Interventions for Unstable Angina

This document discusses the appropriate interventions for patients with unstable angina and provides a rationale for each intervention. It covers topics such as assessing airway patency, administering oxygen therapy, monitoring vital signs, and providing psychological support. The document also includes information on diagnostic findings and investigations.

Assignment 4 Template
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List all the appropriate interventions in order of priority (be specific).
1. Assess airway patency and any signs of risk of obstruction
2. Oxygen therapy
3. Monitor vital signs every 5 minutes
4. Administer analgesics promptly as indicated
5. Proper positioning of the patient
6. Place the patient at complete rest during a chest pain episode
7. Maintain a quiet, comfortable environment. Limit visitors when necessary
8. Assess and document patients response to the medication
9. Provide psychological support to the patient
10. Identify precipitating events and if any, note the frequency, duration,
intensity, and location
11. Observe for any associated symptoms and signs
12. Gather relevant information on the past medical and surgical history of the
patient
13. Laboratory investigation and diagnostic findings.

Patients diagnosed with unstable angina have higher chances of acute life-
threatening dysrhythmias, which results due to response to ischemic alteration
and/or stress (Edmondson, et.al, 2012).
Provide a rationale for these interventions in order of priority (1500 words)
1. Assess for airway patency and any risk of obstruction.
Unattended airway obstruction causes low Partial pressure of oxygen with the
risk of oxygen deprivation to the brain tissues, kidneys and heart, cardiac
arrest, and even death (Peter, 2016). Assessing the patient’s ability to speak
fluently and swallow is helpful in assessing airway patency. If the patient is not
able to speak fluently then it indicates airway compromise (Ten Hoorn, et.al,
2016).
Nursing intervention includes; eliminating ant obstruction, for example
sanctioning if secretions are the once causing obstruction. Also, intubation can

be done in cases where the patient is at risk of obstruction for example in
cases of airway oedema (Abdi et.al 2015).
2. Oxygen therapy
Chest pain can impair the normal breathing mechanism and oxygen supply.
This is because pain limits proper chest and lung expansion and therefore
decreased oxygen intake (Weinberger, Cockrill, & Mandel, 2017). Oxygen
supplement to the patient via a rebreather mask or nasal prongs helps to
increase the amount of oxygen reaching the tissues and organs. With these,
there is effective elimination carbon IV oxide which might have otherwise
accumulated in the tissues. When this happens, the central respiratory centre
senses the decrease in levels and triggers the external intercostal muscles to
reduce the rate of breathing to normal. This lowers respiratory effort, makes
the patient relax and minimum energy is used during breathing. Oxygen
saturation rate should be monitored continuously (Hofmann et.al 2017).
3. Monitor vital signs every 5 minutes
Vital signs are used to identify a predisposition to a disease or disorder
(Gibson, et.al, 2015). It is also an indicator to determine the proper dose of
medicine to be administered. It is also an indication of improvement or
deterioration before or after an intervention. Sympathetic stimulation causes a
rise in blood pressure initially and then blood pressure can fall when cardiac
output is altered. Tachycardia also occur due to to sympathetic stimulation and
may be maintained as a compensatory response if cardiac output drops.
Therefore, close monitoring is very important as any changes in patient’s
condition can be detected early and appropriate interventions started to avoid
complications and even death (Atherton et al 2018).

4. Administer analgesic medications promptly as indicated
Mrs Fitzgerald has a pain score of 7/10. According to Byrne (2014), pain and
lowered cardiac output may trigger the sympathetic nervous system to release
norepinephrine in increased amounts. Norepinephrine causes an increase in
platelet aggregation and thromboxane A2. This potent vasoconstrictor causes
coronary artery spasm, which can fasten, complicate, and/or prolong an angina
attack. Intense pain may cause a vasovagal response (Friedman, & Alexander,
2013), decreasing blood pressure and heart rate (.
The nurse should assess the severity of pain before interventions are started.
Characteristic of pain is also important in diagnosis, for example, if it is
radiating to the arm and jaw it can indicate angina. Aggravating and alleviating
factors are also important. Performing a pain scale helps to know appropriate
analgesic that will be helpful to the patient. This is because analgesics come
with different strength of pain-relieving properties. Paracetamol is used to
manage mild pain and morphine for severe pain (Chew et.al 2016).
Morphine sulfate is a potent narcotic analgesic that is widely used in the
management of severe pain (McCarthy, et.al, 2016). It has many benefits
which include; reduction in myocardial workload, peripheral vasodilation,
interruption of the flow of catecholamines which cause vasoconstriction,
produce a relaxation effect through sedation and finally pain relieve. It is given
IV for quick action and since lowered cardiac output alters peripheral tissue
absorption. Nitric oxide is a potent vasodilator and is also important in
relieving chest pain. It does so by increasing blood supply to the chest tissues
and organs (Bellchambers, Deane and Pottle 2016).
Antihypertensive medication can also play an important role in pain
management. Antihypertensive drugs such as nifedipine reduce blood pressure

by acting as vasodilators reducing peripheral vascular resistance and lowering
blood pressure (Laurent, 2017). With these actions, there is increased blood
flow to the muscles and subsequent oxygen supply hence pain reliever. Chest
pain commonly occurs due to ischemia of the tissues and increased blood
supply is one of the interventions.
5. Proper positioning of the patient
Patients experiencing chest pain would prefer certain positioning (Magee,
2013). The patient should be positioned to sit upright in a chair with pillows to
support. The feet should be fixed flat on the floor and chest leaned forward a
little. The elbows should be placed to rest on the knees and let the patient
relax their neck and shoulders as much as they can. This positioning allows
proper chest expansion and alleviates chest pain. This will allow the patient to
breathe at ease and decrease breathing effort. If the patient is placed in this
position and still feels uncomfortable, the patent can be asked to stay in a
position that makes them more comfortable. High semi Fowler's position is
usually preferred as it relieves chest compression by abdominal organs. With
this position, the patient is more relaxed and chest expansion is facilitated.
6. Place the patient at complete rest during chest pain episodes.
Rest reduces myocardial oxygen demand to minimize the risk of tissue
injury/necrosis. It also reduces energy consumption and helps the patient
relax. Drugs administered work best when the patient is relaxed and not
agitated.
7. Maintain a quiet, comfortable environment. Restrict visitors as necessary.
Mental and emotional stress increases myocardial workload. A noisy
environment can trigger anxiety. This will activate the sympathetic nervous

system to increase heart rate and breathing rate of the patient. This may
further increase the pain experienced as more oxygen is consumed than
oxygen intake. The patient should also be encouraged not to talk unnecessarily
in order to conserve energy.
8. Assess and document patient response to the medication
Medication response provides information about disease management
progression. Aids in evaluating the effectiveness of interventions, and may
indicate the need for change in the therapeutic regimen. Any abnormal
response to medication should be reported as some patients may have an
allergic reaction not otherwise mentioned before.
9. Psychological support
Presence of a nurse can reduce feelings of fear and helplessness. The patient
should also be educated on the cause of the pain so that she can understand
the disease condition. She should also be informed about the aggravating
factors and relieving factors of pain and what she is supposed to do when pain
episodes occur. With a clear understanding of their conditions, patients tend to
cope well with their condition and episodes of anxiety are greatly reduced.
Collaborative management can be involved at this point for example involving
doctors and counselors (Thomsett and Cullen 2018).
10. Identify precipitating event, if any; frequency, intensity, duration, and
location of the pain.
Helps differentiate this chest pain, and aids in evaluating possible progression
to unstable angina. (Stable angina usually lasts 3 – 15 min and is often relieved
by sublingual nitro-glycerine (NTG) and rest; unstable angina usually occurs
without prediction, lasts longest and the pain is more severe. Main relievers

are nitrogen glyceride use and rest. Knowing these factors will help the patient
avoid them and prevent episodes of chest pain occurrence. Also, appropriate
relieving factors that the patient is comfortable with can be put into place.
11. Observe for associated symptoms.
The decrease in cardiac output which may be due to during ischemic
myocardial episode triggers the parasympathetic and sympathetic nervous
system, leading to various vague sensations that patient may not recognise as
related to angina episode. These symptoms may manifest as dyspnoea,
palpitations, nausea and vomiting and desire to micturate. Observation of
these signs and symptoms will help to manage the patient accordingly
(O'Donovan 2013).
12. Information on any past medical and surgical history
Gathering information on the past medical history of the patient especially
information related to current chest pain is important (Bickley, & Szilagyi,
2012). How the pain was managed and the outcome helps to deduce whether
the condition has worsened or improved and it helps to implement
appropriate measures. Any surgical interventions, especially in the chest
region, are helpful to relate the cause of chest pain. They also help to direct
diagnostic procedures to be carried out and making it easier to manage the
patient.
13. Investigations and Diagnostic Findings
ECG: Usually normal when the patient is resting or when pain-free; T wave
inversion or depression of ST segment signifies ischemia (de Luna, et.al, 2014).
It can also signify heart block and dysrhythmias. In addition, Q waves show that
the patient had myocardial infarction earlier (Wang, et.al, 2013).

24-hour ECG monitoring: this is done to deduce whether chest pain is related
to exercise and activity or something else. When the ST segment is depressed
when there is no pain, it indicates ischemia (Sandhu, Heidenreich,
Bhattacharya and Bundorf 2017).
Cardiac enzymes (CPK, AST, CK, and CK-MB; LDH and isoenzymes LD1, LD2):
they are at normal levels in a healthy individual. Any elevation indicates that
the patient has myocardial infarction.
Chest x-ray: infiltrates may be observed which indicate that the patient has
cardiac decompensation or pulmonary complication. The chest is clear in a
normal individual.
Pco2, potassium, and myocardial lactate: when the patient has angina, the
levels are elevated higher than the normal levels.
Echocardiogram: this can indicate causes of chest pain which may include
abnormal valvular action.
Cardiac catheterization with angiography: this is the definitive test to confirm
CAD especially in patients experiencing ischemia with unknown cause and
chest pain of unknown origin (Ponikowski, et.al, 2016). It can also be beneficial
for patients experiencing abnormal ECGs and any heart disease that runs in the
family. Abnormal results from this test indicate ventricular failure, altered
contractility, valvular disease, and circulatory abnormalities. Research has
confirmed that 10 percent of patients with unstable angina have coronary
artery abnormalities (Hassan, et.al, 2014).

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