Symptom: Pain, Chest

Initial Grading Reminder

CTCAE grading of chest pain:

Grade 1: Mild pain
Grade 2: Moderate pain; limiting instrumental ADLs
Grade 3: Severe pain; limiting self-care ADLs

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Have you had issues with chest pain the past? Is this a new or worsening symptom? When did it start or get worse? Has it developed gradually or suddenly? Have you been using your arms a lot? (suggestive of costochondritis)

Grade the symptom

Ask the patient:

Can you describe your pain–dull, heavy, or sharp, stabbing, constant, or intermittent? How would you rate the pain: mild, moderate, or severe?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

Do you have any nausea/vomiting? Does your heart feel like it is racing or skipping a beat? Do you have any pain in your shoulder or radiating down your arm?

Patient Factors to Consider That Affect the Approach to Intervention

Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?

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    Suggested Intervention

    Any chest pain, with or without the red-flag symptoms, warrants urgent evaluation.

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    Nursing Assessment of Potential Causes

    Cardiotoxicity - Nursing Assessment

    • Look
    • Listen
    • Recognize
    • Look
    • Listen
    • Recognize
    • Look
    • Listen
    • Recognize
    • Does the patient look unwell?
    • Fatigued?
    • Diaphoretic?
    • SOB or in respiratory distress?
    • Is there leg edema?
    • Change in energy level?
    • SOB or DOE?
    • Leg edema?
    • Palpitations?
    • Changes in BP?
    • Dizziness or syncope?
    • What exacerbates or improves symptoms?
    • Any new prescribed or OTC meds? Illicit substances?
    • Any underlying cardiac disease (CAD, MI, or other)?
    • What exacerbates or improves symptoms?
    • Prior radiation therapy?
    • Determine specific toxicity and related grade (if applicable)
    • Other related symptoms: hypotension, syncope, chest pain, DOE, SOB, palpitations, edema, etc.
    • Impact of symptoms on QOL/performance status
    • Changes in cardiac function: ECG changes, decreased EF, elevated cardiac enzymes (troponin, CK)
    • Assess other changes in oxygen saturation, BP, lung function

    Differential Diagnosis

    What do you suspect is the cause of the chest pain?