What are the appropriate nursing interventions for a patient presenting with shortness of breath (SOB), chest pain, and calf pain?

Nursing Interventions for Patients with SOB, Chest Pain, and Calf Pain

For a patient presenting with the triad of shortness of breath (SOB), chest pain, and calf pain, immediate assessment for venous thromboembolism (VTE) with potential pulmonary embolism (PE) should be the primary nursing intervention, as this combination strongly suggests a life-threatening condition requiring urgent medical attention. 1, 2

Initial Assessment and Interventions

Immediate Actions (First 5-10 Minutes)

• Obtain vital signs including oxygen saturation
• Apply supplemental oxygen if saturation <94% 2
• Place patient in semi-Fowler's position (unless hypotensive)
• Establish IV access with two large-bore (18G or larger) catheters
• Obtain 12-lead ECG within 10 minutes of arrival 1
• Alert medical team immediately about the concerning symptom triad

Critical Assessments

• Chest Pain Assessment:

  • Character: pressure, tightness, heaviness, or burning sensation
  • Location: central/substernal, radiating to neck, jaw, shoulders, back, or arms
  • Duration: constant or intermittent
  • Aggravating/relieving factors: worse with breathing (suggests PE)
  • Response to nitroglycerin (if administered) 1

• Respiratory Assessment:

  • Respiratory rate and pattern
  • Use of accessory muscles
  • Presence of cyanosis
  • Lung sounds (crackles, wheezes, decreased breath sounds)
  • Oxygen saturation trends 2

• Calf Assessment:

  • Unilateral swelling, warmth, tenderness
  • Positive Homan's sign (calf pain with dorsiflexion)
  • Measure calf circumference bilaterally to document asymmetry 1

Diagnostic Support

Laboratory Tests to Prepare

• Cardiac biomarkers (troponin)
• D-dimer (critical for PE evaluation)
• Complete blood count
• Basic metabolic panel
• Coagulation studies (PT/INR, PTT) 2

Diagnostic Tests to Anticipate

• Venous Doppler ultrasound of lower extremities
• CT pulmonary angiogram (CTPA)
• Ventilation/perfusion (V/Q) scan (if CTPA contraindicated)
• Echocardiography (to assess for right heart strain) 1, 2

Ongoing Monitoring and Interventions

Continuous Monitoring

• Cardiac monitoring for arrhythmias
• Frequent vital signs (every 15 minutes until stable)
• Oxygen saturation monitoring
• Neurological status assessment
• Pain level assessment using standardized scale 1

Medication Administration

• Prepare for potential anticoagulation therapy
• Administer aspirin (162-325 mg) if cardiac etiology suspected and no contraindications 1
• Prepare for possible thrombolytic therapy if massive PE confirmed with hemodynamic instability 2
• Administer analgesics as ordered for pain management

Documentation

• All assessments, interventions, and patient responses
• Timing of symptom onset and changes
• Medication administration and effects
• Patient education provided

Special Considerations

High-Risk Patient Factors

• Recent surgery, trauma, or immobilization
• History of cancer or active cancer treatment
• Previous VTE
• Hormonal therapy
• Advanced age
• Obesity 1

Warning Signs Requiring Immediate Physician Notification

• Hypotension (systolic BP <90 mmHg)
• Worsening hypoxemia despite supplemental oxygen
• Altered mental status
• Syncope or near-syncope
• Severe respiratory distress 2

Patient Education and Emotional Support

• Explain all procedures and interventions
• Provide reassurance while acknowledging the seriousness of symptoms
• Keep family informed of care plan with patient's permission
• Address anxiety with therapeutic communication techniques

Common Pitfalls to Avoid

• Dismissing symptoms in women or elderly patients who may present with atypical symptoms 1, 3
• Focusing only on cardiac causes and missing PE diagnosis 4
• Delaying ECG or troponin measurement in patients with atypical presentations 3
• Failing to recognize that the combination of SOB, chest pain, and calf pain strongly suggests VTE with PE 2
• Overlooking the need for rapid assessment and intervention in patients with this symptom triad 1, 2

This symptom combination represents a potential life-threatening emergency, and nursing interventions should focus on rapid assessment, monitoring, diagnostic support, and preparation for immediate treatment while providing emotional support to the patient.