Question

A 57-year-old man with a history of hypertension and unstable angina is admitted to the emergency room with severe, crushing chest pain. He was working in the yard when he began to have pain in his left arm with diaphoresis and nausea. He took three sublingual nitroglycerin tablets before asking his wife to call EMS.

1. Why is nitroglycerin indicated for the relief of chest pain caused by myocardial ischemia?
2. What instructions should be given to patients prescribed sublingual nitroglycerin?
3. The following medications are ordered. What is the purpose of these drugs, and what assessment should the nurse perform related to administration of these drugs?

• Aspirin 81 mg chewable tablets, give 4 tablets STAT
• Intravenous morphine sulfate 2 to 4 mg every 10 minutes as needed to control pain
• Atenolol 5 mg IV
• Nitroglycerin IV drip at 10 mcg/minute

The patient undergoes a successful placement of a stent in the right coronary artery. The patient has aspirin 324 mg orally every day and metoprolol 100 mg orally twice a day prescribed.

4. The following medications are ordered. What is the purpose of each of these drugs and patient teaching required?

• Isosorbide dinitrate PO
• Nifedipine 20 mg PO twice a day
• Clopidogrel 75 mg PO daily

5. What does the nonpharmacologic management of CAD include and why?

Answer 1

Answer: The nitroglycerin acts by dilating the blood vessels and hence reduces the chest pain. It works by relaxing the cardiac muscles of vessels. Hence it reduces pain of the myocardial ischemia.

The patient should be Instructed not to take medicine more than 3 tablets within a 15 minutes. Tablet should be taken 15 minutes before Exercise to prevent angina.

The use of Aspirin 81 mg chewable tablets is to treat painpain, prevents the blood clot as well as prevent the attack.

Atenolol 5 mg IV hypertension, angina, for management of acute myocardial infarction