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NURING MANAGEMENT FOR CHEST PAIN

( Unit policy review)

CHEST PAIN : Angina is chest pain or discomfort caused when your heart muscle doesnt get
enough oxygen rich blood. It may feel like pressure or squeezing in your chest.

A tight, squeezing, or crushing sensation


Feels heavy, pressing or tight
Lasts longer than 15 minutes
Spreads to other parts of your body such as your arms, back or jaw
Is alongside other symptoms such as breathlessness, nausea, sweating, or coughing up blood
increase in blood pressure and tachycardia.

CAUSES :

1. Heart Problems
Coronary Artery Disease

Myocardial infarction (heart attack)


Signs and symptoms
Fatigue
Chest discomfort
Malaise

Characteristics of Chest pain:

Intense and unremitting for 30-60 minutes


Substernal, and often radiates up to the neck, shoulder, and jaw, and down the left arm
Substernal pressure sensation such as ( squeezing, aching, burning, or even sharp)
Epigastric, with a feeling of indigestion or of fullness and gas

Vital signs in Myocardial infarction :

Tachycardia
Pulse may be irregular
Hypotension and Cardiogenic shock
The respiratory rate may be increased
Coughing, wheezing, and frothy sputum

DIAGNOSTIC STUDIES :
Laboratory studies
>Cardiac enzyme
>Troponin I
Electrocardiography
Cardiac imaging
2. Lung Problems

Pleuritis
Pneumonia or lung abscess
Asthma

3. Gastrointestinal Problems

Gastroesophageal reflux disease (GERD).


Esophageal hypersensitivity
Peptic ulcers

4. Bone, Muscle, or Nerve Problems

Rib problems
Chest trauma
Muscle strain
Shingles
Caused by the varicella zoster virus, shingles may prompt a sharp, band-like pain
before a telltale rash appears several days later.

NURING ASSESSMENT Of CHEST PAIN :Myocardial Infarction

Description of chest pain, including location, intensity, radiation, duration, nausea.


Effect of chest discomfort on cardiovascular perfusion to the heart (e.g. change in BP,
Heart rate and sound ).
Place the patient comfortably in bed semi- fowler's position.
Vital signs are assessed frequently
ECG
IV fluids.
Physical rest and comfort.
Alleviating anxiety and fear .

MEDICAL MANAGEMENT

Analgesics: Help alleviate pain by decreasing venous return to the heart.


Nitroglycerin used to treat continuing pain despite aggressive therapy.
Morphine for severe pain unless patient is hypotensive or bradycardic.
Thrombolytic - Helps relieve coronary occlusion.

Prepared by: Alfadz H. Asakil ,RN


ED Staff Nurse