CARE OF

CLIENT WITH
ANGINA
ABRINA, Mary
LIM, Maverick
MALQUESTO, Aliana
MARAVILLA, Dessa
ROLEDA, Jonel
SUBEJANO, Raymart
ANGINA is a type of chest pain
caused by reduced blood flow to the
heart.
 It is a symptom of coronary artery
disease.
 Angina, also called angina pectoris, is
often described as squeezing, pressure,
heaviness, tightness or pain in your
chest.
TO ISCHEMIC HEART
DISEASE AFFECTS
APPROXIMATELY 112
MILLION PEOPLE (1.6%
OF THE POPULATION)
BEING SLIGHTLY MORE
COMMON IN MEN THAN
WOMEN (1.7% TO 1.5%).
 SIGNS AND
SYMPTOMS
 Angina symptoms include chest pain and discomfort, possibly described as
pressure, squeezing, burning or fullness.
 You may also have pain in your arms, neck, jaw, shoulder or back.
 Other symptoms that you may have with angina include:
 Dizziness
 Fatigue
 Nausea
 Shortness of breath
 Sweating
 MANAGEM
Other


ECG
ENT
Diagnostics Medical Procedures:
•Echocardiogram
Angioplasty and Stenting
Treatment
 Medications:
Nitrates

•Chest


Coronary
Nuclear Stress Test
X-ray
artery bypass


Aspirin
surgery
Clot-preventing Drugs

•Blood
External
Test


Beta blockers
counterpulsation
Statins (ECP)
 Coronary Angiography  Calcium channel blockers
 CT Scan  Blood Pressure lowering
 Cardiac MRI
medications
 Ranolazine (Ranexa)
SIGNIFICANCE
OF
LABORATORY
TESTS TO THE
PATIENT
 CBC: WBC = 5,600/mm3, hemoglobin = 15.2g/dL, hematocrit = 45%, platelet
count = 320,000/mm3 Chemistries: Glucose 110mg/dL, Blood Urea Nitrogen
(BUN) 11mg/dL, Creatinine 0.9mg/dL Urinalysis: Specific gravity: 1.016;
Protein, Glucose, Ketones = negative.
 Chest X-ray: Normal
 Blood Test: Certain heart enzymes slowly leak out into your blood if your heart
has been damaged by a heart attack. Samples of your blood can be tested for the
presence of these enzymes.
 Chest x-ray: This test takes images of your heart and lungs. This is to loo for
other conditions that might explain your symptoms and to see if you have an
enlarged heart.
 Urinalysis: To find out other conditions such as kidney problems and Diabetes
that could aggravate the current disease and lead to heart disease
 Complete Blood Count: Counts the cells and measures the levels of different
substances in your blood. For instance: abnormal red blood cell, HGb or
Hematocrit levels may indicate anemia, iron deficiency or Heart disease.
WBC count as a predictor of future coronary events, elevated WBC is a well-
recognized indicator of inflammation.
PATHOPHYSI
OLOGY
NON-MODIFIABLE FACTOR MODIFIABLE FACTOR
AGE
Family history of Active smoker
Heart disease Obese
Build-up of fatty substances to
the coronary arteries or
plaques

LAB TEST
Developing Atherosclerosis
CHEMISTRIES
Glucose –
110mg/dL

Vessels becomes obstructed

Reduced Blood flow to the

heart

Decrease oxygen to the heart S/X

Chest pain
Heavy feeling
tender
ANGINA PECTORIS
Burning sensation
in his chest
DRUG
STUDY
DRUG GEN/BRAND MOA INDICATIONS CONTRAINDICATIONS SIDE EFFECTS NURSING
NAME CONSIDERATION
ASPIRIN Bloodstream- It Pain Hypersensitivity Nausea and vomiting -Assess pain and/or
acetylsalicylic acid inhibits platelet Cardiovascular upset stomach pyrexiabefore and
(ASA) function by diseases heartburn after administration.
Ecotrin, Ecpirin, irreversibly inhibiting (The patient was drowsiness -Assess BP before
Miniprin. the production of admitted due to mild headache and after
NSAID/Antiplatelet COX1 which results chest pain and has an hypertension administration.
in inhibiting admitting diagnosis -WOF any signs of
325 mg q4h PRN production of of angina pectoris.) salicylate toxicity. In
prostaglandin and adults, a sensation of
therefore platelet’s fullness in the ears,
aggregation. tinnitus, and
In liver it is decreased or muffled
hydrolyzed into hearing are the most
salicylate which frequent symptoms.
works by inhibiting -Instruct the patient
COX 2 which reduces to take medication
prostaglandin after meal to reduce
synthesis and GI irritation
therefore reducing -Tell the patient not
inflammation, pain to break, crush, or
and fever. chew extended-
release tablets and
do not open
extended-release
capsules. Swallow
them whole.
-Ensure hydration
-Tell the patient not
to drink alcohol while
taking the
medication.
DRUG GEN/BRAND MOA INDICATIONS CONTRAINDICATIONS SIDE EFFECTS NURSING
NAME CONSIDERATION

NITROGLYCERIN Dilates coronary Angina pectoris Allergy to adhesives Headache -record onset, type
arteries, improving (Transdermal) (sharp, dull,
NITRO-PATCH PATCH (the patient has been Lightheadedness
collateral blood flow squeezing), radiation,
admitted due to
Nitrates to ischemic area Dizziness location, intensity,
chest pain with an
within the duration of pain.
2x a day q12 admitting diagnosis Transient flushing of
myocardium. Hence,
of angina pectoris) face/neck -assess BP, apical
decreasing
pulse before
myocardial oxygen Contact dermatitis administration and
demand.
periodically following
dose.

-assess for facial,

neck flushing.

-avoid alcohol intake

as it intensifies
hypotensive effect.

-go from lying to

standing slowly
DRUG GEN/BRAND MOA INDICATIONS CONTRAINDICATIONS SIDE EFFECTS NURSING
NAME CONSIDERATION

PROPRANOLOL Propranolol generally Angina Hypersensitivity Difficulty sleeping -assess BP/HR before
reduces the oxygen and after
INDERAL Hypertension Tobacco smoking Cough producing
requirement of the administration
mucus
Non-selective beta heart at any given (The patient has difficulty with - advise patient to
blocker level of effort by admitting diagnosis breathing notify physician for
blocking the of angina pectoris, tightness in the chest
80mg q12h difficulty breathing
catecholamine- the patient is
induced increases in hypertensive with a Bradycardia - stopping abruptly
the heart rate, BP of 162/94 (RA) may result in life
systolic blood threatening
pressure, and the 160/92 (LA).)
arrhythmias
velocity and extent
of myocardial -advise to change
contraction. positions slowly to
prevent orthostatic
hypotension

- masks symptoms
associated with
diabetes mellitus

-Tell patient to avoid

alcohol intake and
not to smoke alcohol.
DRUG GEN/BRAND MOA INDICATIONS CONTRAINDICATIONS SIDE EFFECTS NURSING
NAME CONSIDERATION

ATORVASTATIN Atorvastatin (Lipitor) The patient is obese Hypersensitivity cold symptoms such -Obtain LFTs as a
competitively inhibit as runny nose, baseline and
Lipitor Angina pectoris sneezing, and periodically during
HMG coenzyme A
20mg OD PO reductase, a rate- Used as an adjunct to coughing therapy; discontinue
limiting step in diarrhea drug if AST or ALT
diet for treatment of
Lipid-Lowering cholesterol synthesis. gas levels increase to 3
elevated total-C, Apo
Agents, Statins; heartburn times normal levels.
Reduce cholesterol B, and TG levels and
HMG-CoA Reductase joint pain -WARNING: Withhold
synthesis results in a to increase HDL-C.
Inhibitors forgetfulness atorvastatin in any
compensatory Preventing heart confusion acute, serious
increase in uptake of attack/heart condition (severe
plasma cholesterol disease/problems infection,
mediated by an such as angina. hypotension, major
increase in the surgery, trauma,
number of LDL severe metabolic or
receptors. therefore endocrine disorder,
LDL level in plasma seizures) that may
reduces. suggest myopathy or
serve as risk factor
for development of
renal failure.
-Ensure that patient
has tried cholesterol-
lowering diet
regimen for 3–6 mo
before beginning
therapy.
-Administer drug
without regard to
food, but at same
time each day.
DRUG GEN/BRAND MOA INDICATIONS CONTRAINDICATIONS SIDE EFFECTS NURSING
NAME CONSIDERATION

AMLODIPINE Dilates (widens) Hypertension Hypersensitivity Swelling of ankle and Assess BP before and
blood vessels and feet after administration
5mg OD PO Angina
improves blood flow
Nausea Monitor BP very
Calcium channel- It was given to the carefully if patient is
blocker patient to treat high Vomiting also on nitrates.
Antianginal drug blood pressure and
Antihypertensive Dizziness
chest pain Monitor cardiac
rhythm regularly
during stabilization
of dosage and
periodically during
long-term therapy.
Administer drug
without regard to
meals.

Take with meals if

upset stomach
occurs.
You may experience
these side effects:
Nausea, vomiting
(eat frequent small
meals); headache
(adjust lighting,
noise, and
temperature;
medication may be
ordered).
Report irregular
heartbeat, shortness
NURSING CARE
PLAN
ASSESSMENT DIAGNOSIS PLANNING
Subjective: Risk for risk-prone health At the end of 8-hour
“Business is poor, my kid behavior related to Nursing Interventions,
is always in trouble. multiple stressors the client will be able to:
Who’s going to take care   a. Demonstrate
of things?" increasing interest
  in self-care
“Sumasakit ang dibdib b. Develop ability to
ko. Nawawala pero assume
pabalikbalik. Mga anim responsibility for
na buwanna na ganito personal needs
ang nararamdaman ko” when possible
  c. Identify stress
  situations leading
Objective: to difficulties
d. Initiate lifestyle
Physical Examination: changes that will
permit adaptation
(+) obese to current life
situations
e. Identify and use
(+) anxious
appropriate support
systems
 
Vital sings: BP right arm  
162/94; left arm 160/92.
Weight 176lbs; Height
5’7".
INTERVENTION RATIONALE
Independent: Rationale
Assess degree of impaired function Knowing the patients level
  of function will give us an
  idea of management for the
  patient
   
Identify the causative/contributing  
factors relating to the change in Knowing the factors will give
the medical practitioners an
health behavior
  idea on what to focus on for
  the patient’s management
   
Assist client in coping/dealing with  
impairment To help the client achieve a
better life
 
Promote wellness  
  The patient needs a lifestyle
  change which includes
  getting of smoking and
  drinking and having a
healthy lifestyle
EVALUATION
GOAL MET. After 8
hours of nursing
intervention, the
patient was able to
demonstrate increasing
interest in self-care,
develop ability to
assume responsibility
for personal needs
when possible, identify
stress situations leading
to difficulties, initiate
lifestyle changes that
will permit adaptation
to current life situations
and identify and use
appropriate support
systems.
 
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Anxiety related to At the end of 8-hour Independent: GOAL MET. After 8
stress as Nursing Interventions, the hours of nursing
“Business is poor,
manifested by client will be able to:
my kid is always in To assist the patient to intervention, the
verbalization of Establish a therapeutic
trouble. Who’s Reduce anxiety change his life for the
patient. relationship conveying better patient was able to
going to take care
a. Verbalize empathy and unconditional reduce anxiety by
of things?" positive regard.
awareness of verbalization of
feelings of anxiety Different levels of anxiety
Assess patient’s level of awareness of feelings
b. Report anxiety is will affect the coping
anxiety. mechanism of the client of anxiety and
Objective: reduced to a
manageable level and different factors may reporting that his
Physical exacerbate anxiety. anxiety is reduced to
Examination: a manageable level
Long Term: Acknowledgment of the
Assist client to identify feelings patient’s feelings
(+) anxious
At the end of 3-days and begin to deal with validates the feelings and
Nursing Interventions, the problems communicates
Vital sings: BP right client will be able to: acceptance of those
feelings and dealing with GOAL MET. After 3
arm 162/94; left
Alleviate anxiety the problems lessens the days of nursing
arm 160/92. patients burden.
a. Report anxiety is intervention, the
lost or reduced to
a manageable To identify physical patient was able to
level Monitor vital signs. responses associated alleviate anxiety by
b. Identify healthy with both medical and reporting that his
ways to deal with emotional conditions. anxiety is lost or
and express reduced to a
anxiety manageable level,
c. Use This may help the client
Instruct to do deep breathing to relax. identifying healthy
resources/support
systems exercise. ways to deal with and
effectively Helps the client to express anxiety and
Provide accurate information identify what is reality use
about the situation. based. resources/support
systems effectively
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION
Establish a working relationship
with the patient through
continuity of care.
Use simple language and brief
statements when instructing
patient about self-care measures
or about diagnostic and surgical
procedures.
Promote wellness and assist the
patient in developing anxiety-
reducing skills.
Instruct patient in the proper use
of medications and educate him
or her to recognize adverse
reactions.
Collaborative:
Refer the patient to a specialist
RATIONALE EVALUATION
own anxiety to the
hypersensitive patient.
An ongoing relationship
establishes a basis for
comfort in communicating
anxious feelings.
When experiencing
moderate to severe
anxiety, patients may be
unable to comprehend
anything more than
simple, clear, and brief
instructions.
Encouraging the patient to
increase activities helps in
decreasing anxiety. Using
anxiety-reduction
strategies enhances
patient’s sense of personal
mastery and confidence.
Medication may be used if
patient’s anxiety continues
to escalate and the anxiety
becomes disabling.
DISCHARGE
PLANNING
DISCHARGE PLAN  
 Since the patient isn´t yet discharged from the
MEDICATION hospital, he can take his medications from the
hospital to their home. He is going to maintain his
medication like Aspirin, Nitro-patch, Inderal
(Propranolol), Atorvastatin and Amlodipine.
 Exercise at least 30 minutes, 5 times a week—
ENVIRONMENT / EXERCISE Making regular physical activity part of your
lifestyle is one of the most effective ways to improve
your heart health such as;
Waking at a brisk pace, about 3 to 4 miles per
hour
Jogging or running
Swimming or water aerobics
 Dancing
 Tennis
 Riding a bicyle or stationary bike
 If you need immediate relief from your angina:
TREATMENT  Stop, relax, and rest. Lie down if you can. Calm yourself by focusing on your breathing.
Breathe in through the nose and breathe out slowly from the mouth.
 Take Nitroglycerin.
 Sit down before you take your nitroglycerin. The medicine may make you feel dizzy
because it lowers blood pressure rapidly.
 
 Using fast-acting tablets

 Place 1 tablet under your tongue. You can also place it between your lip and gum, or
between your cheek and gum.
 Let the tablet dissolve completely. Don’t swallow or chew the tablet.
 As the tablet is dissolving, do not eat or drink anything, or smoke or chew tobacco.
 Using fast-acting spray

Open your mouth and hold the sprayer just in front of your mouth.
Press the button on the top. Spray once on or under your tongue. Do not inhale.
Close your mouth. Then wait a few seconds before you swallow.
 After taking 1 tablet or spraying once

 Continue sitting for 5 minutes.

 If the angina goes away completely, rest for a while and continue your normal routine.
 If the pain or discomfort doesn’t stop a few minutes after taking nitroglycerin or if your
symptoms become more severe, call 911 or let someone know that you need immediate
medical assistance.
 
 
  Educating the patient about the benefits of
HEALTH TEACHING smoking and alcohol cessation as it is not only
reduces the risk of death and having another
heart attack, but it also reduces the risk of having
chest pain and may likely to improve general
mental health.
 Also, a low-cholesterol diet, physical activity, and
maintain a ideal body weight as weight
contributes strongly to the critical risk factors for
heart diseases.
 
 

 Follow-up monitoring. Patient needs reminders

OBSERVATION / OUT — about follow-up monitoring, including periodic
PATIENT blood laboratory testing and ECGs.