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Chest Pain
History of present illness: The patient is a 71 year old male of the Veteran Association. His past medical history includes coronary artery disease and chronic obstructive pulmonary disease. The patient was involved in a contraindication at home where he was thrown into a dresser and hit his lower back. Shortly following the incident the police were contacted. During this time the patient consequently began to develop some substernal chest pain with a radiation to the left arm; the patient also became diaphoretic and somewhat out of breath. Emergency medical services (EMS) were contacted. EMS gave the patient aspirin and nitroglycerin and started a saline lock. EMS brought the patient to the emergency department. The patient had
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All of the other laboratory values were within the normal ranges. The recommended therapeutic range for oral anticoagulant therapy is 2.0-3.0, except for patients with mechanical heart valves and recurrent MI (2.5-3.5). So this patient needs to be put on an anticoagulant therapy since his INR is low at 1.1. As far as the BNP goes knowledge of each individual patient 's BNP range may be more useful that using similar cut-points for every patient. Marked elevation in BNP levels may be observed in states other than left ventricular congestive failure, including: acute coronary syndrome, right heart strain/failure, critical illness, renal failure as well as advanced age (P.R.I.D.E., 2004). Falsely low BNP in congestive heart failure patients may be observed with increasing body-mass index (P.R.I.D.E., …show more content…
The patient no longer had chest pains and it was determined he did not have an acute myocardial infarction at the time. He was released to do a follow up stress test for his heart and encouraged to maintain regular visits with his primary care physician. He was also educated on smoking cessation and diet and exercise. The patent stated "I am 71 years old and I do not plan on changing my habits now."
Conclusion: This patient did not end up having a myocardial infarction. He is at increased risk in the future since he has CAD, HTN, and smokes a pack of cigars a day. Nurses use pathophysiology to understand the progression of disease in order to identify the disease and implement treatment for their patients. Nurses use the information that they find to identify the next course of the disease so that they can provide their patient’s with the appropriate care they need. The medical procedures and medications that nurses administer to patients depend greatly on the nature of the
J.P., a 58 year old female, presents to the Emergency Room on March 18th. She has a past medical history of cervical cancer, atheroembolism of the left lower extremity, fistula of the vagina, peripheral vascular disease, neuropathy, glaucoma, GERD, depression, hypertension, chronic kidney disease, and sickle cell anemia. She complains of right lower extremity pain accompanied by fatigue, a decreased appetite, increased work of breathing, burning on urination, and decreased urine output for three days.
The secondary diagnoses of the patient are psychotic disorder, impulse control disorder, and post traumatic stress disorder (PTSD). His medical history includes hepatitis C, diabetes, benign essential hypertension, obesity, and history of falls related to
The patient is a 45 year old male who was in a car accident that
It was to this respect that, the search could detect ‘’hypertension’’ as the leading risk factor for heart disease. And this preceded three quarters of heart failures cases as compared to coronary artery disease, which led to most heart failures in less than 40% of the cases. Also, an increase in left ventricular end-diastolic diameter became a mirror to the Framingham study as incident heart diseases in the individuals who are free from myocardial infarction. Although studies have shown that, the manifestation of heart failures can be present without the left ventricular systolic dysfunction, other risk factors could lead to that. Also, they (Framingham study) were able to detect ‘’too much of cholesterol’’ as a link to cardiovascular diseases. Moreover, research believed that has elevated among certain heart diseases such as coronary heart often leads to stroke, too high blood pressure among numerous patients. Having said that, the search discovered ‘’obesity’’ also as a concomitantly with hypertension which elevates lipids and diabetes versus questions on smoking behavior. Having said that, these risk factors are believed to have attributed to heart diseases. Therefore, it became a national concern to the general US population and that of the fourth director of Framingham heart study, William Castelli
You could have been treated symptomatically while awaiting test results. Consultation with other healthcare professionals could also have been done in observation. There was no hemodynamic (blood), pulmonary (lung) or metabolic (chemical process) measurement or physical exam result that justified the need for acute inpatient level of care. You could have been kept in observation according to guidelines as there was no electrocardiogram (recording of your heart activity) change and there were no positive biomarker tests (blood tests for the heart) or other finding that would require admission to acute care. Also there was no planned intervention that would have required an acute inpatient level of care. With negative test results for an acute cardiac or other event the member could have been discharged from observation with ambulatory plan of
L. H. a 22-year-old female who came into the clinic as a new patient complaining of lower back pain. Vital signs include: height 62 inches, weight 108 lbs., and 16 respirations. The patient stated that her back pain has gone on for quite sometime now (about 2 years total). She works as a nursing assistant in a nursing home in Wahoo. The physician stated that he wanted to taper her off tramadol (she takes 150 mg a day). He also wants to taper her off Effexor as well. The doctor noticed that the painful region was in the patient’s upper left side of her back. He recommended to the patient that L1 to L2 and L2 to L3 facets would benefit from steroid injections. The patient and her mother wanted to make sure they met their
Client Profile: Lane Bronson is a 55 year old male with a history of angina, hypertension, Type 2 diabetes, COPD, and sleep apnea. He comes to the physican’s office complaining of worsening shortness of breath. His skin tone is grey, and his angina is worsening. Previously stable, he now does not get relief from rest or nitroglycerin. The physician called 911 and had Mr. Bronson directly admitted to the hospital.
During my morning rounds I began my assessment of Mrs. M., and I noted that she had shortness of breath and she was making gurgling sounds. I immediately auscultated her lungs and noted bilateral wheezing throughout all fields, her heart was irregular and rapid and she had 2plus pitting pedal edema. I noticed she had an IV running at 125ml/hr, which I quickly stopped. The patient did not have orders for IV fluid there was only an order to KVO. I raised the head of the bed and paged respiratory to the floor.
After a review of the clinical information provided by Lenox Hill Hospital, the Medical Director has denied the admission to Lenox Hill Hospital. It was determined that the clinical information did not justify an inpatient stay. Acute inpatient hospitalization was not medically necessary. We have to deny this inpatient admission as the information was never submitted by the provider, is limited and/or incomplete for this requested service. We have requested information and it has not been submitted in a timely manner. This would include but not limited to your presenting symptoms, pertinent blood work results, imaging performed such as x-rays, vital signs upon presentation, physical examination and the course of treatment received in the
Nurses play a very important role in managing a patient from the moment of his admission up to making a discharge plan. Each part of the nursing process is vital to the wellbeing of the person he is taking care of. Clinical reasoning is always essential in each part of the nursing process from assessment, setting up goals and intervention. Effective nursing management is done when a nurse looks for the early and right cues at the right patient and implementing it at the right time. This essay will delve deeper into the case of Rob Geis, a patient who was suffering from angina, given his history and the signs and symptoms he experienced up to the time when his condition worsened to Myocardial Infarction. This essay will also look into how the nurse should provide effective nursing care to the patient with this condition.
Glen Carver is a 56 year old male who was admitted unto the cardiovascular care unit 48 hours ago with the diagnosis of heart failure. Mr. Carver went to see his primary care provider with complaints of dyspnea on exertion, a nonproduction cough, decreased activity intolerance, and general fatigue all of which have been worsening over the past two months. The primary care provider found Mr. Carver to have lower extremity swelling, profound ...
In February of this year the patient did present to a local emergency department, with a chief complaint of chest pain. However, he left the emergency
759. Mr. Miller is likely presenting with an acute myocardial infarction. Based on his past medical history of hypertension, hyperlipidemia, obesity, and diabetes, along with his current symptoms of chest pain, shortness of breath, pale skin with beads of sweat on the forehead, as well as elevated lab 's Troponin, CK, and CK-MB, he is most likely presenting with an acute myocardial infarction.
I'd been warned that I would help take the history on this patient, and I was planning out my questions. A pulmonary complaint - "I can't breath" -- elicit a standard list, designed to distinguish heart failure from pneumonia from various other ailments - when did the shortness of breath start? Had he noticed he was more tired recently when he walked or exercised? Did he sleep with lots of pillows to prop him up when he slept? Did he feel pain in his chest when he inhaled? Exhaled? My mind was racing.
Mr. GB is a 78 year old white male admitted to Bay Pines VAMC on 6/18/96. for " atypical chest pain and hemoptysis". V/S BP 114/51, P 84, R 24, T 97.4. He seems alert and oriented x 3 and cheerful. Bowel sounds present x 4. Pt. has a red area on his coccyx. Silvadene treatments have been started. Pt. Has a fungal lung infection with a pleural suction drainage tube inserted in his chest . Pt is extremely thin with poor skin turgor with a diagnosis of cachexia ( wasting) secondary to malnutrition and infection. Patient is no known allergies to drugs but is allergic to aerosol sprays disinfectants and dust.. Advanced directives on chart. Code status DNR. Primary physician Dr. R, Thoracic surgeon Dr. L. Psychology Dr.W. There is PT, OT Dietary and Infectious Disease consults when necessary. He lives with his wife who he has been married to for 56 years. His son and his daughter come to visit him. He does not smoke. He wears dentures but did not bring them. He dose not use a hearing aid but he does have a hearing deficit.