Coronary artery disease (CAD), often referred to as coronary heart disease, is one of the leading cardiovascular conditions encountered in nursing practice. It occurs when the coronary arteries become narrowed or blocked due to a buildup of atherosclerotic plaque, reducing oxygen delivery to the heart muscle. This restriction can lead to angina, shortness of breath, arrhythmias, or even myocardial infarction.
For nursing students, understanding the nursing diagnosis for coronary artery disease is essential to planning effective patient care. By recognizing early warning signs and applying appropriate interventions, nurses play a vital role in stabilizing patients, reducing complications, and promoting lifestyle changes that lower future risk.
Key Points Nursing Students Should Remember
- Definition: CAD is the partial or complete obstruction of blood flow through the coronary arteries, leading to decreased myocardial oxygen supply.
- Primary risk factors: Hypertension, smoking, diabetes, obesity, high cholesterol, sedentary lifestyle, family history, and advanced age.
- Clinical manifestations: Chest pain or pressure (especially on exertion), fatigue, diaphoresis, shortness of breath, nausea, palpitations, or atypical signs in older adults.
- Diagnostics commonly seen in practice: Electrocardiogram (ECG), troponin levels, lipid profile, echocardiogram, stress testing, and cardiac catheterization.
- Common medical management: Antiplatelets (aspirin, clopidogrel), nitrates, beta-blockers, statins, ACE inhibitors, oxygen for hypoxemia, and revascularization procedures like PCI or CABG.
- Nursing priorities: Relieving ischemic pain, monitoring hemodynamic stability, supporting oxygen balance, educating on risk reduction, and reinforcing medication safety.
Focused Nursing Assessment for CAD
- Vital signs & oxygenation: Monitor heart rate, blood pressure, respiratory rate, and oxygen saturation at baseline and during episodes of chest discomfort.
- Cardiac rhythm monitoring: Watch for arrhythmias such as atrial fibrillation, ventricular tachycardia, or bradyarrhythmias.
- Pain assessment (PQRST): Helps differentiate ischemic chest pain from other causes.
- Activity response: Note tolerance to exercise or ADLs, including dyspnea, fatigue, and chest tightness.
- Psychosocial evaluation: Anxiety and stress can aggravate symptoms and hinder recovery.
- Laboratory review: Focus on lipid levels, blood glucose, troponin, and renal function to guide treatment decisions.
Nursing Care Plans for Coronary Artery Disease
Below are five CAD nursing care plans designed to help students understand how to link nursing diagnoses with interventions and outcomes.
Nursing Care Plan 1: Ineffective Cardiac Tissue Perfusion
Nursing Diagnosis Statement:
Ineffective cardiac tissue perfusion related to reduced coronary blood flow as evidenced by chest pain, ECG changes, and shortness of breath.
Related Factors/Causes:
Atherosclerotic narrowing, thrombosis, increased myocardial oxygen demand, hypertension, and smoking.
Nursing Interventions and Rationales:
- Administer nitrates and monitor blood pressure – dilates coronary arteries and decreases preload.
- Encourage bed rest during acute chest pain – reduces oxygen consumption.
- Obtain and review ECG – identifies ischemic changes requiring intervention.
- Provide oxygen if hypoxemic – increases oxygen supply to ischemic tissue.
- Monitor cardiac enzymes – detects ongoing injury or infarction.
Desired Outcomes:
Patient reports relief of chest pain, maintains stable vital signs, and shows no evidence of worsening ischemia.
Nursing Care Plan 2: Acute Pain (Angina)
Nursing Diagnosis Statement:
Acute pain related to myocardial ischemia as evidenced by substernal chest pressure radiating to the left arm and jaw.
Related Factors/Causes:
Increased oxygen demand, exertion, emotional stress, or cold exposure.
Nursing Interventions and Rationales:
- Use a pain scale to document severity and response to interventions – ensures appropriate management.
- Administer prescribed nitroglycerin, up to three doses if indicated – relieves angina through vasodilation.
- Administer prescribed beta-blocker – decreases myocardial workload and oxygen demand.
- Provide calm environment and teach relaxation breathing – reduces sympathetic drive.
- Prepare patient for potential advanced interventions (PCI, CABG) – ensures readiness for escalation of care.
Desired Outcomes:
Pain reduced to tolerable levels within 15 minutes; patient verbalizes effective relief strategies.
Nursing Care Plan 3: Decreased Cardiac Output
Nursing Diagnosis Statement:
Decreased cardiac output related to impaired myocardial contractility as evidenced by hypotension, fatigue, and weak peripheral pulses.
Related Factors/Causes:
Ventricular dysfunction, arrhythmias, fluid imbalances, or ischemic injury.
Nursing Interventions and Rationales:
- Monitor vital signs, capillary refill, and urine output – evaluates perfusion status.
- Keep patient on continuous telemetry – detects dysrhythmias early.
- Administer medications as ordered (ACE inhibitors, diuretics, inotropes) – support cardiac function.
- Encourage rest periods between activities – reduces myocardial oxygen demand.
- Collaborate with the healthcare team for possible advanced interventions – ensures timely escalation.
Desired Outcomes:
Patient maintains adequate BP and HR, shows warm extremities, and demonstrates improved activity tolerance.
Nursing Care Plan 4: Activity Intolerance
Nursing Diagnosis Statement:
Activity intolerance related to imbalance between oxygen supply and demand during exertion as evidenced by dyspnea and fatigue on minimal activity.
Related Factors/Causes:
Reduced coronary reserve, deconditioning, obesity, anemia, or hypertension.
Nursing Interventions and Rationales:
- Assess tolerance to activity with vital signs and oxygen saturation – establishes safe limits.
- Provide rest between activities – prevents overexertion.
- Teach energy conservation techniques – helps patient manage ADLs.
- Collaborate with cardiac rehabilitation – promotes safe progression of physical activity.
- Encourage gradual increase in walking or exercise – builds endurance without excessive strain.
Desired Outcomes:
Patient performs basic ADLs without significant fatigue or chest discomfort; demonstrates improved physical tolerance.
Nursing Care Plan 5: Ineffective Health Management
Nursing Diagnosis Statement:
Ineffective health management related to complex medication regimen and knowledge deficit as evidenced by missed doses and continued smoking.
Related Factors/Causes:
Poor understanding of CAD management, medication side effects, financial barriers, and lack of support.
Nursing Interventions and Rationales:
- Educate on medication purpose, dosing, and side effects – improves adherence.
- Provide written instructions and teach-back – ensures understanding.
- Reinforce importance of smoking cessation, diet modification, and weight management – reduces progression of CAD.
- Connect patient with support resources (support groups, cardiac rehab) – adds accountability.
- Collaborate with provider to simplify regimen when possible – improves compliance.
Desired Outcomes:
Patient correctly follows medication regimen, makes lifestyle adjustments, and demonstrates improved self-management skills.
Conclusion
Coronary artery disease remains one of the most common and serious cardiac conditions nurses will encounter. Effective nursing care focuses on stabilizing patients, controlling symptoms, preventing complications, and promoting long-term health changes. By linking accurate nursing diagnoses with interventions and outcomes, nursing students can strengthen their clinical judgment and deliver safe, patient-centered care.
References
- Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. Lippincott Williams & Wilkins.
- Lewis’s Medical-Surgical Nursing. Elsevier.
- American Heart Association & American College of Cardiology Guidelines on Chronic Coronary Disease.
- Potter, Perry, Stockert, Hall. Fundamentals of Nursing. Elsevier.