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Jamie Ranse Registered Nurse Emergency Department The Canberra Hospital Chest Pain: Nursing Assessment and Management
Overview <ul><li>Causes of chest pain </li></ul><ul><li>Risk factors </li></ul><ul><li>Chain of Survival </li></ul><ul><li...
Pneumothorax Myocardial Infarction Respiratory Infection Angina Musculoskeletal Pericarditis Aortic Dissection Trauma Anxi...
<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...
Diabetes High Blood Pressure Physical Inactivity Over 40 Vascular Disease High Cholesterol Previous MI Obesity Smoking Fam...
<ul><li>Early Recognition and Assessment </li></ul><ul><li>Early Access </li></ul><ul><li>Early CPR </li></ul><ul><li>Earl...
<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...
 
<ul><li>Primary Assessment </li></ul><ul><li>A – clear and open  </li></ul><ul><li>B – spontaneous, AE R=L  o  added sound...
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:  Doe...
Inspect Palpate Percussion Auscultation Assessment
<ul><li>Ineffective cardiopulmonary tissue perfusion related to reduced coronary blood flow </li></ul><ul><li>Notify Nursi...
Nursing Intervention
<ul><li>Ineffective cardiopulmonary tissue perfusion related to reduced coronary blood flow </li></ul><ul><li>Notify Nursi...
<ul><li>Interpretation of ECG  </li></ul><ul><li>Chest X-Ray </li></ul><ul><li>IVC    bloods to pathology </li></ul><ul><...
<ul><li>Percutaneous Transluminal Coronary Angioplasty </li></ul><ul><li>Examine coronary arteries </li></ul><ul><li>Dilat...
PTCA
<ul><li>Unsuccessful stenting (<10%) </li></ul><ul><ul><li>Inability to advance the wire  </li></ul></ul><ul><ul><li>Re-cl...
 
 
 
 
 
<ul><li>Indications for use  </li></ul><ul><li>When PTCA unavailable </li></ul><ul><li>25% - 40% to achieve normal blood f...
<ul><li>Causes of Chest Pain </li></ul><ul><li>Risk Factors </li></ul><ul><li>Chain of Survival </li></ul><ul><li>Assessme...
Questions
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Chest pain: nursing assessment and management

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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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