What should you assess before giving Nitroglycerin to your chest pain patient?

Question

You get a 42-year-old male patient from the ED who has presented with chest pain. The doctor has prescribed nitroglycerin sublingual tablets to be given, (0.4mg per 5 minutes up to 3 times). What should you assess before giving him his medication?

Answer 1

Double-check for allergies like nitrates, or other medication interactions like viagra, Levitra, sildenafil etc, if possible. Usually, it's hard to do during an emergency, but in this case, it is a doctor's order.

Prior to administration always check vitals (including pain level) prior to administration! Hold it for hypotension or bradycardia, including severe tachycardia. Immediately inform the doctor if you feel you should hold the medication due to abnormal vitals.

Also be sure to educate your patient on how sublingual tabs work prior to or during administration, as well as what to expect such as tingling during or after taking the medication.

Be sure to reassess pain and VS before administering the next dose. If the pain as subsided or been resolved, let the doctor know before giving the second dose. It is important to do this before the 5min is up.

FYI: Even though it is an order from the doctor, nurses will usually not give more than 3 tabs within 15 minutes regardless.

Always, store the medication in a light-protected area/vial. Also educate your patient on medication, side effects, storage, dosing, and administration as well as causes and prevention of angina.

Answer 2

Prior to administering nitroglycerin to a 42 year male patient, the nurse should asses the patient’s blood pressure. Since the patient is male, he should also be assessed for having recently taken male enhancement drugs such as sildenafil (Viagra) due to a severe interaction they can result in severe hypotension.