Afib: A question of nursing judgment

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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.

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Specializes in Med/Surg, Ortho, ASC.

Homework?

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Sorry.

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Sorry. The message has been edited.

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Specializes in Medical Oncology, ER.

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.

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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.

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Specializes in Medical-Surgial, Cardiac, Pediatrics.

Sounds like a good discussion question for homework.

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Specializes in ICU, LTACH, Internal Medicine.

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.

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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.

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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.

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Yes, the coworker is a nurse.

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Yes, the coworker is a nurse.
Then you should be questioning THEIR judgement, instead of yours. I would now be watching him/her like a hawk.
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