Case Study: Florence Blackman - Intermittent Squeezing Chest Pain, Exams of Nursing

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Pain.

Pain.

Pain. 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

Pain. •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

Pain. •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

Pain. •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

Pain. 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

Pain.

• 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)