When assessing a patient who is complaining of left-sided chest pain, it can be a rather stressful and scary situation because as a nurse, one knows that minutes count and that it can be a life or death situation. The key elements when a patient presents in this manner is to remain calm and to stay focused. The first question one should ask is “Does this pain have other signs and symptoms? ” such as shortness of breath, nausea, or diaphoresis? If the patient does, the nurse will want to alleviate the patient by applying 2 liters of oxygen via a nasal cannula. Next, the nurse should ask should relate specifically to the pain itself.
“Does it radiate down the arm, back or up the neck? ” “What does the pain feel like? ” “Is it a crushing pain or burning pain? ” “Does it come and go, or is it constant? ” “Severe, immobilizing chest pain not relieved by rest, position change? is the hallmark sign of a Myocardial Infarction (heart attack)” (Lewis, Heitkemper 2005). This patient has a history of Gastroesophogealregurgitation Disease (GERD), and it is therefore important to simultaneously rule out indigestion. Inquire when his last meal was, and what it contained. Medications, therefore, become the next focal point.
It is important to know; what cardiac medications the patient is currently taking, has the patient taken an antacid recently, does the patient have an Aspirin available to take at this time? If the patient has Aspirin available to take, it would be ideal to administer the medication. “Aspirin is a platelet, interrupting platelet aggregation at the site of plaque rupture. Patients who receive aspirin have a 15% higher mortality than those who do not” (Nursing 2006). Another medication to consider, if the patient has available to them would be Nitroglycerin; a nitrate that dilates veins making it easier for the blood to pump through.
Also, if pain is significant, it would be ideal to administer a pain reliever such as Morphine. By administering analgesia, ischemia is also decreased. (Lewis, Heitkemper 2005). Nurses sometimes find the acronym “MOAN”, an easy way to remember what steps to do when patients present with chest pain. It stands for Morphine, Oxygen, Aspirin, and Nitroglycerin. It would also be ideal for the nurse to utilize the resources around her, by calling upon a qualified fellow co-worker to aid in the further investigation of this patient.
This person can be useful in many tasks, such as; assisting with hands on assessments, notifying the doctor, assisting with CPR if necessary, and getting more assistance as needed, to name a few. It is also equally as important, to remain calm and to communicate with the patient in a calm manner in an attempt to keep the patient’s stress level at a minimum. While one is obtaining answers to the above mentioned questions, it would be ideal to begin assessing the patient. It is standard to obtain a set of vital signs and compare them to early recorded ones (Pope 2006). Assess the apical heart rate for any abnormalities; such as tachycardia/bradycardia, a new murmur, or rub.
While performing this assessment, one can also note whether the patient’s jugular veins are distended. Jugular vein distention is commonly found in right ventricular infarction. One can also check distal extremities for pulse presentation. Pulses should be palpable, but not bounding. Bounding indicates the heart is working too hard to perfuse the body. Capillary refill is also a quick test to check for adequate perfusion. Inspect the patient’s skin. Are they pale in color? Does the patient feel clammy or sweaty? Is the skin cool to the touch?
Do you notice any swelling, particularly around the eyes, hands, or lower extremities? (Nursing 2006). Auscultation of lung sounds can be useful to determine patient’s chest pain. “Diminished breath sounds or absent breath sounds on one side can indicate a pneumothorax” (Pope 2006). It is also appropriate to listen to bowel sounds and palpate the patient’s abdomen. Inquire when the patient’s last bowel movement was, and whether it was normal for the patient (Pope 2006). Risk factors are divided into two groups, controlled and uncontrolled.
Those that are in the controlled group, are factors that individuals can change; such as diet and smoking cessation. The uncontrolled group, are factors that the patient cannot change; such as ethnicity and family history. The patient being presented has several risk factors, according to the American Heart Association. Age is a significant risk factor. “83% of people who die of coronary heart disease are 65 and older” (AHA 2007). Gender is another risk factor that impacts chances of heart attack. Males are at a higher risk of having a heart attack, and generally have them early in life than women do.
Those that are smokers are at an increased risk of developing heart disease and consequently having a heart attack. This patient reports having recently stopped smoking, but has a long extensive history of heavy smoking. Co-morbidity of certain diseases, such as Diabetes and Hypertension, can also amplify ones risk for having a heart attack. There are other risk factors that were not covered due to lack of information, but require further investigation. For example, race is also a factor to consider, it is reported that African Americans are more are risk because of hypertension.
Whereas other races, such as Caucasians, Mexican American, Native Hawaiians, are at risk because of diabetes and obesity. Family history should also be considered when reviewing possible risks for heart attack. Those with “physical inactivity” and a sedentary lifestyle are more likely to have inadequate heart muscles and be over-weight/obese, have increased cholesterols, and consequently have an increased risk for having a heart attack. (AHA, 2007) It would be highly beneficial to review this information with the patient and to discuss healthy choices and changes he can make to lessen his chances of having a heart attack.
In conclusion, it can be reviewed that patients who present with left sided chest pain can be a serious emergent situation that requires immediate intervention. It is important to know what questions to ask the patient, and their purpose. It is equally important to perform a rapid, yet thorough assessment. By following these simple steps, one can feel confident to provide the utmost patient care in a critical situation.
References American Heart Association (2007). “Risk Factors and Coronary Heart Disease”. Information retrieved on May 5, 2007, from, http://www. americanheart. org/presenter.jhtml? identifier=4726 Lackey, S. (2006). Suppressing the Scourge of AMI. Information retrieved on May 5, 2007, from http://web. ebscohost. com/ehost/pdf? vid=9&hid=102&sid=1daba809-ff91-456c-a0f3-a46478964a8a%40sessionmgr106 Lewis, Heitkemper, Dirksen (2005).
Medical-surgical Nursing: Assessment and Management of Clinical Problems, Pg 818 table 33-12, Pg 828 p10. Pope, Barbara (2006). “What’s Causing Your Patient’s Chest Pain? ” Information retrieved on, May 7, 2007, from http://web. ebscohost. com/ehost/pdf? vid=11&hid=120&sid=e509b87b-094e-4ab2- 8a77-89f0f748d698%40sessionmgr106.