C/O chest pain

  1. Whats the best assessment for a student complaining of chest pain? I always ask if they have a cold or been coughing a lot or if it is heart burn. If they say no to either I check their HR and BP and do a visual assessment to see if they are faint or sweating. Is there anything else that I am missing?
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    About zombieghoast, BSN

    Joined: Jul '14; Posts: 407; Likes: 1,116
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    32 Comments

  3. by   Farawyn
    Is something upsetting them?
  4. by   SnowyJ
    I do a general assessment. I will also listen to their heart and lungs, and have them drink some water. maybe some SALTINES!!!
  5. by   Keepstanding
    What have they been doing in PE or doing at home ? Sometimes it's muscle soreness and not heart related chest pain.
  6. by   MrNurse(x2)
    I am a cardiac nurse first, school nurse after that. The first question to pin down, is the pain worse on inspiration? Pain with inspiration is most likely muscular, probably from coughing. Continuous pain should include VS, with emphasis on heart rate and rhythm. Is it regular or irregular? Then you can proceed to the GI issues. Remember, pulmonary emboli can also present as pain with movement, inspiration, with a good differentiation of sudden onset of cough without other obvious URI symptoms. In light of a hit to the chest, you may have a pneumo or hemo thorax, listen for absent breath sounds. Just a few things to keep in mind.
  7. by   Flare
    i do the same. Have you been coughing? When did it start? what makes it worse? Any nausea, dizziness, headache? Depending on those answers and how the student looks / acts i will probably take a set of vitals. I think it's rare that i wouldn't take vitals - they take a minute to do and they CYA.

    Oddly, I've had a run on 7th grade girls suddenly having cardiac issues and needing cardiac clearance before they can participate in PE lately. I have no clue what that's all about.
  8. by   MrNurse(x2)
    Quote from Flare
    i do the same. Have you been coughing? When did it start? what makes it worse? Any nausea, dizziness, headache? Depending on those answers and how the student looks / acts i will probably take a set of vitals. I think it's rare that i wouldn't take vitals - they take a minute to do and they CYA.

    Oddly, I've had a run on 7th grade girls suddenly having cardiac issues and needing cardiac clearance before they can participate in PE lately. I have no clue what that's all about.
    Are they in the same class? Could it be something they are doing "socially"? Energy drinks? I would think given some of the pressures for these kids to perform, energy drinks may become a common denominator in cardiac issues in school aged kids.
  9. by   Flare
    no, i think they only have PE and recess together. And to my knowledge I don't think these girls are all that friendly with one another. I'm not saying that's not a possibility - i think that is a great thought worth looking into. Thanks!
  10. by   JenTheSchoolRN
    Quote from MrNurse(x2)
    Are they in the same class? Could it be something they are doing "socially"? Energy drinks? I would think given some of the pressures for these kids to perform, energy drinks may become a common denominator in cardiac issues in school aged kids.
    I ask about caffeine intake. My school is right next to Dunkin' Donuts. So. Much. Caffeine. (And sugar, but that is another thread).

    I get a lot of chest pain complaints during the flu season. Usually the kid is coughing up a storm at the same time, so if those two are together with the description "it hurts when I breathe in" I think muscle soreness and respiratory. But I'll run vitals based on answers - usually a quick HR and auscultation.

    But I also have had a student with costochondritis - that student had a doctor's order for 600 mg ibuprofen.
  11. by   MrNurse(x2)
    Glad I can contribute rather than take. This is one area I know.
  12. by   Flare
    my specialty in the "before life" was trauma and orthopedics - i always am glad to learn from someone with a lot more know power!!
  13. by   SchoolNurseTXstyle
    I always do a set of vitals, listen to heart and lungs. Ask about what sports they play if any, activity level. Found some muscle soreness due to tennis and baseball pitching as the culprit in the past. Mental health assessment also, possible anxiety issue. Even if my assessment is normal, I always touch base with parents. Never know what condition is underlying....
  14. by   MrNurse(x2)
    Quote from Jen-Elizabeth
    I ask about caffeine intake. My school is right next to Dunkin' Donuts. So. Much. Caffeine. (And sugar, but that is another thread).

    I get a lot of chest pain complaints during the flu season. Usually the kid is coughing up a storm at the same time, so if those two are together with the description "it hurts when I breathe in" I think muscle soreness and respiratory. But I'll run vitals based on answers - usually a quick HR and auscultation.

    But I also have had a student with costochondritis - that student had a doctor's order for 600 mg ibuprofen.
    I would love to be right next to a DD, and I don't drink coffee. Glad I'm not, but I can dream.

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