Emergency Nursing: Acute substernal chest pain

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Mr. Jones is an 88 year-old patient transported to the Emergency Department by EMS. Patient's chief complaint was acute substernal chest pain (8 out of 10 on a pain scale). Vital signs include: BP 98/58, HR 108, RR 26 (labored), and Temperature 99.5F. Med HX: COPD, Hypertension, Diabetes (insulin-dependent), Pneumonia, and Depression. Consider the following question pertaining to this case.

1. As the Emergency Department nurse caring for this patient, in what order would you select (list in the order of priority) the interventions needed to care for this patient?

a. Connect the patient to a cardiac monitor

b. Apply a pulse oximetry to the patient

c. Take a fingerstick to test blood glucose

d. Take a non-invasive blood pressure

e. Insert an intravenous line

f. Insert a urinary catheter

2. Based on your list of prioritized interventions, answer the following question: What rationale did you use to prioritize the order of each of the above interventions? (Please write clearly and support your answer with evidence-based research).

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Specializes in ER.

Sorry not gonna do homework but remember the ABC's- airway, breathing, circulation. Nothing else matters if you don't have those 3.

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This is my quick reply sorry dont have all the detail you asked for ABC is my explanation ....would like to see what other nurses say though to see if the think IV goes any sooner

ABC

a.Pulse Oximetry patient already has labored breathing should know how much oxygen is needed

b.Cardiac Monitor (having chest pain need to see EKG and rhythm)

c. Blood Pressure although you have one its low will need to know if it dropped more Doc need this in order to see patient

getting nitro amoung other reasons

d. Finger Stick Patient diabetic

e. IV line

f. Insert urinary catherter

__________________________________________

a. Connect the patient to a cardiac monitor

b. Apply a pulse oximetry to the patient

c. Take a fingerstick to test blood glucose

d. Take a non-invasive blood pressure

e. Insert an intravenous line

f. Insert a urinary catheter

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I am looking for published evidence-based practice articles relevant to the scenario.

Thank you for reinforcing my ABCs.

I was simply looking for thoughts experienced RNs could share with me.

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Specializes in ER.

Ok...well I would do A, D, B, E, C, and then F. In real life- the monitor, BP, and pulse ox gets done the same time. Then I do a quick EKG. Put a line or two in. I don't do the blood glucose or foley. Blood glucose gets checked with labs and the foley is pointless unless they are going to the cath lab.

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The UCLA Acute MI protocol recommends placement of a foley catheter on page 2 of the following document: http://www.med.ucla.edu/champ/CLOT%20Team%20Protocol.PDF

Maybe the rationale just to provide rest and record urinary output?

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Says place foley if patient going for catherization in other words straignt to cath lab like PARREN 20 mentioned earlier but thanks for the protocol post I like reading other agencies polices.

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ok, i'm just gonna have to say this...DO YOUR OWN HOMEWORK please.

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Thank you for the tough love!

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it might have been less obvious that it's homework if you would have worded and formatted it differently

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You see, I was looking for thoughts from other nurses.

I wasn't looking to disguise my homework, and get someone else to do it for me.

I looked at this as a substitute for a real-time conversation... since most of my classes are online.

People have the option to respond or be indifferent to this post.

People who feel like contributing are welcome.

People who feel like criticizing are also welcome. I won't stand in their way of feeling smart.

There are all kinds of people everywhere.

You just have to learn to learn from everybody.

From some, you learn how to be.

From others, you learn how not to be.

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You see, I was looking for thoughts from other nurses.

I wasn't looking to disguise my homework, and get someone else to do it for me.

I looked at this as a substitute for a real-time conversation... since most of my classes are online.

People have the option to respond or be indifferent to this post.

People who feel like contributing are welcome.

People who feel like criticizing are also welcome. I won't stand in their way of feeling smart.

There are all kinds of people everywhere.

You just have to learn to learn from everybody.

From some, you learn how to be.

From others, you learn how not to be.

Very nice response:yeah:

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