Angelite Nurses: Angina Pectoris

Angina Pectoris

General information

Transient, paroxysmal chest pain produced by insufficient blood flow to the myocardium resulting in myocardial ischemia.
Risk factors: CAD, atherosclerosis, hypertension, diabetes mellitus, thromboangiitis obliterans, severe anemia, aortic insufficiency
Precipitating factors: physical exertion, consumption of a heavy meal, extremely cold weather, strong emotions, cigarette smoking, sexual activity

Medical management

Drug therapy: nitrates, beta-adrenergic blocking agents, and/or calcium-blocking agents, lipid reducing drugs if cholesterol elevated
Modification of diet and other risk factors
Surgery: see Coronary Artery Bypass Surgery

Assessment findings

Pain: substernal with possible radiation to the neck, jaw, back, and arms; relieved by rest
Palpitations, tachycardia
Dyspnea
Diaphoresis
Increased serum lipid levels
Diagnostic tests

ECG may reveal ST segment depression and T-wave inversion during chest pain
Stress test may reveal an abnormal ECG during exercise.

Nursing interventions

Administer oxygen.
Give prompt pain relief with nitrates or narcotic analgesics as ordered.
Monitor vital signs, status of cardiopulmonary function.
Monitor ECG.
Place client in semi- to high-Fowler's position.
Provide emotional support.
Provide client teaching and discharge planning concerning

Proper use of nitrates

nitroglycerin tablets (sublingual)

allow tablet to dissolve.
relax for 15 minutes after taking tablet to prevent dizziness.
if no relief with 1 tablet, take additional tablets at 5-minute intervals, but no more than 3 tablets within a 15-minute period.
know that transient headache is a frequent side effect.
keep bottle tightly capped and prevent exposure to air, light, heat.
ensure tablets are within reach at all times.
check shelf life, expiration date of tablets.

nitroglycerin ointment (topical)

rotate sites to prevent dermal inflammation.
remove previously applied ointment.
avoid massaging/rubbing as this increases absorption and interferes with the drug's sustained action.

Ways to minimize precipitating events

reduce stress and anxiety (relaxation techniques, guided imagery)
avoid overexertion and smoking
maintain low-cholesterol, low-saturated fat diet and eat small, frequent meals
avoid extremes of temperature
dress warmly in cold weather

Gradual increase in activities and exercise

participate in regular exercise program
space exercise periods and allow for rest periods

Instruct client to notify physician immediately if pain occurs and persists, despite rest and medication administration.

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