wordpress-seo domain was triggered too early. This is usually an indicator for some code in the plugin or theme running too early. Translations should be loaded at the init action or later. Please see Debugging in WordPress for more information. (This message was added in version 6.7.0.) in /home/intelligentwr/nursingassignmentcrackers/wp-includes/functions.php on line 6114Take a moment to observe your breathing. Notice the sensation of your chest expanding as air flows into your lungs. Feel your chest contract as you exhale. How might this experience be different for someone with chronic lung disease or someone experiencing an asthma attack?<\/span>\u00a0<\/span><\/p>\n In order to adequately assess the chest region of a patient, nurses need to be aware of a patient’s history, potential abnormal findings, and what physical exams and diagnostic tests should be conducted to determine the causes and severity of abnormalities.<\/span>\u00a0<\/span><\/p>\n In this DCE Assignment, you will conduct a focused exam related to chest pain using the simulation too, Shadow Health. Consider how a patient’s initial symptoms can result in very different diagnoses when further assessment is conducted.<\/span>\u00a0<\/span><\/p>\n Complete the following in Shadow Health:<\/span>\u00a0<\/span><\/p>\n Note: <\/span><\/i><\/b>Each Shadow Health Assessment may be attempted and reopened as many times as necessary prior to the due date to achieve a total of 80% or better (this includes your DCE and your Documentation Notes), but you must take all attempts by the Week 7 Day 7 deadline.\u00a0<\/span><\/i>\u00a0<\/span><\/p>\n Chief Complaint (CC): <\/strong>\u201cI have sporadic chest pain\u201d<\/p>\n History of Present Illness (HPI): <\/strong>Mr. J.M. is a 38-year-old African American male who presented to the emergency department with complaints of sporadic chest pain for the last one month. The pain is usually centrally located and radiates to the left arm. He has experienced 3 episodes since the last month with each episode lasting several minutes. Currently, the pain is at 0 on a scale of zero to 10 although it is generally at 5 at its worst. The pain is characteristically uncomfortable and tight. It is aggravated by activities such as climbing stairs and yardwork while brief episodes of rest relieve the pain. He has not taken any medications for the pain.<\/p>\n Medications: <\/strong>Reports taking Lopressor 100mg PO once daily for hypertension and Lipitor 20mg PO once daily for hyperlipidemia as well as fish oil 1000mg PO twice daily.<\/p>\n Allergies: <\/strong>None<\/p>\n Past Medical History (PMH): <\/strong>Reports hypertension and hypercholesterolemia. No previous hospitalizations or blood transfusions. Denies prior chest pain treatment. Poor blood pressure monitoring both at home. Denies regular blood pressure checks at the pharmacy and drug store. Reports a recent EKG test that was normal. His last visit to a healthcare provider was three months ago.<\/p>\n Past Surgical History (PSH): <\/strong>No previous surgeries.<\/p>\n Sexual\/Reproductive History<\/strong>: <\/strong>Heterosexual.<\/p>\n Personal\/Social History: <\/strong>Has lived a relatively stress-free lifestyle. Regular water intake of about a liter per day. Drinks 2 cups of coffee daily. Denies routine regular physical activity and his last regular exercise was 2 years ago. Reports moderate alcohol consumption of about 2 to 3 drinks per week mostly on weekends but no tobacco or illicit drug use. His typical breakfast is a granola bar and instant breakfast shake, lunch turkey sub, and his dinner is typically grilled meat alongside vegetables.<\/p>\n Immunization History: <\/strong>All immunization up to date. The last COVID-19 vaccine was February this year, the last Tdap was May 2022 and the last influenza was January 2022.<\/p>\n Significant Family History: <\/strong>His mother is 65 years old and hypertensive while the father is 70 years old and obese. The grandmother died at 77 years due to a heart attack while the grandfather is 85 but suffered a stroke at 80 years. He has two daughters all alive and well.<\/p>\n \u00a0<\/strong><\/p>\n General: <\/strong>Denies fever, changes in weight, chills, fatigue, night sweats, and palpitations.<\/p>\n \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Cardiovascular\/Peripheral Vascular: <\/strong>No edema, easy bruising, angina, or easy bleeding.<\/p>\n \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Respiratory: <\/strong>No difficulty in bleeding, sputum, cough, or shortness of breath.<\/p>\n \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Gastrointestinal: <\/strong>Denies alteration in bowel habits, abdominal pain and nausea, and vomiting<\/p>\n \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Musculoskeletal: <\/strong>No back pains, joint pains, and muscle weakness.<\/p>\n \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Psychiatric: <\/strong>No anxiety, depression, delusions, or hallucinations<\/p>\n \u00a0<\/strong><\/p>\n Physical Exam:<\/strong><\/p>\n Vital signs:<\/strong> Temperature- 98.5 F, pulse 80 beats per min, respiratory rate- 19 breaths per minute, blood pressure- 132\/86 mmHg, saturation- 92% on room air, height 70. 86 inches, weight 251 lbs. BMI- 29.<\/p>\n <\/p>\n General: <\/strong>A young African American male, well kempt and groomed, and appropriate for his stated age. Not in any obvious distress, good body built and well hydrated. No pallor, finger clubbing, splinter hemorrhages, jaundice, cyanosis, lymphadenopathy, or peripheral edema.<\/p>\n \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Cardiovascular\/Peripheral Vascular: <\/strong>Nondistended neck veins (JVP less than 4cm above sternal angle), right carotid pulse 3+ with a thrill and bruit, left carotid pulse 2+ with no thrill or bruit, right and left brachial and radial arteries pulses 2+ with no thrills, right and left femoral arteries pulses 2+ with no thrills and bruits, right and left popliteal arteries pulses 1+ with no thrills, right and left tibial and dorsalis pedis pulses 1+ with no thrills, no renal, iliac and abdominal aorta bruits, and capillary refill is less than 3 seconds in all the digits. Precordium is brisk and tapping. The point of maximal impulse is displaced laterally and less than 3 cm, with a heave but no thrill. S1, S2, and S3 were heard with gallops, no murmurs.<\/p>\n Respiratory: <\/strong>Symmetric chest, moves with respiration with no obvious scars or masses on inspection. the trachea is central, with equal chest expansion, no tenderness or palpable masses, and equal tactile fremitus on palpation. Resonant on percussion. Good air entry and vesicular breath sounds in all lung zones, and no wheezes or rhonchi on auscultation.<\/p>\n Gastrointestinal: <\/strong>Nondistended, moves with respiration, symmetric, normal contour and fullness, umbilicus everted and no visible distended veins, striae, or scars. No tenderness or palpable masses on light and deep palpation. The liver is palpable 2 cm below the right costal margin. Liver span 8 cm. Spleen and both kidneys are impalpable. Tympanic on percussion, no shifting dullness or fluid thrill. No friction rubs over the liver and spleen.<\/p>\n Musculoskeletal:<\/strong> Normal muscle bulk, power of 5\/5 in all muscle groups, normal reflexes, and range of movement across all joints.<\/p>\n Neurological:<\/strong> GCS 15\/15, oriented to time place, and person, all cranial nerves and sensation intact, no neurological deficits noted, good bladder and bowel function.<\/p>\n Skin: <\/strong>No rashes, darkening, tenting, or nail changes.<\/p>\n Diagnostic Test\/Labs: <\/strong>An EKG was done which revealed a sinus rhythm with no ST changes. Other critical tests include cardiac biomarkers particularly, troponin T\/I, CK-MB, and myoglobin to exclude myocardial injury (Harskamp et al., 2019). Lipid profile and random blood sugar are required to check the level of lipid control and exclude diabetes mellitus respectively. Additionally, LDH to assess for cell necrosis, BNP to exclude concurrent heart failure, and inflammatory markers especially CRP for prognostication. Similarly, complete blood count with differential, urea creatinine, and electrolytes as well as liver function tests are required as a baseline for medication. Imaging tests include a transthoracic echocardiogram to assess left ventricular function, detect any wall motion abnormalities and identify any complications (Harskamp et al., 2019). Finally, a cardiac CT with IV contrast may be required to rule out differentials such as pulmonary embolism and aortic dissection.<\/p>\n \u00a0<\/strong><\/p>\n Mr. J.M. is a 38-year-old African American male, known patient with hyperlipidemia and hypertension who presents with complaints of sporadic centrally located chest pain that radiates to the left arm. The pain is usually aggravated by exertion but relieved by rest with a history of physical inactivity. On examination, the right carotid artery pulse is increased with a bruit and thrill, the apex is displaced laterally, and S1, S2, and S3 are heard with gallops but no murmurs.<\/p>\n Main Diagnosis- <\/strong>The primary diagnosis is stable angina. Mr. J.M. presents with retrosternal chest pain that is tight and uncomfortable and that radiates to the left arm. This is characteristic of angina. However, these symptoms are worsened by exertion but relieved by rest which is a distinct feature of stable angina (Rousan & Thadani, 2019). According to Rousan and Thadani (2019), atherosclerosis is the most common etiology of this condition. Mr. J.M. has classic risk factors for atherosclerosis including arterial hypertension, hyperlipidemia, alcohol consumption, and overweight as well as a family history of cardiovascular events.<\/p>\n Non-ST segmented elevated myocardial infarction- Myocardial infarction refers to an acute myocardial injury caused ischemia that results in tissue necrosis. This condition also presents with a retrosternal chest pain that dull and tight, precipitated by exertion and radiates to the left arm, shoulder, neck or jaw. Myocardial infarction may also be precipitated by an atherosclerotic event. However, lack of ST changes on EKG suggests NSTEMI (Cohen & Visveswaran, 2020).<\/p>\n Hypertension and hyperlipidemia- Mr. J.M. has previous history of hypertension on metoprolol and hyperlipidemia on Lipitor. Furthermore, lateral displacement of the apex beat as well as a heave suggest left ventricular hypertrophy which is usually a consequence of arterial hypertension (Oparil et al., 2018).<\/p>\n Cohen, M., & Visveswaran, G. (2020). Defining and managing patients with non-ST-elevation myocardial infarction: Sorting through type 1 vs other types.\u00a0Clinical Cardiology<\/em>,\u00a043<\/em>(3), 242\u2013250. https:\/\/doi.org\/10.1002\/clc.23308<\/a><\/p>\n Harskamp, R. E., Laeven, S. C., Himmelreich, J. C., Lucassen, W. A. M., & van Weert, H. C. P. M. (2019). Chest pain in general practice: a systematic review of prediction rules.\u00a0BMJ Open<\/em>,\u00a09<\/em>(2), e027081. https:\/\/doi.org\/10.1136\/bmjopen-2018-027081<\/a><\/p>\n Oparil, S., Acelajado, M. C., Bakris, G. L., Berlowitz, D. R., C\u00edfkov\u00e1, R., Dominiczak, A. F., Grassi, G., Jordan, J., Poulter, N. R., Rodgers, A., & Whelton, P. K. (2018). Hypertension.\u00a0Nature Reviews. Disease Primers<\/em>,\u00a04<\/em>(1), 18014. https:\/\/doi.org\/10.1038\/nrdp.2018.14<\/a><\/p>\n Rousan, T. A., & Thadani, U. (2019). Stable angina medical therapy management guidelines: A critical review of guidelines from the European Society of Cardiology and National Institute for Health and Care Excellence.\u00a0European Cardiology<\/em>,\u00a014<\/em>(1), 18\u201322. https:\/\/doi.org\/10.15420\/ecr.2018.26.1<\/a><\/p>\nTo Prepare<\/span><\/b>\u00a0<\/span><\/h2>\n
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DCE Focused Exam: Chest Pain Assignment:<\/span><\/b>\u00a0<\/span><\/h2>\n
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Submission and Grading Information<\/span><\/b>\u00a0<\/span><\/h2>\n
By Day 7 of Week 7<\/span><\/b>\u00a0<\/span><\/h3>\n
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A Sample Answer For the Assignment: NURS 6512 Assignment 1: Digital Clinical Experience: Assessing the Heart, Lungs, and Peripheral Vascular System<\/strong><\/h2>\n
Title: <\/strong> NURS 6512 Assignment 1: Digital Clinical Experience: Assessing the Heart, Lungs, and Peripheral Vascular System<\/strong><\/h2>\n
SUBJECTIVE DATA: <\/strong><\/h2>\n
Review of Systems:<\/strong><\/h2>\n
OBJECTIVE DATA: <\/strong><\/h2>\n
ASSESSMENT: <\/strong><\/h2>\n
Differential diagnosis<\/strong><\/h2>\n
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Rubric Detail\u00a0<\/span><\/b>\u00a0<\/span><\/h2>\n