Sandra is a 55-year-old woman with diabetes who is being seen in the emergency department for jaw pain and nausea that began while she was pruning the bushes in front of her house. The patient is diagnosed with angina. The nurse administers the ordered sublingual nitroglycerine, and the patient immediately has shortness of breath and breaks out in hives along her neck, chest, and upper arms. The patient is treated with oral diphenhydramine (Benadryl®) and intravenous (IV) dexamethasone(Decadron), and she recovers without incidence.
1. Sandra asks the nurse how a problem with the heart can manifest as jaw pain and nausea. How will the nurse respond?
2. The patient asks the nurse, “What am I going to do if I experience more chest pain? Isn’t nitroglycerine the only medication that treats chest pain?” How will the nurse respond?
3. The main aim in the pharmacological treatment of angina is to reduce the workload of the heart and, in doing so, the amount of oxygen it demands. Briefly outline how nitrates would achieve this aim.
4. What type of angina is Sandra experiencing?
5. Two months later, Sandra is sweeping out her garage when she develops shortness of breath and becomes diaphoretic. She sits down to rest, and the “heaviness” does not go away. What would be the priority action?
6. Anti-platelets, such as aspirin, are essential in the management of stable and unstable angina. Explain how aspirin produces its effect.