Question

Sandra is a 55-year-old woman with diabetes who is being seen in the emergency department for jaw pain and nausea that began while she was pruning the bushes in front of her house. The patient is diagnosed with angina. The nurse administers the ordered sublingual nitroglycerine, and the patient immediately has shortness of breath and breaks out in hives along her neck, chest, and upper arms. The patient is treated with oral diphenhydramine (Benadryl®) and intravenous (IV) dexamethasone(Decadron), and she recovers without incidence.

1. Sandra asks the nurse how a problem with the heart can manifest as jaw pain and nausea. How will the nurse respond?

2. The patient asks the nurse, “What am I going to do if I experience more chest pain? Isn’t nitroglycerine the only medication that treats chest pain?” How will the nurse respond?

3. The main aim in the pharmacological treatment of angina is to reduce the workload of the heart and, in doing so, the amount of oxygen it demands. Briefly outline how nitrates would achieve this aim.

4. What type of angina is Sandra experiencing?

5. Two months later, Sandra is sweeping out her garage when she develops shortness of breath and becomes diaphoretic. She sits down to rest, and the “heaviness” does not go away. What would be the priority action?

6. Anti-platelets, such as aspirin, are essential in the management of stable and unstable angina. Explain how aspirin produces its effect.

Answer 1

1.Heart Attack is a condition in which the myocardium muscles are deprived on the oxygen supply causing necrosis and infarction .the jaw bone nerve is present very close to the nerves of the heart so when there is no enough oxygen supply to the heart .the heart send a reaction of pain to the brain using the nervous system .the brain misinterprets as the jaw nerve and causes jaw to pain .the same cardiac nerves activates the vomiting receptors causing nausea

2.t he nurse will have to tell that nitroglycerine is the drug of choice during angina as it increases the blood flow of the blood vessels thus reducing the load on the weak working heart .the nurse should instruct the dose route of nitroglycerine to be taken .the nurse also should advice to avoid nitroglycerine if the patient feels her Blood pressure is below than normal .because it may cause even more hypotension

3.nitrates are a group of medicines which causes vasodilation this increasing the blood flow to the heart and reducing the oxygen demand of the patient

4.sandra is having stable Angina or angina pectoris

5.since this. Is second episode of angina she should call 911 emergency no and can take one nitroglycerine prrovided she has a normal blood pressure

6 Aspirin is an anticoagulant which will prevent the blood from clotting thus reducing the development of thrombosis this reducing the risk of blocked vessels