Week 4 Discussion Chest Pain<\/p>\n
CP is a 64-year-old male who presents to the emergency department (ED) via ambulance for chest pain. He was out shoveling snow from his driveway when he developed left anterior chest pain, pressure-type, radiating to his jaw and shoulder. Despite the cold weather, he was sweating. He also noted palpitations and shortness of breath, although he thought it was just because he was \u201ca little out of shape.\u201d He was afraid that something was wrong, so he asked his wife to call 911.<\/p>\n
Past Medical History<\/p>\n
Hypertension
\nHyperlipidemia
\nDiabetes mellitus
\n\u2022 Gout Medications<\/p>\n
Hydrochlorothiazide, 25 mg once daily
\nAllopurinol, 300 mg once daily
\nSocial History<\/p>\n
Retired factory worker
\nSmokes one pack of cigarettes per day
\nDrinks about six beers per day (sometimes more)
\nPhysical Examination<\/p>\n
Well-developed obese man in moderate distress
\nHeight: 69 inches; weight: 252 lbs.; blood pressure: 172\/110; pulse: 92; respiration rate: 16; temperature: 98.7 \u00b0F
\nLungs: Scattered bilateral wheezes
\nHeart: Regular with grade II\/VI systolic murmur
\nExtremities: No edema
\nLabs and Imaging<\/p>\n
Complete blood count with mild leukocytosis (WBC 12.9k)
\nPotassium: Low at 2.9 mEq\/L
\nGlucose: 252 mg\/dL
\nTroponin I: 1.7 ng\/L
\nUric acid: 11.1 mg\/dL
\nEKG: ST segment depression with T-wave inversion over lateral leads; no pathologic Q waves Next Steps
\nCP\u2019s admitting diagnoses are non-ST segment elevation acute coronary syndrome, hypertension, diabetes mellitus, obesity, alcohol abuse, hyperuricemia, and smoker
\nDiscussion Questions<\/p>\n
1. What medications should be instituted for CP?<\/p>\n
2. What medications should be continued after discharge?<\/p>\n
3. What lifestyle modifications can be recommended for CP?<\/p>\n
Medications that should be instituted for CP include:
\nAspirin: to be given immediately to reduce the risk of further cardiac damage and to prevent thrombosis.
\nNitroglycerin: to relieve chest pain and improve myocardial oxygen supply.
\nMorphine: to provide pain relief.
\nHeparin or unfractionated heparin (UFH) : to decrease the risk of thrombosis.
\nA beta-blocker: to decrease the risk of arrhythmia and to decrease heart rate and blood pressure.
\nA statin: to reduce the risk of further cardiac events by decreasing cholesterol levels.
\nACE inhibitors or ARBs: to control hypertension and improve blood flow to the heart.
\nMedications that should be continued after discharge include:
\nAspirin: to reduce the risk of further cardiac damage and to prevent thrombosis.
\nA beta-blocker: to decrease the risk of arrhythmia and to decrease heart rate and blood pressure.
\nA statin: to reduce the risk of further cardiac events by decreasing cholesterol levels.
\nACE inhibitors or ARBs: to control hypertension and improve blood flow to the heart.
\nHydrochlorothiazide: to control hypertension.
\nAllopurinol: to control hyperuricemia.
\nLifestyle modifications that can be recommended for CP include:
\nQuitting smoking: to reduce the risk of further cardiac events and improve overall health.
\nLimiting alcohol intake: to reduce the risk of further cardiac events and improve overall health.
\nMaintaining a healthy diet: to control diabetes, hypertension, and obesity.
\nRegular physical activity: to improve cardiovascular health and overall health.
\nMonitoring blood glucose and blood pressure levels: to control diabetes and hypertension.
\nMedication adherence: to ensure optimal control of hypertension and hyperlipidemia.
\nStress management techniques: such as yoga, meditation or deep breathing to reduce the risk of cardiovascular events.
\nIt’s important to note that this patient have multiple co-morbidities and risk factors that need to be addressed, so an interdisciplinary team should be involved in the management of this patient to provide the best care.<\/p>\n","protected":false},"excerpt":{"rendered":"
Week 4 Discussion Chest Pain CP is a 64-year-old male who presents to the emergency department (ED) via ambulance for chest pain. He was out shoveling snow from his driveway when he developed left anterior chest pain, pressure-type, radiating to his jaw and shoulder. Despite the cold weather, he was sweating. He also noted palpitations […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1129,280],"tags":[1333],"class_list":["post-2472","post","type-post","status-publish","format-standard","hentry","category-nursing-case-study-writing-help-examples-how-to-guide","category-case-study-assignment-help","tag-cp-is-a-64-year-old-male-who-presents-to-the-emergency-department-ed"],"_links":{"self":[{"href":"https:\/\/www.colapapers.com\/us\/wp-json\/wp\/v2\/posts\/2472","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.colapapers.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.colapapers.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.colapapers.com\/us\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.colapapers.com\/us\/wp-json\/wp\/v2\/comments?post=2472"}],"version-history":[{"count":0,"href":"https:\/\/www.colapapers.com\/us\/wp-json\/wp\/v2\/posts\/2472\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.colapapers.com\/us\/wp-json\/wp\/v2\/media?parent=2472"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.colapapers.com\/us\/wp-json\/wp\/v2\/categories?post=2472"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.colapapers.com\/us\/wp-json\/wp\/v2\/tags?post=2472"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}