The document outlines the responsibilities of nurses in managing patients with chest pain in an emergency room setting. It emphasizes the importance of quickly assessing the patient's condition, performing initial tests like EKG and chest X-ray, and stabilizing the patient through appropriate medication and interventions. Additionally, it highlights the need for detailed history taking, physical examination, and effective communication with the patient about their care.

1. CHEST PAIN–
Nurse’s Responsibilities
By: Ms. Shanta Peter

2. Chest Pain ------Emergency Room
INITIAL GOAL in is to identify life threats……….
MI, PE, aortic dissection
Remember …..ABCs ………..always first

3. 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?

4. 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

5. Next 10 mins
• Patient already stabilized, initial data
gathered, and initial orders carried out
• Secondary survey: More detailed history and
physical exam
Address patient’s pain…Goal now is to
categorize patient
1) Chest wall pain- Musculoskeletal
2) Pleuritic chest pain- Respiratory
3) Visceral chest pain- Cardiac

6. Role of EKG—
GET AN EKG IN ALL CASES OF CHEST PAIN

7. Infarction

10. 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

11. • 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

12. • 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?

13. 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 !!!!!!!!!

14. • Patient C/O chest pain – in ward
• Any area – Medical… Surgical…..
What you will do…………..???????