Nursing care plan angina CAD ACS

ANGINA (CORONARY ARTERY DISEASE, ACUTE
CORONARY SYNDROME)

I. Pathophysiology
a. The disorder is characterized by a narrowing of coronary
arteries due to atherosclerosis, spasm or, rarely, embolism.
b. Atherosclerotic changes in coronary arteries results in damage
to the inner layers of the coronary arteries with stiffening
of vessels and diminished dilatory response.
c. Accumulation of fatty deposits and lipids, along with
development of fibrous plaques over the damaged areas in
the vessels, causes narrowing of the arteries, thus reducing
the size of the vessel’s lumen and impeding blood flow to
the myocardial tissues.
d. Decreased delivery of oxygen and nutrients to the tissues
causes transient myocardial ischemia and pain.
e. Hard plaque causes hardened arteries, whereas soft plaque
can cause formation of blood clots.

II. Types

a. Stable
i. Most common type, precipitated by physical exertion,
emotional stress, exposure to hot or cold temperatures,
heavy meals, and smoking
ii. Occurs in a regular pattern, usually lasts 5 minutes or
less, and is easily relieved by medications
b. Unstable
i. May be new onset of pain with exertion or at rest, or
recent acceleration in severity of pain
ii. Occurs in no regular pattern, usually lasts longer (30 minutes),
not generally relieved with rest or medications
iii. Sometimes grouped with myocardial infarction (MI)
under the diagnosis of acute coronary syndrome (ACS)
c. Variant (Prinzmetal’s)
i. Rare, usually occurs at rest—midnight to early morning
hours
ii. Pain possibly severe
iii. Electrocardiogram (ECG) changes due to coronary
artery spasm

III. Classification

a. New York Heart Association Classification (9th edition
update, 1994) quantifies the functional limitation imposed
by patients’ symptoms:
i. Class I—no limitation of ordinary physical activity
ii. Class II—slight limitation of ordinary physical activity
iii. Class III—moderate limitation of activity; comfortable
at rest, but less than ordinary activities cause symptoms
iv. Class IV—unable to perform any physical activity
without discomfort, therefore severe limitation and may
be symptomatic even at rest
b. Canadian Cardiovascular Society Functional Classification
(CCSC) System of unstable angina aids in determining the
risk of adverse outcomes and level of treatment needs:
i. Class 1—no angina with usual physical activities such
as walking, climbing stairs; occurs with strenuous,
rapid, or prolonged exertion at work or recreation
ii. Class 2—slight limitation of ordinary activity with
angina occurring with moderate exertion such as walking
or climbing stairs rapidly, walking uphill, activity
after meals, activity in cold or wind, during emotional
stress, or during the few hours after awakening
iii. Class 3—marked limitations of ordinary physical
activity with angina occurring during mild exertion,
such as walking one to two level blocks or climbing one
flight of stairs at a normal pace
iv. Class 4—angina at any level of physical exertion; may
be present even at rest

IV. Etiology

a. Increased cardiac workload: exertion, hypertension, aortic
stenosis or regurgitation, hypertrophic cardiomyopathy
b. Decreased O2 supply: severe anemia, hypoxia
c. Risk factors: being overweight and obese, smoking, sedentary
lifestyle, diabetes, family history of early heart disease,
metabolic syndrome (fasting hyperglycemia and insulin
resistance, hypertension, central obesity, decreased highdensity
lipoprotein [HDL] and elevated low-density
lipoprotein [LDL] cholesterol, elevated triglycerides)
V. Statistics (National Heart, Lung and Blood Institute
[NHLBI], 2007; Centers for Disease Control and Prevention
[CDC], 2007b)
a. Morbidity: There are an estimated 79.4 million Americans
with some form of cardiovascular disease.
i. Coronary artery disease (CAD) accounting for 15.8 million;
angina, approximately 9 million
ii. 400,000 new cases annually, most are over age 65
b. Prevalence: leading cause of death in Caucasians, African
Americans, Hispanics, and American Indians for both males
and females
c. Mortality: There were 872,000 deaths from cardiovascular
disease in 2004; accounts for approximately
36% of total deaths.
d. Cost: An estimated $432 billion was spent in 2007.

Care Setting

Clients judged to be at intermediate or high risk for MI are
often hospitalized for further evaluation and therapeutic
intervention.

Related Concerns

Cardiac surgery: postoperative care,
Dysrhythmias,
Heart failure: chronic,
Myocardial infarction,
Psychosocial aspects of care,

Nursing Priorities

1. Relieve or control pain.
2. Prevent or minimize development of myocardial complications.
3. Provide information about disease process, prognosis,
and treatment.
4. Support client or significant other (SO) in initiating
necessary lifestyle or behavioral changes.

Discharge Goals

1. Desired activity level achieved, with return to activity
baseline, and self-care needs met with minimal or no
pain.
2. Remains free of complications.
3. Disease process, prognosis, and therapeutic regimen
understood.
4. Participates in treatment program and behavioral
changes.
5. Plan in place to meet needs after discharge.

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