Pt reports chest pain 6/10, tightness in chest, can cover pain with palm...

[algebra_demystified]

Also dizziness, and a hx of seizures. By the time pt got halfway through the list of complaints, I was on the phone calling the doctor who covered tonight to come and send this pt to the ED for an EKG and a blood test for CK/MB. Hey, maybe it's nothing, but maybe it's something.

The other nurse on tonight wasn't around for this particular incident, and looked at me like I was an idiot for calling the MD. Hey, even if she said everything was fine, I went ahead and charted that the MD said everything was OK and to give the pt a benadryl for sleep. OK, that's the doctor's order.

After handling this piece of business, I went on dinner break. When I came back, the other nurse asked me in front of the rest of the staff how I would handle that situation next time.

Call the MD and have them r/o MI. Any complaint of chest pain, I'm getting the MD involved. Chest pain plus tightness? No doubt in my mind. Even if the pt has a hx of c/o chest pain and enjoys playing the sick role. 99 times out of 100, it's probably all BS. It's the one out of 100 where the pt dies right in front of you (happened to me once or twice) that spurs me to action.

Sorry pal, I'm definitely waking the precious MD out of her beauty sleep to come and assess the pt.

Yes, it's a psych unit, but this IS a hospital, so I'm going ahead and doing what I think is right.

[britgirl37]

I think you did the right thing, and in your situation I would have done the same, you covered your own backside by telling the doctor and getting it on record, regardless of the outcome. Fair play to you.

[rn/writer, RN]

I was a psych nurse for years. One of the hazards of working psych is missing something because you assume that the patient is faking or somatizing. Just because someone is a psych patient doesn't mean they can't have physical complaints--real ones--as well. And just because the person has cried wolf before, that doesn't rule out the possibility that it's real this time.

There are a lot of physical complaints that could, in good conscience, be downplayed or worked around. Chest pain isn't one of them. Anyone who decides that isn't a cardiac problem without objective data to back up the decision (labs, EKG, etc.) is taking a chance. Let it be the doc's license on the line, not yours. Besides, how long can it take to wheel in a portable EKG and run a strip? If I were a doc, I'd want at least that to cover my behind, just in case.

The only exception to calling the doc might be if the person had a very recent cardiac work-up and minimal risk factors. Barring that, I would do what you did.

[crb613, BSN, RN]

You absolutely did the right thing! I had a 43yo male come in w/clean cardiac workup the week before.......c/o cp tightness/pressure, dizziness, nausea....he rated his pain "maybe a 5".....coded & died. You just never know! I think you did the right thing.

[UM Review RN, ASN, RN]

As a cardiac nurse, I ditto what rn/writer said. We have lots of patients who have multiple medical dx's and psych is only the tip of the iceberg.

Please call if your patients c/o chest pain regardless of what your coworkers say.

[Whispera, MSN, RN]

Back in the olden days I had a psych patient who was SOB and ashen. I called the doc who didn't think it was a problem. I called the supervisor who called a resident. The patient was transferred to ICU and died of lung cancer shortly afterwards.

You did the absolute right thing for the patient. I'm proud of you.

[RochesterRN-BSN, BSN, RN]

Keep in mind that many psych nurses have no experience in medical nursing or none recently-- I was one of few with medical experience when I worked inpatient psych. If the harrassment continues I might bring this to your manager. God forbit one of those other nurses has a patient and downplays medical complaints and something happens to the patient. I always used to say just because you are a psych nurse doesn't negate the fact that you still have RN after your name and with that comes the responsibility to be able to handle basic emergencies...even if that means just being knowledgable enough to be able to recognize when a patient is unstable and GET the right people to be able to provide a more in depth assessment and treatment/care.

Sounds like yo need to just focus on providing the best care you know how and chalk their behavior up to ignorance. Maybe they need a refresher on recongnizing the basic medical emergencies-- MI, Stroke, PE, Acute CHF, acute renal failure.....etc. as Psych patients DO get sick!!!

Keep doin what your doin' !!!