CHEST PAIN – Nurse’s Responsibilities

By: Ms. Shanta Peter

Chest Pain ------Emergency Room

INITIAL GOAL in is to identify life threats………. MI, PE, aortic dissection

Remember …..ABCs ………..always first

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?

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

Next 10 mins • Patient already stabilized, initial data

gathered, and initial orders carried out • Secondary survey: More detailed history and

physical examAddress patient’s pain…Goal now is to categorize patient

1) Chest wall pain- Musculoskeletal2) Pleuritic chest pain- Respiratory3) Visceral chest pain- Cardiac

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

Infarction

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

• 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

• 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?

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 !!!!!!!!!

• Patient C/O chest pain – in ward • Any area – Medical… Surgical…..

What you will do…………..???????