Interventions for Unstable Angina

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