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Case Study For Patient Complaining Of Severe Chest Pain

Case Study For Patient Complaining Of Severe Chest Pain

Case 2: A 58-year-old male presents with a complaint of severe chest pain over the last hour. He states that he did not call 911 because he cannot afford an ambulance.
Discuss what questions you would ask the patient, what physical exam elements you would include, and what further testing you would want to have performed.
In SOAP format, list:
Pertinent positive findings that validate your main diagnosis
Pertinent negative findings that make you think of other differential diagnoses
Treatment plan, including: pharmacotherapy with complementary and OTC therapy, diagnostics (labs and testing), health education and lifestyle changes, age-appropriate preventive care, and follow-up to this visit.
Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.
Initial post must have a minimum of 300 words, excluding references. Case Study For Patient Complaining Of Severe Chest Pain

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NURS 681 Discussion Board
NURS 681 Discussion Board
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeInitial Response Timing
4 pts
Proficient
On time (posted by Wednesday, 11:59 p.m. of the week in which assigned)
0 pts
Unsatisfactory
Late (did not submit by Wednesday, 11:59 p.m. of the week in which assigned)
4 pts
This criterion is linked to a Learning OutcomeEvidence of Critical Thinking: Initial Responses to Discussion Prompt(s)
10 to >9.2 pts
Proficient
Applies course content sufficiently by expanding on the main points of the prompt. Responses exhibit critical thinking and analysis. There is a significant correlation to course materials, national guidelines, and evidence-based research.
9.2 to >8.2 pts
Acceptable
Content knowledge is exhibited by identification of the main topics. There is some evidence of critical thinking and analysis. Responses may be insufficient or lacking in detail.
8.2 to >7.5 pts
Needs Improvement
An understanding of content knowledge is poorly exhibited and insufficient in critical thinking, analysis, and detail. Some main discussion topics are not covered, or they significantly digress from the topic at hand. Case Study For Patient Complaining Of Severe Chest Pain
7.5 to >0 pts
Unsatisfactory
An initial response is missing or provides no indication of understanding. Main topics are not covered.
10 pts
This criterion is linked to a Learning Outcome Word Count Initial Post
2 to >1.0 pts
Proficient
The initial post is 300 words or more.
1 to >0.0 pts
Acceptable
n/a You will either receive 100 or 0.
0 pts
Needs Improvement
n/a You will either receive 100 or 0.
0 pts
Unsatisfactory
The initial post has fewer than 300 words.
2 pts
This criterion is linked to a Learning Outcome Frequency of Participation and Minimum Posting Requirements
4 to >3.0 pts
Proficient
Responses to peers’ initial posts occur throughout the week with replies to peers and/or instructors present on two or more days. A minimum of 2 replies on 2 separate days per weekly prompt is evident. Case Study For Patient Complaining Of Severe Chest Pain
3 to >1.0 pts
Acceptable
n/a You will either receive 100 or 0.
1 to >0.0 pts
Needs Improvement
n/a You will either receive 100 or 0.
0 pts
Unsatisfactory
Responses to peers’ initial posts do not occur throughout the week with replies to peers and/or instructors present on two or more days. Less than a minimum of 2 replies on 2 separate days per weekly prompt is evident.
4 pts
This criterion is linked to a Learning OutcomeEvidence of Critical Thinking:<br>Responses to Peers and/or Instructors
11 to >10.12 pts
Proficient
Well-developed and insightful replies provide an opportunity for response. Responses promote discussion either by sharing prior knowledge and experiences, making meaningful connections with course content, asking meaningful questions, or challenging viewpoints. There is a significant correlation of student ideas to course materials, national guidelines, and evidence-based research.
10.12 to >9.02 pts
Acceptable
Somewhat developed replies provide some opportunity for response. Responses contribute to the discussion either by sharing prior knowledge and experiences, making connections with course content, or asking questions. Case Study For Patient Complaining Of Severe Chest Pain
9.02 to >8.25 pts
Needs Improvement
Poorly developed replies provide little or no opportunity for response. Responses do little to contribute to the discussion.
8.25 to >0 pts
Unsatisfactory
Responses are severely limited; no critical thought is present.
11 pts
This criterion is linked to a Learning OutcomeWriting Mechanics
9 to >8.28 pts
Proficient
The writing is clear, concise, formal, and organized. Responses contain a maximum of 2 errors in spelling and grammar. Sources are paraphrased, referenced, and cited correctly in current APA style in all but 1 or 2 instances.
8.28 to >7.38 pts
Acceptable
The writing is generally clear and organized but is not concise or formal in language. Responses contain 3- to 5 errors in spelling and grammar with minor interference with readability or comprehension. Sources are paraphrased, referenced, and cited correctly in current APA in all but 3 or 4 instances.
7.38 to >6.75 pts
Needs Improvement
The writing is unclear and unorganized. Responses contain more than 5 errors in spelling and grammar that detract from the readability of the paper. Sources are missing or they are improperly cited; APA style is barely evident.
6.75 to >0 pts
Unsatisfactory
Extensive errors in spelling and grammar detract from readability and comprehension, and/or the writing includes slang or is inappropriate for academic discourse. APA style is not evident. Case Study For Patient Complaining Of Severe Chest Pain
9 pts
Total Points: 40

Case 2

Questions to Ask the Patient

  1. Where is your pain?
  2. Does your pain move to any other part?
  3. How bad is your pain on a scale of 0 to 10?
  4. Have you used any medication to relieve your pain?
  5. Do you experience any of the following: dizziness, shortness of breath, fatigue, weakness, nausea, indigestion, or cold sweat?
  6. Do you have any of the following: Hypertension, smoking history, history of heart disease, high cholesterol, or diabetes? Case Study For Patient Complaining Of Severe Chest Pain

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Physical Exam Elements to Consider

  1. Electrocardiogram (ECG)
  2. Chest X-ray
  3. Blood tests

Further Tests

  1. Computerized tomography (CT) scan
  2. Stress Tests
  3. Echocardiogram
  4. Coronary catheterization (angiogram) Case Study For Patient Complaining Of Severe Chest Pain

A.

Pertinent Positive Findings

The ECG allowed the detection of dynamic ST-segment changes. This information provided by the ECG helps determine the responsible mechanisms for chest pain. Also, allows the healthcare provider to determine appropriate further testing or investigation, as well as to tailor the optimal treatment for the patient. However, there is a significant variation between resting ECG and exercise ECG.

Pertinent Negative Findings

In a study conducted by Cherulil et al. (2021) on the ECG profile of patients with angina pectoris, it was found that exercise ECG is more specific and sensitive than resting ECG in detecting myocardial ischemia. Myocardial ischemia involves an imbalance between myocardial oxygen consumption and myocardial oxygen supply, which produces a series of events such as; biomedical and metabolic alterations, as well as painful symptoms of angina (Cherulil et al., 2021)Case Study For Patient Complaining Of Severe Chest Pain. Thus, this finding contributed to deciding considering other differential diagnoses.

P.

Treatment Plan:

The patient will be prescribed to take artery relaxers – Nitroglycerin, which helps to relax heart arteries to allow easy blood flow through narrow spaces. The medications are used on or under the tongue and are usually taken 5 to 10 minutes before activities that can cause attacks of chest pain. Also,  Asprin, an OTC drug, will help relieve the chest pain before the patient reaches out to the healthcare provider (Radico et al., 2022).

Diagnostics:

  1. Echocardiogram
  2. CT scan
  3. Blood tests

Health Education and Lifestyle Changes

The patient will be educated on the need for the diagnoses, which are useful in determining the cause of the chest pain. Also, how are helpful to determine the appropriate treatment plan. The patient will be advised on adhering to the medication and helped to understand when and how to take the medications. Also, the patient will be directed on instances when he should seek immediate medical assistance. The patient education will involve teachings on a healthy dietary pattern that emphasizes various vegetables and fruits, low-fat dairy products, whole grains, and non-tropical vegetable oils. Also, the patient would be advised to engage in low- to medium-intensive physical activities, including walking and cycling. Case Study For Patient Complaining Of Severe Chest Pain

Follow-up Plan

After being discharged, the patient will be directed to how the healthcare provider will reach him after one week to check on him. The technology has enabled healthcare settings to utilize mobile health technologies to improve healthcare service delivery and track and educate patients. Thus, it will be possible to make a follow-up after this visit.

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References

Cherulil, S., Maldar, A., & Khursheed, R. (2021). Clinical and Electrocardiographic Profile of                  Inferior Wall Myocardial Infarction with Right Ventricular Involvement: One Year Hospital          Based Cross Sectional Study. Journal of Krishna Institute of Medical Sciences                            (JKIMSU), 10(3).

Radico, F., Di Castelnuovo, A., Aimo, A., Zimarino, M., Knuuti, J., Rossi, S., … & De Caterina, R.          (2022). Factors for heterogeneous outcomes of angina and myocardial ischemia without               obstructive coronary atherosclerosis. Journal of Internal Medicine, 291(2), 197-206 Case Study For Patient Complaining Of Severe Chest Pain