Triage Question

  1. 0
    Yes, this is technically homework help- but it's not for a grade it's for CEUs... which I actually don't need.

    I am a jobless new grad RN in California taking an emergency nursing certificate class to pad my resume and stimulate my brain. I would really appreciate help on the following assignment- I have already answered most of the questions, but I am think my responses might be overdramatic... not sure.

    I would really appreciate and feedback/help. Here's the assignment and my rough-draft answers....

    -------

    Patient History:
    A 33 year old man presented in the ED with complaints of a 2 hour history of mild mid-chest discomfort (3/10) when he coughs and has bilateral hand pain. He is a guitarist, has been playing a lot recently and wonders if that has anything to do with his complaints. He denies medical problems, is a vegetarian and appears to be in no distress.

    BP 120/70 HR. 74 RR 22 O2 Sat 98% Temp: 98.6 Oral

    Note: I know that you want more information on this patient but this is all you can obtain for now!

    What category would you give this patient & why? (Emergent-Urgent-NonUrgent)
    I would categorize him as emergent because he is complaining of chest pain. Until life-threatening causes are ruled out I will anticipate the worse case scenario. Heart problems can present very atypically and I would rather be safe than sorry.

    Where would you place him after triage is completed & why? (waiting room, monitored bed, non-monitored bed)
    I would place the patient in a monitored bed because I would want to keep track of his rhythm.


    What do you anticipate doing for him once he is in a bed/room? (tests, any nursing actions)
    Labs
    ECG, drug screen, Troponin, D-Dimer, CXR, electrolytes

    What do you think his medical problem is ?

    Get the hottest topics every week!

    Subscribe to our free Nursing Insights newsletter.

  2. 18 Comments...

  3. 0
    In my ER anyone over the age of 25 presenting with chest pain would get an EKG right away to rule out anything, placed on a monitored bed, CXR for the cough, as the nurse you could draw labs, but I have seen the MD wait to order labs untill he sees the EKG because his pain is only a 3/10, if his pain was higher they would draw labs and possibly a nitro. Labs most likley are CK and troponin.

    of course I am only a ED tech/second year student, so I could be wrong, but that is what I have seen done.
    My hospital is trying to become a cardiac center, so they dont mess around with anyone that states chest pain. Our goal is to have EKGs done in less then 10 min from arrival, if that means we are doing EKGs in a chair in the hallway because we dont have beds that is what we do.
  4. 0
    Thanks for the reply!

    Yeah, I keep getting distracted by the 3/10 pain and that it is present when he coughs. Chest pain is chest pain is chest pain, I guess- heh.

    Now I'm stuck on what it could be.... it all seems a stretch to me when I lack a physical patient.

    MI(really?), angina, pneumonia (but he has no fever), PE (but symptoms have been going on too long and he's there's no SOB), anxiety?- maybe his rhythm is irregular and he's coughing b/c of PVCs and it's all b/c he's got an electrolyte imbalance.

    Bah!
  5. 1
    ABCs, ekg w/retrieval of previous one if available, if ekg is OK my dept would make him acuity 2 (not emergent, i suppose it would be the equivalent of what your test says is urgent). i work in a large level 1 detroit ER that doesn't use cardiac monitors unless they are in acuity 1 area, but we'd get an iv, draw cbc (see if theres elevated wbcs), lytes coags/d-dimer, troponin, uetox then chest xray. maybe give him ASA and/or GI cocktail. pending results of everything he could have nothing wrong and go home or have anything from pneumonia/PE/asthma/GERD/angina with a stress the next day. hope that helped
    rwright15 likes this.
  6. 0
    We would do an EKG in triage if that was normal and pt did not have any cardiac hx and wasn't pale, diaphoretic he would be made a 3...if there were any abnormalities on the EKG and/or hx or triage nurse felt it could be cardiac related he would be made a 2 and labs would be drawn etc.

    I have had plenty of young MI's in my career and tend to go down a very cautious route...
  7. 0
    Consider ridiculopathy (spelling?)
  8. 1
    we have a 5 level triage system, and without the aid of a stethoscope or monitor I would probably make this guy a level 3.

    I would want to ask some questions though,

    has he had a cold? is the cough productive or non productive, is he a smoker, does he use recreational drugs, has he taken a long distance trip recently? Is the pain reproducible? what do his lungs sound like?

    We would do an EKG to cya, but chances are this guy is not cardiac, and instead has some other problem.

    As far as triage goes, you have already ascertained that his ABC's are intact, his vital signs are stable and he is in no distress.

    If he were in our ED he would get the ekg, and some labs and then we would go from there.
    canoehead likes this.
  9. 0
    Quote from .laura.
    Yes, this is technically homework help- but it's not for a grade it's for CEUs... which I actually don't need.

    I am a jobless new grad RN in California taking an emergency nursing certificate class to pad my resume and stimulate my brain. I would really appreciate help on the following assignment- I have already answered most of the questions, but I am think my responses might be overdramatic... not sure.

    I would really appreciate and feedback/help. Here's the assignment and my rough-draft answers....

    -------

    Patient History:
    A 33 year old man presented in the ED with complaints of a 2 hour history of mild mid-chest discomfort (3/10) when he coughs and has bilateral hand pain. He is a guitarist, has been playing a lot recently and wonders if that has anything to do with his complaints. He denies medical problems, is a vegetarian and appears to be in no distress.

    BP 120/70 HR. 74 RR 22 O2 Sat 98% Temp: 98.6 Oral

    Note: I know that you want more information on this patient but this is all you can obtain for now!

    What category would you give this patient & why? (Emergent-Urgent-NonUrgent)
    I would categorize him as emergent because he is complaining of chest pain. Until life-threatening causes are ruled out I will anticipate the worse case scenario. Heart problems can present very atypically and I would rather be safe than sorry.

    Where would you place him after triage is completed & why? (waiting room, monitored bed, non-monitored bed)
    I would place the patient in a monitored bed because I would want to keep track of his rhythm.


    What do you anticipate doing for him once he is in a bed/room? (tests, any nursing actions)
    Labs
    ECG, drug screen, Troponin, D-Dimer, CXR, electrolytes

    What do you think his medical problem is ?
    I'm only a student nurse and I work as a tech. in an ER (although its a Peds. only ER) but here is what I was thinking off the top of my head.

    I would place the patient in an emergent because of the chest pain. After triage I would have him placed on a monitored bed. Once he was placed in a room I would expect that he is going to get an ECG, IV insertion, labs drawn (CBC, Electrolytes, Cardiac Enzymes) and a CXR D/T chest pain R/T cough. I'm thinking that maybe this is an atypical presentation of a cardiac issue but I'm not really sure but those are the interventions I would expect that they start with even to rule it out.

    !Chris
  10. 0
    I would put him in a monitored bed, EKG, biosite (gets troponin, CKMB, and myoglobin) PCXR. Really it all depends on which doc is working. Some go way overboard and order EVERYTHING known to man and others add a little at a time till they r/o whatever. Probably watch him and do another biosite 4 hours later.
  11. 0
    In my ED, he would get a STAT EKG as soon as the words CP came out of his mouth, regardless of history. I would triage him as a level 2 CP/Poss ACS. He would immed get to a room, a tech would put him on a monitor while I started his iv and ran an istat troponin. If a cardiac event is ruled out, I would then change his acuity level and make him a chest wall pain. You have to rule out cardiac before you can ever assume it isn't. Something I have seen in 30 somethings, is the MI with cocaine use that they somehow fail to mention...


Nursing Jobs in every specialty and state. Visit today and Create Job Alerts, Manage Your Resume, and Apply for Jobs.

A Big Thank You To Our Sponsors
Top