Case Study- Florence Blackman A Patient with Intermittent Squeezing Chest Pain, Exams of Nursing

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Severe infections:

• Pneumonia, pleurisy, pericarditis Pneumothorax
• Primary (most common, no apparent reason)
• Secondary (collapse lung, injury ect) Define costochondritis and its aetiology Inflammatory condition affecting the sternocostal joints or costochondral junctions. Aetiology
• No cause can be identified in many cases
• May be a history of trauma or mechanical overloading e.g. strenuous exercise, recent URTI

• Rheumatological conditions CF of costochondritis ~90% of patients: multiple painful joints
• Pain is mild - moderate
• Aggravated by breathing, physical activity or a specific position
• Palpation of affected joints elicits tenderness
• +/- radiation along chest, abdomen or to back
• Not usually accompanied by swelling Define Tietze Syndrome
• Often confused with costochrondritis

• Rowers (excessive action of serratus anterior), golfers, fast bowlers, baseball pitchers Characteristics
• Displacement, completeness, orientation, skin penetration
• Displaced # = risk for visceral injury (lungs, spleen, liver, kidneys) CF of rib fracture
• History: Trauma, health status
• Pain aggravated by deep inspiration or coughing

• Localised tenderness over affected rib(s)
• +/- Bruising (direct blow)
• Damage to underlying viscera:
• Splenic rupture – can be life-threatening due to vascularity of the spleen
• Traumatic pneumothorax – breach of the pleura List traumatic SC joint injuries grades Traumatic:
• Usually associated with high-energy impact e.g. MVA, falls, sporting injuries

List non-traumatic SC joint injuries Non-Traumatic:

• Most commonly due to degeneration: SCJ OA is seen in 50-90% of adults >60 years
• Infection: septic arthritis – Staphylococcus aureus is the most common organism
• Rheumatological: rheumatoid arthritis, psoriatic arthritis, reactive arthritis, inflammatory bowel disease Red flags associated with chest pain
• (^) Dizziness/syncope
• Pain in arms L>R, jaw
• Thoracic pain
• (^) Sweating

• (^) Palpitations
• (^) Dyspnoea
• Pain on inspiration
• (^) Pallor
• Past history: ischaemia, diabetes, hypertension Some causes of musculoskeletal chest pain (there are 7)
• Referred pain from CV/CT joints or thoracic facet joints
• Muscle strains
• (^) Costochondritis
• Rib #
• Vertebral #
• Sternoclavicular joint dysfunction
• Thoracic Outlet Syndrome (pec minor compression)