It's easy to tell a patient in distess. Sometimes the problems are glaringly apparent..like hands clutching the chest or holding their head. like folks breathing like a guppy(fish out of water) in air hunger.  But some problems are not so apparent, and ruling out the possibilities are something we have to do quickly. So I'm going to run through a few major symptoms and then what some of the causes of those symptims could be.


What if your patient is complaining of shortness of breath or having chest pain. Both of these complaints can have multiple causes and we have to differentiate some particulars. Think about the major causes in generality as you assess. Is it cardiac or pulmonary or a combination of both? Could it cardiac ischemia, congestive heart failure, a bronchospasm, a COPD exacerbation, a pulmonary embolus, or possibly some aupper airway obstruction? We should, in addition to assessment, be checking things like respiratory rate and oxygen saturation, medications recently taken and the possibility of an allergic reaction or side effect to them, do they need an EKG or a chest x-ray, and should we consider coags or a BNP or cardiac enzymes? In treating the patient we should be considering oxygen, sublingual nitro, further labs( arterial blood gases), and then more intense mechanical interventions suach as Bipap,Cpap, or intubation. Do they need to be on a cardiac monitor?

What if you notice sudden hypotension or pulse rate change? I should be thinking about hypovolemia, hemmhorage(GI bleeding), sepsis, or perhaps a dysrhythmia? Check , if you feel appropriate, the patients temperature and other vital signs, I&O's, any medications taken) again a side effect or allergic reaction), check the stool for blood, check an H&H, or again perhaps an EKG. Does you r patient need IV fluids for volume support, do they need blood or vasopressors, and do they need a cardiac monitor or increase dlevel of care and monitoring of the ICU?

And what about a change in level of consciousness? We should be thinking about things like medications (sedatives and analgesics firstly), hypoglycemia (when was the sugar checked last), hypoxia and hypercarbia, hypotension, sepsis, and the dreaded possibilty of stroke or intercranial bleed. We should be checking the respiratory rate and effectiveness, oxygen saturation, blood glucose, medications administered, and labs like sodium, hemoglobin, CO2,UA, ammonia and creatinine. We should be thiking of giving oxygen or glucose as appropriate, narcotic and sedative reversal agents like Naloxone and Flumazenil, an evaluation by a neurologist or the primary physician, and again a cardiac monitor or a trip to the ICU.

The above are just a few thigs, but perhaps the most common things we run into as nurses that require a timely assessment of. All interventions are suggestions and must be tailored as appropriate to the patient. But by running through these common steps, timely treatment of acute symptoms can result in early treatment of complex, and perhaps fatal, conditions of your patient.