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P A R T 8
Drugs acting on the cardiovascular system
medication from heat and light
because these drugs
are volatile and lose their potency.
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Instruct the person that a sublingual dose may be
repeated in 5 minutes if relief is not felt, for a total
of three doses, if pain persists. They should go to
an emergency department
to ensure proper medical
support if an MI should occur.
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Give sustained-release forms with water, and
caution the person not to chew or crush tablets/
capsules
because these preparations need to reach
the GI tract intact.
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Rotate the sites of topical forms
to decrease the
risk of skin abrasion and breakdown
; monitor for
signs of skin breakdown
to arrange for appropriate
skin care as needed.
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Make sure that sublingual spray is used under
the tongue and not inhaled
to ensure that the
therapeutic effects can be achieved.
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Break an amyl nitrate capsule and wave it under
the nose of the person with angina
to provide
rapid relief using the inhalation form of the drug
;
this may be repeated with another capsule in 3 to
5 minutes if needed.
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Keep a record of the number of sprays used if a
sublingual spray form is used,
to prevent running
out of medication and episodes of untreated
angina.
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Have emergency life support equipment readily
available
in case of severe reaction to the drug or
myocardial infarction.
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Taper the dose gradually (over 4 to 6 weeks) after
long-term therapy
because abrupt withdrawal
could cause a severe reaction, including MI.
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Provide comfort measures
to help the person
tolerate drug effects.
These include small, frequent
meals
to alleviate GI upset
; access to bathroom
facilities if GI upset is severe or the person
experiences incontinence; environmental controls
such as temperature, controlled lighting and noise
reduction
to decrease stresses that could aggravate
cardiac workload
; safety precautions such as
lying or sitting down after taking the drug and
assistance with ambulation
to reduce the risk of
injury
; reorientation; and appropriate skin care
as needed.
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Offer support and encouragement
to help the
person deal with the diagnosis and the drug
regimen.
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Provide thorough teaching, including the name
of the drug; dosage prescribed; proper technique
for administration (oral, sublingual, transbuccal,
transdermal, inhalation spray or topical); need
for removal of transdermal or topical drug before
application of the next dose; the importance of
having an adequate supply of drug (e.g. teaching
the individual to count the number of sprays used
for a translingual spray so as not to run short);
measures to prevent anginal attacks and actions
to take when an attack occurs; use of medication
during an attack (such as the number of tablets
and time span that the person can take sublingual
tablets); measures to avoid adverse effects, warning
signs of problems and signs and symptoms to
report immediately; and the need for periodic
monitoring and evaluation
to enhance knowledge
about drug therapy and to promote compliance.
Evaluation
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Monitor response to the drug (alleviation of signs
and symptoms of angina, prevention of angina).
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Monitor for adverse effects (hypotension, cardiac
arrhythmias, GI upset, skin reactions, headache).
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Evaluate the effectiveness of the teaching
plan (person can name drug, dosage, proper
administration, adverse effects to watch for,
specific measures to avoid them and the importance
of continued follow-up).
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Monitor the effectiveness of comfort measures and
compliance with the regimen.
See the Critical thinking scenario for measures for
handling an angina attack.
CRITICAL THINKING SCENARIO
Handling an angina attack
THE SITUATION
S.W. is a 48-year-old Caucasian woman with a 2-year history
of angina pectoris. She was given sublingual glyceryl
trinitrate to use when she had chest pain. For the past
6 months, she has been stable, experiencing little chest
pain. This morning after her exercise class, S.W. had an
argument with her daughter and experienced severe chest
pain that was unrelieved by four glyceryl trinitrate tablets
taken over a 20-minute period. S.W.’s daughter rushed
her to the hospital, where she was given oxygen through
nasal cannula and placed on a cardiac monitor, which
showed a sinus tachycardia of 110 beats/min. A 12-lead
electrocardiogram (ECG) showed no changes from her
previous ECG of 7 months ago.
