Patient Care Management Goal: to relieve acute pain and reduce the cardiac work load

1. Administer oxygen to relieve ischemia at a flow rate based on institutional policy and the patient’s condition.
2. Assess and document continuous ECG rhythm, vital signs, mental status, heart and lung sounds.
3. 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.
4. Assess vital signs with complaints of chest pain, and compare to baseline.
5. 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.
6. Administer IV morphine in small doses to relieve pain and decrease preload.
7. Give sublingual, oral, or topical nitroglycerin prophylactically for chronic pain.
8. 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.
9. Use beta-adrenergic blockers to decrease myocardial oxygen demand by decreasing contractility, heart rate, and blood pressure.
10. Notify the doctor and obtain a 12-lead ECG at the onset of recurring chest pain.
11. Maintain activity restrictions based on the patient’s activity tolerance to reduce myocardial oxygen demands.
12. Begin the patient on a low-cholesterol, low-sodium diet to alleviate the modifiable risk factors.
13. Consider percutaneous transluminal coronary angioplasty (PTCA) to improve blood flow through the stenotic coronary arteries.
14. 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.
15. 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).
16. Work with the patient and family to identify the patient’s risk factors and necessary life style modifications.
17. Refer the family to appropriate sources for cardiopulmonary resuscitation (CPR) training.
18. Ensure that the family can activate the emergency medical system if any problems occur at home.

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