Chest Pain Case Study

Ebunoluwa Mikiie

Chest Pain

There are various Chest pains. Chest pain may be caused by gastrointestinal, respiratory, cardiac or musculoskeletal analysis. Chest pains may also be caused by anxiety, pericardium, myocardium, parietal pleural, aorta, esophagus, Chest wall, trachea and large bronchi, skin, and musculoskeletal system. As a nurse, I must carefully assess by asking questions, such as Location: where do you feel the pain in your chest? Onset: when did the pain begin? Duration: Does it happen with breathing? Is it nonstop or comes and goes? Associated manifestation: what else is experienced with the chest pain? Characteristics: describe your pain? Treatment: have you seen anyone or tried any medication? Relieving factors: does anything make it better (Nursing Guide)?

Anxiety procedure is not clear. It is located below the left breast or across the anterior chest. The quality of pain is stabbing, sticking, dull or aching. Its severity is varying. It can be from hours to days. Symptoms are shallow breathing, anxiety, weakness and palpitations. Aggravating factor may be emotional stress. A relieving factor is unknown (Nursing Guide).

Pulmonary: Tracheobronchitis is Inflammation of the trachea and bronchi, and is located at the on both sides of the sternum or at the sternal. The quality of pain is a burning sensation, severity, mild to moderate. The timing is variable. Aggravating factor is coughing, and relieving factor is lying on the affected side (Nursing guide).

Pleuritis Pain: Inflammation of the parietal pleura as in pleurisy, pneumonia, pulmonary infarction or neoplasm, located at the chest wall. The quality of pain is sharp and can hurt like a knife with severe pain. Aggravating factors are inspiration, coughing and movements of the trunk, and relieving factors are medication and treatment. Its timing is persistent (Nursing Guide).

Cardiovascular: Angina Pictoris: Temporary myocardial ischemia, usually secondary to coronary atherosclerosis, located at the anterior chest that sometimes radiates to the shoulder, arm, neck, lower jaw or upper abdomen. The quality of pain is pressing, squeezing, tight and heavy with occasional burning. The severity is mild to moderate; this is sometimes perceived as discomfort rather than pain. Its timing is usually 1-3 minutes but up to 10 minutes, prolonged episodes are up to 20 minutes. Association symptoms are dyspnea, nausea and sweating. Aggravating factors are exertion in the cold, meals, emotional stress, it sometimes occurs at rest. Relieving factors are rest and nitroglycerin (Nursing Guide)

Myocardial Infarction: This is prolonged myocardial ischemia, and results in irreparable muscle damage and/or necrosis. It is located at the anterior chest that sometimes radiates to the shoulder, arm, lower jaw, neck or upper abdomen. The quality of pain is like angina. Myocardial Infarction is often but not always a severe pain, with a timing of 20 minutes to several hours. The relieving and aggravating factors are unknown (Nursing Guide).

Pericarditis: Irritation of the parietal pleura, adjacent to the pericardium. It is located at the precordial space and could radiate to the tip of the shoulder and the neck. The quality of pain is also sharp and knife-like and also severe with persistent timing. Aggravating factors are breathing changing position, lying down, swallowing and coughing. A relieving factor is sitting forward (Nursing Guide).

Gastrointestinal: Reflex Esophagitis: Inflammation of the esophageal mucosa by reflux of gastric acid. It is located retro sternal and may radiate to the back. Its severity is mild to severe with variable timing. The quality of pain is burning and squeezing sensation. Aggravating factors are eating large meals, lying down, and also bending over. Relieving factors are antacid and sometimes belching. Associated symptoms are regurgitation and dyspnea (Nursing Guide).

Chest wall Pain: The progression is not always clear, it is frequently found along the costal cartilages or below the left breast. The quality of pain is aching, dull, stabbing, or sticking. Its timing can be from hours to days and has variable severity. An associated symptom is a local tenderness. An aggravating factor may be movement of arms, trunk and chest. Relieving factor is unknown (Nursing Guide).

Assessment

SOAP note on two individuals adults. The first individual has a history of high blood pressure; he is taking his blood pressure medication regularly. The second individual has a history of diabetes; he exercise regularly and eat healthily, but is concerned that his lifestyle change is not apparent in weight loss outcome. A general assessment was done on both patients, but focused area was done on the upper and lower extremities for skin turgor, color temperature and capillary refills.

Patient one: Mr. J.M. is a 49-year-old white male, a car salesperson. He was born in Georgia.

Subjective: Mr. J.M. has a history of High Blood Pressure. Mr. J.M. said that he has been taking atenolol 25mg once a day by mouth for one year, and has no negative effect from it. He rated his pain scale as 0/10 (0-10 pain scale). He said he was concern about having a heart failure form cardiac issues from stress due to the nature of his job.

Objective: Vital Signs, temperature 98.4, pulse 77, respiration 18 and blood pressure 130/80. Head, eyes and nose appears normal no pallor noted. Skin turgor normal and elastic, no signs of dehydration or excessive dryness noted. Color fair, normal for race, no change or abnormal pigmentation observed. Skin is warm and dry to touch (using the back of my hands). Capillary refills in upper and lower extremities of nail beds less than 2 seconds. Respiration clear, no, wheezing or shortness of breath or noisy breathing noted. Lung sounds auscultated, clear bilaterally at anterior and posterior lower and upper lobes. Normal breath sounds, soft and low pitch over most of both lungs, equal expiratory and inspiratory sounds. Irregular breath sounds will necessitate instantaneous care. No adventitious breath sounds such as crackles, wheezes or rhonchi noted. Heart sounds auscultated, normal S1 and S2 noted. These areas were palpated, brachial pulse found at the inner aspect of the elbow; it is also a regular site use to obtain blood pressure measurements. The radial pulse is located at the thumb site of the wrist, the popliteal pulse at the back of the knee, the femoral pulse is located in the groin region, the dorsalis pedis pulse at the top of the foot, the posterior tibial pulse at the lower side at the inner aspect of the ankle. It is to locating these sites are imperative because they are necessary pressure points in case of severe bleeding. The amplitude of the pulses compares equitably, when the pulses were palpated (www.nursing times.net). Abdomen is soft and non-tender, and the bowel sounds active in all four quadrants, with active range of motion (ROM) noted in bilateral upper and lower extremities.

Diagnosis: Knowledge deficit related to signs and symptoms of heart failure as evidence by patient’s concern of stress and impending heart failure. Blood pressure within normal range.

Plan: Encourage Patient to continue taking his medication, increase water intake to at least eight glasses per day, decrease additional salt intake to help maintain normal blood pressure. Patient to continue daily exercise. Encourage patient to keep physician appointment. Routine laboratory test include complete blood count (CBC), urinalysis, thyroid panel, chemistry panels, thyroid panel, blood urea nitrogen (BUN), glucose check, and white blood count (WBC).

Patient 2:

Mr. J.J. is a 40-year-old African America male, businessperson. He was born in Georgia.

Subjective: Patient came into the clinic with concern of not able to see the resulting exercise with his weight, change in diet. Patient associated his not being able to loose with his history of being a diabetic for over three years. He said that currently he takes metformin 1000mg twice a day by mouth. Patient denies any pain at this time.

Objective: Vital Signs, temperature 98.6, pulse 84, respiration 20 and blood pressure 127/76. Blood sugar 115 mg/dl. Weight 200 pounds. Head, eyes and nose appears normal. Skin turgor normal and elastic, no signs of dehydration or excessive dryness noted. Color appropriates to ethnicity, no pallor noted, no change or abnormal pigmentation noted. Temperature of the skin is warm to touch. Capillary refills in upper and lower extremities nail beds less than 2 seconds. Respiration clear, no shortness of breath, wheezing or noisy breathing noted. Lung sounds auscultated, clear bilaterally at anterior and posterior upper and lower lobes. Normal breath sounds noted. No crackles or wheezes or rhonchi. Heart sounds auscultated and normal. These areas were palpated; brachial pulse establish at the inner part [tm1]of the elbow. Radial pulse found at the wrist. Femoral pulse found in the groin area. Popliteal pulse found at the back of the knee, the dorsalis pedis pulse found at the top of the foot, the posterior tibial pulse found at the lower side at the inner aspect of the ankle. The amplitude of the pulses compares equitably, when the pulses were palpated (www.nursing times.net). Abdomen soft and non-tender, bowel sound noted in all four quadrants, active range of motion noted in bilateral upper and lower extremities.

Diagnosis: Non-reassuring weight loss related history of diabetes. GLucose 115mg/dl before food.

Plan: The patient should be congratulated on taking steps to live a healthy life. I would encourage the patient to continue his exercise and include exercises to target specific areas he wants to loose. I would encourage him to continue with his medication regimen and continue with his healthy lifestyle change to help with his medication. Routine laboratory test: Glucose (hemoglobin A1C); thyroid panel; white blood count (WBC); blood urea nitrogen (BUN); complete blood count (CBC).

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