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Cleansweep RN

A. General Information:
  • Transient, paroxysmal chest pain produced by insufficient blood flow to the myocardium resulting to myocardial ischemia.
  • Angina is caused by an in balance between oxygen supply and demand.
  • Cases includes obstruction of coronary blood flow resulting from atherosclerosis, coronary artery spasm or conditions increasing myocardial oxygen consumption
  • Risk factors includes CAD, atherosclerosis, hypertension, diabetes mellitus thromboangitis obliterans, severe anemia, and aortic insufficiency
  • Precipitated by physical excretion, consumption of heavy meal, extremely cold weather, strong emotions, cigarette smoking and sexual activity

B. Classifications of Angina:

  1. STABLE ANGINA (exertional angina) - occurs with activities that involve exertion or emotion and increases in occurrence, duration and severity and relieving factors.
  2. UNSATBLE ANGINA (pre-infarction angina) – occurs with an unpredictable degree of exertion or emotion and increases in occurrence, duration and severity over time.
  3. VARIANT ANGINA (prinzmetal or vasospastic angina) – results from coronary artery spasm and may occurs at rest. Attacks may associated with ST segment elevation noted on ECG.
  4. INTRACTABLE ANGINA – chronic incapacitating angina and unresponsive to interventions.
  5. PREINFARCTION ANGINA – associated with acute coronary insufficiency. Last longer than 15 mins. Occurs after an MI, when residual ischemia may cause episodes of angina.

C. Assessment Findings:

  • Pain - can develop slowly and quickly, usually described as mild or moderate. Substernal squeezing and crushing pain and may radiate to shoulders, arm, jaw, neck or back.
  • Dyspnea, Palpitations and Tachycardia
  • Pallor, Sweating, Dizziness and faintness
  • Hypertension and digestive disturbances
  • Increased serum lipid levels
  • Diagnostic Tests: ECG may reveals ST segment depression and T wave invertion. Stress test may reveal abnormal ECG during exercise. Cardiac enzymes and troponin levels are normal.

D. Nursing Interventions:

  • Assess the pain, its location and severity
  • Administer oxygen at 3L/ min by nasal cannula as prescribed
  • Administer Nitrogycerin as prescribed to dilate the coronary arteries, reduce the oxygen requirements of the myocardium anf relieve chest pain.
  • Monitor vital signs and cardiopulmonary status
  • Monitor ECG and obtain a 12-lead ECG
  • Place the patient of a semi to high Fowlers position
  • Provide client teachings and discharge instructions
  • Provide instructions on how to use nitroglycerin: (sublingual) allow tablet to dissolve and relax for 15 mins after taking the tablet to prevent dizziness, if no relief take additional tablets at 5 min intervals, but no more than 3 tablets with in 15 min period. Prevent exposure to air and light and check the expiration date of the drug. Transient headache is the frequent side effect of the drug. (Topical) rotate the sites to prevent dermal inflammation and remove first the previously applied ointment. Avoid massaging and rubbing as this increases absorption and interferes with the drug actions.
  • Instruct the patient to minimize precipitating events like reducing stress and axiety, avoid over exertion and smoking.
  • Gradual increase in activities and exercise by participating in regular exercise program and allow rest periods.

E. Medical Management:

  • Drug Therapy: Nitrates, beta-adrenergic blocking agents, or calcium channel blockers, lipid reducing agents when lipid levels increases.
  • Modification of diets and other risk factors
  • Coronary bypass surgery to improve blood flow to the myocardial tissue.
  • Percutatneous transluminal coronary angioplasty (PTCA) to compress the plaque against the walls of artery and dilates the vessel.

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4 Responses
  1. Felicia UK Says:

    The primary cause of oxygen deprivation is ischemia, the blockage of blood vessels. This condition of blockage in the blood vessels may also contribute to erectile dysfunction. http://www.viagrathunder.com


  2. CODEBLUE_2008 Says:

    DONT FORGET TO ADD ASPIRIN IN THE INITIAL MANAGEMENT OF ISCHEMIC CHEST PAIN...DOSE OF 162-325 MG NONENTERECOATED ...CRUSHED THEN FOLLOWED BY 75-325 MG DAILY IF NO CONTRAINDICATION...OTHERWISE PLAVIX OF 300 MG LOADING DOSE THEN 75MG/DAY.


  3. CODEBLUE_2008 Says:

    EVERY ISCHEMIC CHEST PAIN MUST MEET MONA...(MORPHINE OXYGEN NTG AND ASPIRIN) IF NOT RELIEVED BY NTG MORPHINE CAN BE GIVEN 2-4MG IVP OVER 1-5 MINUTES AND 2-8 MG IVP REPEATED 5-15 MINUTES AS NEEDED.
    12 ECG SERIAL, CARDIAC MARKERS, CBC,CHEMISTRY,MG, CA AND PHOS COAGS,
    THEN EVALUATE PATIENT FOR FIBRINOLYTIC OR EMERGENT PCI..


  4. CODEBLUE_2008 Says:

    IN CASE OF PRINZMETAL/VARIANT ANGINA, ONLY DURING PAIN THAT SHOWS ST ELEVATION ...BETA BLOCKERS IS CONTRAINDICATED BECAUSE IT CAUSES VASOSPASM (THROUGH UNOPPOSED BETA-2 BLOCKING EEFECT OF THE SMOOTH MUSCLES.. THUS INCREASE CHEST PAIN.. INSTEAD THE USE OF CALCIUM CHANNEL IS PREFERED (AGENT OF CHOICE)IF UNRESPONSIVE NTG MIGHT BE ADDED...ALSO AVOID HIGH DOSES OF NITROGLYCERIN ..THOUGH CALCIUM ANTAGONIST MAY CONTROLL THE PAIN OF CORONARY SPASM..IT THUS NOT PREVENT DEATH...


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