LPNI Health Topic
- January 2023
Chest
pain is concerning to the client and to the nurse, it does need immediate
attention. In the community it usually means a call for assessment and
assistance from Emergency Services. A
full work-up is required at the hospital to rule-out cardiac origin of chest
pain. There are other causes of chest pain other than of cardiac origin.
These
include:
- Gastrointestinal
causes such as Gastroesophageal reflux disease, Oesophageal spasm, or Biliary
disease.
- Musculoskeletal
causes such as Intercostal muscle strain, Costochondritis or Fibromyalgia.
- Respiratory
causes such as Pneumonia, Pleurisy, Pulmonary embolism, Pneumothorax.
- Neurological
causes such as Shingles.
- Psychiatric
causes such as Anxiety/panic attacks.
- Emotional
causes such as Grief.
For
the client this is a very anxious time to go through a battery of invasive and
non- invasive procedures. It is time consuming and adds a significant burden to
the health system. It may happen that the patient presents in the emergency
department several times. Throughout this process the nurse needs to remain
vigilant as the patient’s condition may change.
Chest pain cannot be ignored. It is important to exclude underlying
cardiac conditions.
Of
note is a short-lived cardiac condition called Takotsubo Syndrome or “Broken
Heart Syndrome” it is most common in the first 3 to 6 months after the death of
a spouse or other significant person in the patient’s life, other significant emotional or physical
trauma. This condition can be picked-up
on angiogram as the shape of the left ventricle changes. It usually resolves
with medication and adherence to the recommended cardiac rehab program.
Panic
attacks are a common disorder that may lead to chest pain. Panic attack
is not always acknowledged, recognised, or treated in the emergency department.
As community nurses, when we support our clients in the community, this is
something to be followed through when chest pain of cardiac, gastrointestinal,
and neurological cause has been ruled out.
Walking
alongside clients at this time builds trust as their symptoms are validated
rather than pushed aside. Words of encouragement and affirmation of what is
going on in the mind and body with an explanation of how the body responds to
stress builds rapport with the client. As nurses we can encourage healthy
living which includes a healthy diet, regular exercise, social support,
spiritual guidance, psychological support, and adequate sleep. Nurses can work
alongside the client and with their consent attend General Practitioner
appointments and advocate for the client if needed.
Nurses
working in the community have the advantage of building relationship over time
with the client and the multidisciplinary team to improve physical, emotional,
psychological and spiritual health.
Angela
Uhrhane BHSc (nursing), Grad Dip Theology (FCN), RN
Community
Nurse in Wodonga, Victoria Australia
Member
of Wodonga Lutheran Parish
Member
of Lutheran Nurses Association Australia
Board
member of AFCNA (Australian Faith Community Nurses Association)
auhrhane@westnet.com.au
References