Sample Intervention Plan on Nursing Practice for Patients with Coronary Artery Disease

Sep 15, 2021
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An intervention plan, or nursing care plan, is a document that lays out the specific care that will be provided to a patient. It identifies and addresses the patient’s existing health issues, risks the patient might be facing, and any other needs. Both professional and student nurses accomplish this document, and in the case of students, this is often assigned as one of many nursing papers.

Since nursing was revolutionized in the late 19th century by pioneers such as Florence Nightingale, the profession has become increasingly dependent on empirical evidence. Indeed, there is a good reason why evidence has come to play such a valuable role in the delivery of nursing care. For one, evidence-based practice or EBP leads to better outcomes for patients (Chien, 2019). Care that has been proven to be safe and effective by way of research has greater a positive impact on the welfare of patients. For another, evidence-based practice streamlines processes in clinical settings, enhances the efficiency of the staff, and protects against adverse events. Knowing how to perform evidence-based practice, however, is not enough. To truly optimize the application of EBP, a nurse must also know how to tailor or customize care according to the specific needs of individuals. An effective method is the creation of an intervention plan, or what is more popularly known as a nursing care plan or NCP. This nursing paper presents a nursing care plan for a patient recently diagnosed with coronary artery disease or CAD.

The Nursing Care Plan

The nursing care plan is both a tool and a process that nurses utilize to determine a patient’s problems, risks, and needs and develop appropriate interventions to address these. The NCP serves a number of purposes including providing the patient with competent evidence-based care, addressing the holistic needs in a systematic manner, lending structure to interventions, establishing concrete goals and outcomes, and involving the patient in matters concerning his or her health (Doenges et al., 2019). In other words, the value of the nursing care plan extends beyond catering to the health of the patient; rather, it serves as a guide to the nurse who provides care and as a tool for evaluating the effectiveness of care.

There is no single format for the NCP, and the version a nurse or a student uses usually depends on the school or health facility. Complexity and detail also vary. The common element, however, is its employment of the nursing process. A comprehensive NCP features six steps: Assessment, Diagnosis, Goals and Outcomes, Nursing Interventions, Rationale, and Evaluation. Over the years there have been calls for the standardization of the NCP, with researchers asserting that this will further enhance the plan’s efficiency (Johnson et al., 2018). They are discussed in greater detail below:

  1. Assessment: The first step of the NCP, assessment involves data collection through various methods including health history, interview, laboratory and diagnostic procedures, and physical examination among others.
  2. Diagnosis: The problems, risks, and needs facing the client are identified using the data and prioritized according to importance. Nursing diagnoses are standardized and are usually based on the list published by NANDA International (formerly the North American Nursing Diagnosis Association).
  3. Goals and Outcomes: This step involves setting up the goals and outcomes that the nurse and patient wish to achieve. Such objectives may also be categorized into short-term and long-term if necessary. Input from the patient is also essential.
  4. Nursing Interventions: The interventions are steps the nurse and the patient will implement in order to address the diagnoses and thereby achieve the objectives outlined.
  5. Rationale: Rationale refers to the reasons behind the interventions. In line with evidence-based practice, such interventions need to be based on empirical findings from research rather than mere conjectures.
  6. Evaluation: This step involves determining if the interventions have been effective. Outcomes are measured against set expectations. If the goals and outcomes are not met, then the process is repeated with modifications to the interventions.

Sample Nursing Care Plan

The nursing care plan created for this project is based on real-life scenario data collection conducted during clinical sessions at a local hospital. The patient is a 57-year old white male recently admitted following an episode of chest pain. The diagnosis was angina pectoris secondary to coronary artery disease. The patient stayed in the hospital for 3 days, after which he was discharged with home medications for hypertension, prediabetes, hypercholesterolemia, and angina pectoris. Follow-up care was scheduled two weeks after discharge.

In creating a nursing care plan, it is essential to conduct prioritization. In line with models including Abraham Maslow’s hierarchy of needs, physiological and safety needs are prioritized over psychological and self-actualization needs. Furthermore, actual existing problems and issues should be given priority over potential ones. The NCP below is adjusted to assume that the patient is still admitted in the hospital. Three nursing diagnoses are indicated.

Assessment

Diagnosis

Outcomes

Interventions

Rationale

Evaluation

(+) Chest pain following heavy physical activity.

Acute pain RT decreased myocardial blood flow.

Decreased frequency, duration, and severity of chest pain episodes.

1. Instruct the patient to inform the nurse on duty once chest pain episode starts.

2. Document episodes including frequency, severity, duration, and precipitating factors.

3. Watch out for episodes that occur for 15 minutes or longer and pain that extends beyond the arms.

4. Maintain quiet and comfortable environment.

5. Administer medication as ordered.

1. Pain from angina pectoris may cause the release of norepinephrine, which in turn leads to the release of the vasoconstrictor thromboxane A2. Further vasoconstriction can eventually lead to prolonged chest pain.

2. Documenting details such as frequency, severity, duration, and precipitating factors can help determine if the patient is progressing towards unstable angina. Identifying precipitating factors can also help with avoidance.

3. Episodes that last beyond 15 minutes or pain that extends beyond the arms may be indicative of another condition including possible unstable angina or myocardial infarction.

4. Stress from the environment including noise, extreme heat or cold, and disorder may cause stress and anxiety.

5. Administering medication as ordered helps alleviate pain and prevent subsequent episodes.

Patient reports decreased frequency, duration, and severity of angina pectoris episodes.

Patient verbalizes feelings of fatigue and tiredness after performing activities of daily living.

 

Patient manifests weakness and discomfort.

Activity intolerance related to oxygen supply-demand imbalance.

Patient will be able to participate in adequate physical activity and perform activities of daily living.

1. Allow the patient to perform activities at own pace and with help as necessary.

2. Gradually increase activity with a variety of appropriate exercises.

3. Assist with ADLs while maintaining autonomy.

4. Refer patient to cardiopulmonary rehabilitation therapist for evaluation.

1. Allowing the patient to take part in activities at patient’s own level establishes baseline for assessment and aids in increasing tolerance over time.

2. Gradual increase in level of activity prevents the patient from overexerting.

3. Balancing assistance and autonomy encourages independence while preventing overexertion.

4. Cardiopulmonary rehabilitation therapists help set up customized routine exercises for cardiac patients based on individual patient needs. Examples include aerobic exercise and yoga (Wang et al., 2020; Pullen et al., 2018; Guddeti et al., 2019).

Patient reports increased tolerance to activity and increased independence in performing ADLs and routine exercises.

(+) Chest pain following heavy physical activity.
 
 (+) Activity intolerance.

 

Patient verbalizes the need to catch breath and feeling drained following physical exertion.

Risk for decreased cardiac output RT inotropic changes. 

Patient will exhibit decreased episodes of shortness of breath, tiredness, and chest pain following physical activity.

1. Maintain rest and comfort during episodes of chest pain.

2. Provide adequate rest.

3. Identify and avoid precipitating factors.

4. Promote adherence to treatment regimen including medications.

1. Maintaining rest and comfort during episodes lowers demand for oxygen, thus allowing the heart to rest and promoting circulation.

2. Adequate rest helps prevent recurrence of episodes.

3. Identifying triggers enables the patient to avoid events that lead to episodes.

4. Adherence to treatment regimen allows the patient to actively manage health and prevent condition from further progressing. Taking nitroglycerin as prescribed, in particular, is essential to addressing acute episodes (MedlinePlus, 2021).

Patient reports decrease in episodes that manifest characteristics of decreased cardiac output.

 

The sample nursing care plan provided above addresses only three possible nursing diagnoses. Note that many more can be added including actual and potential ones. Some of the more common ones not included are deficient knowledge related to lack of familiarity or access to information regarding the health condition, anxiety related to change in health status, imbalanced nutrition: more than body requirements related to food intake that exceeds needs, and many others. The patient’s other issues may also be addressed, such as the patient’s elevated hemoglobin A1c or glycated hemoglobin test, in which case the NCP may integrate steps to planning meals for diabetic patients.

Conclusion

The nursing care plan is an essential tool in the provision of care to patients. More than just individualizing care, it provides nurses and patients the opportunity to collaborate over the planning and implementation of care. This NCP is tailored towards the case of a 57-year old white male recently diagnosed with angina pectoris secondary to coronary artery disease. Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Over time, learning to efficiently create comprehensive NCPs will lead to provision of safe and efficient care.

While the nursing care plan is a major project student nurses are required to accomplish, there are other bigger written works that are also part of advanced nursing curricula. These include extended works like theses and dissertations. Make sure you get through all the challenges of nursing school by enlisting the help of expert professional writers from CustomEssayMeister.


References

Chien, L. Y. (2019). Evidence-based practice and nursing research. The Journal of Nursing Research, 27(4), e29. doi: 10.1097/jnr.0000000000000346

Doenges, M. E., Moorhouse, M. F., and Murr, A. C. (2019). Nursing care plans: Guidelines for individualizing client care across the life span (10th Ed.). F. A. Davis.

Guddeti, R. R., Dang, G., Williams, M., and Alla, V. M. (2019). Role of yoga in cardiac disease and rehabilitation. Journal of Cardiopulmonary Rehabilitation and Prevention, 39(3), 146-152. doi: 10.1097/HCR.0000000000000372

Johnson, L., Edward, K. L., and Giandinoto, J. (2018). A systematic literature review of accuracy in nursing care plans and using standardized nursing language. Collegian, 25(3), 355-361. https://doi.org/10.1016/j.colegn.2017.09.006

MedlinePlus. (2021, August 23). Nitroglycerin sublingual. U.S. National Library of Health. https://medlineplus.gov/druginfo/meds/a601086.html

Pullen, P. R., Seffens, W. S., and Thompson, W. R. (2018). Yoga and heart failure: A review and future research. International Journal of Yoga, 11(2), 91-98. doi: 10.4103/ijoy.IJOY_24_17

Wang, L., Ai, D., and Zhang, N. (2017). Exercise benefits coronary heart disease. In J. Xiao (Ed.), Exercise for cardiovascular disease prevention and treatment. Advances in experimental medicine and biology, vol. 1000. Springer. https://doi.org/10.1007/978-981-10-4304-8_1

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