Question

L.P., a 63-year-old Asian American male, is brought to the emergency department by ambulance at 6 AM with complaints of chest tightness, shortness of breath (SOB), and palpitations. The paramedics have started an IV and O2 at 2 L/min via nasal cannula. They also administered four chewable baby ASA and a nitroglycerin tablet, and they obtained a 12-lead ECG. L.P. is pain free on arrival but still complains of palpitations.

Subjective Data:

* PMH: History of hypertension, mitral valve prolapse with mild regurgitation, heart failure, and type 2 diabetes.

* Medications: Lisinopril (Prinivil) 10 mg/day PO, metoprolol (Lopressor) 50 mg PO BID, ASA 81 mg/day PO, furosemide (Lasix) 40 mg/day PO, and glipizide (Glucotrol) 5 mg/day PO.

* Health Perception–Health Management: L.P. denies any previous history of chest pain or CAD. He was feeling fine until this morning when he awoke and experienced SOB, chest tightness, and palpitations while walking to the bathroom. He became frightened that he was having a heart attack, so his wife called 911. Denies smoking or alcohol intake. SOB and chest tightness are now gone, but he continues to feel palpitations.

* Elimination: Denies any edema. States takes Lasix in the morning and typically “passes urine until lunchtime.” Denies nocturia.

Objective Data

* BP 100/54, apical-radial pulse 154, pulse irregular, respiratory rate 20, temperature 98.2° F (36.8° C), O2 saturation 94% on room air

* Awake, alert, and oriented ×3

* Lungs clear on auscultation; systolic murmur present

* Heart monitor shows atrial fibrillation with a rapid ventricular response

* +1 pedal pulses bilaterally

* No peripheral edema, jugular venous distention, or heaves noted

Discussion Questions

1. What should be included in the physical assessment?

2. Which physical assessment findings are of most concern to you?

3. Based on the results of the subjective and physical assessment findings, what diagnostic studies do you think will be ordered for L.P.?

the questions are at the bottom of the post.

Answer 1

General health checks, including physical examinations performed when the patient reported no health concerns, often include medical screening for common conditions, such as high blood pressure.

The physical assessment should include cardiovascular system assessment with observation, palpation and auscultation.

Observation: jugular venous distention helps to ide if the central venous pressure . Organ-specific observation.

Palpation: to access the point of maximal impulse and identity ventricular dysfunction.

This is when the examiner uses their hands to feel for abnormalities during a health assessment.

Carotid artery palpation also assessed to rule out blood supply to the brain.

Auscultation: to dine at the pulmonic area, aortic area, tricuspid area and mitral area.

Auscultation is often performed by using a stethoscope

Intake and output measurements to rile out fluid overload or deficit.

- Respiratory system for fluid collection or backup -CNS for consciousness

- The physical assessment which concern most is

The blood pressure is low especially the diastolic pressure is very low which needs immediate intervention.

Tachycardia with irregular pulse + 1 oedema.

Murmur

# The diagnostic tests needed to be done are cardiac markers to rule out any interaction or ischemia.

• Serum electrolyte

• ANG or assess the acid base balance

• Urine analysis

• CBC

• Chest x-ray

• ECH

• Echocardiogram

• Coronary angiography.

The given case study pertains to L.P., who is a 63-year-old man who complained of shortness of breath (SOB), chest pain, palpitations and dizziness.

These assessments will include looking for change in the structure and function of the chest wall, heart and blood vessels.