N512-19A Module Two: Cardiovascular Disease Across the Life Span DQ

N512-19A Module Two: Cardiovascular Disease Across the Life Span DQ N512-19A Module Two: Cardiovascular Disease Across the Life Span DQ Discussion 2 Jackie Johnson, a 35 y.o. African-American, married female, advertising executive, presents to the emergency department with complaints of chest pain. The pain is described as 8 on a scale ranging from 1 to 10, retrosternal, and sharp in nature. It radiates to the back, is worse with taking a deep breath, and is improved by leaning forward. On review of systems, she has noted a “flulike illness” over the last several days, including fever, rhinorrhea, and cough. She has no medical history and is taking no medications. She denies tobacco, alcohol, or drug use. On physical examination, she appears in moderate distress from pain, with a blood pressure of 125/85 mm Hg, heart rate 105 bpm, respiratory rate 18/min, and oxygen saturation of 98% on room air. She is currently afebrile. Her head and neck examination is notable for clear mucus in the nasal passages and a mildly erythematous oropharynx. The neck is supple, with shotty anterior cervical lymphadenopathy. The chest is clear to auscultation. Jugular veins are not distended. Cardiac examination is tachycardic with a three-component high-pitched squeaking sound. Abdominal and extremity examinations are normal. N512-19A Module Two: Cardiovascular Disease Across the Life Span DQ Permalink: https://nursingpaperessays.com/ n512-19a-module-…the-life-span-dq / In this discussion: Provide and discuss this patient’s likely diagnosis with your colleagues. Why do you support this “likely” diagnosis? Discuss your differential diagnoses clinical reasoning. Why do you support this list of potential differential diagnoses? Provide and discuss what the most common causes of this disease are, and which is most likely in this patient? Identify the pathophysiologic mechanism for her chest pain. Develop a plan of care post-discharge based upon your recommendations living arrangements and social supports. Support your discussion with citations from the external literature and your textbook. Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria. Example Approach Jackie Johnson is most likely experiencing pericarditis. Patients presenting with pericarditis usually present with severe chest pain (Hammer & McPhee, 2019). Not only does Jackie have severe chest pain, but she also described the pain as being sharp, retrosternal, radiating to her back, increasing with deep inspiration, and improved with leaning forward. According to Hammer & McPhee (2019), these are all important clues leading to a diagnosis of pericarditis. On her examination, Jackie was also found to have a high pitched squeaking sound on auscultation of her heart. This is also characteristic of pericarditis (Hammer & McPhee, 2019). While in the Emergency Department, Jackie would need to have an EKG, Chest xray, CT of the chest, CBC, BMP, PT/PTT, and cardiac enzymes. Differential diagnoses for Jackie include myocardial infarction, stable vs unstable angina, pneumonia, and constrictive pericarditis. While in the ED awaiting results, Jackie should be placed on a cardiac monitor and have repeat vital signs done in order to rule out any differential diagnoses. A common cause of pericarditis is a viral infection (American Heart Association, 2016). In Jackie’s case, it sounds as if she has had a viral upper respiratory infection which has led to pericarditis. Two layers make up the pericardial sac which surrounds the heart (Hammer & McPhee, 2019). Between these two layers is a small amount of fluid which allows the layers to slide easily over each other (Hammer & McPhee, 2019). In pericarditis, swelling occurs and these layers no longer can slide easily over each other (Hammer & McPhee, 2019). This is the cause of the chest pain (Hammer & McPhee, 2019). Most often, no treatment is necessary for pericarditis (Newman, 2018). Depending on the severity of pain the patient may be having, medication would be the first line of defense (Newman, 2018). The current treatment would consist of NSAIDs and Colchicine (Newman, 2018). Based on their anti-inflammatory properties, these medications will help to decrease the amount of swelling in order to decrease pain (Newman, 2018). Most patients recover fully after having pericarditis (Newman, 2018). It could take, however, from only a few days to many weeks to recover (Newman, 2018). References American Heart Association, (2016). What is Pericarditis? Retrieved from https://www.heart.org/en/health-topics/pericarditis/what-is-pericarditis Hammer, G. D., and McPhee, S. J. (2019). Pathophysiology of Disease: An Introduction to Clinical Medicine, Eighth Edition. New York, NY: McGraw Hill Education Newman, T., (2018). Everything you need to know about pericarditis. Medical News Today. Retrieved from https://www.medicalnewstoday.com/articles/193320 411 words Permalink In reply to Lisa Re: Discussion 2 Lisa – N512-19A Module Two: Cardiovascular Disease Across the Life Span DQ by Faye – Monday, August 3, 2020, 1:11 AM Hi Lisa, Thanks for your post. I didn’t consider constrictive pericarditis as a potential differential diagnosis for this patient, but you may be right, especially since pericardial friction rub may still be assessed in the patient. Constrictive pericarditis is usually seen after radiation or cardiac surgery or after a recent episode of recurrent pericarditis. In this condition, the heart seems like it is inside a box. Kussmaul sign (an increase in jugular vein pressure upon inspiration) is a sign of constrictive pericarditis than can assist health care providers in differentiating between cardiac tamponade (Mahadevan & Agrawal, 2020). The best way to differentiate between constrictive pericarditis and cardiac tamponade is via echocardiography. There will be no effusion in constrictive pericarditis, but a thickened pericardium (Mahadevan & Agrawal, 2020). -Dr. Rey Mahadevan, V.S., & Agrawal, H. (2020, July 17). Cardiac tamponade. Epocrates. https://online.epocrates.com/diseases/45911/Cardiac-tamponade/Key-Highlights 146 words N512-19A Module Two: Cardiovascular Disease Across the Life Span DQ Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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