Assessment and Nursing Diagnosis for Coronary Heart Disease

Coronary Heart Disease (CHD), also known as Coronary Artery Disease (CAD), remains one of the leading causes of morbidity and mortality in the United States. For nursing students, learning how to perform a proper assessment and create accurate nursing diagnoses is essential for delivering optimal patient care. This article provides a complete, evidence-based guide tailored for beginner and advanced nursing students, including physical assessment, diagnostic tests, nursing diagnoses, and a detailed Nursing Care Plan (NCP) in table format.

What Is Coronary Heart Disease?

Coronary Heart Disease occurs when the coronary arteries become narrowed or blocked due to atherosclerosis, reducing oxygen-rich blood supply to the myocardium. This leads to ischemia, angina, myocardial infarction (MI), arrhythmias, and in severe cases, heart failure.

Pathophysiology Overview

The development of CHD begins with endothelial injury caused by factors such as hypertension, smoking, diabetes, and hyperlipidemia. This injury triggers inflammation and plaque buildup, which gradually narrows the arteries. When blood flow is significantly restricted, the heart muscle becomes ischemic, causing chest pain or, in extreme cases, myocardial cell death.

Comprehensive Nursing Assessment for Coronary Heart Disease

1. Health History

• Presence of chest pain: quality, intensity, duration, radiation
• Associated symptoms: dyspnea, diaphoresis, nausea, palpitations
• Medical history: hypertension, diabetes, dyslipidemia
• Lifestyle factors: smoking, alcohol use, activity level, diet
• Family history of early cardiac disease

2. Physical Assessment

• Vital signs: BP elevation, tachycardia, tachypnea
• Heart sounds: S3 or S4 gallop, murmurs
• Skin assessment: diaphoresis, pallor
• Respiratory assessment: crackles indicating heart failure
• Peripheral circulation: weak pulses, prolonged capillary refill

3. Diagnostic Tests

• ECG: ST elevation, ST depression, T-wave inversion
• Cardiac biomarkers: troponin, CK-MB
• Lipid profile: LDL, HDL, triglycerides
• Stress test or exercise tolerance test
• Echocardiogram: ventricular function, ejection fraction
• Coronary angiography: gold standard for arterial blockages

Common Nursing Diagnoses for Coronary Heart Disease

Based on the assessment findings, the following nursing diagnoses are commonly associated with CHD:

1. Ineffective Tissue Perfusion (Cardiac) related to reduced coronary blood flow
2. Acute Pain related to myocardial ischemia
3. Activity Intolerance related to imbalance between oxygen supply and demand
4. Anxiety related to fear of death or hospitalization
5. Risk for Decreased Cardiac Output related to impaired myocardial function

Detailed Nursing Care Plan (NCP) for Coronary Heart Disease

Nursing Diagnosis	Goals/Outcomes	Nursing Interventions	Rationales
Ineffective Tissue Perfusion (Cardiac)	Patient will maintain adequate cardiac perfusion as evidenced by stable vital signs. Patient will verbalize reduction of chest discomfort.	Monitor vital signs and ECG changes every 15–30 minutes. Administer oxygen as prescribed. Administer prescribed nitrates, beta-blockers, or antiplatelet agents. Encourage rest and reduce physical exertion.	Identifies early signs of ischemia or deterioration. Improves oxygen availability to the myocardium. Reduces myocardial workload and prevents clot formation. Decreases oxygen demand and promotes perfusion.
Acute Pain related to myocardial ischemia	Patient will report pain relief within 30 minutes of intervention.	Assess pain characteristics using OLDCARTS. Provide nitroglycerin as ordered. Position patient in semi-Fowler's. Keep the patient calm and limit stimuli.	Identifies worsening cardiac pain. Improves coronary blood flow and relieves angina. Reduces preload and eases breathing effort. Calm environment reduces oxygen consumption.
Activity Intolerance	Patient will tolerate gradual activity without chest pain or dyspnea.	Assess response to activity: dyspnea, fatigue, heart rate. Assist with ADLs as needed. Implement cardiac rehabilitation education. Encourage progressive ambulation.	Helps identify limits of physical endurance. Reduces energy expenditure. Promotes long-term heart function improvement. Increases exercise tolerance safely.

Nursing Evaluation

The effectiveness of nursing interventions is evaluated by monitoring the patient’s vital signs, oxygenation status, pain level, ECG results, tolerance of activity, and overall comfort. Improvement in cardiac perfusion and reduction of ischemic symptoms indicate successful outcomes.

Patient Education

• Teach the patient about heart-healthy diet (low sodium, low fat)
• Explain the importance of medication adherence
• Encourage smoking cessation and weight management
• Educate about recognizing early signs of MI
• Promote regular follow-up with cardiology

Conclusion

Coronary Heart Disease requires early recognition, accurate assessment, and effective nursing diagnoses to prevent complications such as myocardial infarction and heart failure. Nursing students must understand the key components of assessment and interventions to deliver safe and evidence-based care. With proper evaluation and individualized NCP, patient outcomes can be significantly improved.

References

• American Heart Association (AHA). (2024). Coronary Artery Disease Guidelines.
• Lewis, S. L., Dirksen, S., & Heitkemper, M. (2023). Medical-Surgical Nursing, 11th ed.
• Ignatavicius, D. & Workman, M. (2024). Patient-Centered Collaborative Care.

Share :

Facebook Twitter