chest pain or anxiety

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What would you have done, we have a resident in my facility who had a major MI a week and a half ago. They did a cardiac cath and put in a stint. She came back to the facility about a week ago. Last Friday when I came into work at 6am the night nurse told me the res. had c/o chest pain, but the nurse thought it was just anxiety so she gave her an ativan and maalox for indegestion. Well I called the cardiologist to give him an update and possibly get an order for nitro. since she had not come back with an order for any nitro. Well the cardiologist said due to the size of the stint he really did not want to give any nitro at this time but if the chest pain continued he may. He said for now just to monitor her. Well she was fine the rest of the day. I was off this weekend and when I came in on Monday, I guess she had continued to c/o chest pain so they had gotten a nitro order, but they had not given her any over the weekend, they had only given her ativan. As soon as I got there Monday morning she said she couldn't catch her breath and had chest pain she rated as an eight. I checked her vitals asked her if it was radiating anywhere, it wasn't and gave her a nitro. The order read give 1 every 15 min up to 4 times if no relief send to ER. Well she had 4 over an hour and her chest pain had not allieviated. I called the doctor and told him I was sending her to the ER. When the paramedics came she was in and out of A-fib and was admitted to the hospital. The nurse that had given her the ativan was there when I gave her the first dose of nitro and she said I would just give her and ativan. When I gave her the nitro anyway she went to the other nurse and said "Well if she doesn't want to benefit from 26 years of nursing experience, that's just ridiculous." But I don't feel you should disguise potential heart problems with ativan. What do you all think/

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What would you have done, we have a resident in my facility who had a major MI a week and a half ago. They did a cardiac cath and put in a stint. She came back to the facility about a week ago. Last Friday when I came into work at 6am the night nurse told me the res. had c/o chest pain, but the nurse thought it was just anxiety so she gave her an ativan and maalox for indegestion. Well I called the cardiologist to give him an update and possibly get an order for nitro. since she had not come back with an order for any nitro. Well the cardiologist said due to the size of the stint he really did not want to give any nitro at this time but if the chest pain continued he may. He said for now just to monitor her. Well she was fine the rest of the day. I was off this weekend and when I came in on Monday, I guess she had continued to c/o chest pain so they had gotten a nitro order, but they had not given her any over the weekend, they had only given her ativan. As soon as I got there Monday morning she said she couldn't catch her breath and had chest pain she rated as an eight. I checked her vitals asked her if it was radiating anywhere, it wasn't and gave her a nitro. The order read give 1 every 15 min up to 4 times if no relief send to ER. Well she had 4 over an hour and her chest pain had not allieviated. I called the doctor and told him I was sending her to the ER. When the paramedics came she was in and out of A-fib and was admitted to the hospital. The nurse that had given her the ativan was there when I gave her the first dose of nitro and she said I would just give her and ativan. When I gave her the nitro anyway she went to the other nurse and said "Well if she doesn't want to benefit from 26 years of nursing experience, that's just ridiculous." But I don't feel you should disguise potential heart problems with ativan. What do you all think/

You should be proud of youself for doing right by your patient. Chest pain should be taken seriously the other nurse hopefully will learn from YOUR actions.

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You absolutely did the right thing. Follow your gut! I would always rather err on the side of caution.

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"Last Friday when I came into work at 6am the night nurse told me the res. had c/o chest pain, but the nurse thought it was just anxiety so she gave her an ativan and maalox for indegestion."

My question is HOW could the nurse just ASSUME that knowing the pt's cardiac history? That's a little idiotic.

I'm interested to hear what cardiac/telemetry nurses have to say regarding the ativan, and to explain the decision-making of the experienced RN & MD.

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Specializes in Education, Acute, Med/Surg, Tele, etc.

We have overcome this probelm by really talking with cardiologists and PCP's to get the right PRN med routine for our patients. Sadly we do have many chest pain complaints that are NOT cardiac in nature despite history...but me, I treat worse case first which I assume each time cardiac till told otherwise and I am not an MD so I treat cardiac! But I am a rare bird there in my facility!

I have several patients that take one nitro, can repeat to two after 5 minutes, in combo with maalox and a pain med or even ativan. If relieved and doesn't return..we continue the GI/pain meds. If it returns...we call 9-11 for evaluation at the hospital! But our ativan for PRN is very low for these patients as not to cover too much of the s/sx for us to make a choice (we came up with a great protocol catered to each individual...I mean..some get snowed with just a little, so we hold off till we know).

So far so great! Haven't had a cardiac probelm go missed yet!!! :) Especially with me on duty..LOL! (I learned from paramedics, and my hubby is one...so I think like them a lot! LOL).

Also..afib is typical in elderly, but symtomatic is always a probelm! I don't take chances on symtomatic A fib...can turn ugly in a blink! If your nurse has any probelms with that...refer her to the AHA ACLS booklet and have her read symptomatic A fib! (it won't be in the BLS one I don't think).

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