NURS 6512 Week 7 Focused Exam Chest Pain Brian Foster Required Completed Shadow Health

NURS 6512 Week 7 Focused Exam Chest Pain Brian Foster Required Completed Shadow Health

NURS 6512 Week 7 Focused Exam Chest Pain Brian Foster Required Completed Shadow Health

Please see focused chest pain template attached to be completed. I completed the week 7 shadow health assignment Brian Foster chest pain. Need assistance with the Focused chest pain template. Please see the 2 examples attached from other students I found online, objective data attached from shadow health, and the template to be completed.

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NURS 6512 Week 7 Focused Exam Chest Pain Brian Foster Required Completed Shadow Health Sample

Week 7: Focused Chest Pain

SUBJECTIVE DATA:

Chief Complaint (CC): “Chest pain over the last month.”

History of Present Illness (HPI): The patient is a 58-year-old Caucasian male, Mr. Brian Foster, who seeks evaluation for recurring chest pain. Mr. Foster has experienced episodic chest tightness rated at 5 out of 10 in intensity, localized to the center of the chest, specifically over the heart area. These episodes have occurred approximately three times within the past month. The individual currently reports the absence of pain. The patient experienced the first instance of chest pain approximately one month ago while engaging in garden work. The most current chest discomfort occurred on Friday night after a stair climb. Physical effort, like yard work or taking the stairs, causes pain episodes, which normally last a few minutes. Exertion exacerbates pain, while rest ameliorates it. The patient disputes experiencing radicular discomfort, palpable pain, diaphoresis, nausea, vomiting, lightheadedness, dyspnea, syncope, or a sense of impending doom. He refutes the notion that consuming certain types of food, such as spicy or high-fat foods, does not impact pain perception. The individual states that the pain is disrupting their usual level of activity.

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Location- the center of the chest, specifically over the heart area

Quality- tightness

Quantity or severity- 5/10

Timing, including onset, duration, and frequency- These episodes have occurred approximately thrice in the past month.

Setting in which it occurs- The most recent occurrence of chest tightness was on Friday evening after climbing a flight of stairs.

Factors that have aggravated or relieved the symptom: Exertion exacerbates pain, while rest ameliorates it.

Associated manifestations- none

Medications: The patient has been taking a 20mg oral dose of atorvastatin once daily at bedtime for the past year to manage hyperlipidemia. The patient has also been taking lisinopril, 20mg taken orally once daily, Omega-3 supplementation at a dosage of 1200mg orally per day, Tylenol 1g after every four hours as needed, and Ibuprofen 400mg every four hours as needed for pain and fever.

Allergies: The patient does not have any recorded food or drug allergies. However, he exhibits signs of vomiting and nausea upon ingestion of codeine.

Past Medical History (PMH):  

• Hypertension
• Hyperlipidemia

Past Surgical History (PSH):

• none.

Sexual/Reproductive History: Heterosexual. No HIV/AIDs

Personal/Social History: He resides with his spouse, with whom he has been married for 27 years, and their 19-year-old daughter. He has worked as an engineer for the past 40 years since his college graduation. He indicates minimal levels of stress in both familial and occupational contexts. He states that fishing is their primary strategy for managing stress. Additional hobbies include watching sports, engaging in family-oriented activities, and repairing electronic devices. His support network includes their spouse, offspring, and intimate companions. The individual denies any current or past history of tobacco or drug use. he consumes 2-3 beers per week during weekends and occasionally consumes spirits. The patient denies any concerns related to alcohol consumption or the potential for alcohol abuse.

Immunization History: up to date.

Significant Family History: Father passed away at age 75 from colon cancer. His mother, who is 80 years old, has second-type diabetes and hypertension. His 24-year-old brother was killed in a car crash. His 52-year-old sister has diabetes and high blood pressure. His maternal grandfather died at 54 from a heart attack, and his maternal grandmother died at 65 from breast cancer. The grandfather died at age 85 from “old age,” whereas the paternal grandmother died at age 78 from sickness. His son is 26 and healthy, while his daughter, who has asthma, is 19.

Review of Systems:

General: denies having recently been ill, tired, perspiring excessively, or having a temperature.

Cardiovascular/Peripheral Vascular: denies feeling lightheaded, short of breath, or aware of a heartbeat.

Respiratory: denies coughing and breathlessness.

Gastrointestinal: denies having stomach pain, diarrhea, vomiting, or nauseousness.

Musculoskeletal: denies experiencing any joint or back pain.

Psychiatric: denies feeling melancholy, maniacal, or delirious.

Dermatological: denies skin changes, rashes, or lesions.

OBJECTIVE DATA:

            Physical Exam:

Vital signs: The patient’s height is 71 inches, weight is 89.5 kg, and BMI is 27.5. blood pressure is 146/90, with a pulse rate of 109. heart rate (HR) is 104 beats per minute, respiratory rate (RR) is 19 breaths per minute, oxygen saturation (SPo2) is 98% on room air (RA), and body temperature (T) is 36.7 degrees Celsius. Blood pressure in the left arm is 146/88 mmHg, while the blood pressure in the right arm is 146/90 mmHg.

General:  alert and oriented to person, place, time, and situation. No signs of immediate physical discomfort. He is calm, cooperative, and can provide accurate information.

Cardiovascular/Peripheral Vascular: The electrocardiogram (EKG) shows a normal sinus rhythm (NSR) without any ST segment changes. S3 heart sound is detected. The right carotid artery exhibits a positive bruit, positive thrill, and a 3+ amplitude. The left carotid artery exhibits no bruit or thrill and has a 2+ amplitude. No rubs or murmurs, thrill or bruits. Bilateral femoral arteries exhibit a 2+ pulse strength and no presence of thrill or bruit.

Respiratory: There are subtle inspiratory crackles in both posterior lower lobes. The chest appears symmetrical and without any signs of trauma. Asymmetrical chest rise is observed during respiration, and there is no evidence of accessory muscle use or retractions. No wheezing, stridor, or reduced breath sounds were heard.

Gastrointestinal: Inspection revealed that the abdomen was breathing and moving usually, was symmetrical, had a typical fullness and shape, and had no apparent lesions or scars.  On the percussion, tympanic. Impalpable organs include the spleen and both kidneys. All quadrants had normal bowel sounds, and an auscultation revealed no abdominal bruit.

Musculoskeletal: The abdomen appears symmetrical, rounded, and without distension. The bowel sounds are within normal limits in all four quadrants. The liver is palpable 1 cm below the costal margin, while the spleen and bilateral kidneys are nonpalpable. The liver span measures 7 cm at the midclavicular line. No enlargement of organs is observed during palpation or percussion.

Neurological: His Glasgow Coma Scale (GCS) score is 15/15, indicating full consciousness and orientation to time, place, and person. The patient’s memory is intact, and all cranial nerves function usually. Motor and sensory functions are intact, and the patient can follow commands.

Skin: Dry, warm, and completely pink. On skin, no tenting.

Diagnostic Test/Labs: An electrocardiogram (EKG) was conducted as part of the assessment. The results indicated a normal sinus rhythm (NSR) and no evidence of ST elevation. Electrocardiograms (EKGs) capture the electrical signals of the heart’s conduction system, providing valuable information about cardiac pathologies. Additional tests were ordered, including cardiac enzymes (Troponin, CK-MB, CPK), complete blood count (CBC), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), brain natriuretic peptide (BNP), chest X-ray (CXR), echocardiogram, and computed tomography (CT) scan.  

ASSESSMENT:

1. Stable Angina: Stable angina is primarily caused by insufficient blood flow to the heart muscle, typically due to atherosclerosis (Zhou et al., 2022). Exertion-induced substernal chest pain of an episodic nature typically lasts for 2 to 10 minutes and can be alleviated by rest or the administration of nitroglycerin (Joshi & de Lemos, 2021). The diagnosis is supported by the patient’s subjective and objective data.
2. Congestive Heart Failure: Systemic under-perfusion is a feature of CHF caused by poor ventricular filling or blood ejection. Chest discomfort, exercise intolerance, bibasilar inspiratory crackles, unintended weight gain, and S3 gallop are clinical indications of CHF that correspond to the signs and symptoms described in the case study (Bell & Goncalves, 2019). The majority of these symptoms are present in the patient.
3. Uncontrolled Hypertension: Mr. Foster has a confirmed diagnosis of high blood pressure and is currently being treated with lisinopril. The patient claims adherence to his medication regimen but admits to not taking his prescribed hypertensive medications today. Consequently, the individual exhibits hypertension with a blood pressure reading of 146/90 (Slivnick & Lampert, 2019).

References

Bell, D. S. H., & Goncalves, E. (2019). Heart failure in the patient with diabetes: Epidemiology, etiology, prognosis, therapy and the effect of glucose‐lowering medications. Diabetes, Obesity and Metabolism, 21(6), 1277–1290. https://doi.org/10.1111/dom.13652

Joshi, P. H., & de Lemos, J. A. (2021). Diagnosis and Management of Stable Angina: A Review. JAMA, 325(17), 1765–1778. https://doi.org/10.1001/jama.2021.1527

Slivnick, J., & Lampert, B. C. (2019). Hypertension and Heart Failure. Heart Failure Clinics, 15(4), 531–541. https://doi.org/10.1016/j.hfc.2019.06.007

Zhou, J., Li, C., Cong, H., Duan, L., Wang, H., Wang, C., Tan, Y., Liu, Y., Zhang, Y., Zhou, X., Zhang, H., Wang, X., Ma, Y., Yang, J., Chen, Y., & Guo, Z. (2022). Comparison of Different Investigation Strategies to Defer Cardiac Testing in Patients With Stable Chest Pain. JACC: Cardiovascular Imaging, 15(1), 91–104. https://doi.org/10.1016/j.jcmg.2021.08.022