Nursing Diagnosis, Care Plan, and Interventions for Chest Pains-A Student’s Guide

Introduction

Chest pains are a common complaint in the emergency room. You may be experiencing cardiac chest pain caused by coronary artery disease, arrhythmia, or other conditions that affect the heart.

Chest pain may also be due to pulmonary embolism or esophageal spasm, and these should both be ruled out with testing before your treatment plan begins. You need to know what kind of chest pain you’re dealing with so that we can best diagnose and treat it! Keep reading this post to learn more about how nursing diagnoses, care plans, and interventions will differ depending on whether your patient has cardiac chest pain vs non-cardiac chest pain and be better guided as a student. Also, as you read, keep in mind that our top writers are ready to help in case you get stuck with your assignment. All you need to do is place an order with us!

Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students, for learning purposes only, and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

What is Chest Pain?

Chest pain refers to discomfort, tightness, pressure, or soreness in the chest area. Chest pains are also known as angina pectoris. The most common symptom of a problem with the oesophagus is chest pain. The oesophagus is the tube connecting the mouth and stomach.

Chest pain is often associated with anxiety and stress. However, it can also be a sign of more serious health complications such as coronary artery disease.

What Are the Causes of Chest Pains?

Chest pain is often caused by;

-Digestive disorders such as ulcers or indigestion

–Pneumonia: A lung infection that causes inflammation of your lungs

-Acid reflux disease: Esophageal spasm caused by stomach acid moving backwards from your stomach

-Stress or anxiety: Chest pains are often associated with stress and anxiety

-Other thyroid problems such as hyperthyroidism or hypothyroidism

-Heart problems, including

• Angina -Unstable angina can occur when the coronary artery reduces blood flow to the heart muscle.
• Coronary artery disease (CAD) is a condition caused by atherosclerosis that reduces blood flow to the heart.
• Heart attack -Known as myocardial infarction, a heart attack occurs when your coronary artery is completely blocked by a blood clot, causing tissue in part of your heart to die.
• Arrhythmia -An irregular heartbeat. An arrhythmia can be caused by an underlying disease, damage to the heart muscle or by a faulty electrical system in the heart itself.
• Aneurysm -An aneurysm (sometimes called a “bulge”) can occur anywhere in your arteries but most often occurs in the arteries of your brain or abdomen.
• Pericarditis -Inflammation of the sac that surrounds the heart and can cause chest pain.
• Coronary artery bypass grafting (CABG)-An invasive heart surgery to widen a narrowed or blocked blood vessel. CABG is done for severe coronary artery disease.
• Congestive heart failure (CHF)-A condition that happens when your heart is working harder than normal due to high blood pressure or damage.
• Pulmonary embolism (PE) -A blood clot that forms in your leg and travels to your lungs, blocking an artery.

These types of chest pains often radiate from your upper abdomen down into your arms or up into your

Heart attacks cause severe discomfort in the center of your chest that may also feel like pressure, squeezing or tightness. If you are experiencing symptoms such as shortness of breath with any type of chest pains, fainting spells or dizziness, you should contact 911 immediately without hesitation!

Risk Factors for Chest Pain

There are risk factors for both cardiac chest pain and non-cardiac chest pain. These risk factors include:

Urgency, Acuity Level & Overall Illness

Acute conditions have an urgency of care that may require immediate interventions such as medications or treatments to relieve symptoms and/or find the cause of the underlying issue. On the other hand, chronic conditions are usually long-lasting and require ongoing interventions to manage the underlying issue. Acute chest pain that is severe or does not improve with rest may be a sign of a more serious problem like a heart attack.

The urgency and acuity level for non-cardiac chest pain will differ based on your diagnosis and the severity of your symptoms. If you are experiencing pain that doesn’t improve with rest and is causing significant distress, it’s important to see your doctor ASAP to find an underlying cause early on.

Signs and Symptoms of Chest Pains

Symptoms of chest pain include;

-Sensation of burning, tearing or tightening in your chest, acute pain that radiates to the back, neck, throat or arms.

-Other symptoms may include cramping, which may be worse during a cough, deep breath, sneeze or laugh intense pressure against your chest

-Shooting pain (or pain that shoots across) under one or both arms and/or in the back.

-Feeling as if you are not getting enough air (a symptom called dyspnea) or feeling short of breath

Nursing Diagnosis for Chest Pain

Your doctor will ask you about your symptoms, do an examination and may also order tests such as X-rays or MRI scans to help determine the cause of your chest pain.

The following are examples of nursing diagnoses that may be appropriate, based on the condition or underlying cause:

Nursing diagnoses -Acute Pain

-Ineffective Breathing Pattern related to the patient’s medical condition

Underlying Causes

-Acute myocardial infarction

-Inadequate tissue perfusion related to the patient’s medical condition

Nursing Diagnosis -Dyspnea

A person with chronic heart failure may experience;

– Ineffective breathing pattern related to the patient’s medical condition

-Pain related to the patient’s medical condition

-Profound physical/emotional stress related to the patient’s medical condition

–Activity intolerance related to the patient’s cardiovascular status (chronic)

-Fatigue related to inactivity, inadequate sleep and concurrent conditions (chronic)

Chronic Pain

Chronic pain is pain that lasts more than 12 weeks. Chronic pain is often unpredictable in that it may come and go, worsen or lessen at unexpected times over an extended period of time

-Activity intolerance related to the patient’s cardiovascular status (chronic)

-Impaired physical mobility related to the patient’s cardiovascular status (chronic)

– Ineffective pain coping related to the patient’s medical condition

-Ineffective respirations related to breathing pattern and inadequate tissue perfusion (cardiovascular status, chronic)

Nursing Care Plans

Comprehensive Nursing Care Plan- Cardiac ische sems

The purpose of this care plan is to provide a framework for the management of patients who are admitted to the cardiac care unit or other acute settings and require special monitoring. This “universal”/population-based nursing care plan may be used by all caregivers treating this type of patient in any hospital, emergency department, urgent care clinic, ambulatory facility, or skilled nursing facility, regardless of the specialty area.   Care plans that are specific to cardiac patients must identify or define the following:

Cardiac Risk Factors for Coronary Heart Disease (CHD)

A patient’s risk factors for coronary heart disease include age, gender, history of diabetes mellitus and tobacco use. The following list includes some other clinical disorders that may increase the risk of CHD:

• Age
• Male gender
• Family history of CHD
• Diabetes mellitus
• Hypertension (high blood pressure)
• High cholesterol levels
• Obesity
• Excessive alcohol use/abuse
• Smoking
• Excessive stress
• Levels of homocysteine (an amino acid in the blood)
• Transient ischemic attack/cerebral infarction
• Diseases such as cancer, AIDS, and lupus are also associated with an increased risk of CHD.

Assessment and monitoring for these factors should follow the established guidelines for cardiac care at a particular institution. Cardiovascular status at baseline is an important factor in determining which candidate patients can undergo cardiovascular surgery.  All patients should have a clinical examination, including blood pressure measurements, electrocardiogram, and an assessment of functional capacity.

The following are some specific factors to be assessed for at baseline:

• Presenting complaint (symptoms)
• Cardiac risk factors
• History of any cardiac event
• Family history
• Ethnic background
• Medication regimen
• Past surgical procedures/surgical history
• Physical examination
• Electrocardiogram (ECG)
• Laboratory tests, including renal function test and liver function test

The care plan is based on nursing assessments that may be useful in this population, which include information regarding monitoring, follow up or education.

Care plans include the following:

• Determining appropriate therapeutic interventions for each problem
• Immediate life-saving interventions
• Potential long term care needs
• Diagnosis of complications, including cardiac arrest
• Preparation for discharge activities
• Discharge teaching and information, which includes follow-up with primary care physician or cardiologist, prevention measures, diet, exercise, smoking cessation

Angina Nursing Care Plans

These include; assessment of the patient, cardiac history, what is angina pain and when it happens, how to treat the patient effectively, teaching, monitoring and evaluation of the patient.

– The nurse assesses the client’s level of pain and helps them understand that it is their body’s way of telling a problem exists with the heart.

– The nurse educates the client about angina (what causes it, how to recognize it) and potential complications, rehabilitation and home care.

– The nurse teaches the client about medications to alleviate pain and help in the early detection of heart problems.

-The nurse monitors for response to medication and informs the physician if not effective or if there are adverse side effects.

(World Health Organization; 2000)

Nursing Care Plans for Acute Coronary Syndrome in Heart Failure Patients

The main focus of the nursing management is to ensure that the patient receives appropriate treatment at an early stage to reduce further occurrence and or complications. Patients with acute coronary syndrome may be admitted to a coronary care unit, where they are closely monitored by a team of medical and nursing staff.

Late post-MI Nursing Care Plans:

Lifelong management of risk factors and adherence to cardiac rehabilitation programs are important for successful recovery. Dehydration is common on the first day after a heart attack because the heart is not working properly, and less blood is pumped to the body. As such, patients may be encouraged to drink as much beverages with simple sugars until they begin urinating again, normally around day two after a heart attack.

Recovery from MI Nursing Care Plans:

After an MI, most of the complications are related to resulting damage in the myocardium, i.e. damage of heart muscle due to an infarct and/or reperfusion injury, which is the death of tissue following the restoration of blood flow after an infarct or cardiac arrest (myocardial revascularization).

The acute phase response in patients who had a myocardial infarction can lead to life-threatening complications. The primary cause of death following an acute myocardial infarction is cardiogenic shock, which occurs in 25 to 35 percent of patients 10 days after a heart attack and ultimately results in mortality.

Care plans include;

-Comprehensive monitoring of the heart rhythm, electrolytes and cardiac enzymes.

-Minimizing complications related to obesity (such as diabetes mellitus)

-Maintaining optimal nutritional levels,

-Controlling and managing psychological and social problems,

-Helping to improve functional capacity,

-Promoting healthy lifestyle choices and compliance with medical therapy

Nursing Interventions for Chest Pains

Nursing Interventions of Chest Pains -Emergency Department

The nurse prepares the emergency cardiac care kit and monitors patients for signs that may indicate their condition is worsening, including increasing pain, abdominal discomfort or chest pains; respiratory distress; shortness of breath and coughing up blood. The patient experiencing cardiac arrest will exhibit a loss of consciousness, irregular breathing or agonal respirations, no palpable pulse when assessing the radial artery, and cool, clammy skin with cyanosis.

The initial management of chest pain is to assess the severity of symptoms, offer supplemental oxygen and determine the need for ECG evaluation and initiation of cardiac care protocol.

Immediate treatment includes administration of Aspirin immediately if not given before admission and often provided with nitroglycerine sublingual product, which relaxes blood vessels, thus lowering blood pressure and relieving pain.

-The patient is then sent to a cardiologist where they are managed per their condition at the time of arrival, i.e. if the ECG indicates that the heart is beating abnormally, it will be stabilized through appropriate medications. If no abnormalities are detected, then it is often enough to observe the patient’s condition overnight.

-During admission, patients are observed and precautions implemented to prevent complications such as infection or excessive bleeding due to the antiplatelet medications typically used following a heart attack. Patients may be monitored with frequent ECGs, blood tests (e.g., troponin), and nursing observations regarding vital signs, blood pressure, pain scores, mental status etc. Patient may be put on bed rest.

Interventions during Chest Pain- Skilled Nursing Facility

These interventions focus on monitoring the vital signs and cardiac status, including providing oxygen through a mask if indicated by decreased SpO2. It also includes monitoring blood pressure and pulse rate and the level of pain experienced by patients.

Patients are examined for signs of bleeding and given an aspirin tablet to chew or allow to dissolve in their mouth unless contraindicated by another medical condition. The patient’s medications are reviewed, and dosage is adjusted as needed.

The patient may be allowed to rest for some time but will be encouraged to walk if this does not cause chest pain.

To help the patient get back onto his feet more quickly, intervention is used to prevent atrial fibrillation and ventricular arrhythmias by reducing cardiac biomarkers (e.g., troponin) support for the patient and his family and the initiation of an appropriate cardiac rehabilitation program.

If a patient cannot get up on their own, they will be placed in a semi-sitting position with the head of their bed elevated. The oxygen flow rate is adjusted to keep SpO2 greater than 92%.

As patients may often be quite irritable with chest pain, they need support to cope with their situation and benefit from family members or friends being present during admission. Patients also benefit greatly from having information given in laymen’s terms about their disease, treatment plan and condition.

Nursing Interventions during a Heart Attack

The cardiac arrest followed by reperfusion is very likely to cause severe damage to the heart muscle. The goal of treatment is to minimize this irreversibly damaged ventricular tissue, which can lead to arrhythmias and increase the risk of sudden cardiac death.

-A guideline-based approach is used for ACLS:  In the first phase of resuscitation care, the appropriate interventions are given according to the signs and symptoms displayed by the patient. In the second phase, a plan is made for advanced cardiac life support per clinical guidelines. During this time, patients may be taken to an operating room where cardiopulmonary bypass can be used to rewarm and oxygenate blood that has become cold and stagnant, allowing the heart to recover.

-Treatment of arrhythmias includes the administration of antiarrhythmic medications such as amiodarone or lidocaine for atrial fibrillation and/or cardiac pacing to stabilize the heart rhythm. If these measures fail, then more aggressive resuscitative efforts may be needed, including defibrillation, cardioversion or implantation of a pacemaker.

Patients in cardiac arrest will receive chest compressions and the use of drugs such as epinephrine and vasopressin to minimize the damage caused by ischemia in the heart muscle.

Nursing interventions focus on patient education, discharge planning, support and counseling.

Interventions during Angina

Patients experiencing angina will receive cardiac medications such as nitrates or calcium channel blockers to stabilize the heart’s rhythm so it can function normally under increased workload or stress. If a patient has the acute coronary syndrome, they will be given medications such as Aspirin, clopidogrel or prasugrel, and if the heart is not beating properly, heparin will be administered.

If patients have pain after activity, they are instructed to take nitroglycerin tablet(s) to decrease blood vessel constriction. Patients can also self-monitor their symptoms by keeping an angina diary, which is a written record of specific aspects of the attack such as location, time and duration.

Patients who experience severe pain may need to be admitted to the hospital for continuous monitoring and cardiac care to prevent damage from reocclusion or re-stenosis, manage heart failure, regulate blood pressure and treat arrhythmias. Some patients may not feel their angina while they are in the hospital but continue to be monitored for any changes or complications that might occur.

Nursing Interventions during Myocardial Infarction

The main focus of nursing care is to stabilize patients with a cardiac conditions by treating their cardiovascular, pain or respiratory symptoms. Medications are given to treat cardiac problems during the acute phase of an event until the patient’s condition stabilizes and then provide information about how to manage these issues at home.

A daily resting pulse rate value and blood pressure reading are also important information for patients to record.

The patient’s heart rhythm, blood pressure and oxygen levels are monitored and recorded every fifteen minutes for twenty-four hours after the beginning of a cardiovascular event.

Patients should also be assessed for complications such as hypotension or tachycardia, which require immediate attention by medical staff.

Assessment of the patient’s pain level and ability to perform ADLs is also noted by the nurse.

After a heart attack or cardiac event, many patients still have underlying cardiac issues that need medical attention. The patient may be on medications such as beta-blockers (propranolol), Aspirin (Aspirin) and/or clopidogrel (Plavix), and the nurse will monitor them to ensure that they are taking it as prescribed and that no symptoms or side effects occur.

As many heart attacks are related to coronary artery disease, patients might have other medical conditions like diabetes, hypertension or hyperlipidemia. Medical staff may suggest lifestyle changes for these issues to reduce the risk of heart disease. The nurse will instruct the patient on managing their health in a manner that promotes better cardiac health and reduces the risk of another event.

After discharge from the hospital, patients are instructed to keep track of their symptoms and medication use. They should also visit their primary care physician within fourteen days after they are admitted to the hospital.

Patients should also incorporate other ways of managing heart health such as quitting smoking, exercising every day and changing eating habits by reducing saturated fats and increasing fruits and vegetables. Nurses will assist patients with these changes by providing motivational support from discharge through follow-ups during outpatient care visits for up to one year.

Cardiac rehabilitation, which focuses on exercise and lifestyle changes, is also recommended for cardiac patients. This program will help decrease the chance of a second event by providing information and support for behavioural change to prevent future occurrences.

The nurse will encourage compliance with these educational interventions and maintain a healthy diet and exercise routine to reduce the risk of future cardiac events.

Treatment

Cardiac Rehabilitation Programs

Cardiac rehabilitation programs begin with a cardiac event and incorporate the following elements:  behavioral change, education, exercise training, emotional support, smoking cessation and social support. The program’s goal is to reduce or eliminate the risk of another heart attack while improving physical condition and quality of life.

Speech Therapy

The speech-language pathologist (SLP) will work with the cardiac patient to help regain basic communication skills. This can happen in a group setting or on an individual basis.

Medication Management

Medications that can be stopped or reduced during the CRP include beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor beta-blockers (ARBs), and Aspirin.  There are two exceptions to this rule: 1) diuretics, which will be gradually reduced, and 2) nitrates, which may be continued with caution, but a nitroglycerine patch may require discontinuation or modification. Patients are usually advised to continue medications that may be protective against heart diseases, such as ACEIs, ARBs, and Aspirin.  Patients should cooperate with their physician to alleviate some novel cardiovascular drugs (i.e., statins).

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Summary

Chest pain may be related to coronary artery disease, narrowing the heart’s blood vessels. In this condition, the arteries that supply oxygen-rich blood to the heart muscle are narrowed. This is a common type of heart disease that affects millions of people worldwide.  Chest pains have many possible causes. It is important to differentiate them so as not to make a serious error in diagnosis, such as diagnosing chest pains resulting from angina as cardiac arrest. The assessment of the patient is crucial for the accurate identification of these conditions and to initiate appropriate treatment for each condition.

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