Med-Surg Care Plan

Student: Abigail Rodriguez Date: 2/24/2020

Course: 320CC Instructor: Karina Mondragon

Clinical Site: Banner Boswell Hospital Client Identifier: L.M. Age: 72

Reason for Admission: Patient was admitted due to refractory angina, chest pain, and multivessel disease. He was admitted the week of 2/18
for angina, and underwent a cardiac catheter procedure, but returned this week, 2/23/20, with persistent chest pain and episodes of shortness of
breath. He presented with severe chest pain in the ED with his wife. He was well aware of what was going on, but was fearful and anxious that
the pain would persist into a myocardial infarction.

Medical Diagnoses: (Include Pathophysiology and Risk Factors): Clinical Manifestation(s):

Multivessel disease - Presented clinical manifestations:
o Chest pain
The underlying cause for multivessel coronary artery disease (MCAD)
begins with the process of atherosclerosis, which develops by partaking in o Shortness of breath
risk factors like high blood pressure, high cholesterol, smoking, diabetes, o Weakness or fatigue
and genetics (Ambrose, & Singh 2015). As the disease progresses, there is - Expected clinical manifestations:
a gradual thickening of plaque and inflammation in the inner layers of the o Heart attack
major arteries that supply the heart with blood, oxygen, and nutrients. o Pain in shoulder, back, or jaw
This disease process can become life-threatening, as the plaque builds up o N/V
and narrows the arteries, decreasing the blood flow to the heart, it can lead o Indigestion
to an acute myocardial infarction (Ambrose, & Singh 2015). - (Sampson, 2018).
The risk factors to developing multivessel disease include age, as getting
older generally increases the risk of damage or narrowed arteries, family
history, obesity, physical inactivity, high stress, and unhealthy diet. The
main causes of MCAD include smoking, high blood pressure, high
cholesterol, diabetes/insulin resistance, and a sedentary lifestyle.
Symptoms include chest pain or angina, which may feel like pressure or
© 2019. Grand Canyon University. All Rights Reserved.
tightness in the chest. Additionally, the patient may experience shortness
of breath, or a heart attack (Mayo Clinic. 2018).

Assessment Data
Subjective Data: Patient stated, “The chest pain continued after the cardiac catheter was placed. My chest would hurt, and the Nitro would
only relieve the pain each hour. After going through like 3 different pills in 3 hours, I had to come to the hospital.” After being told he would
undergo a CABG surgery, he stated, “I am very relieved. The chest pain gets really scary sometimes. My nitro is effective, but I do get really
scared when the pain level gets high. Its my heart! I need my heart to work!”
VS: Q4 Hours Labs: (Harding, Roberts…, Kwong, 2019). Diagnostics:
0800: WBC: 7,200 (02/23/20) WNL - 2/23/20- Chest X-ray:
Normal: 5,000-10,000/ μL
o Reason: Refractory angina
T : 36.8 °C (oral)
o Findings: Showed no pneumothorax, no
BP: 166/84 mmHg RBC: 4,110,000 WNL discrete pleural effusion.
(02/23/20) - 2/23/20- EKG:
HR: 67 BPM
Normal: 3,800,000- o Reason: Refractory angina
RR: 18 br/min 5,700,000 o Findings: Sinus Rhythm
O2 Sat: 96% RA HgB: 12.2 (02/24/20) The client has a low HgB - 2/24/20- Vascular diagrams:
level because of the o Reason: CABG surgery scheduled,
1200 Normal: 12-18 g/dL diagnosis of multivessel surgeon needed to see how severe the
T : 36.6 °C (oral) disease. He is not multivessel disease is.
oxygenating his cells
o Findings: showed no significant
BP: 136/81 mmHg sufficiently, and may have
anemia. atherosclerotic plaque in the R or L Carotid
HR: 76 BPM arteries. Did show mild heterogenous
Hct: 36.0% (02/23/20) The HCT is low because irregular atherosclerotic plaque in both
RR: 18 br/min this determines the
Normal: 37-52% percentage of RBC’s in
right and left Carotid arteries.
O2 Sat: 92% RA the blood. It can be low
0400 due to the patients
multivessel disease or
possible anemia.

2
 T : 37 °C (oral) Platelets: 211,000 WNL
(02/23/20)
BP: 161/78 mmHg
Normal: 150,000-400,000
HR: 80 BPM μL
PT: N/A in chart N/A in chart
RR: 18 br/min (02/23/20)
O2 Sat: 94% RA Normal: 11-12.5 sec

PTT: N/A in chart N/A in chart

(02/23/20)

Normal: 10-15 sec

aPTT: N/A in chart N/A in chart

(02/23/20)

Normal: 30-40 sec

INR: N/A in chart N/A in chart

(02/23/20)

Normal: 0.75-1.25

Na+: 141 (02/23/20) WNL

Normal: 136-145 mEq/L

K+: 4.0 (02/23/20) WNL

Normal: 3.5-5.0 mEq/L

Phosphorus: N/A in chart N/A in chart

Normal: 3.0-4.5mg/dL

Magnesium: N/A in N/A in chart

chart

3
Normal: 1.3-2.1mEq/L

BUN: N/A in chart N/A in chart

(02/23/20)

Normal: 10-20 mg/dL

Cr: N/A in chart N/A in chart

(02/23/20)

Normal: 0.5-1.2 mg/dL

Glucose: 162 (02/10/20) The patient’s blood

glucose is high because he
Normal: 70-110mg/dL is a diabetic patient.

Ca+: N/A in chart N/A in chart

Normal: 9.0-10.5mg/dL

GFR: N/A in chart N/A in chart

Normal: 125 mL/min

ALT: N/A in chart N/A in chart

Normal: 4-36 U/L

AST: N/A in chart N/A in chart

Normal: 0-35 U/L

Albumin: N/A in chart N/A in chart

Normal: 3.5-5.0 g/dL

Troponin: 17 (02/23/20) The clients troponin level

is high due to his
Normal: <11 multivessel coronary
artery disease.

Cholesterol: 211 The clients cholesterol is

4
(02/23/20) high because of his
hypercholesterolemia.
Normal: <200mg/dL

HDL: 32 (02/23/20) The clients cholesterol is

high because of his
Normal (male): >45 hypercholesterolemia.

LDL: 116 (02/23/20) WNL

Normal: <130mg/dL

Triglycerides: (02/23/20) The clients triglyceride

levels are high because of
Normal: 35-160 mg/dL his hypercholesterolemia.

pH: 7.45 (02/24/20) WNL

Normal: 7.35-7.45

paCO2: 40mmHg WNL

(02/24/20)

Normal: 35-45 mmHg

PaO2: 67mmHg The clients paO2 Is low

(02/24/20) because of his multivessel
coronary artery disease.
Normal: 80-100 mmHg

HCO3: 29mmol/L HIGH

(02/24/20)

Normal: 22-28mEq/L

5
Assessment: Orders:
PMH: DM II, Hiatal hernia, hypercholesterolemia, HTN - 2/24/2020- NPO before surgery (except beta blocker
medication)
- Neuro: - Full Code
- Vitals Q4H
- LOC: Alert and Oriented x4
- Speech: Clear
- Pupils: Brisk, Regular. Equal pupil size both R and L were
3mm.
- Eyes: open normally, through conversation and assessment.
- Affect: Cooperative.

- Resp:
- Oxygen status: O2 sat at 94% on RA.
- Lung sounds: Clear bilaterally
- Effort: Unlabored bilaterally
- Cough: Non-productive
- Sputum: None
- Cardio/Vascular:
- Heart rate: Regular
- Heart tone: S1 and S2 sounds bilaterally. No S3 or S4 sounds
auscultated bilaterally.
- Pulses: Radial: Palpable, 2+. Pedal: Palpable, 2+.
- Capillary Refill: <3 seconds bilaterally.
- Edema: Absent bilaterally on upper and lower extremities.

- GI:
- Abdomen: round, nontender, soft.
- Bowel sounds: Present in all quadrants, normoactive.
- Last BM: patient stated it was 2 days ago on 02/22/20.
- Diet: NPO except beta blocker medications for surgery.
- Blood Glucose: 162. Last Accucheck on 2/24/20 at 1200

6
- GU:
- Status: Foley- approximately 150mL of dark yellow urine
before it was removed. Patient was in pain, so the Foley was
removed and a new Foley was put in, and the patient was sent to
surgery.
- Urine: Clear, dark Yellow
- Output amount: 150mL (catheter was only in for a short
amount of time before a new one was put in)
- Pain/Burning/Difficulty: Pain and burning while voiding, so
Foley was removed and new one was put in.
- Skin:
- Color: Normal color for ethnicity, pink.
- Status: Intact, warm.
- Wound: None
- MSK:
- Upper extremity motor response: Moves with and without
resistance bilaterally, strong.
- Lower extremity motor response: Moves with and without
resistance bilaterally, strong.
Mobility: able to ambulate alone.
- Assistive Devices: None.
Fall Precautions: No.
- Hygiene:
- Status: partial bath and oral care last done on -2/24/20 at 0800.
- Monitoring Lines/IVs
-Peripheral IVs: Right lower forearm, 22 gauge. On a Nitro
drip.
-Central line: None.
-AV Fistulas: None.
- PD/HD Cath: None.
- JP Drains: None.
-Wounds: None.

7
- Pain: Patient stated he had a burning sensation each time he urinated
via Foley catheter. The urine was clear, dark yellow, with no blood.
Due to the bladder spasms patient kept experiencing, the catheter was
removed and there was a small hint of blood at the end of the catheter
when it was removed. A new one was inserted, as he was getting sent
up to a surgery for a Coronary Artery Bypass Graft (CABG).
- Precipitating factors: Voiding in urinary catheter.
-Quality: Stinging, burning.
- Radiation/Region: Perineal area. Specifically the penis.
- Severity: 8/10 on pain scale.
- Time: 1200
- Goal: 2/10.
- Alternative pain control methods: N/A in chart.

8
 Medications
ALLERGIES: NKDA, NKFA

Name Dose Route Frequency Indication/Therapeutic Adverse Effects Nursing

Effect Considerations
Generic name: 50mg + Titrate IV Continuous Relief angina or prevent it. ]Dizziness, HA, apprehension, Nursing Assessment:
Nitroglycerin premix infusion Increases cardiac output and restlessness, weakness, 1. Assess intensity,
Brand name: Nitrostat 250mL of decreases BP. Increases hypotension, tachycardia, location, and
Class: Nitrates Dextrose 5% coronary blood flow by dilating syncope and abdominal pain duration of the
the coronary arteries and (Vallerand et al., 2017). pain.
improving collateral flow to 2. Monitor BP and
ischemic regions (Vallerand et HR before and after
al., 2017). administering dose.
3. Do not administer
if the patient has
severe anemia
(Vallerand et al.,
2017).
Patient Education:
1. Instruct the patient
to never double
dose or stop
abruptly.
2. Warn the patient
about orthostatic
hypotension, and to
rise slowly.
3. Inform the patient
that a headache is a
common side
effect, and to
advise HCP to get
aspirin or
acetaminophen
(Vallerand et al.,
2017).
9
Generic name: 81mg PO Qday Aspirin is a nonopioid Dyspepsia, epigastric distress, Nursing assessment:
Acetylsalicylic Acid analgesic/antipyretic, that can nausea, hepatotoxicity, and 1. Assess the patients
Brand name: Aspirin also be used as an antiplatelet. anemia (Vallerand et al., 2017). pain, noting the
Class: Nonsteroidal anti- The client is on aspirin for heart location, type, and
inflammatory drug health, to prevent a blood clot intensity before and
(NSAID) or MI’s (Vallerand et al., 2017). after
  administration.
2. Assess fever, and
note any associated
signs, such as
diaphoresis or
malaise.
3. Caution with
patients who drink
alcohol; drinking
while concurrently
taking the
medication will
cause gastric
irritation, and
increase the risk of
GI bleeding
(Vallerand et al.,
2017).

Patient Education:
1. Teach patients on
sodium restriction
diets, such as a
cardiac diet, to
avoid effervescent
tablets or buffered-
aspirin
preparations.
2. Teach the patient to
discontinue/discard
other medications if
they have an acetic,
vinegar-like odor.

10
 3. If patient is on
long-term therapy,
advice the patient
to inform their
provider, as it
needs to be
discontinued before
surgeries
(Vallerand et al.,
2017).

Generic name: Atorvastatin 40mg
Brand name: Lipitor
Class: HMG-CoA reductase
inhibitor (Statin)
PO QDay Primary prevention of Adverse effects include chest Nursing assessment:
cardiovascular disease pain, peripheral edema, flatus, 1. Monitor liver
(decrease risk of MI or stroke) heartburn, elevated liver function tests (AST
in patients with multiple risk enzymes and rhabdomyolysis & ALT) before
factors for coronary heart (Vallerand et al., 2017). initiating therapy
disease. Lowers total and LDL and if signs of liver
cholesterol and triglycerides. injury (fatigue,
Slightly increase HDL anorexia, right
(Vallerand et al., 2017). upper abdominal
discomfort, dark
urine or jaundice)
occur.
2. If patient develops
muscle tenderness,
monitor CPK
levels. Treat with
immunosuppressive
agents. .
3. Obtain a diet
history,
especially
regarding fat
consumption
(Vallerand et al.,
2017).
Patient teaching:
1. Avoid large
amounts of

11
 grapefruit juice
during therapy;
may increase risk
of toxicity.
2. Instruct patient to
notify the HCP if
they experience
any unexplained
muscle tenderness,
pain, or weakness.
3. Advise the patient
to take the
medication in
conjunction to a
diet restricting
cholesterol, fat,
alcohol, and
carbohydrates
(Vallerand et al.,
2017).

Generic name: Finasteride Reduce Reduces prostate size Gynecomastia, prostate cancer, Nursing assessment:
Brand name: Proscar and decreases hair loss by angioedema, decreased libido, 1. Assess for
Class: 5-alpha reductase inhibiting enzyme alpha 5 breast cancer, decreased volume symptoms of
inhibitor which is responsible for of ejaculation, and ED prostatic
converting testosterone into 5 (Vallerand et al., 2017). hyperplasia before
alpha and that can lead to and during therapy.
prostatic hyperplasia and hair 2. Digital rectal
loss (Vallerand et al., exams performed
2017). Patient is taking it before and during
because of his enlarged therapy. 
prostates. 3. Serum prostate-
specific antigen
may be
evaluated before
and periodically
during therapy,
as it may
decrease PSA
12
 levels (Vallerand
et al., 2017).
Patient education:
1. Instruct patient to
take it as directed
even if symptoms
improve (Vallerand
et al., 2017).
2. Advise the patient
to read the patient
package insert
before starting
therapy and with
each refill.
3. Inform the patient
that ejaculation
volume may be
decreased, ED, and
decreased libido
may occur
(Vallerand et al.,
2017).

Generic name: 1mg PO Qday The patient was on Clonazepam Suicidal thoughts, behavioral Nursing assessment:
Clonazepam to treat his severe anxiety. changes, drowsiness, slurred 1. Assess degree and
Brand name: Klonopin speck, and sedation (Vallerand manifestations of
Class: Benzodiazepines et al., 2017). anxiety and mental
status periodically
during therapy.
2. Monitor the patient
for notable
behavior changes
that could indicate
worsening of
suicidal thoughts.
3. Advise the client
that the drug may
cause dizziness or
drowsiness
(Vallerand et al.,

13

Generic name: Metoprolol 50mg
Brand name: Lopressor
Class: Beta blocker
2017).
Patient teaching:
1. Instruct the client
to take it as
directed, and to not
double doses.
2. Instruct the patient
to notify the HCP if
any unexplained
tiredness, bleeding,
sore throat, or clay-
colored stool
occurs.
3. Advise the patient
to avoid taking
medication with
alcohol (Vallerand
et al., 2017).
PO QBID Hypertension, angina pectoris, Weakness, anxiety, depression, Nursing Assessment:
prevention of MI and decreased bradycardia, HF, pulmonary 1. Assess frequency
mortality in patients with a edema, and erectile dysfunction and characteristics
history of MI. Decrease BP and (Vallerand et al., 2017). of anginal attacks
heart rate , decreased frequency throughout therapy.
of attacks and angina pectoris 2. Abrupt withdrawal
(Vallerand et al., 2017).. may precipitate
life-threatening
arrhythmias, HTN,
or MI. 
3. Monitor BP, ECG
and pulse
frequently during
dose adjustments
and periodically
during therapy
(Vallerand et al.,
2017).
Patient teaching:
1. Notify HCP if
14
 patient experiences
slow pulse,
difficulty breathing,
and wheezing.
2. Teach patient and
family how to
check pulse daily
and BP biweekly.
3. Advise the patient
for orthostatic
hypotension, to rise
slowly and dangle
feet (Vallerand et
al., 2017).

Generic name: 40mg PO Qday Erosive esophagitis associated HA, C.diff, abdominal pain, Nursing assessment:
Pantoprazole with GERD. Binds to an diarrhea, eructation, flatulence, 1. Assess patient
Brand name: Protonix enzyme in the presence of hyperglycemia, routinely for
Class: Proton pump acidic gastric pH, preventing hypomagnesemia, and acute epigastric or
inhibitor the final transport of hydrogen interstitial nephritis (Vallerand abdominal pain.
ions to the gastric lumen et al., 2017). 2. Check labs
  (Vallerand et al., 2017). Patient frequently.
is on it to treat history of hiatal 3. Monitor serum
hernia. magnesium prior to
administering.
Monitor bowel
function (Vallerand
et al., 2017).

Patient Education:
1. Teach patient to
report signs or
black tarry stool.
2. Advise patient to
avoid alcohol,
aspirin, NSAIDs,
and food that may
cause irritation.
3. Instruct the patient
to notify the HCP

15
 of all OTC
medications,
including herbal
products (Vallerand
et al., 2017).

Generic name: Terazosin 10mg PO Qday Terazosin is used to treat mild Dizziness, headache, nasal Nursing assessment:
Brand name: Hytrin to moderate hypertension congestion, nausea, abdominal 1. Assess for
Class: Alpha (Vallerand et al., 2017). Patient pain, weight gain, and orthostatic
is on it to treat his history of paresthesia (Vallerand et al., reactions like
HTN. 2017). dizziness, and
syncope.
2. Monitor intake and
output and daily
weights, and assess
for edema daily.
3. Monitor the BP and
pulse frequently
during therapy
(Vallerand et al.,
2017).
Patient education:
1. Instruct the patient
to take medication
at the same time
every day.
2. Advice the patient
to weigh
themselves twice a
week and to assess
for edema on feet
and ankles.
3. Advice the patient
to notify HCP if
frequent dizziness,
fainting, or
swelling of feet
occurs (Vallerand
et al., 2017).
Generic name: 300mg PO PRN Treatment of: Mild to moderate Agitation, anxiety, fatigue, Nursing Assessment:

16
Acetaminophen pain, Moderate to severe pain headache, insomnia, atelectasis, 1. Assess overall
Brand name: Tylenol with opioid analgesics dyspnea, HTN, and constipation health status and
Class: Analgesic (Vallerand et al., 2017). Patient (Vallerand et al., 2017). alcohol usage.
is on it to treat any headaches 2. Assess amount,
associated with other frequency and type
medications. of drugs taken.
3. Assess for rash
periodically during
therapy (Vallerand
et al., 2017).
Patient education:
1. Advice the patient
that chronic use can
cause severe
injuries to the liver.
2. Advise the patient
to avoid alcohol
when taking this
medication.
3. Advise the patient
to notify HCP
immediately if rash
occurs (Vallerand
et al., 2017).

Generic name: Lispro Sliding scale SQ PRN Control of hyperglycemia in               Nursing assessment:
insulin patients with type 1 and type 2 Hypoglycemia. Lipodystrophy, 1. Assess for
Brand name: Humalog diabetes mellitus (Vallerand et pruritus, erythema, swelling symptoms of
Class: al., 2017).Patient is on lispro to (Vallerand et al., 2017). hypoglycemia and
                                                 treat his DM II, and lower his hyperglycemia.
blood glucose. 2. Instruct patient on
                                             proper
                                 administration and
that is a life-long
therapy and won’t
treat diabetes.
3. Monitor blood
glucose every six
hours during
therapy (Vallerand

17
 et al., 2017).
Patient education:
1. Demonstrate to
patient how to draw
up the medication
and administer it.
2. Explain to the
patient that it treats,
but does not cure,
DM II.
3. Advise the patient
of the importance
of compliance with
nutritional
guidelines and
exercise (Vallerand
et al., 2017).

Generic name: Morphine 10mg IV PRN Sever pain Confusion, sedation, Nursing assessment:
Brand name: Decreases severity of pain hypotension, constipation, and 1. Advise to change
Class: Opioid (Vallerand et al., 2017). Patient blurred vision (Vallerand et al., positions slowly to
is on PRN morphine for angina. 2017). avoid orthostatic
hypotension 
2. Assess location,
intensity, and type
prior and 1 hour
following.
3. Assess the type and
location of pain
prior and 1hr after
administration
(Vallerand et al.,
2017).
Patient education
1. Instruct the patient
when and how to
ask for pain
medication.
2. Teach patient about
orthostatic

18

Goal
Client or family focused.
Priority Nursing Diagnosis (including rationale for choosing this as the priority diagnosis)
Decreased cardiac output related to altered stroke volume as evidence by refractory angina and multivessel coronary artery
disease.
(Phelps et al., 2017).
Patient will experience no
chest pain.
Nursing Diagnoses and Plan of Care
Expected Outcome
Measurable, time-specific,
reasonable, and attainable.
Patient will experience no
chest pain throughout
shift, measured by pain
assessments and vital
signs.
Intervention(s)
Nursing or interprofessional Provide reason why intervention
interventions.
1. Monitor the patient
at least every 4
hours for
irregularities in
cardiac rate or
rhythm, dyspnea,
fatigue, crackles in
lungs, jugular
venous distention, or
chest pain.
2. Tell patient to report
chest pain right
away.
hypotension, and to
rise slowly.
3. Caution patients ot
avoid concurrent
use of alcohol or
other CNS
depressants while
on morphine
(Vallerand et al.,
2017).
Rationale Evaluation
Was goal met? Revise the
is indicated/therapeutic. plan of care according the
Provide references. client’s response to current
plan of care.
1. Any or all of these 1. Met. The patient
may indicate was monitored
impending cardiac Q4H.
failure or other 2. Met. The patient
complications. was advised to
2. Chest pain may report and notify
signal myocardial the nurse if any
hypoxia or injury. chest pain
3. These measures let occurred. None
patient and did.
caregivers 3. Met. The patient
participate in was taught to
patient care and report any
19

Secondary Nursing Diagnosis:
Anxiety related to situational crisis, as evidence by chest pain and shortness of breath.
(Phelps et al., 2017).
Client will cope with their
current medical situation.
(Phelps et al., 2017)
Patient will cope with
current medical situation
without demonstrating
severe signs of anxiety,
with a continual normal
heart rate between 60-100,
by end of shift, at 1800.
3. Teach patient about help the patient abnormalities,
reportable symptoms make informed and he was well
(chest pain, decisions about aware of what
palpitations, health status. would need to be
weakness, dizziness, reported.
and syncope), (Phelps et al., 2017)
prescribed
medications, diet,
(name, dosage,
frequency, and
therapeutic and
adverse effects) and
activity level.
1. Spend 10 minutes 1. Specific amount of 1. Met. Time was
with client twice uninterrupted, non- spent with the
per shift. Convey a care-related time patient for longer
willingness to spent with anxious than 10 minutes,
listen. Offer patient builds trust especially when he
understanding and and reduces expressed feelings
empathy. tension. Acute of anxiety.
2. Listen attentively; listening helps 2. Met. Long
allow patients to patient ventilate conversations were
express feelings feelings. spent with the
verbally. 2. This may allow client, as he
3. Teach patient patient to identify distracted himself
relaxation anxious behaviors by talking about
20
 techniques to be and discover the
performed at least source of the 3. Met. The client
every 4 hours, such anxiety.
as guided imagery, 3. These measures
progressive muscle restore
relaxation, and psychological and
meditation. physical
equilibrium by
(Phelps et al., 2017) decreasing
autonomic
response to
anxiety.
(Phelps et al., 2017)
his grandchildren.
enjoyed taking
deep breathes, so
this was done
together each time
the patient
expressed feelings
of anxiety.

Definition of Client-Centered Care: Care that is unique to the age/developmental stage, gender, race, ethnicity, socio-economic
status, cultural and spiritual preferences of the individual and focused on providing safe, evidence based care for the achievement of
quality client outcomes.”

References

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Ambrose, J. A., & Singh, M. (2015). Pathophysiology of coronary artery disease leading to acute coronary syndromes. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4311268/

Harding, M., Roberts, D., Reinisch, C., Hagler, D., Kwong, J. (2019). Lewis's Medical-Surgical Nursing. [Pageburstls]. Retrieved

from https://pageburstls.elsevier.com/#/books/9780323551496/

Mayo Clinic. (2018). Coronary artery disease. Retrieved from https://www.mayoclinic.org/diseases-conditions/coronary-artery-

disease/symptoms-causes/syc-20350613

Phelps, L., Ralph, S., & Taylor, C. (2017). Sparks & Taylors nursing diagnosis reference manual (10th ed.). Philadelphia, PA:

Sampson, S. (2018). Coronary Artery Disease Symptoms. Retrieved from https://www.healthline.com/health/coronary-artery-

disease/symptoms

Vallerand, A., Sanoski, C., & Deglin, J. (2017). Davis’s Drug Guide for Nurses (15th ed.) Philadelphia, PA: F.A. Davis

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