During the previous few months, a 56-year-old woman felt brief twinges of chest pain while working in her garden and has had frequent episodes of indigestion. She comes to the hospital after experiencing severe anterior chest pain while raking leaves. Her evaluation confirms a diagnosis of stable angina pectoris. After stabilization and treatment, the client is discharged from the hospital. At her follow-up appointment, she is discouraged because she is experiencing pain with increasing frequency. She states that she is visiting an invalid friend twice a week and now cannot walk up the second flight of steps to the friend’s apartment without pain. Which of the following measures that the nurse could suggest would most likely help the client deal with this problem?
A. Visit her friend earlier in the day.
B. Rest for at least an hour before climbing the stairs.
C. Take a nitroglycerin tablet before climbing the stairs.
D. Lie down once she reaches the friend’s apartment.
Correct Answer: C. Take a nitroglycerin tablet before climbing the stairs.
Nitroglycerin may be used prophylactically before stressful physical activities such as stair climbing to help the client remain pain-free. Nitrates relax vascular smooth muscle leading to dilation of veins primarily; this decreases cardiac preload and, in turn, decreases myocardial oxygen demand providing relief in anginal symptoms.
Option A: Visiting her friend early in the day would have no impact on decreasing pain episodes. An average of 150 minutes of moderate-intensity exercise per week or 75 minutes of high-intensity exercise per week has been shown to decrease overall cardiac risk factors and, in turn, decrease the risk of coronary heart disease.
Option B: Resting before or after an activity is not as likely to help prevent an activity-related pain episode. The 2017 AHA/ACC guidelines define hypertension as systolic blood pressure ?130 mmHg or diastolic pressure ?80 mmHg. Goal blood pressure will be unique to each patient; however, it is important to keep in mind that for each 20/10 mmHg increase in systolic/diastolic blood pressure, evidence has supported a two-fold increased risk of coronary heart and stroke-related mortality.
Option D: Treatment for stable angina is geared toward reducing risk factors for presumed underlying coronary heart disease. An interdisciplinary approach would likely benefit individuals with multiple comorbidities; nutrition, diabetic educator, addiction counselor, physical and occupational therapy.
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