I had a pt the other night (med surg unit, specializing in ischemic CVAs). I had this pt the night before, she was admitted with "chest pain & syncope", but she denied any syncopal episodes to me. No c/o chest pain the entire time I had her. She was a direct admit from the MD office for work up.
Had a cardiac cath and came back shortly before my shift began. When I went to assess she was still sleepy from the procedure, c/o pain at the cath site 10/10. Took VS, stable... Checked the cath site, which was dry. Called the MD, who just ordered Toradol IVP.
Later that night, I transferred her to the cardiac floor (why wasn't she admitted there when she first came in anyway? We are a medical tele floor, not cardiac tele) b/c we needed a tele bed. In report, the nurse told me she shouldn't be having that much pain at the site. I mentioned this to my preceptor and she said it was OK b/c cardiac caths ARE very painful and in my assessment, there was nothing out of the ordinary.
I trust my preceptor because she's worshipped on our floor as she's been there the longest and knows everything about anything (so I've heard anyway!).
But did I miss something? Was there something else I should've done?
I frequently take care of post cath pts, and 10/10 pain at the site would definitely raise some warnings. Was the site soft? Was there swelling?
A blown groin is sometimes obvious, but in a larger person it would be harder to see. And toradol? That seems a little conservative for such a high pain rating/situation. Did she have an allergy to any narcs?
I agree with RobLPN. If you checked the site and there is no sign of hematoma or bleeding, VS stable, Pulses all good then medicate and continue to monitor. Pain is very subjective and what you might rate as a 2 I would rate as a 10 (Im a big whimp)! I've taken care of patients that I thought HAD to be in severe pain and they've told me its not that bad and I've had others that I could not see how they could be having as much pain as they claim but it is totally subjective so your objective is to control the pain and make sure all the objective facts are within normal.
That doesnt mean that someone with severe pain isnt having a issue that just hasnt shown up yet but until you see a change in vitals, change in the site, monitor, etc then you job is to keep the patient comfortable and continue to watch for any changes that might signal a problem.
As for the person saying she should've been transferred to a tele floor... We do have tele, but its medical tele. We don't usually get cardiac pts. Most of our pts are CVA, TIA, change in LOC, pneumonia, peritoneal dialysis pts, and a few chronic and acute renal failures. Do you mean she should've been transferred to a cardiac tele floor or did you not read we have tele? A little confused there.
Well, maybe the concern is that med-surg tele is different than cardiac tele. You stated in your post that you don't usually take care of post caths. When I think 'tele floor', I think nurses that are familiar with cardiac pts.
Specializes in ED, Cardiac Medicine, Retail Health.
I have never had patient complain of 10/10 s/p cath. They may have had 10/10 back pain from lying on the hard table for a period of time, but not pain at the cath site.
From what you described you did everything possible. I would have check the pulses, checked for bruits, or bleeding at the site. Even a perf or pseudo aneurysm more than likely wont cause 10/10 pain. Strange.
Virgo_RN, BSN, RN
3,543 Posts
It can be harder to achieve hemostasis on heavier patients. A high pain score like that could indicate hematoma or pseudoaneurysm.