A client with no history of cardiovascular disease comes into the ambulatory clinic with flu-like symptoms. The client suddenly complains of chest pain. Which of the following questions would best help a nurse to discriminate pain caused by a non-cardiac problem?
A. “Have you ever had this pain before?”
B. “Can you describe the pain to me?”
C. “Does the pain get worse when you breathe in?”
D. “Can you rate the pain on a scale of 1-10, with ten (10) being the worst?”
Correct Answer: C. “Does the pain get worse when you breathe in?”
Chest pain is assessed by using the standard pain assessment parameters. It is very important to find out what makes the pain worse. Is there an exertional component, is it associated with eating or breathing? Is there a positional component? Don’t forget to ask about new workout routines, sports, and lifting. Ask what medications they have tried.
Option A: Option A may or may not help discriminate the origin of pain. Pain of pleuropulmonary origin usually worsens on inspiration. In addition to when the pain started, ask what the patient was doing when the pain started. Was the pain brought on by exertion or were they at rest?
Option B: Like all workups, chest pain evaluation starts with taking a complete history. Start by getting a good understanding of their complaint. Let the patient describe the pain in his or her own words. Carefully review the patient’s medical history for cardiac history, coagulopathies, and kidney disease. Ask about family history, especially cardiac, and ask about social histories like drug use and tobacco use.
Option D: Once you have thoroughly ruled out life-threatening causes, move on to other possibilities. Pneumonia should be considered in patients with a productive cough and/or recent upper respiratory infection (URI). Gastroesophageal reflux disease (GERD) is a common cause of chest pain so ask about any reflux symptoms. New exercise routines or recent trauma may help support a musculoskeletal cause.
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