NURS 6512 Assessment of the Heart, Lungs, and Peripheral Vascular System
NURS 6512 Assessment of the Heart, Lungs, and Peripheral Vascular System
NURS 6512 Assessment of the Heart, Lungs, and Peripheral Vascular System
Diagnostic Test/Labs
An electrocardiogram is required as the clinical manifestations displayed lead to the patient potentially suffering from a cardiovascular condition. A chest x-ray is required to reveal any abnormalities in the chest region and in the underlying organs of the chest region that could be causing the symptoms. Lab values on CBC are also required to determine the WBC if it’s a bacterial or viral condition causing the symptoms.
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Lipid profile test is also required since the patient was diagnosed with high cholesterol it would determine if the levels could be causing the symptoms. Echocardiogram could be required to determine if there could be an observable abnormality in the heart causing the symptoms. An exercise stress test is required as the patient reported symptoms are aggravated when conducting physical activity.
Pharmacology: diltiazem 30mg 6 hourly prescription is required as it would help manage his hypertension and also angina that the patient could be suffering from until the angina is controlled. Nitroglycerin when needed should also be added. The patient should also continue with previous prescriptions. Patient education: Patient should also undergo health education on diet modification and importance of a healthy diet. Referrals: patient should also consult with a vascular surgeon to see deliberate on potential interventions.
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ASSESSMENT
Differential diagnosis
- Coronary artery disease: this is due presence of a damage in the major blood vessels of the heart could be caused by occurrence of a plaque that narrows the vessels and limits blood flow to the heart. This is a potential diagnosis as the patient present with chest pain and the lifestyle patient has reported such as eating red meat are in line in what is found in patient with this condition (Hinkle & Cheever, 2014).
- Pericarditis: this is a condition that occurs due to swelling and irritation of the structure that surrounds the heart the pericardium. It could be due to a viral infection and manifests with a sharp chest pain hence it being a potential diagnosis as the patient presents with the same (McCance & Huether, 2019).
- Congestive heart failure: this is whereby the heart is unable to pump enough blood to the organs that require it. The clinical manifestations include pain in the chest area and probable weight gain hence placing it as a potential diagnosis as the patient also presented with this (Hinkle & Cheever, 2014).
- Hypertension: this is a possible differential diagnosis since the patient was previously diagnosed with it whereby his blood pressure was higher than normal and if there was poor management of the condition it could lead to the clinical manifestations the patient presented with (McCance & Huether, 2019).
- Hypercholesterolemia: the patient was previously diagnosed with this whereby his cholesterol levels were higher than normal hence if this condition complicated it could have led to cholesterol accumulating in the blood and limiting blood flow which could have then affected the heart and causing the symptoms the patient presented with such as chest pain (Hinkle & Cheever, 2014).
Priority diagnosis: coronary artery disease.
References
McCance, K. L., Huether, S. E., BRASHERS, V. L., & ROTE, N. S. (2019). Pathophysiology: The biologic basic for diseases in adults and children (No. ed. 8). Elsevier.
Hinkle, J. L., & Cheever, K. H. (2014). Brunner & Suddarth’s textbook of medical-surgical nursing (Edition 13.). Wolters Kluwer Health/Lippincott Williams & Wilkins.
SUBJECTIVE DATA:
Chief Complaint (CC): “I have been having some troubling chest pain in my chest for some time now.”
History of Present Illness (HPI): A 58-year-old Caucasian male comes to the clinic. The patient
reports, “I have been having some troubling chest pain in my chest for some time now.” The patient further reports that he has been having chest pains periodically, particularly when exerting himself in the yard or while overeating. The location of the pain is at the mid sternum region, and he scores it as a 5/10 whenever he experiences it. His description of the pain is “tight and uncomfortable.” The pain does not radiate.
The pain does not last for long and disappears upon the patient’s resting. His latest chest pain episode occurred three days ago at a restaurant due to a large dinner. He did not think the pain required urgent attention; however, he demonstrates concern due to the three episodes within the month, and, as such, he needs the heart to be examined. He also states that his legs cramp mildly when engaged in inactivity. He rejects the presence of dyspnea, GERD, indigestion, and heartburn. He states there is no chest pain at the time of assessment.
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Medications: The patient has a medical history of using omega three on a daily basis from fish oil, atorvastatin (20 mg) on a daily basis, for high cholesterol for the last one year, occasional use of ibuprofen. The patient takes metoprolol, 100 mg for high blood pressure.
Allergies: The patient confirms some allergies
Past Medical History (PMH): The patient last visited a primary care provider last three months ago. The patient has had treatments for high cholesterol and high blood pressure but reports no incidences of hospitalization.
Past Surgical History (PSH): no past surgical history was reported
Personal/Social History: while the patient denies using tobacco, he agrees that he consumes alcohol moderately, with the patient using two to three alcoholic drinks every week. The patient does not engage in any regular exercise in recent times as the last regular exercise was done the last time two years ago.
NURS 6512 Assessment of the Heart, Lungs, and Peripheral Vascular System
Worldwide, cardiovascular disease (CVD) is the leading cause of death. CVD, which claims 610,000 lives each year (CDC, 2017), frequently goes unnoticed until it is too late. Many patients with CVD can be saved by early detection and prevention measures. Conducting a physical examination of the heart, lungs, and peripheral vascular system is one of the first steps in detecting CVD and a variety of other conditions that can manifest in the thorax or chest area.
This week, you will evaluate abnormal findings in the area of the chest and lungs. In addition, you will appraise health assessment techniques and diagnoses for the heart, lungs, and peripheral vascular system.
Learning Objectives:
Students will:
- Evaluate abnormal cardiac and respiratory findings
- Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for the heart, lungs, and peripheral vascular system
- Evaluate chest X-Ray and ECG imaging
Learning Resources
Required Readings (click to expand/reduce)
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
- Chapter 14, “Chest and Lungs”This chapter explains the physical exam process for the chest and lungs. The authors also include descriptions of common abnormalities in the chest and lungs.
- Chapter 15, “Heart”The authors of this chapter explain the structure and function of the heart. The text also describes the steps used to conduct an exam of the heart.
- Chapter 16, “Blood Vessels”This chapter describes how to properly conduct a physical examination of the blood vessels. The chapter also supplies descriptions of common heart disorders.
Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.
- Chapter 107, “X-Ray Interpretation: Chest (pp. 480–487) (specifically focus on pp. 480–481)
Chapter 107, “X-Ray Interpretation: Chest (pp. 480–487)
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Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.
Note: Download the Student Checklists and Key Points to use during your practice cardiac and respiratory examination.
This study examines the medical decision making among Hispanics and non-Hispanic whites. The authors also analyze the preferred information sources used for making decisions in these populations.
This article describes the warning signs of impending deterioration of the respiratory system. The authors also explain the features of common respiratory conditions.
The authors of this article specify how to identify the major causes of acute breathlessness. Additionally, they explain how to interpret a variety of findings from respiratory investigations.
Chief Complaint (CC): “I have been having some troubling chest pain in my chest now and then for the past month.”
History of Present Illness (HPI): Brian Foster is a 58-year-old Caucasian male presenting with troubling chest pain since the last month. The pain is situated in the middle of his chest. Currently, the pain is at zero although he rates the pain at 5/0 during the previous episodes. It is usually a tight uncomfortable feeling that is neither burning nor crushing. He had 3 episodes in the past month. The initial episode commenced with physical activity, while he was doing his yard work whilst the second episode commenced when he was taking stairs at work.
The most recent episode was three days ago. These episodes lasted only for a few minutes and they all felt the same. The pain does not radiate to the neck, shoulder, back, or even to the arm and is not associated with food intake. It is aggravated by physical activity and relieved by laying down with a brief rest. Has not taken any medications for the chest pain.
Medications: Metoprolol 100 mg PO once daily, atorvastatin 20 mg PO once daily, and omega 3 fish oil 1200mg PO once daily. He occasionally takes over-the-counter medications particularly Tylenol or Motrin when having headaches. Denies aspirin use.
Allergies: codeine (nausea/vomiting). No known food allergies.
Past Medical History (PMH): He was diagnosed with Stage 2 hypertension a year ago. Also diagnosed with hyperlipidemia last year. Denies regular blood pressure monitoring, history of coronary artery disease, or previous chest pain treatments. Formerly had a heavy EKG but the last one done 3 months ago was normal. He sees his primary care provider every 6 months.
Past Surgical History (PSH): Denies any previous surgeries or blood transfusion.
Sexual/Reproductive History: Heterosexual.
Personal/Social History: Married with two children, the wife is 50 years old and well. Drinks 2 to 3 beers per week although he does not use tobacco or illicit drugs. Has not exercised regularly for 2 years. Unsure of salt intake. Diet mainly consists of granola bars, turkey subs, grilled meat, and veggies. Reports a daily water intake of 1 liter and 1 to 2 cups of coffee daily. No unusual stress was noted.
Immunization History: The last dose of TDAP was 10/2014 while his influenza vaccination is up to date.
Significant Family History: Father had hypertension, hyperlipidemia, and obesity but died at 75 years due to colon cancer. His mother is 80 years old but has type 2 diabetes and hypertension. His brother deceased at 24 years as a result of a motor vehicle accident. His sister is 52 years old and has type 2 diabetes and hypertension. Maternal grandfather experienced a heart attack at the age of 54 years while maternal grandmother died of breast cancer at the age of 65 years. Paternal grandmother succumbed from pneumonia at the age of 75 years while paternal grandfather died aged 85 years due to “old age.” He has a healthy son aged 26 years and an asthmatic daughter aged 19 years.
Shadow Health Support and Orientation Resources
Use the following resources to guide you through your Shadow Health orientation as well as other support resources:
Document: Shadow Health. (2014). Useful tips and tricks (Version 2) (PDF)
Document: DCE (Shadow Health) Documentation Template for Focused Exam: Chest Pain (Word document)
Use this template to complete your Assignment 1 for this week.
Optional Resource
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.
- Chapter 8, “The Chest: Chest Wall, Pulmonary, and Cardiovascular Systems; The Breasts” (Section 1, “Chest Wall, Pulmonary, and Cardiovascular Systems,” pp. 302–433)Note:Section 2 of this chapter will be addressed in Week 10.This section of Chapter 8 describes the anatomy of the chest wall, pulmonary, and cardiovascular systems. Section 1 also explains how to properly conduct examinations of these areas.
Required Media (click to expand/reduce)
Advanced Health Assessment and Diagnostic Reasoning
Thoughtful, reasoned questioning leads from initial complaint to diagnosis in these three scenarios.
Note: Close the viewing window after the intro segment and after each diagnosis segment to view the menu. (12m)
Photo Credit:Provided courtesy of the Laureate International Network of Universities.
Assessment of the Heart, Lungs, and Peripheral Vascular System – Week 7 (28m)
Online media for Seidel’s Guide to Physical Examination
In addition to this week’s media, it is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapters 13 and 14 that relate to the assessment of the chest, heart, and lungs. Refer to Week 4 for access instructions on https://evolve.elsevier.com/
Assignment 1: Digital Clinical Experience: Assessing the Heart, Lungs, and Peripheral Vascular System
Photo Credit: [Squaredpixels]/[E+]/Getty Images
Take 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?
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.
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.
Section:
Week 7 Shadow Health Digital Clinical Experience Focused Exam: Chest Pain Documentation
SUBJECTIVE DATA:
The patient is B.F, a 58-year-old Caucasian male.
Chief Complaint (CC): troubling chest pain for one month.
History of Present Illness (HPI):
B.F is a 58-year-old Caucasian male presenting with troubling chest pain for the last one month. The pain occurs right in the middle of his chest and he describes it affirmatively as a tight, uncomfortable feeling that is currently at zero, on a pain scale of 0-10. However, during the previous episodes when he was experiencing the pain, he rates it at 5/10 and states that it is not crushing or burning.
For the last month, he has had 3 episodes. The first episode started with physical activity, while he was doing his yard work whereas the second episode started when he was taking stairs at work. All these episodes last for a few minutes and they all feel the same. To whatever extent, the pain does not radiate to the neck, shoulder, back, or even to the arm and is not associated with food intake. It is aggravated by physical activity and relieved by laying down with a brief rest but denies taking any medication for the chest pain. These manifestations are associated with hypertension and hyperlipidemia. However, he denies regular blood pressure monitoring, any coronary artery disease, or previous chest pain treatments. His medications are still current and unchanged and no new allergies are noted.
Medications: Current medications include, metoprolol 100 mg PO once daily, atorvastatin 20 mg PO once daily, omega 3 fi