NRNP 6531Fred O Macintyre V5 PC/RATED A

NRNP 6531 Interview How can I help today? What are the events surrounding the start of your chest pain? When did the pain in your chest start? Does the pain in your chest radiate someplace else? Where? Where more pre ...

NRNP 6531 Interview How can I help today? What are the events surrounding the start of your chest pain? When did the pain in your chest start? Does the pain in your chest radiate someplace else? Where? Where more precisely is the pain in your chest? What does the pain/discomfort in your chest feel like?(Squeezing, pressure, crushing, burning, stabbing, aching, tingling, suffocating) Does your pain awaken you from sleep? Is the chest pain worse with deep inspiration? Does anything make the pain in your chest better or worse? How often does this chest pain occur? How severe (1-10) is the pain in your chest? Do you have a problem with fatigue/tiredness? Do you have unusual heartbeats (Palpitations)? Do you have any other symptoms or concerns we should discuss? Have you noticed swelling in any part of your body? Do you have episodes of excessive sweating? Have you had any more stress in your life lately? PMH/FH/SH as needed Any new or recent change in medications? Do you have any allergies? ROS Do you have problems with dizziness, fainting, spinning room, seizures, weakness, numbness, tingling, or tremor? Do you have any problem with fatigue, difficulty sleeping, unintentional weight loss or gain, fevers, or night sweats? When you urinate, have you noticed any pain, burning, blood, difficulty starting or stopping, dribbling, incontinence, urgency during day or night, or any changes in frequency? Do you have any problems with headaches that don’t go away with aspirin or Tylenol, double vision or blurred vision, difficulty with night vision, problems hearing, ear pain, sinus problems, chronic sore throats, or difficulty swallowing? Do you experience shortness of breath, wheezing, difficulty catching your breath, chronic cough, or sputum production? Do you have problems with nausea, vomiting, constipation, diarrhea, coffee grounds in your vomit, dark tarry stool, bright red blood in your bowel movements, early satiety, or bloating? Key Finding: Two-month history of chest pressure occurring with exertion and under stress; relieved by rest: RELATED Hypertension: RELATED History of elevated cholesterol Rx with diet: RELATED >50 pack-year history of smoking: RELATED Family history of heart disease: RELATED Right carotid bruit: RELATED Left femoral bruit: RELATED Single episode SOB and diaphoresis with chest tightness: RELATED Chronic smoker’s cough: UNKNOWN Assessment Vitals: Pulse, Respirations, BP, Temperature, Mental Status Skin, Hair, Nails, Inspect Skin Overall Neck: Inspect, Measure JVP, Auscultate carotid arteries Heart: Auscultate heart, Heart palpate for PMI Chest wall & Lungs: Anterior and posterior: Visual inspection, palpation, percussion and auscultation of lungs Diagnosis Stable Angina is the main diagnosis, Unstable Angina (Must not miss diagnosis), GERD, Esophageal spasm Test Nuclear stress test, 12 lead Electrocardiogram (ECG), Lipid Profile, serum, Complete blood count (CBC), Basic metabolic panel (BMP), Glycated hemoglobin (HbA1c). Problem Statement Fred Macintyre is a 62 year old male who presents with a two month history of chest pressure/pain that radiates to cause “throat tightness”. Episodes occur with exertion or emotional upset and are relieved by rest. He denies palpitations, lightheadedness, or syncope but had SOB and diaphoresis during one episode. PE is positive for HTN (140/94), R carotid and L femoral bruits, no cardiac murmurs or edema. PMH includes HTN, elevated cholesterol levels treated with diet alone due to medication side effects, and > 50 packs-year history of smoking. FH is significant for both parents dying of CVD and now an older sister s/p MI.