For This Assignment You Will Complete An Aquifer Case Study ✓ Solved

For This Assignment You Will Complete A Aquifer Case Study Based On T

For this assignment, you will complete a case study based on the course objectives and weekly content. The case emphasizes core learning objectives for an evidence-based primary care curriculum. Throughout your nurse practitioner program, you will use the case studies to promote the development of clinical reasoning through ongoing assessments, diagnostic skills, and evidence-based patient care planning. These assignments are interactive and enhance learning. Material from the case may be included in quizzes, midterm, and final exams.

Complete the case titled “Internal Medicine 02: 60-year-old woman with chest pain” and apply information from the case to answer the following questions:

• Discuss the history of present illness you would obtain from this patient in preparation for the clinic visit, including questions related to Onset, Location, Duration, Characteristics, Aggravating factors, Relieving factors, Treatment, and Severity (OLDCARTS).
• Describe the physical examination and diagnostic tools you would use for Ms. Johnston. Are there any additional assessments you would have liked to include that were not mentioned?
• Outline the plan of care to be given to Ms. Johnston during this visit, including patient education and follow-up considerations.

Sample Paper For Above instruction

Introduction

The assessment and management of chest pain in middle-aged women require a thorough history, physical examination, appropriate diagnostic testing, and patient-centered care planning. In this case, Ms. Johnston, a 60-year-old woman, presents with chest pain, prompting critical clinical reasoning to determine the underlying etiology and appropriate interventions.

History of Present Illness (HPI)

Effective history-taking is fundamental to identify the potential causes of chest pain, which could range from cardiac to musculoskeletal or gastrointestinal origins. The OLDCARTS acronym helps structure this assessment.

• Onset: When did the chest pain begin? Was it sudden or gradual? Is it ongoing or intermittent?
• Location: Where exactly is the pain located? Does it radiate to the neck, jaw, arms, or back?
• Duration: How long does each episode of pain last? Is it seconds, minutes, or longer?
• Characteristics: How would the patient describe the pain (sharp, dull, pressure, burning)?
• Aggravating Factors: What activities or exposures worsen the pain? Does exertion, emotional stress, or food intake trigger symptoms?
• Relieving Factors: What alleviates the pain? Rest, medications, position changes?
• Treatment: Has the patient tried any medications or interventions? What was the response?
• Severity: How severe is the pain on a scale of 0-10? Does it interfere with daily activities?

Additional questions should include inquiries about associated symptoms such as shortness of breath, diaphoresis, nausea, dizziness, or palpitations, which can help differentiate cardiac causes from others.

Physical Examination and Diagnostic Tools

The physical exam should focus on vital signs, cardiovascular assessment, and respiratory evaluation. Inspection, palpation, auscultation, and percussion can reveal signs of heart failure, murmurs, or pulmonary issues.

Diagnostic tools include:

• Electrocardiogram (ECG): To identify ischemic changes, arrhythmias, or other cardiac abnormalities.
• Cardiac enzymes: Troponins help detect myocardial injury.
• Chest X-ray: To evaluate cardiac size, pulmonary congestion, or other thoracic issues.
• Further testing: Stress testing, echocardiography, or coronary angiography may be indicated based on initial findings.

Additional assessments that could be considered include a lipid profile, diabetes screening, and lifestyle evaluation for risk factors.

Plan of Care and Patient Education

The initial management involves stabilizing Ms. Johnston, if needed, and initiating further diagnostics. Depending on findings, her care plan may include:

• Urgent referral to cardiology if ischemia is suspected.
• Medications such as antiplatelets, nitrates, or statins as appropriate.
• Lifestyle modifications including smoking cessation, diet, and exercise.
• Patient education about recognizing warning signs of myocardial infarction and when to seek immediate care.
• Scheduling follow-up visits to monitor symptoms and response to treatment.

Ensuring Ms. Johnston understands her condition, the importance of medication adherence, and lifestyle changes is crucial for optimizing her health outcomes.

Conclusion

Assessment of chest pain in a 60-year-old woman requires a systematic approach focusing on history, physical examination, appropriate diagnostics, and personalized management strategies. Combining evidence-based guidelines with patient-centered communication enhances clinical reasoning and ensures comprehensive care.

References

• Amsterdam, E. A., et al. (2014). 2014 ACC/AHA guideline for the management of patients with non–ST-elevation acute coronary syndromes. Journal of the American College of Cardiology, 64(24), e139-e228.
• Bethea, M., et al. (2017). Evaluation of chest pain. Journal of Emergency Medicine, 52(1), 38-45.
• Fletcher, R. H., et al. (2019). Evidence-Based Practice of Cardiology. McGraw-Hill Education.
• Fox, K. A. A., et al. (2016). Coronary artery disease: evaluation and management. The Lancet, 672(9774), 1822-1834.
• Gibbons, R. J., et al. (2012). ACCF/AHA guideline for the management of patients with stable ischemic heart disease. Journal of the American College of Cardiology, 59(23), e44-e164.
• Levy, P. D., et al. (2013). Chest pain evaluation in primary care. The Medical Clinics of North America, 97(6), 1181-1194.
• McGraw-Hill Education (2019). Cardiology Examination & Board Review. McGraw-Hill Education.
• Nhlanhla, N., et al. (2020). Diagnostic approach to chest pain in adults. South African Medical Journal, 110(4), 265-270.
• Yusuf, S., et al. (2019). Global burden of cardiovascular diseases: part I. Circulation, 138(24), 2743-2754.
• Zechmeister, J. B., et al. (2018). Chest pain assessment and management. Journal of Primary Care & Community Health, 9, 2150132718781232.