Chest Pain--- PQRST - Assessment
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Transcript of Chest Pain--- PQRST - Assessment
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PAIN
PAIN
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Pain is an unpleasant feeling often caused by intense or damaging stimuli
Pain is an unpleasant sensory and emotional experience
associated with actual or potential tissue damage, or described in terms of such damage
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CHEST PAIN
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CHEST PAIN EVALUATION
O – X Format
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O : OVERALL ( PRIMARY) SURVEY ABCs-- CAB Age Vital signs Oxygen therapy Cardiac monitoring History of previous heart conditions Diabetes Hypertension Stroke Medications
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P: POSITION P: PROVOCATIONPosition Left chest Right Chest Sub sternal Epi gastric Mid back Generalized Provocation
ColdHeat
Stress
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Q : QUALITY
Pressure/squeezing Discomfort
Burning Sharp
Aching
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R: RADIATION Left/right arm
Neck, Jaw Anywhere at all
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S: SIGNS & SYMPTOMS Nausea vomiting
Diaphoresis Anxiety
Shortness of breath Dizziness
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T: TIMING – DURATION
When did the pain begin? When did the pain end? Does it come and go?
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U: UNCOMFORTABLE FEELING Pain scale 0-10 (0 - NO pain to 10
worst pain or discomfort)
Signs of non cardiac pain
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V: Variation Variation with deep inspiration Pain increased or changed with position
W: Worse With palpation
X: eXisting Pain lasts a few fleeting seconds
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CHEST PAIN IN CHILDREN Costochondritis : painful inflammation of
the cartilage that attaches the ribs to the sternum Common cause of chest pain in kids and teen.
Girls more – sharp stabbing pain ( like Heart Attack) It goes off in 2- 3 days – or last bit
longer Cause ?? …. related to injury .. physical
strain – heavy lift – exercise --- repeated coughing
Pain go worse when child take deep breathing – coughing ..
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Other Assessments….
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Why does pain during a heart attack tend to radiate toward the left side of the body
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Many organs in the body have very few specific pain receptors (nociceptors).
the heart has very few or no nociceptors, the brain has a difficult time interpreting irritation as pain.
The nerves from your heart join with other organs from the general area and follows the same nerve pathways to your spinal cord then to your brain.
This creates a sensation of generalized discomfort commonly interpreted as pressure or a dull ache to the generalized area, typically the left arm and neck
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Assessments……………… Putting together ……………
What we will do ??????
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Initial Assessment: CAB ……….ABC Determine whether the pain may be
cardiac --- the other origin Consider -----HistoryPresence of CV risk factorsH/O IHD – Previous treatmentsPrevious investigations – for chest pain
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Determine the cause of Chest Pain
Brief targeted History – physical assessment
Admitted before – pneumonia, GB, COPD,
U. Angina,-- DM Describe chest pain --- character– scale –PQRST Initiate appropriate intervention
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Vital signs: Baseline ----------• B Cardia----- poor function of heart • Tachy Cardia – Inadequate perfusion
• ^BP – result of pain -- • ^workload of heart /myocardial O2 requirement
Head to toe assessment : use senses –
--- Look ---Listen ---- Feel—
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Neurological assessment ( brief) ..ask personal questions , Squeeze your hand, Press feet against hard surface ( all can be done while checking VS/monitoring
Heart …monitoring --- Rhythm– rate – Auscultation--- Lungs –Resp effort – dyspnea, /tachypneaBreath sounds– clear– crackly– wheezingPain on inspiration --- O2 sat--- >94% Abdomen– distended, Bowel movement, nauzea, vomiting. Pain begin -…
after eating(GERD) relieved by eating
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If no definite diagnosis – treat as of cardiac origin Investigations – Medications