CARE PLAN ON

Angina pectoris
SUBJECT: ADVANCED NURSING PRACTICE

SUBMITTED TO:

Mr. SRIDHARA P M
VICE PRINCIPAL and
PROFESSOR
KTG COLLEGE OF NURSING
BENGALURU

SUBMITTED BY:

Mr. LOKESHA P S
1ST YEAR MSc NURSING
KTG COLLEGE OF NURSING
BENGALURU

Date of submission:

BIOGRAPHICAL INFORMATION
 Name : Mrs. Parvathamma
Age : 56 yrs
Sex : Female
Address : No.35/18,
Main road,Virajinagar,
Religion : Hindu
Education : 4th
Marital status : Married
Occupation : Agriculture
Ward : Special Ward.
Date of admission : 4-07-2023
I.P No. : 0164558
DIAGNOSIS : Angina pectoris

CHIEF COMPLAINTS
Mrs. Parvathamma , 56yrs got admitted to Victoria Hospital with complaints of,
1. Breathlessness
2. Sudden onset of chest pain

MEDICAL HISTORY
Present Medical History
Mrs. Parvathamma, 56yrs old got admitted to Victoria Hospital on 4-07-2023 with
breathlessness and chest pain. Chest pain was sudden in onset, tightening type,moderate to
severe 6-8 in pain scale, and associated with dyspnoea, weakness and headache and reduces
with rest and medication. Breathlessness was associated with restlessness and anxiety. It
increased with walking and standing and decreased with rest and sleep.

Past Medical History

Mrs. Parvathamma no history of any serious disease conditions in the past. She is not a
known diabetic or hypertensive.
SURGICAL HISTORY
Present Surgical History
Mrs.Parvathmma not undergone any surgery at present.

Past Surgical History

Mrs.Parvathmma not underwent any surgical interventions in the past.

FAMILY HISTORY
Mrs.Parvathmma resides with her husband and three younger sons. All other family
members expect her are healthy. There is no history of any hereditary diseases like
diabetes, hypertension, asthma or epilepsy in his family.

Genogram

62yrs 56yrs Key

- Male

- Female
29 yrs 22 yrs 18 yrs - Client

SOCIO ECONOMIC HISTORY

Mrs.Parvathmma is a member of middle class family. She is also earning member of the
family. Their living standard is moderate. She is having good relationship with family
members and friends.
PERSONAL HISTORY
Mrs.Parvathmma decreased appetite and sleep pattern. She takes vegetarian and non-
vegetarian diet. Her bowel and bladder pattern is regular and normal. She has no bad habits.
She is a social person who interacts with neighbours and social members.

ENVIRONMENTAL HISTORY
Mrs.Parvathmma residing in his own house. It is a pucca house having electricity connection
and is well ventilated. They are using bore well water for drinking and cooking purposes.
They are practicing closed waste disposal method. Good toilet facility is also available there.

PHYSICAL EXAMINATION

GENERAL OBSERVATION
Mrs.Parvathmma who is a 56 year old person is moderately built, conscious, oriented and co
operative.

VITAL SIGNS
Temperature : 98.40 F
Pulse : 84 beats/ min
Respiratory rate : 22 breaths/ min
Blood pressure : 120/80 mm of Hg

HEIGHT AND WEIGHT

Height : 162cm
Weight : 60 kg

SKIN AND MUCOUS MEMBRANE

Color of the skin : Tan brown
Edema : Absent
Moisture : Dry skin
Lesions or cyanosis : Absent

HEAD
Shape & size : Normal size and shape, normal range of motion
Scalp : Normal. No lesions or dandruff

EYES
Expressions : Normal
Eyelids : Symmetric, no edema
Eyeballs : Globes clear and firm
Conjunctiva : Pale
Sclera : White and clear
Iris : Black color
Visual acuity : Normal
Pupils ‘PERRLA’ : Round, symmetrical, equally reacting tolight
Eye movements : Normal

EARS
Appearance : Auricles are symmetric, wax present
Hearing : Normal
Otitis media : Absent, no discharge

NOSE
Appearance : Normal, no nasal septal deviation, no polyps
Sense of smell : Normal
Discharge : Absent

MOUTH AND THROAT

Lips : Dry, no cracks
Tongue : No glossitis or coating
Gum : No inflammation
Buccal mucosa : No stomatitis
Palate : Intact, no deformity
Taste : Normal
NECK
Appearance : No deformity or stiffness, ROM normal

Trachea : No deviation
Lymph nodes : Not palpable
Thyroid gland : Symmetric, no enlargement

NERVOUS SYSTEM
Higher function : Normal
Speech : Normal
Cranial nerves : Normal
Motor function : Normal muscle tone, gait normal
Sensory function : Respond to pain, position of light touch
Reflexes : Normal superficial and deep reflexes.

CARDIO VASCULAR SYSTEM

INSPECTION
Chest contour : Normal, no sternal depression
Supra sternal notch : No depression
Pericardium : No Bulging
PALPATION
Apical and radial pulses : Normal
Neck : Normal Carotid arterial pulsation present.
No jugular venous distention present.
PERCUSSION
Cardiac outline : Cardiac border found to be normal.
AUSCULTATION
Apical heart sounds : Normal S1 & S2 heart sounds heard, Crepitus present
Blood pressure : 120/80mm of hg
Heart rate : 96 beats/ min

RESRPIRATORY SYSTEM
INSPECTION
Size & Shape : Normal size and shape
Symmetry : Bilaterally symmetrical
Type of respiration : Abdominothoracic
Rate & Rhythm : 22 breaths/min & rapid and irregular
Accessory muscles not used for respiration.
PALPATION
Expansion : Normal
Local swelling : Absent
Vocal tactile fremitus : Present, normal
PERCUSSION
Basal : Normal Resonance
Apical ; NormalResonance
Axillaries of mid zone : NormalResonance
AUSCULTATION
Bronchial breath sounds : Normal and clear, harsh loud sound heard on
trachea
Bronco vesicular : Normal, moderate sound heard at 2nd Inter coastal
Space on both sides of the chest.
Vesicular : Normal, mild sound heard all over the lung field.
Friction rub : Nothing significant at front as well as the back of
the chest

ABDOMEN:
INSPECTION
Shape : Normal shape.
Movement : Abdominal wall bulges during inspiration and falls
during expiration
Skin texture : No discoloration, cyanosis or distention
Contour : Normal, flat
PALPATION
Tenderness or rigidity : Absent
No organomegaly or abnormal masses found.
PERCUSION
Organ borders : Normal, dull sound present, no gaseous
Distention
AUSCULTATION
Bowel sounds are normal.

MUSCULO SKELETAL SYSTEM

Upper and Lower Extremities : Normal range of motion of all extremities
No deformities
Muscles : Normal size
Normal tone and strength
 No rigidity, spasticity or flaccidity
Spine : Normal curvature
No deformities

GENITO URINARY SYSTEM

Bladder elimination pattern : Normal
No genital infections or discharges.

INVESTIGATIONS

Name of the investigation Patient Value Normal Value

Blood studies
Biochemistry Studies
- Blood urea 19 mg/ dl 15-45 mg/ dl
-Serum Creatinine 0.8mg/ dl 0.5-1.5 mg/ dl
-Sodium 138mEq/L 135- 150 mEq/ L
-Potassium 3.7mEq/ L 3.5-5 mEq/ L
-Chloride 103mEq/ L 98 – 110 mEq/ L
-RBS 110 mg/ dl Up to 140 mg/ dl
LIPID PROFILE
- Total cholesterol 168mg% 140-220mg/dl
-HDL 60mg%
-LDL 85mg%
-Triglycerides 119mg% 10-160mg/dl
CBC
-Hb 13 g / dl 13 – 18g/dl
-PCV 54.0% 50 – 54%
-RBC 4.7 4.5 – 6.5
-WBC 10,800 4000 – 11000
-Neutrophils 70 46 – 75
-Lymphocytes 22 20 – 45
-Eosinophils 01 1-6
-Monocytes 02 1-10
 -Platelets 1,40,000 lakhs 1,50000 – 4,00000lakhs

Urine Analysis: Normal urine routine

Pus cells absent
ECG: S-T segment elevation present
TREATMENT
1. InjPethidine 100 mg
2. Tab clopidogril 75mg
3. Inj Pan 40 mg
4. Tab Sorbitrate 5 mg
Name of the drug Dose, Route, Action Side Effects Nurse’s Responsibility
Frequency
Inj.Pethidine 100 mg, IM, OD Opioid analgesic. It acts on CNS and neural elements GI disturbances, Assess for GI symptoms and

in the bowel. It produces, sedation, respiratory respiratory depression, weakness.

urinary retention Monitor respiratory rate and urine

depression and euphoria.
output.
T. Clopidogril 75 mg, oral, OD Antiplatelet drug. It inhibits binding of ATP to its GI symptoms, Assess for GI symptoms and
platelet receptors and thereby inhibiting platelet neutropenia, weakness.

aggregation. It also blocks the amplification of thrombocytopenic Monitor blood cell counts and
purpura purpura.
platelet activation.
Inj. Pan40 40 mg, IV, OD Proton pump inhibitor. Exerts action by inhibition of H, K Diarrhea, dizziness, Ask for GI symptoms and manage.
and ATPase enzyme system at the secretory surface of pruritus, skin rashes Observe skin for rashes.
gastric parietal cell. It blocks the final step of acid
production and is dose related and inhibits acid secretion.
T.Sorbitrate 5 mg, oral, Antianginal. It causes direct smooth muscle relaxation due Sweating, skin rashes, Observe skin for rashes.
to the production of nitric oxide. It causes arteriolar and palpitation, weakness Assess the heart rate and activity
venous dialation. level of patient
NURSING MANAGEMENT
Assessment
A detailed history is collected on the occurrence of signs and symptoms of the patient.
Thorough physical examination including detailed cardiovascular examination is done. On
the basis of this list of nursing diagnosis is planned.

LIST OF NURSING DIAGNOSIS

1. Ineffective cardiac tissue perfusion secondary to coronary artery disease as evidenced

by chest pain.
2. Impaired gas exchange related to accumulation of secretion in respiratory tract as
evidenced by cough and respiratory distress.
3. Impaired physical mobility related to weakness and breathing difficulty as evidenced
by difficulty in initiation of purposeful movements.
4. Anxiety related to uncertain outcome and lack of knowledge regarding disease
condition & treatment as manifested by expressions of concern about future
treatments.
5. Knowledge deficit regarding disease process, prognosis, treatment and follow up care.
6. Fear and anxiety related to prognosis of the disease.
Orientation Nursing diagnosis Identification Phase Exploitation Phase Resolution Phase
Phase
Subjective data Ineffective cardiac  Assess the level and severity  Assessed that patient is .
Patient tissue perfusion of pain. having pricking type of pain.
complaints that secondary to coronary
he is having artery disease as
chest pain.. evidenced by chest  Assist the patient to assume  -Provided comfortable
Objective data pain. positions of comfort. position to the patient. Chest pain will be
On observation reduced from high
his facial  Provided  -Provided divertional therapy degree to low
expression shows divertional therapy to patient. by communicating with degree.
that he is having patient..
pain.
 Advice patient to take bed  Advised to take bed rest.
rest.

 Administer medications.  Administered analgesics as

per doctor’s order.
Assessment Nursing Goal Intervention Implementation Evaluation
Diagnosis
Subjective data Impaired gas Maintain  Assess the respiratory - Assessed that respiratory rate is
Patient exchange related to normal pattern of the patient. 26 br/mt.
complaints of accumulation of breathing
breathing secretion in pattern.  Provide comfortable -Provided semi fowlers position
difficulty. respiratory tract as position of patient. to the patient.
Objective data evidenced by cough Clients
Patient is and respiratory breathing
coughing contain distress.  Administer O2 as per -Administered 6 litres of O2. pattern is
large amount of doctor’s order. improved.
sputum.

 Provide nebulization -Provided nebulization therapy to

therapy to patient. the patient.

 Administer -Administered bronchodilators.

bronchodilators.
Assessment Nursing Goal Intervention Implementation Evaluation
Diagnosis
Subjective data Impaired physical Client will - Assess the physical mobility -Assessed that patient’s
Patient mobility related to experience of the patient. physical mobility is impaired.
complaints that weakness and improved
she is unable to breathing difficulty physical - Assist patient with initial -Assisted patient with initial
do her daily as evidenced by mobility. ambulation to determine ambulation.
activities. difficulty in degree of impairment and The client
Objective data initiation of prevent injury. improved
On observation purposeful physical
patient is movements. -Consult physical therapist -Consulted physical therapist mobility.
slowness in day to about ambulation plan to about ambulance plan to
day activities. facilitate activities of daily facilitate activities of daily
. living. living.

-Provide assistive -Provided assistive devices to

device(walker) for patient.
ambulation,if the patient is
unsteady.
Assessment Nursing Goal Intervention Implementation Evaluation
Diagnosis
Subjective data Anxiety related Client will - Assess the level of anxiety -Assessed the level of anxiety-
Patient to uncertain demonstrate patient is anxious
is asking so outcome and reduced anxiety
many questions lack of level -Provide quiet relaxed -Provided calm and quiet
Objective data knowledge environment and limit visitors. environment
On observation regarding The client
patient is anxious disease experienced
. condition & -Maintain good IPR with the -Maintained good IPR with the reduction of
treatment as patient patient anxiety level
manifested by
expressions of
concern about -Clarify all the doubts of patient -Clarified all the doubts of patient
future
treatments
- Reassure the patient with -Reassured the patient
encouraging words

-Explain the disease process, - Explained the disease process,

treatment ,out comeetc treatment ,out comeetc
THEORY APPLICATION

APPLICATION OF INTERPERSONAL THOERY IN NURSING PRACTICE.

Introduction

Peplau’s theory focuses on the interpersonal process and therapeutic relationship that
develops between the nurse and client .The interpersonal focus of Peplau’s theory requests
the nurse to manage properly the interpersonal process that occur between the nurse and
client. Interpersonal process is valuing forces for personality and roles of the nurse. This
theory stresses on the importance of nurse’s ability to understand own behavior and to help
others identify their personal difficulties.

Four Phases of Nurse-Patient Relationship.

orientation

identification

exploitation

resolution.

Orientation
This phase occurs at the time of admission. It includes assessment of need of the client
and also the exchange of views between nurse and client..

Identification
This phase occurs during the time of intensive care. Goal setting and planning by
consulting with the client occurs.
Exploitation
This phase occurs during the care of client at hospital. Implementation of goals occurs
and the client initiates all activities.

Resolution
This phase occurs at the time of discharge.Termination of Nurse Patient Relationship
occurs in this phase.

Problem 1
Here the client has ineffective cardiac perfusion. At orientation phase she explains it to
nurse. At identification phase nurse sets goals like diversion therapy, positioning,
administering oxygen, drugs, etc.. At exploitation phase actions were implemented with
client’s initiation and at last at resolution phase, the IPR between client and nurse comes to an
end.

Problem 2
Here the client has impaired gas exchange. At orientation phase he explains it to nurse.
At identification phase nurse sets goals like positioning, comfortable environment,
administering oxygen and bronchodilators etc.. At exploitation phase actions were
implemented with client’s initiation and at last at resolution phase, the IPR between client
and nurse comes to an end.
Health Education

Measures to reduce chest pain

1. Avoid external stimuli like light and crowd.

2. Provide comfortable position

3. Instruct to monitor complications like loss of consciousness and altered sensorium

Diet

 Educates them about the importance of nutritious diet.

 Encourages him to take more fluids such as water, juice, tender coconut etc.
 Advice to take vitamin c rich foods to prevent infection.

Personal Hygiene

 Educates them about the importance of maintaining good personal hygiene.

 Advised to take bath daily.

 Advised on oral hygiene.

Follow up

 Advised on importance of follow up care.

 Provide date for follow up check up.

BIBLIOGRAPHY

1. Sandra MN. The Lippincott manual of nursing practice. 7 th ed. Jaypee

brothers: Lippincott; 2003. P. 441-45.
2. Rochele LB, Maribeth. American association of critical care nurses, procedure
manual of critical care. Philadelphia: WB Saunders company; 1993. P.505-11.
3. Lewis, Heitkemper, Dirsken, O’Brien, Bucheri. Medical surgical nursing. 7 th
ed. New Delhi: Elsevier publishers; 2008. P. 1461-62.