Establish Goals:
Our patient with STEMI was experiencing rapid breathing and central chest discomfort. The patient exhibits rapid breathing and pain in the center of the chest; this could be the pain associated with non-ST segment elevation myocardial infarction (NSTEMI), and vital signs have shown tachycardia, high blood pressure, and high breathing rate. In this case, SMART goals would be:
1. Specific:
The patient must experience decreased rapid breathing and report improvement in chest pain within 4 hours.
2. Measurable:
The patient's respiratory rate falls to stable breathing rate of 16–20 breaths per minute and pain is reduced to 3/10 or less on the pain scale.
3. Attainable:
Administer prescribed medications that is glyceryl trinitrate (GTN) and morphine to reduce pain and improve breathing.
4. Relevant:
Along with medication the nurse should ensure pain and anxiety control as it is crucial to stabilize the patient and prevent further cardiac damage.
5. Time-based:
Reassess the patient's respiratory rate and pain level at every hour to achieve desired outcomes within next 4 hours.
The nurse should closely monitor vital and physical signs and administer medications as prescribed and keep assessing the patient's respiratory rate, pain level, and overall well-being time to time. The nurse must adjust the care plan if outcomes are not achieved.
Take Actions:
Two evidence-based nursing interventions to acquire SMART goals for NSTEMI patients with tachypnea and chest pain:
Administer Glyceryl Nitrate GTN:
As per the prescription of our patient, he is given Glyceryl nitrate with the formula Nitroglycerin which is a vasodilator that relieves chest pain by dilating coronary arteries, which increasing myocardial blood flow, and reduce myocardial oxygen demand. It is evidenced by several researches that that timely administration of nitroglycerin can relieve angina symptoms and improve reduce pain efficiently (Ibanez et al., 2017).
American Heart Association and the European Society of Cardiology supports the use of GTN, because it reduces myocardial ischemia, lower blood pressure and relieve angina pain, making it a cornerstone of first-line treatment of acute coronary syndromes (ACS) (Ng et al., 2024).
Komaki et al. (2024) stated that GTN use prior the Percutaneous coronary intervention or PCI for ACS is associated with lower blood pressure in elderly patients. Thus, clinical guidelines are necessary for immediate relief of chest pain. This intervention is evidenced by randomized controlled trials where its effectiveness is proven in reducing chest pain and improving patient outcomes for NSTEMI.
Pain Relief with Morphine:
Morphine is analgesic that is also used for treating severe chest pain in NSTEMI patients. As per our patient prescription he was also prescribed this drug, along with pain it also relieves anxiety which helps in slowing the respiratory and heart rate (Ghadban et al., 2019).
Morphine also reduces myocardial oxygen demand, decrease vasodilation and preload, thereby reducing pain and discomfort. Studies have shown that morphine may improve patient outcomes by stabilizing hemodynamic status and reducing myocardial oxygen consumption (Furtado et al., 2020).
However, it should be carefully administered, balancing the pain relief against potential risks and strictly following the clinical guidelines that recommend morphine when other pain management strategies are not working (Stiermaier et al., 2021).
