Mr. John Preston, a 52-year-old businessman, was admitted with chest pain; rule out myocardial infarction. He had experienced substernal chest pain and weakness in his arms after having lunch with a business associate. The pain had lessened by the time he arrived at the hospital. The Nursing history revealed that he had been hospitalized 5 months previously with the same complaints and had been told by his physician to go to the emergency department if the pain ever recurred. He had been placed on a low-fat diet and had stopped smoking. Physical examination revealed that Mr. Preston's vital signs were within normal limits. He stated that he had feared he was having a heart attack until his pain subsided and until he was told that his electrocardiogram was normal. He verbalized that he wanted to find out how he could prevent the attacks of pain in the future. The physician's orders on admission included activity as tolerated, low-cholesterol diet, and nitroglycerin 0.4 mg (1/500 gr) sublingually as needed
Acute Pain related to angina pectoris/rule out myocardial ischemia
Short-term: Relief of pain
Long-term: Altered lifestyle to include measures that decrease myocardial oxygen demands Compliance with therapeutic regimen
Monitor blood pressure (BP), pulse (P), respirations (R) q4h.
Assess frequency of chest pain and precipitating events.
Encourage food and fluid intake that promotes normal nutrition, digestion, and elimination and that does not precipitate chest pain: light, regular meals; foods low in cholesterol; 1,500 to 2,000 mL fluid/day.
Request consultation with dietitian. Reinforce diet teaching.
Encourage alterations in activities and exercise that are necessary to prevent episodes of anginal pain
Teach nitroglycerin regimen.
BP, P, R will remain within normal limits.
Patient will remain free from chest pain
Will tolerate dietary regimen.
Will not experience chest pain after meals.
Will maintain normal bowel elimination.
Will have intake of 1,500 to 2,000 mL fluid/day.
Will identify foods low in cholesterol and those foods that are to be avoided.
Will select well-balanced diet within prescribed restrictions.
Will identify activities and exercises that could precipitate chest pain: those that require sudden bursts of activity and heavy effort.
Will identify emotionally stressful situations; will explain the necessity for alternating periods of activity with periods of rest.
Actual Outcomes (Evaluation)
BP: stable at 116 to 122/72 to 84
P: stable at 68 to 82
R: stable at 16 to 20
Denies chest pain; able to walk length of hall, eat meals, and visit with family and friends without chest discomfort.
Denies chest pain after meals; no constipation or diarrhea; fluid intake 1,700 to 2,100 mL/day.
Dietitian reviewed diet restrictions with patient and wife; wife counseled in meal planning. Patient selects and eats a balanced diet consisting of foods low in cholesterol.
Patient and wife have identified activities and situations that should be avoided; patient and wife have studied their usual daily routine and have made plans to alter the routine to allow for rest periods; teenage son has volunteered to assist with strenuous home-maintenance chores.
Accurately stated action, use, and dosage of nitroglycerin; demonstrated correct administration.
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