Acute Chest Pain in Adults Discussion Paper

Acute Chest Pain in Adults Discussion Paper

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Case Study 1: Chest Pain

Additional Clinical Questions

1. Have you experienced swelling around your belly?
2. Have you taken any medication to relieve the chest pain?

• Does the shortness of breath increase with lying down?

1. Have you experienced swelling in the ankles, legs, or feet?
2. Do you have a family history of cognitive heart failure (CHF)?

Mr. Fern presented a chief complaint of chest and arm pain to the emergency department. He describes the chest pain as pressure below his sternum, which radiates to other body parts, including his jaw and arms. Studies show that chest pain that radiates to the arms, shoulders, or neck is a significant symptom of CHF in adults (McConaghy et al., 2020). Whether the shortness of breath reduces with lying down would guide the clinician in making the most appropriate diagnosis since shortness of breath increases with lying down or exercising in CHF patients. Secondly, the client should be asked about swelling water retention causes edema in CHF patients. Lastly, CHF is common in individuals with a family history of this disorder. Therefore, having a family history of CHF would predispose the patient to this medical condition. Acute Chest Pain in Adults Discussion Paper

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Recommended Physical Exam

First, the clinician should physically examine the patient’s peripheral vascular/extremities. Swelling in the abdomen, ankles, or legs caused by fluid accumulation would indicate a potential heart defect (Bickley et al., 2021). Secondly, the nurse practitioner should assess the patient’s neck. Swelling in neck veins would indicate that the blood is backing up in his heart. The patient’s cardiovascular system should also be assessed. The presence of abnormal murmurs or gallops would indicate valve defects. Additionally, an irregular heart rate would imply that his heart is pumping faster to compensate for the inadequacy of blood flow. Lastly, the clinician should assess the patient’s lungs. A crackling or wheezing sound would imply fluid is accumulated in his lungs. Acute Chest Pain in Adults Discussion Paper

Differential Diagnosis

CHF: This CVD is characterized by several clinical manifestations, including chest pain, productive or dry cough, fatigue, dizziness, reduced appetite, shortness of breath that increases with lying down or exercise, weight gain, and fluid retention (McConaghy et al., 2020). The patient reports similar symptoms, including chest pain that radiates to his jaw and left arm and shortness of breath relieved by rest and accelerated by climbing stairs. Furthermore, the patient’s blood is 160/100 mmHg, which is significantly high, exerting high pressure on the heart. The patient’s respiratory rate is also 28 breaths/minute, indicating rapid breathing to meet the body’s oxygen demand. Thus, CFC is considered as the patient’s pertinent diagnosis. Acute Chest Pain in Adults Discussion Paper

Chronic pulmonary disease (COPD): The patient qualifies for this diagnosis because it is characterized by shortness of breath during physical activities and chest tightness (Peckens et al., 2020). However, COPD is disqualified since other pertinent symptoms, including wheezing, reduced energy, chronic cough, and unintended weight loss, were absent.

Angina: It is characterized by a pressing chest pain, pain radiating to the shoulders, back, jaw, or neck, and shortness of breath (Weng et al., 2021). Nonetheless, angina is disqualified since other symptoms, including weakness and feeling faint were not reported (Weng et al., 2021).

Recommended Labs

Blood tests are commended in patients with suspected CHF. These tests are used to detect other comorbidities, including thyroid problems, anemia, and high cholesterol (Dains et al., 2023). Acute Chest Pain in Adults Discussion Paper

References

Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bates’ Guide to Physical Examination and history taking (13th ed.). Wolters Kluwer.

Dains, J. E., Scheibel, P., & Baumann, L. C. (2023). Advanced Health Assessment & Clinical Diagnosis in Primary Care (7th ed.). ELSEVIER

McConaghy, J. R., Sharma, M., & Patel, H. (2020). Acute chest pain in adults: outpatient evaluation. American Family Physician, 102(12), 721-727.

Peckens, S., Adelman, M. M., Ashcraft, A. M., Xiang, J., Sheppard, B., & King, D. E. (2020). Improving Chronic Obstructive Pulmonary Disease (COPD) symptoms using a team-based approach. The Journal of the American Board of Family Medicine, 33(6), 978-985.

Weng, L. M., Su, X., & Wang, X. Q. (2021). Pain symptoms in patients with coronavirus 

Assignment Instructions – Choose One Case Study.
Read the Case Studies below.
Use the information to respond to all the questions. Acute Chest Pain in Adults Discussion Paper
APA Format with references are required
Upload your responses.
Case Study #1: Chest Pain

CHIEF COMPLAINT: “I have pain in my chest ” x 1 day

History of present illness:

Mr. Fern is a 55-year-old advertising executive who comes to the emergency room complaining of pain in his chest and arm which began one hour ago. He describes the pain as pressure under the sternum that radiates into his left arm and up into his jaw. On a scale of 1 to 10 he rates it as a 7 in intensity. He feels short of breath. He has had similar symptoms during the last two weeks, but these episodes have lasted for 5 to 10 minutes at the most. He noticed that the symptoms are brought on by climbing the stairs and are relieved with rest. Right now, he reports nausea and diaphoresis. He was given sublingual nitroglycerin by the triage nurse in the emergency room, which has helped to ease the pain. Acute Chest Pain in Adults Discussion Paper

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Vital Signs: BP 160/100 mmHg in both arms; heart rate 85 bpm and regular; respiratory rate 28 breaths/minute; temperature 98.7°F

1. What additional questions would you ask Mr. Fern and why?

2. Which parts of the physical exam would you like to perform? Explain your rationale for selecting those parts

general survey

breasts and axilla

vital signs

male genitalia

skin

head and neck

anus, rectum, and prostate

thorax and lungs

peripheral vascular/extremities

cardiovascular

musculoskeletal

abdomen

nervous system

lymphatic

3. Based on this information, list three differential diagnosis? Explain your rationale for each diagnosis.

4. What tests or labs would you order for this patient and why? Acute Chest Pain in Adults Discussion Paper

Requirements Textbook and Resources:
Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bates’ Guide to Physical Examination and history taking (13th ed.). Wolters Kluwer.
Dains, J. E., Scheibel, P., & Baumann, L. C. (2023). Advanced Health Assessment & Clinical Diagnosis in Primary Care (7th ed.). ELSEVIER – HEALTH SCIENCE. Acute Chest Pain in Adults Discussion Paper