Chest pain: nursing assessment and management
Upcoming SlideShare
Loading in...5
×
 

Chest pain: nursing assessment and management

on

  • 43,779 views

 

Statistics

Views

Total Views
43,779
Views on SlideShare
43,762
Embed Views
17

Actions

Likes
3
Downloads
243
Comments
0

4 Embeds 17

http://ccdhbedv.blogspot.com 10
http://www.jamieranse.com 5
http://www.slideshare.net 1
http://elearning.kctcs.edu 1

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment
  • Inspect  skin colour, scars, etc.. Palpate  pulse Percussion  lungs / heart boarders Auscultation  heart murmurs
  • B 2 via HM or NRB C FBC: Hb  anaemia, WCC  infection UEC: electrolyte imbalance CP: coagulation ?PE CK / Troponin: muscle / cardiac enzymes ABG: ventilation / perfusion status F Observations 5mins apart G Analgesia / medications
  • B 2 via HM or NRB C FBC: Hb  anaemia, WCC  infection UEC: electrolyte imbalance CP: coagulation ?PE CK / Troponin: muscle / cardiac enzymes ABG: ventilation / perfusion status F Observations 5mins apart G Analgesia / medications
  • Anginine Vasodilator, decreases preload and afterload therefore decreasing the workload of the heart, dilates coronary arteries Aspirin Platelet aggregation inhibitor  a study of 17,000 people showed a reduced re-infarction rate of 50% Morphine Analgesia, decreases anxiety, Clopidogrel Platelet aggregation inhibitor GTN Infusion Blood pressure control, reduces pain

Chest pain: nursing assessment and management Chest pain: nursing assessment and management Presentation Transcript

  • Jamie Ranse Registered Nurse Emergency Department The Canberra Hospital Chest Pain: Nursing Assessment and Management
  • Overview
    • Causes of chest pain
    • Risk factors
    • Chain of Survival
    • Prioritising / Triage
    • Assessment
    • Nursing Management
    • Medical Management
    • Conclusion
    • Questions
  • Pneumothorax Myocardial Infarction Respiratory Infection Angina Musculoskeletal Pericarditis Aortic Dissection Trauma Anxiety Pulmonary Embolism Oesophageal Reflux / Spasm Causes
    • Case 1:
    • 40 year old man
    • 2 hours central chest pain
    • Radiating to (L) arm
    • Pale, cold, clammy
    • Case 2:
    • 55 year old woman
    • 1 hour generalised weakness and unwell
    • Discomfort in throat
    Who is having an MI?
  • Diabetes High Blood Pressure Physical Inactivity Over 40 Vascular Disease High Cholesterol Previous MI Obesity Smoking Family History Unhealthy Dietary Habits Risk Factors
    • Early Recognition and Assessment
    • Early Access
    • Early CPR
    • Early Defibrillation
    • Early Advanced Cardiac Life Support
    Chain of Survival
    • Case 1:
    • 40 year old man
    • 2 hours central chest pain
    • Radiating to (L) arm
    • Pale, cold, clammy
    • Triage:
    • Rapid Assessment
    • Prioritise Injury / Illness
    • Allocate Triage Category
    Scenario
  •  
    • Primary Assessment
    • A – clear and open
    • B – spontaneous, AE R=L o added sounds
    • C – tachycardic - weak, diaphoretic
    • D – GCS 15, PEARL, full ROM / Strength / Sensation all limbs
    • Secondary Assessment
    • E – Change into patient gown
    • F – Observations: R: 28, P: 120, BP: 149/66, T: 37 2 ,
    • (monitor) BSL: 6.9, Pain 5/10, SpO 2 99% RA
    • G – Comfort measures
    • H – Detailed history / Family History / heat-to-toe assessment
    Time = Muscle Assessment
  • lleregies A M P L E edications revious medical, surgical and family history ast meal vents Assessment
  • osition: Where is the Pain? P Q R S T A A A uality: What does the pain feel like? [sharp, dull, burning] adiation: Does the pain move anywhere? everity: Rate the pain on a scale between 0 and 10 iming: When did the pain start? Is it continuous? lleviating factors: What makes it better? ggravating factors: What makes it worse? ssociated symptoms: e.g., nausea / pins and needles Assessment
  • Inspect Palpate Percussion Auscultation Assessment
    • Ineffective cardiopulmonary tissue perfusion related to reduced coronary blood flow
    • Notify Nursing Team Leader and Senior Doctor
    • Primary
    • B – Supplementary Oxygen
    • C – ECG
    Nursing Intervention
  • Nursing Intervention
    • Ineffective cardiopulmonary tissue perfusion related to reduced coronary blood flow
    • Notify Nursing Team Leader and Senior Doctor
    • Primary
    • B – Supplementary Oxygen
    • C – ECG
    • IVC 18g
    • Bloods to pathology (FBC, UEC, CP, CK, Troponin, ABG)
    • Secondary
    • F – Observations
    • G – Analgesia / Medications
    • Reassurance, bed rest, patient and family education
    Nursing Intervention
    • Interpretation of ECG
    • Chest X-Ray
    • IVC  bloods to pathology
    • Medications
      • Anginine
      • Aspirin
      • Morphine
      • GTN infusion
      • Clopidogrel
      • Heparin
      • Cardiology Review
    • Treatment Options
      • PTCA
      • Thrombolysis
    Medical Intervention
    • Percutaneous Transluminal Coronary Angioplasty
    • Examine coronary arteries
    • Dilate coronary arteries
    • “ Gold standard”
    PTCA
  • PTCA
    • Unsuccessful stenting (<10%)
      • Inability to advance the wire
      • Re-closure
      • Vessel recoil
    • Pain
    • Arrhythmia
    • Coronary spasm
    • Haemorrhage
    PTCA: Complications
  •  
  •  
  •  
  •  
  •  
    • Indications for use
    • When PTCA unavailable
    • 25% - 40% to achieve normal blood flow
    • Complications
    • Major bleeding
    Thrombolytics
    • Causes of Chest Pain
    • Risk Factors
    • Chain of Survival
    • Assessment / Recognition Bias
    • Assessment
    • Nursing Interventions
    • Medical Management
      • PTCA v Thrombolytics
    Conclusion
  • Questions