LPN NorQuest , Edmonton Downtown

Acne
What is acne? It is caused when blocked skin follicles from a plug caused by oil from glands, bacteria, and dead cells clump together and swell.

Alopecia Areata
What is alopecia areata? It is a condition that attacks your hair follicles (they make hair). In most cases, hair falls out in small, round patches.

Atopic Dermatitis
What is atopic dermatitis? It is a skin disease causing much itchiness. Scratching leads to redness, swelling, cracking, weeping clear fluid, crusting, and scaling.

Epidermolysis Bullosa
What is epidermolysis bullosa? It is a group of diseases causing painful blisters to form on the skin. These blisters can cause problems if they become infected.

Hidradenitis Suppurativa (HS)
Hidradenitis suppurativa (also known as acne inversa) is a chronic, noncontagious, inflammatory condition characterized by pimple-like bumps or boils and tunnels or tracts on and under the skin.

Ichthyosis
What is ichthyosis? It is a disorder that causes dry, thickened skin that may look similar to fish scales.

Pachyonychia Congenita
What is pachyonychia congenita? It is a rare disorder causing thick nails and painful calluses on the bottoms of the feet and other symptoms.

Pemphigus
What is pemphigus? It is a disease where the immune system attacks healthy cells in the top layer of skin, resulting in blisters.

Psoriasis
Psoriasis is a skin disease that causes red, scaly skin that may feel painful, swollen, or hot. Learn more about the types and what causes psoriasis.

Raynaud’s Phenomenon
What is Raynaud’s phenomenon? It is a disease that affects blood vessels. It causes your body to not send enough blood to the hands and feet for a period of time.

Rosacea
What is rosacea? It is a long-term disease that causes reddened skin and pimples, usually on the face. It can also make the skin thicker and cause eye problems.

Scleroderma
Scleroderma causes areas of tight, hard skin, but can also harm your blood vessels and organs. Learn the causes and treatments of this skin disease.

Vitiligo
Vitiligo is a disorder that causes patches of skin to become white. It happens because cells that make color in your skin are destroyed.

Specific Learning Outcomes
Identify which determinants of health may influence outcomes for the client with altered cardiovascular function.
Describe the ethical, legal, cultural, and religious considerations related to the administration of blood and blood products.
Explore factors that increase the risk of altered cardiovascular function.
Describe assessment findings common to clients with altered cardiovascular function.
Discuss how diagnostic tests used to assess the client with altered cardiovascular supports the nursing process.
X ray
12-Lead ECG
Ambulatory ECG Monitoring ( Holter, tele)
Stress test
Echocardiography
Cardiac Angiography/Cardiac Catheterization
Diagnostic Blood Studies
Describe pharmacologic and non-pharmacologic therapies commonly used for the client with altered cardiovascular function.
Discuss the nursing role in the prevention and management of complications associated with altered cardiovascular function.
Integrate the nursing process in the formulation of priority nursing care for the client with altered cardiovascular function.
Atrial fibrillation (A-fib)
Heart failure
Deep vein thrombosis
Peripheral Arterial Disease (PAD)
Coronary Artery Disease (CAD)
Anemia
Myocardial Infarction (MI)
Identify the rationale, methodology, and nursing responsibilities associated with the following diagnostic tests.
Vein finder
ECG monitoring
Rhythm identification and treatment (NSR)
Ambulatory ECG monitoring
Holter monitor
Cardiac Catheterization
Cardiac Stent/CABG
Peripheral Stent/graft
Defibrillation and pacing
Describe components of blood products commonly transfused.
Describe and apply safe nursing practice for administration of blood and blood products.
Requesting and receiving blood and blood products from the blood bank.
Client identification and assessments prior to transfusion.
Cross match and BBN number
Consent
Initiation of transfusion and the role of the practical nurse during initiation.
Monitoring the client during transfusion
Potential reactions during and after transfusion
Discontinuing transfusion.
Examine safe nursing practices and responsibilities with regard to phlebotomy. ( blood draw)
Identify health teaching that may be required for a client with altered cardiovascular function.
Phlebotomy
Blood transfusions
Identify what pertinent information is required for documentation and reporting regarding the client with altered cardiovascular function.

As of my last update in January 2022, the leading causes of death worldwide, often referred to as "death diseases," include:

Ischemic Heart Disease: This condition occurs when the arteries become narrowed or blocked, leading to reduced blood flow to the heart. It's a major cause of heart attacks and is consistently one of the leading causes of death globally.

Stroke: Strokes occur when there is a disruption of blood flow to the brain, either due to a blockage (ischemic stroke) or bleeding (hemorrhagic stroke). Strokes can result in severe disability or death if not treated promptly.

Chronic Obstructive Pulmonary Disease (COPD): COPD is a group of lung diseases, including chronic bronchitis and emphysema, characterized by airflow obstruction and difficulty breathing. Smoking is the primary cause of COPD, and it's a major contributor to global mortality.

Lower Respiratory Infections: These infections primarily include pneumonia and bronchitis, which affect the lower respiratory tract. They can be caused by bacteria, viruses, or other pathogens and are particularly dangerous for young children, older adults, and individuals with weakened immune systems.

Alzheimer's Disease and other Dementias: Alzheimer's disease is the most common cause of dementia, a progressive neurological disorder that affects memory, thinking, and behavior. As populations age worldwide, the prevalence of Alzheimer's disease and other dementias is increasing, making it a significant cause of death and disability.

It's essential to note that the leading causes of death can vary by region and may change over time due to factors such as advancements in medical treatment, changes in lifestyle behaviors, and shifts in population demographics

Paralytic ileus is the condition where the motor activity of the bowel is impaired, usually without the presence of a physical obstruction. Although the condition may be self‐limiting, it is serious and if prolonged and untreated will result in death in much the same way as in acute mechanical obstruction.

Polyuria: Polyuria is the medical term for excessive urination. It refers to the production of abnormally large volumes of urine. In diabetes, polyuria occurs due to high levels of glucose in the blood. When blood sugar levels are elevated, the kidneys attempt to remove the excess glucose by filtering it out of the blood and into the urine. This leads to increased urine production, resulting in frequent urination.

Polydipsia: Polydipsia is excessive thirst, which is often accompanied by an increased intake of fluids. In diabetes, polydipsia is a result of the body's attempt to replenish the fluids lost through polyuria. When blood sugar levels are high, the body tries to dilute the excess glucose in the bloodstream by increasing urine production. This leads to dehydration, triggering the sensation of thirst.

Polyphagia: Polyphagia refers to excessive hunger or increased appetite. In diabetes, particularly untreated or poorly controlled diabetes, cells may not receive adequate glucose despite high levels of sugar in the bloodstream. This can occur because insulin is either insufficient (as in type 1 diabetes) or ineffective (as in type 2 diabetes). The body's cells are starved for energy, even though there is plenty of glucose available in the blood. This results in increased hunger and a tendency to eat more, despite the high blood sugar levels.

These three symptoms—polyuria, polydipsia, and polyphagia—are often referred to as the "3 P's" and can be early signs of diabetes. If someone experiences these symptoms persistently, especially when accompanied by other signs such as unexplained weight loss, fatigue, or blurred vision, it's essential to seek medical attention for proper evaluation and diagnosis. Managing blood sugar levels through appropriate medical treatment, lifestyle changes, and dietary modifications can help alleviate these symptoms in individuals with diabetes.

Thyroid Hormones:

Thyroid-Stimulating Hormone (TSH): 0.4 to 4.0 mIU/L
Free Thyroxine (Free T4): 0.8 to 1.8 ng/dL
Triiodothyronine (T3): 80 to 200 ng/dL
S*x Hormones:

Testosterone:
Male:
Total Testosterone: 300 to 1000 ng/dL
Free Testosterone: 5.0 to 21.0 ng/dL
Female:
Total Testosterone: 15 to 70 ng/dL
Free Testosterone: 0.1 to 6.4 pg/mL
Estrogen:
Estradiol (E2):
Prepubertal:

Complete Blood Count (CBC):

White Blood Cell Count (WBC): 4,500 to 11,000 cells/mcL
Red Blood Cell Count (RBC):
Male: 4.7 to 6.1 million cells/mcL
Female: 4.2 to 5.4 million cells/mcL
Hemoglobin (Hb):
Male: 13.8 to 17.2 grams/dL
Female: 12.1 to 15.1 grams/dL
Platelet Count: 150,000 to 450,000 platelets/mcL
Basic Metabolic Panel (BMP):

Glucose: 70 to 100 mg/dL
Sodium: 135 to 145 mEq/L
Potassium: 3.5 to 5.0 mEq/L
Calcium: 8.5 to 10.5 mg/dL
BUN (Blood Urea Nitrogen): 7 to 20 mg/dL
Creatinine: 0.6 to 1.3 mg/dL
Liver Function Tests (LFTs):

Total Bilirubin: 0.1 to 1.2 mg/dL
ALT (Alanine Aminotransferase): 7 to 56 units/L
AST (Aspartate Aminotransferase): 5 to 40 units/L
Alkaline Phosphatase: 44 to 147 units/L
Lipid Panel:

Total Cholesterol: Less than 200 mg/dL
LDL (Low-Density Lipoprotein): Less than 100 mg/dL
HDL (High-Density Lipoprotein):
Male: Greater than 40 mg/dL
Female: Greater than 50 mg/dL
Triglycerides: Less than 150 mg/dL
Thyroid Function Tests:

TSH (Thyroid-Stimulating Hormone): 0.4 to 4.0 mIU/L
Free T4 (Thyroxine): 0.8 to 1.8 ng/dL

Assignment HEAS

Allergic Reaction Scenario: Integumentary, Cardiac & Respiratory System

Date: 22 November 2023

The patient arrived at the Emergency Room at approximately 2000 in Fowler's position, with 2 bed rails up. The chief complaints were skin rashes and dyspnea, which began 30 minutes prior while dining in a restaurant. The initial symptoms included skin rashes, followed by swelling of the lips and tongue, occasional dry cough, and difficulty breathing, prompting the visit to the Emergency Room. The patient has a known allergy to seafood, nuts, and pollens, along with a history of bronchial asthma. Family history includes diabetes and bronchial asthma. The patient is a nonsmoker and does not consume alcoholic beverages.

Vital signs were obtained, revealing a blood pressure of 95/62 mmHg, heart rate of 125 beats per minute, respiratory rate of 26 breaths per minute, and SPO2 of 93% on room air. The patient was alert but unable to communicate verbally. Physical examination revealed cold, erythematous skin with raised welts on the face and neck. There was swelling of the mouth and face, along with cyanotic buccal mucosa. The patient exhibited tachypnea, shallow respiration, and the use of accessory muscles. Wheezes were appreciated on both lung fields upon auscultation.

Treatment began with intravenous fluid administration (0.9% NaCl IL) initiated as a fast drip, subsequently regulated to 8 hours. Medications administered included Diphenhydramine 50mg IV and Hydrocortisone 100mg IV. After 5 minutes, the patient reported skin pruritus, dyspnea, chest pain, and lightheadedness. The chest pain, present for 30 minutes, was described as constant tightness and burning in the middle of the chest, non-radiating, aggravated by movement, with a pain score of 3/10, relieved by rest. The chest pain was attributed to muscle pain and stress from the allergic reaction. The patient denied orthopnea, fatigue, chronic cough, or edema.

Five minutes later, vital signs were reassessed, showing a blood pressure of 110/85 mmHg, heart rate of 95 beats per minute, respiratory rate of 20 breaths per minute, and SPO2 of 97% with oxygen inhalation at 2L per minute. The patient remained alert and oriented to person, time, place, and self.

Upon further assessment, the skin was warm with erythema and urticarial lesions. Facial swelling had diminished, and there were no signs of pigmentation, bleeding, or cyanosis, with normal skin turgor. Cardiac examination revealed no heaves on the anterior precordium, Point of Maximal Impulse at the 5th intercostal space midclavicular line, audible S1 and S2 with no murmurs. Chest inspection showed a normal respiratory rate, normal depth of respiration, and no intercostal space retractions, with symmetrical chest expansion. Lung auscultation revealed no wheezes, with vesicular breath sounds noted in both lower lung fields.

Peripheral vascular assessment showed 2+ radial pulses with no thrills bilaterally in the upper extremities. Lower extremities exhibited no edema, with 2+ posterior tibialis and dorsalis pedis pulses and no thrills bilaterally.

Dietary advice and educational sessions on allergies were provided. The patient was instructed to call for episodes of dyspnea, chest pain, or pruritus. The patient was left in bed with 2 bed rails up, a call bell within reach, and a patent intravenous fluid line. The curtain was closed."

Cardiovascular Assessment

A comprehensive cardiovascular assessment involves the systematic examination of the cardiovascular system, including the heart and blood vessels. Here is a structured overview of a cardiovascular assessment:

Patient History:

Obtain a detailed medical history, including any cardiovascular conditions, surgeries, or interventions.
Inquire about symptoms such as chest pain, shortness of breath, palpitations, dizziness, and fatigue.
Explore risk factors such as smoking, hypertension, diabetes, hyperlipidemia, family history of cardiovascular disease, and lifestyle factors.
Vital Signs:

Measure blood pressure in both arms to assess for discrepancies.
Assess heart rate, respiratory rate, and temperature.
Evaluate oxygen saturation (SpO2) for signs of hypoxemia.
General Inspection:

Observe the patient's general appearance, noting any signs of distress or discomfort.
Check for signs of peripheral cyanosis or pallor.
Assess for peripheral edema in the extremities.
Jugular Venous Pressure (JVP):

Inspect the neck for jugular venous distension.
Measure the JVP to assess right atrial pressure.
Palpation:

Palpate the carotid arteries for strength, symmetry, and any abnormal pulsations.
Feel for the apical impulse to assess the point of maximal impulse (PMI).
Palpate the chest for any thrills or abnormal pulsations.
Auscultation:

Listen to heart sounds at the aortic, pulmonic, tricuspid, and mitral areas using the diaphragm and bell of the stethoscope.
Identify S1 (lub) and S2 (dub) sounds and any additional heart sounds (S3, S4).
Check for murmurs, clicks, or rubs during systole and diastole.
Perform a vascular assessment, including auscultation of peripheral pulses for any abnormalities.
Peripheral Vascular Assessment:

Assess capillary refill time.
Palpate peripheral pulses (radial, brachial, femoral, popliteal, dorsalis pedis, posterior tibial).
Check for edema in the extremities.
Inspect for signs of peripheral artery disease, such as skin changes, hair loss, and ulcerations.
Precordial Movements:

Observe for heaves or lifts during systole, which may indicate ventricular hypertrophy.
Electrocardiogram (ECG or EKG):

Perform an ECG to assess the electrical activity of the heart.
Additional Diagnostic Tests:

Depending on the clinical context, additional tests such as echocardiography, stress testing, and cardiac biomarker measurements may be indicated.
Throughout the assessment, collaborate with the patient to gather information and address any concerns. Document findings systematically and communicate relevant information to the healthcare team for further evaluation and management.

HEAS 1000 HEART AUSCULTATION

Auscultating the heart involves listening to the sounds produced during the cardiac cycle. The following is a systematic approach to cardiac auscultation:

Auscultatory Areas (Cardiac Landmarks):
Identify the traditional cardiac landmarks on the chest where you'll place the stethoscope. These areas include:

Aortic area
Pulmonic area
Erb's point
Tricuspid area
Mitral (apical) area
Routine Using Diaphragm Endpiece:

Rate and Rhythm (a): Assess the heart rate (number of beats per minute) and rhythm (regular or irregular).
Identify S1 and S2 (b): S1 (first heart sound) is associated with the closure of the atrioventricular valves, while S2 (second heart sound) is associated with the closure of the semilunar valves.
Assess S1 and S2 Separately (c): Focus on each heart sound independently. Note the quality and timing of S1 and S2.
Listen for Extra Heart Sounds (d): Pay attention for additional sounds such as S3 (ventricular filling) or S4 (atrial contraction). These can indicate certain cardiac conditions.
Listen for Murmurs (e): Murmurs are abnormal heart sounds caused by turbulent blood flow. Determine if any are present and note their intensity, timing, and location.
Specific Auscultatory Areas:

Aortic Area: Second right intercostal space.
Pulmonic Area: Second left intercostal space.
Erb's Point: Third left intercostal space.
Tricuspid Area: Fourth left intercostal space.
Mitral (Apical) Area: Fifth left intercostal space at the midclavicular line.
Remember to use the diaphragm endpiece for higher-frequency sounds like S1 and S2 and the bell endpiece for lower-frequency sounds like murmurs. Ensure a quiet environment, and ask the patient to breathe normally during auscultation. Document your findings accurately for a comprehensive assessment of the patient's cardiac status.

NCOM EXAM QUESTIONS AND ANSWERS

Definition of Communication:
Communication is the process of exchanging information, ideas, thoughts, and feelings between individuals or groups through verbal and non-verbal means. It involves a sender encoding a message and a receiver decoding that message to understand the intended meaning.

Importance of Communication in Nursing:
Effective communication is crucial in nursing for several reasons. It enhances patient care, ensures accurate information transfer between healthcare professionals, promotes a supportive work environment, and contributes to patient safety. In nursing, clear communication is vital for accurate diagnosis, proper treatment, and building trust with patients.

Different Levels of Communication:
Communication occurs at various levels, including:

Intrapersonal (within oneself)
Interpersonal (between two people)
Small group (among a few individuals)
Public (communication to a larger audience)
Elements of the Communication Process:
The communication process involves:

Sender: Initiates the message
Message: Information being conveyed
Channel: Medium through which the message is transmitted
Receiver: Individual or group receiving the message
Feedback: Response or reaction to the message
Therapeutic and Non-Therapeutic Communication:

Therapeutic communication: Enhances the well-being of the patient and fosters a positive nurse-patient relationship.
Non-therapeutic communication: Hinders the nurse-patient relationship and may impede the healing process.
Factors Influencing Communication:
Various factors influence communication, including cultural differences, language barriers, emotional state, environment, and personal perceptions.

Therapeutic Communication Techniques:
Techniques include active listening, open-ended questioning, paraphrasing, clarification, reflection, and empathy. These techniques facilitate understanding, trust, and a therapeutic nurse-patient relationship.

Categories of Communication:

Verbal: Involves spoken or written words
Non-verbal: Includes body language, facial expressions, and gestures
Touch: Communicates care, comfort, and support
Proxemics: Use of personal space to convey messages
Barriers of Effective Communication:
Barriers include language differences, cultural diversity, emotional barriers, physical barriers, and preconceptions. These can impede the accurate exchange of information.

Techniques to Reduce Barriers to Communication:
Techniques include active listening, cultural competence, clarity in expression, and adapting communication to the individual's needs.

Active Listening Responses:
Responses include paraphrasing, summarizing, asking open-ended questions, and providing feedback. These techniques demonstrate understanding and encourage further communication.

Communication Styles:

Passive: Avoids conflict, often at the expense of personal needs.
Passive-aggressive: Indirect expression of hostility or anger.
Aggressive: Assertive in an inappropriate and disrespectful manner.
Importance of Receiving Feedback:
Feedback is essential for personal and professional growth. It helps identify areas for improvement and enhances self-awareness.

Providing Constructive Feedback:
Constructive feedback should be specific, timely, and focused on behaviors. It should aim to motivate improvement rather than criticize.

Effective communication is the cornerstone of successful nursing practice, contributing to positive patient outcomes and a supportive healthcare environment.

Listing 50 common diseases along with their respective causative agents can be quite extensive, but I can provide a diverse list of common diseases and the pathogens responsible for them:

Influenza (Flu):

Cause: Influenza virus (types A, B, C)
Common Cold:

Cause: Rhinovirus, Coronavirus, Adenovirus
Pneumonia:

Cause: Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae
Urinary Tract Infection (UTI):

Cause: Escherichia coli (E. coli), Staphylococcus saprophyticus
Gastroenteritis:

Cause: Rotavirus, Norovirus, Salmonella, Escherichia coli (E. coli)
Tuberculosis (TB):

Cause: Mycobacterium tuberculosis
HIV/AIDS:

Cause: Human Immunodeficiency Virus (HIV)
Malaria:

Cause: Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae, Plasmodium ovale
Hepatitis:

Cause: Hepatitis A virus, Hepatitis B virus, Hepatitis C virus
Chickenpox:

Cause: Varicella-zoster virus
Measles:

Cause: Measles virus
Rubella (German Measles):

Cause: Rubella virus
Whooping Cough (Pertussis):

Cause: Bordetella pertussis
Diphtheria:

Cause: Corynebacterium diphtheriae
Tetanus:

Cause: Clostridium tetani
Cholera:

Cause: Vibrio cholerae
Leprosy:

Cause: Mycobacterium leprae
Typhoid Fever:

Cause: Salmonella typhi
Gonorrhea:

Cause: Neisseria gonorrhoeae
Syphilis:

Cause: Treponema pallidum
Lyme Disease:

Cause: Borrelia burgdorferi
Dengue Fever:

Cause: Dengue virus
Zika Virus:

Cause: Zika virus
Chikungunya Fever:

Cause: Chikungunya virus
Shigellosis (Bacillary Dysentery):

Cause: Shigella spp.
Hantavirus Pulmonary Syndrome:

Cause: Hantavirus
Norovirus Infection:

Cause: Norovirus
Infectious Mononucleosis:

Cause: Epstein-Barr virus (EBV)
Hand, Foot, and Mouth Disease:

Cause: Enteroviruses (e.g., Coxsackievirus)
Hemorrhagic Fever (e.g., Ebola):

Cause: Ebola virus
Respiratory Syncytial Virus (RSV) Infection:

Cause: Respiratory Syncytial Virus
Cytomegalovirus (CMV) Infection:

Cause: Cytomegalovirus
Q Fever:

Cause: Coxiella burnetii
Brucellosis:

Cause: Brucella spp.
Legionnaires' Disease:

Cause: Legionella pneumophila
Rabies:

Cause: Rabies virus
Yellow Fever:

Cause: Yellow fever virus
Japanese Encephalitis:

Cause: Japanese encephalitis virus
Cryptococcosis:

Cause: Cryptococcus neoformans
Histoplasmosis:

Cause: Histoplasma capsulatum
Candidiasis:

Cause: Candida albicans
Aspergillosis:

Cause: Aspergillus spp.
Pneumocystis Pneumonia (P*P):

Cause: Pneumocystis jirovecii
Toxoplasmosis:

Cause: Toxoplasma gondii
Giardiasis:

Cause: Giardia lamblia
Cryptosporidiosis:

Cause: Cryptosporidium spp.
Trichomoniasis:

Cause: Trichomonas vaginalis
Scabies:

Cause: Sarcoptes scabiei (mite)
Lice Infestation (Pediculosis):

Cause: Pediculus humanus capitis (head louse), Pediculus humanus corporis (body louse)
Meningitis:

Cause: Various pathogens, including bacteria (e.g., Neisseria meningitidis), viruses, and fungi.

Shadow Health Documentation- Chest Pain

Updated on May 6, 2023
Chest Pain (Angina): Nursing Diagnoses & Care Plans
Photo of author
Written by
Maegan Wagner, BSN, RN, CCM
Chest pain or angina is the discomfort a person experiences when the heart does not get enough oxygen. Chest pain is not a disease itself, but a symptom of an underlying cause.

The pain felt in angina can be described as squeezing, dull, sharp, crushing, or burning. Severe chest pain may be described as extreme pressure, such as someone or something sitting on the chest. The pain may radiate to the neck, jaw, or extremities.

In this article:

Types and Risk Factors
Nursing Process
Nursing Care Plans
Acute Pain
Anxiety
Decreased Cardiac Output
Risk for Decreased Cardiac Tissue Perfusion
Risk for Unstable Blood Pressure
References
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.

Nursing Process
Nurses play a vital role in conducting a comprehensive pain assessment as this can promote prompt diagnosis and treatment of chest pain.

The goal of treatment for patients with chest pain include:

Accurate identification of the type of angina and its underlying cause
Immediate and appropriate treatment
Medications for pain relief and vasodilation
Preservation of heart muscles if myocardial infarction is suspected
Lifestyle modifications to reduce risks
Patient education is a priority and includes how to recognize symptoms of stable vs. other types of chest pain, treatment, and when to seek emergency assistance.

Nursing Care Plans
Once the nurse identifies nursing diagnoses for chest pain, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section you will find nursing care plan examples for chest pain.

Acute Pain
Chest pain may be described as squeezing, tight, sharp, or dull. It may be confused with indigestion as it can be a burning sensation. Patients may describe pressure akin to “an elephant sitting on my chest.”

Nursing Diagnosis: Acute Pain

Related to:
Myocardial injury
Ischemia
Disease process
Physical exertion
As evidenced by:
Diaphoresis
Distraction behavior
Expressions of chest pain/pressure/tightness/etc.
Facial expression of pain
Guarding behavior
Positioning to ease pain
Clutching of chest
Tachycardia
Expected outcomes:
Patient will demonstrate the resolution of chest pain.
Patient will identify potential causes of chest pain.
Assessment:
1. Assess pain characteristics noting location and type of pain.
It is important to distinguish when the chest pain started, precipitating factors, pain characteristics, duration, and location for appropriate diagnosis and management.

2. Assess diagnostic test results.
A 12-lead ECG is often obtained immediately for patients with chest pain to confirm or rule out myocardial infarction.

3. Assess for a history of chest pain.
Assessing if the patient has a history of chest pain and if this pain feels similar to other episodes can help the nurse in directing treatment.

Interventions:
1. Administer pain medications as indicated.
Drug therapy for chest pain aims to promote pain relief and reduce the risks of myocardial infarction and death. Medications like short-acting nitrates, angiotensin-converting enzyme inhibitors, analgesics, and calcium channel blockers are given to promote myocardial perfusion.

2. Provide oxygen supplementation if necessary.
Supplemental oxygen is provided to increase oxygenation to the myocardium. If oxygenation levels are normal, this may not be necessary.

3. Prepare for further testing.
Stress tests, echocardiograms, and CTAs assess the need for further treatment. These tests can visualize blockages within coronary arteries.

4. Provide patient education.
Ensure the patient understands how to recognize and treat stable angina. Offer education on administering nitroglycerin tablets and when to seek further assistance.

Anxiety
The feeling of chest pain and its related symptoms can cause fear and anxiety.

Nursing Diagnosis: Anxiety

Related to:
The potential threat of death
Unfamiliar situation
Threat to change in health status
As evidenced by:
Expresses alarm
Expresses fear
Expresses panic
Nausea
Dry mouth
Palpitations
Inability to focus
Tachycardia
Tachypnea
Diaphoresis
Expected outcomes:
Patient will verbalize strategies to cope with fear and anxiety related to chest pain.
Patient will verbalize a sense of safety and feelings of decreased fear.
Assessment:
1. Assess the patient’s feelings of fear/anxiety.
Discuss with the patient the exact thoughts and feelings they are having. The nurse can help alleviate unnecessary fear after the patient expresses their concerns.

Interventions:
1. Provide verbal and physical reassurance of safety.
Providing support and reassurance while the patient verbalizes fear and emotions can help reduce the patient’s anxiety levels. The nurse may also calmly rub the patient’s back or hold their hand to offer physical support.

2. Explore positive coping mechanisms with the patient.
Chest pain, dyspnea, and other symptoms can be alarming. Teach the patient strategies to calm themselves such as breathing exercises or distraction.

3. Administer anti-anxiety medications.
Fear and anxiety can be disruptive to the body and worsen outcomes. Administer benzodiazepines if necessary to promote relaxation and reduce fear.

4. Arm with knowledge.
A patient who is confident in monitoring and managing their health will experience less fear and anxiety. Discuss the patient’s chest pain, symptoms, and treatment once the threat has resolved so they feel in control.

Decreased Cardiac Output
Decreased cardiac output can be caused by insufficient blood flow to the heart leading to chest pain and a poor supply of oxygenated blood (cardiac output) throughout the body.

Nursing Diagnosis: Decreased Cardiac Output

Related to:
Ineffective cardiac muscle contraction
Conditions that compromise the blood supply
Narrowed arteries
Blocked arteries
Rupture of unstable plaque
Coronary vasospasm
Malfunctions of the heart structures
Difficulty of the heart muscle to pump
As evidenced by:
Increased central venous pressure (CVP)
Tachycardia
Dysrhythmias
Ejection fraction less than 40%
Decreased oxygen saturation
Presence of abnormal heart sound S4 upon auscultation
Chest pain (angina)
Increased blood pressure (hypertension)
Difficulty breathing (dyspnea)
Rapid breathing (tachypnea)
Alteration in the level of consciousness
Restlessness
Fatigue
Inadequate tolerance in activities
Cold and clammy skin
Prolonged capillary refill time
Edema
Expected outcomes:
Patient will manifest adequate cardiac output as evidenced by normal sinus rhythm on ECG.
Patient will demonstrate hemodynamic stability by vital signs (particularly the heart rate) within the normal range.
Patient will not experience dyspnea, restlessness, or fatigue from reduced cardiac output.
Assessment:
1. Assess the signs and symptoms along with chest pain.
The following signs and symptoms can occur with chest pain and may signal a decrease in cardiac output and perfusion to different organs:

Excessive sweating (diaphoresis)
Dyspnea
Cough
Nausea and vomiting
Abdominal pain
Fever
Edema
Calf pain
Swelling of the lower extremities
2. Monitor the heart rate.
Most anginal episodes begin with an increase in heart rate as the heart attempts to compensate.

3. Obtain ECG.
Exercise or medication stress testing, nuclear perfusion imaging, and diagnostic cardiac catheterization are all useful tests. ECG alterations such as ST elevation, atrial fibrillation, or tachycardic rhythms drive further treatment.

4. Review lab results.
A complete blood count (CBC) identifies disorders like leukemia, anemia, and infections. It also measures the red blood cells that deliver oxygen. A basic metabolic panel (BMP) measures electrolyte levels as well as kidney function. Both tests indicate the sufficiency of oxygenated blood from the heart to different organs.

Interventions:
1. Treat the underlying cause.
Non-cardiac factors, non-ischemic cardiac disease, and ischemic cardiac disease can produce chest pain, resulting in an imbalance between the heart’s oxygen supply and demand.

Non-cardiac causes include lung disease, musculoskeletal issues, anxiety/panic attacks, and gastric reflux disease.
Pericardial disease is a possible non-ischemic cardiac cause.
Coronary artery atherosclerosis and myocardial infarction are common causes of cardiac ischemia.
2. Risk factor management.
Blood pressure, cholesterol, and blood sugar are controllable risk factors. Educate patients on medications and lifestyle modifications to reduce their individual risks.

3. Encourage participation and adherence to lifestyle modification.
Lifestyle modifications reduce further plaque buildup and lessen blood vessel damage to maintain patent blood flow and supply. Regular exercise, maintaining a healthy weight, and quitting smoking are lifestyle changes that should be included in the patient’s education.

4. Administer medications as ordered.
Antianginal medications such as nitroglycerin provide immediate relief of angina. The general goal of symptomatic control is to reduce myocardial oxygen demand.

5. Control the heart rate.
Three angina medications—beta-blockers, ivabradine, and non-dihydropyridine calcium channel blockers—reduce symptoms by lowering the heart rate. Calcium channel blockers should not be given in patients with a low ejection fraction and left ventricular failure.

Risk for Decreased Cardiac Tissue Perfusion
Chest pain may indicate cardiac conditions like myocardial infarction, heart failure, and CAD, increasing the risk for decreased cardiac tissue perfusion.

Nursing Diagnosis: Ineffective Tissue Perfusion

Related to:
Heart disease/atherosclerosis
Hypoxia
Myocardial infarction
Ischemia
Hypoxemia
As evidenced by:
A risk diagnosis is not evidenced by any signs and symptoms, as the problem has not occurred yet and the nursing interventions will be directed at the prevention of symptoms.

Expected outcomes:
Patient will not experience a myocardial infarction.
Patient will report and display improvement in dyspnea, oxygen saturation, and vital signs.
Assessment:
1. Assess symptoms and risk for impaired cardiac tissue perfusion.
Chest pain, shortness of breath, diaphoresis, indigestion, and associated anxiety can indicate decreased cardiac perfusion.

2. Obtain lab work.
Cardiac enzymes such as troponin levels, electrolytes, ABGs, and more are important to obtain when analyzing chest pain.

3. Monitor telemetry.
Blood pressure, pulse, ECG, and O2 saturation should be monitored continuously for changes.

Interventions:
1. Reduce cardiac workload.
Supplemental oxygen promotes oxygenation. Encourage bed rest or limit activity to prevent oxygen consumption and reduce cardiac workload.

2. Prepare for surgical interventions.
Cardiac catheterization can be used to visualize narrowed or blocked arteries and allow for stent placement. CABG may be required to reroute blood to the heart.

3. Administer medications as ordered.
Vasodilators relax and open blood vessels. Anticoagulants keep blood thin. Digoxin increases cardiac output. Antihypertensives reduce the force on arteries.

4. Educate the patient on lifestyle modifications.
Treating the underlying cause requires lifestyle modifications such as reducing sodium and fat intake, quitting smoking, and increasing physical activity.

Risk for Unstable Blood Pressure
Depending on the underlying cause of chest pain, hypotension or hypertension may occur.

Nursing Diagnosis: Risk for Unstable Blood Pressure

Related to:
Ineffective cardiac muscle contraction
Conditions that compromise the blood supply
Narrowed arteries
Blocked arteries
Rupture of unstable plaque
Coronary vasospasm
Malfunctions of the heart structures
Increased cardiac workload
Dysrhythmias
Electrolyte imbalances
Fluid retention
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred. Nursing interventions are aimed at prevention.

Expected outcomes:
Patient will maintain blood pressure within acceptable limits.
Patient will remain free from orthostatic changes, such as dizziness when standing.
Patient will verbalize when to contact their provider due to hyper or hypotension.
Assessment:
1. Measure the patient’s blood pressure routinely.
In unstable angina, increased oxygen demand occurs at rest, while in stable angina, it occurs during exertion. Exercise-induced demand increases in heart rate, blood pressure, and myocardial contractility are the leading causes of increased myocardial oxygen demand.

2. Assess subjective symptoms.
Inquire if the patient ever feels their heart “skip beats” or if they experience headaches, lightheadedness, or dizziness. The patient may be experiencing symptoms of hyper or hypotension.

3. Review the patient’s medications.
Polypharmacy increases the risk of hyper and hypotension, especially in older adults. Multiple antihypertensive medications, diuretics, antidepressants, and herbal remedies can affect blood pressure.

Interventions:
1. Prevent excess exertion.
Angina can produce pressure, squeezing, soreness, or a sense of fullness in the chest when patients with high blood pressure engage in strenuous exercise, walking uphill, or climbing stairs.

2. Educate on when to seek help for uncontrolled blood pressure.
The patient may not know what constitutes “too high” or “too low.” Encourage them to monitor their blood pressure regularly as ordered, and especially when symptoms occur. Advise on blood pressure findings that require immediate attention.

3. Encourage commitment to lifestyle change.
Simple lifestyle adjustments can lower high blood pressure by 10–20 mmHg or more. This includes eating less sodium, exercising frequently, keeping a healthy weight, consuming less alcohol, and quitting smoking.

4. Strategize to increase blood pressure control.
Nurses are essential in monitoring, evaluating, and encouraging patients’ participation in blood pressure control. The following are strategies for increasing adherence:

Giving clear, concise, and logical instructions in understandable language
Adjusting treatment regimens to once daily schedules
Encouraging patient participation through self-monitoring
Providing learning materials promoting overall good health