Angina Nursing Diagnosis & Care Plan

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Angina is chest pain that happens when the heart muscle isn’t getting enough oxygen. It’s a warning sign of heart problems, usually coronary artery disease. Patients may feel pressure, squeezing, or heaviness in the chest, and the discomfort can spread to the arms, neck, jaw, or back.

For nurses, quick recognition and care are essential to relieve symptoms, prevent heart damage, and teach patients how to manage their condition.

Common Causes

  • Plaque buildup in coronary arteries (atherosclerosis)
  • Coronary artery spasm
  • Severe anemia
  • Uncontrolled high blood pressure

Signs & Symptoms

Common:

  • Pressure or heaviness in the chest
  • Pain radiating to arm, neck, jaw, or back
  • Shortness of breath
  • Fatigue
  • Sweating, nausea, dizziness

Emergency:

  • Pain at rest or lasting longer than usual
  • Pain not relieved by nitroglycerin
  • More frequent or severe pain
  • Severe shortness of breath, pale or clammy skin, fainting

Nursing Assessment

Subjective:

  • Description of pain
  • Activity before onset
  • Relief factors
  • Associated symptoms

Objective:

  • Distress, anxiety, sweating
  • Vital signs (BP, HR, RR, oxygen level)
  • Heart/lung sounds
  • ECG changes
  • Skin color and temperature

Nursing Diagnoses (NANDA-I 2024–2026)

  1. Acute Pain related to decreased coronary blood flow and myocardial ischemia as evidenced by patient’s report of chest pressure 8/10 radiating to left arm, sweating, and anxiety.
  2. Decreased Cardiac Output related to impaired myocardial contractility secondary to ischemia as evidenced by hypotension, tachycardia, weak pulses, and reduced urine output.
  3. Activity Intolerance related to imbalance between oxygen supply and demand during exertion as evidenced by chest pain and shortness of breath with light activity.
  4. Anxiety related to threat of serious illness and unfamiliar hospital environment as evidenced by verbal expressions of fear, restlessness, and elevated heart rate.
  5. Deficient Knowledge related to lack of prior education about angina management as evidenced by inability to describe medication use or lifestyle changes.

Nursing Care Plans

1. Acute Pain

Nursing Diagnosis: Acute Pain related to decreased coronary blood flow and myocardial ischemia as evidenced by patient’s report of chest pressure 8/10 radiating to left arm, diaphoresis, and anxiety.

Goals/Outcomes:

  • Pain reduced to 0–1/10 within minutes of nitroglycerin.
  • Vital signs remain stable during pain episodes.

Interventions with Rationales:

  • Assess pain characteristics – Identifies severity, location, and triggers to guide care.
  • Administer nitroglycerin as prescribed – Dilates coronary arteries to improve blood flow.
  • Provide oxygen if O₂ sat <94% – Increases oxygen to heart tissue.
  • Position in semi-Fowler’s – Reduces cardiac workload and improves breathing.
  • Stay with the patient – Reassures and reduces anxiety.
  • Monitor vitals and ECG – Detects worsening ischemia or arrhythmias.

Evaluation: Pain resolved, vitals stable, patient comfortable.

2. Decreased Cardiac Output

Nursing Diagnosis: Decreased Cardiac Output related to impaired myocardial contractility secondary to ischemia as evidenced by hypotension, tachycardia, weak pulses, and reduced urine output.

Goals/Outcomes:

  • BP and HR within normal limits.
  • Warm skin, strong pulses.
  • Urine output ≥30 mL/hr.

Interventions with Rationales:

  • Monitor vitals, mental status, and cardiac rhythm – Detects early signs of low output.
  • Check skin warmth, pulses, urine output – Shows adequacy of circulation.
  • Limit activity – Prevents extra strain on the heart.
  • Give prescribed cardiac medications – Improves pumping or reduces workload.
  • Prepare for advanced treatment if needed – Allows rapid response to deterioration.

Evaluation: Circulation and perfusion normal, no signs of poor output.

3. Activity Intolerance

Nursing Diagnosis: Activity Intolerance related to imbalance between oxygen supply and demand during exertion as evidenced by chest pain and shortness of breath after minimal activity.

Goals/Outcomes:

  • Patient performs ADLs without pain or excessive fatigue.
  • Gradual increase in activity tolerance without symptoms.

Interventions with Rationales:

  • Assess baseline activity tolerance – Establishes safe starting point.
  • Schedule rest periods and assist with ADLs – Conserves energy and prevents angina episodes.
  • Teach to stop activity at onset of symptoms – Prevents worsening ischemia.
  • Gradually increase activity under supervision – Builds endurance safely.
  • Provide assistive devices as needed – Reduces energy demand during movement.

Evaluation: Patient completes ADLs without symptoms; vitals remain stable.

4. Anxiety

Nursing Diagnosis: Anxiety related to threat of serious illness and unfamiliar hospital environment as evidenced by verbal expressions of fear, restlessness, and elevated heart rate.

Goals/Outcomes:

  • Patient reports less anxiety.
  • Demonstrates relaxation techniques.

Interventions with Rationales:

  • Stay with the patient and speak calmly – Provides emotional support.
  • Encourage expression of fears – Reduces emotional tension.
  • Teach deep breathing – Slows heart rate, lowers stress.
  • Reduce environmental noise and stress – Creates a calming setting.
  • Explain care and procedures – Increases understanding and control.

Evaluation: Patient calmer, uses relaxation techniques, HR normal.

5. Deficient Knowledge

Nursing Diagnosis: Deficient Knowledge related to lack of prior education about angina management as evidenced by inability to describe medication use or lifestyle changes.

Goals/Outcomes:

  • Patient explains angina and treatment steps.
  • Lists three lifestyle changes to reduce episodes.

Interventions with Rationales:

  • Assess current knowledge – Identifies gaps in understanding.
  • Explain angina simply – Improves comprehension of condition.
  • Teach proper nitroglycerin use – Ensures safe and effective self-care.
  • Discuss lifestyle changes – Helps prevent recurrence.
  • Provide written resources – Supports learning after discharge.

Evaluation: Patient demonstrates correct medication use and names lifestyle changes.

Patient Tips

  • Avoid known angina triggers when possible.
  • Keep nitroglycerin with you and use it at first sign of pain.
  • Quit smoking and avoid secondhand smoke.
  • Follow a heart-healthy, low-salt diet.
  • Exercise with medical guidance.
  • Practice stress-reduction techniques.
  • Call emergency services if pain doesn’t improve after the first nitroglycerin dose.

References

  1. NANDA International. (2024). NANDA International Nursing Diagnoses: Definitions and Classification 2024–2026 (13th ed.). Thieme Publishers.
  2. Mayo Clinic. (2024). Angina – Symptoms and causes.
  3. National Heart, Lung, and Blood Institute. (2023). Angina (Chest Pain).
  4. American Heart Association. (2025). Guidelines for the Management of Patients with Acute Coronary Syndromes.
  5. Gillen, C., & Goyal, A. (2023). Stable Angina. StatPearls Publishing.