This Week Complete The Aquifer Case Titled Internal Medicine ✓ Solved

This Week Complete The Aquifer Case Titled Internal Medicine 02 60

This assignment requires completing the Aquifer case titled “Internal Medicine 02: 60-year-old woman with chest pain.” You will use information from the case study to answer specific discussion questions about history-taking, physical exam, diagnostic tools, care planning, patient education, and follow-up. Additionally, you are to develop a comprehensive 1000-word paper that provides in-depth analysis and answers to these questions, supported by credible references. The paper should include headings and subheadings for clarity, integrate in-text citations, and conclude with a references section comprising at least ten scholarly sources.

Sample Paper For Above instruction

Introduction

The evaluation of a patient presenting with chest pain is a fundamental aspect of clinical practice in internal medicine. A thorough history, physical examination, and appropriate diagnostic testing are essential for accurate diagnosis and effective management. The case of Mrs. Susan Johnston, a 60-year-old woman with a history of hypertension, hypercholesterolemia, and recent chest pain, serves as a typical example for illustrating these principles and the subsequent steps in care planning and patient education.

History Taking: The OLDCARTS Framework

The initial step involves a detailed interview using the OLDCARTS mnemonic—Onset, Location, Duration, Characteristics, Aggravating factors, Relieving factors, Treatment, and Severity. For Mrs. Johnston:

• Onset: When did the chest pain start? She reports a three-month history with episodes occurring during exertion and at rest.
• Location: The pain is centrally located in the chest.
• Duration: Each episode lasts two to three minutes.
• Characteristics: Described as burning with a tingling sensation.
• Aggravating Factors: Activities like physical exertion and sometimes sitting watching television worsen the pain.
• Relieving Factors: Drinking cold water provides some relief.
• Treatment: No current medication management indicated.
• Severity: Rated 6/10 on the pain scale, indicating moderate discomfort.

Additional contextual questions should include asking about associated symptoms such as dyspnea, diaphoresis, nausea, or syncope to differentiate cardiac etiology.

Physical Examination and Diagnostic Tools

The physical exam should be comprehensive, focusing on cardiovascular and respiratory assessment:

• Vital signs: Blood pressure, heart rate, respiratory rate, temperature, and oxygen saturation.
• Cardiac auscultation: To detect any abnormal heart sounds, murmurs, or arrhythmias.
• Respiratory auscultation: To identify any abnormal breath sounds indicating pulmonary pathology.
• Vascular examination: Palpation of carotid, radial, and dorsalis pedis arteries for pulse symmetry and strength.
• Inspection for jugular venous distention, edema, and skin pallor or cyanosis.
• Abdominal exam: To rule out other causes of chest discomfort such as abdominal pathology.
• Electrocardiogram (ECG): To assess for ischemic changes or arrhythmias.
• Further diagnostics: Serum cardiac biomarkers, chest X-ray, and possibly stress testing or echocardiography.

  Additional assessments such as lipid profile, fasting glucose, and stress testing would be valuable for risk stratification but may not be immediate concerns.

  Planning of Care, Patient Education, and Follow-Up

  The management plan involves several components:

  • Referral: Urgent cardiology consultation for further evaluation, possibly including advanced imaging or invasive angiography.
  • Medication: Initiation of aspirin for antiplatelet effect, statins for lipid management, and antihypertensives as required for blood pressure control.
  • Lifestyle modifications: Education about smoking cessation, dietary improvements, physical activity, and weight management to mitigate cardiovascular risk.
  • Patient education: Recognizing symptoms of a myocardial infarction—such as chest pressure radiating to the arm or jaw, diaphoresis, nausea, and dizziness—and emphasizing the importance of immediate emergency care if these occur.
  • Follow-up: Regular monitoring of blood pressure, lipid levels, and adherence to prescribed medications. Reassessment of symptoms and functional capacity during outpatient visits.

  Conclusion

  In conclusion, the case of Mrs. Johnston exemplifies the importance of comprehensive history-taking using frameworks like OLDCARTS, thorough physical examination, and appropriate diagnostic testing in managing chest pain. Education and proactive follow-up are pivotal in preventing adverse cardiac events and ensuring optimal patient outcomes. Management strategies should be individualized based on risk stratification and diagnostic findings, adhering to current clinical guidelines and evidence-based practices.

  References

  • Lowry, P. (2017). Chest pain and coronary artery disease. In T. M. Buttaro, J. Trybulski, P. Polgar-Bailey, & J. Sandberg-Cook (Eds.), Primary care: A collaborative practice (pp. 550-555). Elsevier.
  • Amakali, K. (2015). Clinical care for the patient with heart failure: A nursing care perspective. Cardiology Pharmacology, 4(142). https://doi.org/10.4172/1320-1635.1000142
  • Surette, J., et al. (2019). Diagnostic approaches in chest pain: A review. Journal of Cardiology Practice, 15(3), 235-245.
  • Smith, R., & Jones, L. (2020). Cardiovascular risk assessment and management. Heart & Lung, 49(4), 341-348.
  • American College of Cardiology. (2021). Guidelines for the management of patients with stable ischemic heart disease. Circulation.
  • National Heart, Lung, and Blood Institute. (2022). Heart disease statistics. Retrieved from https://www.nhlbi.nih.gov
  • Goff, D. C., et al. (2014). 2013 ACC/AHA guideline on the assessment of cardiovascular risk. Journal of the American College of Cardiology, 63(25 Part B), 2935-2959.
  • Wells, P. S., et al. (2018). Diagnostic accuracy of clinical assessment and investigation in suspected pulmonary embolism: A systematic review. The Lancet, 391(10144), 1408-1421.
  • Thygesen, K., et al. (2018). Fourth universal definition of myocardial infarction. Journal of the American College of Cardiology, 72(18), 2231-2264.
  • Fihn, S. D., et al. (2012). 2012 ACCF/AHA guideline for the diagnosis and management of stable ischemic heart disease. Circulation, 126(25), e354-e471.