Question

Mr. Johnson a 80 yo male who is being admitted for a possible MI after he had taken his 3 sublingual pills of Nitroglycerin (NTG) without relief of his chest pain. In the ED his chest pain was relieved with an intravenous solution of nitroglycerin. However, all is lab work and ECG came back negative for MI.

He will be weaned off of his IV nitro and started on NTG transdermal patches 10mg/24 hrs. He will also be prescribed diltiazem 30mg once a day.

1. How are you the RN going to wean the NTG solution off, and place the NTG patch?

2. When will you give him his first dose of diltiazem?

3. He has a question for you about why his NTG pills at home may not have worked? Based on what you know about NTG tablets explain why his tablets may not have worked.

4. Mr. Johnson is told to only wear the NTG patch for 12 hrs at a time. Why?

5. Mr. Johnson states that he will probably not need any more NTG tablets again. What do you want to tell him? 6. What side effects to you want to warn him about with the diltiazem?

Answer 1

1). To remove the IV nitro, the nurse must perform hand hygiene, put on gloves (non-sterile) and remove the dressing carefully. A piece of sterile gauze or cotton wool must be placed over the exit site without applying the pressure and withdraw carefully and slowly.

Before placing the NTG patch (nitroglycerine patch), a clean site without hair must be selected, the site is free of scars, cuts, or irritation, Handwashing must be done prior to and after applying the patch.