Nitro & SOB

[constantly_learning]

Is nitro spray contraindicated when someone is short of breath without chest pain?

:thnkg:

pt. just had diagnosis of CHF and just came back from hospital at beginning of month once pneumonia was cleared.

vitals - BP - 143/86 P - 80 O2 sats- 80% on 100% non rebreathe 28 resps/min - indrawing abdominals and at the neck - diaphorectic - pale

pt. denied having chest/jaw/L arm pain

I administered one spray of nitro sublingually - thinking that it would help with his SOB... once EMT arrived they said - shouldn't have done that. I need to learn ...please give feedback.

[meandragonbrett]

In this instance I would not have given any NTG. You patient appears to be having a CHF flare up and is drowning.

As far as thinking the NTG would help the SOB....How does NTG act in the body?

[RN1982]

I"ve never seen nitro spray. I have had CHF patients on Nitro gtts. It is believed that all nitrates, including nitroglycerin, correct the imbalance between the flow of blood and oxygen to the heart and the work that the heart must do by dilating the arteries and veins in the body. Dilation of the veins reduces the amount of blood that returns to the heart that must be pumped . Dilation of the arteries lowers the pressure in the arteries against which the heart must pump. As a consequence, the heart works less and requires less blood and oxygen.

[nerdtonurse?, BSN, RN]

Yeah, but if the O2 sat was 80, I'd have made sure I had good O2 flowing, getting the pt a breathing treatment, getting an order for Lasix if there was crackles, and been on the phone to the doc. Nitro's might help if the O2 sat's higher and the pt's symptomatic, but not when it's that low, at least not in my experience.

If you were somewhere without resources (home health with no med box) I'd have been on the phone to the doc saying, "it's time to play MacGuyver RN until EMS gets here, here's what I have (O2 sat at 80), here's what I need (O2 sat at least 90), how do I get from A to B?"

[RN1982]

If the patient is 80% on 100% non rebreather, the patient needs to be intubated. Was this patient giiven lasix?

[Ivanna_Nurse, BSN, RN]

I am gathering that maybe the nurse and patient were in a home health setting?? The poster mentioned EMT arriving....

[SDS_RN, RN]

Always follow your ABC's.

Does the pt have an airway?

Yes

Move onto B is the pt breathing?

Yes.

Is it effective?

No, O2 sat 80%, SOB and rapid resp w/ accessory musle use. If I'm the only one here what is my back up plan until help arrives?

Don't move onto C until B is stable, if you do HH then get that doc on the phone and tell him what's going on, two heads are better than one in those instances.

As for the nitro pt was not c/o CP so pt prob didn't need it

Michigan explained the effects of nitro well

[SpEdtacular, MSN, RN, EMT-P]

Nitro does help pts who are short of breath if it is due to CHF. Michigan explained how it works very well. These effects help to shift the "fluid" which causes the characteristic "crackles" out of the lungs and back to the vasculature.. You do need to be careful though because if the pts respiratory distress is from pneumonia it will not be helpful. In addition if the pt is very "full of fluid" they may need more aggressive treatment like CPAP before they improve. Hope that helps answer your question.

[constantly_learning]

The setting was a nursing home. I am the only RN on nights. 180 residents to one RN.

My rationale: NITRO = dilates blood vessels = increased blood flow = increased hemoglobin = increased oxygen carrying capcity = increased O2 saturation

[Ivanna_Nurse, BSN, RN]

Nitro does vasodilate and would deccrease cardiac workload and pulmonary congestion... Along with the ABC's I might have tried it too. ~Ivanna

[MAISY, RN-ER, BSN, RN]

Just had a patient with serious CHF exacerbation...our medics administered 3 sl nitro with asa....came in on cpap with crappy sats.

Since we had a call from them, respiratory at bedside with bipap-patient placed on bipap-lasix administered and placed on nitro drip. If nitro drip did not work, patient would have been tubed.

Nitro action explanation was excellent....perhaps you should print it and keep it for the next emt crew that are experts.

Maisy

[nursej22, MSN, RN]

We given nitro all the time for CHF, along with Lasix, O2 and usually a little morphine ( 2-4 mg IVP). The doc will order up to 3 SL q 5min while we are setting up the gtt, then titrating the gtt to BP. Once the pt is stable they may be switched to topical.

It does several things: dilates veins and reduces preload(less fluid coming into the right side of the heart and thus to lungs; dilates the coronary arteries increasing blood flow to myocardium; and reduces systemic vascular resistance so the left ventricle can fill and squeeze.:heartbeat

The main contraindication would be a low bp, say less than 90 systolic, so you would monitor the BP with each dose of nitro.