Which of the following actions is the first priority of care for a client exhibiting signs and symptoms of coronary artery disease?
A. Decrease anxiety.
B. Enhance myocardial oxygenation.
C. Administer sublingual nitroglycerin.
D. Educate the client about his symptoms.
Correct Answer: B. Enhance myocardial oxygenation.
Enhancing myocardial oxygenation is always the first priority when a client exhibits signs or symptoms of cardiac compromise. Without adequate oxygenation, the myocardium suffers damage. The desired effect is to decrease myocardial oxygen demand by decreasing ventricular stress. Drugs with negative inotropic properties can decrease perfusion to the already ischemic myocardium. A combination of nitrates and beta-blockers may have cumulative effects on cardiac output.
Option A: Promote expression of feelings and fears. Let the patient/SO know these are normal reactions. Unexpressed feelings may create internal turmoil and affect self-image. Verbalization of concerns reduces tension, verifies the level of coping, and facilitates dealing with feelings. The presence of negative self-talk can increase the level of anxiety and may contribute to an exacerbation of angina attacks.
Option C: Sublingual nitroglycerin is administered to treat acute angina, but the administration isn’t the first priority. Nitroglycerin has been the standard for treating and preventing anginal pain for more than 100 yr. Today it is available in many forms and is still the cornerstone of antianginal therapy.
Option D: Although educating the client is important in care delivery, it is not a priority when a client is compromised. Discuss the pathophysiology of condition. Stress the need for preventing and managing anginal attacks. Patients with angina need to learn why it occurs and what they can do to control it. This is the focus of therapeutic management to reduce the likelihood of myocardial infarction and promote a healthy heart lifestyle.
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