NURSING CARE PLAN

Nursing Care Plan

Nursing Care Plan

Introduction

Angina pectoris is transient chest pain or discomfort that is caused by an imbalance between myocardial oxygen supply and demand. The discomfort typically occurs in the retrosternal area; may or may not radiate; and is described as a tight, heavy, squeezing, burning, or choking sensation. The most common cause of angina pectoris is decreased coronary blood supply due to atherosclerosis of a major coronary artery. The atherosclerosis causes narrowing of the vessel lumen and an inability of the vessel to dilate and supply sufficient blood to the myocardium at times when myocardial oxygen needs are increased. Other conditions that can compromise coronary blood flow (e.g., spasm and/or thrombosis of a coronary artery, hypovolemia) and conditions that reduce oxygen availability and/or increase myocardial workload and oxygen demands (e.g., anemia, smoking, exercise, heavy meals, increased altitude, exposure to cold, stress) may precipitate or increase the frequency of angina attacks by widening the gap between oxygen needs and availability.

The two major types of angina pectoris are stable (classic exertional) angina and unstable angina. Stable angina, the most common type, is usually precipitated by physical exertion or emotional stress, lasts 3 to 5 minutes, and is relieved by rest and nitroglycerin. Unstable angina is characterized by an increasing frequency and/or severity of attacks that occur with less provocation or at rest. It is considered to be an acute coronary syndrome, which is associated with thrombus formation in a coronary artery. Persons with unstable angina are usually hospitalized and treated with heparin and antiplatelet agents while decisions regarding medical versus surgical treatment are made. A third type of angina is Prinzmetal's variant angina. It is less common than stable or unstable angina and is caused by severe focal spasm of a coronary artery.

Nursing Assessment

Assessment as defined by McFerran (1998) is the initial stage of the nursing process, in which information about the patient's health status is gathered and from which a nursing care plan my be devised. The assessment tool used in this case was Roper, Logan and Tierney's model. Roper et al (1996) claims that to plan the nursing care successfully the nurse will need to be able to assess where there are problems of continuing a sufficient quality and quantity of self-care activity for health and well being.

Aggleton and Chalmers (2000) claim that the use of an appropriate nursing model informs assessment by establishing the kind of information required, the detail that is likely to be helpful and the ways in which the information might be gathered. They go on to say that by placing the emphasis on assessment the nursing process encourages the nurse to identify with the patient potential and actual health problems. While some of these problems may be linked to specific medical conditions, others will be specific to individuals, their psychology and their social and cultural status. Aggleton and Chalmers (2000) continue with adding that assessment is more often than not a multistage process in which initial ideas are formed about ...