Nursing Diagnosis and Interventions for Angina Pectoris
Decreased Cardiac Output NANDA Definition :
Inadequate blood pumped by the heart to meet metabolic demands of the body
Angina pectoris, or angina, is a symptom of chest pain or pressure that occurs when the heart is not receiving enough blood and oxygen to meet its needs. Stable angina usually occurs in a predictable fashion during or after physical exercise or emotional stress.
Angina is classified into two types – stable angina and unstable angina.
Unstable angina results from the sudden rupture of a plaque, which causes a rapid accumulation of platelets at the plaque and increased obstruction of blood flow in the coronary artery. Accordingly, unstable angina symptoms occur in an unexpected or unpredictable fashion, such as at rest. The symptoms may be more severe and less responsive to nitroglycerin medication. Unstable angina is a medical emergency. Unchecked, it can result in a heart attack. This risk of heart attack remains even if the unstable angina symptoms lessens or disappears. Thus, if unstable angina occurs, seeking immediate medical attention is very important.
Stable angina results from the gradual accumulation of plaque in the coronary artery. As this accumulation increases, angina symptoms begin to occur in a predictable fashion during or after physical exercise or emotional stress. This predictable pattern can persist for weeks, months, or even years. The kinds of activities that can cause stable angina include walking up a hill or a flight of stairs, doing housework, experiencing severe emotional stress or anxiety, having sex, exposure to cold temperatures, or consumption of heavy meals. Although the symptoms are bothersome, they do not usually indicate that a heart attack is imminent.
Nursing Diagnosis : Decreased Cardiac Output
related to inotropic changes, such as transient or prolonged myocardial ischemia and effects of medications;
alterations in rate, rhythm, and electrical conduction.
Expected Outcome :
- Demonstrate increased activity tolerance.
- Cardiac Pump Effectiveness
- Participate in behaviors and activities that reduce the workload of the heart.
- Report or display decreased episodes of dyspnea, angina, and dysrhythmias.
Intervention :
1. Record the color and the presence / quality of the pulse.
2. Monitor vital signs, eg heart rate, blood pressure.
3. Provide supplemental oxygen as needed
4. Maintain bed rest in a comfortable position during the acute episode.
Rational :
1. Decreased peripheral circulation when cardiac output falls, making skin color pale or gray (depending on the level of hypoxia) and decreased strength of peripheral pulses.
2. Tachycardia can occur because of pain, anxiety, hypoxemia, and decreased cardiac output. Changes also occur in blood pressure (hypertension or hypotension) due to cardiovascular response.
3. Increase the supply of oxygen to the need to improve myocardial contractility, decrease ischemia, and lactic acid levels.
4. Lowering the oxygen consumption / demand, lowering employment and risk of myocardial decompensation.
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