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Coronary Artery Disease: Nursing Diagnoses, Care Plans, Assessment & Interventions

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Written by
Maegan Wagner, BSN, RN, CCM

Coronary artery disease (CAD) is a term used to describe conditions that affect the arteries that provide nutrients, blood, and oxygen to the heart.

Atherosclerosis, a known cause of CAD, is characterized by lipid deposits within the walls of the arteries. These plaques narrow arteries, obstructing blood flow. It increases the risk of angina and myocardial infarction.

CAD is a progressive disease that develops over time. The condition is often advanced before the patient exhibits symptoms like angina, shortness of breath, and fatigue.

When blood flow through the coronary arteries becomes partially or completely blocked, ischemia and infarction in the heart muscles occur. When insufficient blood and oxygen supply (ischemia) to the myocardium, decreased tissue perfusion and necrosis (infarction) will develop, requiring immediate intervention.

In this article:

Nursing Process

The management of CAD involves modifying risk factors to prevent and slow disease progression. Since symptoms may not always be evident, it is important to identify people who are at risk for CAD. 

Nurses provide health promotion efforts that are directed toward controlling the modifiable risk factors for CAD. Patient education about the disease process and progression along with necessary lifestyle changes is important in preventing CAD. 

For patients who present with symptoms such as chest pain or dyspnea, medications or surgical interventions may be indicated. Medications like aspirin or cholesterol-lowering agents are prescribed to prevent blood clots and heart attacks and reduce plaque buildup in the arteries. Surgical interventions like coronary angioplasty and stent placement may be indicated to remove blockages, widen the artery, and restore blood flow to the heart. Coronary artery bypass grafting (CABG) is indicated for patients who have multiple narrowed arteries.

Nursing Assessment

The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In this section we will cover subjective and objective data related to coronary artery disease.

Review of Health History

1. Ask the patient about their general symptoms.
Note the patient’s complaints and general symptoms, such as:

  • Chest pain
  • Shortness of breath (dyspnea) both at rest and during activity
  • Rapid breathing (tachypnea)
  • Difficulty of breathing while lying or sitting (orthopnea)
  • Fainting (syncope)
  • Palpitations
  • Lower extremity edema
  • Pain in the lower extremity 
  • Difficulty in performing physical activities

2. Investigate the chest pain further.
Ask the patient to describe the characteristics of chest pain:

  • Chest tightness
  • Feeling of squeezing 
  • Heaviness
  • Burning sensation
  • Pain during physical activity
  • Triggers such as stress or substance use
  • Pain that radiates to the jaw, neck, left arm, or back

3. Assess the patient’s risk.

Non-modifiable risk factors:

  • Age: A damaged and narrowed artery is more likely to develop as people age.
  • Gender: Men are at greater risk, but the risk increases for women after menopause.
  • Family history of ischemic heart disease: There is a high risk if the immediate male relative (father or brother) had heart disease before age 55 or if the female relative (mother or sister) had it before age 65.
  • Race/ethnicity: Minority groups such as Hispanics and Blacks have a higher incidence of CAD.

Modifiable risk factors:

  • Hypertension: The arteries may become stiff and rigid if high blood pressure is uncontrolled. Blood flow may be slowed by coronary artery narrowing.
  • Hyperlipidemia/hypercholesterolemia: The risk of atherosclerosis can rise if there is excessive “bad” cholesterol (low-density lipoprotein – LDL) or decreased “good” cholesterol (high-density lipoprotein – HDL) in the blood.
  • Diabetes or insulin resistance: Diabetes or insulin resistance causes hardening of the blood vessels and fatty plaque buildup.
  • Kidney disease: Kidney disease impairs the blood pressure regulation function of the kidneys.
  • Tobacco use: Firsthand and secondhand smoke increases blood vessel constriction.
  • Obesity: Obesity increases cholesterol levels by contributing to plaque buildup in the arteries, narrowing of blood vessels.
  • Physical inactivity: Lack of physical activity increases cholesterol in the blood.
  • Diet: Food rich in saturated fat raises LDL “bad” cholesterol.
  • Stress: Stress increases inflammatory levels causing the narrowing of the blood vessels.
  • Alcohol use: Alcohol weakens the heart muscle and affects blood clot formation causing blood vessel obstruction.
  • Lack of sleep: Poor sleeping habits and insomnia increase stress levels resulting in blood vessel constriction.

4. Review the patient’s medications and treatment record.
Medications (such as anthracyclines, and anabolic steroids) and previous vascular surgery compromise blood vessel integrity.

Physical Assessment

1. Monitor vital signs.
Due to the decreased oxygenated blood supply to the heart, vital signs (especially the pulse rate and blood pressure) are expected to increase or alter. 

2. EKG and telemetry monitoring.
An EKG should be completed immediately when a patient reports chest pain to assess for dysrhythmias. Continuous telemetry monitoring is appropriate for a known cardiac history.

3. Systemic assessment approach:

  • Neck: distended jugular veins 
  • CNS: acute distress, dizziness, lightheadedness, syncope, and lethargy
  • Cardiovascular: tachycardia, chest pain, abnormal heart sounds (murmur at the apex or bruit on carotid artery) upon auscultation, irregular heartbeats (arrhythmias)
  • Circulatory: decreased peripheral pulses
  • Respiratory: dyspnea, tachypnea, orthopnea, abnormal sounds (crackles) upon auscultation, activity intolerance
  • Gastrointestinal: nausea and vomiting
  • Lymphatic: peripheral edema
  • Musculoskeletal: neck, arm, back, jaw, and upper body pain, fatigue
  • Integumentary: cyanotic and pale skin and excessive sweating

4. Calculate the patient’s risk.
Calculate the patient’s ASCVD (atherosclerotic cardiovascular disease) risk score. The ideal score is low ( <5%). It measures a 10-year risk of CAD and heart diseases objectively, considering the following:

  • Age
  • Gender
  • Race
  • Blood pressure
  • Cholesterol
  • Medications
  • Diabetes
  • Smoking

Diagnostic Procedures

1. Note for arrhythmias.
CAD is brought on by the buildup of fatty substances obstructing the heart’s blood flow. It causes arrhythmias or disruption in the electrical activity of the heart. Look for any ST segment changes, as they may indicate cardiac ischemia. Other arrhythmias, such as atrial fibrillation, bundle branch block, and supraventricular tachycardia, may be present.

2. Obtain samples for blood work.
Analyze the results of the following procedures:

  • Complete blood count with differential – a possible underlying infection (WBC), blood clotting response (platelets), and signs of anemia (low RBC levels).
  • B-type natriuretic peptides (BNP) – show volume overload with a cardiogenic cause. It can be falsely high in kidney conditions and low with obesity. 
  • Cardiac enzymes – Troponin and CK levels offer insight into acute ischemia. 
  • Lipid panels – monitor hypercholesterolemia. 
  • Ultra-sensitive C-reactive protein (us-CRP), or high-sensitivity CRP – assesses vascular inflammation, which increases the risk of CAD.
  • Liver function tests (LFT) – evaluate the liver and heart simultaneously, like in hemochromatosis (a CAD complication from a buildup of iron in the body). Also, monitor liver function since it is affected due to the intake of cholesterol medications.

3. Assist the patient in completing a stress test.
Stress testing is useful for the noninvasive evaluation of CAD. It evaluates the heart’s response to physical activity.

4. Prepare the patient for cardiac catheterization.
Cardiac catheterization or angiogram is the most reliable and precise method of visualizing the heart’s blood vessels. Risks are involved since it is an invasive procedure using contrast dye.

5. Investigate further.

  • Echocardiogram shows the structure of the heart and how heart valves function. This can assist in diagnosing a heart valve abnormality or underlying conditions like heart failure.
  • Exercise treadmill test is used for a patient with a normal resting ECG who is physically competent to exercise. 
  • Nuclear stress test is the opposite of an exercise stress test. It combines ECG recordings with images of blood flow to the heart muscle at rest and during stress.
  • Stress imaging is for patients who have undergone revascularization, have difficult-to-interpret ECGs, or cannot exercise due to physical limitations.
  • Cardiac CT scans show calcium buildup and blockages in the heart arteries. 
  • CT coronary angiogram is similar to a cardiac CT scan but uses dye (contrast) for a more detailed image.

Nursing Interventions

Nursing interventions and care are essential for the patients recovery. In the following section you’ll learn more about possible nursing interventions for a patient with coronary artery disease.

Promote Perfusion

1. Reduce cholesterol plaque buildup.
Cholesterol medications (such as statins, fibrates, niacin, and bile acid sequestrants) can decrease bad cholesterol and lessen plaque formation in the arteries. 

2. Prevent blood clots.
Aspirin thins the blood to avoid blood clots. Daily low-dose aspirin therapy is the primary prevention against CAD. Anticoagulant medications may be added if the patient is at an increased risk.

2. Fix the blocked artery.

  • Coronary angioplasty and stent placement open the clogged heart arteries via a stent (small tube acting as a passageway). It is also known as balloon angioplasty. This procedure may also be called percutaneous coronary intervention (PCI). 
  • Coronary artery bypass graft surgery (CABG) builds an additional pathway for blood in the heart to bypass the blocked or constricted coronary artery. It is indicated for patients with multiple vessel CAD damage.

3. Monitor the cholesterol levels.
Regular monitoring of cholesterol levels will aid in the early detection of CAD in patients at high risk. 

Manage the Symptoms

1. Control blood pressure.
Administer the following medications to control the blood pressure in CAD:

  • Beta-blockers slow the heart rate and lower blood pressure. 
  • Calcium channel blockers are given if the patient cannot take beta blockers. 
  • Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) lower blood pressure. 

2. Relieve chest pain.
The most prevalent sign of CAD is chest pain (angina) which occurs because arteries are not receiving adequate oxygenated blood. Nitroglycerin dilates veins to allow blood flow and relieve chest pain.

3. Know the triggers of angina.
Have the patient track when chest pain is triggered, such as with physical activity, stress, after eating, or at rest. This can help the healthcare team plan interventions.

4. Improve ischemic angina.
Treat chronic and ischemic angina with ranolazine. Typically, ranolazine is combined with:

  • Hypertensive medications (such as ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, and beta-blockers) 
  • Nitrates
  • Antiplatelets
  • Lipid-lowering medications

5. Maintain the recommended blood pressure.
A significant risk factor for coronary heart disease is hypertension. Patients with CAD should keep their blood pressure under 140/90 mmHg. Caution is suggested with diastolic blood pressure below 60 mmHg. Patients with coronary artery disease may experience angina brought on or worsened by low diastolic blood pressure.

Cardiac Rehabilitation

1. Adhere to the plan.
The support, exercise, and education program in cardiac rehabilitation (cardiac rehab) is designed for each patient’s needs. It supports the patients and their families’ long-term lifestyle changes.

2. Prevent complications.
Cardiac rehabilitation helps the patient recover after CAD. It lowers their risk of developing complications and readmissions to the hospital.

3. Refer to home and community health services.
After being discharged from the hospital, cardiac rehabilitation continues (at home or a community healthcare facility). It typically lasts 6 to 10 weeks, depending on the program and the patient’s condition.

4. Motivate the patient to adhere to the plan.
Positive outcomes are highly associated with adherence to the program’s interventions. Comprehensive cardiac rehabilitation programs reduce mortality in patients with CAD and enhance exercise capacity, body mass index, lipid profiles, psychological well-being, and quality of life.

Lower the Risk: Prevention Measures

1. Promote ambulation. 
The risk of cardiovascular events is significantly lowered by consistent physical activity and exercise. Adults should complete 150 minutes of moderate-intensity exercise per week that includes aerobic and strength training activities.

2. Aim for an ideal BMI.
Fatty deposits can accumulate in the arteries as a result of being overweight. Weight loss enhances blood pressure, cholesterol levels, and metabolic activity. 

3. Educate the patient.
Patient education improves adherence to medications and treatments. It also encourages patient-centered care and continuity of care. Effective CAD management and prevention result from increased patient motivation and adherence.

4. Cope with stress.
The heart rate and blood pressure increase during stress. Blood vessels in the body constrict, raising the risk of CAD due to the activation of the inflammatory response. Instruct on stress reduction techniques such as yoga, guided imagery, deep breathing techniques, and meditation.

5. Manage comorbidities.
Controlling comorbidities (such as diabetes and hypertension) results in long-term survival, complication prevention, and effective symptom management in patients with CAD. 

6. Emphasize when to seek medical attention.
If a heart attack or stroke symptoms are suspected, immediate medical attention is required. Instruct the patient with a history of angina to seek help if their chest pain does not respond to nitroglycerin therapy.

7. Teach the importance of lifestyle modification. 
Most of the risk factors of CAD are modifiable. CAD can be prevented and managed when a healthy lifestyle is followed. Patients with CAD can benefit from making lifestyle changes such as:

  • Getting regular exercise
  • Eating a heart-healthy diet
  • Smoking cessation
  • Avoiding secondhand smoke
  • Low intake of alcohol
  • Managing stress
  • Treating depression

8. Consider taking omega-3 fatty acids.
Omega-3 fatty acids reduce the inflammatory response in the blood vessels, decreasing the risk of CAD. It can be found in fish, flaxseeds, and soybeans or supplemented through fish oil pills.

9. Acknowledge the possible use of alternative medicine.
Always consult your healthcare provider before taking herbal supplements, as they can interfere with prescribed medications. These herbs are known to lower cholesterol and blood pressure levels:

  • Garlic
  • Barley
  • Oats
  • Psyllium

10. Follow up with a cardiologist.
Completing follow-up visits with a cardiologist and routine testing and blood work ensures the treatment plan is effective. It is recommended to see the cardiologist every three to six months for patients diagnosed with CAD.

Provide Safety

1. Use blood thinners with caution.
Management of CAD often requires anticoagulant therapy. These medications increase the risk of bleeding by preventing blood clot formation. 

2. Implement bleeding precautions.
Lower the risk of severe injury and bleeding by:

  • Using a toothbrush with gentle bristles
  • Use electric clippers instead of manual razors when shaving
  • Avoid blowing the nose too hard
  • Prevent bowel straining and constipation
  • Avoid contact sports

3. Remind the patient about medical identification.
A medical identification bracelet, necklace, or ID tag lets emergency responders know about the patient’s history of CAD, the potential risk of heart attack and stroke, and the use of anticoagulant therapy.

Nursing Care Plans

Once the nurse identifies nursing diagnoses for coronary artery disease, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section you will find nursing care plan examples for coronary artery disease.

Acute Pain

CAD may cause chest pain, known as angina. Pain occurs when there is decreased blood supply to the heart muscles due to blocked arteries. Chest pain in CAD is often described as pressure or tightness and the patient may describe it as something “sitting on my chest.” 

Nursing Diagnosis: Acute Pain

  • Increased cardiac workload 
  • Decreased blood flow to the myocardium

As evidenced by:

  • Reports of chest pain or tightness varying in duration, frequency, and intensity
  • Diaphoresis
  • Distraction behavior
  • Facial grimace
  • Guarding or protective behavior
  • Positioning to ease pain
  • Altered physiologic parameters or vital signs

Expected outcomes:

  • Patient will demonstrate pain relief as evidenced by the absence of pain behaviors and stable vital signs. 
  • Patient will verbalize what to do when chest pain occurs and when to seek emergency assistance.

Assessment:

1. Assess and monitor vital signs.
Vital signs may be altered with the presence of pain. Tachycardia and hypertension may present initially. However, with the progression of poor cardiac output, hypotension, hypoxemia, and bradycardia may develop.

2. Assess pain characteristics.
Rapid pain assessment of a patient reporting or exhibiting chest pain is crucial. It is important to differentiate chest pain from other possible causes such as heartburn or indigestion. Unstable angina is more intense, unpredictable, lasts longer, and is not relieved with rest or sublingual nitroglycerin compared to stable angina.

3. Assess diagnostic studies.
ECG results can identify both the presence and the location of infarction or angina. During angina, ST depression or T-wave inversion may be present. When there is infarction, ECG results will reveal ST-elevation MI, non-ST-elevation MI, and an abnormal Q wave.

Interventions:

1. Provide supplemental oxygen as needed.
Supplemental oxygen can help maintain arterial oxygen saturation of 90% or higher. Oxygen should only be administered if SpO2 levels are below normal limits, as it can have a counterproductive effect.

2. Administer medications promptly as indicated.
Nitroglycerin dilates coronary arteries to increase blood flow. Morphine sulfate may be ordered to promote comfort, relax smooth muscles, and decrease myocardial oxygen demand. Beta-blockers reduce the workload of the heart.

3. Raise the head of the bed.
This position promotes comfort and reduces myocardial oxygen demand. Raising the head of the bed will facilitate gas exchange to minimize hypoxia and resultant shortness of breath.

4. Maintain a quiet and comfortable environment.
This can help reduce anxiety and reduce chest pain. Mental and emotional stress can increase myocardial workload and pain.

5. Help the patient recognize triggers.
Chest pain is often precipitated by a stressful or emotional event or exercise. Stopping the activity that is causing the chest pain can help the patient identify if the chest pain requires further assessment.

Anxiety

Anxiety is a normal response to stressful situations like a cardiac event but can be detrimental to the patient’s overall health if it is present in excess. Timely and accurate identification, management, and treatment of both anxiety and CAD are essential.

Nursing Diagnosis: Anxiety

  • Situational crisis or stressors
  • Pain
  • Underlying pathophysiological response
  • Threat of change in health status

As evidenced by:

  • Expression of distress and insecurity
  • Awareness of  physiological symptoms
  • Feelings of helplessness
  • Heart pounding
  • Nausea
  • Fear of death as an impending reality
  • Physiologic manifestations like altered respiratory pattern, facial flushing, increased blood pressure, increased heart rate, and increased sweating

Expected outcomes:

  • Patient will verbalize awareness of feelings of anxiety and healthy ways to cope with them.
  • Patient will demonstrate two effective relaxation strategies.
  • Patient will report that anxiety has been reduced to a manageable level.

Assessment:

1. Assess stress levels.
Stress can aggravate the patient’s condition. It can increase blood pressure levels, which increases cardiac workload.

2. Monitor vital signs.
Attempt to decipher between medical and emotional responses. Both can result in rapid pulse, diaphoresis, and hyperventilation.

Interventions:

1. Encourage the patient to express feelings and fears.
Unexpressed feelings and fears tend to develop into anxiety, affecting the patient’s overall health and aggravating existing health conditions like CAD.

2. Provide reassurance to the patient.
Reassuring the patient can help relieve anxiety. Reiterate that they are safe. Present a calm presence to invoke a sense of control.

3. Administer medications as indicated.
Benzodiazepines like alprazolam can help the patient relax until physically able to rebuild adequate coping strategies.

4. Provide accurate information about the disease.
Patient education is vital because it allows the patient to understand what is happening and what to expect. It will also allow the patient to actively participate in the treatment regimen.

5. Encourage coping methods for relaxation.
Remind and encourage the patient to practice coping strategies to decrease anxiety such as breathing exercises, meditation, distraction, and positive talk.

Decreased Cardiac Output

CAD can lead to decreased cardiac output which results in inadequate oxygenation and perfusion to meet the demands of the body.

Nursing Diagnosis: Decreased Cardiac Output

  • Inotropic changes like transient or prolonged myocardial ischemia
  • Altered heart rate and rhythm

As evidenced by:

Expected outcomes:

  • Patient will report decreased episodes of angina, dyspnea, and dysrhythmias.
  • Patient will participate in activities that reduce the workload of the heart.

Assessment:

1. Assess heart rate, blood pressure, and cardiac rhythm.
Tachycardia may be present because of pain, hypoxemia, anxiety, and reduced cardiac output. Changes in blood pressure may also occur because of cardiac response.

2. Assess breath and heart sounds.
Crackles in the lungs can occur with cardiac decompensation. Abnormal heart rhythms or heart sounds such as a gallop or S3 or S4 heart sound signal heart failure.

3. Assess skin color and pulse.
When cardiac output is compromised, peripheral circulation is reduced, manifesting as pallor, cyanosis, and diminished peripheral pulses.

Interventions:

1. Allow adequate rest periods.
Rest periods decrease oxygen consumption and demand, reduce the risk of decompensation, and minimize myocardial workload.

2. Stress the importance of avoiding bearing down or straining.
Valsalva maneuver can cause vagal stimulation which reduces heart rate and is followed by rebound tachycardia; both of these can impair cardiac output.

3. Administer medications as indicated.
Inotropic medications like digoxin can raise cardiac output by making heart contractions stronger.

4. Prepare for tests and procedures.
Echocardiograms show how blood moves through the heart and valves and can identify weak areas. Cardiac catheterizations or angiograms use guided catheters and dye to visualize blockages.

Ineffective Tissue Perfusion

Ineffective tissue perfusion associated with coronary artery disease can be caused by plaque formation leading to narrowed or obstructed arteries and decreased perfusion to tissues and organs.

Nursing Diagnosis: Ineffective Tissue Perfusion

  • Formation of plaque
  • Narrowed arteries
  • Obstructed arteries
  • Rupture of unstable plaque
  • Vasospasm of coronary arteries
  • Ineffective cardiac muscle contraction
  • Conditions that compromise the blood supply
  • Difficulty of the heart muscle to pump
  • Increased exertion in workload
  • Inadequate blood supply to the heart

As evidenced by:

  • Decreased blood pressure (hypotension)
  • Decreased peripheral pulses
  • Increased central venous pressure (CVP)
  • Tachycardia
  • Dysrhythmias
  • Decreased oxygen saturation
  • Chest pain (angina)
  • Difficulty breathing (dyspnea)
  • Difficulty of breathing when lying down and relieved by upright position (orthopnea)
  • Rapid breathing (tachypnea)
  • Alteration in the level of consciousness
  • Restlessness
  • Fatigue
  • Intolerance in activities
  • Cold and clammy skin
  • Prolonged capillary refill time
  • Pallor or cyanosis
  • Edema
  • Complaints of claudication
  • Numbness
  • Pain in the lower extremities

Expected outcomes:

  • Patient will display palpable peripheral pulses and capillary refill time < 3 seconds.
  • Patient will manifest skin that is warm to the touch without edema.
  • Patient will maintain an alert, conscious, and coherent level of consciousness.

Assessment:

1. Determine the patient’s vascularization status.
Reduced vascularization or blood flow to the tissues results in inadequate tissue perfusion. Chronic conditions such as peripheral vascular disease can result in poor circulation to the lower extremities. 

2. Calculate ankle-brachial index.
This test checks the blood pressure in the arms and ankles and compares the readings to assess for poor blood flow in the legs.

3. Assess the patient’s skin color, capillary refill, and sensations.
Note the following signs and symptoms:

  • Edema
  • Poor ulceration or wound healing
  • Skin color (pale/cyanotic)
  • Temperature
  • Hair loss
  • Thickened nails
  • Absent or weak pulses
  • Pain
  • Dulled sensations
  • Claudication (pain when the legs are dependent such as with walking)

4. Use doppler ultrasound.
By reflecting high-frequency sound waves (ultrasound) onto moving red blood cells, a Doppler ultrasound is a noninvasive diagnostic that assesses blood flow and tissue perfusion, particularly in the lower extremities.

Interventions:

1. Administer medications to improve blood flow.
Vasodilators (such as nitroglycerin for chest pain or hydralazine for hypertension) enhance tissue perfusion by widening the blood vessels.

2. Prepare for a possible surgical procedure.
Surgical procedures may be necessary to enhance blood flow and tissue perfusion.

  • Placing a stent to reopen the obstructed artery (Percutaneous coronary intervention (PCI) 
  • Re-route the blood to flow around the obstructions (Coronary artery bypass grafting (CABG)

3. Start aspirin therapy as ordered.
Aspirin, a blood thinner, can assist in lowering the risk of plaque rupture and clotting and improve blood flow and tissue perfusion in patients with coronary artery disease.

4. Instruct on mobility and activity contraindications.
Educate the client not to sit for long periods, cross their legs, or wear constricting clothing, as this can prevent venous return. Perform active and passive ROM exercises and ambulate as tolerated. Keep the legs elevated when sitting to promote venous return.

5. Refer the patient to cardiac rehab.
Improving risk factors, exercise ability, medication adherence, and diet control following percutaneous coronary intervention and coronary artery bypass graft surgery are benefits of cardiac rehabilitation for a patient with coronary artery disease.

Risk for Unstable Blood Pressure

Risk for unstable blood pressure (BP) associated with coronary artery disease can be caused by the formation of plaque resulting in narrowed or obstructed arteries and reduced blood flow, resulting in blood pressure instability.

Nursing Diagnosis: Risk for Unstable Blood Pressure

  • Plaque formation
  • Narrowed arteries
  • Blocked arteries
  • Rupture of unstable plaque
  • Coronary vasospasm
  • Ineffective cardiac muscle contraction
  • Conditions that compromise the blood supply
  • Difficulty of the heart muscle to pump
  • Increased workload
  • Inadequate blood supply to the heart
  • Inability to contract and relax effectively

As evidenced by:

A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred and the goal of nursing interventions is aimed at prevention.

Expected outcomes:

  • Patient will display blood pressure within ordered parameters.
  • Patient will be able to sit or stand without significant fluctuation in blood pressure.
  • Patient will not experience complications of unstable blood pressure such as myocardial ischemia or cerebrovascular accident.

Assessment:

1. Track the patient’s blood pressure.
Because it exerts more tension on the arterial walls, high blood pressure can develop into coronary artery disease, damaging blood vessels and causing plaque rupture.

2. Assess for signs and symptoms.
Initial symptoms may not be apparent or only present as tachycardia during exercise. Decreased blood reaches the heart as the coronary arteries narrow, and symptoms may worsen or occur more frequently. Angina, dyspnea, fatigue, and dizziness are all symptoms of unstable blood pressure.

3. Determine the patient’s risk factors.
When combined, certain risk factors increase the likelihood of developing hypertension, such as high blood sugar, physical inactivity, high triglyceride levels, high sodium diets, and excessive alcohol intake.

4. Assess body fat.
Excess body weight or obesity can cause high blood pressure. Increasing visceral and retroperitoneal fat can elevate blood pressure by directly compressing the kidneys. Hypertension is linked to excessive fat buildup in and around the kidneys.

Interventions:

1. Advise caution with exertional activities.
Blood pressure increases when the arteries are obstructed, and the blood cannot flow freely. It is more evident in stressful conditions such as exertional activities because the heart has to work harder to provide the body with enough oxygen and nutrients.

2. Administer medications as prescribed.
Beta-blockers and ACE inhibitors reduce blood pressure and the workload on the heart. For some patients with atherosclerosis, antiplatelet or anticoagulant medications may help lower the risk of complications.

3. Educate on blood pressure control.
Atherosclerosis causes heart attacks and strokes, with high blood pressure as a common trigger. Educate patients that <120/80 mmHg is a “normal” blood pressure. Patients should be instructed on the parameters for their blood pressure based on their cardiovascular history.

4. Emphasize blood pressure control in lifestyle modification.
Modifying diet and exercise routines and other potential lifestyle changes like smoking cessation are often the first steps in treating atherosclerosis by lowering blood pressure levels.

5. Assist with stress testing.
The patient must run on a treadmill during an exercise stress test until the heart rate reaches 85% of what is anticipated for the patient’s age. A stress test indicates whether a patient has exertional hypotension or hypertension (>200/110 mmHg).

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Maegan Wagner, BSN, RN, CCM
Maegan Wagner is a registered nurse with over 10 years of healthcare experience. She earned her BSN at Western Governors University. Her nursing career has led her through many different specialties including inpatient acute care, hospice, home health, case management, travel nursing, and telehealth, but her passion lies in educating through writing for other healthcare professionals and the general public.