Did I do the right thing?

[Live.Love.Nurse.♡]

I work in an ALF and today one of my residents called me complaining of chest pain radiating down her left arm and SOB. When I checked her vitals, BP was normal but pulse was 122. This has happened with this particular resident before and it turned out to be nothing but anxiety. I gave her nitrostrat, little to no effect on her chest pain. Her pulse worried me so I called the on-call physician who ordered her to go to the ER. When I told my supervisor, she sort of rolled her eyes and said something along the lines of this has happened many times before with her and it's always nothing. About 2 hours later, the hospital discharged her and also treated me the same way.. like I had wasted their time. My issue is.. if I would've blown it off as her anxiety again, then what if it had been an actual emergency and then I'd be in trouble for not sending her out? What would you have done?

[quiltynurse56, LPN, LVN]

If she suffers this much from anxiety, does she receive ativan? She probably needs a PRN order for these instances.

Edited to Add: Yes you did the right thing.

[widi96]

You did the exact right thing. The patient had a complaint that was concerning - you did what you could in your facility with no improvement and notified the physician who made the decision to send them to the ED. I'm an ED nurse and can tell you that about 95% of the time we can't find a cause for a patient's chest pain - it happens all the time. But I'd rather work up all of those patients than miss it when they are having an acute cardiac event.

The only thing that you might've been able to try (if the physician was agreeable) would be if they would order something for anxiety and see if that improved her pain/HR.

But again, your actions were appropriate.

[icuRNmaggie, BSN, RN]

Yes, you did the right thing.

[meanmaryjean, DNP, RN]

Unless you had a magical Google glass EKG app you didn't use you did exactly the right thing and what I would want you to do for my parent in the same circumstance.

[SubSippi]

You definitely did the right thing, a pulse rate of 122 isn't normal for a person who is at rest.

Arrhythmias such as SVT and a-fib can cause a high heart rate, and they also will make a lot of people feel anxious and/or have chest pain if their ventricles aren't filling. Next time, check and see if the pulse is irregular and get her blood pressure. Having a bit more information might make them your concerns more seriously.

If her blood pressure will tolerate it, see if you can get her a PRN beta blocker. OR these episodes might be prevented entirely with a scheduled beta blocker. How long does it last?

[FloatRN19]

It's not about all the times it turns out to be nothing, it's about that one time it is something.

[RescueNinjaKy]

I'm gonna tell you what an icu nurse who responds to rapid responses told me. They rather come over and check your patient out and not have to do anything than to come later when it's too late and they have to work damn hard to save the patient.

So yea you did the right thing. Just about everything is better to be caught early. They rather it be a false alarm than to risk being notified when it's at a critical stage.

[nrsang97, BSN, RN]

Yes you did the right thing. You never know if it is really something or not. I would rather be safe and send the patient to the ER rather than not send them and it turns out they were really having a problem.

[NurseSpeedy, ADN, LPN, RN]

You did the right thing. People with anxiety are not exempt from the possibility of a heart attack.

If the patient or POA refuse to go to the ER document the HECK out of it because if it is an MI, you're going to want proof that you did everything in your power get them to go in for treatment.

[_zoubisoubisou_]

Yes you did the right thing! If this time hadn't been like all the rest and the patient was treated with "rolled eyes", guess who would be at fault? Your supervisor wouldn't be rolling her eyes then! You absolutely did the right thing. *high five*

[jadelpn, LPN, EMT-B]

You did the right thing. My response would have been "if it is 'nothing' but anxiety, why is it that she is not being treated for it?" It COULD have been all sorts of things, from a heart attack to an arrhythmia issue, to a panic attack. Which, unless you could whip out an EKG machine, do bedside triponins you really have no way of knowing. That is was "nothing" is not your issue, as the MD ordered a transfer. And does your manager NOT want the MD called when a resident c/o SOB and/or chest pain with vitals that are not ideal? Then be sure to mention that next time, you will defer to her when a resident complains---call her at home, perhaps? (