Primary Nursing Diagnosis

Chest pain (acute) related to injury, swelling, bruising

OUTCOMES. Comfort level; Pain control behavior; Pain level; Well-being; Symptom severity

INTERVENTIONS. Analgesia administration; Pain management; Medication management; Distraction; Vital signs monitoring


Management of patients with suspected or known cardiac contusion is similar to that of any myocardial ischemic problem. Strategies include oxygen therapy, cardiac and hemodynamic monitoring, analgesics, and, if necessary, antidysrhythmics and inotropic agents. Even in patients without obvious dysrhythmias, maintain intravenous access for treatment of complications that may be associated with myocardial contusion. Place the patient on continuous cardiac monitoring to assess for dysrhythmias. Perform serial monitoring of vital signs to determine if the patient's heart function is changing. If signs of falling cardiac output occur (confusion or decreased mental status, delayed capillary blanching, cool extremities, weak pulses, pulmonary congestion, increased heart rate, decreased urine output), the physician may insert a pulmonary artery catheter.

One of the more severe complications of myocardial contusion is pericardial tamponade, which can develop more than 1 week after the injury. Elective surgery for associated injuries (open reduction of fractures, repair of minor facial fractures) involving general anesthesia may be delayed, if possible, until cardiac function is stable. Delay allows for stabilization and healing of the contusion, which lowers intraoperative and postoperative risk for cardiac complications.



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