Overview
This video provides step-by-step guidance on administering sublingual nitroglycerin tablets and oral spray for chest pain, emphasizing safety protocols, patient monitoring, and dosing limits.
Purpose and Action of Nitroglycerin
- Nitroglycerin is used to relieve or treat chest pain by causing vasodilation, increasing blood flow to the heart, and decreasing cardiac workload.
- It is part of the nitrate family and can cause side effects like facial flushing, tingling under the tongue, headache, dizziness, and hypotension.
Preparation and Safety Precautions
- Always follow hospital protocols, manufacturer’s instructions, and ensure proper credentials before administration.
- Confirm the patient is not allergic to nitroglycerin and has not recently used phosphodiesterase inhibitors (e.g., sildenafil or tadalafil).
- Do not administer to patients with increased intracranial pressure.
- Perform hand hygiene, follow the “5 rights,” and wear gloves to avoid absorbing medication through the skin.
Administration of Sublingual Nitroglycerin Tablets
- Tablets come in a dark vial, sensitive to light, heat, and moisture, and are good for 3 months after opening.
- Seat the patient, obtain baseline vitals (especially BP), and confirm systolic BP is above 90 mmHg.
- Place one tablet under the tongue without chewing, swallowing, or rinsing the mouth; monitor for tingling and absorption.
- Continuously monitor BP and chest pain; if pain persists and BP remains adequate, give up to two more doses at 5-minute intervals (max three doses).
- If pain is not relieved after three doses, notify the physician.
Administration of Nitroglycerin Oral Spray
- Remove cap and prime new bottles by spraying 5–8 times away from faces.
- Do not shake or invert the spray bottle; store upright and away from heat/light.
- Administer one spray under the tongue, instructing the patient to slightly hold their breath and not inhale.
- Advise the patient not to rinse, eat, or drink for at least 10 minutes post-spray.
- Follow the same dosing and monitoring protocol as tablets (max three doses at 5-minute intervals).
Monitoring and Documentation
- Regularly monitor and document blood pressure and chest pain intensity throughout administration.
- Use cardiac monitoring if available to observe for changes in rhythm or ST segment abnormalities.
Decisions
- Maximum of three nitroglycerin doses should be administered; contact physician if chest pain persists after third dose.
Action Items
- TBD – Nurse: Monitor patient’s blood pressure and chest pain continuously during and after nitroglycerin administration.
- TBD – Nurse: Notify physician if chest pain persists after three doses or if systolic BP falls below protocol threshold.