Question

Discuss the nursing assessment of the patient with chest pain. What questions are important to include in the nursing history when assessing for stable or unstable angina? Discuss the nursing management of the patient with an ST elevation MI (STEMI).

Answer 1

Ans: Chest pain and discomfort are common symptoms that
may be caused by a number of cardiac and noncardiac
problems. The nurse should keep the following important points in
mind when assessing patients reporting chest pain or dis-
comfort:
1. The location of chest symptoms is not well correlated
with the cause of the pain. For example, substernal chest pain can result from a number of causes.

2. Assessment should be on the basis of following factors:

(a). Location of pain, pain occurs at different regions like jaw, right side , epigastrium and back.

(b). Character of the pain: For example in angina there is uncomfortable pressure, squeezing and fullness while as in pericarditis there is sharp, severe substernal or epigastric pain that can radiate to neck, arms, and back.

(c). Duration of pain.

(d). Aggravating factors.

(e). Alleviating factors.

3. The nurse needs to determine whether there is radiationor discomfort in other areas and must assess for associated signs and symptoms such as diaphoresis or nausea.

4.It is important to identify the events that precipitate the onset of symptoms, the duration of the symptoms, and measures that aggravate or relieve the symptoms.

5. The severity or duration of chest pain or discomfort does not predict the seriousness of its cause.

While assessing angina stable/unstable the nurse should keep in mind that chest pain can be very deceptive. It is a subjective discomfort experienced by the individual which may be of cardiac or non-cardiac origin. In the short term, the safest course is to always assume it is cardiac until the prevalence of data convinces you otherwise. The nurse should ask for the location, duration and character of pain. Angina is the most commonly reported manifestation of cardiac chest pain. Typical angina is described as a pressure, heaviness, and/or a burning sensation. The discomfort of angina is the result of insufficient oxygen in one or more areas of the heart muscle.

Nursing management of patients with STEMI :

1. Initially assess document and report to physician the patient’s description of chest discomfort, including location, intensity, radiation, duration, and factors that affect it. Other symptoms such as nausea, diaphoresis, or complaints of unusual fatigue.

2. Obtain a 12-lead ECG recording during symptomatic events, as prescribed, to assess for ongoing ischemia.

3. Administer oxygen as per requirement.

4. Administer medication therapy as prescribed and evaluate the patient’s response continuously.