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Cardiovascular Patient Assessment
Describe your clinical experience for this week.
- Did you face any challenges, any success? If so, what were they?
- Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and at least 3 possible differential diagnosis with rationales.
- Mention the health promotion intervention for this patient.
- What did you learn from this week’s clinical experience that can beneficial for you as an advanced practice nurse?
- Support your plan of care with the current peer-reviewed research guideline.
Submission Instructions:
- Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
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Answer
Weekly Clinical Experience Reflection
This week in my clinical rotation, I encountered various cases that challenged my clinical assessment and decision-making skills, but one patient interaction stood out. The experience provided valuable insight into the complex interplay between symptoms, diagnosis, and the importance of health promotion. Through assessment, I learned essential skills in identifying critical signs and symptoms, differentiating possible diagnoses, and planning effective care. Cardiovascular Patient Assessment
Patient Assessment
The patient I assessed was a 50-year-old male presenting with chest discomfort, shortness of breath, and fatigue. The patient reported a gradual onset of chest pain, worsened with exertion, and occasionally accompanied by radiating pain to the left shoulder. The patient’s medical history included hypertension, hyperlipidemia, and a family history of cardiovascular disease. Physical examination revealed an elevated blood pressure of 145/90 mmHg, irregular heart rhythm, and slightly reduced breath sounds on auscultation. Lab results showed elevated troponin levels and abnormal EKG readings with ST-segment depression, pointing towards a potential cardiac etiology.
Plan of Care
Given the initial findings, the primary plan was to stabilize the patient while conducting further diagnostic evaluations to rule out a myocardial infarction (MI). The plan involved monitoring cardiac enzymes every four hours, repeating EKGs, and conducting a stress test. The patient was also started on aspirin and nitroglycerin to manage symptoms and prevent clot formation. Supportive care, including oxygen therapy, was administered to address hypoxia related to chest pain. Cardiovascular Patient Assessment
Three differential diagnoses considered were:
- Acute Coronary Syndrome (ACS): Considering the patient’s symptoms (chest pain, shortness of breath), risk factors (hypertension, hyperlipidemia), and EKG changes, ACS was highly probable. This diagnosis encompasses unstable angina and non-ST-elevation myocardial infarction (NSTEMI), both of which can present with similar symptoms.
- Pulmonary Embolism (PE): The shortness of breath and chest discomfort could also suggest PE. Pulmonary embolism presents with sudden-onset chest pain, often sharp, which might radiate. A D-dimer test was scheduled to evaluate this possibility.
- Gastroesophageal Reflux Disease (GERD): Despite being less likely, GERD can sometimes mimic cardiac symptoms with chest discomfort and shortness of breath. Given the patient’s history and symptom profile, GERD was considered a lower-priority differential diagnosis but could be pursued if cardiac causes were ruled out.
Health Promotion Intervention
Health promotion for this patient centered on lifestyle changes to reduce cardiovascular risk. Educating the patient on dietary adjustments to manage hyperlipidemia, recommending a regular physical activity routine, and discussing smoking cessation strategies were…