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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.

What is a common nursing diagnosis for pain?

Nursing Care Plan 3 – Nursing Diagnosis: Acute Pain related to psychological distress as evidenced by patient verbalizing pain, moaning and crying, narrowed focus and altered passage of time, and pallor. Desired Outcome : Within 4 hours of nursing interventions, the patient will demonstrate a reduction in crying and pain verbalization.

What is the nursing diagnosis for angina?

Assessment and Diagnostic Findings – The diagnosis of angina pectoris is determined through:

ECG : Often normal when a 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): D 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 the 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. Chest x-ray : Usually normal; however, infiltrates may be present, reflecting cardiac decompensation or pulmonary complications. Pco2, potassium, and myocardial lactate: May be elevated during the anginal attack (all play a role in myocardial ischemia and may perpetuate it). Serum lipids (total lipids, lipoprotein electrophoresis, and isoenzymes cholesterols ; triglycerides ; phospholipids): May be elevated (CAD risk factor). Echocardiogram : May reveal abnormal valvular action as the cause of chest pain. Nuclear imaging studies (rest or stress scan): Thallium-201: Ischemic regions appear as areas of decreased thallium uptake. MUGA: 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 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 to demonstrate hyper spastic coronary vessels. (Patients with resting angina usually experience chest pain, ST elevation, or depression and/or pronounced rise in left ventricular end-diastolic pressure, fall in systemic systolic pressure, and/or high-grade coronary artery narrowing. Some patients may also have severe ventricular dysrhythmias.)

What causes chest pain?

Other causes of chest pain – There are many other potential causes of chest pain, including:

gastro-oesophageal reflux disease (GORD) – acid from the stomach comes up into the oesophagus (gullet) causing burning chest pain (heartburn) and an unpleasant taste in the mouth acute cholecystitis – inflammation of the gallbladder that can cause a sudden sharp pain in the upper right side of your tummy that spreads towards your right shoulder strained muscle – can cause chest pain that’s painful and tender to touch costochondritis – inflammation in the cartilage that joins the ribs to the breastbone (sternum) that can cause pain, swelling and tenderness around the ribs panic attack or anxiety – can sometimes be accompanied by chest pain

What are 5 priority assessments for a patient with heart failure?

Assessment: – 1. Assess vital signs, cardiac rhythm, and hemodynamic measurements. HF patients benefit from continuous cardiac monitoring via telemetry. The nurse can then act quickly if a dysrhythmia is observed. Blood pressure, pulse rate, and oxygen saturation should also be assessed regularly for changes.

• Unstable patients may need hemodynamic monitoring to maintain adequate perfusion.2.
• Monitor skin and pulses.
• Poor cardiac output will result in decreased tissue perfusion,
• The nurse may observe skin mottling, pallor, or cyanosis.
• The skin may also feel cool or clammy.
• Along with these outward changes, peripheral pulses may be weak or irregular due to the lack of circulating blood volume.3.

Monitor mental status changes. HF can have long-term mental effects on the brain leading to poor memory and impaired cognition. The nurse can monitor for subtle changes or a decline in baseline presentation such as acute confusion or altered alertness.

Is decreased cardiac output a nursing diagnosis?

INTRODUCTION – Standardized language systems in nursing organize the vocabulary scope of concepts and elements related to the phenomena that nurses must identify, treat and assess in health care ( 1 ), In the clinical setting, changes in the capacity of the blood volume required for circulation, called cardiac output ( 2 ), can produce signs and symptoms resulting from hypoperfusion that are of special interest to nursing.

• Decreased cardiac output (DCO) (00029) is a nursing diagnosis (ND) from NANDA International, Inc.
• NANDA-I) ( 3 ), defined as “an inadequate volume of blood pumped by the heart to meet the metabolic demands of the body”.
• It is contained in the Activity/Rest domain and has 36 defining characteristics (DC), divided into five groups: altered heart rate/rhythm, altered preload, altered afterload, altered contractility, behavioral/emotional ( 3 ),

By DC, we understand the set of observable clues or inferences that are grouped as manifestations of an ND. As for associated conditions (conditions not modifiable by a nurse), six are described for DCO: altered contractility, altered heart rate, altered afterload, altered preload, altered heart rhythm and altered stroke volume ( 3 ),

Although DCO has been present in the classification since 1975 and has already been the focus of conceptual research regarding its pertinence in the field of nursing ( 4 ), to date, previous studies have not identified antecedent elements that show a causal relationship with this human response, called related factors (RF), and that are subject to modification by independent nursing interventions ( 3 ),

It is also observed that, although DCO is often identified in people with cardiovascular diseases, especially heart failure ( 5 ), its diagnostic structure does not include a description of populations at risk, which are defined as a group of people who share common characteristics and who, due to such characteristics, are more susceptible to certain human responses ( 3 ),

• NANDA-I ( 3 ) is the only classification that presents well-defined criteria regarding validity evidence levels of ND present in its structure, defined so far as level of evidence (LoE).
• Therefore, each ND must present a set of evidence (theoretical and clinical) that allow its correct interpretation, from a set of manifestations for certain clinical contexts ( 3 ),

In this context, DCO does not present the minimum level of evidence required by NANDA-I to justify its permanence in the classification, and its withdrawal is suggested in the next edition 2024-2026. Therefore, DCO refinement from the literature allows identifying possible contributing factors (RF, associated conditions, populations at risk) that explain the causal dynamics of this ND as well as the characterization of its occurrence in the scenarios in which it has been identified.

Is hypertension a nursing diagnosis?

Nursing diagnosis for hypertension is made considering all of the causes of hypertension like stress and high cholesterol. An example would be ineffective coping leading to high-stress levels resulting in high blood pressure. What is hypertension? Hypertension is a disease where the blood pressure is too high.

What is the most common nursing diagnosis?

1. Problem-focused diagnosis – A patient problem present during a nursing assessment is known as a problem-focused diagnosis. Generally, the problem is seen throughout several shifts or a patient’s entire hospitalization. However, it may be resolved during a shift depending on the nursing and medical care. Problem-focused diagnoses have three components.

• Nursing diagnosis
• Related factors
• Defining characteristics

Examples of this type of nursing diagnosis include:

• Decreased cardiac output
• Chronic functional constipation
• Impaired gas exchange

Problem-focused nursing diagnoses are typically based on signs and symptoms present in the patient. They are the most common nursing diagnoses and the easiest to identify.

What is the most reliable indicator of pain nursing?

Self-report is the most reliable source of information on pain.

What is the most common pain assessment?

Visual Analogue Scale/Graphic Rating Scale. The Visual Analogue Scale (VAS) consists of a straight line with the endpoints defining extreme limits such as ‘no pain at all’ and ‘pain as bad as it could be’ (Fig.1). The patient is asked to mark his pain level on the line between the two endpoints.

Chukwudi Eze