how to assess chest pain

TakeTwoAspirin, MSN, RN, APRN · Aug 11, 2010

Simply, if the patient says they are in pain then they are in pain. I think you are treading into very hot waters if you assume someone who has a psych diagnosis may not be as believable as someone who doesn't so tread very carefully with that. If they say they have pain but no other S&S get an EKG ordered. Follow your facility's policy with regard to how to proceed with a complaint of new onset chest pain. If a doc orders nitro, administer nitro of the symptoms meet the laid-down protocols for administration.

April, RN, BSN, RN · Aug 11, 2010

Yes, a pt can be having chest pain without apparent distress or change in vitals at that time. I would notify the MD regardless of whether there is a question if the chest pain is real or not. It's tough to assess if the patient isn't oriented, but as you said, he's usually reliable in making his needs known. Does he have a cardiac history? Did he just eat a big meal? Is the pain only on inspiration? Does he have a history of anxiety attacks?

JulieCVICURN, BSN, RN · Aug 11, 2010

You must notify the MD of the patient's claims whether you think they're true or not. The MD will very likely order you to give sublingual nitro if the patient's blood pressure can tolerate it, do an EKG, and a set of cardiac enzymes X3. Just because someone is looney doesn't mean they're not having a heart attack.

Not everyone has other symptoms, such as diaphoresis, hypertension or hypotension, or arrhythmia. These are late signs of an MI and you should not wait for them in order to act on this. You will be in much more trouble for not reacting to real pain than you will for acting on fake pain.

anonymurse · Aug 11, 2010

I had a patient who said his chest was hurting, and he also said his shoulder is hurting and is having a hard time breathing. I went into his room, saw him in no distress, skin dry, no respiratory distress, patient calm, no signs of pain. His vitals were perfectly normal, no abnormals. This patient is not A & O x 3, have a psych diagnosis and he gets confused at times but most of times he can tell us what he want. I've had patient who faked chest pain. My question is, how do you assess if patient is having a chest pain or not? Can patient be in no distress and vitals are normal and stil be having a chest pain? Is it wrong to give nitroglycerin?

You just have to define yourself. Are you a nurse, or are you the fake pain police?

Our "prime directive" is "do no harm." In the case of CP, "no harm" tends more to taking action, at the very least to assess in depth, consider all PRN and standing orders, and notify the physician, than inaction.

Besides, O2 and SL NTG are themselves diagnostic. Do they make the pain go away or not? That tells you a lot.

Added: running out the door now, but wanted to comment that those sx paint a perfect pic of angina. You also want to know the pt's recent and complete hx. Also the way you put it, maybe you didn't stop to get advice from co-workers. I do hardly anything without mentioning what's up to every nurse I run across. It pays to get more sets of eyes on the problem, and maybe they know more about the pt than they put in report. If you're on a MS floor you have less time than on a tele or ICU unit because frequently you'll have to move your pt to get definitive care, so you have to move faster. This may seem counterintuitive, but it's true.

noregrets · Aug 11, 2010

Always believe the patient when they say they have pain. Put on O2 and notify the MD. If allowed by hospital policy do an EKG before your call the MD so you have more info at hand.

roser13, ASN, RN · Aug 11, 2010

It is not your place to determine cause/believability of chest pain. If the patient states chest pain, believe them. Take action.

The only "assessment" necessary is with regard to whether the proper steps are taken to activate a chest pain protocol, including alerting the MD.

marilynmom, LPN, NP · Aug 11, 2010

I work in psych and hear all sorts of complaints from patients. Whether they are valid or not is really not up to me. What I have learned is to COVER YOUR BUTT, report things to the MD, its up to them on what to do, but whatever you do, report it and keep yourself safe because no one else will. And chart your subjective and objective assessment.

Schmoo1022 · Aug 11, 2010

I work in psych and hear all sorts of complaints from patients. Whether they are valid or not is really not up to me. What I have learned is to COVER YOUR BUTT, report things to the MD, its up to them on what to do, but whatever you do, report it and keep yourself safe because no one else will. And chart your subjective and objective assessment.

Exactly...Assess and report to MD....

Have I thought at times that some of our Psych patients just wanted a trip to the hospital...sure, but it is still up to me to assess and report. Pain is what they say it is..simple as that!

ObtundedRN, BSN, RN · Aug 12, 2010

Along with the usual assessment questions and data, I also always as if it hurts worse when they take a deep breath. Also, if it hurts worse when you push on their chest (then push in between the ribs on the intercoastal muscles). This helps to determine between cardiac and muscular chest pain. Get an EKG, and the MD if needed. I've seen patient's in the 30's (even 20's) having an MI. I once had a 32 y/o male having an MI and it all seemed like an anxiety attack after an argument with his girlfriend about the bills.

I was always taught that if the patient says they have pain, believe them. Pain is subjective. You may have changes in VS but not always.

Give the nitro. If they lied about the chest pain, then maybe that awful headache will teach them not to fake it again. :)

Maria Lenore,RN · Aug 12, 2010

Pain is subjective if a patient claims he is in pain. He is really in pain as a nirse we must assess the severity of pain.... And report it to the doctor.