Which of the following interventions should be the first priority when treating a client experiencing chest pain while walking?
A. Sit the client down.
B. Get the client back to bed.
C. Obtain an ECG.
D. Administer sublingual nitroglycerin.
Correct Answer: A. Sit the client down.
The initial priority is to decrease the oxygen consumption; this would be achieved by sitting the client down. Place the patient at complete rest during anginal episodes. Reduces myocardial oxygen demand to minimize the risk of tissue injury. Monitor vital signs every 5 min during the initial anginal attack. Blood pressure may initially rise because of sympathetic stimulation, then fall if cardiac output is compromised.
Option B: Stay with a patient who is experiencing pain or appears anxious. Anxiety releases catecholamines, which increase myocardial workload and can escalate and/or prolong ischemic pain. The presence of a nurse can reduce feelings of fear and helplessness.
Option C: An ECG can be obtained after the client is sitting down. Monitor heart rate and rhythm. Patients with unstable angina have an increased risk of acute life-threatening dysrhythmias, which occur in response to ischemic changes and/or stress.
Option D: After the ECG, sublingual nitro would be administered. When the client’s condition is stabilized, he can be returned to bed. 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.
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