Patient with Chest Pain: Head-To-Toe Assessment

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Patient with Chest Pain: Head-To-Toe Assessment

Introduction

Nursing assessment is regarded to be an important part of the nursing process. Incorrect assessment can result in an inappropriate diagnosis and selecting the wrong plan of care, interventions, and patient condition evaluation. The purpose of this paper is to perform a complete head-to-toe assessment of one of the patients. The participant is a 50-year-old woman who reports chest pains over the past week. It is a first visit of the patient to the hospital.

Patient Body Systems Assessment

Before completing an assessment, a nurse should wash hands and introduce herself to a patient, as well as to explain the purpose of the assessment. Physical assessment includes the evaluation of the functioning of all body systems, including cognitive and mental aspects. The findings of the head-to-toe assessment are utilized to understand the overall condition of the patient.

Vital Signs

The patients pulse is 89; the regular rhythm is 60 100 per minute

The patients temperature is 37°C; the normal temperature is 36°C

The patients blood pressure is 170/99 mm Hg; the normal systolic range is 90 140

Respirations are of 21 breaths/min; the norm is 12 20

Consciousness and Orientation

The patient seems to be oriented, alert, and cooperative.

Skin

The skin of the patient appears to be normal in texture, appearance, and temperature.

HEENT

The scalp of the patient is normal. The pupils are 4 mm, equally round, reactive to accommodation and light, conjunctiva and sclera are normal. The patients nasal mucosa within the norm. External auditory canals and tympanic membranes are functioning normally. Oral pharynx appears to have no signs of erythema and exudate. Gums and tongue are within the norm.

Neck

The patients neck is movable, no abnormal adenopathy detected. The thyroid gland is without masses and the trachea is midline. Jugular venous pressure is 9 cm at 45 degrees.

Chest

The patients lungs seem to be clear. No rub or heart sound heard during the examination. The third sound noticed at the apex. In the breasts, cystic changes are noticed. Nipples are within the norm.

Abdomen

The patients abdomen appears to be symmetrical; bowel sounds are within the norm. No splenomegaly and masses are noted. The percussion showed that the liver span is 9 cm.

Extremities

No signs of edema, cyanosis, and clubbing. The peripheral pulse appears to be within the norm in all the areas.

Nodes

No palpable nodes detected in the inguinal, supraclavicular, axillary, and cervical areas.

Rectal and genital inspection

Guaiac test is negative; stool is within the norm and brown. External genitalia is normal. Speculum examination shows that the vagina and cervix have no pathologies. Bimanual examination shows no signs of palpable ovaries, uterus, and masses.

Neurology

The examination of sensory and motor reactions of lower and upper extremities reveals no pathologies. Cerebellar and gait functions are within the norm. Reflexes seem to be normal and bilateral. Cranial nerves appear to be normal as well.

Differential Diagnosis

All the findings of head-to-toe health assessment were reported to the health care provider and properly documented. The description of the patient made it possible to suppose that the chest pain is related to ischemic cardiac problems. The patient suffers from hypertension which enhances the risk factors for coronary artery disease development. The most probable diagnosis is angina pectoris with such possible complications as ischemic heart disease. It is noted that intravascular ultrasound and optical coherence tomography provide more precise information about the severity of

stenosis and plaque morphology than does coronary angiography and, in certain cases, can be useful adjunctive tests (Fihn et al., 2015, p. e10).

The patients pain in the chest might be explained by such causes as pulmonary infection since she lives in a polluted industrial area and her lungs might be vulnerable to illness. Still, the presence of dyspnea and chest pain prove that ischemic heart disease is the most probable diagnosis. Thurston at al. (2016) claims that air pollution is the main cause of high mortality from ischemic heart disease among the urban population.

The patients abdominal bruit and hypertension increase the possibility of renovascular hypertension. Murmur and aortic stenosis might cause valvular heart disease as well. Nevertheless, the symptoms confirm the probable problems with blood supply to the heart, which is accompanied with narrowed coronary arteries.

Age-specific Risk Reduction Health Screen and Immunizations

It is a general opinion that patients in their fifties are in the risk group of the potential development of ischemic heart disease. Cardiovascular disease mortality is usually associated with poor blood supply to the individuals heart typical to ischemic heart disease that leads to a heart attack. It should be noted that when the heart muscle does not receive blood flow at all, the cells of this muscle die, which causes myocardial infarction. To reduce the risks of myocardial infarction, it is recommended to apply a healthy diet and lifestyle. It is noted that poor dietary practices are a leading risk factor for illness, disability, and death worldwide and in the United States (Petersen et al., 2017, cdn-117). Therefore, it is crucial to identify dietary patterns to decrease chronic diseases and improve population health.

Plan of Care

The development of an enhanced plan of care greatly assists in decreasing the length of stay in the hospital and improve patient outcomes. For the described case, it is necessary to monitor the patient carefully to detect increasing chest pain timely because it might be a sign of myocardial infarction to impend. To decrease the risk of infarction, the patient should receive such platelet inhibitors as aspirin. The risk of occlusion should be decreased by nitrates which also will help to manage pain symptoms. If the patient is unresponsive to nitrate medication, such analgesic as morphine might be utilized. Some researchers also state that the ability to use pre-prepared allogeneic cells for cell-based therapy allows for a level of quality control and scalability that far exceeds autologous strategies (Karantalis & Hare, 2015, p. 1413). Mesenchymal stem cells are known to be distributed in the human body outside the bone marrow and are present in the heart as well. They are believed to be active immune system modulators since they suppress cells of the white blood and trigger anti-inflammatory subsets. Thus, they have therapeutic potential when combining with other medications.

Nursing interventions should include physical monitoring of the patient during her stay at the hospital, as well as a timely refill of medications and evaluation of laboratory data to detect whether further interventions are required. Thus, it is important to monitor the patients cholesterol. She should also be advised to initiate a low-fat diet and appropriate exercises to lose weight after she is discharged from the hospital. If a patients cholesterol is high, she might need such medications as HMG Co-reductases to lower it. Cardiac catheterization should be scheduled for this patient as well because it is a high probability that non-invasive tests will be positive. To manage the patients dyspnea and high blood pressure, it is possible to apply diuretics. Laboratory tests should include blood urea nitrogen/creatinine tests to evaluate kidney function, as well as electrolytes and electrocardiograms.

Pharmacological Treatment

Pharmacological treatment of cardiac disease should include both management of pain symptoms, reducing infarction risks, and declining cholesterol in the blood. Some researchers note that statin therapy effectively reduces the cholesterol levels of low-density lipoprotein to avoid the risk of cardiovascular complications (Cannon et al., 2015). It is also stated that when added to statins, ezetimibe reduces LDL cholesterol levels by an additional 23 to 24%, on average (Cannon et al., 2015, p. 2387).

Common cardiac disease medications also include angiotensin receptor blockers which are utilized to decrease blood pressure in individuals who had heart failure. They are also known to decrease fluid and salt buildup in the patients body. The other group of medications is beta-blockers which are applied to block adrenaline effects and allow the heart to work better. Calcium channel blockers assist in treating chest pain and high blood pressure. Cholesterol-lowering drugs have a different effect on the human body. They might influence the liver or intestines, and even block cholesterol circulating in the blood. It is emphasized that over the past two decades, statin trials have shown clinical benefit when LDL cholesterol was lowered to progressively lower levels (Cannon et al., 2015, p. 2396).

Evidence-Based Strategies for Health Promotion

To prevent cardiovascular disease events, it is crucial to follow the medication regimen, control blood pressure, practice exercise, and diet. Weight control and smoking cessation are regarded as the most important factors in health promotion among the population. Efficient utilizing of communication technologies and evidence-based strategies play a significant role in promoting cardiovascular health among various social layers of the population. Food, tobacco, and environmental policies are the main aspects of evidence-based strategies.

Thus, in the United States and other countries, dietary guidelines are mainly focused on pattern-based recommendations. It is advised to enrich the everyday menu with plant-based food such as legumes, vegetables, nuts, whole grains, soy products, seeds, and vegetable oils. Low-fat dairy is also recommended. In many countries, a protein food such as lean meats, seafood, eggs, and poultry is popular. Still, Petersen et al. (2017) emphasize that the health effects of animal products such as red meat and dairy products are not proved.

A higher plant protein diet is associated with decreasing mortality related to cardiovascular disease. It is noted that higher animal protein intake only increased the risk of CVD mortality in people with an unhealthy lifestyle, which was defined as smoking for >5 pack-years high alcohol consumption or <150 min physical activity/wk (Petersen et al., 2017, p. cdn-117). Nevertheless, high plan protein food may assist in decreasing mortality risks in people with an unhealthy lifestyle. Thus, red meat consumption is strongly associated with cardiovascular risks.

Conclusion

The paper dealt with the head-to-toe assessment of a 50-year-old woman who suffers from chest pain. The assessment and findings analysis made it possible to state that the patient might have a developing ischemic cardiac disorder, which might lead to myocardial infarction. The effective plan of care and pharmacological treatment were proposed on the basis of differential diagnosis. The main aspects of health promotion related to the evidence-based strategies were defined as well.

References

Cannon, C. P., Blazing, M. A., Giugliano, R. P., McCagg, A., White, J. A., Theroux, P., & De Ferrari, G. M. (2015). Ezetimibe added to statin therapy after acute coronary syndromes. New England Journal of Medicine, 372(25), 2387-2397.

Fihn, S. D., Blankenship, J. C., Alexander, K. P., Bittl, J. A., Byrne, J. G., Fletcher, B. J., & Naidu, S. S. (2015). 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. The Journal of Thoracic and Cardiovascular Surgery, 149(3), e5-e23.

Karantalis, V., & Hare, J. M. (2015). Use of mesenchymal stem cells for therapy of cardiac disease. Circulation Research, 116(8), 1413-1430.

Petersen, K. S., Flock, M. R., Richter, C. K., Mukherjea, R., Slavin, J. L., & Kris-Etherton, P. M. (2017). Healthy dietary patterns for preventing cardiometabolic disease: The role of plant-based foods and animal products. Current Developments in Nutrition, 1(12), cdn-117.

Thurston, G. D., Burnett, R. T., Turner, M. C., Shi, Y., Krewski, D., Lall, R., & Pope III, C. A. (2016). Ischemic heart disease mortality and long-term exposure to source-related components of US fine particle air pollution. Environmental Health Perspectives, 124(6), 785.

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