A patient with diabetes is surprised to learn that he has been having angina when the only problem he has been experiencing is a "bit of fatigue and shortness of breath."
Which of the following should the nurse explain to this patient? 1. fatigue is the first symptom of angina
2. shortness of breath is the first symptom of angina
3. the diabetes has caused you to have reduced pain sensitivity so the fatigue and shortness of breath were the symptoms that you felt
4. there is no classic symptom of angina
3
Rationale: Not all patients with altered myocardial tissue perfusion have classic anginal chest pain symptoms. Diabetics are especially prone to having silent ischemia and usually present with shortness of breath and fatigue because of the microvascular changes associated with diabetes leading to neuropathies and decreased sensitivity to pain. There are classic symptoms of angina.
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