Angina-first intervention

[monica1matos]

Hello, I am a nursing student, and I am a little confused about which intervention should be first when caring for a patient with an Angina? should it be administer Oxygen or give the Nitro?

thanks in advance,

BTW I am new to the site so I don't know how to use it well.

[NRSKarenRN, BSN, RN]

Moved to our Nursing Student Assistance forum.

[Esme12, ASN, BSN, RN]

We are happy to help but we won't do the homework. Tell me what you think and I will be happy to lead you in the right direction and tell you why.

[ckh23, BSN, RN]

Look into what angina is and what causes it. That should put you on the right path.

[monica1matos]

I don't expect my homework to be done by anyone but me. I understand the concern.

I know that Angina is caused by an obstruction to the coronary artery causing ischemia. I know that I need to decrease the oxygen demand of the myocardium and to increase the oxygen supply. I know I would give the oxygen and I would give the nitro to decrease the myocardium oxygen consumption, decrease the ischemia and decrease the pain. My question is, in a given situation which order would I do it. If I go by ABC, I would give the oxygen first and then I would give the nitro. Am I correct?

[Esme12, ASN, BSN, RN]

I need to know where you are starting and what have you gained on your own and where you have left off. Many come here looking for us to complete their homework and we don't do that here.

You are right.........If the chest pain is from the heart being starved of oxygen then giving it supplemental O2 would be your priority. Sometimes just the application of O2 as the first med is enough to relieve the pain and nitro is not needed.

Check here and on page 8 you will see the AHA recommendations.

http://www.georgiahealth.edu/medicine/clerkships/EM/ACLSalgorithmsManual.PDF

[nurseprnRN, BSN, RN]

good thinking. my compliments to your faculty for helping you going down the path of critical thinking and decision-making early on.

assuming both are ordered for prn (or you have standing orders for all unit patients with these symptoms), i agree c esme-- you're at the bedside, you can reach for the o2, it's right there, and put it on the patient. take vs.

give it a minute, and if it helps, bonus! then call the md and let him/her know that the pt has developed new chest pain relieved by o2 at 2 lpm (or whatever).

if it doesn't help (and sometimes--often-- it won't) you slip him the sublingual ntg and see if that helps. take vs. call for ekg, labs, or whatever else you have in your standing orders. repeat ntg as ordered; if it works, bonus! take vs. call md and report event.

if it doesn't work, call the md and anticipate a quick trip to the cath lab (if ischemia on the ekg) or something else (if no ischemia).

[monica1matos]

Thanks for the info..

[Pneumothorax, BSN, RN]

Thanks for the info..

Oxygen oxygen oxygen!!!!

[Merlyn]

I was taught in a hospital that was just for heart and lung , if it is the first time that they have chest pain, 30 cc of Mylanta. It Gas pain can feel like angina. I know I'm recovering from triple Bypass. If the Dx is angina he show have NTG at his bed side. In my case the SOB came with the angina. When this happen I took the NTG first then I would take a few deep breaths. I never had angina in the hospital. So I don't know the protocol. With me, I couldn't take the deep breaths while I was in pain

[NCRNMDM, ASN, RN]

Give the oxygen first. In situations like these, I often find that it's sensible to pick the quickest, and simplest, intervention that is likely to help. Since angina is caused by cardiac ischemia, the oxygen may alleviate the symptoms, and effectively decrease the oxygen consumption of the myocardium. Apply the oxygen, take the patient's vitals, and assess the pain. If the oxygen hasn't worked within a few minutes, administer the first nitro (if the systolic pressure is above 90). Remain with the patient while calling for an EKG, lab work, etc. Continue to closely assess the vitals. If the systolic remains above 90, and the pain isn't relieved, administer the second nitro. You can give a third nitro, if the systolic is above 90 and pain is unrelieved.

If you have given all three nitro doses, call the MD and report your findings. Include the onset of pain, the fact that pain was unrelieved by oxygen, the patient's initial vitals, the fact that you've given three nitro, the vital signs throughout administration and the current vitals, and the results of the EKG, if you did one.

[NP Sam]

Here is my advice for priority questions: if you could only do ONE thing before leaving the room what would that be? I think the answer was already given to you though :)