Questions about chest pain
0Jul 1, '12 by CandynHello Cardiac nurses,
I am a new grad and I have questions about chest pain.
For patients that have recurring chest pain, when is the time that you call and report to doctor to get EKG and Nitro order? Do you call every single time when they say chest pain?
For example: a patient that came with chest pain and had a work up done to rule out MI. With patient's previous admission, he had chest pain too. Another patient has constant chest pain after coded and bunch of CPR. What I was told is it is normal for patient to have chest pain after CPR and code before basically patient suffers from ischemia.
Thank you for responses
2Jul 1, '12 by airborneinf82Evaluate the type of pain. Is it new and/or different from the pain they came in with. Are the characteristics different and more in line with what one would expect with an MI? Is the person already having cardiac markers checked? Do they have SL nitro ordered? If given, does the pain go away? What about other pain relief alternatives? There's many questions to ask and to evaluate but mainly if it is not different than what they came in with I wouldn't be calling the doc every 30 minutes. Being new, the best thing you can do (and it seems you already are) is to consult with those more experienced on your floor and get their opinions. Maybe even have them come in and evaluate with you. If you are getting concerned you can always get an EKG.
As you seem to be learning, chest pain is more often not related to an MI. It can be respiratory or other host of issues. But just stay on top of your assessment with them and don't become complacent just because they are complaining of chest pain. Proper evaluation is important because the time you don't will be the time it is.
1Jul 1, '12 by Silverlight2010just agreeing with airborneinf82. good evaluation is important and checking with those who have the experience will help you expand your skills and benefit your patients. we have standing orders on my floor and we use them frequently. everything from o2 and nitro to ekgs and painkillers. we evaluate their pain, circumstances, response to treatment, what previous treatments they had and their effectiveness, and any ekg changes or change in patient condition. if something is significant, questionable, or is causing us concern then we call the resident or cardiologist.
someone who received cpr i would expect to have some chest discomfort at minimum (rare that someone doesn't have at least a little initally). i would include a detailed pain assessment as part of my initial assessment. do they have fractured ribs? how many and where? what have we been doing for this pain, how well is it working? were they defibrillated? how many times? any areas of skin breakdown or irritation from the pads? how are they overall? changes since admission? this gives me my baseline and helps me track changes in their condition.
we don't call for every chest pain but i also work on a cardiac unit. we expect chest pain (but we also keep in mind if there is another known reason for the pain such as pericarditis) when in doubt get an ekg. it doesn't hurt the patient and can help determine if something significant is happening. a patient with 3/10 chest pain relieved with nitro sl and o2 with no significant changes on his ekg, stable vitals and no further episodes won't have me on the phone to the doctor, but this is included on my shift report to be passed on to the cardiologist on rounds.
the patient that has significant ekg changes, the one that isn't responding to treatment or requires lots of treatment, frequent treatments, is becoming unstable...those have us making the calls no matter what time of day it is.
1Jul 1, '12 by newstudentrnI agree with Silverlight. I work on a cardiac floor and we deal with a lot of pts who come in with chest pain and are likely already having ROMI panels completed along with at least 2 good EKG readings before admittance to the floor. If this is the case and the pt has a cardiac consult ordered, we just have protocol orders for morphine, oxygen, nitro, and aspirin. Now, if this is a different type of pain or persistant, we go ahead and get another EKG. It never hurts the pt and a doctor will never chew you out for ordering one without their say so.
I would like to also say that you need to check with your facility/floor policy and be sure you are following it. It never hurts to ask your charge nurse for an opinion either.
0Jul 6, '12 by eatmysoxRNAgree with the above. As a new cardiac nurse myself, I have encountered the FF CP patients. I always take their pain seriously, but always ask if it is different than usual. Most of the time the patient will refuse nitro of any form and request Morphine since it is all that helps. It might be. Once I had a patient who had just had Morphine tell me that ice cream relieves his chest pain... I took him some ice cream, and he was all better (until his pain meds were available again)
0Jul 6, '12 by Esme12, BSN, RN Senior Moderator"candyn;6660937" hello cardiac nurses,
i am a new grad and i have questions about chest pain.
for patients that have recurring chest pain, when is the time that you call and report to doctor to get ekg and nitro order? do you call every single time when they say chest pain?
for example: a patient that came with chest pain and had a work up done to rule out mi. with patient's previous admission, he had chest pain too. another patient has constant chest pain after coded and bunch of cpr. what i was told is it is normal for patient to have chest pain after cpr and code before basically patient suffers from ischemia.
thank you for responses" end quote
this is where those critical thinking skills come into play. each situation is different. every patient with a cardiac history when first admitted and c/o chest pain should have a 12 lead done and the md called for further orders. if the pain is recurring depending on the orders you would get a 12 lead, give nitro, start o2, give pain rx, and labs according to the orders. you would call each time until instructed otherwise be the md.
a patient that has coded and received cpr would have chest pain but also obviously has cardiac issues. as you get to know the patient you will try to get them to discern which pain is their cardiac pain. pain after cpr/non cardiac pain will increase with palpation, movement, deep breath, usually will not radiate, and can be reproduced.
for chest pain....... i always tell my patients that their heart is not a part of any democracy....they are guilty until proven innocent....it's safer for them that way.