Chest pain

Title Your Name Subject and Section Professor’s Name Date Processing and Interpreting Abnormal Findings The client presented with moderate chest pain rated as 7/10. This is the most pressing issue in this case. Other abnormal findings include increased heart rate (120 beats per minute) and respiratory rate (30 breaths per minute) and elevated blood pressure at 160/95mmHg (Nischal & Madan, 2020; Johns Hopkins Medicine, n.d.). Given these abnormal parameters, the cardiac origin of chest pain must be excluded. Three differential diagnoses must be considered. First, the patient might be suffering from a non-cardiac cause, such as a gastrointestinal reflux disease (GERD), which is one of the most common causes of non-cardiac chest pain (NCCP) and accounts for 30% of the causes of acute chest pain (Gulati et al., 2021; Johnson & Ghassemzadeh, 2024). This presents with atypical chest pain that often has higher intensity. It is characterized by chest and epigastric pain, cough, and asthma, which may be perceived as difficulty breathing (Antunes et al., 2023). Consequently, cardiac causes must be excluded in patients presenting with acute chest pain because these are often fatal if not provided with prompt action and appropriate treatment. Some differentials include acute coronary syndrome (ACS), which accounts for 31% of the cases, and pulmonary embolism (PE), which accounts for 2% of the cases in the emergency department (Johnson & Ghassemzadeh, 2024). Jameson (2018) explained that ACS presents as an acute chest pain that increases in intensity with time. It is described as something pressing the chest at the substernal area. Moreover, it is often diffuse and not localized at a single point (i.e., the patient cannot point the pain using a single finger), and it may or may not be precipitated by exertion. The suspicion for ACS is also heightened by the lack of pain relief after ten minutes, particularly with the administration of sublingual nitroglycerin. In this case, the patient has been experiencing acute, moderate chest pain for an hour precipitated by eating foods (seafood) that are usually the cause of an abrupt increase in blood pressure. Hence, ACS must be ruled out. Lastly, the patient had sudden chest pain despite resting, accompanied by desaturation at 92% at room air. This signifies a probable obstruction in the airway, which gives a differential of PE. Failure of diagnosis results in a high mortality rate, accounting for 30% if not treated immediately. It presents tachycardia, chest pain, difficulty breathing, and decreased oxygen availability to the tissues. In some cases, it can be seen as a case of obstructive shock (Howard, 2019; Freund et al., 2022). All of these are also present in the case given. Nursing Intervention Upon diagnosis, the nurse's role becomes crucial in preventing the patient from succumbing to her illness. Electrocardiogram (ECG) monitoring is vital in evaluating patients with acute chest pain with typical or atypical presentation. This will show old areas of ischemia and recent myocardial infarction (MI) (Mechanic et al., 2023). The critical findings that must be observed include ST-segment elevation or depression in at least two contiguous leads. ACS-STE must be observed as at least 2mm elevation in chest leads (v1-v6) or at least 1mm elevation in the limb leads (I, II, III, aVL or aVF). For non-STE ACS, at least 1mm ST depression must be observed in any leads or T wave inversion of at least 5mm (Jameson, 2018). The nurse's role is also essential in monitoring the patient's vital signs, as the situation might worsen. Predicted Patient Outcomes Patient outcomes mainly depend on prompt diagnosis and treatment. The prognosis will depend on the complications that may or may not be present in the patient in the emergency room. These include arrhythmia and pump failure. Patients with STE-ACS deemed eligible for reperfusion strategies (i.e., percutaneous coronary insertion) to ensure adequate blood flow to the myocardial tissues should be under the procedure in less than two hours (door-to-balloon time). If identified correctly in a minimal time, the patient may achieve reperfusion without significant damage to the myocardium. In the emergency department, once the diagnosis has been established, if this is a case of ACS, the patient must receive anti-thrombotic agents such as aspirin, and the nurse in charge must administer oxygen to prevent further hypoxemia since the patient's oxygen saturation is only 92% at room air. Consequently, pain management must also be done since the patient is experiencing moderate chest pain to prevent aggravating the condition (Jameson, 2018; Frisch et al., 2020). Clinical Reasoning Cycle: Establishing SMART Goals Objective No. 1 Specific The nurse in charge shall do regular cardiac monitoring, with the provision of oxygen therapy per nasal cannula at three litres per minute (3 lpm), and to assess the intensity of chest pain to keep vital signs within normal limits and to reduce discomfort for the next six hours and to prevent the deterioration of the patient’s case (Jameson, 2018). Measurable Vital signs will be monitored every hour, particularly for the presence of abnormal rhythms in the heart rate, via the cardiac monitor to prevent one of the most fatal complications of ACS, which is arrhythmia. Oxygen saturation should also be maintained above 94%, and hypertension should be prevented (Jameson, 2018). Achievable The nurse in charge should ensure the timely introduction of medications and coordinate with other healthcare team members by updating the patient's situation. Relevant Consistent and timely evaluation is vital for the nurse in charge to allow for timely intervention. Time-Bound The assessment and care nurses provide the patient should be completed within the next 6 hours of continuous nursing care, starting from the evaluation to stabilization. Objective No. 2 Specific The nurse in charge will do a comprehensive assessment of the patient after the first 24 hours of admission to check on her mental and emotional states and her family. Measurable The Hospital Anxiety and Depression Scale (HADS) shall be employed to identify the stakeholders' emotional and mental distress levels (Wynne et al., 2020). Achievable A mandatory training session for all nurses in the emergency department to administer the HADS assessment tool and seminars for all members of the emergency department team shall ensue to coordinate efforts with a multidisciplinary team (Wynne et al., 2020). Relevant Harlan et al. (2020) ...