Ihuman Comprehensive Case Study 49-Year-Old Patient with Intermittent Squeezing Chest Pain, Exams of Nursing

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Ihuman b.Comprehensive b.Case b.Study: b.49-Year-Old b.Patient b.with b.Intermittent b.Squeezing

b.Chest b.Pain b.standard

Subjective

Chief b.complaint: b.Florence b.Blackman b.is b.a b.49-year-old b.female b.with b.a b.past b.medical b.history b.significant b.for

b.hypertension b.and b.hypercholesterolemia b.who b.presents b.today b.for b.complaints b.of b.“intermittent b.squeezing b.chest

b.pain”.

History:

Medical:

• Hypertension b.diagnosed b. 2 b.years b.ago

• Hypercholesterolemia b.diagnosed b. 1 b.year b.ago, b.currently b.uncontrolled

Surgical/Hospitalizations:

• No b.past b.surgeries, b.trauma/injuries, b.or b.hospitalizations

Family b.Hx:

• Biological b.father b.(deceased): b.stroke b.at b.age b. 65

• Biological b.mother b.(deceased): b.heart b.disease b.at b.age b. 54

• Biological b.sister b.(living): b.Recent b.open-heart b.surgery b.at b.age b. 58

Social Hx

b.Diet:

• Frequently b.eating b.fast b.food b.and b.restaurant b.meals b.Exercise:

• High-intensityb.aerobics b.class b.three b.times b.per b.week b.Occupation:

• Marketing b.executive b.with b.own b.firm b.that b.is b.demanding b.and b.requires b.long b.work b.hours

Home b.Environment:

• Patient b.lives b.independently b.in b.a b.loft b.and b.reports b.being b.in b.a b.safe b.environment

b.Tobacco:

Comprehensive b.Case b.Study: b.49-Year-Old b.Patient b.with b.Intermittent

b.Squeezing b.Chest b.Pain b.(CLASSb.6512) b.| b.iHuman b.Case b.Analysis b.Week b.#

Case

Comprehensive b.Case b.Study: b.49-Year-Old b.Patient b.with b.Intermittent

b.Squeezing b.Chest b.Pain b.(CLASSb.6512) b.| b.iHuman b.Case b.Analysis b.Week b.#

Case

Comprehensive b.Case b.Study: b.49-Year-Old b.Patient b.with b.Intermittent

b.Squeezing b.Chest b.Pain b.(CLASSb.6512) b.| b.iHuman b.Case b.Analysis b.Week b.#

Patientb.Name:b. Florenceb.Blackmanb. Patient

b.Age: b. 49-year-old

Subjective

Chief b.complaint: b.Florence b.Blackman b.is b.a b.49-year-old b.female b.with b.a b.past b.medical b.history b.significant b.for

b.hypertension b.and b.hypercholesterolemia b.who b.presents b.today b.for b.complaints b.of b.“intermittent b.squeezing b.chest

b.pain”.

Case

Comprehensive b.Case b.Study: b.49-Year-Old b.Patient b.with b.Intermittent

b.Squeezingb.Chest b.Pain b.(CLASSb.6512)b.|b.iHuman b.Case b.Analysis b.Week b.#

HOPI: b.The b.patient b.is b.a b.49-year-old b.female b.who b.presents b.to b.the b.clinic b.with b.complaints b.of b.intermittent b.midsternal

b.chest b.pain b.that b.started b.two b.weeks b.ago. b.She b.describes b.it b.as b.a b.moderate b.6/10 b.“squeezing” b.pain b.which b.radiates

b.to b.the b.left b.arm b.and b.is b.worse b.with b.exertion. b.The b.patient b.also b.reports b.dyspnea b.associated b.with b.the b.episodes b.of

b.chest b.pain b.and b.worsening b.pain b.in b.the b.cold b.weather. b.The b.pain b.and b.shortness b.of b.breath b.has b.a b.sudden b.onset b.and

b.is b.only b.alleviated b.by b.rest b.which b.sometimes b.interferes b.with b.her b.ability b.to b.do b.cross-country b.skiing b.in b.the b.winter.

b.Patient b.denies b.any b.fatigue, b.fever, b.chills, b.nausea, b.vomiting, b.sleeplessness, b.or b.abdominal b.discomfort. b.She b.denies

b.any b.allergies b.or b.use b.of b.over-the-counter b.prescription b.medications b.or b.herbal b.supplements b.to b.help b.with b.symptoms.

b.She b.reports b.a b.past b.medical b.history b.of b.hypertension b.for b.which b.she b.is b.taking b.12.5 b.mg b.of b.hydrochlorothiazide

b.daily b.and b.hypercholesterolemia b.which b.she b.is b.attempting b.to b.manage b.with b.diet b.changes. b.The b.family b.includes

b.stroke b.and b.coronary b.artery b.disease. b.The b.physical b.examination b.is b.normal, b.except b.for b.a b.BMI b.of b.25.5.

History:

b.Medical

: • Hypertension b.diagnosed b. 2 b.years b.ago

• Hypercholesterolemia b.diagnosed b. 1 b.year b.ago, b.currently b.uncontrolled

typically b.lasting b.a b.few b.minutes b.for b.the b.past b.two b.weeks, b.especially b.in b.the b.cold b.weather b.when b.she b.is b.cross-country

b.skiing. b.The b.pain b.is b.in b.the b.center b.of b.her b.chest, b.and b.she b.rates b.it b.as b.a b.moderate b.6/10. b.She b.denies b.any b.exercise

b.intolerance b.and b.is b.able b.to b.attend b.a b.high-intensity b.aerobics b.class b.three b.times b.a b.week b.despite b.current

b.symptoms. b.Denies b.any b.palpitation, b.syncope, b.or b.history b.of b.irregular b.heartbeats.

Gastrointestinal: b.Denies b.nausea, b.vomiting, b.constipation, b.diarrhea, b.coffee b.ground b.emesis, b.dark b.tarry b.stool, b.bright

b.red b.blood b.in b.bowel b.movements, b.early b.satiety, b.or b.bloating. b.No b.abdominal b.pain b.reported.

Musculoskeletal: b.Reports b.that b.the b.chest b.pain b.radiates b.to b.left b.arm. b.Denies b.pain, b.weakness, b.or b.swelling b.in b.any b.other

b.extremities b.or b.joints.

Peripheral b.vascular: b.Denies b.any b.extremity b.edema b.or b.lower b.extremity b.pain.

Case

Comprehensive b.Case b.Study: b.49-Year-Old b.Patient b.with b.Intermittent

b.Squeezing b.Chest b.Pain b.(CLASSb.6512) b.| b.iHuman b.Case b.Analysis b.Week b.#

Objective

Vitals:

Ht: b.5’ b.6” b.(168 b.cm)

Wt: b. 158 b.lb b.(71.8 b.kg)

BMI: b.25. b. 5

b.BP:

b.132/

b.HR: b. 74

RR: b. 18

T: b.98.5 b.F

Physical b.Exam:

General b.survey: b.She b.is b.alert b.and b.oriented b.to b.person, b.place, b.time, b.and b.situation. b.No b.signs b.of b.acute

b.cardiac/respiratory b.problems b.at b.rest. b.Hygiene/dress-up b.is b.appropriate b.for b.situation, b.able b.to b.maintain b.normal b.eye

b.contact b.and b.facial b.expressions. b.BMI b.25.5, b.making b.her b.slightly b.overweight.

HEENT: b.Head b.is b.normocephalic, b.atraumatic, b.with b.no b.deformities. b.Facial b.features b.are b.symmetric b.and b.there b.is b.no

b.edema b.or b.swelling b.noted.b.Conjunctivae b.are b.pink b.with b.no b.discharge b.and b.there b.are b.no b.signsb.of b.cyanosis. b.No b.cyanosis b.is

b.noted b.around b.the b.mouth b.or b.lips, b.and b.mucous b.membranes b.are b.moist, b.pink, b.dry b.and b.intact. b.Pupils b.are b.equal,

b.round, b.reactive b.to b.light, b.and b.accommodation.

Respiratory: b.Respiratory b.rate, b.depth, b.rhythm, b.and b.effort b.are b.normal b.without b.any b.audible b.wheezing, b.gasping, b.or

b.grunting. b.Trachea b.is b.midline b.and b.there b.are b.no b.signs b.of b.trauma b.to b.the b.thorax. b.No b.deformities b.of b.the b.thorax

b.anteriorly b.or b.posteriorly, b.retractions, b.or b.use b.of b.abdominal/accessory b.muscles b.noted. b.There b.are b.no b.areas b.of

b.tenderness b.or b.pain b.with b.palpation. b.Chest b.expansion b.is b.symmetrical, b.and b.lung b.fields b.are b.resonant b.throughout. b.All

b.lung b.fields b.are b.clear b.upon b.auscultation b.anteriorly b.and b.posteriorly, b.no b.adventitious b.sounds b.are b.noted.

Cardiovascular: b.Chest b.is b.symmetric b.without b.any b.trauma. b.Regular b.heart b.rate, b.rhythm, b.and b.strength. b.S1 b.and b.S

b.heart b.sounds b.present. b.No b.murmurs, b.rubs, b.click, b.or b.gallops. b.PMI b.is b.normal b.and b.located b.inside b.the b.midclavicular

line b.at b.the b.fifth b.intercostal b.space. b.There b.is b.no b.jugular b.vein b.distention b.and b.patient b.has b.normal b.jugular b.venous

b.pressure. b.No b.abnormal b.pulsations b.and/or b.bruits.

Gastrointestinal: b.Abdomen b.is b.nondistended b.and b.there b.are b.no b.masses b.observed. b.Soft/ b.non-tender b.to b.palpation

b.and b.tympanic b.to b.percussion b.with b.dullness b.over b.solid b.viscera. b.Bowel b.sounds b.are b.present b.and b.normoactive b.in b.all

b.four b.quadrants. b.Patient’s b.symptoms b.are b.not b.reproduced b.when b.applying b.epigastric b.pressure.

Musculoskeletal: b.All b.extremities b.are b.symmetric b.with b.no b.deformities b.present. b.No b.localized b.pain b.or b.tenderness.

b.Full b.range b.of b.motion b.of b.upper b.and b.lower b.extremities. b.Strength b.test b.is b.5/5 b.bilaterally.

Peripheral b.vascular: b.No b.peripheral b.edema b.of b.lower b.or b.upper b.extremities b.and b.are b.warm b.and b.dry. b.Radial b.pulses b.are

b.2+ b.bilaterally b.and b.capillary b.refill b.is b.less b.than b. 3 b.seconds b.for b.all b.extremities. b.No b.cyanosis b.or b.clubbing b.in b.the b.finger b.or

b.toenails.

Laboratory b.data :

• Complete b.blood b.count b.(CBC) b.with b.differential b.is b.normal b.– b.no b.signs b.of b.anemia
• Normal b.creatinine b.kinase-MB b.– b.one b.of b.the b.enzymes b.that b.is b.used b.to b.detect b.myocardial b.injury b.along b.with

b.troponin

• Abnormal b. serum b. lipid b. profile b. – b. hypertriglyceridemia b. and b. hypercholesterolemia b. with

b. moderately b.elevated b.LDL b.fraction b.which b.can b.contribute b.to b.coronary b.artery b.disease

• Normal b.troponin-T b.– b.cardiac b.myocyte b.protein b.released b.into b.the b.blood b.following b.myocardial b.infarction

b.and b.is b.most b.sensitive

Imaging b.data :

• 12 b.Lead b.Electrocardiogram b.– b.normal b.sinus b.rhythm, b.no b.ST b.segment b.abnormalities
• Abnormal b. cardiac b. stress b. test b. – b. ST b. elevation b. in b. the b. inferior b. lead b. suggests b. inferior

b. ischemia b. vs. b. ST b.depression b.on b.exercise b.testing b.is b.of b.no b.value

• Transthoracic b.Echocardiogram b.– b.no b.evidence b.of b.structural b.or b.functional b.cardiac b.abnormalities b. Normal

b.Chest b.X-ray

Assessment

Primary b.Differential

Dx: b. Stable b.Angina b.related b.to b.coronary b.artery b.disease

a. b.Inclusion b.Criteria:

o b. History b.of b.hypercholesterolemia, b.hypertension, b.smoking, b.and b.overweight b.status b.o

Family b.history b.of b.cardiac b.disease b.o b.Abnormal b.serum b.lipid b.profile b.o b.Normal b.chest b.X-ray

o Chest b.pain b.and b.shortness b.of b.breath b.with b.exertion b.which b.is b.relieved b.with b.rest b.b.

b.Exclusion b.Criteria: b.o b.Cardiac b.stress b.test b.showing b.ST b.depression b.in b.the b.inferior b.lead b.may

b.warrant b.further b.testing b.with b.an b.angiography, b.but b.patient b.is b.refusing

Differentialsb.forb.Primaryb.Problem b. Alternative

b.DDX: b. Myocardial b.Infarction

c. Inclusion b.Criteria: b.o b. Chest b.pain b.which b.radiates b.to b.the b.left b.arm b.with

b.associated b.shortness b.of b.breath b.o b.History b.of b.cardiac b.disease b.in b.the b.family

o b. Patient’s b.past b.medical b.history b.of b.hypertension b.and b.hypercholesterolemia b.o

Abnormal b.cardiac b.stressb.test

d. Exclusion b.Criteria: b.o b.Pain b.is b.intermittent b.and b.relieved b.with b.rest b.vs. b.with b.an b.MIb.it b.would b.be

b.a b.constant b.pain b.o b.Troponin b.levels b.were b.normal