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Angina Pectoris- aspirin, heparin, nursing management, nursing assessment

Medical management cont…

Antiplatelet and Anticoagulant Medications

Aspirin prevents platelet activation. A 160- to 325-mg dose of aspirin should be given as soon as diagnosis is made and then continued with 81 to 325 mg daily.

Heparin

Unfractionated heparin prevents the formation of new blood clots. The patient is started on a continuous infusion or given an intravenous bolus every 4 to 6 hours. The amount of heparin administered is based on the results of activated partial thromboplastin time (aPTT). Heparin therapy is usually considered therapeutic when the aPTT is 1.5 to 2 times the normal aPTT value.

A subcutaneous injection of low-molecular-weight heparin (LMWH; enoxaparin [Lovenox] or dalteparin [Fragmin]) may be used instead of intravenous unfractionated heparin to treat patients with unstable angina or non–ST-segment elevation MIs.

Patient is monitored for signs and symptoms of external and internal bleeding and is placed on bleeding precautions, which include:

  • Applying pressure to the site of any needle puncture for a longer time than usual
  • Avoiding intramuscular injections
  • Avoiding tissue injury and bruising from trauma or use of constrictive devices

Oxygen Administration

Oxygen therapy is usually initiated to increase the amount of oxygen delivered to the myocardium and to decrease pain. Oxygen inhaled directly increases the amount of oxygen in the blood. The therapeutic effectiveness of oxygen is determined by observing the rate and rhythm of respirations. Blood oxygen saturation is monitored by pulse oximetry; the normal oxygen saturation (SpO2) level is greater than 93%.

NURSING PROCESS

NURSING ASSESSMENT

The nurse gathers information about the patient’s symptoms and activities, especially those that precede and precipitate attacks of angina pectoris. Appropriate questions are asked regarding duration of onset of symptoms, effect of

Nitroglycerin and time taken to get relief are asked.

NURSING DIAGNOSES

  • Ineffective myocardial tissue perfusion secondary to CAD, as evidenced by chest pain or equivalent symptoms
  • Anxiety related to fear of death
  • Deficient knowledge about the underlying disease and methods for avoiding complications
  • Noncompliance, ineffective management of therapeutic regimen related to failure to accept necessary lifestyle changes

NURSING GOALS

  • To treat angina
  • To reduce anxiety
  • To create awareness of the disease process and understanding of the prescribed care
  • Adherence to the self-care program
  • Absence of complications

NURSING INTERVENTIONS

TREATING ANGINA

  • When patient experiences angina direct him to stop all activities and sit in semi-Fowler position.
  • Assess angina by asking questions to determine whether it is same as patient experiences. A difference may indicate a worsening of the disease
  • Measure vital signs and observe for signs of respiratory distress.
  • If the patient is in the hospital, a 12-lead ECG is obtained
  • Nitroglycerin is administered sublingually, and the patient’s response is assessed. If the chest pain is unchanged or present, administration is repeated up to three doses.
  • Each time, blood pressure, heart rate, and the ST segment are assessed
  • Administer Oxygen therapy at 2 L/min by nasal cannula

REDUCING ANXIETY

  • Providing information about illness, treatment and methods of preventing its progression
  • Stress reduction methods are explored with the patient. For example, music therapy, in which patients are given opportunity to listen to selected music
  • Addressing the spiritual needs of the patient and family also assist in allaying anxieties and fears.

PREVENTING PAIN

  • Review assessment findings, identify level of activity that causes pain and plan activitiesaccordingly.
  • If the patient has pain frequently or withminimal activity, alternate the patient’s activities withrest periods.
  • Balance activity with rest

TEACHING PATIENT SELF CARE

  • Participate in daily program of activities that do not produce chest discomfort, shortness of breath or undue fatigue.
  • Avoid exercises requiring sudden bursts of activity
  • Avoid temperature extremes (particularly cold)
  • Alternate activity with periods of rest
  • Use appropriate resources for support during emotionally stressful times
  • Avoid using medications or any over-the-counter substances (eg, diet pills, nasal decongestants) without prescription
  • Stop smoking
  • Eat a diet low in saturated fat, high in fiber, and lower in calories.
  • Take medications, especially aspirin and beta-blockers, as prescribed.
  • Carry nitroglycerin at all times

EVALUATION

Expected patient outcomes may include

1. Reports that pain is relieved promptly

2. Reports decreased anxiety

3. Understands ways to avoid complications and demonstrates freedom from complications

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