Chest Pain Nursing Diagnosis
Types and Risk Factors – Chest pain is essentially a symptom of an underlying problem like coronary artery disease (CAD), coronary microvascular disease (MVD), pleuritis, pulmonary embolism, pneumothorax, and gastroesophageal reflux disease (GERD). There are different types of angina:
- Stable Angina. This type of angina is also referred to as angina pectoris and occurs due to CAD with decreased oxygenated blood flow to the heart muscles due to narrowed or blocked arteries. This type of chest pain is often predictable and resolves with rest or medication.
- Unstable Angina, This type of angina causes unexpected and sudden chest pain usually occurring while at rest due to a rupture of unstable plaque. Immediate diagnosis and treatment are required.
- Variant (Prinzmetal) Angina, Variant angina is characterized by pain caused by coronary vasospasm usually happening between midnight and early morning while the patient is at rest.
The major risk factors of angina include the following:
- High cholesterol
- Hypertension
- Smoking
- Overweight or obesity
- Diabetes
- Metabolic syndrome
- Sedentary lifestyle
- Unhealthy diet
- Family history of heart disease
- Old age (men above 45 years old and women above 55 years old)
Prompt diagnosis and treatment of chest pain are important to prevent myocardial infarction, Physical assessment and risk identification are essential. Diagnostic exams like an electrocardiogram, blood tests, stress tests, coronary angiography, chest x-ray, cardiac catheterization, or computed tomography angiography (CTA) can confirm and treat the underlying condition that is causing the chest pain.
Contents
What are the nursing interventions for chest pain?
Immediate management –
- Assess pain.
- Provide bed rest.
- Administer oxygen at 3 L/min by nasal cannula as prescribed.
- Administer nitroglycerin as prescribed to dilate the coronary arteries, reduce the oxygen requirements of the myocardium and relieve the chest pain.
- Obtain a 12-Lead electrocardiogram.
- Provide continuous cardiac monitoring.
What is a nursing diagnosis of risk for cardiac output?
Causes of decrease in cardiac output – Conditions like myocardial infarction, hypertension, valvular heart disease, congenital heart disease, cardiomyopathy, heart failure, pulmonary disease, arrhythmias, drug effects, fluid overload, decreased fluid volume, and electrolyte imbalance is common causes of decreased cardiac output.
- Alteration in heart rate, rhythm, and conduction. Any disturbance in the heart’s electrical system can disrupt the coordinated contraction and relaxation of the cardiac muscle, leading to decreased cardiac output.
- Cardiac muscle disease. Conditions that affect the structure and function of the heart muscle, such as cardiomyopathy or myocarditis, can impair the heart’s ability to pump effectively, resulting in decreased cardiac output.
- Decreased oxygenation. Insufficient oxygen supply to the heart muscle, often caused by conditions like coronary artery disease or respiratory disorders, can lead to impaired cardiac function and decreased cardiac output.
- Impaired contractility. Damage to the heart muscle due to conditions like myocardial infarction or heart failure can weaken the heart’s ability to contract forcefully, resulting in decreased cardiac output.
- Increased afterload. When the resistance against which the heart must pump blood increases, such as in conditions like hypertension or aortic stenosis, the heart has to work harder to overcome this resistance, leading to decreased cardiac output.
- Increased or decreased ventricular filling (preload). If the volume of blood entering the heart (preload) is either excessively high or low, it can affect the amount of blood the heart can pump out, resulting in decreased cardiac output.
What are the top 3 nursing priorities for MI?
Nursing Priorities Relieve pain, anxiety. Reduce myocardial workload. Prevent/detect and assist in treatment of life-threatening dysrhythmias or complications.
What is the first intervention for myocardial infarction?
All patients with a suspected myocardial infarction should be given aspirin. It is a powerful antiplatelet drug, with a rapid effect, which reduces mortality by 20%. Aspirin, 150-300 mg, should be swallowed as early as possible.
What are the nursing diagnosis for ischemic stroke?
Evaluation – Expected patient outcomes may include the following:
Improved mobility. Absence of shoulder pain. Self-care achieved. Relief of sensory and perceptual deprivation. Prevention of aspiration, Continence of bowel and bladder. Improved thought processes. Achieved a form of communication. Maintained skin integrity. Restored family functioning. Improved sexual function. Absence of complications.
Is pain a nursing diagnosis?
Diagnoses – Commonly used NANDA-I nursing diagnoses for pain include Acute Pain (duration less than 3 months) and Chronic Pain, See Table 11.5 for more information regarding these diagnoses. For more information about defining characteristics and related factors for other NANDA-I nursing diagnoses, refer to a current nursing diagnosis resource. Table 11.5 Pain NANDA-I Nursing Diagnoses
| NANDA-I Diagnosis | Definition | Defining Characteristics |
|---|---|---|
| Acute Pain | Unpleasant sensory and emotional experience associated with acute or potential tissue damage, or described in terms of such damage; sudden or slow onset of any intensity from mild to severe with an anticipated or predictable end, and with a duration of less than 3 months. |
Alteration in sleep pattern Appetite change Change in physiological parameters (i.e., blood pressure, heart rate, respiratory rate) Diaphoresis Distraction behavior Evidence of pain using standardized pain behavior checklist for those unable to communicate verbally Expressive behavior Facial expression of pain Guarding behavior Hopelessness Narrowed focus Protective behavior Proxy report of pain behavior/activity changes Pupil dilation Restlessness Self-focused Self-report of intensity using standardized pain scale Self-report of pain characteristics using standardized pain instrument |
| Chronic Pain | Unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage (International Association for the Study of Pain); sudden or slow onset of any intensity from mild to severe, constant or recurring without anticipated or predictable end, and with a duration of greater than 3 months. |
Alteration in ability to continue previous activities Alteration in sleep pattern Anorexia Evidence of pain using standardized pain behavior checklist for those unable to communicate verbally Facial expression of pain Proxy report of pain behavior/activity changes Self-focused Self-report of intensity using standardized pain scale Self-report of pain characteristics using standardized pain instrument |
