Dr. Marquez orders a continuous intravenous nitroglycerin infusion for the client suffering from myocardial infarction. Which of the following is the most essential nursing action?
A. Monitoring urine output frequently
B. Monitoring blood pressure every 4 hours
C. Obtaining serum potassium levels daily
D. Obtaining infusion pump for the medication
Correct Answer: D. Obtaining infusion pump for the medication
Administration of Intravenous nitroglycerin infusion requires a pump for accurate control of medication. There are intravenous (IV) routes of administration for nitroglycerin used most commonly in emergency rooms and intensive care units (ICU). It is administered as a 5% dextrose in water drip and is indicated when sublingual nitroglycerin has failed to provide symptomatic relief or if rapid and continued relief of symptoms is necessary. When administered, its effect requires tight monitoring, as discussed below.
Option A: There is no indication to monitor urine output frequently. In the event of overdose, monitoring of vital signs may be necessary to monitor the hemodynamic effects of nitroglycerin. Continuous monitoring of blood pressure, heart rate, respiratory rate, and oxygen saturation is recommended.
Option B: Blood pressure must be monitored regularly, but it is not the most essential action. Any testing does not currently monitor nitroglycerin levels as its half-life is approximately 2 to 3 minutes, and the drug undergoes rapid metabolism from the body. When administered as a drip in the emergency room or ICU, its effects are often very closely monitored via an arterial line for real-time blood pressure monitoring. This vigilance is necessary to maximize the effectiveness of the drip and provide rapid feedback on the patient’s condition.
Option C: Monitoring serum potassium levels daily is unnecessary. Nitroglycerin is both a protein-bound drug and undergoes hepatic metabolism. Therefore it has numerous drug interactions. Before prescribing, providers should determine if the patient is taking any medications that may interact with nitroglycerin.