Advance Practice Essay Discussion
Advance Practice Essay Discussion
Apply information from the Aquifer Case Study to answer the following discussion questions:
•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).
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•Describe the physical exam and diagnostic tools to be used for Ms. Johnston. Are there any additional you would have liked to be included that were not?
•What plan of care will Ms. Johnston be given at this visit; what is the patient education and follow-up?
Do Two pages.
Provide References.
See attached Aquifer Case Study.
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AquiferCaseStudy.pdf7/13/19, 3(41 PMInternal Medicine 02: 60-year-old woman with chest pain – South Univ…ollege of Nursing and Public Health Graduate Online Nursing Program
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South University College of Nursing and Public Health Graduate Online
Nursing Program
Aquifer Internal Medicine
Internal Medicine 02: 60- year-old woman with chest pain
Author:Author: Kirk A. Bronander, MD; Associate Editor, Amy E. Blatt, MD; Case Editor, Amalia Landa-Galindez, MD
INTRODUCTION CARE DISCUSSION
DIAGNOSES
FINDINGS
NOTES
BOOKMARKS
MENUMENU
7/13/19, 3(41 PMInternal Medicine 02: 60-year-old woman with chest pain – South Univ…ollege of Nursing and Public Health Graduate Online Nursing Program
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Dr. Lorenzen asks Dr. Lorenzen asks you to see Ms. Johnston.you to see Ms. Johnston.
!
You are working with Dr. Lorenzen, who asks you to start interviewing Susan Johnston, a patient she knows well who is here to discuss recent symptoms of chest pain.
DIFFERENTIAL DIAGNOSIS CLINICAL REASONING Before seeing the patient, Dr. Lorenzen asks you to review the differential diagnosis for chest pain. She reminds you, “There are many causes of chest pain including cardiac, gastrointestinal, pulmonary, musculoskeletal and psychogenic causes.”
Question List below three potential causes of chest pain in each of the categories mentioned.
7/13/19, 3(41 PMInternal Medicine 02: 60-year-old woman with chest pain – South Univ…ollege of Nursing and Public Health Graduate Online Nursing Program
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The suggested answer is shown below.
Pericarditis, Myocardial Infarction, Aortic Dissection, GERD, Esophageal Spasm, Heart Burn, Pneumonia, Pleuritis, Flu, Costochondritis, Trauma, Lower Rib Pain Syndrome, Anxiety, Hyperventilation, Depression.
Letter Count: 207/1000
SUBMITSUBMIT
Answer Comment See Teaching Point below
Broad DiIerential Diagnosis of Chest Pain
CardiacCardiac
Cardiovascular Causes of Chest PainCardiovascular Causes of Chest Pain
SymptomsSymptoms SignsSigns OtherOther abnormalitiesabnormalities
AnginaAngina
Chest pressure that may radiate to neck/arm/shoulder. May have associated
May have abnormal blood pressure, lower
May have ST segment
TEACHING POINTTEACHING POINT
7/13/19, 3(41 PMInternal Medicine 02: 60-year-old woman with chest pain – South Univ…ollege of Nursing and Public Health Graduate Online Nursing Program
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Pectoris/CoronaryPectoris/Coronary Artery DiseaseArtery Disease
dyspnea. Risk factors include obesity, diabetes, hypertension and hyperlipidemia.
extremity edema, cardiac murmurs or normal exam.
abnormalities on EKG.
Variant AnginaVariant Angina
Vasospastic cause of angina, often younger pt with few risk factors. Risk factors include tobacco use.
Between episodes of chest pain physical exam may be completely normal.
Accompanied by transient ST elevation on EKG.
Cocaine InducedCocaine Induced Chest PainChest Pain
Chest pain after cocaine use from infarction or intense coronary spasm.
Patients may have burn marks on lips and fingers from crack pipe, needle marks on skin from injections, and/or inflammation and ulcerations in the pharynx and nasal septa.
Urine tox screen positive for cocaine and drug metabolites. Elevated CPK levels may be seen with associated rhabdomyolysis.
Aortic DissectionAortic Dissection
Crushing or tearing quality pain in center of chest, radiates to back.
Murmur of aortic insufficiency may be present.
Widened mediastinum on CXR.