Question

Case: Chest Pain

F.C. is a 57-year-old male who presents to the emergency department with chest pain and shortness of breath.

Subjective data:

• PMH: HTN, hyperlipidemia, coronary artery bypass graft 4 years ago secondary to myocardial infarction
• Sudden onset shortness of breath
• Crushing feeling, chest pain 10/10
• Current smoker, 1 pack a day for 41 years

Objective data:

• Vital signs: T 37 C, P 72, R 20, BP 144/64
• Lungs: clear bilaterally
• O₂ sat: 94%
• Skin: cool to touch
• CV: heart rate regular, positive peripheral pulses, EKG = no changes

Medications: metoprolol 50 mg per day, Simvastatin 75 mg at night, 325 mg of aspirin per day

Questions:

1. What other questions should the nurse ask about the chest pain?
2. What other assessments are necessary for this patient?
3. What are some of the causes of chest pain?
4. Develop a problem list from objective and subjective data.
5. What should be included in the plan of care?
6. What risk factors are associated with this age group?
7. Based on the readings, what is the most likely cause of shortness of breath and chest pain for this patient?

Answer 1

1. Nurse asks about the intensity of pain, asks about when the chest pain started, ask about whether he was getting any pain in the left arm,any neck discomfort,jaws or back and what were the patient was doing when the pain started,ask about when the pain occur whether at rest or during any exertion, asks about the feeling of nausea,vomiting,dyspnoea.

2.Clinical assessments include monitoring of elevated levels of the serum enzyme levels in the blood like cardiac troponin, creatinine kinase,C- reactive protein . Other tests are done like doppler flow studies, cardiac nuclear scanning or ECG is done.

3.Cigarette smoking is one of the major factor for the cause and other causes like hypertension, hyperlipidemia,obesity, sedentary life style, stress, diabetes, family history, age is also a factor, any muscle strain, any problem with the esophagus like gastroesophageal reflex diseases, any stomach problems or any lung diseases,anxiety, depression, any previous surgery related to heart.

4.Problem list includes:

- Patient was having hypertension,hyperlipidemia, and feeling shortness of breath, intense chest pain.

-Vital signs shows high blood pressure,. 4 years back he was undergone for bypass graft procedure for heart attack.

5. Plan of care includes Therapeutic Interventions ,management of pain, promotion of comfort and rest, assessment of complications. Support the patient for the cessation of smoking,weight control, and exercise programs.

- Provide emotional support regarding alteration of lifestyle .

- Encourage for the dietary program like intake of low cholesterol ,low fat, . Encourage the patient to take fibre rich diet such as fruits , vegetables.

- Educate about the medications to be taken .

- Reinforce the need to avoid over exposure of cold .

6. Risk factors include cigarette smoking, hypertension, hyperlipidemia, obesity, sedentary lifestyle, type 2 diabetes, stress,depression,anxiety and other metabolic syndromes,family history,increasing age.

7. The main cause of shortness of breath and chest pain is due to cigarette smoking, hyperlipidemia and hypertension. CIgarette smoking contributes to vasoconstriction ,platelet activation, arterial smooth cell proliferation, and reduced oxygen availability.