Nursing Care Plans Nursing Diagnosis for Coronary Artery Disease (CAD): 5 Sample Care Plans & Interventions
Nursing diagnosis for coronary artery disease centers on five NANDA-I–aligned diagnoses you will see across stable angina, acute coronary syndromes (ACS), and post-revascularization care: Acute Pain, Decreased Cardiac Output, Risk for Decreased Cardiac Tissue Perfusion, Anxiety, and Deficient Knowledge. Together they cover symptom relief, hemodynamic stability, perfusion protection, psychosocial response, and the secondary-prevention teaching that drives long-term outcomes.
This article walks through coronary artery disease pathophysiology, current guideline-directed medical therapy (GDMT) per the 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Chronic Coronary Disease guideline and 2025 ACC/AHA/ACEP/NAEMSP/SCAI ACS guideline, revascularization decisions, cardiac rehabilitation, and the five full sample NANDA care plans nursing students need for clinicals and NCLEX preparation.
Educational use only. This article is for nursing student education and is not a substitute for clinical judgment, facility protocol, or current institutional care guidelines. Always verify medications, doses, and interventions against your facility’s policy, the patient’s provider orders, and the most current NANDA-I labels for your program. Escalate clinical changes per your facility’s chain of command.
Table of contents
- Coronary artery disease pathophysiology
- CAD signs and symptoms
- CAD nursing assessment
- Diagnostic studies
- Medical management of CAD/CCD
- Revascularization (PCI/CABG)
- Cardiac rehabilitation
- CAD nursing interventions
- Sample nursing care plans for coronary artery disease
- Nursing goals and expected outcomes
- Escalation red flags
- Discharge and secondary-prevention teaching
- NCLEX-style practice question
- Frequently asked questions
- Related resources
- References
Coronary artery disease pathophysiology
Coronary artery disease (CAD) is the narrowing or obstruction of the coronary arteries that reduces oxygen delivery to the myocardium. Atherosclerosis — plaque buildup in the arterial wall — is the dominant mechanism, but CAD also includes coronary vasospasm, microvascular dysfunction, and spontaneous coronary artery dissection (SCAD). The 2023 AHA/ACC guideline retired the older term “stable ischemic heart disease” and now uses chronic coronary disease (CCD) as the umbrella for the chronic side of the disease spectrum (stable angina, post-ACS ≥ 1 year, prior revascularization, asymptomatic CAD with imaging evidence, ischemia with non-obstructive coronary arteries [INOCA], and vasospastic angina). The acute side is acute coronary syndromes (ACS) — unstable angina, NSTEMI, and STEMI.
How atherosclerotic plaque develops
Plaque begins when LDL particles deposit in the arterial intima, oxidize, and recruit monocytes that ingest the lipid and become foam cells. Smooth muscle cells proliferate, a fibrous cap forms around a lipid-rich core, and inflammatory cytokines maintain the lesion. Stable plaques have thick fibrous caps and cause angina by demand-supply mismatch — typically on exertion or emotional stress. Unstable or vulnerable plaques have thin caps, large lipid cores, and active inflammation; when they rupture or erode, exposed tissue factor triggers platelet aggregation and thrombus formation — that is the moment a chronic disease becomes ACS.
Modifiable vs non-modifiable risk factors
Knowing which risk factors a patient can change is the foundation of secondary-prevention teaching — and a high-yield NCLEX target.
| Non-modifiable | Modifiable |
|---|---|
| Age (men ≥ 45; women ≥ 55 or post-menopause) | Tobacco use (cigarettes, vaping) |
| Male sex (premenopause; risk equalizes after menopause) | Hypertension |
| Family history of premature CAD (1st-degree male < 55 or female < 65) | Dyslipidemia (high LDL-C, low HDL-C, high triglycerides) |
| Ethnicity / ancestry (higher CAD in South Asian, Black, Hispanic adults) | Diabetes mellitus / insulin resistance |
| Genetic conditions (familial hypercholesterolemia, elevated Lp(a)) | Obesity, physical inactivity, diet, CKD, sleep apnea, chronic inflammation, psychosocial stress |
CAD signs and symptoms
The classic CAD presentation is angina pectoris — substernal pressure, squeezing, or heaviness that may radiate to the jaw, neck, left arm, or back. The Levine sign (clenched fist over the sternum) is a common gesture patients make when describing it. Pain is triggered by exertion, emotion, cold exposure, or a heavy meal and relieved by rest or sublingual nitroglycerin within about 5 minutes.
Anginal equivalents and atypical presentations
Many patients — especially women, older adults, persons with diabetes, and patients after heart transplant — present without classic chest pain. Look for:
- Dyspnea on exertion (the most common anginal equivalent)
- Exertional fatigue or new exercise intolerance
- Epigastric or heartburn-like discomfort
- Jaw, neck, or arm pain alone
- Diaphoresis without chest pain
- Nausea, lightheadedness, or syncope
- New atrial fibrillation in a previously healthy heart
Stable vs unstable angina
| Feature | Stable angina | Unstable angina |
|---|---|---|
| Onset | Predictable threshold | New onset, at rest, or crescendo |
| Duration | 2–5 minutes | Longer, often unrelieved |
| Relief | Rest or sublingual nitro within 5 min | Inconsistent or no relief |
| ECG | Normal or stable | May show ST depression or T-wave inversion |
| Troponin | Negative | Negative (positive = NSTEMI) |
| Disposition | Outpatient OMT | Admit — early invasive evaluation |
If you cannot tell stable from unstable angina at the bedside, treat as ACS until ruled out.
CAD nursing assessment
A focused nursing diagnosis for coronary artery disease assessment starts with the history, vital signs, and a cardiopulmonary exam, then layers in the diagnostic data. This article uses the nursing process and follows the ADPIE framework.
Health history
- Chest-pain characterization — PQRST (Provocation/palliation, Quality, Radiation, Severity, Timing)
- Anginal pattern (frequency, threshold, last episode, response to nitro)
- Risk-factor inventory (smoking pack-years, BP history, lipid history, diabetes, family history of premature CAD)
- Medication history — antiplatelet/anticoagulant, statin, beta-blocker, nitrate, ACEi/ARB, CCB, anti-diabetic agents, OTC NSAIDs, PDE-5 inhibitors
- Allergies — especially iodinated contrast, aspirin, P2Y12 inhibitors
- Functional capacity (METs) — can the patient climb 2 flights of stairs without stopping?
- Psychosocial — depression, anxiety, stress, social support, recent loss
Focused physical assessment
- Vital signs — BP both arms, HR, RR, SpO₂ on room air, temperature, pain score
- Heart sounds — S1/S2; new S3 (HF), S4 (stiff LV), murmur (papillary muscle dysfunction, MR), pericardial rub
- Lung sounds — crackles suggest pulmonary congestion / acute LV dysfunction
- JVP — elevated with right-sided HF or tamponade
- Peripheral perfusion — pulses (radial, dorsalis pedis, posterior tibial), capillary refill, skin color/temperature, peripheral edema
- Mental status — restlessness, anxiety, confusion can signal hypoperfusion
- Skin — diaphoresis, pallor, cyanosis
Diagnostic studies
| Study | Purpose | Key values / nursing notes |
|---|---|---|
| 12-lead ECG | Detect ischemia, arrhythmia, prior infarction | Compare to prior; ST elevation ≥ 1 mm in 2 contiguous leads = STEMI; Q waves = old MI |
| High-sensitivity troponin (I or T) | Detect myocardial injury | Rises 2–4 h after injury, peaks 12–24 h, persists 7–14 days; serial draws at presentation and 1–3 h |
| BNP or NT-proBNP | Assess concurrent HF | Cutoffs vary by age, BMI, renal function — interpret in context |
| Lipid panel | Risk stratification, lipid management target | LDL-C goal < 70 mg/dL for very-high-risk ASCVD (some target < 55) |
| HbA1c | Diabetes screening / control | < 5.7% normal; 5.7–6.4% prediabetes; ≥ 6.5% diabetes |
| BMP (creatinine, eGFR, electrolytes) | Pre-contrast and pre-medication baseline | Affects metformin hold, ACEi titration, iodinated contrast risk |
| CBC | Anemia (can precipitate angina), pre-procedure bleeding risk | Hgb < 7 g/dL may precipitate demand ischemia |
| Stress test (exercise ECG, pharmacologic, imaging) | Provoke ischemia; risk-stratify | Hold caffeine 24 h before regadenoson/dipyridamole; hold beta-blocker per provider |
| Coronary CT angiography (CCTA) | Non-invasive anatomy in low–intermediate pretest probability | High negative predictive value; first-line option per 2021 chest pain guideline |
| Echocardiogram | LV function, wall motion abnormalities, valves, mechanical complications | EF guides medical therapy and revascularization |
| Invasive coronary angiography | Gold-standard anatomy; allows PCI in the same setting | Indicated for high-risk stress test, ACS, refractory angina |
Medical management of CAD/CCD
Modern CAD management is guideline-directed medical therapy (GDMT) plus revascularization when indicated. The cornerstones below come from the 2023 AHA/ACC Chronic Coronary Disease guideline and the 2025 ACC/AHA ACS guideline.
| Drug class | Typical agent / dose | Why | Nursing pearls |
|---|---|---|---|
| Antiplatelet — aspirin | 75–100 mg PO daily (loading 162–325 mg chewed for suspected ACS) | Class I for CAD; reduces MI and stroke | Non–enteric-coated for ACS loading dose; bleeding precautions; no NSAIDs without provider OK |
| Antiplatelet — P2Y12 inhibitor | Ticagrelor 90 mg BID or prasugrel 10 mg daily (preferred over clopidogrel for PCI-managed ACS); clopidogrel 75 mg daily | DAPT after PCI; 12 mo ACS, 6 mo stable CAD post-DES | Ticagrelor — twice daily, transient dyspnea common; prasugrel — avoid prior stroke/TIA or age ≥ 75; ticagrelor cap on aspirin (≤ 100 mg) |
| Statin (high-intensity) | Atorvastatin 40–80 mg daily or rosuvastatin 20–40 mg daily | Class I for ASCVD; LDL-C < 70 mg/dL goal (some target < 55) | Myalgias common; report sudden severe muscle pain + dark urine (rhabdomyolysis); LFTs at baseline only — routine monitoring not required |
| Ezetimibe | 10 mg daily | Add-on if LDL not at goal on statin | Well tolerated; combines with statin or alone if statin intolerant |
| PCSK9 inhibitor | Alirocumab/evolocumab SC q2 wk; inclisiran SC q6 mo | Class IIa for very-high-risk ASCVD not at LDL goal on statin + ezetimibe | SC technique; injection-site reactions; cold-chain storage |
| Beta-blocker | Metoprolol succinate, bisoprolol, or carvedilol | Class I for recent ACS (≤ 1 yr), LVEF ≤ 50%, or angina | Hold HR < 50 or SBP < 90 per parameters; do not stop abruptly; orthostatic precautions |
| ACEi/ARB | Lisinopril, losartan | Class I for CCD with HTN, diabetes, LVEF ≤ 40%, or CKD; initiate within 24 h of STEMI/NSTEMI | Cough, angioedema, hyperkalemia; check K⁺ and Cr within 1–2 wk of titration |
| Sublingual nitroglycerin | 0.4 mg SL — one dose, wait 5 min; call 911 if pain not relieved, may repeat × 2 doses 5 min apart while EMS responds | First-line for acute angina | Headache expected; sit/lie before taking; contraindicated with PDE-5 inhibitors within 24–48 h; original container; replace annually |
| Long-acting nitrate | Isosorbide mononitrate 30–120 mg daily or dinitrate 5–40 mg BID-TID | Chronic angina prevention | 12-hour nitrate-free interval to prevent tolerance |
| Calcium channel blocker | Amlodipine, diltiazem, verapamil | Alternative or add-on anti-anginal | Non-DHP CCBs (diltiazem, verapamil) contraindicated in HFrEF; verapamil — constipation; grapefruit interaction |
| Ranolazine | 500–1,000 mg BID | Refractory angina add-on | CYP3A4 interactions; QT prolongation |
| SGLT2 inhibitor | Empagliflozin, dapagliflozin, canagliflozin | Class I for CCD + diabetes with ASCVD; Class I for HFrEF and HFpEF regardless of diabetes | Hold ~3 days pre-op to reduce euglycemic DKA; sick-day rules; volume status; genital mycotic infections |
| GLP-1 RA | Semaglutide, liraglutide, dulaglutide | Class I for CCD + diabetes with ASCVD or high ASCVD risk | GI side effects; SC injection; site rotation; gradual titration |
What changed from MONA-B
The classic ACS mnemonic MONA-B (Morphine, Oxygen, Nitrates, Aspirin, Beta-blocker) no longer reflects current practice. Per the 2025 ACC/AHA ACS guideline: oxygen is not routinely given in non-hypoxic ACS (target SpO₂ ≥ 90%); morphine is reserved for refractory pain (associated with worse outcomes in some studies and can delay onset of P2Y12 inhibitors); nitroglycerin and aspirin remain first-line; beta-blockers are still indicated but initiation timing is individualized (avoid in cardiogenic shock or evolving HF).
Revascularization (PCI/CABG)
Revascularization is added to GDMT to relieve symptoms and — in selected anatomy — improve survival. The decision between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) is driven by anatomy, LV function, diabetes status, and patient preference (per the 2021 ACC/AHA/SCAI revascularization guideline).
When CABG is preferred
- Left main coronary artery disease (Class I)
- Multivessel CAD with diabetes (Class I)
- Multivessel CAD with reduced LVEF ≤ 35% (Class I)
When PCI is reasonable
- Single-vessel CAD (non–left main)
- Multivessel CAD in patients with low-to-intermediate SYNTAX scores
- Stable angina refractory to OMT
- Most ACS scenarios with primary PCI
DAPT duration after drug-eluting stent
- Stable CAD: aspirin + clopidogrel for 6 months, then aspirin monotherapy. Can be shortened to 1–3 months for high bleeding risk.
- ACS: aspirin + ticagrelor or prasugrel (preferred) or clopidogrel for 12 months. High bleeding risk — 1–6 months DAPT then monotherapy may be reasonable.
- Radial access > femoral access for PCI — lower bleeding and mortality benefit in ACS.
Post-PCI nursing implications
- Post-femoral PCI — bedrest 2–6 h (institution-specific); monitor groin for bleeding, hematoma, pulsatile mass (pseudoaneurysm)
- Post-radial PCI — no bedrest; band pressure released per protocol over 1–2 h
- Distal pulse, color, sensation, motion checks q15 min × 1 h, then q30 min × 2 h, then per protocol
- Bleeding teaching for DAPT
Post-CABG nursing implications
- Sternal precautions for 6–8 weeks — no lifting > 10 lbs, no pushing through arms to stand, no pulling, no driving
- Incentive spirometry, splinted cough, early ambulation
- Pain control with acetaminophen, NSAIDs (if not contraindicated), short-course opioid if needed
- Wound surveillance — sternal and saphenous vein harvest sites
- Post-op AFib is common — telemetry, rate/rhythm control, anticoagulation per orders
Cardiac rehabilitation
Cardiac rehabilitation is a Class I, life-saving intervention that nursing is often the gatekeeper for. Referral after MI, PCI, CABG, stable angina, HFrEF, valve surgery, or heart transplant should be routine. One of nursing’s most measurable secondary-prevention contributions is making sure eligible patients enroll before discharge.
| Phase | Setting | Typical duration | Focus |
|---|---|---|---|
| Phase I | Inpatient | 1–3 days during admission | Early mobilization, risk-factor education, discharge planning, CR referral |
| Phase II | Outpatient supervised | ~36 sessions over 12 weeks (3×/week) | Monitored exercise, risk-factor counseling, psychosocial support |
| Phase III | Community / maintenance | Months to years | Independent or community-based exercise, continued risk-factor management |
| Phase IV | Lifetime maintenance | Ongoing | Self-directed exercise, ongoing follow-up |
Core components (AACVPR / AHA): patient assessment, nutrition counseling, weight management, BP management, lipid management, diabetes management, tobacco cessation, psychosocial management (depression screening), physical activity counseling, supervised exercise training. The 2019 AHA/ACC/AACVPR statement supports hybrid CR (facility + home/virtual) for stable, low-to-moderate-risk patients.
CAD nursing interventions
Acute angina relief
- Stop activity; sit or lie down.
- Administer sublingual nitroglycerin 0.4 mg; reassess in 5 minutes.
- If pain is not relieved within 5 minutes of the first dose, call 911 (community) or activate Rapid Response (inpatient) and obtain a 12-lead ECG immediately. Repeat sublingual nitro × 2 doses 5 minutes apart while EMS or the rapid response team responds, per facility protocol.
- Administer chewed non–enteric-coated aspirin 162–325 mg per protocol for suspected ACS.
- Establish IV access; draw troponin and basic labs.
- Provide supplemental oxygen only if SpO₂ < 90%.
Medication administration and teaching
- Verify aspirin, P2Y12 inhibitor, statin, beta-blocker, ACEi/ARB, and anti-anginal dosing against orders.
- Teach the sublingual nitro protocol (call 911 after the first dose if pain persists).
- Teach DAPT bleeding precautions and to never stop antiplatelet therapy without provider OK.
- For statins, teach to report sudden severe muscle pain with dark urine (rhabdomyolysis).
- For beta-blockers, teach not to stop abruptly (rebound tachycardia and ischemia).
- For SGLT2 inhibitors, teach sick-day rules and pre-op hold (~3 days) to reduce euglycemic DKA risk.
Lifestyle counseling
- Diet — Mediterranean or DASH; reduce saturated fat, trans fat, sodium; increase fiber, vegetables, fish.
- Exercise — 150 minutes/week moderate-intensity; enroll in cardiac rehab.
- Tobacco cessation — combine behavioral counseling with pharmacotherapy (varenicline, bupropion, NRT).
- Weight — target BMI < 25; waist < 40 in (men), < 35 in (women).
- Alcohol — moderate intake at most.
Psychosocial support
- Screen for depression and anxiety (PHQ-2/9, GAD-7); refer to CBT or pharmacotherapy as indicated.
- Provide reassurance and explain procedures in plain language to reduce procedural anxiety.
- Engage family / social support; coordinate with social work for community resources.
Coordination and discharge planning
- Cardiology follow-up within 1–2 weeks post-discharge.
- Make the cardiac rehab referral before discharge.
- Medication reconciliation with pharmacy.
- Patient teach-back on sublingual nitro use, when to call 911, and red-flag symptoms before discharge.
Verify your NANDA-I labels. This article uses NANDA-I–aligned educational language consistent with the NANDA-I 2024–2026 edition. Cardiac tissue perfusion is reflected using the current NANDA-I system-specific label Risk for Decreased Cardiac Tissue Perfusion — the generic “Ineffective Tissue Perfusion” diagnosis was retired in favor of system-specific labels. Always verify the exact label, defining characteristics, and related factors against the current NANDA-I edition your program adopts.
Sample nursing care plans for coronary artery disease
Nursing diagnosis for coronary artery disease examples below follow the standard NANDA-I care plan template (Related to / As evidenced by / Expected outcomes / Interventions with rationales).
Care Plan #1 — Acute Pain (Stable or Unstable Angina)
Acute Pain related to imbalance between myocardial oxygen supply and demand, coronary artery narrowing or plaque rupture, and increased cardiac workload, as evidenced by reports of substernal chest pressure rated ≥ 4/10, radiation to jaw/neck/left arm/back, diaphoresis, pallor, restlessness, elevated BP and HR, facial grimacing, guarding, and the Levine sign.
Expected outcomes (SMART):
- Within 5 minutes of initiating the acute angina protocol, patient reports pain decreased to ≤ 2/10.
- Within 1 hour, vital signs return to patient’s baseline.
- Before discharge, patient verbalizes the sublingual nitroglycerin protocol and when to call 911 using teach-back.
| Intervention | Rationale |
|---|---|
| Stop activity; sit or lie the patient down; stay with them during the episode. | Reduces myocardial oxygen demand and sympathetic surge. |
| Administer sublingual nitroglycerin 0.4 mg per protocol; reassess pain at 5 minutes. | Nitrate vasodilation reduces preload and dilates coronary arteries. |
| Call 911 (community) or activate Rapid Response (inpatient) if pain is not relieved within 5 minutes of the first dose; obtain a 12-lead ECG immediately. | Time-to-PCI is the strongest determinant of STEMI outcome. |
| Repeat sublingual nitro × 2 doses 5 minutes apart while EMS or rapid response responds, per facility protocol. | Continues vasodilation while definitive evaluation is mobilized. |
| Administer chewed non–enteric-coated aspirin 162–325 mg for suspected ACS, unless allergy or active GI bleed. | Antiplatelet effect within 15–30 min reduces clot propagation. |
| Establish IV access; draw troponin (presentation and 1–3 h) and baseline labs. | Confirms or excludes myocardial injury. |
| Provide supplemental oxygen only if SpO₂ < 90%. | Routine O₂ in normoxic ACS is not recommended per 2025 ACC/AHA. |
| Document pain characteristics (PQRST), location, radiation, and response to interventions. | Supports diagnostic reasoning and trend evaluation. |
| Teach the sublingual nitro protocol with teach-back before discharge. | Patient self-management drives timely escalation at the next event. |
Care Plan #2 — Decreased Cardiac Output (NSTEMI / Unstable Angina)
Decreased Cardiac Output related to myocardial ischemia or infarction with reduced contractility, altered heart rate/rhythm, and possible acute mechanical complication, as evidenced by hypotension, tachycardia or new arrhythmia, cool diaphoretic skin, decreased peripheral pulses, new crackles or S3, altered mental status, oliguria, troponin elevation, and ECG changes.
Expected outcomes (SMART):
- Within 1 hour, MAP ≥ 65 mm Hg with measures of perfusion improving (warm dry skin, alert mentation, urine output ≥ 0.5 mL/kg/h).
- Within 24 hours, cardiac rhythm stable on telemetry; troponin trend declining or plateaued.
- Before discharge, LV function reassessed by echocardiogram and GDMT optimized.
| Intervention | Rationale |
|---|---|
| Continuous telemetry; 12-lead ECG with any new symptom or rhythm change; serial troponins per protocol. | Detects evolving ischemia and arrhythmias; troponin trajectory guides risk stratification. |
| Vital signs at least q15 min during active ischemia, then per protocol; trend MAP, SpO₂, capillary refill, urine output. | Tracks perfusion adequacy in real time. |
| Administer antiplatelet (aspirin + P2Y12 inhibitor — ticagrelor or prasugrel preferred for PCI-managed ACS), anticoagulation (heparin or bivalirudin per protocol), high-intensity statin, beta-blocker when not contraindicated, and ACEi/ARB per orders. | GDMT reduces 30-day and 1-year mortality after ACS. |
| Prepare patient for early invasive evaluation — NPO, allergy screen, marked peripheral pulses, IV access, type and screen, consent reviewed. | Early invasive strategy improves outcomes in moderate-to-high-risk NSTE-ACS. |
| Provide supplemental oxygen only if SpO₂ < 90%; treat dysrhythmias per ACLS protocols. | Avoids harm from hyperoxia; restores rhythm-driven CO. |
| Monitor for mechanical complications (new murmur, sudden hemodynamic collapse, JVD with hypotension and muffled heart sounds suggesting tamponade). | Mechanical complications require emergent imaging and surgical intervention. |
| Coordinate with cardiology and ICU for vasopressor or mechanical circulatory support (IABP, Impella, VA-ECMO) if cardiogenic shock develops. | Shock requires multidisciplinary escalation. |
See Decreased Cardiac Output Nursing Care Plans for additional NANDA framings and scenario plans.
Care Plan #3 — Risk for Decreased Cardiac Tissue Perfusion
Risk for Decreased Cardiac Tissue Perfusion (NANDA-I 2024–2026 system-specific label) related to coronary artery atherosclerosis with significant stenosis, recent ACS with residual at-risk myocardium, post-PCI with residual non-culprit disease, hypertension, diabetes, dyslipidemia, tobacco use, coronary vasospasm history, family history of premature CAD, and subtherapeutic antiplatelet or statin therapy. Risk diagnosis — related-to factors only; no “as evidenced by.”
Expected outcomes (SMART):
- Throughout admission, patient maintains chest-pain-free state with stable telemetry and SpO₂ ≥ 94% on room air (or patient’s baseline).
- Before discharge, patient demonstrates adherence behaviors — verbalizes DAPT and statin schedule and never-stop-without-provider-OK rule.
- At 30-day follow-up, lipid panel and BP are progressing toward goal (LDL-C < 70, BP < 130/80).
| Intervention | Rationale |
|---|---|
| Continuous telemetry during admission; assess for chest pain, dyspnea, diaphoresis, palpitations every shift and PRN. | Early detection of recurrent ischemia. |
| Administer DAPT, high-intensity statin, beta-blocker, ACEi/ARB, and anti-anginal per orders; document adherence. | Each class addresses a specific mechanism of recurrent ischemic events. |
| Monitor BP at least q4h; titrate antihypertensives to MAP 65–95 mm Hg per orders (target BP < 130/80 long-term). | Maintains perfusion pressure while reducing wall stress. |
| Maintain hemoglobin > 8 g/dL in stable CAD per facility protocol (transfusion thresholds individualized — restrictive thresholds appropriate for most). | Severe anemia precipitates demand ischemia. |
| Avoid NSAIDs (worsen CV risk and interact with antiplatelet/anticoagulation); use acetaminophen for pain control when appropriate. | Reduces concurrent thrombotic and bleeding risk. |
| Coordinate referral to outpatient cardiac rehabilitation before discharge. | Class I intervention that reduces recurrent events and mortality. |
| Teach modifiable risk-factor management (DASH/Mediterranean diet, exercise, tobacco cessation, weight, BP, glucose, lipid goals). | Secondary prevention is the highest-yield long-term tissue-perfusion intervention. |
See Ineffective Tissue Perfusion Nursing Care Plan for the full system-specific perfusion library.
Care Plan #4 — Anxiety (New Diagnosis or Pre-Procedure)
Anxiety related to new diagnosis of CAD with perceived threat to life, impending cardiac catheterization or PCI or CABG, pain, dyspnea, hospitalization, and uncertainty about prognosis, as evidenced by verbalized fear, restlessness, tachycardia, elevated BP, tachypnea, sweating, trembling, repetitive questioning, and sleep disturbance.
Expected outcomes (SMART):
- Within 1 hour of nursing intervention, patient reports anxiety decreased on a 0–10 scale by ≥ 2 points.
- During pre-procedure period, patient demonstrates a relaxation technique (paced breathing or guided imagery).
- Before discharge, patient is screened with PHQ-2 or GAD-7 and referred to behavioral health or CBT if positive.
| Intervention | Rationale |
|---|---|
| Assess anxiety severity and contributing factors at admission and PRN; use PHQ-2/9 and GAD-7 for objective screening. | Quantifies symptoms and identifies depression/anxiety requiring follow-up. |
| Provide clear, plain-language explanations of procedures (what, where, how long, expected sensations). | Procedural knowledge reduces anticipatory anxiety. |
| Teach a brief paced-breathing or progressive muscle relaxation exercise; practice with the patient. | Activates parasympathetic response; reduces sympathetic surge that worsens myocardial oxygen demand. |
| Allow family / support person presence per facility policy. | Social support reduces psychological distress. |
| Avoid leaving the patient alone during acute anxiety episodes or chest pain. | Reduces fear; gives nurse continuous assessment opportunity. |
| Administer anxiolytics only when nonpharmacologic measures are insufficient and per provider order; avoid benzodiazepines as routine pre-procedure premedication in older adults. | Pharmacologic anxiolysis is adjunct; benzodiazepines carry delirium risk in older adults. |
| Screen for depression with PHQ-2/9 and refer to behavioral health, CBT, or pharmacotherapy if positive. | Depression after MI is undertreated and associated with worse outcomes. |
Care Plan #5 — Deficient Knowledge (Secondary Prevention)
Deficient Knowledge (secondary prevention of CAD) related to new diagnosis, multiple new medications (DAPT, statin, beta-blocker, ACEi/ARB, anti-anginal), lifestyle modification requirements, inadequate prior teaching or low health literacy, and the cognitive load of recent hospitalization, as evidenced by verbalized questions, inability to teach back key points, misconceptions, and prior non-adherence.
Expected outcomes (SMART):
- Before discharge, patient verbalizes the names, purposes, doses, and frequencies of all discharge medications using teach-back.
- Before discharge, patient verbalizes the sublingual nitroglycerin protocol and when to call 911.
- Before discharge, patient verbalizes at least 3 modifiable risk-factor targets.
- At 30-day follow-up, patient demonstrates medication adherence and has attended initial cardiac rehab evaluation.
| Intervention | Rationale |
|---|---|
| Assess current knowledge, health literacy, language preference, and learning style at admission and before discharge teaching. | Tailored teaching is more effective and more retained. |
| Teach each medication: name, purpose, dose, frequency, timing, side effects, when to call provider. Use teach-back at each session. | Comprehension verification reduces post-discharge medication errors. |
| Emphasize never stop DAPT without provider OK (strongest risk factor for in-stent thrombosis). | Catastrophic if stopped before recommended duration. |
| Teach sublingual nitroglycerin protocol — one dose, sit/lie down, wait 5 minutes; call 911 if not relieved; can repeat × 2 doses 5 minutes apart while EMS responds. Avoid PDE-5 inhibitors within 24–48 h of nitrate. | Time-to-PCI is the outcome driver in STEMI. |
| Teach modifiable risk-factor goals — DASH/Mediterranean diet, 150 min/week moderate exercise, tobacco cessation, BMI < 25, BP < 130/80, A1C individualized, LDL-C < 70. | Secondary prevention drives long-term outcomes. |
| Provide written discharge materials at 6th-grade reading level; include medication list, follow-up appointments, warning signs, and cardiac rehab referral. | Reinforces verbal teaching and supports caregivers. |
| Coordinate cardiac rehab enrollment before discharge. | Referral rates jump when CR is built into the discharge order set. |
| Schedule follow-up — cardiology 1–2 weeks; primary care 4 weeks; cardiac rehab eval within 4 weeks. | Tight post-discharge follow-up reduces 30-day readmissions. |
Nursing goals and expected outcomes
Across the nursing diagnosis for coronary artery disease plans above, common SMART goals include symptom relief (chest pain ≤ 2/10 within 5 minutes of acute-angina protocol), hemodynamic stability (MAP ≥ 65 mm Hg, no new arrhythmias), perfusion preservation (chest-pain-free state, SpO₂ ≥ 94% or baseline), knowledge demonstration (medication schedule + SL nitro + 3+ modifiable risk-factor targets via teach-back), adherence behavior (DAPT and statin without missed doses; cardiac rehab evaluation within 30 days), functional recovery (Phase II CR within 4–6 weeks), and psychosocial follow-up (depression screen + CBT/pharmacotherapy if positive).
Escalation red flags
| Sign / scenario | What it suggests | Nursing action |
|---|---|---|
| New ST elevation ≥ 1 mm in 2 contiguous leads | STEMI | Activate STEMI / Cath Lab protocol; goal first-medical-contact-to-device ≤ 90 minutes |
| Chest pain unrelieved by first SL nitro within 5 minutes | Possible evolving ACS | Call 911 (community) / Rapid Response (inpatient); 12-lead ECG; serial troponins |
| Troponin rise with chest pain at rest | NSTEMI / unstable angina | Cardiology consult; antiplatelet + anticoagulation per orders; admit for early invasive evaluation |
| New murmur after MI | Papillary muscle rupture or VSD | Urgent echocardiogram; cardiothoracic surgery consult |
| Sudden hypotension + JVD + muffled heart sounds | Pericardial tamponade | Rapid Response; emergent echo; pericardiocentesis |
| HR < 40 with hypoperfusion | Symptomatic bradycardia or AV block | ACLS algorithm; atropine, transcutaneous pacing |
| New irregular pulse with HR > 130 + hemodynamic instability | New AFib RVR or VT | 12-lead ECG; ACLS if unstable; cardiology |
| Cool clammy skin, altered mental status, SBP < 90 | Cardiogenic shock | Activate code team; vasopressors; mechanical support / urgent revascularization |
| Black tarry stools or hematemesis on DAPT | GI bleeding | Hold antiplatelet per provider; type and cross; GI consult |
| Sudden severe muscle pain with dark urine on statin | Rhabdomyolysis | Hold statin; CK, BMP; provider notification |
Discharge and secondary-prevention teaching
| Domain | What to teach | Why |
|---|---|---|
| Medications | Names, purposes, doses, frequencies of DAPT, statin, beta-blocker, ACEi/ARB, anti-anginal; never stop without provider OK | Premature DAPT discontinuation is the strongest risk factor for in-stent thrombosis |
| Sublingual nitro | One dose, sit/lie down, wait 5 min; call 911 if not relieved; can repeat × 2 doses while EMS responds; store in original container; replace annually | Time-to-PCI is the outcome driver in STEMI |
| Drug interactions | No PDE-5 inhibitors within 24–48 h of nitrate; no NSAIDs without provider OK on DAPT | Severe hypotension or bleeding risk |
| Diet | Mediterranean or DASH; reduce saturated fat, trans fat, sodium; increase fiber, vegetables, fish | Reduces recurrent events |
| Exercise | 150 min/week moderate-intensity; enroll in cardiac rehab | Class I intervention; reduces mortality |
| Tobacco cessation | Quit-line referral, varenicline or bupropion plus NRT | Single most impactful modifiable factor |
| Weight | BMI < 25 if achievable; waist < 40 in (men), < 35 in (women) | Reduces metabolic risk |
| BP / glucose / lipids | BP < 130/80; A1C individualized; LDL-C < 70 | Drives long-term mortality reduction |
| Sex resumption | Usually safe ~1 week after uncomplicated PCI; avoid nitrate + PDE-5 combination | PDE-5 + nitrate causes severe hypotension |
| Air travel | Typically 1–2 weeks post-PCI; 2–4 weeks post-CABG (institution-specific) | Pressurization, immobility, DVT risk |
| Follow-up | Cardiology 1–2 weeks; primary care 4 weeks; cardiac rehab evaluation within 4 weeks | Tight follow-up reduces 30-day readmissions |
| When to call 911 | Chest pain unrelieved by first SL nitro after 5 min, new or worsening dyspnea, syncope, stroke symptoms (FAST) | Patient self-recognition drives time-to-care |
NCLEX-style practice question
A nurse is teaching a 58-year-old patient newly diagnosed with coronary artery disease about modifiable risk factors and the safe use of sublingual nitroglycerin. Which statements indicate that the patient understands the teaching? Select all that apply.
- A. “If my chest pain doesn’t go away 5 minutes after I take the first nitro tablet, I will call 911 right away.”
- B. “I should store my nitroglycerin in a clear plastic pill organizer with my other meds so I remember to take it.”
- C. “If I take a Viagra or Cialis, I have to wait at least 24 to 48 hours before I can use my nitroglycerin again.”
- D. “I will keep eating a Mediterranean-style diet, walking 30 minutes most days, and quit smoking with the patch and counseling.”
- E. “I can stop my aspirin and clopidogrel as soon as I feel back to normal so I don’t bruise easily.”
- F. “I’ll plan to start cardiac rehab and follow up with my cardiologist within the next two weeks.”
Answers: A, C, D, F.
- A — correct. Per current ACS framing, call 911 if the first SL nitro dose doesn’t relieve pain within 5 minutes. Time-to-PCI is the outcome driver.
- B — incorrect. Sublingual nitroglycerin should be stored in its original light-resistant container and replaced approximately every 12 months or per package instructions.
- C — correct. PDE-5 inhibitors combined with nitrates can cause severe, sometimes fatal hypotension. Minimum safe interval is generally 24 h for sildenafil/vardenafil and 48 h for tadalafil — longer with CKD or hepatic impairment.
- D — correct. Mediterranean/DASH diet, 150 min/week moderate exercise, and tobacco cessation with combined behavioral and pharmacotherapy are Class I lifestyle interventions for established CAD.
- E — incorrect. Never stop dual antiplatelet therapy without provider OK. Premature DAPT discontinuation is the strongest risk factor for in-stent thrombosis.
- F — correct. Cardiology follow-up within 1–2 weeks and cardiac rehab enrollment within ~4 weeks are evidence-based discharge benchmarks.
Frequently asked questions
What is the most common nursing diagnosis for coronary artery disease?
The most common nursing diagnosis for coronary artery disease in clinical and NCLEX scenarios is Acute Pain related to imbalance between myocardial oxygen supply and demand from coronary artery narrowing or plaque rupture. Decreased Cardiac Output, Risk for Decreased Cardiac Tissue Perfusion, Anxiety, and Deficient Knowledge are also high-frequency diagnoses across stable angina, ACS, and post-revascularization care.
How is the nursing care plan for CAD different from the plan for an MI?
The CAD care plan addresses chronic, recurrent ischemia and secondary prevention — modifiable risk-factor counseling, medication adherence, cardiac rehab, and recognition of warning signs. The acute MI care plan layers in active myocardial injury management: hemodynamic stabilization, antiplatelet plus anticoagulation, urgent revascularization, prevention of mechanical complications, and post-MI psychosocial recovery. Both share the modifiable-risk-factor and DAPT-adherence backbone.
What are the priority nursing interventions for a patient with chest pain?
Stop activity and sit or lie the patient down, administer sublingual nitroglycerin 0.4 mg, reassess pain in 5 minutes, and call 911 (community) or activate Rapid Response (inpatient) if pain is not relieved within 5 minutes of the first dose. Obtain a 12-lead ECG immediately, give chewed non–enteric-coated aspirin 162–325 mg per protocol for suspected ACS, establish IV access, and provide oxygen only if SpO₂ < 90%.
When is cardiac rehabilitation indicated after CAD diagnosis?
Cardiac rehabilitation is a Class I indication after acute MI, PCI, CABG, stable angina, HFrEF, heart-valve surgery, heart transplant, and peripheral arterial disease with claudication. Phase II — the outpatient supervised program — is typically 36 sessions over 12 weeks, 3 times per week. Referrals before discharge significantly improve enrollment rates and reduce 30-day readmissions.
How long does dual antiplatelet therapy (DAPT) last after a drug-eluting stent?
After a DES for stable CAD, DAPT is typically aspirin + clopidogrel for 6 months, then aspirin monotherapy. After PCI for ACS, DAPT is aspirin + ticagrelor or prasugrel (preferred) or clopidogrel for 12 months. High bleeding risk patients may have shortened regimens (1–6 months) per cardiology. Patients should never stop DAPT without provider OK — premature discontinuation is the strongest risk factor for in-stent thrombosis.
What lifestyle changes are most effective for CAD secondary prevention?
The five highest-yield changes are tobacco cessation (behavioral counseling + varenicline, bupropion, or NRT), Mediterranean or DASH diet, 150 minutes per week of moderate-intensity exercise (with cardiac rehab enrollment), adherence to high-intensity statin therapy with an LDL-C goal < 70 mg/dL for very-high-risk ASCVD, and blood pressure control to < 130/80 mm Hg. Weight management, glycemic control, sleep, and depression screening also contribute meaningfully.
Related resources
Cardiovascular care plan siblings:
- Decreased Cardiac Output Nursing Diagnosis & Care Plans
- Ineffective Tissue Perfusion Nursing Care Plan
- Acute Pain Nursing Care Plan
References
- NANDA International. (2024). Nursing Diagnoses: Definitions and Classification, 2024–2026 (13th ed.). Thieme. thieme.com
- Virani SS, Newby LK, Arnold SV, et al. (2023). 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease. Circulation. 148(9):e9–e119. ahajournals.org
- Rao SV, O’Donoghue ML, Ruel M, et al. (2025). 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes. Circulation. 151:e771–e862. ahajournals.org
- Lawton JS, Tamis-Holland JE, Bangalore S, et al. (2022). 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization. Circulation. 145(3):e18–e114. ahajournals.org
- Grundy SM, Stone NJ, Bailey AL, et al. (2019). 2018 AHA/ACC/Multisociety Guideline on the Management of Blood Cholesterol. Circulation. 139(25):e1082–e1143. ahajournals.org
- Arnett DK, Blumenthal RS, Albert MA, et al. (2019). 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease. Circulation. 140(11):e596–e646. ahajournals.org
- Thomas RJ, Beatty AL, Beckie TM, et al. (2019). Home-Based Cardiac Rehabilitation. Circulation. 140(1):e69–e89. ahajournals.org
- Shahjehan RD, Sharma S, Dababneh E, Bhutta BS. (2024). Coronary Artery Disease. In: StatPearls. Updated October 9, 2024. ncbi.nlm.nih.gov
- Shan Y, Chen J, Zhou S, Wen G. (2023). Nursing Interventions and Care Strategies for Patients with Coronary Heart Disease. Galen Medical Journal. 12:e2994. pmc.ncbi.nlm.nih.gov
- Centers for Disease Control and Prevention. (2024). Heart Disease — About Coronary Artery Disease. cdc.gov
- American Diabetes Association Professional Practice Committee. (2026). Standards of Care in Diabetes — 2026. Diabetes Care. 49(Suppl 1). diabetesjournals.org
Source notes. NANDA-I 2024–2026 is the current edition; verify labels against the edition your program adopts. Guidelines cited reflect the most current US multisociety publications at the time of this review (2026-06-10). Facility protocol always supersedes general educational guidance at the bedside.
