NURSING PROCESS CARE PLAN FOR INEFFECTIVE BREATHING PATTERN

ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION EVALUATION

PATIENT NURSING SCIENTIFIC

SUPPORTIVE NURSING GOALS/ OBSERVATIONS/
ACTIONS PRINCIPLES/RATIONALE
DATA DIAGNOSIS OUTCOME CONCLUSIONS
CRITERIA

Ineffective Breathing Before discharge, Place patient with A sitting position permits After Intervention,
Subjective Data:
the client must be proper body maximum lung excursion the goal was met as
Pattern related to
able to: alignment for and chest expansion. evidenced by client’s
Client verbalizes Fatigue as maximum breathing ability to:
“Madalas ho ay
evidenced by pattern.
hirap na hirap
ako sa Dyspnea Short Term:
paghinga.” -maintain an
Assess and record The average rate of maintain an effective
effective breathing respiratory rate and respiration for adults is 10 breathing
pattern, as depth at least every to 20 breaths per minute. pattern at normal
evidenced by 4 hours. It is important to take rate and depth
relaxed breathing action when there is an
Objective Data:
at normal rate and alteration in breathing verbalize feeling
depth and patterns to detect early comfortable when
Abnormal rate,
signs of compromise on breathing
rhythm, depth in absence of
the respiratory system
breathing dyspnea.
perform
Dyspnea -indicate, either Auscultate breath This is to detect diaphragmatic
verbally or through sounds at least decreased or adventitious pursed-lip
Use of a
behavior, every 4 hours. breath sounds. breathing
accessory
feeling successfully
muscles to
breathe comfortable when
Observe if client is Sometimes anxiety can demonstrate
. breathing. “short of breath” and cause dyspnea, so watch maximum lung
Nasal flaring
note any dyspnea. the patient for “air hunger,” expansion with
which is a sign that the adequate
Pursed lip
cause of shortness of ventilation.
breathing
breath is physical.
Lab and -perform Encourage These techniques promote
Diagnostic diaphragmatic sustained deep deep inspiration, which
Tests: breaths. Techniques increases oxygenation
pursed-lip
include (1) using and prevents atelectasis.
breathing. demonstration: Controlled breathing
Chest x-ray
highlighting slow methods may also aid
inhalation, holding slow respirations in
Abnormal ABG end inspiration for a tachypneic patients.
values Long Term: few seconds, and Prolonged expiration
passive exhalation; prevents air trapping.
(2) utilizing incentive
-respiratory rate
spirometer and (3)
remains within requiring the patient
established limits. to yawn.

-ABG levels return Monitor for Paradoxical movement of

to and remain diaphragmatic the abdomen (an inward
muscle fatigue or versus outward movement
within established
weakness during inspiration) is
limits. (paradoxical indicative of respiratory
motion). muscle fatigue and
-Demonstrate weakness.
maximum lung
expansion with
adequate Evaluate the This training improves
appropriateness of conscious control of
ventilation.
inspiratory muscle respiratory muscles and
training. inspiratory muscle
-When client
strength.
carries out ADLs,
breathing pattern
remains normal.
 NURSING PROCESS CARE PLAN FOR INEFFECTIVE AIRWAY CLEARANCE

ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION EVALUATION

PATIENT NURSING SCIENTIFIC

SUPPORTIVE NURSING GOALS/ OBSERVATIONS/
ACTIONS PRINCIPLES/RATIONALE
DATA DIAGNOSIS OUTCOME CONCLUSIONS
CRITERIA

Ineffective Airway Before discharge, Perform Suctioning is needed After Intervention,

Subjective Data:
Clearance related the client must be nasotracheal when patients are unable the goal was met as
to COPD as able to: suctioning as to cough out secretions evidenced by client’s
Client verbalizes
evidenced by necessary, properly due to weakness, ability to:
“Kasabay ng
shortness of especially if cough thick mucus plugs, or
paninikip ng aking
breath, wheeze, is ineffective. excessive or tenacious
dibdib ay
SpO2 level of mucus production.
nakakaramdam ho Short Term:
85%, productive
ako ng labis na -maintain clear,
cough, difficulty to
pagod open airways as A change in the usual
expectorate Assess respirations. maintain clear,
evidenced by respiration may mean
greenish phlegm Note quality, rate, open airways
respiratory compromise.
normal breath pattern, depth, and effectively
flaring of nostrils, An increase in respiratory cough up
sounds, normal
dyspnea on rate and rhythm may be a secretions after
rate and depth of compensatory response to
exertion, evidence treatments and
Objective Data: respirations, and airway obstruction
of splinting, use of deep breaths
ability to effectively accessory muscles,
Abnormal breath cough up and position for demonstrate
sounds (crackles, secretions after breathing. increased air
rhonchi, wheezes)
treatments and Bronchodilators: To dilate exchange
.
deep breaths. Administer the or relax the muscles on
Abnormal
prescribed COPD the airways. Steroids: To recognize the
respiratory rate,
medications (e.g., reduce the inflammation in significance of
rhythm, and depth -demonstrate
bronchodilators, the lungs. Antibiotics: To changes in sputum
increased air steroids, or to include color,
Excessive treat bacterial infection,
exchange. combination character, amount,
secretions which may trigger
inhalers / exacerbation of COPD. and odor
nebulizers) and
 Inability to remove Long Term: antibiotic
airway secretions medications.
-recognize the
Ineffective or
absent cough significance of Teach the patient The most convenient way
changes in sputum the proper ways of to remove most secretions
to include color, coughing and is coughing. So, it is
character, amount, breathing. (e.g., necessary to assist the
and odor take a deep breath, patient during this activity.
Lab and Diagnostic hold for 2 seconds, Deep breathing, on the
Tests: -identify and avoid and cough two or other hand, promotes
specific factors that three times in oxygenation before
Abnormal ABG inhibit effective succession). controlled coughing.
values airway clearance.
Position the patient Upright position limits
upright if tolerated. abdominal contents from
Regularly check the pushing upward and
patient’s position to inhibiting lung expansion.
prevent sliding This position promotes
down in bed. better lung expansion and
improved air exchange.

Encourage patient Fluids help minimize

to increase fluid mucosal drying and
intake to 3 liters per maximize ciliary action to
day within the limits move secretions.
of cardiac reserve
and renal function.
Oral care freshens
Provide oral care the mouth after respiratory
every 4 hours. secretions have been
expectorated.
 NURSING PROCESS CARE PLAN FOR IMPAIRED GAS EXCHANGE

ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION EVALUATION

PATIENT NURSING SCIENTIFIC

SUPPORTIVE NURSING GOALS/ OBSERVATIONS/
ACTIONS PRINCIPLES/RATIONALE
DATA DIAGNOSIS OUTCOME CONCLUSIONS
CRITERIA
Im
Before discharge, Assess respiratory Rapid and shallow After Intervention,
Subjective Data: paired Gas
the client must be rate, depth, and breathing patterns and the goal was met as
Exchange related able to: effort, including the hypoventilation affect gas evidenced by client’s
Client reports
to altered oxygen use of accessory exchange (Gosselink & ability to:
feeling short of
breath supply secondary muscles, nasal Stam, 2005). Increased
to emphysema as Short Term: flaring, and respiratory rate, use of
Client expresses evidenced by abnormal breathing accessory muscles, nasal
feelings of being -maintain optimal patterns. flaring, abdominal
shortness of breath, -maintain optimal
tired and weak gas exchange as breathing, and a look of
wheeze upon gas exchange as
evidenced by panic in the patient’s eyes
evidenced by
auscultation, may be seen with hypoxia
usual mental usual mental
phlegm, oxygen . status, unlabored
Objective Data: status, unlabored
saturation of 82%, Assess the lungs Any irregularity of breath respirations at 12-
respirations at 12- for areas of sounds may disclose the
restlessness, and 20 per minute,
Abnormal breathing 20 per minute, decreased cause of impaired gas oximetry results
pattern reduced activity oximetry results ventilation and exchange. The presence within normal
tolerance within normal auscultate presence of crackles and wheezes range, blood
Abnormal arterial range, blood of adventitious may alert the nurse to gases within
blood gases
gases within sounds. airway obstruction, leading normal range, and
normal range, and to or exacerbating existing baseline HR for
Restlessness
baseline HR for hypoxia. Diminished patient
Coughing patient breath sounds are linked
with poor ventilation.
Nasal flaring
Help patient deep This technique can help -maintain clear
breath and perform increase sputum lung fields and
Use of accessory
remains free of
muscles
signs of
Lab and Diagnostic -maintain clear controlled coughing. clearance and decrease respiratory
Tests: lung fields and Have the patient cough spasms. Controlled distress
remains free of inhale deeply, hold coughing uses the
Abnormal ABG signs of breath for several diaphragmatic muscles,
Values seconds, and cough making the cough more
respiratory -manifest resolution
two to three times forceful and effective.
distress or absence of
Pulse Oximetry with mouth open
symptoms of
(with and without while tightening the
-verbalize respiratory distress
walking) upper abdominal
understanding of muscles as
oxygen and other tolerated.
therapeutic
interventions.
Encourage slow This technique promotes
Long Term: deep breathing deep inspiration, which
using an incentive increases oxygenation and
-participate in spirometer as prevents atelectasis.
indicated.
procedures to
optimize
Assess the home Irritants in the environment
oxygenation and in environment for decrease the patient’s
management irritants that impair effectiveness in accessing
regimen within gas exchange. Help oxygen during breathing.
level of capability/ the patient adjust
condition the home
environment as
-manifest necessary (e.g.,
resolution installing an air filter
or absence of to decrease dust)
symptoms of
Turn the patient Turning is important to
respiratory
every 2 hours. prevent complications of
distress Monitor mixed immobility, but in critically
venous oxygen ill patients with low
saturation closely hemoglobin levels
after turning. If it
drops below 10% or or decreased cardiac
fails to return to output, turning on either
baseline promptly, side can result in
turn the patient desaturation.
back into a supine
position and
evaluate oxygen
status.

Maintain an oxygen Supplemental oxygen may

administration be required to maintain
device as ordered, PaO2 at an acceptable
attempting to level.
maintain oxygen
saturation at 90% or
greater.
 NURSING PROCESS CARE PLAN FOR DECREASE CARDIAC OUTPUT (CO)

ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION EVALUATION

PATIENT NURSING SCIENTIFIC

SUPPORTIVE NURSING GOALS/ OBSERVATIONS/
ACTIONS PRINCIPLES/RATIONALE
DATA DIAGNOSIS OUTCOME CONCLUSIONS
CRITERIA

Decreased cardiac Before discharge, the For patients with Fluid restriction decreases After Intervention,
Subjective Data:
output related to client must be able to: increased preload, the extracellular fluid the goal was met
limit fluids and volume and reduces as evidenced by
altered heart rate
sodium as ordered. demands on the heart. client’s ability to:
Client expresses secondary to
feeling fatigue valvular heart Short Term:
Closely monitor In patients with decreased -demonstrate
disease as -demonstrate
fluid intake, cardiac output, poorly adequate cardiac
Client complains evidenced by a adequate cardiac
including IV lines. output as
about chest persistent heart output as functioning ventricles may
evidenced by
pain/pressure with rate of >120 bpm Maintain fluid not tolerate increased fluid
evidenced by blood pressure
activity restriction if volumes.
blood pressure and pulse rate
ordered.
and pulse rate and and
Client verbalizes The body compensates
rhythm within rhythm within
dizziness/lightheaded Monitor the from decreased cardiac normal
/Fatigue, weakness normal patient’s urine output by reabsorbing fluid parameters for
parameters for output and from the renal tubules patient; strong
patient; strong commence the back into systemic peripheral pulses;
Objective Data: peripheral pulses; patient on a fluid circulation to increase and an ability to
and an ability to balance chart. blood volume. tolerate activity
Alteration in heart
tolerate activity without symptoms
rate, rhythm, and
without symptoms of chest pain.
conduction
of chest pain. Administer oxygen The failing heart may not
therapy as be able to respond to -remain free of
Decreased
prescribed. increased oxygen side effects from
oxygenation
demands. Oxygen the medications
saturation needs to be used to achieve
Impaired
adequate cardiac
contractility greater than 95%.
output.
 Increased Long Term: Administer Depending on etiological -explain actions
afterload medications as factors, common and precautions
prescribed, noting medications include to take for cardiac
-remain free of
Increased or side effects and digitalis therapy, diuretics, disease.
decreased side effects from
toxicity. vasodilator therapy,
ventricular filling the medications
antidysrhythmic,
(preload) used to achieve
angiotensin-converting
adequate cardiac enzyme inhibitors, and
output. inotropic agents.
Abnormal heart
sounds (S3, S4)
-explain actions
Fatigue and precautions Monitor blood The nurse must assess
to take for cardiac pressure, pulse, how well the patient
disease. and condition tolerates current
before medications before
administering administering cardiac
cardiac medications; do not hold
Lab and Diagnostic medications such medications without
Tests: as angiotensin- physician input. The
converting enzyme physician may decide to
Chest x-ray (ACE) have medications
inhibitors, digoxin, administered even though
EKG and beta-blockers the blood pressure or
such as carvedilol. pulse rate has lowered.
Notify the
physician if heart
rate or blood
pressure is low
before holding
medications.

Identify emergency
plan, including use Persistent decreased
of CPR. cardiac output can be life-
threatening.
 NURSING PROCESS CARE PLAN FOR IMPAIRED TISSUE PERFUSION

ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION EVALUATION

PATIENT NURSING SCIENTIFIC

SUPPORTIVE NURSING GOALS/ OBSERVATIONS/
ACTIONS PRINCIPLES/RATIONALE
DATA DIAGNOSIS OUTCOME CONCLUSIONS
CRITERIA

Ineffective cardiac Before discharge, Check respirations Cardiac pump malfunction After Intervention,
Subjective Data:
tissue perfusion the client must be and absence of and/or ischemic pain may the goal was met.
secondary to CAD able to exhibit: work of breathing. result in respiratory as evidenced by
Client verbalizes
as evidenced by distress. Nevertheless, client’s ability to:
numbness, pain,
chest pain or other Immediate and abrupt or continuous
altered sensation in
prodromal appropriate dyspnea may signify
extremities
symptoms thromboembolic
treatment when
Client verbalizes angina occurs. pulmonary complications. -Reported pain is
headaches relieved promptly.
Prevention of Sufficient fluid intake
Client verbalizes Check for optimal -Reported decrease
angina. maintains adequate filling
chest pain fluid balance. in anxiety.
pressures and optimizes
Administer IV
cardiac output needed for
Reduction of fluids as ordered. -Understood ways
tissue perfusion.
anxiety. to avoid
Objective Data: Awareness of the Administer complications and
This enhances myocardial
disease process and nitroglycerin (NTG) is free of
perfusion.
Symptoms understanding pf the sublingually for complications.
associated with complaints of
coronary syndrome prescribed care.
angina. -Adhered to self-
Adherence to the care program.
Elevated/low blood Maintain oxygen
pressure self-care program. To enhance myocardial
therapy as ordered.
perfusion.
Increased
respirations/ shallow
breathing
Absence of The nurse should instruct
complications. Treating angina
 the patient to stop all
Lab and Diagnostic activities and sit or rest in
Tests: bed in a semi-Fowler’s
position when they
experience angina, and
Abnormal CT scans administer nitroglycerin
sublingually.
Abnormal EEG
results Follow-up The patient may need
monitoring. reminders about follow-up
monitoring, including
periodic blood laboratory
testing and ECGs.

NURSING PROCESS CARE PLAN FOR IMPAIRED GAS EXCHANGE RELATED TO ALTERED OXYGEN CARRYING CAPACITY OF BLOOD
 DUE TO DECRESED ERYTHROCYTES/ HEMOGLOBIN

ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION EVALUATION

PATIENT NURSING SCIENTIFIC

SUPPORTIVE NURSING GOALS/ OBSERVATIONS/
ACTIONS PRINCIPLES/RATIONALE
DATA DIAGNOSIS OUTCOME CONCLUSIONS
CRITERIA

Impaired gas Before discharge, Monitor oxygen Consistent monitoring After Intervention,
Subjective Data:
exchange related to the client must be saturation allows for better tracking the goal was met.
altered oxygen continuously. of a trend. A slow as evidenced by
Client reports able to exhibit:
carrying capacity of decline in oxygen client’s ability to:
feeling short of
blood due to saturation might get
breath
decreased missed with only spot-
erythrocytes/ The patient will
Expresses feelings checking oxygen
hemoglobin demonstrate -demonstrate
of being tired and saturation. Increased
weak adequate oxygen demand and adequate
oxygenation with decreased oxygen oxygenation with
ABGs within normal saturation indicate a ABGs within
limits compromise in normal limits
oxygenation.
Objective Data: The patient will have -have vital signs
vital signs that are Check Hemoglobin Hemoglobin carries that are within the
Oxygen saturation (Hbg) levels. oxygen within the blood. patient’s normal
below 90% within the patient’s
If Hbg levels are low, range
normal range
there is a decreased
Abnormal lung -have clear lung
sounds capacity to carry oxygen
The patient will have sounds
to the tissues.
clear lung sounds
Irritability,
restlessness, Monitor WBCs. An increased white -deny any difficulty
confusion The patient will deny count can be an breathing
any difficulty indication of infectious
breathing disease.

The patient will be Monitor the effects Medications such as

Abnormal vital signs: free of any signs of of medications. sedatives, pain -be free of any
Increased heart rate respiratory distress medications, and other signs of respiratory
above baseline; drugs might affect the distress
brain’s ventilatory
Increased response. This could
respiratory rate lead to carbon dioxide
above baseline; retention impeding
adequate oxygenation.
Altered
characteristics of
Review chest x- Imaging can often
respirations: rate,
rays. provide information
rhythm, and depth
about the etiology of the
impaired gas exchange
and monitor a trend of
Lab and Diagnostic
the disease process.
Tests:

Abnormal chest x- Early recognition and

Explain to the family
ray intervention can make a
and caregiver early
signs of decreased big difference in the
Abnormal blood gas oxygenation and patient’s outcome.
value interventions to Taking action may
take. reduce the number of
Anemia: Decreased hospital visits and
hemoglobin and emergencies.
hematocrit Teach about the
correct use of Safe and correct use of
medications. medications ensures the
Indication best possible patient
Dosage outcome. It is most
Frequency beneficial for the patient
Route if the drug is used as
Possible side intended and ordered.
effects

NURSING PROCESS CARE PLAN FOR ACTIVITY INTOLERANCE RELATED TO TISSUE HYPOXIA
 ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION EVALUATION

PATIENT NURSING SCIENTIFIC

SUPPORTIVE NURSING GOALS/ OBSERVATIONS/
ACTIONS PRINCIPLES/RATIONALE
DATA DIAGNOSIS OUTCOME CONCLUSIONS
CRITERIA

Activity Intolerance Before discharge, Assess for the The reason why the After Intervention,
Subjective Data:
related to tissue the client must be cause of the activity patient cannot engage in the goal was met.
hypoxia intolerance. activities will guide as evidenced by
able to exhibit:
planning and client’s ability to:
Client verbalizes
pain on a numeric interventions. The care
pain scale higher plan will have a different
The patient will
than 3 focus on whether the
verbalize the cause is physical, - verbalize the
Client verbalizes importance of psychological, or importance of
weakness continued physical motivational. continued physical
exercise exercise
Client verbalizes
feeling of The patient will Complete a Sometimes medications -report the onset of
shortness of report the onset of medication and their side effects pain during
breath reconciliation. can contribute to exercises right
pain during
sleepiness and fatigue. away
exercises right
away Note if the patient takes
Objective Data: -report an
sleeping aids, muscle
relaxers, sedatives, or increased
The patient will tolerance to
Requires narcotics. For example,
report an antipsychotics can perform activities
increased amount
increased cause orthostatic
of supplemental
oxygen tolerance to hypotension. -participate in
perform activities physical activities
Difficulty to engage Encourage activity The patient might with PT and OT
in activities progressively. tolerate it much better if achieve an
activities are increased increased
slowly. It provides more conditioned
Elevated blood time for the body to physical state.
 pressure The patient will adjust.
participate in
Elevated heart physical activities -have normalized
rate Observe for Progressive mobility vital signs
with PT and OT
symptoms of may decrease
Signs of pain intolerance when symptoms. Sitting the
(frequent grimace, The patient will
getting the patient patient up on the side of
reluctancy to achieve an
up. Symptoms may the bed and dangle legs,
initiate activities) increased include nausea, standing for a few
conditioned pallor, dizziness, minutes before
physical state. visual impairment, ambulating, and sitting
loss of up in the chair are great
Lab and Diagnostic
The patient will consciousness, and interventions to
Tests: vital signs changes. counteract signs and
have normalized
vital signs symptoms of
ABG test deconditioning.

Pulse Oximetry
Encourage the Regular exercise
patient to perform maintains muscle
active ROM strength, flexibility, and
exercises. joint and tendon
alignment. Over time,
repeated exercises help
increase tolerance,
which is vital to perform
ADLs.

Assess the patient’s Patients might often be

emotional and depressed or frustrated
motivational status. over their situation and
condition. Performance
strongly depends on the
patient’s mental state
and mood.
CASE STUDY: Coronary Artery Disease
Patient Profile: A.R, a 52-year-old woman, comes to the emergency department with a burning sensation in her epigastric
area extending into her sternum.
Subjective Data
• Has had chest pain with activity that is relieved with rest for the past 2 and a half months
• Has had type 2 diabetes since she was age 33
• Has a smoking history of 1 pack a day for 20 years
• Is more than 35% over her ideal body weight
• Has no regular exercise program
• Expresses frustration with physical problems
• Is reluctant to get medical therapy because it will interfere with her life
• Has no health insurance

Objective Data
Physical Examination
• Anxious, clenching fists
• Appears overweight and withdrawn
Diagnostic Studies
• 12-lead ECG
• Cholesterol: 255 mg/dL
• LDL: 160 mg/dL
• Glucose: 210 mg/dL
Collaborative Care
•Metoprolol (Toprol) XL 100 mg PO daily
• Nifedipine (Procardia) 10 mg tid
• Nitroglycerin 0.4 mg sublingual PRN for chest pain
• Exercise treadmill testing

Discussion Questions

1. What are A. R.’s risk factors for CAD?

Diabetes, smoking history, physical inactivity, and stress response.

2. What symptoms should lead the nurse to suspect the pain may be angina?
Unexplained fatigue; radiation of the burning from epigastric area into the sternum; and prior episodes of chest pain with activity,
relieved by rest; anxiety with fist clenching.

3. What nursing actions should be taken for A.R.'s discomfort?

Provide emotional support and explain all interventions and procedures. Position her in an upright position, apply oxygen per nasal
cannula, obtain vital signs, start continuous ECG monitoring, auscultate heart and breath sounds, assess pain using PQRST,
medicate as ordered, and obtain baseline laboratory values and a chest x-ray.

4. What ECG changes would indicate myocardial ischemia?

Depressed ST-segment and/or T wave inversion would show myocardial ischemia.

5. What information should the nurse provide for A.R. before the exercise treadmill testing?
The nurse should inform H.C. that she will have continuous cardiac monitoring while she walks on a treadmill with increasing
 speed and elevation to evaluate the effects of exercise on the blood supply to her heart. Her pulse, respiration, BP, and heart
rhythm will be measured while she walks and after the test until they return to normal, and the cardiac monitor will be used after
the test until any changes return to normal.

6. What are the priority nursing measures that should be instituted to help A.R. decrease her risk factors?
This patient does not seem motivated to assume responsibility for her health and, in the absence of symptoms, has not had a
desire to make lifestyle changes. First, the nurse should assist her to clarify her personal values and goals. Then, by explaining the
symptoms related to her risk factors and having her identify her personal vulnerability to various risks, the nurse may help her
recognize her susceptibility to CAD. Help the patient set realistic goals and allow her to choose which risk factor (smoking, activity
level, diabetes management, or stress response) to address first.

7. Based on the assessment data presented, what are the priority nursing diagnoses? Are there any collaborative
problems?

Treatment for chronic stable angina

A: Antianginal, ACE inhibitor or ARB therapy, antiplatelet
B: BP control, β-adrenergic blocker
C: Cigarette smoking cessation, cholesterol management, calcium channel blockers, and cardiac rehabilitation
D: Diet for weight management, diabetes management, and depression screening
E: Education and exercise
F: Flu vaccination
- Many of these measures can be used now to help the patient better manage her current health if she is motivated to do so.
Nursing diagnoses
• Acute pain; Etiology: imbalance between myocardial oxygen supply and demand
• Anxiety; Etiology: diagnosis and uncertain future
• Overweight; Etiology: lack of physical activity
• Difficulty coping; Etiology: lack of effective coping skills
• Hyperglycemia; Etiology: history of Type 2 diabetes, increased glucose level
• Substance abuse; Etiology: history of smoking 1 pack per day, 27 years
• Lack of knowledge: Etiology: management of coronary artery disease

Collaborative problems
Potential complications: myocardial infarction, dysrhythmias