chest pain : immediate nursing interventions
TRANSCRIPT
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CHEST PAIN – Nurse’s Responsibilities
By: Ms. Shanta Peter
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Chest Pain ------Emergency Room
INITIAL GOAL in is to identify life threats………. MI, PE, aortic dissection
Remember …..ABCs ………..always first
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Treat …. like his life is critical
What do you do in the first 60 seconds?• How does the pt look?• What are the pt’s vital signs? ……………• EMS/ relative/friend’s story?
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Next 5 mins ??? Brief History…….Brief Physical (ABCs)
• What are 2 bedside tests that can be done to help stratify the patient? *EKG * Portable CXR• IV … Blood Investigations
• What is an important and cheap medication you should consider? *ASA
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Next 10 mins • Patient already stabilized, initial data
gathered, and initial orders carried out • Secondary survey: More detailed history and
physical examAddress patient’s pain…Goal now is to categorize patient
1) Chest wall pain- Musculoskeletal2) Pleuritic chest pain- Respiratory3) Visceral chest pain- Cardiac
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Role of EKG—GET AN EKG IN ALL CASES OF CHEST PAIN
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Infarction
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What Should You Do? • Bed rest• Oxygen unless contraindicated (severe COPD)• Chew ASPIRIN 325mg, regardless of if they
“took one” earlier(Assess for active GI bleed)• Anticoagulation– Heparin– LMWH
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• Pain Free…Morphine Sulfate 2 mg IV q5-10 min • Maximize GTN therapy• Minimize Oxygen Demand --O2 Sat• Labs to be ordered– CK with MB– Troponin– CBC– PT/PTT within that admission– Elect ,LFT if not known in last 24 hours– Fasting profiles ---- – Chest X-Ray
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• Questions to ask yourself
Is my nursing approach is correct? Is the treatment is appropriate?Is my nursing care plan is appropriate ?Does my patient understand the treatment and care?Do I need help?
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Caring your patient • Talk to patient --- • Examine patient and assess & document • Obtain & review original documents …. • DO NOT believe everything in the computer ?• Consider – differential diagnosis
• Reassess …. Exam patient • THINK !!!!!!!!!
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• Patient C/O chest pain – in ward • Any area – Medical… Surgical…..
What you will do…………..???????