medication

Nitroglycerin SHAKIRA-LYNN SCOTT

NURSE 481L

11/8/2021

LATOYA STRICKLAND

J.D. Case Study

J.D., a 78-year-old Caucasian man, presented to the ER with

lightheadedness, lethargy, worsened chest pain, and SOB. Upon admission that patient was found to have a heart rate of 134, blood pressure of 98/59, and respiratory rate 11. An EKG revealed a ST-

Elevation. J.D. has a hx of a heart attack that occurred in 2018 and high blood pressure. He currently takes metoprolol for blood pressure and states that he took one sublingual tablet of nitroglycerin prior to

admission.

Priority Nursing Diagnosis

 Acute pain related to tissue ischemia evidenced by patient stating

his pain level is 6/10 and facial grimacing

 Risk for decreased cardiac output related to ST-elevation on EKG, increased pulse, and decreased blood pressure

Nitroglycerin:

Mechanism of Action

 Converts to nitric oxide in the body and activates enzyme chain in vascular muscles and tissues. This promotes calcium reuptake and opening of the calcium and potassium channels resulting in dephosphorylation of myosin chains and smooth muscle fibers. This ultimately leads to relaxation of smooth muscles leading to a vasodilatory effect (Kim et al., 2021).

Nitroglycerin

 Vasodilator/ Nitrate

 Indication (Nitrolingual, n.d.)

 Hypertensive emergencies

 Angina pectoris

 Coronary Heart Failure

 Routes

 Sublingual

 Rectally

 Topical

 IV

 J.D. prescription- to relieve angina pectoris

 Sublingual tablet: 400mcg (300mcg or 600 mcg) during onset of attack and repeated every 5 minutes as needed with max dosage of 3 tablets in a 15- minute period

Nitroglycerin Continued…

 Side effects (National Library of Medicine, 2017)

 Headache

 Blurred vision

 Dry mouth

 Rash

 Itching

 Flushing

 Contraindications (Kim et al., 2021)

 Allergies to nitrates

 Increased intracranial pressure

 Severe anemia

Nitroglycerin Interventions

 Check blood pressure before administering

 Assess patient pain before administering dose (or another dose)

 Get baseline vitals of patient

 Educate that headaches are a normal side effect duet o vasodilator properties

 Continuous EKG monitoring

 Alert for w orsening symptoms or STEMI

 Sublingual tablets should be used

 No nitroglycerin intravenous infusions should be discontinued abruptly

 Acetaminophen can be given for headache

 Sit patient in semi-high fow lers position if tolerated

 Reassess patient’s vitals and pain level for effectiveness

Teaching Plan

 Nitroglycerin is used to treat symptoms of angina including pressure

and pain that is caused by lack of oxygen perfusion to the heart

 Nitroglycerin should be taken sublingually with the onset of any new chest pain as prescribed (300mcg, 400mcg, 600mcg)

 Sublingual nitroglycerin medication is placed under to the tongue or

between the check and gum and fully dissolved

 This medication can be taken every five minutes if pain still presides for up to 15mins with max of 3 tablets

 CALL 911 if you experience any more pain

 Headaches are a common side effect of this medication and is due to its vasodilator properties

J.D. Case Study

After administering the rest of the nitroglycerin tablets without

resolution and recognizing the ST elevation on J.D.’s EKG, the STEMI team was alerted, and he was taken to the catheter lab for surgery.

References

 Kim, K. H., Kerndt, C. C., Adnan, G., & Schaller, D. J. (2021). Nitroglycerin. In

StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK482382/

 Nitrolingual (nitroglycerin) dose, indications, adverse effects, interactions... From

PDR.net. (n.d.). https://www.pdr.net/drug-summary/Nitrolingual-nitroglycerin-

3340

 National Library of Medicine (2017, March 15). Nitroglycerin sublingual.

https://medlineplus.gov/druginfo/meds/a601086.html