Patient Care Management Goal: to relieve acute pain and reduce the cardiac work load
- Administer oxygen to relieve ischemia at a flow rate based on institutional policy and the patient’s condition.
- Assess and document continuous ECG rhythm, vital signs, mental status, heart and lung sounds.
- Assess and document pain characteristics: location, duration, intensity (have patient grade pain on a scale from 1 to 10), precipitating factors, relief measures and any symptoms that indicate changes in these parameters.
- Assess vital signs with complaints of chest pain, and compare to baseline.
- Begin IV nitroglycerin titrated until acute pain is relieved; check blood pressure every 15 minutes or according to institutional policy; maintain systolic blood pressure greater than 90 mm Hg or according to institutional protocol; document the patient’s response to therapy.
- Administer IV morphine in small doses to relieve pain and decrease preload.
- Give sublingual, oral, or topical nitroglycerin prophylactically for chronic pain.
- Consider calcium channel blockers with Prinzmetal’s angina to block the influx of calcium into the cell; calcium channel blockers produce vasodilation of coronary and peripheral arteries.
- Use beta-adrenergic blockers to decrease myocardial oxygen demand by decreasing contractility, heart rate, and blood pressure.
- Notify the doctor and obtain a 12-lead ECG at the onset of recurring chest pain.
- Maintain activity restrictions based on the patient’s activity tolerance to reduce myocardial oxygen demands.
- Begin the patient on a low-cholesterol, low-sodium diet to alleviate the modifiable risk factors.
- Consider percutaneous transluminal coronary angioplasty (PTCA) to improve blood flow through the stenotic coronary arteries.
- Remember that a coronary artery bypass graft (CABG) may be indicated when medical treatment has been unsuccessful, based on the patient’s symptoms and the cardiac catheterization report.
- Provide patient education, and ensure that the patient can recognize signs and symptoms necessitating medical attention (unrelieved chest pain after taking three nitroglycerin tablets sublingually 5 minutes apart).
- Work with the patient and family to identify the patient’s risk factors and necessary life style modifications.
- Refer the family to appropriate sources for cardiopulmonary resuscitation (CPR) training.
- Ensure that the family can activate the emergency medical system if any problems occur at home.
More Nursing Interventions soon.
Nursing Care Plan Samples