Nursing Care Plan for Coronary Artery Disease (CAD)

Coronary Artery Disease Pathophysiology

Coronary artery disease (CAD) is a condition that affects the coronary arteries, which are the blood vessels that supply oxygen-rich blood to the heart. 

When these arteries become narrowed or blocked, it can cause chest pain (angina) or even a heart attack. This can happen when plaque builds up on the inner walls of the arteries, making them more narrow and difficult for blood to pass through. CAD is also called atherosclerosis.

CAD usually starts with atherosclerosis, when plaque (fat, cholesterol, and other substances) builds up inside the arteries, and over time, they can harden and narrow. This narrowing reduces blood flow to the heart, which can cause chest pain (angina). 

Causes

• Hypercholesterolemia (high levels of cholesterol in the bloodstream)
• Hypertriglyceridemia (high levels of triglycerides in the bloodstream)
• Smoking
• Hypertension (high blood pressure)
• Obesity
• Smoking
• Family history

Subjective (Patient May Report)

• Chest pain or discomfort
• Shortness of breath
• Upper abdominal pain
• Nausea or vomiting
• Dizziness
• Feeling tired or weak
• Numbness or tingling in the arms and legs
• Fainting

Objective

• Pale skin
• Shortness of breath or chest pain
• Muscle weakness or numbness in the arms or legs

Risk Factors

• Smoking
• Diabetes mellitus
• Hyperlipidemia
• Obesity
• Hypertension
• Age over 45 years 
• Family history 
• Elevated blood cholesterol levels

Coronary Artery Disease Symptoms

• Chest Pain
• Shortness of Breath
• Fatigue 
• Heart palpitations
• Nausea and Vomiting
• Dizziness, lightheadedness, or fainting 

CAD Nursing Assessment

Nurses should assess their clients by taking the patient’s pulse, vital signs, and auscultating heart and lung sounds. A prescribed electrocardiogram may need to be administered and reported to the HCP.

Assessment 

• Heart sounds
• Blood pressure 
• Central venous pressure 
• Residual volume (RV) and total lung capacity (TLC)

Coronary Artery Disease Nursing Interventions

The main goal of nursing interventions for CAD is reducing the risk of complications and death. Nurses can help patients by administering medications that reduce cholesterol levels, lowering blood pressure, improving circulation, and reducing other risk factors associated with the condition.

Cardiac Function

• Increased heart rate
• Systolic blood pressure

Respiratory Function

• Impaired assimilation & gas exchange
• Decreased oxygen supply

Neurologic & Sensory Functions

• Mental status changes
• Loss of vision
• Peripheral nerve damage
• Bradycardia (slow heart rate)
• Hypoesthesia (numbness)
• Hyperglycemia (high blood sugar)

Visual Appearance & Labs

• Jaundice (yellowing) of the skin and mucous membranes
• Dullness to the eyes and skin
• Skin that breaks or bruises easily
• Extremities that appear blue (cyanosis) or swollen
• Blood tests (glucose, electrolytes, complete blood count, liver function tests)
• Chest X-ray
• Electrocardiogram (ECG)

CAD Nursing Actions

Perform

• A focused physical exam (including auscultation of heart sounds, palpation of precordium, and peripheral perfusion)

Provide

• Prescribed pain management for clients who experience chest pain or discomfort
• Education on lifestyle changes that can help reduce the risk of cardiovascular disease.

Administer

• Pain medication as ordered
• Oxygen, if hypoxemic
• Nitroglycerin as needed

Monitor

• Heart rate
• Blood pressure
• Oxygen saturation levels
• Electrocardiogram (ECG) tracings for ST segment changes or arrhythmias
• Signs of infection (such as fever or chills)

Encourage

• Eating a healthy diet 
• Getting regular physical activity (as tolerated by their health status)

Goals and Outcomes

• Preventing future cardiac events

CAD NCLEX Questions

1. A client with coronary artery disease (CAD) requires education on risk factors that can be controlled or modified. Which of the risk factors will the nurse indicate that are controllable or modifiable?

Choose one of these four answers:

A. Gender, obesity, family history, and smoking.

B. Genetics, smoking, inactivity, and gender.

C. Drinking alcohol, stress, gender, and smoking.

D. Obesity, inactivity, diet, and smoking.

Answer: D. Clients should be taught the controllable or modifiable risk factors for CAD, including stress, obesity, inactivity, diet (including alcohol intake), and smoking. This will help prevent the most common cause of CAD, atherosclerosis, which is the buildup of cholesterol and other substances that can narrow the arteries and decrease blood supply in the arteries.

2. A nurse conducts a home visit with an older adult client who has a history of coronary artery disease, hypertension, atrial fibrillation, and heart failure. The client has a new prescription for furosemide 40 mg PO daily. Which client statement indicates a correct understanding regarding safety in the home environment? 

Choose one of these four answers:

A. “I will take my furosemide with a full glass of water just before bedtime.”

B. “I will change position slowly when going from sitting to standing.”

C. “I will notify my doctor if my urine output increases after a few doses.”

D. “I will not eat my usual banana with my breakfast cereal in the morning.”

Answer: B. Clients should be instructed to avoid abrupt position changes in order to prevent acute drops in blood pressure and falls; therefore, this client statement indicates a correct understanding of the safety instruction provided by the home care nurse related to the use of furosemide, a loop diuretic. 

Sources

https://www.ncbi.nlm.nih.gov/books/NBK564304/

https://www.cdc.gov/heart-disease/about/coronary-artery-disease.html