Coronary Artery Disease Nursing Diagnosis and Care Plan (CAD)

Coronary artery disease (CAD)—also called coronary heart disease—is a narrowing of the coronary arteries from atherosclerotic plaque. The result is myocardial ischemia that can present as stable angina, acute coronary syndrome, or silent ischemia. Early recognition and targeted nursing care improve outcomes, reduce complications (MI, heart failure), and support long-term lifestyle change.

What Nursing Students Should Know (Quick Guide)

  • Definition: Reduced blood flow to the myocardium due to plaque, spasm, or thrombosis.
  • Major risk factors: Hypertension, hyperlipidemia, diabetes, smoking, obesity, inactivity, age, family history, chronic kidney disease.
  • Common symptoms: Chest pain/pressure (often with exertion), dyspnea, fatigue, diaphoresis, nausea, radiating pain (arm, jaw, back), or atypical symptoms in older adults and people assigned female at birth.
  • Key diagnostics nurses see: ECG (ST-T changes), troponins (if acute), lipid panel, A1C, chest x-ray (baseline), stress testing, echocardiogram, coronary CT angiography, cardiac catheterization.
  • Typical provider orders you’ll support: Anti-ischemic therapy (nitrates, beta-blockers), antiplatelets (aspirin), statins, ACE-I/ARB, oxygen if hypoxemic, PCI or CABG when indicated.
  • High-yield nursing priorities: Relieve chest pain, optimize oxygen supply/demand, monitor hemodynamics and ECG, educate for risk-factor control, medication safety (e.g., nitroglycerin).

Focused Nursing Assessment for CAD

  • Airway/Breathing/Circulation first: VS, rhythm, SpO₂, pain score (PQRST), perfusion (color, cap refill).
  • 12-lead ECG readiness: Compare to prior if available.
  • Ischemia triggers: Recent exertion, heavy meals, cold exposure, emotional stress.
  • Medication review: Nitrates, beta-blockers, antiplatelets, erectile-dysfunction drugs (contraindicated with nitrates).
  • Red flags requiring rapid escalation: Rest pain >20 minutes, new/worsening dyspnea, syncope, hypotension, ST elevation/depression.

5 CAD Nursing Care Plans

Use these “complete statements” with related factors, targeted interventions with rationales, and measurable outcomes.

Nursing Care Plan 1: Ineffective Tissue Perfusion (Cardiac)

Nursing Diagnosis Statement:
Ineffective tissue perfusion (cardiac) related to reduced coronary blood flow secondary to atherosclerotic plaque as evidenced by exertional chest pressure, ST-segment changes, and relief with rest/nitroglycerin.

Related factors/causes:
Coronary artery narrowing, increased myocardial oxygen demand, anemia, tachyarrhythmias, smoking, hypertension, hyperlipidemia.

Nursing Interventions and Rationales:

  • Obtain 12-lead ECG during pain and compare with pain-free tracing – identifies ischemia and guides urgent actions.
  • Place patient at rest in semi-Fowler’s; limit activity – decreases oxygen demand and improves ventilation.
  • Administer prescribed nitrates; assess pain and BP before/after each dose – dilates coronary vessels and reduces preload; prevents hypotension.
  • Provide oxygen only if SpO₂ < 90% or evidence of hypoxemia – improves arterial oxygen content when indicated.
  • Start/maintain IV access and keep defibrillator nearby in high-risk patients – ensures rapid treatment if deterioration occurs.
  • Monitor troponins as ordered; report rising values – detects myocardial injury requiring escalation.

Desired Outcomes:
Chest pain resolves; ECG returns to baseline; SpO₂ ≥ 94% on appropriate therapy; no signs of ongoing ischemia.

Nursing Care Plan 2: Acute Pain (Angina)

Nursing Diagnosis Statement:
Acute pain related to myocardial ischemia secondary to coronary artery disease as evidenced by substernal pressure 7/10 radiating to left arm, diaphoresis, and anxiety.

Related factors/causes:
Physical exertion, emotional stress, cold exposure, large meals, uncontrolled hypertension, coronary vasospasm.

Nursing Interventions and Rationales:

  • Use PQRST pain assessment at onset and q5 minutes during treatment – characterizes ischemic pain and tracks response.
  • Administer nitroglycerin per protocol (up to three doses, 5 minutes apart) if SBP ≥ 100 mmHg and no PDE-5 inhibitor in last 24–48 hrs – relieves angina safely.
  • Give prescribed beta-blocker and teach to report dizziness/bradycardia – reduces heart rate/contractility to lower oxygen demand.
  • Maintain calm environment; coach slow, deep breathing – reduces sympathetic drive that worsens ischemia.
  • Prepare for further evaluation (stress test or catheterization) if pain persists – supports timely diagnosis and reperfusion when needed.

Desired Outcomes:
Pain ≤ 2/10 within 10–15 minutes of therapy; HR and BP stabilize; patient verbalizes triggers and relief strategies.

Nursing Care Plan 3: Decreased Cardiac Output

Nursing Diagnosis Statement:
Decreased cardiac output related to altered heart rate/contractility secondary to myocardial ischemia as evidenced by hypotension, cool extremities, fatigue, and delayed capillary refill.

Related factors/causes:
Ischemic myocardial dysfunction, dysrhythmias, ventricular remodeling, fluid imbalance.

Nursing Interventions and Rationales:

  • Trend VS, urine output, mental status – early indicators of perfusion changes.
  • Continuous cardiac monitoring; treat or escalate new dysrhythmias – arrhythmias can sharply reduce output.
  • Maintain IV access; anticipate fluids or vasoactive meds per provider if signs of poor perfusion – supports preload/afterload as ordered.
  • Review labs (electrolytes, H/H) and correct abnormalities – potassium/magnesium shifts and anemia worsen output.
  • Space care and cluster activities – prevents surges in oxygen demand.

Desired Outcomes:
MAP ≥ 65 mmHg, warm/pink extremities, UO ≥ 0.5 mL/kg/hr, stable rhythm, improved energy for ADLs.

Nursing Care Plan 4: Activity Intolerance

Nursing Diagnosis Statement:
Activity intolerance related to imbalance between oxygen supply and demand during exertion secondary to CAD as evidenced by dyspnea and chest pressure with minimal activity.

Related factors/causes:
Reduced coronary reserve, deconditioning, anemia, obesity, uncontrolled BP or glucose.

Nursing Interventions and Rationales:

  • Assess baseline tolerance (6-minute walk distance as ordered), HR/BP/SpO₂ response – sets safe starting point.
  • Implement graded activity with rest periods; stop if angina, marked dyspnea, or significant ST/HR changes – builds endurance safely.
  • Pre-medicate per orders (e.g., nitroglycerin before exertion if prescribed) – prevents predictable exertional angina.
  • Teach energy-conservation strategies and use of assistive devices – reduces oxygen demand during ADLs.
  • Coordinate referral to cardiac rehabilitation – improves functional capacity and risk-factor control.

Desired Outcomes:
Patient completes light ADLs without symptoms; progressive increase in exercise tolerance with stable vitals.

Nursing Care Plan 5: Ineffective Health Management

Nursing Diagnosis Statement:
Ineffective health management related to complex medication/lifestyle regimen and limited knowledge about CAD as evidenced by inconsistent medication adherence and ongoing smoking.

Related factors/causes:
Polypharmacy, cost barriers, limited health literacy, lack of support, competing priorities, misinformation.

Nursing Interventions and Rationales:

  • Provide simple, written teach-back education on meds: purpose, timing, side effects (e.g., nitroglycerin use, when to call EMS) – improves safe adherence.
  • Create a personalized risk-reduction plan: smoking cessation supports, heart-healthy diet (low saturated fat, sodium aware), daily activity goals, weight/BP/glucose tracking – targets modifiable risks.
  • Simplify regimen when possible; encourage pillboxes/phone reminders; involve family or caregivers – reduces unintentional nonadherence.
  • Clarify interactions: avoid PDE-5 inhibitors with nitrates; review OTC/herbals – prevents adverse events.
  • Connect to community resources and cardiac rehab – adds accountability and support.

Desired Outcomes:
Patient demonstrates correct med administration, lists warning signs (unrelieved chest pain >5 minutes, dyspnea, syncope), and meets agreed goals (e.g., tobacco-free, LDL and BP at targets).

Patient Education Pearls (Exam-friendly)

  • Nitroglycerin: Sit before taking; 1 tab/spray under tongue; repeat every 5 minutes up to 3 doses; call EMS if pain persists. Store in original container.
  • When to seek help: Chest pain at rest, new/worsening SOB, fainting, or pain not relieved by nitrates.
  • Lifestyle: No smoking/vaping, daily movement, weight and BP checks, heart-healthy diet, stress management, vaccination (flu, pneumococcal as indicated).
  • Medication adherence: Do not stop beta-blockers abruptly; take statins at same time daily; report muscle pain or dark urine.

Conclusion

For coronary artery disease, nursing care centers on restoring myocardial oxygen balance, relieving angina, monitoring for complications, and coaching long-term risk-reduction. Use clear assessments, evidence-based interventions, and practical education to improve patient outcomes and confidence in self-management.

Peer-Reviewed & Authoritative References

  • Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. Lippincott Williams & Wilkins.
  • Lewis’s Medical-Surgical Nursing. Elsevier.
  • American College of Cardiology/American Heart Association. Guideline for the Management of Chronic Coronary Disease.
  • 2021 AHA/ACC Guideline for the Evaluation and Diagnosis of Chest Pain.
  • Ignatavicius & Workman. Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. Elsevier.
  • Potter, Perry, Stockert, Hall. Fundamentals of Nursing. Elsevier.
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