Afib: A question of nursing judgment

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.

Edited Sep 8, 2015 by crazycat1

[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.

Edited Sep 8, 2015 by WKShadowRN

[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.