Do you admister oxygen on your floor to a pt complaing of chest pain?

[Blackheartednurse]

I just have a questions that has been bothered me for a long time..Many nursing books talk about performing basic nursing interventions for a chest pain such as oxygen,beta-blocker,nitro (I guess I'm refering to the angina protocol here) I was wondering if some of the interventions are only specific to an ER such as a beta blocker,oxygen or asprin,I'm slightly confused I guess since when I used to work on a step-down unit when ever we used to get a chest pain patient they just gave nitro but I havent see the oxygen,beta-blocker or aspirin for that matter.I also read in the textbook that oxygen should be given as first line defense.

[netglow, ASN, RN]

Mor-fine is given to relieve pain and lessen cardiac workload, I believe.

[GilaRRT]

Mor-fine is given to relieve pain and lessen cardiac workload, I believe.

Depends, if I am dealing with a RVI or hemodynamic instability, I'll use fentanyl.

[VivaRN]

Even if the patient states that his pain level is 1 or 2 on scale of 10?

Yes. And why not? 02 is not a hard thing to initiate. If it turns out the pain was d/t something else, no harm, no foul.

[LouisVRN, RN]

We always give morphine if the patient has it available regardless of their perceived pain level as I was told it decreases respiratory workload and can slow and relax the breathing.

[murphyle, BSN, RN]

2L NC, sit 'em up and watch the monitor for 5 minutes is my first intervention. (For some incomprehensible reason, lots of our patients come back from triage with no pillow and HOB at about 5 degrees, and we're in an area where at least a third of the populace is obese enough to have positional CP/DIB. This usually straightens the issue right out.) If the pain continues or if I see a non-reassuring rhythm strip, I'll enter ATGs for suspected MI, which gives me a STAT 12-lead ECG and chest X-ray, an MI pack from the Pyxis (500 mL 0.9%, nitro SL x4, ASA 325 mg, and morphine 4 mg) and an automatic bump to Priority II.

Granted, that's in EC, but on the floor my reaction would be very much the same: throw on 2L and sit the patient upright, and watch for a few minutes. Non-reassuring monitoring parameters will buy you the MI protocol.

Hope this helps! :)

[yoshiki56]

Chest pain is related to lack of oxgyen to the heart muscle, so what does the heart really need? O2, nitro is to dilate the vessels to increase the blood flow to the heart , blood contains many nutrients and O2 which helps release the suffocated heart muscle.

Definitely O2 .

[yoshiki56]

We always give morphine if the patient has it available regardless of their perceived pain level as I was told it decreases respiratory workload and can slow and relax the breathing.

But, morphine uses in chest pain is for pain and dilate the vessel, not really for decreasing the respiration workload. In the matter of fact, morphine's main side effect is respiratory depression. You want your pt to breath, they can't breath regularly because they are in pain. Just my thought.

[GilaRRT]

Chest pain is related to lack of oxgyen to the heart muscle, so what does the heart really need? O2, nitro is to dilate the vessels to increase the blood flow to the heart , blood contains many nutrients and O2 which helps release the suffocated heart muscle.

Definitely O2 .

However, increasing the FiO2 will do little in the way of enhancing oxygen delivery to the ischemic myocardium. While I am not against giving supplemental oxygen, in many cases the true benefit is debatable. In fact, in animal models there is some limited evidence that high concentrations of oxygen may cause more harm. While hardly evidence against using oxygen, it's still something to consider when we assume we are greatly benefiting the patient with oxygen therapy. Of course, the game may change with hypoxemia, VQ mismatch and shunting.

But, morphine uses in chest pain is for pain and dilate the vessel, not really for decreasing the respiration workload. In the matter of fact, morphine's main side effect is respiratory depression. You want your pt to breath, they can't breath regularly because they are in pain. Just my thought.

Not exactly. While the histamine release associated with morphine can cause vasodilation, the effect is opposite. In that, I mean you actually have decreased blood return to the heart (decreased preload). In some cases this may be helpful because decreased venous return means decreased myocardial workload, and decreased myocardial oxygen consumption. Another potential benefit of morphine is the fact that controlling pain may blunt the sympathetic response associated with pain. (prevent tachycardias and all the other sympathetic effects that can increase myocardial oxygen consumption) Again, these benefits are potential and the evidence in some cases may suggest otherwise.

A note on nitroglycerine. While NTG may have some effect on coronary arterial tone, the major effect of NTG is to decrease preload and myocardial workload and oxygen consumption. It is a common misconception that NTG's only action is to dilate coronary arteries. This is not the case and and I doubt decreasing the tone of an already occluded artery would be all that helpful. Of course, decreasing the amount of work the heat has to do could potentially be helpful.

[nursemike, ASN, RN]

I need a scrip for Morphine, Nitro, or Aspirin. So I slap on 2L and start paging.

[bonesrn]

ALWAYS!

[dijaqrn]

Always O2!!!!!!!!!!!!!!!!!!!!

For anything else you need a protocol or a Dr's order. Since O2 is a med(gas) your protocol should cover you for this or get an order ASAP but slap it on anyway!

[resumecpr]

Recent evidence has shown that oxygen can be detrimental to a patient whose O2 saturation is greater than 95%. The AHA has several published studies regarding the use of oxygen on chest pain and stroke patients.