Chest Pain on the psych unit

[cargalrn]

New to psych, with Med-surg, and telemetry experience. If a pt comes to you with c/o CP, VSS, no sob, etc, 1rst such complaint- I feel it is appropriate to ask for an order for an EKG and trops. My colleague disagreed with "you haven't worked on psych before- you don't know psych patients". I still feel these orders are appropriate to r/o MI initially vs anxiety. Especially if the pt is near middle age. Please tell me what you think.:redbeathe

[Whispera, MSN, RN]

Since you have med/surg and telemetry experience, you might have a "feel" for these things that psych nurses don't. I'd say call the doctor and tell him or her what you're thinking and go from there.

I had a patient one time who was complaining of shortness of breath. Her breath sounds were sloppy too. The doctor thought it was just an upper respiratory infection and that she was complaining to get attention as SOME psych patients do. He wouldn't order testing. One evening when I was doing vitals, she was very dusky in color. I called him and he still wouldn't do anything. It got to be a big issue, but finally the resident on call came to see the patient. On arriving he was put out that he was called to see an "acting-out psych patient." He didn't think that after seeing her. She was transferred to ICU. She had advanced lung cancer and died shortly afterward.

Listen to your gut, no matter what other nurses might say. The key thought here is, psych patients DO have medical issues. Just because some milk it for all it's worth, that doesn't mean most of them do. Trust your instincts.

[mentalhealthRN]

Being a psych nurse with medical experience as well (granted not tele specifically but...) I would say that is hard to give a general answer for as it depends on so many things. The big picture have you. Some of them behavioral as in what is this pts history as far as psych dx. and yes anxiety can cause pretty bad CP. Generally if you give a PRN for it the CP will go away. (ie-ativan, valium) With the absence of any other signs of this being cardiac I see the point of the other nurse. The other thing is looking at the medical history of the pt. yeah if they have any cardiac hx then that is different. You would more likey be more cautious. So check into that too. Pulmonary hx too. You would know, thanks to your experience, if something in the medical hx stuck out to you as a risk factor for this being more then anxiety or attention seeking behavior. Age. Yeah if I have someone who is older that may make me think more medical. And if a hx of drug abuse--this can be big in psych especially if a newer pt. I have found that those with heavy cocaine abuse hx have increased risk for cardiac issues so with that pt I would be more weary. So as you can see what I mean by there isn't a clear cut black and white answer to your question. So really maybe your both right and can teach each other something. You can't just look at the pt and go out c/o CP.....this guy has a hx of anxiety so nope can't be anything...and dismiss it. Each pt should be looked at individually and his/her chart pulled and reviewed. And of course a thourough physical assessment. All factors should be looked at. Some units wouldn't care if you did a quick EKG just to be safe being that it's not invasive or a med or anything. Then if you see something being that you do know how to read the strip you could call and ask the doc to review and then if needed further can be done--trops, Nitro, etc. You can sometimes give O2 as well without calling first. But it may depend on the unit and the policies. Maybe talking to the manager about putting into place a policy that would allow minimal intervention for these c/o CP that would be standing for all pts. One that with CP complaint would read to give the pt any ordered PRN for anxiety, take VS, assess the pt, do EKG and administer O2. If CP not resolved call to MD. This would keep from bugging the docs and make it more safe for the pts. Just a thought.

Now you are beginning to see why being a psych nurse isn't as easy as some may think. Not every thing is so black and white and they still have medical issues and as you see pulling apart what is medical and what is psych is not always easy. Good luck and remember--that same nurse will probably be running to YOU when a pt codes!!! LOL

[ansturge]

i think an ekg and enzymes are prudent, especially since some of the psych meds can cause a prolonged qt interval.

[PAERRN20]

An EKG and enzymes never hurt anyone unlike untreated chest pain