Chest Pain Clinical Examination Essay Example | Topics and Well Written Essays - 1500 words

Chest Pain Clinical Examination - Essay Example This can be done mainly through eliciting the history in fair detail. As a nurse practitioner in the community, I will be facing many cases of chest pain. Recently I had to manage such a case and I believe that the experience has equipped me with confidence. I adopted a structured approach to evaluate the case and progress through a mental checklist for eliciting the essential historical details (Reigle, 2005). The collected relevant data helped the decision- making and subsequent management. Case Presentation Respecting the confidentiality and privacy of the patient, I met her in the emergency department where I was working. With her consent, as she was conscious and answering, I elicited the history of the chest pain from Mrs John. Mrs John, 81 years old and weighing 85 kg., had been brought to the Emergency Department by her son. I followed the mnemonic TROCAR for eliciting the history of the presenting complaint of chest pain. She had a sudden but mild chest pain while she was in bed. Time of onset was when she woke up with it at 6a.m. and first dismissed it as indigestion. As it was not giving way after her antacid liquid, she called her son. Also experiencing shortness of breath, the duration of pain had lasted for the past forty minutes. Mrs. John had fatigue since the previous night, something she was not accustomed to. Radiation of the left-sided chest pain was to the back. Onset was sudden. The character of the pain was a dull aching sensation. There was no particular aggravation or relief. The severity remained constant as a dull pain. It was a left sided chest pain. The excessive sweating worsened her fatigue. She was reluctant to go to hospital but her son insisted on it. She had then been brought to my department where I was on duty. Past History revealed that she had been a hypertensive on treatment for the past twenty years. There was a history of irregularity in treatment at times. The mild senile dementia with partial loss of memory that the l ady suffered from was the cause of the irregular treatment. Now her son was in charge of giving her the medicine. She became diabetic fifteen years ago and was on oral anti-diabetics since then. Seven years ago she had a fall injuring her left trochanter which was managed accordingly. She now walks with a limp. There was no history of allergies but she had been taking antacids on and off presumably for acid-peptic disease. Smoking was not her weakness and she had not travelled for a long time. Before retirement she was working as a personal secretary in an industrial concern. Family history revealed that two brothers had died of myocardial infarction but at a later age of around 85 years. Obesity was in the family too. Mrs. John’s mother had diabetes and died of renal failure. Nursing care plan This has been elaborated upon the mnemonic ADPIE (assessment, diagnosis, planning, implementation and evaluation). Assessment On inspection, obviously obese Mrs. John appeared dyspnoei c taking short breaths with the respiratory rate being 28 per minute but regular. Her heart rate was 90 per minute and irregular at times due to ectopic beats. Her supine blood pressure was 200/120mm Hg. Palpation of abdomen did not reveal any abnormalities. Percussion ruled out fluid in the chest or abdomen. Auscultation elicited an irregular heart and tachypnea. During the general physical examination, I enumerated and eliminated non-cardiac causes; her symptom details helped me to distinguish her illness