessment The nurse gathers information about the patient’s symptoms and activities, especially those that precede and precipitate attacks of angina pectoris. Appropriate questions are listed in Chart 23-4....

1/16/24, 10:23 PM Realizeit for Student NURSING PROCESS The Patient With Angina Pectoris Assessment The nurse gathers information about the patient’s symptoms and activities, especially those that precede and precipitate attacks of angina pectoris. Appropriate questions are listed in Chart 23-4. The answers to these questions form the basis for designing an effective program of treatment and prevention. In addition to assessing angina pectoris or its equivalent, the nurse also assesses the patient’s risk factors for CAD, the patient’s response to angina, the patient’s and family’s understanding of the diagnosis, and adherence to the current treatment plan. Diagnosis Nursing Diagnoses Based on the assessment data, major nursing diagnoses may include: •Risk for impaired cardiac function •Anxiety associated with cardiac symptoms and possible death •Lack of knowledge about the underlying disease and methods for avoiding complications •Able to perform self care https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zbfuwFjUs0mdxkPeVey4KH2F7i%2fH0LC0NH7inQLoUzK%2fM… 1/8 1/16/24, 10:23 PM Realizeit for Student Collaborative Problems/Potential Complications Potential complications may include the following: Acute Coronary Syndrome (ACS) and/or Myocardial Infarction (MI) Arrhythmias and cardiac arrest Heart failure Cardiogenic shock Planning and Goals Major patient goals include immediate and appropriate treatment when angina occurs, prevention of angina, reduction of anxiety, awareness of the disease process and understanding of the prescribed care, adherence to the self-care program, and absence of complications. Nursing Interventions TREATING ANGINA If the patient reports pain (or cardiac ischemia is suggested by prodromal symptoms, which may include sensations of indigestion or nausea, choking, heaviness, weakness or numbness in the upper extremities, dyspnea, or dizziness), the nurse takes immediate action. The patient experiencing angina is directed to stop all activities and https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zbfuwFjUs0mdxkPeVey4KH2F7i%2fH0LC0NH7inQLoUzK%2fM… 2/8 1/16/24, 10:23 PM Realizeit for Student sit or rest in bed in a semi-Fowler position to reduce the oxygen requirements of the ischemic myocardium. The nurse assesses the patient’s angina, asking questions to determine whether the angina is the same as the patient typically experiences. A change may indicate a worsening of the disease or a different cause. The nurse then continues to assess the patient, measuring vital signs and observing for signs of respiratory distress. If the patient is in the hospital, a 12-lead ECG is usually obtained and assessed for ST-segment and T-wave changes. If the patient has been placed on cardiac monitoring with continuous ST-segment monitoring, the ST segment is assessed for changes. Nitroglycerin is given sublingually, and the patient’s response is assessed (relief of chest pain and effect on blood pressure and heart rate). If the chest pain is unchanged or is lessened but still present, nitroglycerin administration is repeated up to three doses. Each time blood pressure, heart rate, and the ST segment (if the patient is on a monitor with ST-segment monitoring capability) are assessed. The nurse administers oxygen therapy if the patient’s respiratory rate is increased or if the oxygen saturation level is decreased. Oxygen is usually given at 2 L/min by nasal cannula, even without evidence of desaturation, although there is no current evidence of a positive effect on patient outcome. If the pain is significant and continues after these interventions, the patient is further evaluated for acute MI and may be transferred to a higher-acuity nursing unit (Ibanez et al., 2018). REDUCING ANXIETY Patients with angina often fear loss of their roles within society and the family. They may also fear that the pain (or the prodromal symptoms) may lead to an MI or death. Exploring the implications that the diagnosis has for the patient and providing information about the illness, its treatment, and methods of preventing its progression are important nursing interventions. Various stress reduction methods, such as guided imagery or music therapy, should be explored with the patient (Meghani, 2017). Addressing the spiritual needs of the patient and family may also assist in allaying anxieties and fears. PREVENTING PAIN The nurse reviews the assessment findings, identifies the level of activity that causes the patient’s pain or prodromal symptoms, and plans the patient’s activities accordingly. If the patient has pain frequently or with minimal activity, the nurse alternates the patient’s activities with rest periods. Balancing activity and rest is an important aspect of the educational plan for the patient and family. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zbfuwFjUs0mdxkPeVey4KH2F7i%2fH0LC0NH7inQLoUzK%2fM… 3/8 1/16/24, 10:23 PM Realizeit for Student PROMOTING HOME, COMMUNITY-BASED, AND TRANSITIONAL CARE Educating Patients About Self-Care. The program for educating the patient with angina is designed so that the patient and family understand the illness, identify the symptoms of myocardial ischemia, state the actions to take when symptoms develop, and discuss methods to prevent chest pain and the advancement of CAD. The goals of education are to reduce the frequency and severity of anginal attacks, to delay the progress of the underlying disease if possible, and to prevent complications. Example The Patient Tube: All About Angina The Patient Tube: Cardiac | Angina for NCLEX RN https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zbfuwFjUs0mdxkPeVey4KH2F7i%2fH0LC0NH7inQLoUzK%2fM… 4/8 1/16/24, 10:23 PM Realizeit for Student The Patient Tube: Understanding Angina: Visual Explanation for Students Summary Chest pain can be very deceptive. It is a subjective discomfort experienced by the individual, which may be of cardiac or non-cardiac origin. In the short term, the safest course is to always assume it is cardiac until the prevalence of data convinces otherwise. Angina is the most commonly reported manifestation of cardiac chest pain. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zbfuwFjUs0mdxkPeVey4KH2F7i%2fH0LC0NH7inQLoUzK%2fM… 5/8 1/16/24, 10:23 PM Realizeit for Student Typical angina is described as a pressure, heaviness, and/or a burning sensation. The discomfort of angina is the result of insufficient oxygen in one or more areas of the heart muscle. Angina Pectoris is the expected companion of ischemic heart disease. The oxygen deficit created by a reduced blood flow in the arteries feeding the myocardium typically results in what is often described as a 'vice-like squeezing', 'burning', 'elephant on the chest’, ‘crushing', 'heaviness' that is located behind the mid-sternum and may radiate into the arms, neck or jaw. Angina pectoris is a cardiac emergency as it indicates that the myocardial cells are experiencing a critical stress due to the lack of sufficient oxygen to the heart muscle. This ischemic event is usually due to a decrease in the blood flow to the cardiac tissue resulting from a physical constriction or blockage of one or more of the arteries that supply the tissues of the heart. When angina pectoris occurs, that person is at an increased risk of heart attack, cardiac arrest, or sudden cardiac death. Review Angina pectoris is a clinical syndrome resulting from an oxygen deficit to the living tissue of the heart. It is the presence of chest pain or discomfort of a constricting or suffocating quality. Angina pectoris is commonly caused by myocardial ischemia and occurs when the cells of the heart muscle need more oxygen. For example, climbing a flight of stairs could trigger an attack of angina in one person while walking on flat ground might not in that same individual. Angina may happen during exercise, strong emotions, or extreme temperatures. Angina is commonly described as chest pain or discomfort that happens when the heart does not get enough oxygen-rich blood. It may feel like tightness, pressure, squeezing, or pain in the chest. The patient may also feel discomfort in the shoulders, arms, back, https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zbfuwFjUs0mdxkPeVey4KH2F7i%2fH0LC0NH7inQLoUzK%2fM… 6/8 1/16/24, 10:23 PM Realizeit for Student neck, and jaw; angina can sometimes feel like indigestion. Other symptoms of angina include nausea, tiredness, shortness of breath, sweating, and dizziness. The two most common types of angina are called stable and unstable. Stable angina happens when the heart is working harder than usual and usually goes away with rest. The pain has a regular pattern, lasts 5 minutes or less, and comes and goes at expected times, such as during exercise. Unstable angina does not have a pattern and happens more often. It is usually more uncomfortable and lasts longer than stable angina. This type of angina may signal a heart attack and requires emergency treatment. What causes angina? Angina happens when the vessels that supply blood to the heart become narrow or blocked. It is usually a symptom of coronary artery disease, which occurs when a waxy substance called plaque builds up in those arteries. They become narrow, slowing or stopping blood flow and causing discomfort. Some risk factors can increase the chances of getting coronary artery disease and angina. These include smoking, diabetes, high blood pressure, high "bad" cholesterol or triglyceride levels, a family history of heart disease, lack of exercise, obesity, and stress. The risk also goes up if the patient is a man over age 45 or a woman over age 55. Diagnosing Angina A stress test. During the stress test, the patient will walk on a treadmill, pedal a stationary bicycle, or receive a medicine. Blood pressure and ECG will be watched closely. This test shows how the heart responds to exercise. An echocardiogram. This test, which uses sound waves to make images of the heart, can show parts of the heart that are not getting enough blood. Other tests include chest X-rays, blood tests, cardiac computed tomography, or magnetic resonance imaging. Nursing education Making some lifestyle changes can help Stop smoking https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zbfuwFjUs0mdxkPeVey4KH2F7i%2fH0LC0NH7inQLoUzK%2fM… 7/8 1/16/24, 10:23 PM Realizeit for Student If overweight, losing weight Increase physical activity Eat a healthy, low-fat diet, including lots of whole grains, fruits, and vegetables Avoid eating large meals Find ways to relax and manage stress Medication Nitrates Beta-Adgrenergic Blocking Agents Calcium Ion Antagonists A daily low-dose aspirin to help prevent blood clots that can block blood vessels Antiplatelets A medical procedure such as angioplasty, where a small balloon is inserted into the heart's blood vessels to open them may also be used. A stent may be used to help keep the blood vessels open or a coronary artery bypass surgery. During this surgery, one or more veins or arteries from somewhere else in the body, or synthetic ones, are used to bypass a blocked or narrowed artery. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zbfuwFjUs0mdxkPeVey4KH2F7i%2fH0LC0NH7inQLoUzK%2fM… 8/8