Chest pain: nursing assessment and management

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  • 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

    1. 1. Jamie Ranse Registered Nurse Emergency Department The Canberra Hospital Chest Pain: Nursing Assessment and Management
    2. 2. Overview <ul><li>Causes of chest pain </li></ul><ul><li>Risk factors </li></ul><ul><li>Chain of Survival </li></ul><ul><li>Prioritising / Triage </li></ul><ul><li>Assessment </li></ul><ul><li>Nursing Management </li></ul><ul><li>Medical Management </li></ul><ul><li>Conclusion </li></ul><ul><li>Questions </li></ul>
    3. 3. Pneumothorax Myocardial Infarction Respiratory Infection Angina Musculoskeletal Pericarditis Aortic Dissection Trauma Anxiety Pulmonary Embolism Oesophageal Reflux / Spasm Causes
    4. 4. <ul><li>Case 1: </li></ul><ul><li>40 year old man </li></ul><ul><li>2 hours central chest pain </li></ul><ul><li>Radiating to (L) arm </li></ul><ul><li>Pale, cold, clammy </li></ul><ul><li>Case 2: </li></ul><ul><li>55 year old woman </li></ul><ul><li>1 hour generalised weakness and unwell </li></ul><ul><li>Discomfort in throat </li></ul>Who is having an MI?
    5. 5. Diabetes High Blood Pressure Physical Inactivity Over 40 Vascular Disease High Cholesterol Previous MI Obesity Smoking Family History Unhealthy Dietary Habits Risk Factors
    6. 6. <ul><li>Early Recognition and Assessment </li></ul><ul><li>Early Access </li></ul><ul><li>Early CPR </li></ul><ul><li>Early Defibrillation </li></ul><ul><li>Early Advanced Cardiac Life Support </li></ul>Chain of Survival
    7. 7. <ul><li>Case 1: </li></ul><ul><li>40 year old man </li></ul><ul><li>2 hours central chest pain </li></ul><ul><li>Radiating to (L) arm </li></ul><ul><li>Pale, cold, clammy </li></ul><ul><li>Triage: </li></ul><ul><li>Rapid Assessment </li></ul><ul><li>Prioritise Injury / Illness </li></ul><ul><li>Allocate Triage Category </li></ul>Scenario
    8. 9. <ul><li>Primary Assessment </li></ul><ul><li>A – clear and open </li></ul><ul><li>B – spontaneous, AE R=L o added sounds </li></ul><ul><li>C – tachycardic - weak, diaphoretic </li></ul><ul><li>D – GCS 15, PEARL, full ROM / Strength / Sensation all limbs </li></ul><ul><li>Secondary Assessment </li></ul><ul><li>E – Change into patient gown </li></ul><ul><li>F – Observations: R: 28, P: 120, BP: 149/66, T: 37 2 , </li></ul><ul><li>(monitor) BSL: 6.9, Pain 5/10, SpO 2 99% RA </li></ul><ul><li>G – Comfort measures </li></ul><ul><li>H – Detailed history / Family History / heat-to-toe assessment </li></ul>Time = Muscle Assessment
    9. 10. lleregies A M P L E edications revious medical, surgical and family history ast meal vents Assessment
    10. 11. 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
    11. 12. Inspect Palpate Percussion Auscultation Assessment
    12. 13. <ul><li>Ineffective cardiopulmonary tissue perfusion related to reduced coronary blood flow </li></ul><ul><li>Notify Nursing Team Leader and Senior Doctor </li></ul><ul><li>Primary </li></ul><ul><li>B – Supplementary Oxygen </li></ul><ul><li>C – ECG </li></ul>Nursing Intervention
    13. 14. Nursing Intervention
    14. 15. <ul><li>Ineffective cardiopulmonary tissue perfusion related to reduced coronary blood flow </li></ul><ul><li>Notify Nursing Team Leader and Senior Doctor </li></ul><ul><li>Primary </li></ul><ul><li>B – Supplementary Oxygen </li></ul><ul><li>C – ECG </li></ul><ul><li>IVC 18g </li></ul><ul><li>Bloods to pathology (FBC, UEC, CP, CK, Troponin, ABG) </li></ul><ul><li>Secondary </li></ul><ul><li>F – Observations </li></ul><ul><li>G – Analgesia / Medications </li></ul><ul><li>Reassurance, bed rest, patient and family education </li></ul>Nursing Intervention
    15. 16. <ul><li>Interpretation of ECG </li></ul><ul><li>Chest X-Ray </li></ul><ul><li>IVC  bloods to pathology </li></ul><ul><li>Medications </li></ul><ul><ul><li>Anginine </li></ul></ul><ul><ul><li>Aspirin </li></ul></ul><ul><ul><li>Morphine </li></ul></ul><ul><ul><li>GTN infusion </li></ul></ul><ul><ul><li>Clopidogrel </li></ul></ul><ul><ul><li>Heparin </li></ul></ul><ul><ul><li>Cardiology Review </li></ul></ul><ul><li>Treatment Options </li></ul><ul><ul><li>PTCA </li></ul></ul><ul><ul><li>Thrombolysis </li></ul></ul>Medical Intervention
    16. 17. <ul><li>Percutaneous Transluminal Coronary Angioplasty </li></ul><ul><li>Examine coronary arteries </li></ul><ul><li>Dilate coronary arteries </li></ul><ul><li>“ Gold standard” </li></ul>PTCA
    17. 18. PTCA
    18. 19. <ul><li>Unsuccessful stenting (<10%) </li></ul><ul><ul><li>Inability to advance the wire </li></ul></ul><ul><ul><li>Re-closure </li></ul></ul><ul><ul><li>Vessel recoil </li></ul></ul><ul><li>Pain </li></ul><ul><li>Arrhythmia </li></ul><ul><li>Coronary spasm </li></ul><ul><li>Haemorrhage </li></ul>PTCA: Complications
    19. 25. <ul><li>Indications for use </li></ul><ul><li>When PTCA unavailable </li></ul><ul><li>25% - 40% to achieve normal blood flow </li></ul><ul><li>Complications </li></ul><ul><li>Major bleeding </li></ul>Thrombolytics
    20. 26. <ul><li>Causes of Chest Pain </li></ul><ul><li>Risk Factors </li></ul><ul><li>Chain of Survival </li></ul><ul><li>Assessment / Recognition Bias </li></ul><ul><li>Assessment </li></ul><ul><li>Nursing Interventions </li></ul><ul><li>Medical Management </li></ul><ul><ul><li>PTCA v Thrombolytics </li></ul></ul>Conclusion
    21. 27. Questions

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