Chest Pain (Angina) Nursing Diagnosis & Care Plan

Chest pain or angina is the discomfort a person experiences when the heart does not get enough oxygen. Chest pain is not a disease itself, but a symptom of an underlying cause.

The pain felt in angina can be described as squeezing, dull, sharp, crushing, or burning. Severe chest pain may be described as extreme pressure, such as someone or something sitting on the chest. The pain may radiate to the neck, jaw, or extremities.

Chest pain is essentially a symptom of an underlying problem like coronary artery disease (CAD), coronary microvascular disease (MVD), pleuritis, pulmonary embolism, pneumothorax, and gastroesophageal reflux disease (GERD).

There are different types of angina: 

  • Stable Angina. This type of angina is also referred to as angina pectoris and occurs due to CAD with decreased oxygenated blood flow to the heart muscles due to narrowed or blocked arteries. This type of chest pain is often predictable and resolves with rest or medication.
  • Unstable Angina. This type of angina causes unexpected and sudden chest pain usually occurring while at rest due to a rupture of unstable plaque. Immediate diagnosis and treatment are required.
  • Variant (Prinzmetal) Angina. Variant angina is characterized by pain caused by coronary vasospasm usually happening between midnight and early morning while the patient is at rest. 

The major risk factors of angina include the following:

  • High cholesterol
  • Hypertension
  • Smoking 
  • Overweight or obesity
  • Diabetes
  • Metabolic syndrome
  • Sedentary lifestyle 
  • Unhealthy diet
  • Family history of heart disease
  • Old age (men above 45 years old and women above 55 years old)

Prompt diagnosis and treatment of chest pain are important to prevent myocardial infarction. Physical assessment and risk identification are essential. Diagnostic exams like an electrocardiogram, blood tests, stress tests, coronary angiography, chest x-ray, cardiac catheterization, or computed tomography angiography (CTA) can confirm and treat the underlying condition that is causing the chest pain.

The Nursing Process

Nurses play a vital role in conducting a comprehensive pain assessment as this can promote prompt diagnosis and treatment of chest pain. 

The goal of treatment for patients with chest pain include:

  • Accurate identification of the type of angina and its underlying cause
  • Immediate and appropriate treatment
  • Medications for pain relief and vasodilation
  • Preservation of heart muscles if myocardial infarction is suspected
  • Lifestyle modifications to reduce risks 

Patient education is a priority and includes how to recognize symptoms of stable vs. other types of chest pain, treatment, and when to seek emergency assistance.

Nursing Care Plan Related to Chest Pain

Acute Pain Care Plan

Chest pain may be described as squeezing, tight, sharp, or dull. It may be confused with indigestion as it can be a burning sensation. Patients may describe pressure akin to “an elephant sitting on my chest.” 

Nursing Diagnosis: Acute Pain

Related to: 

  • Myocardial injury
  • Ischemia
  • Disease process 
  • Physical exertion

As evidenced by: 

  • Diaphoresis 
  • Distraction behavior
  • Expressions of chest pain/pressure/tightness/etc.
  • Facial expression of pain 
  • Guarding behavior
  • Positioning to ease pain
  • Clutching of chest
  • Tachycardia

Expected Outcomes:

  • The patient will demonstrate the resolution of chest pain
  • The patient will identify potential causes of chest pain

Acute Pain Assessment

1. Assess pain characteristics noting location and type of pain.
It is important to distinguish when the chest pain started, precipitating factors, pain characteristics, duration, and location for appropriate diagnosis and management.

2. Assess diagnostic test results.
A 12-lead ECG is often obtained immediately for patients with chest pain to confirm or rule out myocardial infarction.

3. Assess for a history of chest pain.
Assessing if the patient has a history of chest pain and if this pain feels similar to other episodes can help the nurse in directing treatment.

Acute Pain Interventions

1. Administer pain medications as indicated.
Drug therapy for chest pain aims to promote pain relief and reduce the risks of myocardial infarction and death. Medications like short-acting nitrates, angiotensin-converting enzyme inhibitors, analgesics, and calcium channel blockers are given to promote myocardial perfusion.

2. Provide oxygen supplementation if necessary.
Supplemental oxygen is provided to increase oxygenation to the myocardium. If oxygenation levels are normal, this may not be necessary.

3. Prepare for further testing.
Stress tests, echocardiograms, and CTAs assess the need for further treatment. These tests can visualize blockages within coronary arteries.

4. Provide patient education.
Ensure the patient understands how to recognize and treat stable angina. Offer education on administering nitroglycerin tablets and when to seek further assistance.


Risk for Decreased Cardiac Tissue Perfusion Care Plan

Chest pain may indicate cardiac conditions like myocardial infarction, heart failure, and CAD, increasing the risk for decreased cardiac tissue perfusion. 

Nursing Diagnosis: Ineffective Tissue Perfusion

Related to: 

  • Heart disease/atherosclerosis 
  • Hypoxia
  • Myocardial infarction
  • Ischemia 
  • Hypoxemia

As evidenced by:

A risk diagnosis is not evidenced by any signs and symptoms, as the problem has not occurred yet and the nursing interventions will be directed at the prevention of symptoms.

Expected Outcomes:

  • The patient will not experience a myocardial infarction
  • The patient will report and display improvement in dyspnea, oxygen saturation, and vital signs

Risk for Decreased Cardiac Tissue Perfusion Assessment

1. Assess symptoms and risk for impaired cardiac tissue perfusion.
Chest pain, shortness of breath, diaphoresis, indigestion, and associated anxiety can indicate decreased cardiac perfusion.

2. Obtain lab work.
Cardiac enzymes such as troponin levels, electrolytes, ABGs, and more are important to obtain when analyzing chest pain.

3. Monitor telemetry.
Blood pressure, pulse, ECG, and O2 saturation should be monitored continuously for changes.

Risk for Decreased Cardiac Tissue Perfusion Interventions

1. Reduce cardiac workload.
Supplemental oxygen promotes oxygenation. Encourage bed rest or limit activity to prevent oxygen consumption and reduce cardiac workload.

2. Prepare for surgical interventions.
Cardiac catheterization can be used to visualize narrowed or blocked arteries and allow for stent placement. CABG may be required to reroute blood to the heart.

3. Administer medications as ordered.
Vasodilators relax and open blood vessels. Anticoagulants keep blood thin. Digoxin increases cardiac output. Antihypertensives reduce the force on arteries.

4. Educate the patient on lifestyle modifications.
Treating the underlying cause requires lifestyle modifications such as reducing sodium and fat intake, quitting smoking, and increasing physical activity.


Fear/Anxiety Care Plan

The feeling of chest pain and its related symptoms can cause fear and anxiety. 

Nursing Diagnosis: Fear/Anxiety

Related to:

  • The potential threat of death
  • Unfamiliar situation
  • Threat to change in health status

As evidenced by:

  • Expresses alarm 
  • Expresses fear 
  • Expresses panic
  • Nausea
  • Dry mouth
  • Palpitations
  • Inability to focus
  • Tachycardia
  • Tachypnea
  • Diaphoresis

Expected Outcomes:

  • The patient will verbalize strategies to cope with fear and anxiety related to chest pain
  • The patient will verbalize a sense of safety and feelings of decreased fear

Fear/Anxiety Assessment

1. Assess the patient’s feelings of fear/anxiety.
Discuss with the patient the exact thoughts and feelings they are having. The nurse can help alleviate unnecessary fear after the patient expresses their concerns.

Fear/Anxiety Interventions

1. Provide verbal and physical reassurance of safety.
Providing support and reassurance while the patient verbalizes fear and emotions can help reduce the patient’s anxiety levels. The nurse may also calmly rub the patient’s back or hold their hand to offer physical support.

2. Explore positive coping mechanisms with the patient.
Chest pain, dyspnea, and other symptoms can be alarming. Teach the patient strategies to calm themselves such as breathing exercises or distraction.

3. Administer anti-anxiety medications.
Fear and anxiety can be disruptive to the body and worsen outcomes. Administer benzodiazepines if necessary to promote relaxation and reduce fear.

4. Arm with knowledge.
A patient who is confident in monitoring and managing their health will experience less fear and anxiety. Discuss the patient’s chest pain, symptoms, and treatment once the threat has resolved so they feel in control.


References and Sources

  1. Chest Pain. Cleveland Clinic. May 23, 2022. https://my.clevelandclinic.org/health/symptoms/21209-chest-pain
  2. Chest Pain. Mayo Clinic. October 20, 2021. https://www.mayoclinic.org/diseases-conditions/chest-pain/symptoms-causes/syc-20370838
  3. Goyal A, Zeltser R, Gunn AA. Unstable Angina (Nursing) [Updated 2022 May 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK568785/
  4. Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. 9th Edition. Donna D. Ignatavicius, MS, RN, CNE, ANEF. 2018. Elsevier, Inc.
  5. What’s Causing My Chest Pain? WebMD. 2021. https://www.webmd.com/pain-management/guide/whats-causing-my-chest-pain
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Maegan Wagner, BSN, RN, CCM

Maegan Wagner is registered nurse with over 10 years of healthcare experience. She earned her BSN at Western Governors University. Her nursing career has led her through many different specialties including inpatient acute care, hospice, home health, case management, travel nursing, and telehealth, but her passion lies in educating through writing for other healthcare professionals and the general public.