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7/15/2018

Angina Pectoris (Stable Angina) Nursing Care Management: Study Guide

Angina Pectoris

By Marianne Belleza, RN - December 8, 2016

Pectoris By Marianne Belleza, RN - December 8, 2016 Mr. Gomez is fond of eating in

Mr. Gomez is fond of eating in fast food joints. He likes the convenience and the taste of the food they serve. This has gone for so many years until one day, while he was walking the flight of stairs to his apartment, he felt a sudden, crushing pain vibrating towards his neck and jaw. He sat down immediately when he reached his room, and the pain was relieved. This episode occurred thrice that week so he decided to visit a physician. The physician told him that he is experiencing angina pectoris.

Contents [hide]

1 Description

2 Classification

3 Pathophysiology

4 Causes

5 Clinical Manifestations

6 Gerontologic Considerations

7 Complications

8 Assessment and Diagnostic Findings

9 Medical Management 9.1 Pharmacologic Therapy

10 Nursing Management

10.1 Nursing Assessment

10.2 Nursing Diagnosis

10.3 Nursing Care Planning and Goals

10.4 Nursing Interventions

10.5 Evaluation

10.6 Discharge and Home Care Guidelines

10.7 Documentation Guidelines

11 Practice Quiz: Angina Pectoris

12 See Also

13 Further Reading and Recommended Resources

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Angina Pectoris (Stable Angina) Nursing Care Management: Study Guide

Description

Angina) Nursing Care Management: Study Guide Description Cardiovascular disease is the leading cause of death in

Cardiovascular disease is the leading cause of death in the United States for men and women of all racial and ethnic groups.

Angina pectoris is a clinical syndrome usually characterized by episodes or paroxysms of pain or Angina pectoris is a clinical syndrome usually characterized by episodes or paroxysms of pain or pressure in the anterior chest.

The cause is insufficient coronary blood flow , resulting in a decreased oxygen supply when there is increased insufficient coronary blood flow, resulting in a decreased oxygen supply when there is increased myocardial demand for oxygen in response to physical exertion or emotional stress.

Classi cation

physical exertion or emotional stress . Classi cation There are five (5) classifications or types of

There are five (5) classifications or types of angina.

Stable angina. There is predictable and consistent pain that occurs on exertion and is relieved by rest There is predictable and consistent pain that occurs on exertion and is relieved by rest and/or nitroglycerin.

Unstable angina. The symptoms increase in frequency and severity and may not be relieved with rest or The symptoms increase in frequency and severity and may not be relieved with rest or nitroglycerin.

Intractable or refractory angina. There is severe incapacitating chest pain. There is severe incapacitating chest pain.

Variant angina. There is pain at rest, with reversible ST-segment elevation and thought to be caused by There is pain at rest, with reversible ST-segment elevation and thought to be caused by coronary artery vasospasm.

Silent ischemia. There is objective evidence of ischemia but patient reports no pain. There is objective evidence of ischemia but patient reports no pain.

Pathophysiology

Angina is usually caused by atherosclerotic disease.

Almost invariably, angina is associated with a significant obstruction of at least one major coronary artery . angina is associated with a significant obstruction of at least one major coronary artery.

Oxygen demands not met. Normally, the myocardium extracts a large amount of oxygen from the coronary circulation to meet Normally, the myocardium extracts a large amount of oxygen from the coronary circulation to meet its continuous demands.

Increased demand. When there is an increase in demand, flow through the coronary arteries needs to be When there is an increase in demand, flow through the coronary arteries needs to be increased.

Ischemia. When there is blockage in a coronary artery , flow cannot be increased, and ischemia When there is blockage in a coronary artery, flow cannot be increased, and ischemia results which may lead to necrosis or myocardial infarction.

Schematic Diagram for Angina Pectoris via Scribd . Angina Pectoris via Scribd.

Pathophysiology of Angina Pectoris by Osmosis

Causes

Patreon to make more informative videos like this. Causes Several factors are associated with angina. Cookies

Several factors are associated with angina.

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Angina Pectoris (Stable Angina) Nursing Care Management: Study Guide

Physical exertion. This can precipitate an attack by increasing myocardial oxygen demand. This can precipitate an attack by increasing myocardial oxygen demand.

Exposure to cold. This can cause vasoconstriction and elevated blood pressure , with increased oxygen demand. This can cause vasoconstriction and elevated blood pressure, with increased oxygen demand.

Eating a heavy meal. A heavy meal increases the blood flow to the mesenteric area for digestion, thereby reducing A heavy meal increases the blood flow to the mesenteric area for digestion, thereby reducing the blood supply available to the heart muscle; in a severely compromised heart, shunting of the blood for digestion can be sufficient to induce anginal pain.

Stress . Stress causes the release of catecholamines, which increased blood pressure , heart rate, Stress. Stress causes the release of catecholamines, which increased blood pressure, heart rate, and myocardial workload.

Clinical Manifestations

The severity of symptoms of angina is based on the magnitude of the precipitating activity and its effect on activities of daily living.

Chest pain. The pain is often felt deep in the chest behind the sternum and may radiate The pain is often felt deep in the chest behind the sternum and may radiate to the neck, jaw, and shoulders.

Numbness. A feeling of weakness or numbness in the arms, wrists and hands. A feeling of weakness or numbness in the arms, wrists and hands.

Shortness of breath. An increase in oxygen demand could cause shortness of breath. An increase in oxygen demand could cause shortness of breath.

Pallor. Inadequate blood supply to peripheral tissues cause pallor. Inadequate blood supply to peripheral tissues cause pallor.

Gerontologic Considerations

peripheral tissues cause pallor. Gerontologic Considerations Here’s what you need to know when caring for geriatric

Here’s what you need to know when caring for geriatric patients with angina pectoris:

The elderly person with angina may not exhibit the typical pain profile because of the diminished responses of neurotransmitters angina may not exhibit the typical pain profile because of the diminished responses of neurotransmitters that occur with aging.

Often, the presenting symptom in the elderly is dyspnea.responses of neurotransmitters that occur with aging. Sometimes, there are no symptoms (“silent” CAD), making

Sometimes, there are no symptoms (“silent” CAD), making recognition and diagnosis a clinical challenge.Often, the presenting symptom in the elderly is dyspnea. Elderly patients should be encouraged to recognize

Elderly patients should be encouraged to recognize their chest pain–like symptom (eg, weakness) as an indication that they should rest or take prescribed medications.CAD), making recognition and diagnosis a clinical challenge. Complications Myocardial infarction . Myocardial

Complications

Myocardial infarction . Myocardial infarction is the end result of angina pectoris if left untreated. Myocardial infarction. Myocardial infarction is the end result of angina pectoris if left untreated.

Cardiac arrest. The heart pumps more and more blood to compensate the decreased oxygen supply, and.the cardiac The heart pumps more and more blood to compensate the decreased oxygen supply, and.the cardiac muscle would ultimately fail leading to cardiac arrest.

Cardiogenic shock . MI also predisposes the patient to cardiogenic shock . Cardiogenic shock. MI also predisposes the patient to cardiogenic shock.

Assessment and Diagnostic Findings

The diagnosis of angina pectoris is determined through:

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Angina Pectoris (Stable Angina) Nursing Care Management: Study Guide

ECG: Often normal when patient at rest or when pain-free; depression of the ST segment or Often normal when patient at rest or when pain-free; depression of the ST segment or T wave inversion signifies ischemia. Dysrhythmias and heart block may also be present. Significant Q waves are consistent with a prior MI.

24-hour ECG monitoring (Holter): Done to see whether pain episodes correlate with or change during exercise or activity. ST one to see whether pain episodes correlate with or change during exercise or activity. ST depression without pain is highly indicative of ischemia.

Exercise or pharmacological stress electrocardiography: Provides more diagnostic information, such as duration and level of activity attained before stress electrocardiography: Provides more diagnostic information, such as duration and level of activity attained before onset of angina. A markedly positive test is indicative of severe CAD. Note: Studies have shown stress echo studies to be more accurate in some groups than exercise stress testing alone.

Cardiac enzymes (AST, CPK, CK and CK-MB; LDH and isoenzymes LD1, LD2): Usually within normal limits (WNL); elevation indicates myocardial damage. Usually within normal limits (WNL); elevation indicates myocardial damage.

Chest x-ray: Usually normal; however, infiltrates may be present, reflecting cardiac decompensation or pulmonary complications. Usually normal; however, infiltrates may be present, reflecting cardiac decompensation or pulmonary complications.

Pco2, potassium , and myocardial lactate: May be elevated during anginal attack (all play a role potassium, and myocardial lactate: May be elevated during anginal attack (all play a role in myocardial ischemia and may perpetuate it).

Serum lipids (total lipids, lipoprotein electrophoresis, and isoenzymes cholesterols [HDL, LDL, VLDL]; triglycerides; phospholipids): May be elevated (CAD risk factor). May be elevated (CAD risk factor).

Echocardiogram: May reveal abnormal valvular action as cause of chest pain. May reveal abnormal valvular action as cause of chest pain.

Nuclear imaging studies (rest or stress scan): Thallium-201: Ischemic regions appear as areas of decreased thallium uptake. Thallium-201: Ischemic regions appear as areas of decreased thallium uptake.

MUGA: Evaluates specific and general ventricle performance, regional wall motion, and ejection fraction. Evaluates specific and general ventricle performance, regional wall motion, and ejection fraction.

Cardiac catheterization with angiography: Definitive test for CAD in patients with known ischemic disease with Cardiac catheterization with angiography: Definitive test for CAD in patients with known ischemic disease with angina or incapacitating chest pain, in patients with cholesterolemia and familial heart disease who are experiencing chest pain, and in patients with abnormal resting ECGs. Abnormal results are present in valvular disease, altered contractility, ventricular failure, and circulatory abnormalities. Note: Ten percent of patients with unstable angina have normal- appearing coronary arteries.

Ergonovine (Ergotrate) injection: On occasion, may be used for patients who have angina at rest Ergonovine (Ergotrate) injection: On occasion, may be used for patients who have angina at rest to demonstrate hyperspastic coronary vessels. (Patients with resting angina usually experience chest pain, ST elevation, or depression and/or pronounced rise in left ventricular end-diastolic pressure [LVEDP], fall in systemic systolic pressure, and/or high-grade coronary artery narrowing. Some patients may also have severe ventricular dysrhythmias.)

Medical Management

The objectives of the medical management of angina are to increase the oxygen demand of the myocardium and to increase the oxygen supply.

Oxygen therapy. Oxygen therapy is usually initiated at the onset of chest pain in an attempt to Oxygen therapy is usually initiated at the onset of chest pain in an attempt to increase the amount of oxygen delivered to the myocardium and reduce pain.

Pharmacologic Therapy

Nitroglycerin gives long term and short term reduction of myocardial oxygen consumption through selective vasodilation Nitroglycerin gives long term and short term reduction of myocardial oxygen consumption through selective vasodilation within three (3) minutes.

Beta-blockers reduces myocardial oxygen consumption by blocking beta-adrenergic stimulation of the heart. Beta-blockers reduces myocardial oxygen consumption by blocking beta-adrenergic stimulation of the heart.

Calcium channel blockers have negative inotropic effects. Calcium channel blockers have negative inotropic effects.

Antiplatelet medications prevent platelet aggregation; and anticoagulants prevent thrombus formation. medications prevent platelet aggregation; and anticoagulants prevent thrombus formation.

Nursing Management

The patient with angina pectoris should be managed by a cardiac nurse specifically.

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Nursing Assessment

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Angina Pectoris (Stable Angina) Nursing Care Management: Study Guide

In assessing the patient with angina, the nurse may ask regarding the following:

Location of pain.with angina, the nurse may ask regarding the following: Characteristics of pain. Health history. Pain scale.

Characteristics of pain.the nurse may ask regarding the following: Location of pain. Health history. Pain scale. Onset of

Health history.the following: Location of pain. Characteristics of pain. Pain scale. Onset of pain. Cause of pain.

Pain scale.Location of pain. Characteristics of pain. Health history. Onset of pain. Cause of pain. Measures that

Onset of pain.pain. Characteristics of pain. Health history. Pain scale. Cause of pain. Measures that relieve pain. Other

Cause of pain.of pain. Health history. Pain scale. Onset of pain. Measures that relieve pain. Other symptoms that

Measures that relieve pain.Health history. Pain scale. Onset of pain. Cause of pain. Other symptoms that occur with pain.

Other symptoms that occur with pain.Onset of pain. Cause of pain. Measures that relieve pain. Nursing Diagnosis Based on the assessment

Nursing Diagnosis

Based on the assessment data, major nursing diagnosis may include:

Ineffective cardiac tissue perfusion secondary to CAD as evidenced by chest pain or other prodromal symptoms. tissue perfusion secondary to CAD as evidenced by chest pain or other prodromal symptoms.

Death anxiety related to cardiac symptoms. anxiety related to cardiac symptoms.

Deficient knowledge about the underlying disease and methods for avoiding complication Deficient knowledge about the underlying disease and methods for avoiding complication

Noncompliance, ineffective management of therapeutic regimen related to failure to accept necessary lifestyle changes. related to failure to accept necessary lifestyle changes.

Nursing Care Planning and Goals

Major patient goals include:

Immediate and appropriate treatment when angina occurs.Disease) Nursing Care Plans Major patient goals include: Prevention of angina. Reduction of anxiety. Awareness of

Prevention of angina.Immediate and appropriate treatment when angina occurs. Reduction of anxiety. Awareness of the disease process and

Reduction of anxiety.treatment when angina occurs. Prevention of angina. Awareness of the disease process and understanding pf the

Awareness of the disease process and understanding pf the prescribed care.angina occurs. Prevention of angina. Reduction of anxiety. Adherence to the self-care program. Absence of

Adherence to the self-care program.disease process and understanding pf the prescribed care. Absence of complications. Nursing Interventions Nursing

Absence of complications.pf the prescribed care. Adherence to the self-care program. Nursing Interventions Nursing interventions for a patient

Nursing Interventions

Nursing interventions for a patient with angina pectoris include:

Treating angina. The nurse should instruct the patient to stop all activities and sit or rest in The nurse should instruct the patient to stop all activities and sit or rest in bed in a semi-Fowler’s position when they experience angina, and administer nitroglycerin sublingually.

Reducing anxiety. Exploring implications that the diagnosis has for the patient and providing information about the illness, Exploring 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.

Preventing pain. The nurse reviews the assessment findings, identifies the level of activity that causes the patient’s The nurse reviews the assessment findings, identifies the level of activity that causes the patient’s pain, and plans the patient’s activities accordingly.

Decreasing oxygen demand. Balancing activity and rest is an important aspect of the educational plan for the patient Balancing activity and rest is an important aspect of the educational plan for the patient and family.

Evaluation

The expected patient outcomes are:

Reported pain is relieved promptly.and family. Evaluation The expected patient outcomes are: Reported decrease in anxiety. Understood ways to avoid

Reported decrease in anxiety.patient outcomes are: Reported pain is relieved promptly. Understood ways to avoid complications and is free

Understood ways to avoid complications and is free pf complications.pain is relieved promptly. Reported decrease in anxiety. Cookies help us provide, protect and improve our

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By using our website, you agree to our use of cookies Adhered to self-care program.

Adhered to self-care program.

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Angina Pectoris (Stable Angina) Nursing Care Management: Study Guide

Discharge and Home Care Guidelines

The goals of education ate to reduce the frequency and severity of anginal attacks, to delay the progress of the underlying disease if possible, and to prevent complications.

Reduce anginal attacks. Activities should be planned to minimize the occurrence of angina episodes. Activities should be planned to minimize the occurrence of angina episodes.

Follow-up monitoring. The patient may need reminders about follow-up monitoring, including periodic blood laboratory testing and ECGs. The patient may need reminders about follow-up monitoring, including periodic blood laboratory testing and ECGs.

Adherence. The home care nurse may monitor the patient’s adherence to dietary restrictions and to . The home care nurse may monitor the patient’s adherence to dietary restrictions and to prescribed antianginal medications.

Documentation Guidelines

The focus of documentation in a patient with angina pectoris includes:

Nature, extent, and duration of problem.of documentation in a patient with angina pectoris includes: Effect on independence and lifestyle. Characteristics of

Effect on independence and lifestyle.pectoris includes: Nature, extent, and duration of problem. Characteristics of pain, precipitators, and what relieves

Characteristics of pain, precipitators, and what relieves pain.duration of problem. Effect on independence and lifestyle. Pulses and BP. Client’s fear and signs and

Pulses and BP.of pain, precipitators, and what relieves pain. Client’s fear and signs and symptoms exhibited.

Client’s fear and signs and symptoms exhibited. fear and signs and symptoms exhibited.

Responses and actions of family/SOs.and BP. Client’s fear and signs and symptoms exhibited. Deviation from prescribed treatment plan and client’s

Deviation from prescribed treatment plan and client’s reasons in own words.and symptoms exhibited. Responses and actions of family/SOs. Consequences of actions to date. Plan of care.

Consequences of actions to date.treatment plan and client’s reasons in own words. Plan of care. Teaching plan. Response to interventions,

Plan of care.reasons in own words. Consequences of actions to date. Teaching plan. Response to interventions, teaching, and

Teaching plan.in own words. Consequences of actions to date. Plan of care. Response to interventions, teaching, and

Response to interventions, teaching, and actions performed.of actions to date. Plan of care. Teaching plan. Attainment or progress toward desired outcomes.

Attainment or progress toward desired outcomes.Response to interventions, teaching, and actions performed. Modifications to plan of care. Practice Quiz: Angina

Modifications to plan of care.performed. Attainment or progress toward desired outcomes. Practice Quiz: Angina Pectoris Here’s a 5-item quiz about

Practice Quiz: Angina Pectoris

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Practice Quiz: Angina Pectoris

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7/15/2018

Angina Pectoris (Stable Angina) Nursing Care Management: Study Guide

1.

The pain of angina pectoris is produced primarily by:

A.

Vasoconstriction.

B.

Movement of thromboemboli.

C.

Myocardial ischemia.

D.

The presence of atheromas.

2.

The nurse advises a patient that sublingual nitroglycerin should alleviate angina pain

within:

A.

3 to 4 minutes.

B.

10 to 15 minutes.

C.

30 minutes.

D.

60 minutes.

3.

The scientific rationale supporting the administration of beta-blockers is the drug’s

ability to:

A.

Block sympathetic impulses to the heart.

B.

Elevate blood pressure.

C.

Increase myocardial contractility.

D.

Induce bradycardia.

4.

Calcium channel blockers act by:

A.

Decreasing SA node automaticity.

B.

Increasing AV node conduction.

C.

Increasing the heart rate.

D.

Creating a positive inotropic effect.

5.

All of the following are type of angina except for:

A.

Stable angina.

B.

Unstable angina.

C.

Refractory angina.

D.

Direct angina.

Answers and Rationale

1. Answer: C. Myocardial ischemia.

Ischemia causes lactic acid production that triggers the pain.

2. Answer: A. 3 to 4 minutes.

Nitroglycerin given sublingually alleviates angina pain within 3 minutes.

3. Answer: A. Block sympathetic impulses to the heart.

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Angina Pectoris (Stable Angina) Nursing Care Management: Study Guide

Beta-blockers reduces myocardial oxygen consumption by blocking beta-adrenergic stimulation of the heart.

4. Answer: A. Decreasing SA node automaticity.

Calcium channel blockers decrease sinoatrial node automaticity.

5. Answer: D. Direct angina.

Direct angina is not a type of angina.

See Also

Posts related to this care plan:

Further Reading and Recommended Resources

Quiz (20 Items) Further Reading and Recommended Resources Recommended books and reading materials: 1. Nursing

Recommended books and reading materials: