Question

Gene Cooper is a 56-year-old accountant who is being evaluated at the cardiology clinic for angina. He is 6 feet tall and weighs 260 lb, with a waist measurement of 40 inches. He has a history of hypertension, for which he has been prescribed a thiazide diuretic. He admits that he has not been taking the medication lately. His blood pressure upon this visit is 156/94 mm Hg. He smokes one pack per day. His LDL cholesterol level is 187 mg/dL. He has no history of diabetes, and his fasting glucose level is within normal limits. He states that he “works out at the gym” 3 days per week. He admits to episodes of midsternal chest pain accompanied by dyspnea and diaphoresis and associated with activity that is usually relieved with rest. He states that these episodes have been increasing in frequency, occurring once or twice weekly.

1. The nurse is teaching Mr. Cooper about nonpharmacologic management of his angina. What measures can he take to reduce his risk?

2. Mr. Cooper is given a prescription for sublingual nitroglycerin tablets to use as needed for chest pain and isosorbide mononitrate to take daily. He asks why he needs two prescriptions. How should the nurse respond?

3. Mr. Cooper continues to experience episodes of angina despite treatment with the nitrate. He is given a prescription for ranolazine. He asks whether he can stop taking the nitrate now. How should the nurse answer this question?

Answer 1

1 .He has history of smoking, hypertension and incresed cholestrol level. His BMI is also high. So non pharmacological intervention are following:

• Avoid smoking. Smoking is one of important etiology of angina pectoris.
• Regular physical activity more than 30 minutes. Initially walking. It reduces the cholestrol, high blood pressure.
• Include fiber containing food such as green leafy vegetables, fruits which eliminate cholestrol in blood.
• Drink large amount of fluid.

2.