Date of Scholarly Project Submission

5-2021

Degree Type

Scholarly Project

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

Faculty Chairperson

Kristi Robinia PhD, RN

Second Committee Member

Katie Menard PhD, RN

Third Committee Member

Terry Durley DNP, MPA, CRNA, FNP-C

Abstract

Nitroglycerin (NTG) is medication used to reduce chest pain (Boden et al., 2015) and is the suggested analgesic for angina associated with ST elevation myocardial infarction (STEMI) (de Alencar Neto, 2018). Due to the potential for right ventricular (RV) infarct and hemodynamic collapse in inferior STEMI patients (Nagam, Vinson, & Levis, 2017), the American Heart Association (AHA) recommends avoidance of NTG in patients with suspected RV infarct (Antman et al., 2004). The purpose of this DNP project was to explore the safety of NTG use in the treatment of patients diagnosed with STEMI by evaluating the effects of NTG on hemodynamic measures and angina. Data were collected via a retrospective chart review at a rural Midwestern hospital and analyzed via Fisher’s Exact and multiple linear regression analyses. There were no significant differences between STEMI groups for occurrence of hypotension (p=0.521), bradycardia (p=0.064), medical need for hemodynamic support (p=0.530), or cardiac arrhythmia (p=0.465). For this sample of patients, the results show no difference in adverse occurrences between patients who received NTG with a diagnoses of inferior STEMI versus patients who received NTG with a diagnoses of non-inferior STEMI. A recommendation is that patients with identified inferior STEMI receive a right-sided ECG to evaluate for RV infarct (Bischof et al., 2018), in order to guide individualized patient care including the use of NTG, which was shown to significantly reduce chest pain in this sample of patients (p<0.001).

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