Chest pain.Nitro/oxygen questions.Art

Chaya, ASN, RN · Jan 18, 2006

1. We try to have a PRN order in place for a pt with a history of angina. We give 1 tab every 5 minutes for continued pain, up to 3 tabs. (also monitoring VS and maybe calling MD at same time dep on symptoms)

2. We use 2-5 LPM initially; depending on O2 sat and level of distress we might go to a non-rebreather pretty rapidly.

Going to check out the art next!

Thunderwolf, MSN, RN · Jan 18, 2006

Moved thread to General Nursing Discussion forum.

tinyrita · Jan 18, 2006

Hey thanks.I only do nursing part-time now cause its nuts.it is really not a cool job.But i like to stay on top of things.Thanks for you professionalism.

Antikigirl, ASN, RN · Jan 18, 2006

Chest pain for me always equals a nitro if they have the order, or I call the PCP. I mean, sometimes it is something else like GI, but I tend to go for the worse case then r/o with MD help of course! My protocol typically...nitro sl three times five minutes apart, then call in additional help after the third (either 9-11, MD or whatever). Take vs frequently, and have the person lie down or sit for sure..whatever feels better but NO standing..they will be on the floor faster then you can say oops after a nitro! Also warn them a headache is common after nitro. AND wear gloves or you too will suffer the headache and possible hypotensive reaction to nitro..takes just a tiny touch in most folks!

Oxygen by order typically...but 2-5 L/min is pretty standard. Remember anything higher can NOT be done with a nasal cannula, and heck, I don't find up to 5 very good with NC...I will mask at that point given I have orders for 5 or more L/min. Watch patients carefully after O2 adminstration...a RARE group of folks have what is called a hypoxic reaction or drive...at high levels of o2 they will slow or stop breathing...it is very rare, usually in serious cases of COPD or emphasema...but rule of thumb...you are treating, you watch carefullly!!!!!

Also, don't get all up on the pulse ox for your assessment! Also look at the patient! I have had pts be seen in the 99% by pulse ox only to see them blue! Treat the pt not the machine.

When I came onto pts that had chest pain and I felt things were not working with nitro...I called 9-11 so that paramedics could help with oxygen (they have protocols for oxygen that can exceed what we are ordered), and nitro, also they have EKG's to see what is going on, and other meds to help! And if someone is having chest pain...in my book...time for serious eval by MD..so ER is the best way to go!

BTW..I worked in an ALF for 3+ years, called 9-11 on most acute situations and have NEVER been wrong!!!!! And of course one more thing...DNR doesn't mean do not treat..so if they are breathing and or have a pulse...you treat...PERIOD. If they are NOT breathing, have NO pulse..then you stop and not bring them back (resusitate means bring back from death...).

Hope that was helpful

Timmo · Oct 26, 2009

There is a move towards limiting oxygen delivery to patients with Cardiac Chest Pain.

If my myocardium is ischaemic then I will get pain. But is it ischaemic because of a Coronary artery narrowing and/ or a blockage, or is it ischaemic because my blood is not carrying the oxygen and I am infact hypoxaemic (Low blood O2)??

If I am well saturated (95-100%) then does putting an oxygen mask on my face achieve anything? I say no. The only place for Oxygen to go once HB is saturated is into plasma.

BUT...If we work on the premise that high plasma oxygen levels cause vasoconstriction in the Coronary arteries...then aren't we slowing the flow of blood to the myocardium??

Here is my take on it...Almost all my cardiac patients present with good sats...their blood has all the oxygen in it that they need....so our treatment is to vasodilate their coronary arteries...GTN, Morphine, rest. This ensures that the Heart gets the FLOW, because the Oxygen is all there waiting in the blood already.

If I give High flow / high concentrations of O2...then the vasoconstriction will work against all the good that GTN and Morphine does.

Oxygenate the heart by opening the flood gates....Oxygenate your patient's heart, not their face.

That NRBM at 15lpm...retire it for a patient with low sats and a need for more O2 in their blood...I am not convinced that our Heart patients need to be in that group..

If you really need to oxygenate your Cardiac patients...Go with the simple Face mask for your cardiac patient..at 5-6 LPM flow

As for GTN...it is a Nurse initiated Drug in Queensland...So if the BP systolic is over 100, and they have had no Sildenafil (Viagra or similar) in the last 24 hrs, then give it and watch them carefully.