Health Medical Homework Help

Respond to at least two of your classmates’ initial postings. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite sources in your responses to other classmates.

Tiffany Costley peer #1

1. Discuss the history of present illness that you would take on this patient in preparation for the clinic visit. Include questions regarding Onset, Location, Duration, Characteristics, Aggravating Factors, Relieving Factors, Treatment, Severity (OLDCARTS).

• The patient is a 60-year-old female with a past medical history of high cholesterol and hypertension. Patient presented to clinic with complaints of chest pain for three months. Ms. Johnston was asked about the onset of her chest pain; she states pain occurs with activity and at rest while watching tv. She also states that the pain subsides after three minutes. The patient described her pain as burning like sensation and occasional tingling in the middle of her chest. She states a 6 out of 10 pain intensity that does not radiate to her jaw, arms, or neck. When pain occurs, she is short of breath, but does not experience sweating, nausea, or vomiting. Ms. Johnston states that she tries to alleviate the pain through positioning, however, her pain seemed to be relieved by drinking cold water.

1. Describe the physical examination and diagnostic tools to be used for Ms. Johnston. Are there any additional you would have liked to be included that were not?

Ms. Johnston’s assessment should include both subjective and objective date. This includes a full head to toe assessment. A complete vital sign, listening to heart and lung sounds through a stethoscope. Then palpating all major arteries such as bilateral carotid arteries, radial pulses, dorsalis pedis, and popliteal arteries (Toney-Butler & Unison-Pace, 2020). Patient’s jugular veins should also be examined for distention, as well as extremities checked for edema. Abdomen should also be examined through palpation as well auscultation. Ears, nose, throat, and eyes should be assessed for any abnormalities (Toney-Butler & Unison-Pace, 2020).

Additionally, patient should have a transthoracic echocardiogram done a CT coronary angiogram, and or a stress , if possible, before proceeding to a cardiac catheterization.

1. What plan of care will Ms. Johnston be given at this visit; what is the patient education and follow-up?

• Ms. Johnston should be referred to a cardiologist for further evaluation. However, because patient state chest pains a rest, it is best to send patient to the emergency room for a thorough cardiac evaluation. Patient has several risk factors that may lead to acute coronary syndrome. These include a family history of heart disease, age, obesity, hypertension, and high cholesterol levels.

Patient should be educated regarding lifestyle modifications such as

diet, exercise, and medication compliance to help reduce the recurrence of symptoms (Xian-liang et al., 2017). Patient should be prescribed antiplatelets medication such aspirin for daily maintenance. If she receives coronary stenting, Clopidogrel or Ticagrelor as well as statins for a proper maintenance for coronary syndrome must be prescribed.

Toney-Butler TJ, Unison-Pace WJ. Nursing Admission Assessment and Examination. Updated

(2020 Sep 2). In: StatPearls Internet. Treasure Island (FL): StatPearls Publishing; 2021 Jan-Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK493211/

Liu, X. L., Shi, Y., Willis, K., Wu, C. J. J., & Johnson, M. (2017). Health education for patients with acute coronary syndrome and type 2 diabetes mellitus: an umbrella review of systematic reviews and meta-analyses. BMJ Open, 7(10), e016857. https://doi.org/10.1136/bmjopen-2017-01685

Amber peer #2

• Discuss the history of present illness that you would take on this patient in preparation for the clinic visit. Include questions regarding Onset, Location, Duration, Characteristics, Aggravating Factors, Relieving Factors, Treatment, Severity (OLDCARTS).

I would conduct a through history of Susan’s presenting symptoms. I would ask how long she has been having this chest pain, what brings it on and what makes it better, what is the description of the pain, point to where it is located, if it radiates to any other part of her body, how long the pain lasts at a time, if it causes shortness of breath, dizziness, passing out, diaphoresis, or palpitations, and what the pain scale is on a 0-10 rating.

• Describe the physical examination and diagnostic tools to be used for Ms. Johnston. Are there any additional you would have liked to be included that were not?

During the physical examination I would include a full set of vitals and examine each body system with a focus on heart, lungs, abdomen, musculoskeletal, and vascular. Her vital signs show a BMI of 35.5 kg/m, blood pressure 136/82, and height/weight 5’6”/220lbs. These results are all concerning for cardiac complications. There is no tenderness to the chest wall, on auscultation, she has normal S1 and S2, lung sounds are normal with normal chest rise and fall, abdomen is nontender, obese, and soft with no organ enlargement, there is no edema in her extremities, and radial, carotid, and dorsalis pedis pulses are 2+ bilaterally with a regular rate. An ECG was ordered to examine any abnormalities in her heart rhythm, CBC, BMP, TSH, and fasting lipid panel were ordered to assess for hemoglobin, renal disease, electrolyte imbalances, kidney function, thyroid function, and hyperlipidemia. A positive stress examination led to admission to the hospital for a cardiac angiogram and placement of a stent in her LAD. I would not include any other diagnostic tests since they were able to determine Susan was having angina due to the 75% blockage in her left anterior descending.

• What plan of care will Ms. Johnston be given at this visit; what is the patient education and follow-up?

At this current visit, Susan’s plan of care will be to reduce chest pain. She is being admitted to the hospital, so I would educate the patient to let their nurse know if she is having chest pain so they are able to treat her accordingly. At the follow up appointment after the cardiac catheterization, plan of care will be focused on medication management, weight loss, exercise, and dietary modification. Medication management and understanding why she takes each medicine will lead to increased compliance, reduce chances of clotting at the stent site, control blood pressure, and control lipids. Weight loss, exercise, and dietary changes will improve her health, decrease further cardiac and metabolic risks.