What action should the nurse take first when a patient reports acute chest pain after a PTCA?

What action should the nurse take first when a patient reports acute chest pain after a PTCA?

• A. Place oxygen
• B. Administer morphine
• C. Administer nitroglycerin
• D. Notify the primary physician

Answer: (C)

When chest pain appears after a PTCA, the priority is to relieve ischemia quickly. Nitroglycerin does this by dilating veins, which lowers preload and myocardial oxygen demand, and by improving coronary blood flow. This often eases the chest pain rapidly, making it the best first step provided there are no contraindications (such as low blood pressure or recent use of certain erectile dysfunction medications). Before administering, check the blood pressure because nitroglycerin can cause hypotension; if the systolic pressure is too low, hold the dose. If the first dose is tolerated and the patient remains in pain, many protocols allow additional doses while monitoring vitals, up to a recommended limit. Oxygen should be given if the patient is hypoxic, but it won’t treat ischemia as specifically as nitroglycerin. Morphine may be used later if pain persists after nitro, but nitroglycerin is aimed at quickly resolving the cause of the pain. If chest pain continues despite appropriate nitro therapy, notify the physician for further assessment and intervention.

When chest pain appears after a PTCA, the priority is to relieve ischemia quickly. Nitroglycerin does this by dilating veins, which lowers preload and myocardial oxygen demand, and by improving coronary blood flow. This often eases the chest pain rapidly, making it the best first step provided there are no contraindications (such as low blood pressure or recent use of certain erectile dysfunction medications). Before administering, check the blood pressure because nitroglycerin can cause hypotension; if the systolic pressure is too low, hold the dose. If the first dose is tolerated and the patient remains in pain, many protocols allow additional doses while monitoring vitals, up to a recommended limit. Oxygen should be given if the patient is hypoxic, but it won’t treat ischemia as specifically as nitroglycerin. Morphine may be used later if pain persists after nitro, but nitroglycerin is aimed at quickly resolving the cause of the pain. If chest pain continues despite appropriate nitro therapy, notify the physician for further assessment and intervention.