Myocardial Infarction & Peripheral Vascular Diseases Q 50 - Gyan Darpan : Learning Portal
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Sunday 24 April 2022

Myocardial Infarction & Peripheral Vascular Diseases Q 50

The physician orders continuous intravenous nitroglycerin infusion for the client with MI. Essential nursing actions include which of the following?
     A. Obtaining an infusion pump for the medication.
     B. Monitoring BP q4h.
     C. Monitoring urine output hourly.
     D. Obtaining serum potassium levels daily.

Correct Answer: A. Obtaining an infusion pump for the medication.

IV nitro infusion requires an infusion pump for precise control of the medication. When administered as a drip in the emergency room or ICU, its effects are often very closely monitored via an arterial line for real-time blood pressure monitoring. This vigilance is necessary to maximize the effectiveness of the drip and provide rapid feedback on the patient’s condition.

Option B: BP monitoring would be done with a continuous system, and more frequently than every 4 hours. The drip is frequently used to treat acute coronary syndromes, hypertensive emergency, and acute congestive heart failure (CHF) exacerbations. When administered, its effect requires tight monitoring. Some patients can be more sensitive to the hypotension caused by nitrates, which can result in nausea, vomiting, diaphoresis, pallor, and collapse even at therapeutic doses.
Option C: Hourly urine outputs are not always required. Nitroglycerin is both a protein-bound drug, and undergoes hepatic metabolism. Therefore it has numerous drug interactions. Before prescribing, providers should determine if the patient is taking any medications that may interact with nitroglycerin. Common interactions include alteplase, heparin, tricyclic antidepressants, and other anticholinergic drugs. Alcohol intake should also be limited.
Option D: Obtaining serum potassium levels is not associated with nitroglycerin infusion. Any testing does not currently monitor nitroglycerin levels as its half-life is approximately 2 to 3 minutes, and the drug undergoes rapid metabolism from the body. Continuous monitoring of blood pressure, heart rate, respiratory rate, and oxygen saturation is recommended.

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