Angina Pectoris

  1. General information
    1. Transient, paroxysmal chest pain produced by insufficient blood flow to the myocardium resulting in myocardial ischemia.
    2. Risk factors: CAD, atherosclerosis, hypertension, diabetes mellitus, thromboangiitis obliterans, severe anemia, aortic insufficiency
    3. Precipitating factors: physical exertion, consumption of a heavy meal, extremely cold weather, strong emotions, cigarette smoking, sexual activity
  2. Medical management
    1. Drug therapy: nitrates, beta-adrenergic blocking agents, and/or calcium-blocking agents, lipid reducing drugs if cholesterol elevated
    2. Modification of diet and other risk factors
    3. Surgery: see Coronary Artery Bypass Surgery
  3. Assessment findings
    1. Pain: substernal with possible radiation to the neck, jaw, back, and arms; relieved by rest
    2. Palpitations, tachycardia
    3. Dyspnea
    4. Diaphoresis
    5. Increased serum lipid levels
    6. Diagnostic tests
      1. ECG may reveal ST segment depression and T-wave inversion during chest pain
      2. Stress test may reveal an abnormal ECG during exercise.
  4. Nursing interventions
    1. Administer oxygen.
    2. Give prompt pain relief with nitrates or narcotic analgesics as ordered.
    3. Monitor vital signs, status of cardiopulmonary function.
    4. Monitor ECG.
    5. Place client in semi- to high-Fowler's position.
    6. Provide emotional support.
    7. Provide client teaching and discharge planning concerning
      1. Proper use of nitrates
        1. nitroglycerin tablets (sublingual)
          1. allow tablet to dissolve.
          2. relax for 15 minutes after taking tablet to prevent dizziness.
          3. if no relief with 1 tablet, take additional tablets at 5-minute intervals, but no more than 3 tablets within a 15-minute period.
          4. know that transient headache is a frequent side effect.
          5. keep bottle tightly capped and prevent exposure to air, light, heat.
          6. ensure tablets are within reach at all times.
          7. check shelf life, expiration date of tablets.
        2. nitroglycerin ointment (topical)
          1. rotate sites to prevent dermal inflammation.
          2. remove previously applied ointment.
          3. avoid massaging/rubbing as this increases absorption and interferes with the drug's sustained action.
      2. Ways to minimize precipitating events
        1. reduce stress and anxiety (relaxation techniques, guided imagery)
        2. avoid overexertion and smoking
        3. maintain low-cholesterol, low-saturated fat diet and eat small, frequent meals
        4. avoid extremes of temperature
        5. dress warmly in cold weather
      3. Gradual increase in activities and exercise
        1. participate in regular exercise program
        2. space exercise periods and allow for rest periods
    8. Instruct client to notify physician immediately if pain occurs and persists, despite rest and medication administration.