CHEST PAIN SERIES FOR NURSES

Updated 8/25

Master your Clinical skills is no longer available.

Dear nurses,

New topics and links have been added below.

To learn more, simply click on the links
below and enjoy learning:

Chest pain assessment and quiz

Chest pain for the layperson

Learn more about : Care planning

Learn more about: Your Critical Thinking

RED ALERT FOR NURSES

Updated 6/25

Dear nurses, 

      Communication skills

Enjoy the video: Nursing communication

Learn more about: Your Critical Thinking

UNDERSTANDING HYPOTHERMIA

Updated 2/25

Hypothermia regardless of the cause, is considered to be life-threatening. It is defined as a drop in core temperature of less than 95*F(35*C) and may result in death if left untreated.

Symptoms will depend on the degree of hypothermia. A patient may have shivering , cold bluish lips and extremities and slowly lapse into an unconscious state. Trauma and prolonged exposure to cold in the outdoors may lead to hypothermia. Small children and the elderly are also at risk. For more information on this topic, click on the link: Bair Hugger

UNDERSTANDING HYPOTHERMIA

Updated 2/25

Hypothermia regardless of the cause, is considered to be
 life-threatening. It is defined as a drop in core temperature
of less than 95*F(35*C) and may result in death if left untreated.

Symptoms will depend on the degree of hypothermia. A patient
may have shivering , cold bluish lips and extremities and slowly
lapse into an unconscious state. 

Trauma and prolonged exposure to cold in the outdoors may lead
 to hypothermia. Small children and the elderly are also at risk.
For more information on this topic, click on the link: Bair Hugger.

Learn more about: Lethal rhythms

Here are some diagnostic tests that are done frequently.
Follow the links below:

1. Chest X ray
2. CAT scan
3. EKG
4. MRI scan
5. Ultrasound
6. Echocardiogram

Learn more about:
Dehydration on a long flight
Abdominal Aortic Aneurysm

HYPOTHERMIA

Updated 2/25

Hypothermia increases the body's demand for oxygen and if left
 untreated can lead to a myocardial infarction (heart attack).Cardiac
arrhythmias and alcohol ingestion may also lead to hypothermia. 

      Hypothermia in the outdoors.

HYPOTHERMIA TREATMENT AND PREVENTION

Avoiding hypothermia is the key. Hypothermia can be prevented by understanding the causes and preventing the occasion. THINK AHEAD if going hiking , skiing or other outdoor activities. Carry enough warm clothing and fluids. Keep small children well hydrated and avoid prolonged overexposure of small children to cold weather.

Hypothermia, regardless of the cause, is considered to be life-threatening. It is defined as a drop in core temperature of less than 95*F(35*C) and may result in death if left untreated.

Symptoms will depend on the degree of hypothermia. A patient may have shivering , cold bluish lips and extremities and slowly lapse into an unconscious state. Trauma and prolonged exposure to cold in the outdoors may lead to hypothermia. Small children and the elderly are also at risk. For more information on this topic, click on the link: Bair Hugger

CARDIOGENIC SHOCK ASSESSMENT

Updated 7/25

Scenario: Mrs. R is a 48 year-old female who has a
history of a previous myocardial infarction. She was
resting comfortably when she suddenly started feeling
 short of breath. She is anxious and calls the nurse.

What actions did the nurse take?
-The nurse reassures Mrs. R. She does an assessment,
 vital signs, and oxygen saturation. She gives oxygen 
  per protocol.

-The nurse notifies the doctor of what has occurred and
 her assessment findings. She also mentions the vital signs,
low oxygen saturation, and steps that were taken to correct
the saturation. The doctor gives further orders, including a
transfer to CCU.

Why chest pain assessment?
It must be remembered that a patient with heart damage will
also experience chest pain. Assessment of the pain should also
 be included. This may be sharp, with radiation to shoulder/jaw,
or it may feel like chest pressure.

Helpful Hint:
Chest pain should always be assessed.
 Enjoy learning more about this topic by clicking on the link:
Simplifying Cardiogenic Shock

Learn more about : Organizational Skills

CARDIOGENIC SHOCK AND CRITICAL THINKING

Updated 8/25

Scenario: Mrs. R is a 48 year-old female who has a history
of a previous myocardial infarction. She was admitted 2 days
 ago with mild chest pain. She was resting comfortably when
she suddenly started feeling short of breath. She is anxious 
and calls the nurse.

What actions did the nurse take?
-The nurse reassures Mrs. R. She does an assessment, vital 
signs, and oxygen saturation. She gives oxygen per protocol.

-The nurse notifies the doctor of what has occurred and her
assessment findings. She also mentions the vital signs, low
oxygen saturation, and steps that were taken to correct the
saturation. The doctor gives further orders, including a
transfer to CCU.

Why chest pain assessment?
It must be remembered that a patient with heart damage
 will also experience chest pain. Assessment of the pain
should also be included. This may be sharp, with radiation
 to shoulder/jaw, or it may feel like chest pressure.

Helpful Hint:
Chest pain should always be assessed.
 Enjoy learning more about this topic by clicking on the link:
Simplifying Cardiogenic Shock

Learn more about : ARDS, DVT and PE

Learn more about: Aortic Rupture

CARDIOGENIC SHOCK (CLINICAL PICTURE)

Clinical picture of the patient in Cardiogenic Shock

A  patient, who has sustained a myocardial infarction, involving

the left coronary, may very readily go into cardiogenic shock.

The clinical picture is shown in the image above. The heart loses
its ability to pump blood around the body, resulting in:
-  chest pain, shortness of breath
- hypotension, cool, clammy skin

- EKG changes
- a decrease in urinary output
ICU care and mechanical ventilation become necessary
in the management of these patients.

Learn more about : Avoiding medication errors

CARDIOGENIC SHOCK ( MANAGEMENT)

            Management of the patient in Cardiogenic Shock

Scenario: In the image above, a patient is admitted to the ICU for treatment of
cardiogenic shock. 

Management of the patient in cardiogenic shock may vary from one ICU to another.
Lab values, EKG, drugs like Dopamine, Dobutrex, Nitroglycerin, oxygen and Morphine
are part of the treatment. A Pulmonary Artery Catheter may or may not be inserted.

To learn more, simply click on the links:
Sessions 10- Cardiogenic shock

Cardiogenic shock-quiz questions

Enjoy learning.

Updated 3/25

Scenario: Jim was admitted to the medical floor, with 
with complaints of abdominal pain. The nurse arrives 
at his bedside, to find him unresponsive.

She presses the code button, to alert the code team. 
She then begins CPR. 
Learn more : CPR

CARDIOGENIC SHOCK SIMPLIFIED

The heart is a pump which supplies blood to all the body's
cells. The heart is a small organ that has a lot of work to do.
If the heart becomes damaged by injury such as myocardial
infarction, trauma or cardiomyopathy ( weakness of the heart
muscle), a state of shock may occur.

 Hemodynamics refers to blood flow.

 The heart is a pump, which pumps blood around the body.
 If there is damage, like a myocardial infarction, the heart's
 function will be impaired.

Signs and symptoms include: chest pain,
shortness of breath and EKG changes.

Clinical picture of the patient in Cardiogenic Shock

Cardiogenic Shock / Quiz questions

HYPOVOLEMIC SHOCK SIMPLIFIED

Updated 8/25

Hypovolemic shock is a type of shock caused by fluid
or blood loss.This causes an inadequate volume of

circulating blood.

The organs like the kidneys will be deprived of blood

and may lead to shock.

 Learn more about : Aortic Rupture
                and Cardiac Tamponade

Learn more about: A trauma scene

HYPOVOLEMIC SHOCK

Updated 2/25

                                           In the Emergency Room

The clinical  scenario above shows a patient who
is in the ER following a traumatic event. The nurse
does an assessment and notices significant
changes in vital signs.

When an assessment is done, suspect hypovolemic
shock if there has been a large volume of blood loss,
following trauma. 

Warning signs

- decrease in oxygen saturation, blood pressure or
   level of consciousness
- rapid respirations or heart rate
- cool, clammy skin

                                    What causes hypovolemic Shock? 

Hypovolemic Shock results from excessive fluid loss and 
inadequate circulating volume. The circulatory system collapses
and organs such as the kidneys, brain and lungs, are deprived of 
blood. Causes include : blunt and penetrating trauma, massive 
blood loss, cardiac tamponade, excessive vomiting and more 
listed above.

Complications such as ARDS or renal failure may
occur as a result of Hypovolemic Shock.

CLINICAL PICTURE OF THE PATIENT IN HYPOVOLEMIC SHOCK

   Clinical picture of the patient in Hypovolemic Shock

Updated 10 /24

The patient in Hypovolemic Shock may
present the following clinical picture:

- Altered mental status ( restlessness
 and disorientation be present)

- Dyspnea - due to lack of red blood
  cells which carry oxygen

- Cool, clammy skin due to blood loss

- Hypotension ( a drop in blood loss due
  to a decrease in blood volume)

- Decreased urinary output due to low
   fluid volume

Fluid replacement therapy for the patient in 

Hypovolemic Shock is necessary, to reverse
the signs and symptoms. This may include
 blood transfusion.

To learn more about this topic, just click on the links:

Hypovolemic Shock

About Hypovolemic Shock

Enjoy learning.

Learn more about: Blood transfusion

HYPOVOLEMIC SHOCK

Hypovolemic Shock is a life threatening emergency.
Trauma patients commonly experience Hypovolemic Shock.
Quick management and replacement of the fluid loss brings
about good results. 

Fluid replacement, either with blood / blood products or
  IV fluids will depend on the amount of fluid lost and the

 trauma team's decision.

Updated 8/25

The nurse should always be aware of the warning 

signs of a blood transfusion reaction:

-  chills, anxiety, flushing
- itching, shortness of breath, chest pain

Immediate action should be taken, to stop the blood
and notify MD for further orders.

Read image above.

Learn more about : Blood transfusion

Learn more about: Aortic Rupture

CHEST PAIN MANAGEMENT

Updated 6/25

Dear nurses,

Master Your Clinical Skills is no longer available.
New images and links have been added below.

Mrs. K has an overly demanding boss. Not only is she
experiencing chest pain related to stress, but her heart 
is having PVC's ( premature ventricular contractions),
as reflected in the EKG.

Learn more about: Chest pain

Here are some diagnostic tests that are done frequently.
Follow the links below:

1. Chest X ray
2. CAT scan
3. EKG
4. MRI scan
5. Ultrasound
6. Echocardiogram

ADDRESSING SPINAL SHOCK

Updated 7/25

Injury to the spinal column may not be easy to diagnose

 at the scene of the accident. The spinal column has a high
network of nerves which control blood pressure. 

Injury to the spinal cord will result in blood flow 

              being affected and ultimately a change in blood pressure.

    IV Fluid replacement therapy and drugs such as
    Dopamine, may be necessary to correct hypotension.
                                         

IV Steriods may be ordered bythe doctor, to decrease
      swelling around the spinal cord and reduce further damage.

Learn more about: Triage nurse

Learn more about : Sepsis

Just click on the link :

Emergency Room experience

Enjoy learning!

SPINAL SHOCK

Updated  8/23

The patient above, has sustained a spinal injury.
To learn more about this topic,
please click on the link:

An Emergency Room experience
Enjoy learning.

SPINAL INJURY

                                     

What does SCI mean?
SCI means Spinal Cord Injury.

What impact might this have on the spinal column?

Here are some of the problems that may result from SCI:
- injuries above C3 may affect breathing
Mechanical ventilation may be necessary
- C3-C7 will involve some degree of weakness involving
shoulders, arms, hands and fingers
- T 1-T12 injuries may paraplegia
- L1-L5 injuries may affect the thighs, knees, feet and toes

It is important for the nurse to document her findings
 when an assessment is done. 
For more information, please click on the link:

Defining dermatomes

   

Injury to the spinal cord following trauma may result in shock.
For more helpful information, enjoy the video:

Emergency room experience.

SPINAL SHOCK (WHAT IS IT )

 Updated 2/24

 Dear nurses,

Injury to the spinal column may not be easy to diagnose

 at the scene of the accident. The spinal column has a high
network of nerves which control blood pressure. 

 

Injury to the spinal cord will result in blood flow being affected

and ultimately a change in blood pressure. IV Fluid replacement
therapy and drugs such as Dopamine, may be necessary to correct
hypotension. IV Steriods may be ordered by the doctor, to decrease
swelling around the spinal cord and reduce further damage.

What is the vertebral column made of ? 

The  vertebral column is made up of :
7 cervical , 12 thoracic, 5 lumbar,
5 sacral and  4 coccyx [which are 
fused together] vertebrae.

Documentation and assessment of paralysis is
a nursing responsibility. 

To learn more about spinal cord injury and
assessment, please click on
the link: Defining dermatomes