Coronary artery disease (CAD) and angina pectoris: Nursing process (ADPIE)

Dwayne Harris is a 52 year old African American male client presenting to the cardiac catheterization lab to undergo a percutaneous coronary intervention, also known as PCI.

Mr. Harris has a diagnosis of coronary artery disease, chronic stable angina, hyperlipidemia, and is a current smoker with a 20 pack year history.

Because his angina is no longer responding to treatment, his cardiologist recommended PCI for Mr. Harris.

Coronary artery disease, or CAD, is the narrowing or obstruction of coronary arteries.

This narrowing is caused by atherosclerosis, a lipid containing plaque that accumulates on artery walls.

Over time, the plaque build up reduces myocardial perfusion and causes ischemia as the demand for oxygen exceeds the supply.

Myocardial ischemia leads to a type of chest pain called angina, which can be either stable or unstable.

Stable angina usually occurs when atherosclerotic plaque is fixed to the artery wall and occludes at least 75 percent of the coronary artery, whereas with unstable angina, the plaque ruptures and almost completely occludes the artery lumen.

The clinical presentation helps to differentiate stable and unstable angina using the acronym OPQRST.

O stands for onset, which for stable angina is during activity or emotional stress, due to increased oxygen demand, whereas for unstable angina, onset can be sudden or even at rest.

P is for palliation. Stable angina is relieved by re st or vasodilators like nitroglycerin, whereas unstable angina is not relieved.

Q stands for the quality of pain, which often involves pressure, crushing, squeezing, or tightness. Pain is more severe with unstable angina.

R stands for radiation of pain, because it often radiates to the shoulders, arms, jaw, neck, or back.

S is for site, which is deep, substernal, and sometimes hard to localize, meaning the client is unable to point to the site of pain with a single finger.

T stands for time. With stable angina, pain can last 15 seconds to 15 minutes, whereas in unstable angina, the pain will last longer than 20 minutes.