Chest Pain : Immediate Nursing Interventions

Any category of patient get get chest pain, anytime. The first person to assess, identify and intervene the condition is Nurse.

1. CHEST PAIN – Nurse’s Responsibilities By: Ms. Shanta Peter

2. Chest Pain ------ Emergency Room INITIAL GOAL in is to identify life threats………. MI , PE, aortic dissection Remember …. .ABCs ……….. always first

3. Treat …. like his life is critical What do you do in the first 60 seconds ? How does the pt look? What are the pt’s vital signs? …………… EMS/ relative/friend’s story?

4. Next 5 mins ??? Brief History…….Brief Physical ( ABCs) What are 2 bedside tests that can be done to help stratify the patient ? *EKG * Portable CXR IV … Blood Investigations What is an important and cheap medication you should consider ? *ASA

5. Next 10 mins Patient already stabilized , initial data gathered, and initial orders carried out Secondary survey : More detailed history and physical exam Address patient’s pain …Goal now is to categorize patient Chest wall pain- Musculoskeletal Pleuritic chest pain- Respiratory Visceral chest pain- Cardiac

6. Role of EKG — GET AN EKG IN ALL CASES OF CHEST PAIN

7. Infarction

8. What Should You Do ? Bed rest Oxygen unless contraindicated (severe COPD) Chew ASPIRIN 325mg, regardless of if they “took one” earlier(Assess for active GI bleed) Anticoagulation Heparin LMWH

9. Pain Free…Morphine Sulfate 2 mg IV q5-10 min Maximize GTN therapy Minimize Oxygen Demand --O2 Sat Labs to be ordered CK with MB Troponin CBC PT/PTT within that admission Elect ,LFT if not known in last 24 hours Fasting profiles ---- Chest X-Ray

10. Questions to ask yourself Is my nursing approach is correct? Is the treatment is appropriate? Is my nursing care plan is appropriate ? Does my patient understand the treatment and care? Do I need help?

11. Caring your patient Talk to patient --- Examine patient and assess & document Obtain & review original documents …. DO NOT believe everything in the computer ? Consider – differential diagnosis Reassess …. Exam patient THINK !!!!!!!!!

12. Patient C/O chest pain – in ward Any area – Medical… Surgical….. What you will do…………..???????