A patient with a history of CHF is in respiratory distress with a blood pressure of 157/91 and respirations of 18. How much Nitro can be administered?

In the context of a patient with congestive heart failure (CHF) experiencing respiratory distress, nitroglycerin is often indicated to alleviate symptoms by reducing preload and myocardial oxygen demand. The standard dosing for nitroglycerin involves sublingual administration, and the typical dose is 0.4 mg. This dose is administered for acute management of angina or heart failure exacerbations, and it can be given every five minutes as needed, not exceeding three doses in 15 minutes.

Given the patient's blood pressure of 157/91, which indicates that the patient is somewhat stable hemodynamically, but still in distress, starting with the standard sublingual nitroglycerin dose of 0.4 mg is appropriate. This dose is effective in managing symptoms while being mindful of the need to monitor the patient's response, particularly in relation to their blood pressure and heart rate.

Administering a higher dose, such as 0.8 mg or above, may pose an unnecessary risk of hypotension or adverse effects, especially since the patient's respiratory distress could be exacerbated by excessive vasodilation. Therefore, 0.4 mg is both a safe and effective initial choice in this scenario.