APN discussion week 1
KLeyva
Week_1_NSG6001.docx.docxThis week, complete the Aquifer case titled “Internal Medicine 02: 60-year-old woman with chest pain”
Apply information from the Aquifer Case Study to answer the following discussion questions:
•Discuss the history of present illness that you would take on this patient in preparation for the clinic visit. Include questions regarding Onset, Location, Duration, Characteristics, Aggravating Factors, Relieving Factors, Treatment, Severity (OLDCARTS).
•Describe the physical exam and diagnostic tools to be used for Ms. Johnston. Are there any additional you would have liked to be included that were not?
•What plan of care will Ms. Johnston be given at this visit; what is the patient education and follow-up?
Mrs. Susan Johnston is a 60-year old female with a past medical history of hypertension and high cholesterol, who presented to the office for concern of chest pain that has been going on for three months. When asked about the onset of her chest pain, Mrs. Johnston states that her pain occurs when she is performing physical activity and when she is just sitting watching television, but eventually goes away after two to three minutes. She describes her pain as a 6/10 on the pain intensity scale, being right in the middle of her chest and it feels like burning at times and sometimes a tingling sensation. The pain does not radiate to her jaw, arm, or neck, and does not awaken her from sleep. Mrs. Johnston states that when the pain occurs she feels short of breath, but denies sweating, nausea, or palpitations. She tries to rid the pain by changing body position, but the only thing that seemed to help is drinking cold water.
Mrs. Johnston’s cardiac physical assessment should consist of: a complete set of vital signs; listening to her heart sounds and breath sounds using a stethoscope; palpating her carotid arteries, radial arteries, and dorsalis pedis to check vasculature; inspecting head, eyes, ears, nose, and throat for abnormalities, bruits, and jugular vein distention; inspecting abdomen, listening to bowel sounds, and palpating abdominal organs; and palpating extremities for edema (Lowry, 2017). Additionally, Mrs. Johnston should have an electrocardiogram done to evaluate heart rhythm. Mrs. Johnston's father died of a heart attack at the age of 57, and this puts her at risk for experiencing a heart attack. Although, she does not use recreational drugs and rarely drinks alcohol, her diet is poor, she is inactive, and she has a BMI of 35, placing her at risk for coronary artery disease.
Mrs. Johnston should be referred to a cardiologist for co-management of cardiovascular risk and sent to the hospital for further evaluation of chest pain symptoms. She should be placed on an aspirin dose of 75 to 325mg per day as its benefits women ages 55 to 79 in preventing ischemic stroke (Lowry, 2017, p. 550). Mrs. Johnston should be provided with health education to help enable self- care practices. Health education should be organized around the issues of self-monitoring, lifestyle modification, diet, medication self-administration and follow- up treatment (Amakali, 2015). Mrs. Johnston should also be educated on signs and symptoms of a possible heart attack which include: chest pressure or discomfort pain that radiates to the arm, neck, or jaw; diaphoresis; nausea or vomiting; shortness of breath; dizziness; rapid or irregular pulse; and loss of consciousness (Lowry, 2017). Emphasis should be placed on activating emergency services immediately if any symptoms of a possible myocardial infarction are present.
References
Amakali, K. (2015). Clinical care for the patient with heart failure: A nursing care perspective. Cardiol Pharmacol 4(142). doi: 10.4172/2329-6607.1000142
