Ques. on Lacharity book

[wecan11]

I don't understand Lacharity's logic on this question.

"You are working in ED caring for pt. whose just been admitted w/ L. anterior chest pain, possible unstable angina or myocardial infarction. Which nursing activity would you accomplish first?

1) Ausculatate heart sounds

2) Administer sublingual nitroglycerin

3) Insert IV catheter

4) Obtain breif pt. history.

I chose 1) Correct answer is 2) administer sublingual nitro. I thought Nursing process is Assessment first before giving any medications?

Can you explain this to me?

Thx,

wecan:up:

[kgh31386, BSN, MSN, RN]

Listening to heart sounds will delay treatment and will definitely not fix the problem. Give them the nitro first to see if the pain is relieved. Assessing first will not always be the right answer. Think of it this way...if you had to pick 1 thing to do and go home, what would it be? Listen to heart sounds, or try to fix the problem?

[Bornleader-NP-C]

i think in this case you never want to delay treating the patient, bc a possible MI means irreversible ischemia to heart tissue.

[cooliegirl]

i was thinking along the lines like you have to make the pt. comfortable first, and admisterering tabs would make them comfy, then you can gather your patient history.

[wecan11]

Listening to heart sounds will delay treatment and will definitely not fix the problem. Give them the nitro first to see if the pain is relieved. Assessing first will not always be the right answer. Think of it this way...if you had to pick 1 thing to do and go home, what would it be? Listen to heart sounds, or try to fix the problem?

If the scenario just stated something general, vague about chest pain, nothing about unstable angina would you still immediately give Nitro or first aseess the situation before implementation.?

Thank You.

[ann_08RN]

in my opinion, the scenario gives you an assessment already which is L Anterior chest pain. the assessment in the option which is to auscultate heart sounds will never help solve the problem too. beside the stem of the questions (possible unstable angina or MI) would lead you to think that your immediate action would be to reduce the pain caused by ischemia of the myocardium which can be readily solved by given nitroglycerin.

[wecan11]

Thank You!

[cmorales79]

The best quote that I heard and has always worked is "When in distress don't assess." This is when you want to actually do something. This would eliminate 1 & 4. 2 & 3 are the only A's that pertain to intervention. Pain is the issue causing distress so 2 would be the best answer.

[pinoysn]

My instructor told me when chest pain is involved, you always want to deal with the pain first. even if the pt states c/p of 1 out of 10. you wanna give morphine or nitro.

oh and with MI...remember MONA... Morphine, Oxygen, Nitro, Aspirin....

[wecan11]

Thank you Pinoy!

[Aylin1421]

The way i see this questin is , if you pick 1 you are telling NCLEX you are not sure your patient is having angina and can have an MI. Assessment does goes first most of the time if there is no intervention to solve the problem right away, or the question does not provide any assessment info. so yes you would administer the nitro since you know he is having angina and there has been some assessment given . You do not want to delay treatment, :)