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Responding to Sudden Chest Pain in a Postoperative Patient
nursing • hard

Responding to Sudden Chest Pain in a Postoperative Patient

HardHotMajor: nursing

Scenario

A postoperative patient suddenly reports severe chest pain rated 10/10, becomes diaphoretic, and says they feel “pressure” radiating to the left arm.
Vital signs: BP 86/54 mmHg, HR 120 bpm, RR 24, SpO₂ 88% on 2 L O₂.

Question: What are your immediate nursing actions, and how do you differentiate between cardiac and pulmonary causes?

Best Practice Answer

  1. Recognize Life-Threatening Emergency:
    Chest pain post-surgery may indicate myocardial infarction, pulmonary embolism, or atelectasis — assume worst case (cardiac or embolic) until ruled out.

  2. Immediate Nursing Actions (First 1–2 Minutes):

    • Stop activity, keep patient in bed, and raise head of bed 30–45° to ease breathing.
    • Apply high-flow oxygen (non-rebreather) to maintain SpO₂ > 94%.
    • Assess ABCs — airway patency, breathing quality, and circulation.
    • Obtain a full set of vitals and cardiac rhythm (attach to telemetry/ECG).
    • Notify Rapid Response/Provider: clearly report onset, description, and current status.

  3. Focused Assessment:

    • Cardiac indicators: crushing or radiating pain, diaphoresis, abnormal ECG, elevated troponin.
    • Pulmonary indicators: pleuritic pain, dyspnea, tachypnea, hemoptysis (suggestive of PE).
    • Surgical complications: bleeding, pneumothorax, or reaction to anesthesia.

  4. Interventions and Preparation:

    • Prepare for diagnostic tests: 12-lead ECG, ABG, cardiac enzymes, chest X-ray, possible CT angiogram.
    • Start IV access (large bore) for medication and fluid resuscitation if hypotensive.
    • Anticipate orders for nitroglycerin, morphine, aspirin, or heparin depending on findings.
    • Maintain calm communication and reassurance — anxiety worsens hypoxia.

  5. Monitor and Document:

    • Reassess pain, vitals, and mental status every few minutes.
    • Document onset, duration, character, radiation, interventions, and response precisely.
    • Record the time of notification and actions taken.

Real-World Application

This is a high-acuity scenario frequently used in clinical simulations and hospital interviews for step-down, telemetry, and critical-care roles.
Evaluators look for nurses who:

  • Prioritize oxygenation and rapid assessment
  • Recognize unstable hemodynamics (BP < 90 mmHg, SpO₂ < 92%)
  • Communicate concisely and activate emergency support early

Timely, structured response here demonstrates strong clinical reasoning and situational control.

Tip: In interviews, say —
“At any sign of acute chest pain post-op, I treat it as a cardiac emergency — assess ABCs, apply O₂, get vitals and ECG, notify the rapid team, and prepare for possible MI or PE work-up.”
That statement shows decisive, protocol-driven critical thinking.