Chest Pain Nursing Diagnosis & Care Plan – devshopsimplenursing

Chest Pain Nursing Diagnosis & Care Plan

Amanda Thomas Headshot
By Amanda Thomas
Updated On May 2025
Medically Reviewed by:
Angela Slater FNP, RN
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Chest pain doesn’t always come with flashing lights and dramatic movie moments.

Sometimes it’s quiet, subtle, and easy to miss. But for nurses, it’s always a call to action. 

The goal? 

Relieve the pain, rule out the worst, and keep the patient stable — whether it’s using hydromorphone (Dilaudid) nursing interventions to manage unrelenting pain, or closely monitoring vitals to catch early signs of decline.

What is Chest Pain?

Chest pain refers to discomfort or pain perceived in the chest area, which can arise from various etiologies. 

Understanding the type and cause of chest pain is essential for accurate diagnosis and treatment.

But first, it’s important to understand what chest pain actually is — and why it happens.

Types of Chest Pain

  • Angina pectoris: Chest pain because of myocardial ischemia, often triggered by physical exertion or stress.
  • Myocardial infarction (heart attack): Severe, prolonged chest pain resulting from the complete blockage of coronary arteries.
  • Pericarditis: Inflammation of the pericardium, causing sharp, pleuritic chest pain.
  • Musculoskeletal pain: Chest wall pain due to muscle strain or rib injury.
  • Gastroesophageal reflux disease (GERD): Burning chest pain resulting from acid reflux.

Importance of Early Detection

Early recognition and evaluation of chest pain are vital to rule out life-threatening conditions such as myocardial infarction (MI) and to initiate appropriate interventions promptly.

Nursing Diagnosis for Chest Pain

Chest pain might be a sign of a heart attack, anxiety, or something in between. 

That’s why nurses need to match the diagnosis to what’s really going on, whether it’s acute pain from myocardial ischemia or anxiety that’s sending vital signs into overdrive. Depending on the severity, care might include everything from oxygen and electrocardiograms (ECGs) to hydromorphone nursing interventions for pain relief.

Common Nursing Diagnoses

  • Acute pain related to myocardial ischemia
  • Anxiety related to fear of the unknown or a potential health crisis
  • Risk for decreased cardiac output related to altered heart rate and rhythm

Variations Based on Patient Symptom

  • Acute chest pain: Sudden onset requiring immediate intervention
  • Chronic chest pain: Ongoing discomfort necessitating long-term management strategies

Causes & Risk Factors for Chest Pain

Chest pain can stem from a variety of causes — some minor, others life-threatening.

For nurses, recognizing the source and understanding the contributing risk factors is key to timely, effective care. Here’s what to keep in mind when assessing a patient with chest pain.

Common Causes

  • Cardiac: MI, angina, pericarditis
  • Pulmonary: Pulmonary embolism, pneumothorax
  • Gastrointestinal: GERD, esophageal spasm
  • Musculoskeletal: Costochondritis, muscle strain

Risk Factors

  • Non-modifiable: Age, gender, family history of heart disease
  • Modifiable: Hypertension, obesity, smoking, sedentary lifestyle, high cholesterol

Patient Considerations

  • Age: Older adult patients have a higher risk for cardiac-related chest pain.
  • Gender: Men are at higher risk for MI; however, women may present with atypical symptoms.
  • Lifestyle: Diet, exercise habits, and stress levels influence chest pain risk.

Signs and Symptoms of Chest Pain (As Evidenced By)

When assessing chest pain, knowing what to look for — and how patients describe it — is key to early intervention. 

Chest pain can manifest in various ways, depending on its cause, severity, and duration. Some signs come straight from what the patient says, while others are visible and measurable in real time. 

Understanding the whole picture helps prioritize care and catch the red flags that could signal a medical emergency.

Acute vs. Chronic Signs

  • Acute: Sudden, severe pain; may be accompanied by shortness of breath, diaphoresis
  • Chronic: Persistent discomfort; often associated with exertion and relieved by rest

Objective vs. Subjective Data

  • Subjective: Patient reports of pain intensity, location, quality (e.g., sharp, dull), radiation to other areas
  • Objective: Vital sign changes (e.g., tachycardia, hypertension), diaphoresis, pallor

Red Flags

  • Sudden onset of severe, crushing chest pain
  • Pain radiating to the jaw, neck, or left arm
  • Associated symptoms like shortness of breath, nausea, and dizziness

Nursing Assessment for Chest Pain

Chest pain is a red flag that requires sharp clinical judgment, quick action, and a structured approach. 

An accurate assessment is the first step in managing potential cardiac emergencies.

Effective Assessment Strategies

  • Pain assessment: Use PQRST or OLDCARTS mnemonics to evaluate pain characteristics
  • Vital signs monitoring: Regularly check heart rate, blood pressure, respiratory rate, and oxygen saturation (SpO₂) .

Diagnostic Tests

  • ECG: Detects cardiac ischemia or infarction
  • Laboratory tests: Cardiac biomarkers (e.g., troponin levels)
  • Imaging: Chest X-ray, echocardiogram to assess structural abnormalities

Nursing Interphysical Activity for Chest Pain

Chest pain can signal something as serious as reduced blood flow to the heart, making nursing interventions a top priority. 

Here’s how to manage care effectively when a patient presents with chest pain.

Immediate Interventions

  • Administer nitroglycerin: A vasodilator relieves angina.
  • Provide oxygen therapy: Oxygen therapy enhances oxygen delivery to the myocardium.
  • Administer aspirin: An Antiplatelet agent reduces clot formation.

Long-Term Interventions

  • Medication management: Provide beta-blockers, calcium channel blockers, and statins as prescribed.
  • Lifestyle modifications: Encourage smoking cessation, a balanced diet, and regular physical activity.

Preventing Complications

  • Monitor for arrhythmias: Continuous ECG monitoring
  • Assess for heart failure: Observe for signs like edema, shortness of breath

Patient Education

  • Risk factor reduction: Educate the patient on managing hypertension, diabetes, and cholesterol.
  • Symptom recognition: Teach the patient to identify warning signs and seek prompt medical attention.

Chest Pain Nursing Care Plan Examples

The examples below outline tailored strategies for managing chest pain based on its root cause.

Care Plan #1: Acute Chest Pain from Myocardial Infarction

Nursing Diagnosis

Acute pain related to decreased myocardial oxygen supply secondary to MI as evidenced by patient reports of severe chest pain, ECG changes, elevated cardiac biomarkers, and dyspnea

Expected Outcomes

  • Patient will report decreased chest pain intensity from 9/10 to 2/10 within 30 minutes of intervention
  • Patient will exhibit normal cardiac rhythm and hemodynamic stability
  • Cardiac enzyme levels, such as troponin and creatine kinase MB (CK-MB) will normalize over time
  • Patient will verbalize understanding of post-MI care and medication adherence

Assessment

  • Obtain detailed pain assessment (PQRST method: Provocation, Quality, Radiation, Severity, Timing).
  • Monitor vital signs, including HR, BP, and oxygen saturation.
  • Assess ECG for ST-segment changes indicative of MI.
  • Check troponin and CK-MB levels for myocardial injury.
  • Observe for shortness of breath, diaphoresis, pallor, nausea, and anxiety.

Interventions

  • Administer oxygen therapy if oxygen saturation is below 94%.
  • Administer nitroglycerin (sublingual or IV) to relieve ischemic pain.
  • Give aspirin (160-325 mg, chewed) to reduce platelet aggregation.
  • Administer morphine or hydromorphone (Dilaudid) if pain is unrelieved by nitroglycerin.
  • Monitor cardiac enzymes and ECG for progression of infarction.
  • Prepare for percutaneous coronary intervention (PCI) or thrombolytic therapy as indicated.
  • Educate the patient on lifestyle changes, medication adherence, and signs of worsening symptoms.

Care Plan #2: Angina Related to Coronary Artery Disease

Nursing Diagnosis

Acute pain related to decreased myocardial oxygen supply secondary to coronary artery disease (CAD) as evidenced by reports of chest discomfort relieved by rest or nitroglycerin, ECG changes, and dyspnea

Expected Outcomes

  • Patient will report relief of chest pain within 5 minutes of nitroglycerin administration
  • Patient will demonstrate stable vital signs and absence of ischemic ECG changes
  • Patient will verbalize understanding of angina triggers and lifestyle modifications

Assessment

  • Assess pain characteristics (onset, location, duration, radiation, severity, and relieving factors).
  • Monitor the patient’s oxygen saturation, heart rate, and blood pressure.
  • Perform an ECG to check for ST depression or T-wave inversion.
  • Evaluate stressors or triggers (e.g., exertion, stress, heavy meals).
  • Check lipid profile and cardiac enzymes if indicated.

Interventions

  • Administer nitroglycerin (sublingual or spray) as prescribed.
  • Encourage rest and limit activities during an angina episode.
  • Provide oxygen therapy as needed if the SpO₂ Level is below 94%.
  • Administer beta-blockers or calcium channel blockers to reduce myocardial workload.
  • Encourage smoking cessation, weight management, and dietary modifications.
  • Educate the patient on recognizing angina symptoms and when to seek emergency care.

Care Plan #3: Chest Pain in a Patient with Anxiety

Nursing Diagnosis

Acute pain related to hyperventilation and muscle tension secondary to anxiety, as evidenced by patient reports of tightness in the chest, dyspnea, tachycardia, and a normal ECG and cardiac enzyme levels

Expected Outcomes

  • Patient will verbalize a reduction in chest pain and anxiety within 30 minutes of relaxation techniques
  • Patient’s heart rate and respiratory rate will return to baseline
  • Patient will demonstrate effective coping mechanisms for anxiety

Assessment

  • Assess pain description and location to rule out cardiac causes.
  • Monitor vital signs (HR, BP, respiratory rate).
  • Evaluate the ECG to rule out ischemic changes.
  • Assess history of anxiety disorders or panic attacks.
  • Observe for hyperventilation, diaphoresis, trembling, and dizziness.

Interventions

  • Encourage slow, deep breathing techniques to reduce hyperventilation.
  • Provide reassurance and explain that the symptoms are anxiety-related.
  • Use grounding techniques, such as the 5-4-3-2-1 sensory awareness technique.
  • Administer anti-anxiety medications (if prescribed, e.g., benzodiazepines or SSRIs).
  • Encourage cognitive behavioral therapy (CBT) techniques to manage stress.
  • Educate the patient on identifying anxiety triggers and effective stress management.

Risk Management & Prevention of Chest Pain Complications

Chest pain can signal more than temporary discomfort. It can point to serious underlying issues. 

Preventing complications begins with clear strategies, consistent habits, and recognizing the signs before they escalate.

Strategies to Prevent Future Episodes

1. Prioritize Medication Adherence

Patients should take prescribed medications exactly as directed to prevent recurrent chest pain and complications.

Common medications include:

  • Beta-blockers (e.g., metoprolol) to reduce heart workload
  • Nitrates (e.g., nitroglycerin) to relieve angina
  • Antiplatelets (e.g., aspirin) to prevent clot formation
  • Statins (e.g., atorvastatin) to lower cholesterol

2. Manage Stress

Chronic stress contributes to increased heart rate and blood pressure, exacerbating chest pain.

Effective techniques include:

  • Deep breathing exercises (e.g., diaphragmatic breathing)
  • Mindfulness and meditation
  • Counseling or CBT
  • Engaging in hobbies and social activities

3. Exercise & Get More Physical Activity

Regular, moderate exercise improves heart health and reduces the risk of chest pain episodes.

Recommended Activities
  • Walking, swimming, cycling – at least 150 minutes per week
  • Cardiac rehabilitation programs for post-MI patients
Precautions
  • Avoid overexertion or exercise that triggers chest pain.
  • Always carry nitroglycerin, if prescribed.

Control Blood Pressure and Cholesterol

Uncontrolled hypertension and hyperlipidemia increase the risk of heart failure and stroke.

Strategies include:

  • A low-sodium, heart-healthy diet, like the Dietary Approaches to Stop Hypertension (DASH)
  • Medication adherence (antihypertensives, statins)
  • Regular blood pressure monitoring

Avoid Smoking and Alcohol Overuse

  • Smoking cessation helps lower the risk of coronary artery disease.
  • Limit alcohol intake to reduce cardiac stress and blood pressure spikes.

Monitor for Arrhythmias and Heart Failure Symptoms

Advise patients on the warning signs, such as:

  • Shortness of breath while the patient is at rest or with exertion
  • Edema in legs, ankles, or abdomen
  • Irregular heartbeats (palpitations)
  • Fatigue and dizziness

Patients should actively engage in their health management by learning how to recognize symptoms early and take action to prevent complications.

Recognize Warning Signs of Worsening Chest Pain

  • New or worsening pain that isn’t relieved by nitroglycerin
  • Pain coming from the jaw, arm, or back
  • Associated symptoms such as shortness of breath, nausea, and cold sweats

Create an Emergency Action Plan

  • Teach patients and family members how to respond to a heart emergency.
  • Ensure the patient knows when to call 911 vs. when to use at-home management (e.g., nitroglycerin).

Patient Education & Discharge Planning

Discharge planning helps bridge the gap between hospital care and home recovery. 

For patients with chest pain, clear instructions and ongoing support reduce the risk of complications and readmission. Nurses should focus on practical education, including: 

  • What medications to take
  • How to ease back into activity
  • When to seek urgent help

Discharge Instructions for Chest Pain Patients

1. Medication Management

  • Patients should take medications on time and never skip doses.
  • Keep an updated list of medications and bring it to all health care visits.
  • Store nitroglycerin properly and know how to use it during an episode.

2. Activity Recommendations

  • Gradually increase physical activity as tolerated.
  • Avoid heavy lifting or sudden strenuous exertion.
  • Enroll in a cardiac rehabilitation program if prescribed.

3. Dietary Guidelines

  • Follow a heart-healthy diet, such as the Mediterranean or DASH diet.
  • Reduce the intake of sodium to less than 2,300 mg daily.
  • Increase the intake of fiber, fruits, vegetables, and lean proteins.
  • Avoid processed foods and trans fats.

When to Seek Immediate Medical Help

Instruct patients to call 911 immediately if they experience:

  • Severe chest pain lasting more than 5 minutes, unrelieved by rest or nitroglycerin
  • Sudden shortness of breath, fainting, or dizziness
  • Pain radiating to the left arm, jaw, back, or neck
  • Cold sweats, nausea, or a sense of impending doom

Long-Term Management Strategies

1. Cardiac Rehabilitation

  • Patients recovering from MI or angina benefit from supervised exercise programs that improve cardiovascular health.

2. Regular Follow-Ups

  • Schedule routine check-ups with a cardiologist to adjust medications and monitor health.
  • Perform blood tests for cholesterol, kidney function, and blood pressure assessments.

3. Ongoing Lifestyle Modifications

  • Maintain a healthy weight (BMI < 25).
  • Limit alcohol and caffeine intake to prevent arrhythmias.
  • Manage stress effectively to prevent future episodes.

Recommended Resources for Chest Pain Care

Effective chest pain care starts with staying informed. 

These trusted resources provide evidence-based guidelines, clinical tools, and up-to-date research to support informed decision-making that enhances patient outcomes.

Trusted organizations and resources

Nursing Care Plan Resources

Chest Pain Care, Made Simple

Chest pain demands fast thinking, focused action, and vigilant monitoring. 

Every intervention shapes the patient’s path forward. Thoughtful nursing care doesn’t just manage pain. It builds trust, promotes recovery, and prevents future complications. 

References

  1. American Heart Association. (2017). Highlights of the 2010 AHA Guidelines for CPR and ECC.
  2. Elsevier. (2020). Chest Pain – Adult.
  3. Lecturio. (2024). Chest Pain: Nursing Diagnosis.
  4. NURSING.com. (n.d.). Nursing Care Plan (NCP) for Angina.
  5. StatPearls. (2021). Unstable Angina (Nursing)
  6. StatPearls. (2021). Chest Pain.