A patient has been newly diagnosed with stable angin
a. He tells the nurse he knows a lot about his diagnosis already because his father had the same diagnosis 15 years ago. The nurse asks him to state what he already knows about angina. Which of the following responses by the patient indicates the need for additional education?
a. He should stop smoking.
b. He can no longer drink colas or coffee.
c. He can no longer get a strong back massage.
d. He should take stool softeners to prevent straining.
C
Longer term education of the patient and the family can begin. Points to cover include (1) risk factor modification, (2) signs and symptoms of angina, (3) when to call the physician, (4) medications, and (5) dealing with emotions and stress. It is essential to teach avoidance of the Valsalva maneuver, which is defined as forced expiration against a closed glottis. This can be explained to the patient as "bearing down" during defecation or breath holding when repositioning in bed. Relaxation therapy and techniques including back rubs are encouraged when appropriate.
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