ComprehensivePatient Assessment: Unstable Angina Pectoris

ComprehensivePatient Assessment: Unstable Angina Pectoris

Thehealth care professionals are equipped with the skills that they needto perform patient assessment. Although patient assessment takes alot of time, it helps health care professionals understand theirclients better, identify the specific medical conditions that theirclients could be suffering from, and the possible risk factors. Thispatient assessment paper will focus on a woman, whose names areabbreviated as RJ. The assessment will focus on the demographicfeatures (including age, ethnicity, and marital status) of thepatient, client history, review of systems, physical exam, and labtests as well as other diagnostics, differential diagnosis, and themanagement plan.

Patientassessment

Mrs. RJ

Age:51 years

Race:Negro, African American

Maritalstatus: Married

Chiefcomplaint (CC):Chest pain, vomiting, fatigue, sweating, shortness of breath, andnausea.

Contraceptionmethod:None

Patienthistory

HPP:RJ, a 51 year old woman has been in a good health condition until thelast five days when she visited the health care facility. RJ reportsthat she experienced an abrupt onset of pain in her chest during thefirst day. The pain lasted for about one minute. She describes thepain as being aching and dull in character. The pain started in RJ’spara-sternal region and then it radiated up to the patients’ neck.The first episode of pain occurred when RJ was working in her kitchengarden at around noon. She had worked for about 30 minutes when shefirst felt extremely fatigued, just before the onset of the pain. Herdiscomfort and fatigue were followed by vomiting, sweating, andnausea. She responded to her unusual feeling by going back to thehouse and taking rest. The first episode of pain resolved itselfwithout any medication.

RJassumed that the problem was over when the pain resolved itself.However, she experienced a second episode of chest pain in the thirdday. This episode was similar in location and quality, but it lastedfor about 10 minutes, which was a longer duration compared to thefirst case. However, RJ took acetaminophen oral, instead of waitingfor pain to resolve itself like the case of the first episode. Priorto the onset of the second episode of pain in the chest, RJ had athree-hour walk with her dog.

Inthe midnight of the day that she visited the hospital, RJ experienceda prolonged episode of pain that lasted for about 30 minutes. Thepain occurred in the same location as the first two episodes, but itwas more severe. This prompted RJ to seek for medical help. RJ statedthat she suffered from the shortness of breath during the thirdepisodes, but she denied having suffered from palpitation andparoxysmal nocturnal dyspnea. In addition, there was a significantchange in the severity of pain, which could not be associated withthe movement of the body or ingestion of food. She also deniedhaving suffered from palpable pain. RJ reported that she had neverbeen diagnosed with any case of claudication, heart problem, or painin her chest before the current illness. However, RJ was diagnosedwith HTN-3 about two and a half years ago.

RJdoes not smoke and does not suffer from diabetes. The lady has neverbeen treated with hormonal replacement procedure in her life. She hasnever tested her cholesterol level. RJ narrates that she sufferedfrom BSO and TAH about five years ago.

Pastmedical history:RJ underwent a surgical operation as part of the process of treatingher total abdominal hysterectomy and bilateral oophorectomy. Thesurgery was performed to remove uterine fibrosis. One year later(four years ago), RJ underwent a bunionectomy, which was performed toremove a bunion from a toe on her left leg. Soon after beingdiagnosed with HTN-3, RJ was put on medication that she did not knowmuch about. She stopped the medication after five months due toserious cases of drowsiness that she attributed to prescribed drugs.Six years ago, RJ suffered from an acute peptic ulcer disease thatresolved within a period of two and a half months after takingcimetidine.

Allergy:About 15 years ago, RJ experienced hives and rashes that weresuccessfully treated with penicillin.

Personalsocial history:RJ drinks socially, whereby she takes about one glass of wine perweek and 1-3 bottles of beers every weekend. She has never smokedtobacco in her life. Additionally, RJ has never engaged in the use ofillegal drugs, but she has been taking ibuprofen (boughtover-the-counter) quite often to treat her headache. Her two sonswork in different cities, and she shares a house with her mother andhusband.

Familyhistory:Her mother is still alive and she is 87 years old. Her father died ofa heart attack at the age of 56 years. She has two young brothers,who have no history of any serious medical condition. Although shehas an appositive family history of high blood pressure, there are nocases of cancer or diabetes that have ever been reported in any ofher relatives.

Gynecologichistory:Besides the uterine fibroids that were removed through a surgicaloperation five years ago, RJ has never experienced any significantgynecological issue before.

Obstetrichistory:RJ has two sons and both of them had a birth weight that was withinthe normal range of 5-8 pounds. RJ has never aborted, but sheexperienced a miscarriage of her second pregnancy. However, therewere no serious medical complications that were accompanied by themiscarriage.

Reviewof systems

HEENT:RJ did not complain of any pain in the nose, head, or ears. She didnot experience any change in her vision.

Cardiovascular:See HPI.

Genitourinary:RJ did not complain about nocturia, hematuria, polyuria, and breedingin her vagina.

Gastrointestinal:RJ did not complain about dysphagia, change in color, consistenciesor pattern. However, RJ suffered from vomited during the five days.RJ also felt epigastric pain that occurred at least twice a month,and it was burning in quality. This pain was mainly experiencedduring the night.

Musculoskeletal:RJ complains of some pain in the lower back, which is aching inquality. This pain occurs at least one time in a period of one week.In most cases, the pain occurs after working in her kitchen gardenfor more than half an hour. However, she has not been successful inrelieving the pain with Tylenol. There were no other cases ofarthralgias, pain, or muscle ache reported.

Neurological:RJ complains of no numbness, weakness, and in-coordination.

Respiratory:No complaints of cough, pleurisy, asthma, wheezing, hemoptsis, TB,pneumonia, and pulmonary emboli.

Vascular:RJ has no history of claudication, deep vein thrombosis, gangrene, oraneurysm. However, she experienced an acute venous stasis.

Physicalexam

Vitalsigns:BP 168/90, Pulse rate 90, Temperature 37 0C,respirations 20.

General:RJ appears oriented, alert, and cooperative.

HEENT:Scalp normal. External auditory canals and tympanic membranes arenormal. Nasal mucosa is normal. Pupils are equally around, reactiveto light as well as accommodation, 4 mm, the sclera and conjunctivasare normal. Fundoscopic examination indicates normal vessels withoutany incident of hemorrhage. Oral pharynx is normal and withoutexudates or erythema. Gums and tongue are normal.

Skin:Normal in texture, appearance, and temperature.

Neck:RJ’s neck is easily movable, no abnormal adenopathy noticed incervical, and supraclavicular region. Her thyroid gland is normal,while trachea is midline. She has a normal carotid artery upstroke.RJ’s jugular venous pressure is 8 cm at 45 degrees.

Abdomen:RJ’s abdomen is symmetrical and has no distention. Her bowel soundsappear to be normal in terms of intensity and quality in all regions.However, a bruit was heard in her right paraumbilical area. Nosplenomegaly or masses are noted. The span of RJ’s heart is 8 cm bypercussion.

Chest:RJ’s lungs are percussion bilaterally and auscultation. Her PMI isin the fifth inter-costal space, along the mid clavicular line. Agrade 2/6 systolic decrescendo murmur has been heard in RJ’s secondright inter-costal region. The murmur radiates to her neck. No fourthrub or sound is heard. Some cystic change is noted on RJ’s breast,but there is no discharge or masses at her nipples.

Extremities:No clubbing, cyanosis, or edema is detected. Peripheral pulses in herfemoral, anterior tibial, popliteal, brachial, dorsal pedis andradial regions are normal.

Labtest and other diagnosis:An X-ray test indicates a small build up of fluids around the heart.An electrocardiogram test gave normal results with regard to thepossibility of heart attack and impairment of the blood flow.

Constitutional:RJ did not experience apparent distress. She appears well developedand nourished.

Head/face:Symetrical, normocephalic, no lesions.

Ears:Hearing function is intact. Tymphanic membranes appear to be normal.

Nose/throat/mouth:No deformation in the nasal. Mucous membranes appear normal. Throatand tongue are in their normal condition.

Thyroid:No adenopathy. Thyroid is not enlarged. No signs of palpablecervical.

Lymphatic:No axillary adenopathy, palpable cervical, and supraclavicular.

Respiratory:RJ’s lungs are clear to percussion as well as auscultation.

Cardiovascular:Rhythms are regular. No rubs, gallops, and murmurs.

Vascular:Appears to be well perfused. Femoral, caroid, and pedal pulses appearto be normal.

Integumentary:RJ’s skin does not have skin lesions.

Back/spine:No scoliosis and kyphosis.

Psychiatry:RJ is oriented to person, time, situation, and place. RJ does notappear to have suicidal ideation.

Extremities:No cyanosis and edema. Appear to be normal.

Differentialdiagnosis:The list of chief complaints and the outcome of other forms ofdiagnosis suggest that RJ could be suffering from unstable anginapectoris. Her description of a dull, exertion, and aching chest painindicates the possibility of an ischemic cardiac origin. The FHfindings of the early ASCVD, coupled with hypertension and earlysurgical menopause are some of the key risk factors for theoccurrence of a coronary artery disease. Angina pectoris is among themost common heart diseases, and it is characterized by a feeling ofanxiety (Kolkata, 2011) chest pain during effort (Bolognesi &ampBolognesi, 2014). Other symptoms of unstable angina pectoris includefatigue, vomiting, nausea, dyspnea, pain in the back that tends toradiate to the neck, shoulders, and abdomen (Ranganadhan,Krishnakumar &amp Panayappan, 2015). Unstable angina is differentfrom stable angina because its occurrence is unpredictable, and thepain does not go away even with medication and rest (Giustino &ampGiusep, 2015). Although RJ thought that she experienced the painbecause of working in her kitchen garden or walking with her dog, theoccurrence of chest pain at night during the third episodes suggestthat the pain could not be attributed to suspected activities. Thismakes it clear that she could be suffering from unstable anginapectoris.

Stableangina pectoris:The pain felt in the chest could suggest that RJ is suffering fromstable angina pectoris. However, stable angina pectoris occurs duringphysical exertion, last for at most five minutes and it is relievedsuccessfully with rest and medication (Giustino &amp Giusep, 2015).However, RJ`s third episode of pain lasted for up to 30 minutes.Therefore, the duration and type of symptoms rules out thepossibility of a stable angina pectoris.

Atherosclerosis:Patients suffering from unstable angina and atherosclerosis feel painin the chest, back, and shoulders. However, atherosclerosis ischaracterized by body’s weakness, dizziness, sudden and severeheadache, and loss coordination (Ehrlich, 2015). RJ did not showthese signs, which reduce a possibility that she could be sufferingfrom atherosclerosis.

Managementplan

Diagnosis:Besides the subjective complaints raised by RJ, the client undergoesstress testing. The purpose of this test is to confirm whether anginais stable or unstable (U.S. Department of Health and Human Services,2016). An electrocardiogram is a painless test that is performed onpatients in order to assess the heart rate and functionality. A bloodtest is performed to determine whether RJ’s angina can beattributed to an increase in levels of C-reactive protein or hormonesin the blood.

Medicationand follow-up:After confirming the disease, RJ will be admitted for seven days inorder to put her on a telemetry monitoring of her response tomedication. Several drugs that have been shown to counter both theshort- and long-term adverse events associated with unstable anginawill be prescribed. These drugs include aspirin, lipid-loweringagents, clopidogrel, angiotensin-converting enzyme, and glycoproteinantagonists (Tan &amp Yang, 2015). RJ will be discharged after sevendays. However, she will be required to visit the hospital after threedays, which is part of the follow-up program to ensure that she isrecovering as expected.

Patienteducation:The patient education program for RJ will target three issues. First,RJ will be enlightened on the significance of avoiding strenuousexercise, especially during the cold weather. Secondly, the programwill educate RJ on strategies for the management of psychosocialissues. This is important because it will help RJ manage her currenthigh pressure that is likely to worsen angina condition. Some of thestrategies that will be included in the program include thesignificance of joining support groups, religious resources, andavoiding hostile attitudes (Tan &amp Yang, 2015). The thirdcomponent of the patient education program is the significance ofmonitoring the body weight and level of cholesterol. RJ reported thatshe has never undertaken a test to determine the level of cholesterolin her body.

Rationale:The use of more than one diagnostic procedure will help the healthcare providers determine whether RJ is suffering from angina, andthen identify the specific type of angina, stable or unstable. RJ cansocialize with her mother and husband at home, but a support group isrecommended because it will give her a chance to meet with otherpatients suffering from a similar medical condition (Yopp &ampRosenstein, 2012). Although medication is crucial, accompanying thetreatment process with lifestyle changes (such as diet management,control of physical activities, and social life) will increase thesuccess of the therapeutic process.

Conclusionand reflection

Unstableangina pectoris is a common heart disease, but it can be prevented ormanaged through a change in several aspects of lifestyle. It was anexciting moment to see the patient agreeing to be hospitalized forseven days to allow the doctors monitor her condition, irrespectiveof the fact that her condition had not reached the chronic stage.This gave the health care professionals an assurance that RJ waswilling to adhere to the medication, which is the wish of everyhealth care provider.

References

Bolognesi,M. &amp Bolognesi, D. (2014). Misdiagnosis of Angina pectoris due tosevere coronary artery disease: An anecdotal case. CaseReports in Clinical Medicine,3, 331-335.

Ehrlich,D. (2015, March 25). Atherosclerosis. ADM,Inc.Retrieved July 3, 2016, fromhttp://pennstatehershey.adam.com/content.aspx?productId=107&amppid=33&ampgid=000016

Giustino,G. &amp Giusep, G. (2015). Impact of clinical presentation onlong-term outcomes in women undergoing percutaneous coronaryintervention with drug-eluting stents. AmericanJournal of Cardiology,116 (6), 3-28.

Kolkata,H. (2011). Current aspects in the treatment of angina pectoris.InternationalJournal of Research in Pharmaceutical and Biomedical Sciences,2 (2), 351-359.

Ranganadhan,K., Krishnakumar, K. &amp Panayappan, L. (2015). Spinal cordstimulation: A dominant therapy for refractory angina pectoris.InternationalResearch Journal of Pharmacy,6 (8), 489-492.

Tan,W. &amp Yang, H. (2015, November 22). Unstable angina treatment andmanagement. MedScape.Retrieved July 3, 2016, fromhttp://emedicine.medscape.com/article/159383-treatment

U.S.Department of Health and Human Services (2016). Howis Angina diagnosed?Washington, DC: U.S. Department of Health and Human Services.

Yopp,J. &amp Rosenstein, D. (2012). A support group for fathers whosepartners died from cancer. ClinicalJournal of Oncology Nursing,17 (2), 169-172.