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                                    Ferlanda Piierrelus.          

House Painter Patient Evaluation & Management Plan

While chest discomfort is frequently connected with cardiovascular disorders, it can also be caused by pulmonary, gastric, musculoskeletal, neurologic, psychogenic, or idiopathic conditions. Accurate assessment and management of a patient with pain require a detailed health history and physical examination ( Rhoads, J., Demler, T. L., & Dlugasch, L., 2021).

As a clinician, I will acquire a comprehensive review of chest pain symptoms, including location, quality, duration, aggravating or relieving causes, and connected factors, as well as concurrent symptoms or indicators. I would enquire about the nature of the pain to ascertain the location. I would inquire whether the patient’s pain extends to both arms or only to the left arm. Additionally, I will ask if he is experiencing pain in his upper back, shoulders, or jaws. The history of the 52-year-old patient with chest pain should emphasize personal risk factors for cardiovascular disease.

Due to my suspicion that my patient has Coronary Heart Disease ( CHD), I will take all peripheral pulses, auscultate for carotid bruits, note jugular venous distention, take blood pressure in sitting, lying, and standing positions, and examine the skin and nail beds for evidence of decreased perfusion ( e.g., prolonged capillary refill time ). I will also look for additional symptoms indicative of vascular insufficiencies, such as intermittent claudication or transient ischemic attacks ( Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J., 2019).

C-reactive protein levels can be used to determine a patient’s risk of developing cardiovascular issues because the development of atherosclerosis (the deposit of cholesterol within the walls of blood vessels) is connected with vessel wall inflammation. As a result, people with atherosclerosis have greater CRP levels than individuals without atherosclerosis (Sproston, N. R., & Ashworth, J. J.,2018). If the patient’s CRP levels are elevated, the scope of treatment will be altered. Additionally, this will expand the possibility of treating the illness.

Angina pectoris, the primary clinical manifestation of coronary heart disease, can be caused by various factors. Angina can also be caused by a thrombus, coronary artery vasospasm, aortic stenosis, aortic insufficiency, severe hypertension, or idiopathic subaortic hypertrophic stenosis. Additionally, the differential diagnosis for CHD includes gastrointestinal, pulmonary, and cardiac issues unrelated to ischemia ( Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J., 2019).

Modification of risk factors is critical to halting the progression of CHD. I will encourage the patient to adopt lifestyle modifications such as regular exercise, stress management, and a heart-healthy diet ( less than 300 mg of cholesterol per day and 7 percent or less of total calories from saturated fats) ( Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J., 2019). Additionally, I will teach the patient about weight management and medication compliance.

Due to the development of collateral circulation, the patient is frequently unaware that anything is wrong unless other concomitant diseases such as hyperlipidemia or hypertension are present ( Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J., 2019). I will obtain information from the patient through active listening and appropriate use of open-ended and closed questions and by using clear and adapted language to the patient’s level of understanding. I will appropriately use interview techniques such as clarification, summary, etc.  I will determine the possible influence of the patient’s personal and cultural context on the choices he makes. This visit is a time to be honest with the patient and create a good nurse-patient relationship. Given that he has already been known of his health issue. I, as a provider, have confirmed it, the patient can be reacted to honestly, such as “I am aware that is some unpleasant information for you, and I am truly sorry to hear that.” I will inform the patient that if his health deteriorates, he will be incapable of providing for his family; therefore, it will be better to follow medical advice. His problem cannot be taken care of in one visit.

References

Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (Eds.). (2019). Primary care: The art and science of advanced practice nursing (5th ed.).

Rhoads, J., Demler, T. L., & Dlugasch, L. (2021). Advanced Health Assessment and Diagnostic Reasoning.

Sproston, N. R., & Ashworth, J. J. (2018). Role of C-reactive protein at sites of inflammation and infection. Frontiers in immunology, 9, 754 https://www.frontiersin.org/articles/10.3389/fimmu.2018.00754/full (Links to an external site.)