STUDY - Technical - New Dacian's Medicine
Chest
pain (Classical / Allopathic Medicine)
Chest pain usually
results from a disorder affecting the thoracic or abdominal
organs - the heart, pleurae, lungs, esophagus, rib cage,
gallbladder, pancreas, or stomach. An important indicator of
several acute and life-threatening cardiopulmonary and GI
disorders, chest pain can also result from a musculoskeletal
or hematologic disorder, anxiety, or drug therapy.
Chest pain can
arise suddenly or gradually, and its cause may be difficult to
ascertain initially. The pain can radiate to the arms, neck,
jaw, or back. It can be steady or intermittent, mild or acute.
It can range in character from a sharp shooting sensation to a
dull, achy pain, a feeling of heaviness, a feeling of
fullness, or even indigestion. It can occur at rest or be
provoked or aggravated by stress, anxiety, physical exertion,
deep breathing, or certain foods.
ALERT:
When a patient complains of chest pain:
- take his vital signs
- administer oxygen until the cause of the pain is determined
- attach the patient to a cardiac monitor
- have emergency equipment available.
If the patient's condition permits, perform a focused assessment.
When a patient complains of chest pain:
- take his vital signs
- administer oxygen until the cause of the pain is determined
- attach the patient to a cardiac monitor
- have emergency equipment available.
If the patient's condition permits, perform a focused assessment.
HISTORY:
Ask the patient if he has experienced this type of pain in the past. Ask him to describe the pain. Did it begin suddenly or gradually? Is it more severe or frequent now than when it first started?
Ask the patient if anything in particular seems to cause the pain.
Ask the patient if anything makes the pain better or worse, or if it's constant or intermittent.
Ask the patient what time of day the pain occurs.
Ask the patient about associated symptoms, such as belching.
Ask the patient if the pain radiates to other areas.
Review the patient's medical history for cardiac or pulmonary disease, chest trauma, psychiatric disorders, GI disease, and sickle cell anemia.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs, and ask about recent dosage or schedule changes. Also, ask the patient about alcohol intake.
Ask the patient about his smoking habits and cholesterol levels. Assess his family history for hypertension, coronary artery disease, myocardial infarction, and diabetes mellitus.
Ask the patient if he has experienced this type of pain in the past. Ask him to describe the pain. Did it begin suddenly or gradually? Is it more severe or frequent now than when it first started?
Ask the patient if anything in particular seems to cause the pain.
Ask the patient if anything makes the pain better or worse, or if it's constant or intermittent.
Ask the patient what time of day the pain occurs.
Ask the patient about associated symptoms, such as belching.
Ask the patient if the pain radiates to other areas.
Review the patient's medical history for cardiac or pulmonary disease, chest trauma, psychiatric disorders, GI disease, and sickle cell anemia.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs, and ask about recent dosage or schedule changes. Also, ask the patient about alcohol intake.
Ask the patient about his smoking habits and cholesterol levels. Assess his family history for hypertension, coronary artery disease, myocardial infarction, and diabetes mellitus.
PHYSICAL
ASSESSMENT:
Take the patient's vital signs, noting tachypnea, fever, tachycardia, paradoxical pulse, and hypertension or hypotension. Also, look for jugular vein distention and peripheral edema.
Observe the patient for restlessness and anxiety.
Observe the patient's skin color. Note diaphoresis or cool, clammy skin.
Observe the patient's breathing pattern, and inspect his chest for asymmetrical expansion. Auscultate his lungs for pleural friction rub, crackles, rhonchi, wheezing, or diminished or absent breath sounds.
Auscultate the chest for murmurs, clicks, gallops, or pericardial friction rub. Palpate for lifts, heaves, thrills, gallops, tactile fremitus, and abdominal mass or tenderness.
Take the patient's vital signs, noting tachypnea, fever, tachycardia, paradoxical pulse, and hypertension or hypotension. Also, look for jugular vein distention and peripheral edema.
Observe the patient for restlessness and anxiety.
Observe the patient's skin color. Note diaphoresis or cool, clammy skin.
Observe the patient's breathing pattern, and inspect his chest for asymmetrical expansion. Auscultate his lungs for pleural friction rub, crackles, rhonchi, wheezing, or diminished or absent breath sounds.
Auscultate the chest for murmurs, clicks, gallops, or pericardial friction rub. Palpate for lifts, heaves, thrills, gallops, tactile fremitus, and abdominal mass or tenderness.
SPECIAL
CONSIDERATIONS:
Keep in mind that a patient with chest pain may deny his discomfort, so stress the importance of reporting symptoms so that his treatment can be adjusted accordingly.
Keep in mind that a patient with chest pain may deny his discomfort, so stress the importance of reporting symptoms so that his treatment can be adjusted accordingly.
PEDIATRIC
POINTERS:
Even children old enough to talk may have difficulty describing chest pain, so be alert for nonverbal clues, such as restlessness, facial grimaces, or holding of the painful area. Ask the child to first point to the painful area and then to point to where the pain goes. Determine the pain's severity by asking the parents if the pain interferes with the child's normal activities and behavior.
A child may complain of chest pain in an attempt to get attention or to avoid attending school.
Even children old enough to talk may have difficulty describing chest pain, so be alert for nonverbal clues, such as restlessness, facial grimaces, or holding of the painful area. Ask the child to first point to the painful area and then to point to where the pain goes. Determine the pain's severity by asking the parents if the pain interferes with the child's normal activities and behavior.
A child may complain of chest pain in an attempt to get attention or to avoid attending school.
AGING ISSUES:
Because older patients are at higher risk for developing life-threatening conditions, such as a myocardial infarction, angina, or aortic dissection, carefully evaluate chest pain in an elderly patient.
Because older patients are at higher risk for developing life-threatening conditions, such as a myocardial infarction, angina, or aortic dissection, carefully evaluate chest pain in an elderly patient.
PATIENT
COUNSELING:
If the patient has coronary artery disease, teach him about the typical features of cardiac ischemia and about the symptoms that should prompt him to seek medical attention. If the pain doesn't disappear after taking sublingual nitroglycerin, lasts more than 20 minutes, or has a different pattern than the usual angina, the patient must be evaluated immediately.
If the patient has coronary artery disease, teach him about the typical features of cardiac ischemia and about the symptoms that should prompt him to seek medical attention. If the pain doesn't disappear after taking sublingual nitroglycerin, lasts more than 20 minutes, or has a different pattern than the usual angina, the patient must be evaluated immediately.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)