Question

Situation:A 76-year-old patient has been experiencing arteriosclerosis obliterans with intermittent claudication. He refuses to give up smoking. At his last office visit, he was given a prescription for pentoxifylline (Trental), 400 mg PO tid with meals. After leaving the examination room, he tells you (the office nurse) that the health care provider did not explain how this would work to improve his “leg pain.”

1. Explain in lay terms to the patient what is thought to be the mechanism of action of pentoxifylline and draw a diagram that depicts erythrocyte flexibility. Use the visual aid to help him understand how the drug could improve his leg pain.

2. One week later, the patient calls the office and says, “That new medication you gave me for my leg pain isn’t working.” How should you respond?

Situation: A 64-year-old man comes to the emergency department with acute chest pain. He is holding his chest with his fist directly over the sternum. He is diaphoretic. He is in work clothes and has been mowing the lawn. It is 98° F outside.

1. What nursing actions would be appropriate immediately?

2. What drug would likely be ordered if this is acute angina pectoris?

Answer 1

1. Explain in lay terms to the patient what is thought to be the mechanism of action of pentoxifylline

Pentoxifylline is a drug used to treat peripheral vascular diseases. For you, the leg pain is due to lack of blood flow. Taking Pentoxifylline improves the blood flow by decreasing the blood viscosity and minimizes the platelet aggregation. Thereby it improves the blood flow and reduces leg pain.

2. One week later, the patient calls the office and says, “That new medication you gave me for my leg pain isn’t working.” How should you respond?

The new medication Pentoxifylline has been prescribed to the maximum dosage. Intake of higher dose can lead to serious side effects of weakness, dizziness, vomiting, and diarrhea. It was also harmful to the liver. It takes time to produce the maximum effect. Taking of regular medication and avoiding of over the counter medication will show better results.

1. What nursing actions would be appropriate immediately?

The nurse should put altogether of knowledge, skills, and attitudes in the emergency situation. Though the patient is conscious, the nurse has to immediately check the vital signs and to monitor the cardiovascular system. the nurse should inquire about the location, type, intensity, frequency, and duration of chest pain.ECG and blood investigations such as Troponin, CK-MB can help to rule out the diagnosis. Nurses should also think about the differential diagnosis. The ultimate goal of the nurse is to manage and to care of the patient and to prevent complications.

2. What drug would likely be ordered if this is acute angina pectoris?

ACE inhibitors - Helps to relax the blood vessels and thereby increases the flow of blood.

Angiotensin II receptor Blockers prevents Angiotensin II formation in the surrounding blood vessels. It dilates the blood vessels and reduces the pressure on the blood.

Aspirin - Act as an inhibitor in the platelet aggregation.

Calcium Channel Blockers - Leads to vasodilatation and improving the blood flow and reduces cardiac afterload.

Beta-Blockers - Reduces the demand for oxygen on myocardial cells and thereby reduces the symptoms of angina.