Question

Sublingual nitroglycerin is administered to a male client with unstable angina who complains of crushing chest pain. Five minutes later the client becomes nauseated and his bloods pressure drops to 60/40. Which intervention should the nurse implement?

Answer 1

In response to a drop in blood pressure after nitroglycerin administration for unstable angina, immediately stop the medication, position the patient supine, administer IV fluids or vasopressors if prescribed, provide oxygen, and notify the healthcare provider.

Step-by-step explanation:

When a patient with unstable angina experiences a significant drop in blood pressure and nausea after taking sublingual nitroglycerin, the nurse should immediately halt any further nitroglycerin administration and initiate emergency measures. The priority is to stabilize the patient's blood pressure and manage symptoms. The nurse should place the patient in a supine position to enhance blood flow to the brain, monitor vital signs closely, and prepare to administer intravenous fluids or vasopressors if ordered. Oxygen should be provided as needed, and the healthcare provider must be alerted immediately to the patient's change in status.

The primary concern in this situation is the patient's low blood pressure, which may indicate hypoperfusion to vital organs. Elevating the patient's legs may improve blood flow to the upper body. The nurse should also provide supplemental oxygen to address potential hypoxia. Administering IV fluids can help increase blood volume and improve blood pressure. Finally, notifying the healthcare provider is necessary to ensure appropriate management of the client's condition.