SOB and Chest Pain....

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Specializes in New Grad.

If a patient with a history of asthmatic disorder came in to the ER w c/o chest pain and shortness of breath, based on this patients history, what would you do?

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Specializes in Med/Surg, Ortho, ASC.

Is this a homework question?

What would you do?

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Specializes in New Grad.

I would check ABCs first. Take vitals, place pulse ox.

a.) If patient was not in immediate distress I would then perform a health history and focused assessment.

I would ask when the patient last used their inhaler.

I would ask more questions about his pain following the PQRST model (provoking/ palliative factors, Quality of pain, region/ radiating, other Signs/ Symptoms, and Time/ Tx)

I would tell the patient to take slow deep breaths and try to relax.

I would contact the MD who would probably order a Respiratory consult?

Maybe the doctor would want to see if the patient needed a different asthmatic prescription?

I would educate the patient on medication compliance and how to prevent asthmatic episodes.

b.) If the patient was in obvious distress and the chest pain and SOB appeared to be cardiac related I would immediately contact the physician and begin MONA, according to hospital protocol....

How is that?

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Specializes in New Grad.

And no it's not a HW question....none of them are. I have already graduated and have my RN. The problem is I graduated a couple years ago and I am just now looking for a nursing job and I'm rusty so I need help. I already took one refresher course that did not have clinicals. I am going to take a course with clinicals in February. But in the meantime, I am reading up on nursing scenarios and trying to get help with my critical thinking skills....

I am rusty on hospital policies and procedures, what the standing orders might be, and things of that nature as I have not been in a hospital in awhile.....can I find that in a book somewhere? I will be glad for the recommendations....

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Always treat chest pain as if you are dealing with an acute MI until ruled out. You need a stat EKG and rapid troponin, ASA, and a sublingual nitro.

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Specializes in ER.

I don't even ask many questions until the monitor/O2 is on, EKG is done, ASA given, IV in, and labs drawn. Anything beyond the basic questions can wait.

Really you can't tell if this is due to noncompliance with asthma meds or with an acute disease process i.e. MI or pneumonia. I don't educate about medication compliance until the patient is stabilized. There simply isn't time. ER is about addressing the immediate life threatening issues. ABC's always take priority over other issues.

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Specializes in Emergency.

MONA protocol (morphine, O2 @ 2L, Nitro Sublingual, ASA), STAT 12 Lead EKG, IV, Labs including cardiacs, monitor, v/s, and beta blocker if indicated, and nebs if needed.

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This is for the ER nurses-when you are doing a chest pain protocol, is one of your factors a patients age? I wondered as I have been in the ED with SOB and CP and never had a cardiac workup, even though I have a heart defect. I also have asthma and this is always what I was treated as. I am only 40, so that is why I was wondering if age is a factor in the CP protocol.

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Specializes in ER.
This is for the ER nurses-when you are doing a chest pain protocol, is one of your factors a patients age? I wondered as I have been in the ED with SOB and CP and never had a cardiac workup, even though I have a heart defect. I also have asthma and this is always what I was treated as. I am only 40, so that is why I was wondering if age is a factor in the CP protocol.

In my ER anyone above 15 or so complaining of CP or SOB gets the cardiac workup. However, they most likely will not get any cardiac meds.

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MIs can present similar asthma. chest tightness, wheezing. I would be careful giving someone in an MI situation brochodilators, as they can cause arryhtmias, and increase work on the heart. I would follow the ACS algorythm first.

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Specializes in CVICU, ER.

Also, in the ED, you don't have to "contact" the MD. They are already there...

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Specializes in ER.

how old is the patient? If a child, depends on lung sounds and oxygen saturation - likely Combivent and cxr to start.

If adult, Cardiac workup. Need more info.

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