- ข้อความ
- ประวัติศาสตร์
Pulmonary causesPulmonary condition
Pulmonary causes
Pulmonary conditions such as pulmonary embolism,
pneumonia, pneumothorax and pleurisy may present with
pleuritic type chest pain. Karnath et al (2004) describe
pleuritic chest pain as pain that varies with the respiratory
cycle and is exacerbated during inspiration and coughing.
It may be described as sharp in nature and unilateral.
According to Sabatine and Cannon (2011), chest pain
associated with a spontaneous pneumothorax is sudden in
onset and usually accompanied with shortness of breath.
Karnath et al (2004) comment that the pain may radiate to
the shoulder on the same side as the pneumothorax.
Pneumothorax may be experienced in tall young men or
in those patients with underlying pulmonary disease, such
as cystic fibrosis or chronic obstructive airways disease
(Sabatine and Cannon, 2011).
Patients experiencing a pulmonary emboli may be
asymptomatic or present with a sudden onset of dyspnoea
and pleuritic chest pain and hypoxia. Sabatine and Cannon
(2011) state that massive pulmonary embolus may cause
retrosternal severe and persistent chest pain with associated
symptoms of hypotension, syncope and signs of right
heart failure, such as jugular vein distension and peripheral
oedema. Pulmonary emboli should form part of the
differential diagnosis in those who have undergone recent
surgery, who have an underlying malignancy, or who have
reduced mobility (Karnath et al, 2004).
Gastrointestinal causes
Lenfant (2010) states that gastrointestinal disorders are
the most common cause of non-cardiac chest pain, with
the most frequent diagnosis being gastro-oesophageal
reflux disease. Other causes of gastrointestinal-associated
chest pain include oesophageal spasm, pancreatitis,
oesophageal rupture or tear, cholecystitis and peptic ulcer
disease.
Sabatine and Cannon (2011) report that chest pain
associated with oesophageal disorders can be exacerbated
with alcohol consumption, after taking aspirin and/or
after eating a large meal. The patient may complain that
the pain is worse when lying down and is relieved when
sitting up or following the administration of antacids.
The pain may be located retrosternally and, in a similar
manner to ischaemic chest pain, may radiate to the
neck, jaw and arms. According to Hall and Simpson
(2009), this form of chest pain can be relieved by
short-acting nitrates, such as glyceryl trinitrate. Unlike
ischaemic chest pain, oesophageal pain is not brought on
by exertion. This information can be gleaned during
history taking.
Oesophageal tears or rupture, such as Mallory-Weiss or
Boerhaave syndrome, are normally associated with prolonged
vomiting episodes that may come to light during
history taking. Other symptoms associated with a tear or
rupture are described by Karnath et al (2004) as neck
swelling and subcutaneous emphysema, as well as pain
radiating from the neck to the epigastric region that is
exacerbated by swallowing.
In those with peptic ulcer disease, symptoms may occur
within 60–90 minutes after a meal and are relieved by
antacids. Pain assessment may demonstrate that the pain
is located in the epigastric region but may radiate into the
chest and shoulders (Hall and Simpson, 2009). The key
distinguishing characteristic of peptic ulcer disease is that
the pain is relieved with the intake of antacids or food.
Haemodynamic assessment
Haemodynamic assessment is integral in assessing the
stability of the patient and their perfusion status. In
addition, according to Scott and MacInnes (2006)
haemodynamic assessment can guide subsequent nursing
interventions. Integral to the assessment is the recording
of the patient’s vital signs that are directly related to the
cardiovascular system: pulse and blood pressure.
Respiratory rate, oxygen saturation, temperature and
level of consciousness, however, may be beneficial in
establishing differential diagnoses.
Tough (2004) advises recording blood pressure in both
arms when a patient presents with chest pain. A difference
of >20 mmHg may indicate aortic dissection and can assist
in formulating a diagnosis. Zitkus (2010) advises to look
for ‘red Flags’ during the assessment process that may help
in formulating a diagnosis. Red flags include:
Abnormal vital signs (bradycardia, tachycardia,
tachypnoea, hyper- or hypotension)
Fever, chills, malaise or productive cough
Pain worse on inspiration
Pain relieved by sitting forward
Symptoms persisting for more than 20 minutes.
Haemodynamic assessment is essential in determining
acuity and the urgency of intervention, as well as
providing information that aids in formulating a
diagnosis.
Conclusion
Chest pain is a common clinical presentation to the
healthcare system. NICE (2010) has published guidelines
to aid in assessment and subsequent intervention when
providing care for the patient with chest pain. A thorough
assessment of chest pain and the patient’s haemodynamic
status is key in determining potential causes, and can
guide further nursing intervention.
There are several potential causes of chest pain and a
targeted assessment is essential in confirming or ruling
out a cardiac cause. Assessment tools, such as OLD
CART, help in eliciting the most relevant information and
characteristics of the patient’s symptoms. Nurses assessing
patients with chest pain need to have a rounded knowledge
of potential chest pain causes when considering a
diagnosis. BJCN
Allmasetty S, Seepana S, Griffith KE (2009) 10 steps before you refer for
chest pain. Br J Cardiol 16(2): 80–4
Anderson JL, Adams CD, Antman EM, et al (2007) ACC/AHA 2007
guidelines for the management of patients with unstable angina/non-
ST-Elevation myocardial infarction: a report of the American College
of Cardiology/American Heart Association Task Force on Practice
Pulmonary conditions such as pulmonary embolism,
pneumonia, pneumothorax and pleurisy may present with
pleuritic type chest pain. Karnath et al (2004) describe
pleuritic chest pain as pain that varies with the respiratory
cycle and is exacerbated during inspiration and coughing.
It may be described as sharp in nature and unilateral.
According to Sabatine and Cannon (2011), chest pain
associated with a spontaneous pneumothorax is sudden in
onset and usually accompanied with shortness of breath.
Karnath et al (2004) comment that the pain may radiate to
the shoulder on the same side as the pneumothorax.
Pneumothorax may be experienced in tall young men or
in those patients with underlying pulmonary disease, such
as cystic fibrosis or chronic obstructive airways disease
(Sabatine and Cannon, 2011).
Patients experiencing a pulmonary emboli may be
asymptomatic or present with a sudden onset of dyspnoea
and pleuritic chest pain and hypoxia. Sabatine and Cannon
(2011) state that massive pulmonary embolus may cause
retrosternal severe and persistent chest pain with associated
symptoms of hypotension, syncope and signs of right
heart failure, such as jugular vein distension and peripheral
oedema. Pulmonary emboli should form part of the
differential diagnosis in those who have undergone recent
surgery, who have an underlying malignancy, or who have
reduced mobility (Karnath et al, 2004).
Gastrointestinal causes
Lenfant (2010) states that gastrointestinal disorders are
the most common cause of non-cardiac chest pain, with
the most frequent diagnosis being gastro-oesophageal
reflux disease. Other causes of gastrointestinal-associated
chest pain include oesophageal spasm, pancreatitis,
oesophageal rupture or tear, cholecystitis and peptic ulcer
disease.
Sabatine and Cannon (2011) report that chest pain
associated with oesophageal disorders can be exacerbated
with alcohol consumption, after taking aspirin and/or
after eating a large meal. The patient may complain that
the pain is worse when lying down and is relieved when
sitting up or following the administration of antacids.
The pain may be located retrosternally and, in a similar
manner to ischaemic chest pain, may radiate to the
neck, jaw and arms. According to Hall and Simpson
(2009), this form of chest pain can be relieved by
short-acting nitrates, such as glyceryl trinitrate. Unlike
ischaemic chest pain, oesophageal pain is not brought on
by exertion. This information can be gleaned during
history taking.
Oesophageal tears or rupture, such as Mallory-Weiss or
Boerhaave syndrome, are normally associated with prolonged
vomiting episodes that may come to light during
history taking. Other symptoms associated with a tear or
rupture are described by Karnath et al (2004) as neck
swelling and subcutaneous emphysema, as well as pain
radiating from the neck to the epigastric region that is
exacerbated by swallowing.
In those with peptic ulcer disease, symptoms may occur
within 60–90 minutes after a meal and are relieved by
antacids. Pain assessment may demonstrate that the pain
is located in the epigastric region but may radiate into the
chest and shoulders (Hall and Simpson, 2009). The key
distinguishing characteristic of peptic ulcer disease is that
the pain is relieved with the intake of antacids or food.
Haemodynamic assessment
Haemodynamic assessment is integral in assessing the
stability of the patient and their perfusion status. In
addition, according to Scott and MacInnes (2006)
haemodynamic assessment can guide subsequent nursing
interventions. Integral to the assessment is the recording
of the patient’s vital signs that are directly related to the
cardiovascular system: pulse and blood pressure.
Respiratory rate, oxygen saturation, temperature and
level of consciousness, however, may be beneficial in
establishing differential diagnoses.
Tough (2004) advises recording blood pressure in both
arms when a patient presents with chest pain. A difference
of >20 mmHg may indicate aortic dissection and can assist
in formulating a diagnosis. Zitkus (2010) advises to look
for ‘red Flags’ during the assessment process that may help
in formulating a diagnosis. Red flags include:
Abnormal vital signs (bradycardia, tachycardia,
tachypnoea, hyper- or hypotension)
Fever, chills, malaise or productive cough
Pain worse on inspiration
Pain relieved by sitting forward
Symptoms persisting for more than 20 minutes.
Haemodynamic assessment is essential in determining
acuity and the urgency of intervention, as well as
providing information that aids in formulating a
diagnosis.
Conclusion
Chest pain is a common clinical presentation to the
healthcare system. NICE (2010) has published guidelines
to aid in assessment and subsequent intervention when
providing care for the patient with chest pain. A thorough
assessment of chest pain and the patient’s haemodynamic
status is key in determining potential causes, and can
guide further nursing intervention.
There are several potential causes of chest pain and a
targeted assessment is essential in confirming or ruling
out a cardiac cause. Assessment tools, such as OLD
CART, help in eliciting the most relevant information and
characteristics of the patient’s symptoms. Nurses assessing
patients with chest pain need to have a rounded knowledge
of potential chest pain causes when considering a
diagnosis. BJCN
Allmasetty S, Seepana S, Griffith KE (2009) 10 steps before you refer for
chest pain. Br J Cardiol 16(2): 80–4
Anderson JL, Adams CD, Antman EM, et al (2007) ACC/AHA 2007
guidelines for the management of patients with unstable angina/non-
ST-Elevation myocardial infarction: a report of the American College
of Cardiology/American Heart Association Task Force on Practice
0/5000
Pulmonary causesPulmonary conditions such as pulmonary embolism,pneumonia, pneumothorax and pleurisy may present withpleuritic type chest pain. Karnath et al (2004) describepleuritic chest pain as pain that varies with the respiratorycycle and is exacerbated during inspiration and coughing.It may be described as sharp in nature and unilateral.According to Sabatine and Cannon (2011), chest painassociated with a spontaneous pneumothorax is sudden inonset and usually accompanied with shortness of breath.Karnath et al (2004) comment that the pain may radiate tothe shoulder on the same side as the pneumothorax.Pneumothorax may be experienced in tall young men orin those patients with underlying pulmonary disease, suchas cystic fibrosis or chronic obstructive airways disease(Sabatine and Cannon, 2011).Patients experiencing a pulmonary emboli may beasymptomatic or present with a sudden onset of dyspnoeaand pleuritic chest pain and hypoxia. Sabatine and Cannon(2011) state that massive pulmonary embolus may causeretrosternal severe and persistent chest pain with associatedsymptoms of hypotension, syncope and signs of rightheart failure, such as jugular vein distension and peripheraloedema. Pulmonary emboli should form part of thedifferential diagnosis in those who have undergone recentsurgery, who have an underlying malignancy, or who havereduced mobility (Karnath et al, 2004).Gastrointestinal causesLenfant (2010) states that gastrointestinal disorders arethe most common cause of non-cardiac chest pain, withthe most frequent diagnosis being gastro-oesophagealreflux disease. Other causes of gastrointestinal-associatedchest pain include oesophageal spasm, pancreatitis,oesophageal rupture or tear, cholecystitis and peptic ulcerdisease.Sabatine and Cannon (2011) report that chest painassociated with oesophageal disorders can be exacerbatedwith alcohol consumption, after taking aspirin and/orafter eating a large meal. The patient may complain thatthe pain is worse when lying down and is relieved whensitting up or following the administration of antacids.The pain may be located retrosternally and, in a similarmanner to ischaemic chest pain, may radiate to theneck, jaw and arms. According to Hall and Simpson(2009), this form of chest pain can be relieved byshort-acting nitrates, such as glyceryl trinitrate. Unlikeischaemic chest pain, oesophageal pain is not brought onby exertion. This information can be gleaned duringhistory taking.Oesophageal tears or rupture, such as Mallory-Weiss orBoerhaave syndrome, are normally associated with prolongedvomiting episodes that may come to light duringhistory taking. Other symptoms associated with a tear orrupture are described by Karnath et al (2004) as neckswelling and subcutaneous emphysema, as well as painradiating from the neck to the epigastric region that isexacerbated by swallowing.
In those with peptic ulcer disease, symptoms may occur
within 60–90 minutes after a meal and are relieved by
antacids. Pain assessment may demonstrate that the pain
is located in the epigastric region but may radiate into the
chest and shoulders (Hall and Simpson, 2009). The key
distinguishing characteristic of peptic ulcer disease is that
the pain is relieved with the intake of antacids or food.
Haemodynamic assessment
Haemodynamic assessment is integral in assessing the
stability of the patient and their perfusion status. In
addition, according to Scott and MacInnes (2006)
haemodynamic assessment can guide subsequent nursing
interventions. Integral to the assessment is the recording
of the patient’s vital signs that are directly related to the
cardiovascular system: pulse and blood pressure.
Respiratory rate, oxygen saturation, temperature and
level of consciousness, however, may be beneficial in
establishing differential diagnoses.
Tough (2004) advises recording blood pressure in both
arms when a patient presents with chest pain. A difference
of >20 mmHg may indicate aortic dissection and can assist
in formulating a diagnosis. Zitkus (2010) advises to look
for ‘red Flags’ during the assessment process that may help
in formulating a diagnosis. Red flags include:
Abnormal vital signs (bradycardia, tachycardia,
tachypnoea, hyper- or hypotension)
Fever, chills, malaise or productive cough
Pain worse on inspiration
Pain relieved by sitting forward
Symptoms persisting for more than 20 minutes.
Haemodynamic assessment is essential in determining
acuity and the urgency of intervention, as well as
providing information that aids in formulating a
diagnosis.
Conclusion
Chest pain is a common clinical presentation to the
healthcare system. NICE (2010) has published guidelines
to aid in assessment and subsequent intervention when
providing care for the patient with chest pain. A thorough
assessment of chest pain and the patient’s haemodynamic
status is key in determining potential causes, and can
guide further nursing intervention.
There are several potential causes of chest pain and a
targeted assessment is essential in confirming or ruling
out a cardiac cause. Assessment tools, such as OLD
CART, help in eliciting the most relevant information and
characteristics of the patient’s symptoms. Nurses assessing
patients with chest pain need to have a rounded knowledge
of potential chest pain causes when considering a
diagnosis. BJCN
Allmasetty S, Seepana S, Griffith KE (2009) 10 steps before you refer for
chest pain. Br J Cardiol 16(2): 80–4
Anderson JL, Adams CD, Antman EM, et al (2007) ACC/AHA 2007
guidelines for the management of patients with unstable angina/non-
ST-Elevation myocardial infarction: a report of the American College
of Cardiology/American Heart Association Task Force on Practice
In those with peptic ulcer disease, symptoms may occur
within 60–90 minutes after a meal and are relieved by
antacids. Pain assessment may demonstrate that the pain
is located in the epigastric region but may radiate into the
chest and shoulders (Hall and Simpson, 2009). The key
distinguishing characteristic of peptic ulcer disease is that
the pain is relieved with the intake of antacids or food.
Haemodynamic assessment
Haemodynamic assessment is integral in assessing the
stability of the patient and their perfusion status. In
addition, according to Scott and MacInnes (2006)
haemodynamic assessment can guide subsequent nursing
interventions. Integral to the assessment is the recording
of the patient’s vital signs that are directly related to the
cardiovascular system: pulse and blood pressure.
Respiratory rate, oxygen saturation, temperature and
level of consciousness, however, may be beneficial in
establishing differential diagnoses.
Tough (2004) advises recording blood pressure in both
arms when a patient presents with chest pain. A difference
of >20 mmHg may indicate aortic dissection and can assist
in formulating a diagnosis. Zitkus (2010) advises to look
for ‘red Flags’ during the assessment process that may help
in formulating a diagnosis. Red flags include:
Abnormal vital signs (bradycardia, tachycardia,
tachypnoea, hyper- or hypotension)
Fever, chills, malaise or productive cough
Pain worse on inspiration
Pain relieved by sitting forward
Symptoms persisting for more than 20 minutes.
Haemodynamic assessment is essential in determining
acuity and the urgency of intervention, as well as
providing information that aids in formulating a
diagnosis.
Conclusion
Chest pain is a common clinical presentation to the
healthcare system. NICE (2010) has published guidelines
to aid in assessment and subsequent intervention when
providing care for the patient with chest pain. A thorough
assessment of chest pain and the patient’s haemodynamic
status is key in determining potential causes, and can
guide further nursing intervention.
There are several potential causes of chest pain and a
targeted assessment is essential in confirming or ruling
out a cardiac cause. Assessment tools, such as OLD
CART, help in eliciting the most relevant information and
characteristics of the patient’s symptoms. Nurses assessing
patients with chest pain need to have a rounded knowledge
of potential chest pain causes when considering a
diagnosis. BJCN
Allmasetty S, Seepana S, Griffith KE (2009) 10 steps before you refer for
chest pain. Br J Cardiol 16(2): 80–4
Anderson JL, Adams CD, Antman EM, et al (2007) ACC/AHA 2007
guidelines for the management of patients with unstable angina/non-
ST-Elevation myocardial infarction: a report of the American College
of Cardiology/American Heart Association Task Force on Practice
การแปล กรุณารอสักครู่..
Pulmonary causes
Pulmonary conditions such as pulmonary embolism,
pneumonia, pneumothorax and pleurisy may present with
pleuritic type chest pain. Karnath et al (2004) describe
pleuritic chest pain as pain that varies with the respiratory
cycle and is exacerbated during inspiration and coughing.
It may be described as sharp in nature and unilateral.
According to Sabatine and Cannon (2011), chest pain
associated with a spontaneous pneumothorax is sudden in
onset and usually accompanied with shortness of breath.
Karnath et al (2004) comment that the pain may radiate to
the shoulder on the same side as the pneumothorax.
Pneumothorax may be experienced in tall young men or
in those patients with underlying pulmonary disease, such
as cystic fibrosis or chronic obstructive airways disease
(Sabatine and Cannon, 2011).
Patients experiencing a pulmonary emboli may be
asymptomatic or present with a sudden onset of dyspnoea
and pleuritic chest pain and hypoxia. Sabatine and Cannon
(2011) state that massive pulmonary embolus may cause
retrosternal severe and persistent chest pain with associated
symptoms of hypotension, syncope and signs of right
heart failure, such as jugular vein distension and peripheral
oedema. Pulmonary emboli should form part of the
differential diagnosis in those who have undergone recent
surgery, who have an underlying malignancy, or who have
reduced mobility (Karnath et al, 2004).
Gastrointestinal causes
Lenfant (2010) states that gastrointestinal disorders are
the most common cause of non-cardiac chest pain, with
the most frequent diagnosis being gastro-oesophageal
reflux disease. Other causes of gastrointestinal-associated
chest pain include oesophageal spasm, pancreatitis,
oesophageal rupture or tear, cholecystitis and peptic ulcer
disease.
Sabatine and Cannon (2011) report that chest pain
associated with oesophageal disorders can be exacerbated
with alcohol consumption, after taking aspirin and/or
after eating a large meal. The patient may complain that
the pain is worse when lying down and is relieved when
sitting up or following the administration of antacids.
The pain may be located retrosternally and, in a similar
manner to ischaemic chest pain, may radiate to the
neck, jaw and arms. According to Hall and Simpson
(2009), this form of chest pain can be relieved by
short-acting nitrates, such as glyceryl trinitrate. Unlike
ischaemic chest pain, oesophageal pain is not brought on
by exertion. This information can be gleaned during
history taking.
Oesophageal tears or rupture, such as Mallory-Weiss or
Boerhaave syndrome, are normally associated with prolonged
vomiting episodes that may come to light during
history taking. Other symptoms associated with a tear or
rupture are described by Karnath et al (2004) as neck
swelling and subcutaneous emphysema, as well as pain
radiating from the neck to the epigastric region that is
exacerbated by swallowing.
In those with peptic ulcer disease, symptoms may occur
within 60–90 minutes after a meal and are relieved by
antacids. Pain assessment may demonstrate that the pain
is located in the epigastric region but may radiate into the
chest and shoulders (Hall and Simpson, 2009). The key
distinguishing characteristic of peptic ulcer disease is that
the pain is relieved with the intake of antacids or food.
Haemodynamic assessment
Haemodynamic assessment is integral in assessing the
stability of the patient and their perfusion status. In
addition, according to Scott and MacInnes (2006)
haemodynamic assessment can guide subsequent nursing
interventions. Integral to the assessment is the recording
of the patient’s vital signs that are directly related to the
cardiovascular system: pulse and blood pressure.
Respiratory rate, oxygen saturation, temperature and
level of consciousness, however, may be beneficial in
establishing differential diagnoses.
Tough (2004) advises recording blood pressure in both
arms when a patient presents with chest pain. A difference
of >20 mmHg may indicate aortic dissection and can assist
in formulating a diagnosis. Zitkus (2010) advises to look
for ‘red Flags’ during the assessment process that may help
in formulating a diagnosis. Red flags include:
Abnormal vital signs (bradycardia, tachycardia,
tachypnoea, hyper- or hypotension)
Fever, chills, malaise or productive cough
Pain worse on inspiration
Pain relieved by sitting forward
Symptoms persisting for more than 20 minutes.
Haemodynamic assessment is essential in determining
acuity and the urgency of intervention, as well as
providing information that aids in formulating a
diagnosis.
Conclusion
Chest pain is a common clinical presentation to the
healthcare system. NICE (2010) has published guidelines
to aid in assessment and subsequent intervention when
providing care for the patient with chest pain. A thorough
assessment of chest pain and the patient’s haemodynamic
status is key in determining potential causes, and can
guide further nursing intervention.
There are several potential causes of chest pain and a
targeted assessment is essential in confirming or ruling
out a cardiac cause. Assessment tools, such as OLD
CART, help in eliciting the most relevant information and
characteristics of the patient’s symptoms. Nurses assessing
patients with chest pain need to have a rounded knowledge
of potential chest pain causes when considering a
diagnosis. BJCN
Allmasetty S, Seepana S, Griffith KE (2009) 10 steps before you refer for
chest pain. Br J Cardiol 16(2): 80–4
Anderson JL, Adams CD, Antman EM, et al (2007) ACC/AHA 2007
guidelines for the management of patients with unstable angina/non-
ST-Elevation myocardial infarction: a report of the American College
of Cardiology/American Heart Association Task Force on Practice
Pulmonary conditions such as pulmonary embolism,
pneumonia, pneumothorax and pleurisy may present with
pleuritic type chest pain. Karnath et al (2004) describe
pleuritic chest pain as pain that varies with the respiratory
cycle and is exacerbated during inspiration and coughing.
It may be described as sharp in nature and unilateral.
According to Sabatine and Cannon (2011), chest pain
associated with a spontaneous pneumothorax is sudden in
onset and usually accompanied with shortness of breath.
Karnath et al (2004) comment that the pain may radiate to
the shoulder on the same side as the pneumothorax.
Pneumothorax may be experienced in tall young men or
in those patients with underlying pulmonary disease, such
as cystic fibrosis or chronic obstructive airways disease
(Sabatine and Cannon, 2011).
Patients experiencing a pulmonary emboli may be
asymptomatic or present with a sudden onset of dyspnoea
and pleuritic chest pain and hypoxia. Sabatine and Cannon
(2011) state that massive pulmonary embolus may cause
retrosternal severe and persistent chest pain with associated
symptoms of hypotension, syncope and signs of right
heart failure, such as jugular vein distension and peripheral
oedema. Pulmonary emboli should form part of the
differential diagnosis in those who have undergone recent
surgery, who have an underlying malignancy, or who have
reduced mobility (Karnath et al, 2004).
Gastrointestinal causes
Lenfant (2010) states that gastrointestinal disorders are
the most common cause of non-cardiac chest pain, with
the most frequent diagnosis being gastro-oesophageal
reflux disease. Other causes of gastrointestinal-associated
chest pain include oesophageal spasm, pancreatitis,
oesophageal rupture or tear, cholecystitis and peptic ulcer
disease.
Sabatine and Cannon (2011) report that chest pain
associated with oesophageal disorders can be exacerbated
with alcohol consumption, after taking aspirin and/or
after eating a large meal. The patient may complain that
the pain is worse when lying down and is relieved when
sitting up or following the administration of antacids.
The pain may be located retrosternally and, in a similar
manner to ischaemic chest pain, may radiate to the
neck, jaw and arms. According to Hall and Simpson
(2009), this form of chest pain can be relieved by
short-acting nitrates, such as glyceryl trinitrate. Unlike
ischaemic chest pain, oesophageal pain is not brought on
by exertion. This information can be gleaned during
history taking.
Oesophageal tears or rupture, such as Mallory-Weiss or
Boerhaave syndrome, are normally associated with prolonged
vomiting episodes that may come to light during
history taking. Other symptoms associated with a tear or
rupture are described by Karnath et al (2004) as neck
swelling and subcutaneous emphysema, as well as pain
radiating from the neck to the epigastric region that is
exacerbated by swallowing.
In those with peptic ulcer disease, symptoms may occur
within 60–90 minutes after a meal and are relieved by
antacids. Pain assessment may demonstrate that the pain
is located in the epigastric region but may radiate into the
chest and shoulders (Hall and Simpson, 2009). The key
distinguishing characteristic of peptic ulcer disease is that
the pain is relieved with the intake of antacids or food.
Haemodynamic assessment
Haemodynamic assessment is integral in assessing the
stability of the patient and their perfusion status. In
addition, according to Scott and MacInnes (2006)
haemodynamic assessment can guide subsequent nursing
interventions. Integral to the assessment is the recording
of the patient’s vital signs that are directly related to the
cardiovascular system: pulse and blood pressure.
Respiratory rate, oxygen saturation, temperature and
level of consciousness, however, may be beneficial in
establishing differential diagnoses.
Tough (2004) advises recording blood pressure in both
arms when a patient presents with chest pain. A difference
of >20 mmHg may indicate aortic dissection and can assist
in formulating a diagnosis. Zitkus (2010) advises to look
for ‘red Flags’ during the assessment process that may help
in formulating a diagnosis. Red flags include:
Abnormal vital signs (bradycardia, tachycardia,
tachypnoea, hyper- or hypotension)
Fever, chills, malaise or productive cough
Pain worse on inspiration
Pain relieved by sitting forward
Symptoms persisting for more than 20 minutes.
Haemodynamic assessment is essential in determining
acuity and the urgency of intervention, as well as
providing information that aids in formulating a
diagnosis.
Conclusion
Chest pain is a common clinical presentation to the
healthcare system. NICE (2010) has published guidelines
to aid in assessment and subsequent intervention when
providing care for the patient with chest pain. A thorough
assessment of chest pain and the patient’s haemodynamic
status is key in determining potential causes, and can
guide further nursing intervention.
There are several potential causes of chest pain and a
targeted assessment is essential in confirming or ruling
out a cardiac cause. Assessment tools, such as OLD
CART, help in eliciting the most relevant information and
characteristics of the patient’s symptoms. Nurses assessing
patients with chest pain need to have a rounded knowledge
of potential chest pain causes when considering a
diagnosis. BJCN
Allmasetty S, Seepana S, Griffith KE (2009) 10 steps before you refer for
chest pain. Br J Cardiol 16(2): 80–4
Anderson JL, Adams CD, Antman EM, et al (2007) ACC/AHA 2007
guidelines for the management of patients with unstable angina/non-
ST-Elevation myocardial infarction: a report of the American College
of Cardiology/American Heart Association Task Force on Practice
การแปล กรุณารอสักครู่..
สาเหตุปอด
สภาพปอด เช่น ปอด embolism ปอด และเยื่อหุ้มปอดอักเสบ
ปอดบวม อาจแสดงด้วย
pleuritic ประเภทปวดหน้าอก karnath et al ( 2004 ) อธิบาย
เจ็บหน้าอกตามการหายใจ เช่น ความเจ็บปวดที่แตกต่างกันกับวงจรการหายใจ
และเป็น exacerbated ในแรงบันดาลใจและไอ
มันอาจจะเป็นคมในธรรมชาติ 1 .
ตาม sabatine และปืนใหญ่ ( 2011 )เจ็บหน้าอก
เกี่ยวข้องกับปอดธรรมชาติเป็นอย่างฉับพลันใน
และการโจมตีปกติพร้อมกับหายใจถี่ .
karnath et al ( 2004 ) แสดงความคิดเห็นว่า ความเจ็บปวดอาจฉาย
ไหล่ข้างเดียวเป็นปอด ปอดอาจมีประสบการณ์สูง
หนุ่มๆ หรือในผู้ป่วยที่มีโรคปอดเป็นต้น เช่น
เป็น cystic fibrosis หรืออุดกั้นเรื้อรัง ( โรคแอร์เวย์
sabatine และปืนใหญ่ , 2011 ) .
ผู้ป่วยประสบ emboli ปอดอาจจะไม่มีอาการหรือมีอาการเสนอด้วย
อยู่ๆ ทำเป็นเล่น และเจ็บหน้าอกตามการหายใจ และสังคม sabatine และปืนใหญ่
( 2011 ) รัฐที่มีขนาดใหญ่อาจทำให้ปอดลม
retrosternal รุนแรงและเจ็บหน้าอกแบบถาวรที่เกี่ยวข้องกับอาการของความดันโลหิตต่ำ
,การหมดสติและสัญญาณของหัวใจล้มเหลวครับ
, เช่น แน่นท้องเส้นเลือดดำใหญ่ และอุปกรณ์
อาการบวมน้ำ . ปอด emboli ควรเป็นส่วนหนึ่งของ
วินิจฉัยในผู้ที่ได้รับการผ่าตัดล่าสุด
ที่มีต้นแบบที่มุ่งร้าย หรือผู้ที่มีความคล่องตัวลดลง (
karnath et al , 2004 ) ส่วนสาเหตุ
เลนเฟิน ( 2010 ) ระบุว่า ความผิดปกติของระบบทางเดินอาหารมี
สาเหตุที่พบบ่อยที่สุดของไม่มีหัวใจ เจ็บหน้าอก ด้วย
oesophageal วินิจฉัยระบบทางเดินอาหารที่พบบ่อยที่สุดที่ถูกย้อนโรค สาเหตุอื่น ๆของทางเดินอาหารที่เกี่ยวข้อง
เจ็บหน้าอกรวม oesophageal กระตุก ตับอักเสบ
แตก oesophageal หรือฉีก อักเสบและโรคแผลเป็ปติค
.
sabatine และปืนใหญ่ ( 2011 ) รายงานว่าเจ็บหน้าอก
ที่เกี่ยวข้องกับ oesophageal ความผิดปกติสามารถ exacerbated
การบริโภคเครื่องดื่มแอลกอฮอล์ หลังจากการใช้แอสไพรินและ / หรือ
หลังจากกินอาหารมื้อใหญ่ ผู้ป่วยอาจบ่นว่าปวดจะแย่
เมื่อนอนลง และโล่งใจเมื่อ
นั่งขึ้นหรือต่อการบริหารงานของกรดในกระเพาะอาหาร อาการปวดอาจจะอยู่ retrosternally
และ ในลักษณะที่คล้ายคลึงกับอาการเจ็บหน้าอก ischaemic อาจจะแผ่ไปยัง
คอ ขากรรไกร และแขน ตามโถงและซิมป์สัน
( 2009 )แบบฟอร์มนี้ของอาการเจ็บหน้าอกจะโล่งใจโดย
ม้าล่อ ไนเตรต เช่น กลีเซอรีน trinitrate . ซึ่งแตกต่างจาก ischaemic
เจ็บหน้าอก ปวด oesophageal ไม่นำ
โดยการออกกําลังกาย ข้อมูลนี้จะถูกรวบรวมในการซักประวัติ
.
น้ำตา oesophageal หรือแตก เช่น Mallory Weiss หรือ
boerhaave ซินโดรม โดยปกติจะเกี่ยวข้องกับนาน
อาเจียนตอนที่อาจเข้ามาใน
สภาพปอด เช่น ปอด embolism ปอด และเยื่อหุ้มปอดอักเสบ
ปอดบวม อาจแสดงด้วย
pleuritic ประเภทปวดหน้าอก karnath et al ( 2004 ) อธิบาย
เจ็บหน้าอกตามการหายใจ เช่น ความเจ็บปวดที่แตกต่างกันกับวงจรการหายใจ
และเป็น exacerbated ในแรงบันดาลใจและไอ
มันอาจจะเป็นคมในธรรมชาติ 1 .
ตาม sabatine และปืนใหญ่ ( 2011 )เจ็บหน้าอก
เกี่ยวข้องกับปอดธรรมชาติเป็นอย่างฉับพลันใน
และการโจมตีปกติพร้อมกับหายใจถี่ .
karnath et al ( 2004 ) แสดงความคิดเห็นว่า ความเจ็บปวดอาจฉาย
ไหล่ข้างเดียวเป็นปอด ปอดอาจมีประสบการณ์สูง
หนุ่มๆ หรือในผู้ป่วยที่มีโรคปอดเป็นต้น เช่น
เป็น cystic fibrosis หรืออุดกั้นเรื้อรัง ( โรคแอร์เวย์
sabatine และปืนใหญ่ , 2011 ) .
ผู้ป่วยประสบ emboli ปอดอาจจะไม่มีอาการหรือมีอาการเสนอด้วย
อยู่ๆ ทำเป็นเล่น และเจ็บหน้าอกตามการหายใจ และสังคม sabatine และปืนใหญ่
( 2011 ) รัฐที่มีขนาดใหญ่อาจทำให้ปอดลม
retrosternal รุนแรงและเจ็บหน้าอกแบบถาวรที่เกี่ยวข้องกับอาการของความดันโลหิตต่ำ
,การหมดสติและสัญญาณของหัวใจล้มเหลวครับ
, เช่น แน่นท้องเส้นเลือดดำใหญ่ และอุปกรณ์
อาการบวมน้ำ . ปอด emboli ควรเป็นส่วนหนึ่งของ
วินิจฉัยในผู้ที่ได้รับการผ่าตัดล่าสุด
ที่มีต้นแบบที่มุ่งร้าย หรือผู้ที่มีความคล่องตัวลดลง (
karnath et al , 2004 ) ส่วนสาเหตุ
เลนเฟิน ( 2010 ) ระบุว่า ความผิดปกติของระบบทางเดินอาหารมี
สาเหตุที่พบบ่อยที่สุดของไม่มีหัวใจ เจ็บหน้าอก ด้วย
oesophageal วินิจฉัยระบบทางเดินอาหารที่พบบ่อยที่สุดที่ถูกย้อนโรค สาเหตุอื่น ๆของทางเดินอาหารที่เกี่ยวข้อง
เจ็บหน้าอกรวม oesophageal กระตุก ตับอักเสบ
แตก oesophageal หรือฉีก อักเสบและโรคแผลเป็ปติค
.
sabatine และปืนใหญ่ ( 2011 ) รายงานว่าเจ็บหน้าอก
ที่เกี่ยวข้องกับ oesophageal ความผิดปกติสามารถ exacerbated
การบริโภคเครื่องดื่มแอลกอฮอล์ หลังจากการใช้แอสไพรินและ / หรือ
หลังจากกินอาหารมื้อใหญ่ ผู้ป่วยอาจบ่นว่าปวดจะแย่
เมื่อนอนลง และโล่งใจเมื่อ
นั่งขึ้นหรือต่อการบริหารงานของกรดในกระเพาะอาหาร อาการปวดอาจจะอยู่ retrosternally
และ ในลักษณะที่คล้ายคลึงกับอาการเจ็บหน้าอก ischaemic อาจจะแผ่ไปยัง
คอ ขากรรไกร และแขน ตามโถงและซิมป์สัน
( 2009 )แบบฟอร์มนี้ของอาการเจ็บหน้าอกจะโล่งใจโดย
ม้าล่อ ไนเตรต เช่น กลีเซอรีน trinitrate . ซึ่งแตกต่างจาก ischaemic
เจ็บหน้าอก ปวด oesophageal ไม่นำ
โดยการออกกําลังกาย ข้อมูลนี้จะถูกรวบรวมในการซักประวัติ
.
น้ำตา oesophageal หรือแตก เช่น Mallory Weiss หรือ
boerhaave ซินโดรม โดยปกติจะเกี่ยวข้องกับนาน
อาเจียนตอนที่อาจเข้ามาใน
การแปล กรุณารอสักครู่..
ภาษาอื่น ๆ
การสนับสนุนเครื่องมือแปลภาษา: กรีก, กันนาดา, กาลิเชียน, คลิงออน, คอร์สิกา, คาซัค, คาตาลัน, คินยารวันดา, คีร์กิซ, คุชราต, จอร์เจีย, จีน, จีนดั้งเดิม, ชวา, ชิเชวา, ซามัว, ซีบัวโน, ซุนดา, ซูลู, ญี่ปุ่น, ดัตช์, ตรวจหาภาษา, ตุรกี, ทมิฬ, ทาจิก, ทาทาร์, นอร์เวย์, บอสเนีย, บัลแกเรีย, บาสก์, ปัญจาป, ฝรั่งเศส, พาชตู, ฟริเชียน, ฟินแลนด์, ฟิลิปปินส์, ภาษาอินโดนีเซี, มองโกเลีย, มัลทีส, มาซีโดเนีย, มาราฐี, มาลากาซี, มาลายาลัม, มาเลย์, ม้ง, ยิดดิช, ยูเครน, รัสเซีย, ละติน, ลักเซมเบิร์ก, ลัตเวีย, ลาว, ลิทัวเนีย, สวาฮิลี, สวีเดน, สิงหล, สินธี, สเปน, สโลวัก, สโลวีเนีย, อังกฤษ, อัมฮาริก, อาร์เซอร์ไบจัน, อาร์เมเนีย, อาหรับ, อิกโบ, อิตาลี, อุยกูร์, อุสเบกิสถาน, อูรดู, ฮังการี, ฮัวซา, ฮาวาย, ฮินดี, ฮีบรู, เกลิกสกอต, เกาหลี, เขมร, เคิร์ด, เช็ก, เซอร์เบียน, เซโซโท, เดนมาร์ก, เตลูกู, เติร์กเมน, เนปาล, เบงกอล, เบลารุส, เปอร์เซีย, เมารี, เมียนมา (พม่า), เยอรมัน, เวลส์, เวียดนาม, เอสเปอแรนโต, เอสโทเนีย, เฮติครีโอล, แอฟริกา, แอลเบเนีย, โคซา, โครเอเชีย, โชนา, โซมาลี, โปรตุเกส, โปแลนด์, โยรูบา, โรมาเนีย, โอเดีย (โอริยา), ไทย, ไอซ์แลนด์, ไอร์แลนด์, การแปลภาษา.
- Analyze costs associated withproduction
- พักรบ
- The study has clearly demonstrated the a
- Enterprise integration is a technical fi
- multiply
- take someone's place, often in a work si
- สุชาติ
- นาเบะ
- Under certain circumstances you might us
- the grown
- i will survive i suspect
- เป็นอย่างไรบ้างกับการฉายรังสีวันนี้ผลลัพ
- สุดสัปดาห์ของพวกคุณ
- Love each other for a long time
- เพื่อนฉันถามว่า
- เดี๋ยวมันก็ผ่านไป
- Lucky woman is a woman who doesn't make
- เธอไม่ได้ยินที่พูดเลยหรอ
- attractive
- ฉันถ่ายรูปในสวนวัตว์
- One more moment of this silence
- and raw material type were found to be e
- ภาพนั้นคุณรู้ความหมายของมันหรือไม่
- garment for woman
