Question

what are top 3 priority assessments for chest pain

Answer 1

Chest pain is a critical medical situation, which needs to be assessed and diagnosed properly, before it is managed. Chest pain can be the first hint to an acute myocardial infarction, which is a medical emergency. The assessment of chest pain will help to differentiate whether its a cardiac pain or a non cardiac pain. The priority assessments of a chest pain are:

1. Location, duration and severity of the pain: Assess subjectively the location of the pain, when it started, and on what it started(during a strenuous activity), and whether the pain reduces on rest. Also assess whether the pain is continuous or intermittent.

A cardiac pain is usually is sudden and substernal in origin, and usually starts on a strenuous activity and doesn't relieve much on rest.

The duration of the pain can vary and in AMI the pain is usually continuous , but in angina the pain is intermittent.

The severity of the pain may be beyond tolerance in a cardiac pain, and relieves only with vasodilating drugs, while non cardiac chest pain usually relieves with rest.

2. Quality and Radiation of pain: This is a very important assessment to rule out chest pain. Get a description of the type of pain from the patient. A dull squeezing, burning, cramping, crushing or a pressurizing type of pain is usually a cardiac pain. A sharp, stabbing type of pain is usually non cardiac pain.

The dull pain which starts in the centre of chest and radiates to shoulders and jaw, to back of the neck, to the arms, to the abdomen, needs to be cared promptly as a cardiac pain.

3. Associated symptoms: Presence of any associated symptoms like bradycardia, hypotension,sweating, nausea, vomiting etc has to be assessed, as these occur usually in a cardiac pain.

A clinical nurse must be calm and accurate in assessing the chest pain and diagnosing it promptly.