History of Presenting Illness
Mrs. Johnson, a 60-year-old Caucasian woman, complained of worsening chest problems for three months when she went to the emergency room. Mrs. Johnson has had high blood pressure and high cholesterol levels in the past. The chest pain is gradual and lasts for around 20 minutes, with physical activity serving as the beginning and trigger component. She says that routine physical activity aggravates the chest pain, which is only relieved by rest after a few minutes when she sits down and starts watching television (Hayek et al., 2017). She says that the discomfort is retrosternal and in the middle of the chest and that it does not radiate to the neck or left arm. The discomfort in my chest is searing and tingling.
She says that the discomfort is accompanied by nausea, awareness of the heartbeat, dyspnoea, and no change in body temperature or perspiration. She advises that, in addition to relaxation, sipping cold water can help ease pain (Hayek et al., 2017). She is currently using Lisinopril-hydrochlorothiazide to control her high blood pressure and PRN Aspirin when she experiences chest pain. She also mentions that her father died of a heart attack at 57.
Physical Exam and Diagnostic Tools
A physical exam will involve a physical examination of the damaged system, which is the cardiovascular system, and a full assessment of vital signs and a laboratory test to confirm the diagnosis. Check your blood pressure, temperature, pulse rate, and breathing rate (Hayek et al., 2017). During the physical examination, look for any chest scars that could indicate trauma or injuries, chest symmetry, movement with respiration, and any changes in skin color, such as cyanosis. Additional testing for jaundice and cyanosis in the eyes and jugular venous distension in the neck will be required. Auscultate for unusual heart sounds, notably S1, S2, S3, and S4, which, if present, indicate a problem (Ricci et al., 2016). There will be a need for more heart murmur auscultation. While palpating the jugular venous distension level and the lower limbs for pedal edema, make a note of what you detect. Check the size of your chest on both sides to determine if there is a difference. Blood tests are necessary for laboratory diagnosis to detect blood enzymes such as troponin, which can be used to confirm angina pectoris, and LDL levels, which can be used to detect cholesterol and triglyceride levels (Ricci et al., 2016). Heart size is measured with chest X-rays, heart rhythms are detected using electrocardiography, stress tests, echocardiography, and coronary angiography, and the heart arteries are examined with coronary angiography. However, the patient’s appropriateness will dictate which tests are performed. Other probable diagnoses, such as heart failure, cardiomegaly, myocardial infarction, and heart attack, are ruled out with these further radiologic studies.
Patient education and care plan
Doses of aspirin will need to be increased to 81 mg per day. A combination of cholesterol absorption inhibitors and stains will be effective in treating hyperlipidemia. Vytorin, which contains ezetimibe and a statin, will have a positive effect. Her blood pressure should be treated with lisinopril-hydrochlorothiazide again (Ricci et al., 2016). Patient education will teach the patient about emergency symptoms such as dizziness, exhaustion, and acute chest pain and seek medical help if she experiences them. More diet regulation instruction will be required (Ricci et al., 2016). Additional cholesterol control and the development of chest pains from cholesterol plagues in the heart vessels will necessitate the consumption of fewer fatty meals and a weekly three-day cholesterol-free menu. Educate on the importance of engaging in regular physical activity while under supervision.
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