Coronary Artery Disease Nursing Care Plan & Management


  • Is characterized by the accumulation of plaque within coronary arteries, which progressively enlarge, thicken and calcify. This causes critical narrowing of the coronary artery lumen (75% occlusion), resulting in a decrease in coronary blood flow and an inadequate supply of oxygen to the heart muscle.
  • Ischemia may be silent (asymptomatic but evidenced by ST depression of 1 mm or more on electrocardiogram (ECG) or may be manifested by angina pectoris (chest pain).
  • Risk factor for Coronary Artery Disease include dyslipidemia, smoking, hypertension, male gender (women are protected until menopause), aging, non-white race, family history, obesity, sedimentary lifestyle, diabetes mellitus, metabolic syndrome, elevated homocysteine, and stress.
  • Acute coronary syndrome is a complication of CAD due to lack of oxygen to the myocardium. Mnaifestations include unstable angina, non ST-segment elevation infarction, and ST-segment elevation infarction.
  • Other causes of angina include coronary artery spasm, aortic stenosis, cardiomyopathy, severe anemia, and thyrotoxicosis.
Risk Factors


  • Cigarette smoking
  • Elevated blood pressure
  • High blood cholesterol (hyperlipidemia)
  • Hyperglycemia (diabetes mellitus)
  • Obesity
  • Physical inactivity
  • Use of oral contraceptives
  • Infection (e.g., gingivitis): possibly associated
  • Behavior patterns ( stress, aggressiveness, hostility)
  • Geography: higher incidence in industrialize regions
  • Positive family history ( first degree relative with cardiovascular disease at age 55 or less for males at age 65 or less for female
  • Age ( more than 45 yrs. for men, more than 55 yrs for women)
  • Gender ( occurs 3 times more often in men than in women)
  • Race: higher incidence in Africans Americans than in Caucasian.

Chest pain is provoked by exertion or stress and is relieved by nitroglycerin and rest.

  1. Character. Substernal chest pain, pressure, heaviness, or discomfort. Other sensations include a squeezing, aching, burning, choking, strangling, or cramping pain.
  2. Severity. Pain maybe mild or severe and typically present with a gradual buildup of discomfort and subsequent gradual fading away.
  3. Location. Behind middle or upper third of sternum; the patient will generally will make a fist over the site of pain (positive Levine sign; indicates diffuse deep visceral pain), rather than point to it with fingers.
  4. Radiation. Usually radiates to neck, jaw, shoulders, arms, hands, and posterior intrascapular area. Pain occurs more commonly on the left side than the right; may produce numbness or weakness in arms, wrist, or hands.
  5. Duration. Usually last 2 to 10 minutes after stopping activity; nitroglycerin relieves pain within 1 minute.
  6. Precipitating factors. Physical activity, exposure to hot or cold weather, eating a heavy meal, and sexual intercourse increase the workload of the heart and, therefore, increase oxygen demand.
  7. Associated manifestation. Diaphoresis, nausea, indigestion, dyspnea, tachycardia, and increase in blood pressure.
  8. Signs of unstable angina:
    • A change in frequency, duration, and intensity of stable angina symptoms.
    • Angina pain last longer than 10 minutes, is unrelieved by rest or sublingual nitroglycerin, and mimics signs and symptoms of impending myocardial infarction.
Diagnostic Evaluation
  1. Resting ECG may show left ventricular hypertrophy, ST-T changes, arrhythmias, and possible Q waves.
  2. Exercise stress testing with or without perfusion studies shows ischemia.
  3. Cardiac catheterization shows blocked vessels.
  4. Position emission tomography may show small perfusion defects.
  5. Radionuclide ventriculography shows wall motion abnormalities and ejection fraction.
  6. Fasting blood levels of cholesterol, low density lipoprotein, high density lipoprotein, lipoprotein A, homocysteine, and triglycerides may be abnormal.
  7. Coagulation studies, hemoglobin level, fasting blood sugar as baseline studies.
Primary Nursing Diagnosis
  • Altered tissue perfusion (myocardial) related to narrowing of the coronary artery(ies) associated with atherosclerosis, spasm, and/or thrombosis
Other Diagnoses that may occur in Nursing Care Plans For CAD
  • Acute pain
  • Risk for decreased cardiac output
  • Anxiety
  • Deficient knowledge (Learning Need) regarding condition, treatment plan, self-care, and discharge needs
Medical Management

The goals of medical management are to decrease the oxygen demands of the myocardium and to increase the oxygen supply through pharmacological therapy and risk factor control

Surgical Interventions
  1. Percutaneous transluminal coronary angioplasty or intracoronary atherectomy, or placement of intracoronarystent.
  2. Coronary artery bypass grafting.
  3. Transmyocardial revascularization.
Pharmacologic Intervention
  1. Antianginal medications (nitrates, beta-adrenergic blockers, calcium channel blockers, and angiotensin converting enzyme inhibitors) to promote a favorable balance of oxygen supply and demand.
  2. Antilipid medications to decrease blood cholesterol and tricglyceride levels in patients with elevated levels.
  3. Antiplatelet agents to inhibit thrombus formation.
  4. Folic acid and B complex vitamins to reduce homocysteine levels.
Nursing Intervention
  1. Monitor blood pressure, apical heart rate, and respirations every 5 minutes during an anginal attack.
  2. Maintain continuous ECG monitoring or obtain a 12-lead ECG, as directed, monitor for arrhythmias and ST elevation.
  3. Place patient in comfortable position and administer oxygen, if prescribed, to enhance myocardial oxygen supply.
  4. Identify specific activities patient may engage in that are below the level at which anginal pain occurs.
  5. Reinforce the importance of notifying nursing staff whenever angina pain is experienced.
  6. Encourage supine position for dizziness caused by antianginals.
  7. Be alert to adverse reaction related to abrupt discontinuation of beta-adrenergic blocker and calcium channel blocker therapy. These drug must be tapered to prevent a “rebound phenomenon”; tachycardia, increase in chest pain, and hypertension.
  8. Explain to the patient the importance of anxiety reduction to assist to control angina.
  9. Teach the patient relaxation techniques.
  10. Review specific factors that affect CAD development and progression; highlight those risk factors that can be modified and controlled to reduce the risk.
Documentation Guidelines
  • Episodes of angina describing character, location, and severity of pain; precipitating or mitigating factors; interventions; and evaluation
  • Patient teaching about disease process and planned treatments, including medication regimen
  • Perioperative hemodynamic response: Pulmonary and systemic arterial pressures, presence of pulses, capillary refill, urine output
  • Pulmonary assessment: Breath sounds, ventilator settings, response to mechanical ventilation, secretions
  • Complications: Bleeding, blood gas alterations, fluid volume deficit, hypotension, dysrhythmias, hypothermia
  • Coping: Patient and family
  • Mediastinal drainage and autotransfusion
Discharge and Home Healthcare Guidelines
  • PREVENTION. Review the risk factor and lifestyle modifications that are acceptable to the patient and her or his family members.
  • MEDICATIONS. Be certain that the patient and appropriate family members understand all medications, including the correct dosage, route, action, and adverse effects.
    • Care of Incision. Often the incision heals with no home healthcare, but the patient needs to know the signs of infection.
    • Activity Restrictions. The activity recommendations will depend on the type and extent of the patient’s underlying condition.