MEDizzy - A client admitted to a telemetry unit with a diagnosis of

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Physiological Integrity and Developmental Needs

A client admitted to a telemetry unit with a diagnosis of Prinzmetal’s angina, has the following medications ordered. Upon interpretation of the client’s electrocardiogram (ECG) rhythm, the nurse notes a prolonged PR interval of 0.32 second. Based on this information, which medication order should the nurse question administering to the client?

ExplanationAtenolol, a beta-blocker, blocks stimulation of beta1 (myocardial)- adrenergic receptors, causing a reduction in blood pressure and heart rate. A side effect of the medication is a prolongation of the PR inter- val (normal PR interval is 0.12 to 0.20 second). Continued use of the drug can result in heart block. Nitrates and calcium channel blockers (CCBs) are the mainstays of medical therapy for variant angina rather than beta blockers. Isosorbide mononitrate, a nitrate, causes vasodilatation of the large coronary arteries. Nitrates act as an exogenous source of nitric oxide, which causes vascular smooth muscle relaxation resulting in a decrease in myocardial oxygen consumption and may have a modest effect on platelet aggregation and thrombosis. Amlodipine, a CCB, relaxes coronary smooth muscle and produces coronary vasodilation, which in turn improves myocardial oxygen delivery. Nitroglycerin sublingual effectively treats episodes of angina and myocardial ischemia within minutes of ad- ministration, and the long-acting nitrate preparation (Imdur®) reduces the frequency of recurrent events.