Afib: A question of nursing judgment

[crazycat1]

I am seeking your input and advice on an issue related to nursing judgment.

A patient with a history of heart disease treated with digoxin presents with chest pain (of one week duration), intermittent n/v (felt over the course of the week), fatigue, and feeling cold. Temp, B/P, and HR are within normal range. Pulse is irregular. Paramedics are called and ECG reflects patient is experiencing afib.

As a nurse, you know that digoxin (with anti-coagulants) is a common treatment for chronic afib.

Would you as a nurse working within a community setting recommend that the patient be taken by the paramedics to the hospital ER for further evaluation?

Thank you in advance for your thoughtful response.

[WKShadowNP, DNP, APRN]

WHAT?

Thanks for editing out the text tags. I could not find your questions amidst that.

I'd like to have you think through the question. If the patient is in a community setting and reports chest pain, forget the other information...they need professional evaluation.

[roser13, ASN, RN]

Homework?

[crazycat1]

Sorry.

[crazycat1]

Sorry. The message has been edited.

[WKShadowNP, DNP, APRN]

Thank you . I edited my first post to answer.

[nursephillyphil, BSN, RN]

this sounds like a community health hw assignment, if it is, we encourage you to try giving it a shot, post your answer and rationale, THEN we may help you.

[crazycat1]

No. I'm a community nurse and was ridiculed by a coworker for calling the paramedics. They, in turn, recommended that the patient go to the ER.

[RedInScrubs, ASN, RN]

Sounds like a good discussion question for homework.

[KatieMI, BSN, MSN, RN]

1). Chest pain (indication by itself)

2). N/w: common initial symptoms of dig toxicity, needs levels.

3) fatigue/feeling cold: possible decompensation, needs workup for CHF (US/LVEF as bare minimum), possible thyroid tests, etc.

Three reasons to send the pt in hospital and get it all done at once.

[Been there,done that, ASN, RN]

No. I'm a community nurse and was ridiculed by a coworker for calling the paramedics. They, in turn, recommended that the patient go to the ER.

Is your co-worker a nurse? Any complaints of chest pain needs to be evaluated. The a-fib is a moot point. The patient may or may not be in chronic a -fib, it does not matter in this scenario, the patient is symptomatic.

[crazycat1]

Thank you for your kind responses. It's encouraging to get confirmation of my rationale. I've been experiencing a great deal of lateral violence. Still, I'm a reasonably new nurse and am always open to advice from veteran nurses.