What are the nursing interventions for chest pain?

According to the CDC, approximately 805,000 Americans have a heart attack each year, a leading cause of chest pain. Understanding what are the nursing interventions for chest pain is crucial for providing timely, life-saving care and managing patient outcomes effectively.

Quick Summary

Immediate nursing care for chest pain involves rapid assessment, vital sign monitoring, and crucial interventions like administering oxygen, aspirin, and nitroglycerin as prescribed. Subsequent care focuses on detailed diagnostics, continuous monitoring, pain management, and patient education to address the underlying cause and prevent future episodes.

Key Points

• Immediate Response: A rapid and systematic assessment, including a PQRST pain evaluation and immediate vital sign monitoring, is the first priority.

• Life-Saving Medications: Administering oxygen, aspirin, nitroglycerin, and possibly morphine, as prescribed, is crucial for stabilizing the patient.

• Continuous Monitoring: Ongoing cardiac and vital sign monitoring is essential to detect any changes and evaluate the effectiveness of interventions.

• Diagnostic Support: Nurses are vital in facilitating diagnostic tests like ECGs and lab work, which are necessary to determine the cause of the chest pain.

• Patient Education: Comprehensive patient education on medication, diet, exercise, and stress management is key to preventing future episodes and improving long-term health.

• Anxiety Reduction: Providing emotional support and reassurance is a critical nursing intervention that helps reduce patient anxiety during a frightening and stressful event.

Immediate Nursing Interventions for Chest Pain

Upon a patient's report of chest pain, a nurse's immediate response is critical. The first minutes of care often determine a patient’s outcome. Prompt assessment, stabilization, and intervention are the top priorities.

Assessment

1. Perform a rapid, focused assessment.
   • PQRST assessment: Use this mnemonic to evaluate the pain: Provocation (what caused it?), Quality (what does it feel like?), Radiation (where does it spread?), Severity (scale of 1-10), and Timing (when did it start?).
   • Associated symptoms: Check for diaphoresis (sweating), nausea, vomiting, shortness of breath, palpitations, or anxiety.
   • Medical history: Ask about past cardiac history, risk factors, and current medications.
2. Monitor vital signs.
   • Take and record the patient's heart rate, blood pressure, respiratory rate, and oxygen saturation (SpO2).
   • Establish continuous cardiac monitoring.
3. Obtain a 12-lead electrocardiogram (ECG).
   • Acquire the ECG promptly to identify any signs of myocardial ischemia, injury, or infarction.

Intervention

1. Place the patient in a position of comfort.
   • Elevate the head of the bed to a semi-Fowler's position to reduce myocardial workload and improve breathing.
2. Administer oxygen therapy.
   • Provide supplemental oxygen if the patient's SpO2 is below 94% or if they are experiencing respiratory distress.
3. Administer medications as ordered.
   • Aspirin (chewed): Give aspirin as prescribed to inhibit platelet aggregation, which can limit clot formation.
   • Nitroglycerin: Administer sublingual nitroglycerin as prescribed to cause vasodilation and relieve ischemic pain. Monitor blood pressure before and after administration.
   • Morphine: If pain is unrelieved by nitroglycerin, administer morphine as ordered to reduce pain and decrease myocardial oxygen demand.
4. Establish IV access.
   • Insert an intravenous line to ensure access for medication administration.

Subsequent and Diagnostic Interventions

Following initial stabilization, nursing interventions shift toward diagnostics and more advanced care to confirm the cause and severity of the chest pain.

Continuous Monitoring and Assessment

1. Repeat pain assessment: Reassess the patient's pain level frequently to evaluate the effectiveness of interventions.
2. Monitor ECG: Watch for any changes in the ECG rhythm or ST-segment.
3. Review lab results: Track cardiac biomarkers such as troponin and CK-MB to confirm or rule out myocardial infarction.
4. Prepare for advanced diagnostics: Assist with preparing the patient for further tests, such as a chest x-ray, echocardiogram, or cardiac catheterization.

Long-Term Management and Education

Once the patient is stable, a nurse's role expands to long-term management and patient education to prevent recurrence.

Medication and Lifestyle Management

1. Medication adherence: Educate the patient on their prescribed medications, including purpose and potential side effects.
2. Dietary counseling: Explain the benefits of a heart-healthy diet, such as the DASH or Mediterranean diet, and recommend a low-sodium plan.
3. Smoking cessation: Strongly encourage and provide resources for smoking cessation.
4. Physical activity: Discuss a gradual increase in physical activity as tolerated and as advised by the healthcare provider.

Anxiety and Stress Management

1. Emotional support: Address the patient's anxiety and fear by providing reassurance and a calming presence.
2. Coping mechanisms: Teach and practice relaxation techniques, such as deep breathing, to help manage stress.
3. Referral: If needed, refer the patient to a cardiac rehabilitation program or counseling.

Comparison of Interventions for Angina vs. Myocardial Infarction (MI)

Feature	Angina Interventions	Myocardial Infarction (MI) Interventions
Onset	Pain often triggered by exertion or stress.	Severe, persistent chest pain, often at rest.
Pain Relief	Relieved by rest and nitroglycerin.	May not be relieved by nitroglycerin; often requires stronger pain medication like morphine.
Diagnostics	ECG may show ST depression or T-wave inversion during an episode.	ECG shows significant ST-segment elevation (STEMI) or depression/T-wave inversion (NSTEMI). Cardiac biomarkers are elevated.
Initial Treatment	Rest, nitroglycerin, oxygen.	MONA (Morphine, Oxygen, Nitroglycerin, Aspirin) is often a framework for initial management.
Urgency	Urgent management to prevent MI.	Medical emergency requiring immediate, aggressive intervention and revascularization.
Primary Goal	Reduce myocardial workload and improve blood flow.	Restore blood flow to the heart muscle (e.g., via PCI) and prevent further damage.

A Comprehensive Approach to Care

Nursing interventions for chest pain involve a multi-faceted approach, encompassing immediate life-saving measures, thorough diagnostic support, and comprehensive patient education. Nurses must act with speed and precision while maintaining a compassionate demeanor to reassure the patient. The core of these interventions lies in continuous assessment, targeted medical treatment, and proactive education to empower patients in their long-term health management. This holistic care model not only addresses the immediate crisis but also lays the groundwork for improved cardiac health and prevention of future events. For further authoritative information on cardiac care, please consult the American Heart Association. By following these evidence-based practices, nurses play a pivotal role in optimizing outcomes for patients experiencing chest pain.

Frequently Asked Questions

What is the very first nursing action when a patient complains of chest pain?

The very first action is to conduct a rapid, focused assessment, including the PQRST mnemonic for pain, and take the patient's vital signs while placing them in a position of comfort.

Why is chewing aspirin recommended for chest pain?

Chewing aspirin allows it to be absorbed more quickly into the bloodstream, where it can begin inhibiting platelets and preventing further clot formation in the coronary arteries.

What does a nurse do if nitroglycerin doesn't relieve the chest pain?

If nitroglycerin is ineffective, a nurse will administer stronger pain medication like morphine as ordered by the physician, while continuously monitoring the patient for any changes in their condition.

What position should a patient with chest pain be placed in?

A patient should be placed in a semi-Fowler's position, with the head of the bed elevated. This position helps reduce myocardial workload and improves breathing.

How do nursing interventions for angina differ from those for a heart attack?

While both involve immediate assessment and monitoring, interventions for a heart attack are more aggressive and focus on revascularization, as the pain is severe and persistent, often not relieved by nitroglycerin.

What is the role of patient education regarding chest pain?

Patient education is crucial for long-term management and prevention. Nurses teach patients about medication adherence, heart-healthy lifestyle changes, symptom recognition, and when to seek emergency help.

What should be monitored continuously for a patient experiencing chest pain?

Continuous monitoring of cardiac rhythm via ECG, vital signs (especially oxygen saturation), and frequent reassessment of the patient's pain level and overall status is essential.