this is Sara threats Turner sorry and calm and in this video I'm going to be going over sublingual nitroglycerin and the oral spray and I'm going to show you how to administer it now remember whenever you administer nitroglycerin you always want to follow your hospital protocols for this medication along with the manufacturer's instructions and always be sure you have the proper credentials when administering this medication and for this video we are using demo dose doses of nitroglycerin so it's a simulated dose and these do not really contain nitroglycerin so what does nitroglycerin use for it's used to relieve or treat chest pain and nitroglycerin is part of the nitrate family and because of this what it does is it causes vasodilation on those blood vessels so you have a patient they're having chest pain they're getting limited amount of blood to that heart muscle and what nitroglycerin will do open up those vessels and increase the blood supply to that heart tissue along with decreasing its workload so as a nurse what do you expect to see in your patient after you give them this drug well you can expect to see facial flushing from where they're getting increased blood flow through the body from that vasodilation they can also experience like a burning or tingling sensation underneath the tongue whenever you give this sublingual the tablets you will put underneath the tongue and the spray you will spray under the tongue as well also it can cause a very painful headache from all the extra blood flow they can experience dizziness and definitely hypotension it's going to lower the blood pressure so when your patient is having chest pain as the nurse of course you want to notify the physician and a lot of hospitals already have standing orders there for you to follow out they're usually called chest pain protocols and you will have this order set that you need to do for your patient which will include you know giving the nitroglycerin possibly morphine if the Nitro is not really helping along with oxygen administer via nasal canula of 20 obtaining a 12-lead EKG and drawing cardiac enzymes so before you administer a nitroglycerin to your patient of course you want to confirm that they are not allergic to it and that they haven't recently taken a phosphodiesterase inhibitor like sadena fill which is viagra or $2.00 fill which is cialis because this can lead to severe hypotension and possibly even death and of course you don't want to give this to a patient who has increased intracranial pressure then you'll want to perform hand hygiene perform the patient's 5 right and whenever handling nitroglycerin you want to wear gloves because if you get this on yourself you can give yourself some nitroglycerin and you can get some of the side effects that come along with this drug so first let's talk about sublingual nitroglycerin okay it comes in a dark vial and this vial is dark for a reason because nitroglycerin is very sensitive and it doesn't need to come into contact with white or heat or moisture and it's only good for three months when the bottle is opened and then you're gonna have the patient sat down before administering this to them because remember it can cause dizziness and hypotension and you want to obtain baseline vital signs especially blood pressure because you're gonna see a decrease in their blood pressure and you want to confirm that their systolic blood pressure is within parameters and most Hospital protocols require that that's a solid blood pressure that top number is greater than 90 and if it's not and your patients having chest pain you need to contact the physician for further orders and preferably you want them on a cardiac monitor so you can be monitoring that rhythm looking at the ST segment for normalities like St elevation or depression to administer you will place one tablet under the tongue so how the patient lifts the tongue up and it will dissolve under there the patient does not need to chew it or swallow it and not to rinse the mouth because they may feel like they need to do that whenever they have the tablet under the time because of the tingling sensation and it's going to absorb within that lining there and after giving the tablet you'll want to make sure that you're constantly monitoring their blood pressure especially that's systolic making sure it's greater then 90 and their chest pain how is it rated is it increasing is it decreasing is it going away and if their systolic blood pressure is still within parameters and they're still having chest pain you can do a second dose within five minutes again monitoring that blood pressure and their chest pain and the chest pain is still there you can give a third dose within five minutes now you do not want to get more than three doses and if the chest pain is still not relieved after the third dose you'll want to notify the physician now with the oral nitroglycerin spray what you want to do is of course remove the cap on the bottle and if this is a new bottle you'll want to prime it and a lot of times in the hospital setting and you're going to be using a new bottle of nitroglycerin and to prime it you're going to press the button to spray about five to eight times just to get that line in there nice and primed and whenever you do that tip keep it away from your face and other people's faces you don't want to inhale this so we're gonna probably about five to eight times all right okay and then it's ready to use and another tip with this spray is that you don't want to shake the bottle up and down remember nitroglycerin is very sensitive and it's in a dark bottle so keep it away from heat and light and keep it in the upright position at all times you don't want to store it upside-down and to give the world nitroglycerin spray you're gonna give one spray underneath the tongue and tell the patient to slightly hold their breath and not to breathe in the medication now after giving the oral spray you'll want to make sure that the patient doesn't rinse their mouth or eat or drink anything for at least ten minutes and you'll follow the same protocol as you followed with the sublingual tablet by monitoring that blood pressure constantly making sure it's within parameters and monitoring their chest pain and within five minutes you can give a second dose and within five minutes you can give a third dose and no more than three doses okay so that is how you give sublingual nitroglycerin and oral spray thank you so much for watching and don't forget to subscribe to our channel for more videos