- Pain that is projected onto the arm, neck, back
- Diaphoresis / sweating
- Shortness of breath
- Difficulty sleeping (insomnia)
- Nausea, vomiting, anorexia
- Anxiety, nervous, focus on yourself
- The face tense, m erintih, crying
- Changes in consciousness
Primary Assessment - Nursing Care Plan for Chest Pain
- How airway clearance?
- Is there any obstruction / accumulation of secretions in the airway?
- How to breath sounds, is there any additional breath sounds?
- What is the pattern of breath? frequency? the depth and rhythm?
- What is the use of auxiliary respiratory muscles?
- Are there any additional breath sounds?
- How does the peripheral arteries and carotid arteries? quality (content and voltage)
- How capillary refill, what there is akral cold, cyanosis or oliguria?
- Is there a decrease in consciousness?
- How vital signs? blood pressure, temperature, pulse, respiration?
2. Secondary Assessment - Nursing Care Plan for Chest Pain
Important things that need to be studied further in chest pain (coronary):
a. location of pain
Where to start, propagation (coronary chest pain: from the sternal border radiating to the neck, chin or shoulder to the left arm of the ulna)
b. The nature of pain
Feeling of fullness, heaviness such as seizures, squeezing, stabbing, choking / burning, etc..
c. Characteristics of pain
Degree of pain, duration, how many times arise in a given time period.
d. chronological pain
Beginning there is pain and progress in sequence
e. Circumstances at the time of the attack
Whether arising in times / circumstances
f. Factors that reinforce / relieve pain such as attitude / posture, movement, pressure, etc..
g. Other symptoms that may be present whether or not the relationship with chest pain.