Nitroglycerin for Angina

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Questions and Answers

A client with angina is prescribed sublingual nitroglycerin. What instruction should the nurse provide regarding its administration?

  • Swallow the tablet whole with a glass of water.
  • Chew the tablet for faster absorption.
  • Place the tablet under the tongue and let it dissolve. (correct)
  • Crush the tablet and inhale it.

A client is using transdermal nitroglycerin patches. Which instruction is most important for the nurse to emphasize?

  • Apply the patch to a hairless area and rotate sites daily. (correct)
  • Apply heat to the patch to enhance medication delivery.
  • Apply the patch to the same site each day to ensure consistent absorption.
  • Cut the patch in half if a lower dose is needed.

A client reports a headache after taking sublingual nitroglycerin. What is the nurse's best action?

  • Explain that headache is a common side effect and usually diminishes with time. (correct)
  • Hold the next dose of nitroglycerin and notify the physician.
  • Administer a beta-blocker to counteract the headache.
  • Administer an opioid analgesic for pain relief.

A client is prescribed IV nitroglycerin for unstable angina. Which nursing intervention is most critical during administration?

<p>Monitoring blood pressure closely for hypotension. (A)</p> Signup and view all the answers

A client taking nitroglycerin reports experiencing dizziness upon standing. What should the nurse advise the client to do?

<p>Change positions slowly to minimize orthostatic hypotension. (A)</p> Signup and view all the answers

What is the most important instruction to give a client regarding the storage of nitroglycerin tablets?

<p>Keep the tablets in their original container, away from light and moisture. (B)</p> Signup and view all the answers

A client is prescribed nitroglycerin for angina. Which medication, if taken concurrently, is contraindicated due to the risk of severe hypotension?

<p>Sildenafil (A)</p> Signup and view all the answers

A client using transdermal nitroglycerin patches asks why they need to remove the patch each night. What is the best rationale for the nurse to provide?

<p>To prevent the development of tolerance to the medication. (B)</p> Signup and view all the answers

A client with angina takes one sublingual nitroglycerin tablet but still experiences chest pain after 5 minutes. What is the next appropriate action?

<p>Take a second tablet and wait 5 more minutes. (D)</p> Signup and view all the answers

A nurse is teaching a client about nitroglycerin. Which statement by the client indicates a need for further teaching?

<p>I can take nitroglycerin with my erectile dysfunction medication if I have chest pain. (A)</p> Signup and view all the answers

A client is using nitroglycerin for angina. What activity should the nurse advise the client to avoid due to its vasodilating effects?

<p>Sitting in a hot tub. (C)</p> Signup and view all the answers

A client taking nitroglycerin sublingually reports a burning sensation with the medication. What is the nurse's appropriate response?

<p>This indicates that the medication is still potent. (A)</p> Signup and view all the answers

A client is prescribed nitroglycerin for long-term angina prevention. Which route of administration is most suitable for this purpose?

<p>Transdermal patches (A)</p> Signup and view all the answers

A client on nitroglycerin therapy experiences reflex tachycardia. Which physiological mechanism is responsible for this side effect?

<p>Compensation for hypotension caused by vasodilation (C)</p> Signup and view all the answers

When should a client who is experiencing chest pain call emergency services after taking sublingual nitroglycerin?

<p>After taking three tablets within 15 minutes and experiencing no relief. (B)</p> Signup and view all the answers

A nurse is assessing a client who has been using nitroglycerin patches for several months. What finding suggests the client may have developed nitrate tolerance?

<p>Reports of chest pain even with nitroglycerin use. (A)</p> Signup and view all the answers

A client is prescribed nitroglycerin ointment. What is the correct procedure for applying this medication?

<p>Use the provided applicator paper to measure and apply the ointment. (A)</p> Signup and view all the answers

Alcohol consumption can potentiate the effects of Nitroglycerin, what effect would this have on the patient?

<p>Increased risk of severe hypotension (B)</p> Signup and view all the answers

Which of the following conditions is a contraindication for nitroglycerin administration?

<p>Severe anemia (D)</p> Signup and view all the answers

A patient is scheduled to have sexual activity and asks when they can take sildenafil after taking Nitroglycerin. What is the most appropriate response?

<p>Taking sildenafil after taking Nitroglycerin is contraindicated. (D)</p> Signup and view all the answers

The patient has already administered 3 nitroglycerin tablets and still reports chest pain. After calling 911, what needs to occur while waiting for Emergency Medical Services (EMS)?

<p>Stay lying down (D)</p> Signup and view all the answers

A nurse is teaching a client with angina how to use nitroglycerin sublingual tablets. Which of the following instructions should be included?

<p>Place the tablet under the tongue and allow it to dissolve. (C)</p> Signup and view all the answers

A client is prescribed nitroglycerin transdermal patches. The nurse should instruct the client to:

<p>Apply the patch to a hairless area and rotate sites daily. (A)</p> Signup and view all the answers

A client reports a headache after taking sublingual nitroglycerin. The nurse should:

<p>Explain that headache is a common side effect that usually diminishes with time. (D)</p> Signup and view all the answers

A client is receiving IV nitroglycerin for unstable angina. The nurse should monitor for:

<p>Hypotension. (B)</p> Signup and view all the answers

When teaching a client about nitroglycerin, the nurse emphasizes the importance of:

<p>Changing positions slowly to minimize orthostatic hypotension. (C)</p> Signup and view all the answers

Which medication is contraindicated with nitroglycerin due to the risk of severe hypotension?

<p>Sildenafil (A)</p> Signup and view all the answers

A client using nitroglycerin patches asks why they need to remove the patch each night. The nurse's best response is:

<p>To prevent tolerance to the medication. (C)</p> Signup and view all the answers

If a client takes one sublingual nitroglycerin tablet and still has chest pain after 5 minutes, they should:

<p>Take a second tablet and wait 5 more minutes. (C)</p> Signup and view all the answers

A client states, "I can take nitroglycerin with my erectile dysfunction medication if I have chest pain." The nurse should:

<p>Correct the misunderstanding and explain the danger of combining these medications. (A)</p> Signup and view all the answers

Which activity should a client taking nitroglycerin avoid due to its vasodilating effects?

<p>Sitting in a hot tub (C)</p> Signup and view all the answers

A client taking nitroglycerin sublingually reports a burning sensation with the medication. The nurse should respond:

<p>This indicates the medication is still potent. (C)</p> Signup and view all the answers

Which nitroglycerin administration route is most appropriate for long-term angina prevention?

<p>Transdermal patches (C)</p> Signup and view all the answers

A client on nitroglycerin therapy experiences reflex tachycardia. This occurs due to:

<p>Compensation for hypotension caused by vasodilation. (A)</p> Signup and view all the answers

After administering three nitroglycerin tablets with persistent chest pain, the client should:

<p>Call 911 (A)</p> Signup and view all the answers

A nurse assessing a client on long-term nitroglycerin patch therapy finds persistent chest pain. This indicates:

<p>Nitrate tolerance. (A)</p> Signup and view all the answers

When applying nitroglycerin ointment, the correct procedure involves:

<p>Using the applicator paper to measure the ointment. (C)</p> Signup and view all the answers

Flashcards

Nitroglycerin

Medication to treat angina by dilating blood vessels, reducing heart workload.

Nitroglycerin Administration Routes

Under the tongue, through the skin (patch), or IV.

Sublingual Nitroglycerin Instructions

Place under the tongue until dissolved. Don't swallow or chew.

Transdermal NTG Patch Application

Apply to hairless skin, rotate sites daily.

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IV Nitroglycerin Administration

Use dedicated IV line, infusion pump. Monitor BP closely.

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Sublingual Nitroglycerin Dosage

Typically 0.4 mg, repeat every 5 mins (max 3 doses).

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Transdermal NTG Patch Strengths

Various strengths (0.2 mg/hr to 0.8 mg/hr).

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IV Nitroglycerin Dosage Adjustment

Individualized based on response and BP.

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Sublingual NTG - No Relief

Call emergency services.

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Nitroglycerin Common Side Effects

Headache, dizziness, lightheadedness, flushing.

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Orthostatic Hypotension

Sudden BP drop upon standing.

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Reflex Tachycardia

Increased heart rate due to hypotension.

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Nitroglycerin Tolerance

Decreased effectiveness with long-term use.

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Nitroglycerin Contraindication

Hypersensitivity to nitrates.

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Drugs Contraindicated with NTG

PDE5 inhibitors (sildenafil, tadalafil).

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Nitroglycerin Other Contraindications

Severe anemia, head trauma, increased intracranial pressure.

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Antihypertensives & Nitroglycerin

Increased hypotension risk.

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Alcohol & Nitroglycerin

Potentiates hypotensive effects.

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Aspirin/NSAIDs & Nitroglycerin

May reduce effectiveness.

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Pre-Administration Assessment

Assess BP and HR.

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Post-Administration Monitoring

Monitor for relief of chest pain.

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Nitroglycerin Patient Education

Proper use, storage, disposal.

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Activities to Avoid with NTG

Hot showers, saunas.

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When to Contact Provider

Report persistent/severe side effects.

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Nitroglycerin Storage

Original container, away from light/moisture.

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Nitroglycerin Replacement

Replace every six months.

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Position When Taking NTG

Sit or lie down.

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Transdermal Patch Removal

Remove patch nightly for 10-12 hours.

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Home Monitoring

Take pulse and BP at home, know when to call.

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Signs of Nitrate Tolerance

Decreased medication effectiveness.

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How Nitroglycerin Relieves Angina

Widening blood vessels, improving blood flow to the heart.

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Steps to Take During Chest Pain

Stop, sit/lie down, place tablet under tongue, let dissolve.

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Timing of NTG Doses

If pain persists after 5 minutes, take up to 3 tablets total, then call 911.

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Common Side Effects of Nitroglycerin

Headache, dizziness, and flushing.

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How to Store NTG Tablets

Cool, dry place, away from light and moisture, original container.

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How Often to Replace NTG

Every 6 months.

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ED Drugs to Avoid with NTG

Sildenafil, tadalafil, vardenafil.

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Alcohol Interaction with NTG

Increases dizziness and low blood pressure risk.

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NTG Patch Applications

Hairless area, rotate daily to prevent skin irritation, remove each night for 10-12 hours.

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All Medications with NTG

Includes over-the-counter drugs and herbal supplements.

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Study Notes

  • Nitroglycerin treats angina by dilating blood vessels, reducing the heart's workload.

Administration

  • Nitroglycerin can be administered sublingually, transdermally, or intravenously.
  • Sublingual tablets provide immediate angina relief.
  • Transdermal patches are for long-term angina prevention.
  • IV nitroglycerin treats severe, unstable angina or controls blood pressure.
  • Sublingual nitroglycerin: place the tablet under the tongue and allow it to dissolve completely, without swallowing or chewing.
  • Transdermal patches: apply to a hairless skin area, rotating sites daily to prevent irritation.
  • IV nitroglycerin requires a dedicated IV line and infusion pump, with close blood pressure monitoring due to the risk of rapid drops.

Dosage

  • Sublingual nitroglycerin is typically 0.4 mg, repeated every 5 minutes for up to three doses.
  • Transdermal nitroglycerin patches range from 0.2 mg/hr to 0.8 mg/hr.
  • IV nitroglycerin dosage is based on individual response and blood pressure.
  • If chest pain persists after the first sublingual nitroglycerin dose, call emergency services.

Side Effects

  • Common side effects: headache, dizziness, lightheadedness, and flushing.
  • Orthostatic hypotension is a significant side effect, especially with the first dose, change positions slowly to minimize this.
  • Reflex tachycardia can occur in response to hypotension.
  • Tolerance to nitroglycerin's effects can develop with long-term use.

Contraindications

  • Contraindicated in clients with hypersensitivity to nitrates.
  • Avoid use with phosphodiesterase-5 (PDE5) inhibitors (e.g., sildenafil, tadalafil, vardenafil) due to the risk of severe hypotension.
  • Also contraindicated in clients with severe anemia, head trauma, or increased intracranial pressure.

Interactions

  • Concurrent use with antihypertensive medications (e.g., beta-blockers, calcium channel blockers) can increase hypotension risk.
  • Alcohol can potentiate nitroglycerin's hypotensive effects.
  • Aspirin and other NSAIDs may reduce nitroglycerin's effectiveness.

Nursing Considerations

  • Before administering nitroglycerin, assess blood pressure and heart rate.
  • Monitor for chest pain relief after administration.
  • Educate about proper use, storage, and disposal.
  • Avoid activities causing vasodilation, such as hot showers or saunas.
  • Report any persistent or severe side effects to the healthcare provider.
  • Store tablets in the original container, away from light and moisture.
  • Check the expiration date, replace the supply every six months.
  • Sit or lie down when taking nitroglycerin to prevent falls.
  • Remove transdermal patches each night for 10-12 hours to prevent tolerance.
  • Teach how to take pulse and blood pressure at home, and when to seek medical attention.
  • Assess for signs of nitrate tolerance.

Patient Education

  • Nitroglycerin relieves chest pain (angina) by widening blood vessels.
  • If chest pain occurs, stop activity and sit or lie down. Place one tablet under the tongue and let it dissolve.
  • If pain doesn't improve within 5 minutes, take a second tablet. If it still doesn't improve 5 minutes after the second tablet, take a third tablet and call 911 immediately. Do not exceed three tablets within 15 minutes.
  • Common side effects: headache, dizziness, and flushing, sit or lie down when taking nitroglycerin to avoid falls.
  • Store tablets in a cool, dry place, in the original container.
  • Replace tablets every 6 months due to potency loss.
  • Avoid taking nitroglycerin with erectile dysfunction medications (sildenafil, tadalafil, or vardenafil) due to hypotension risk.
  • Avoid alcohol while taking nitroglycerin, as it can increase dizziness and low blood pressure.
  • For patches, apply one patch daily to a hairless skin, rotate the application site daily and remove the patch each night for 10-12 hours to prevent tolerance.
  • Inform your doctor about all medications, including over-the-counter drugs and herbal supplements.

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