What other diagnostic tests would be appropriate for this case,
CHES PAIN ASSIGNMENT:
To Prepare
• Review this week’s Learning Resources and the Advanced Health Assessment and Diagnostic Reasoning media program and consider the insights they provide related to heart, lungs, and peripheral vascular system.
• Review the Case Study on Chest Pain to complete the assignment (SEE BELOW)
4
Focused Exam: Chest Pain Results | Turned In
Advanced Health Assessment – Chamberlain, NR509-April-2018
Return to Assignment
Your Results
Lab Pass
Lab Pass
Document: Vitals Document: Provider Notes
Document: Provider Notes
Student Documentation
Student Documentation
Model Documentation
Model Documentation
Subjective
Patient information Brian Foster date of birth August
17th, a 58 year old Caucasian male
CC: mr. Foster States” I have been having some
troubling chest pain in my chest now and then for
the past month.”
HPI:
VS:
b/p (L) ARM 146/88 mmhg
(R) arm 146/90 mmhg
MAP 109mmhg
HR 109 BPM
RR- 19
O2 Sat 98% RA
Temp: 36.7 C (98 F)
Onset of chest pain one month ago, lasting ” few
min” pt states, “thought it may be heart burn”
reports Tight and uncomfortable right in the middle
of the chest. Denies any pain radiating denies any
arm pain shoulder pain back pain or neck pain. Pain
only last a few minutes. An uncomfortable feeling
that lasts a few minutes reporting 3 episodes in the
past month and all feels the same. Pain currently a
zero when having chest pain is 5 out of 10 on pain
scale. Patient describes pain as tight and
uncomfortable. Patient denies crushing or burning
pain to the chest. Laying down seems to alleviate
the pain with a brief rest. Not taking any
medications for chest pain. Episodes of chest pain
started with physical activity while doing yard work
Pt. reports “I have been having some troubling
chest pain in my chest now and then for the past
month.” Experiencing periodic chest pain with
exertion such as yard work as well as with
overeating. Points to midsternum as location.
Describes pain as “tight and uncomfortable.”
Denies radiation. Pain lasts for “a few” minutes and
goes away when he rests. Most recent episode was
three days ago after eating a large restaurant dinner.
States “It has never gotten ‘really bad’” so didn’t
think it was an emergency, but is concerned after
three episodes in one month and wants his heart
checked out. Reports mild cramping in legs with
activity. Denies shortness of breath, indigestion,
heartburn. Denies chest pain at this time
CASE STUDY FOR THE ASSIGNMENT:
CHEST PAIN:
4
Focused Exam: Chest Pain Results | Turned In
Advanced Health Assessment – Chamberlain, NR509-April-2018
Return to Assignment
Your Results
Lab Pass
Lab Pass
Document: Vitals Document: Provider Notes
Document: Provider Notes
Student Documentation
Student Documentation
Model Documentation
Model Documentation
Subjective
Patient information Brian Foster date of birth August
17th, a 58 year old Caucasian male
CC: mr. Foster States” I have been having some
troubling chest pain in my chest now and then for
the past month.”
HPI:
VS:
b/p (L) ARM 146/88 mmhg
(R) arm 146/90 mmhg
MAP 109mmhg
HR 109 BPM
RR- 19
O2 Sat 98% RA
Temp: 36.7 C (98 F)
Onset of chest pain one month ago, lasting ” few
min” pt states, “thought it may be heart burn”
reports Tight and uncomfortable right in the middle
of the chest. Denies any pain radiating denies any
arm pain shoulder pain back pain or neck pain. Pain
only last a few minutes. An uncomfortable feeling
that lasts a few minutes reporting 3 episodes in the
past month and all feels the same. Pain currently a
zero when having chest pain is 5 out of 10 on pain
scale. Patient describes pain as tight and
uncomfortable. Patient denies crushing or burning
pain to the chest. Laying down seems to alleviate
the pain with a brief rest. Not taking any
medications for chest pain. Episodes of chest pain
started with physical activity while doing yard work
Pt. reports “I have been having some troubling
chest pain in my chest now and then for the past
month.” Experiencing periodic chest pain with
exertion such as yard work as well as with
overeating. Points to midsternum as location.
Describes pain as “tight and uncomfortable.”
Denies radiation. Pain lasts for “a few” minutes and
goes away when he rests. Most recent episode was
three days ago after eating a large restaurant dinner.
States “It has never gotten ‘really bad’” so didn’t
think it was an emergency, but is concerned after
three episodes in one month and wants his heart
checked out. Reports mild cramping in legs with
activity. Denies shortness of breath, indigestion,
heartburn. Denies chest pain at this time
Pt. BC, 60y/o, Male, Caucasian reports “I have been having some troubling chest pain in my chest now and then for the past month.” Experiencing periodic chest pain with exertion such as yard work as well as with overeating. Points to midsternum as location. Describes pain as “tight and uncomfortable.” Denies radiation. Pain lasts for “a few” minutes and goes away when he rests. Most recent episode was three days ago after eating a large restaurant dinner. States “It has never gotten ‘really bad’” so didn’t think it was an emergency but is concerned after three episodes in one month and wants his heart checked out. Reports mild cramping in legs with activity. Denies shortness of breath, indigestion, heartburn. Denies chest pain at this time. There’s nothing that relieves the pain, he did not take any medications to alleviate the pain.
PMHx: hypertension stage 2 diagnosed 1 year ago, hyperlipidemia diagnosed 1 year ago.
SOCIAL Hx: denies any illicit drug use or tobacco use. Patient does report drinks 2 to 3 alcoholic beverages per week (beer). No unusual stress noted. No regular exercise. Diet consist of granola bars turkey subs and grilled meat and veggies. Unsure of salt intake. Reports drinking a one liter of water a day. Drinks coffee one to two a day . denies illegal drugs and comfirmed alcohol intake.
FAMILY Hx: father- hypertension hyperlipidemia obesity, deceased at age 75 of colon cancer, mother- type 2 diabetes and hypertension 80, brother- disease at age 24 MVA,
sister- type 2 diabetes and hypertension age 52, maternal grandfather- by the age 54 of a heart attack, maternal grandmother- died of breast cancer at age 65, paternal grandmother- died of pneumonia at age 78, paternal grandfather- disease at 85 years old”old
age”
OBJECTIVE FINDINGS
• GENERAL SURVEY: 58 year old male is alert and oriented, with clear speech and in no acute distress
• CARDIAC: S1, S2, without murmurs or rubs. PMI displaced laterally. S3 noted at mitral area. Peripheral Vascular: Right side carotid bruit. JVP 3cm above sternal angle. Right carotid pulse with thrill, 3+. Left carotid pulse without thrill, 2+. Brachial, radial, femoral pulses without thrill, 2+. Popliteal, tibial, and dorsalis pedis pulses without thrill, 1+. Cap refill less than 3 seconds – 4 extremities.
• RESPIRATORY: Breathing is quiet and unlabored. Breath sounds are clear to auscultation in upper lobes and RML. Fine crackles/rales in posterior bases of L/R lungs.
• GASTROINTESTINALl: Round, soft, non-tender with normoactive bowel sounds in 4 quadrants; no abdominal bruits. No tenderness to light or deep palpation. Tympanic throughout. Liver is 7 cm at the MCL and 1 cm below the right costal margin. Spleen and bilateral kidneys are not palpable.
• NEUROLOGICAL: Alert and oriented x 3, follows commands,
moves all extremities.
• SKIN: Warm, dry, pink, and intact. No tenting.
• EKG (interpretation): Regular sinus rhythm. No ST
changes
THE ASSIGNMENT TO BE COMPLETED (Pls provide subtitles)
• What other diagnostic tests would be appropriate for this case, and how would the results be used to make a diagnosis? Include any pertinent labs, x-rays, or diagnostic test that would be appropriate to support the differential diagnoses mentioned.
• List five possible conditions that may be considered as a differential diagnosis for this patient. Your primary or presumptive diagnosis should be at the top of the list.
• Explain your reasoning using at least four different references from current evidence-based literature within the last 5 years. (1 or 2 from learning resources and 2 or 3 from other credible sources).
Learning Resources
Required Readings
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
• Chapter 14, “Chest and Lungs”
This chapter explains the physical exam process for the chest and lungs. The authors also include descriptions of common abnormalities in the chest and lungs.
• Chapter 15, “Heart”
The authors of this chapter explain the structure and function of the heart. The text also describes the steps used to conduct an exam of the heart.
• Chapter 16, “Blood Vessels”
This chapter describes how to properly conduct a physical examination of the blood vessels. The chapter also supplies descriptions of common heart disorders.
Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.
• Chapter 107, “X-Ray Interpretation: Chest (pp. 480–487) (previously read in Week 6; specifically focus on pp. 480–481)
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.
Chapter 8, “Chest Pain”
This chapter focuses on diagnosing the cause of chest pain and highlights the importance of first determining whether the patient is in a life-threatening condition. It includes questions that can help pinpoint the type and severity of pain and then describes how to perform a physical examination. Finally, the authors outline potential laboratory and diagnostic studies.
Chapter 14, “Dyspnea”
The focus of this chapter is dyspnea, or shortness of breath. The chapter includes strategies for determining the cause of the problem through evaluation of the patient’s history, through physical examination, and through additional laboratory and diagnostic tests.
Chapter 26, “Palpitations”
This chapter describes the different causes of heart palpitations and details how the specific cause in a patient can be determined.
Note: Download the Student Checklists and Key Points to use during your practice cardiac and respiratory examination.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Chest and lungs: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Heart: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Heart: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Shiri, R., Solovieva , S., Husgafvel-Pursiainen, K., Telama, R., Yang, X., Viikari, J., Raitakari, O. T., & Viikari-Juntura, E. (2013). The role of obesity and physical activity in non-specific and radiating low back pain: The Young Finns study. Seminars in Arthritis & Rheumatism, 42(6), 640–650. doi:10.1016/j.semarthrit.2012.09.002
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