nitroglycerine

cardiacRN2006, ADN, RN · May 4, 2008

NTG goes sublingually, under the tongue, not in the buccal cavity (which is between the teeth and lips.)

I'd hate to think of a pt in chest pain going into his kitchen, finding a cup, and getting a glass of water before taking this med. If you need the med, you need it.

ETA: I see that you can also deliver it via the buccal cavity-my bad. Never done that before....

Daytonite, BSN, RN · May 4, 2008

this is one of my favorite subjects. my first hospital job was on a combined medical/telemetry unit where we had a lot of patients getting chest pain, so we had standing orders to give ntg. i made a "cheat sheet" for myself which is now over 25 years old and i am looking at now! here are the side effects of ntg that i was to look for and instruct the patient about that i typed (yes, typed--no home computers yet in those days) for myself:

faintness (due to hypotension)
drowsiness (due to hypotension)
dizziness or syncope (due to hypotension)
pounding headache (due to dilation of cerebral vessels)
visual disturbances (due to dilation of cerebral vessels)

unfortunately, since this sheet is hand typed it cannot be just copied and pasted onto a post. but if there is something you want to know from it about the bedside care of chest pain, ask.

Daytonite, BSN, RN · May 4, 2008

oops! i sort of got off track there. i went to a pharmacology textbook i have lying around here (pharmacology: an introduction, 5th edition by henry hitner and barbara nagle, published in 2005) and it says on page 19 for ntg that it takes "several minutes" for the onset of action when the nyg is given sublingually. on page 257 they specifically say "effects usually occur within 1 to 3 minutes with the peak effect occurring at about 5 minutes." when i gave ntg sublingual tablets in series of 3, i, generally, pulled up a chair and sat with the patient for the next 15 or 20 minutes monitoring their response and taking vital signs.

gaajr1, RN · May 4, 2008

Daytonite,

Thanks a lot for the info you gave on nitroglycerine. I have noted it down for future use.

Sorry if I sound foolish asking, but from your explanation do I conclude that in instructing a patient concerning sublingual admin of nitroglycerine, the nurse should first ask him to check his radial pulse? I'm asking only because, the question states, "which of the following will the nurse instruct the patient to do first".

-check radial pulse or place it in buccal cavity or take a sip of water.

Please let me know, thanks again.

gaajr1, RN · May 4, 2008

CardiacRN2006, I too thot of the same about running for water when you are in pain. So, I am concluding it should be "check radial pulse". Thanks a lot for your reply.

Daytonite, BSN, RN · May 4, 2008

I would have the patient rest (not be moving around) and then instruct them to report any worsening of the chest pain as that would be a symptom of a possible MI. With regard to the drug itself, just place the tablet under their tongue and leave it alone--no drinking of water or making movements with their mouth and tongue that would dislodge the tablet. If I'm not mistaken they are kind of bitter tasting if they do. Within a few minutes they completely dissolve.

Daytonite, BSN, RN · May 4, 2008

if as a nurse you are instructing a patient concerning admin of sublingual nitroglycerine, what instruction will you give the patient first?

check radial pulse, place a tablet in buccal cavity or take a sip of water.

wait a minute! is this a question from a book and these the answer choices? if so, then "place tablet in buccal cavity" would be the answer since it can sting pretty badly when it comes in contact with the mucus membranes. it doesn't necessarily need to be placed under the tongue. when a patient is having chest pain they don't need to be stopping to check their pulse because ntg doesn't have that much of an effect on their pulse rate or stop to take a drink of water to dilute an counteract the stinging effect of the medication.

gaajr1, RN · May 4, 2008

Daytonite, thanks a lot for clearing my doubt.