Standing orders for chest pain Standing orders for chest pain - pg.4 | allnurses

Standing orders for chest pain - page 5

Does anyone have standing orders or a practice guidline for pts with chest pain at thier facility? It seems to me that pts get faster care for chest pain if they out in the community than if they... Read More

  1. Visit  GoNightingale profile page
    #39 0
    Quote from nursej22
    ST and T wave abnormalities can appear chronically, that is why enzymes and other testing is usually done (echo, stress test), and having an old 12 EKG can be valuable for comparison.
    T wave inversion can be seen post MI and may continue, but usually resolves after several weeks. It is also seen in RBBB.
    ST depression and T wave inversion may appear in left ventricular hypertrophy or volume overload of the left ventricle. You will usually also see increased voltage in the precordial leads.
    Most 12 lead classes that I have been to say that ischemia cannot be seen on a 12 lead in a patient with BBB, a pacemaker or LVH.
    Digitalis toxicity can also result in ST-T wave abnormalities.
    Thank you nursej22. Great Information. I don't exactly know where my career path is going to take me, but I really want to get involved with Cardiac. LOVE IT.....!
    Think I'm going to start by taking a 12-lead class.
  2. Visit  CCL RN profile page
    #40 0
    Quote from GoNightingale
    . Pt. complains of MI, whether symptomatic or not, I call the doctor because in the long run, it's the nurse that gets dinged if the pt. had an MI and didn't call the doctor.
    Pts rarely, if ever, c/o of an "mi"

    MIs that are missed are those that complain of nausea, indigestion, DB/SOB, shoulder pain, etc, etc. In fact, lots of NSTEMIs present with very vague symptoms. Many do not get troponins drawn, or only have one set and they are negative. Many have angina, but no real damage, no troponin bump, and s/s so vague that they don't even consider cardiac.

    Recently, we had a NSTEMI, with a very mild troponin bump. Still <1.0. Pt was ambulating and feeling fine. Came in feeling like he had the flu. The flu has been really running around our hospital lately...
    Anyhow, we almost didn't cath him because he didn't look like a "real case"
    He had triple vessel disease, with his left main, (left main!!!) hanging on by a thread.

    Anyway, my rambling point was, MIs can be insidious. They may lurk and look like something completely different. You'd be surprised how easily they can be missed...
  3. Visit  GoNightingale profile page
    #41 0
    Quote from CCL RN
    Pts rarely, if ever, c/o of an "mi"

    MIs that are missed are those that complain of nausea, indigestion, DB/SOB, shoulder pain, etc, etc. In fact, lots of NSTEMIs present with very vague symptoms. Many do not get troponins drawn, or only have one set and they are negative. Many have angina, but no real damage, no troponin bump, and s/s so vague that they don't even consider cardiac.

    Recently, we had a NSTEMI, with a very mild troponin bump. Still <1.0. Pt was ambulating and feeling fine. Came in feeling like he had the flu. The flu has been really running around our hospital lately...
    Anyhow, we almost didn't cath him because he didn't look like a "real case"
    He had triple vessel disease, with his left main, (left main!!!) hanging on by a thread.

    Anyway, my rambling point was, MIs can be insidious. They may lurk and look like something completely different. You'd be surprised how easily they can be missed...
    Thanks so much for your input. Definitely was not rambling. You are right on target. I meant to say c/o chest pain not MI. But either way, your answer is right on target.

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