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.
No. I am not a nursing student posting my homework. I call myself a community nurse,†because that is what I am. It is a course, which I decided upon before entering nursing school, and when I obtain the requisite experience in the field (and as finances allow) I hope to return to school and obtain an FNP.
When criticized for my decision, I did what any good nurse should do and reviewed the literature. I was reluctant at first to post a question on this board and spent some time carefully wording my initial post so as not to be in violation of HIPAA.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
OP your post was worded in an unusual manner giving the feeling it was a homework question. We are happy to help with any question but ask that all information is posted at the beginning and if you are a student that you post your research first.
If the patient is having active chest pain they need to be evaluated for an acute problem at the nearest ER.
I would be more concerned with chest pain and fatigue. Feeling cold maybe due to thyroid issue. Unrelieve chest pain with resting and breathing is mostly a sign of cardiopulmonary issue. The patient is taking digoxin already and that indicated the dysthymia is not new. So calling the paramedics is not a bad idea as the patient requires more evaluation to rule out transient MI or CHF exacerbation.
Is the A-Fib a new onset? If the patient is already on metropolol and Coumadin, then the A-fib is not new. After alleviating the chest pain with nitroglycerin at the ER, Chest X-Ray and some lab work such as Troponin level, BNP, TSH, and Stress Test maybe completed before further evaluation/treatment.
If someone was wondering if a cab or bus would do instead of an ambulance, well maybe it would be fine, but you are rolling the dice. As a nurse you aren't paid to roll the dice, you need to get treatment to your patients in the safest way possible. Family might pressure you to say it's OK, or a coworker, but in actual fact you'd be guessing. And no one wants to guess about health. I'm behind you in calling EMS.
When somebody has chest pain you need to call 911 - chest pain is chest pain. It does not matter that the chest pain was there for a week.
(Unless the patient is on hospice at home - in which case you would want to call the hospice medical director and medicate the patient at home to be comfortable).
There is a lot of pressure towards HH agencies who send the patients to the ER for "everything" and "anything" but fact is that certain symptoms need immediate attention. The most encountered problem sending the pat to the ER via 911 in the community for me were chest pain, shortness of breath and altered mental states....
If you are a new nurse in home care try to find an experienced nurse who is wiling to mentor you for a while, somebody who seems responsible and who you can call when you need a second opinion.
When pat at home have non acute complains and need a MD visit I would just call the MD office and discuss the symptoms with the triage nurse who usually fits the patient in to the schedule. Some patients are in a SCO program and have a primary care NP who will even come out to make home visits.
BostonFNP, APRN
2 Articles; 5,584 Posts
Come on OP, be honest, this is homework...