CAD question..

[futurenurse85]

good morning! quick question..what are some nursing diagnoses for someone w/ coronary artery disease besides altered perfusion? if you could offer any input or anything i would greatly appreciate it! thanks and have a great day!

[Daytonite, BSN, RN]

Any nursing diagnosis you pick has to based upon the symptoms the patient is having. The symptoms of the medical diagnosis of CAD are:

• angina
  
• nausea and vomiting
  
• cool extremities and pallor
  
• diaphoresis from sympathetic stimulation
  
• fatigue
  
• dyspnea

From that you get the following potential nursing diagnoses (assuming your patient has all of those symptoms):

• Activity Intolerance R/T acute pain, dysrhythmias, imbalance between oxygen supply and demand
  
• Acute Pain R/T myocardial ischemia
  
• Anxiety R/T ineffective breathing pattern, situational crisis
  
• Ineffective Breathing Pattern R/T compromised cardiac/pulmonary function, extreme anxiety
  
• Decreased Cardiac Output R/T myocardial ischemia, effect of medications, dysrhythmia
  
• Fear R/T potential death, threat to state of well-being
  
• Impaired Gas Exchange R/T imbalance between oxygen supply and demand
  
• Grieving R/T pain, changes in lifestyle
  
• Impaired Comfort R/T excessive sweating
  
• Ineffective Coping R/T deterioration of health
  
• Ineffective Denial R/T deficient knowledge of need to seek help with symptoms
  
• Fatigue R/T diseased state, increased energy requirements to perform ADLs
  
• Ineffective Health maintenance R/T deficient knowledge of condition
  
• Ineffective Sexuality pattern R/T disease process, medications, loss of libido
  
• Nausea R/T cardiac pain, dysrhythmias
  
• Sleep Deprivation R/T ineffective breathing pattern
  
• Disturbed Sleep Pattern R/T difficulty breathing, positioning required for effective breathing
  
• Ineffective Tissue Perfusion (Cardiopulmonary, Peripheral) R/T interruption of arterial or venous flow

[Achoo!, LPN]

They could have impaired gas exchange as well as decreased cardiac output. Activity intolerance is another one typically. Good luck!

[kmoore32405]

any nursing diagnosis you pick has to based upon the symptoms the patient is having. the symptoms of the medical diagnosis of cad are:

• angina
  
• nausea and vomiting
  
• cool extremities and pallor
  
• diaphoresis from sympathetic stimulation
  
• fatigue
  
• dyspnea
  

from that you get the following potential nursing diagnoses (assuming your patient has all of those symptoms):

• decreased cardiac output r/t myocardial ischemia, effect of medications, dysrhythmia
  

first, i love your advice that you give to nursing students. i learn alot by reading your advice. we are currently studying cardiology. i was wondering for this diagnosis is myocardial ischemia automatic with cad?

[akulahawkRN, ADN, RN, EMT-P]

For CAD, it's very possible that myocardial ischemia is not yet an issue if the CAD hasn't progressed to where it actually impairs blood flow in the various coronary arteries. It's quite possible to have very severe CAD and absolutely no signs or symptoms. However, once a certain point is reached, then you'll see those symptoms... up to and including decreased cardiac output because the myocardium is becoming ischemic (or worse).

So, it's not automatic, but it's within the range of problems that can develop as CAD progresses.

[kmoore32405]

Thank you so much. My book was too vague.:)