Chest pain Diagnosis and Treatment.

Chest pain Diagnosis and Treatment.

HPI: an in depth physical examination is essential in patients with chest pains. Sometimes the signs and symptoms of the patient will appear normal and hence the need for a thorough investigation. The subjective data to be collected include the following:Chest pain Diagnosis and Treatment.

Onset: When did the pain begin?

Duration: is the pain chronic? How long does it last?

Characteristic: how bothersome, severe; does it affect the daily activities? Does it interfere with you night sleep?

Aggravating/Alleviating: what makes the pain more severe?

Radiation: does the pain emerge from a particular point? Is it located in a specific place or has it changed with time?

Treatments: are there any therapeutic options tried? Are they making the pain better or worse?Chest pain Diagnosis and Treatment.

REVIEW OF SYSTEMS

GENERAL: Any recent chills, cold sweats, fever, vomiting, nausea or anorexia?

HEENT:  Any neck swellings?

NEURO: is the client having dizziness, weakness, lightheadedness, or passing out?

CARDIO: are there any chest pains, inflammations on palpation?

RESP: has the client had fullness, indigestion, pressure, tightness or burning in the chest, any recent respiratory illness, and shortness of breath?

GI/GU: does the patient complain of nausea, vomiting, change in stool, constipation, dysuria, hematuria, hematochezia, and diarrhea. When is the last bowel movement?Chest pain Diagnosis and Treatment.

MSKLTL: any muscle, strain aches or fatigue?

PSYCH: Is the client anxious?

PERSONAL & FAMILY HISTORY

Any family history of respiratory chronic diseases, allergies, complications?

Any past surgeries?

SOCIAL HISTORY

Does the patient smoke or abuse alcohol and substances?

O.

Focused Physical Exam:

VITALS:  what are the client’s vital signs: RR, Ht, Wt, BMI, BP, Temp?

Thorax & Lungs: are there any adventitious sounds?

Abdomen: give a presentation of findings from auscultation, palpation, inspection and percussion of the chest and assessment of the abdomen

Skin: any changes in the moisture and color and, moisture or skin temperature

Back: observe for CVA or tenderness

Rectal Exam: examine for tenderness, pain and blood stains

Extremities: any edema, tenderness, intact distal pulses?

Neurologic: any general focal deficits?

Diagnostics: chest X-ray, blood test for measurement of enzyme levels, echocardiogram, MRI, electrocardiogram (ECG or EKG) (Hoorweg et al., 2017)Chest pain Diagnosis and Treatment.

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A.

Differential DX

• Acute chest syndrome
• Pneumonia
• Gastroesophageal reflux disease

Assessment

Acute chest syndrome

P.

Plan:

No referrals

When patients present with chest pain, especially as a constellation of symptoms, the differentials can go in several directions:
· Respiratory- embolism, pneumonia, pneumothorax, pleuritic
· Gastrointestinal-reflux, esophageal spasm, cholecystitis, pancreatitis, gastritis
Seright_Disc_#2
by Teresa Seright – Sunday, January 24, 2021, 7:05 AM
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· Musculoskeletal-chostrochondritis, herpes zoster
· Psychiatric-anxiety, panic disorder
· Cardiac-valve issues, infarction, pericarditis
The important thing to keep in mind with chest pain, is that the physical exam may be normal. This makes the HPI, and use of
OLD CARTS, critical to quickly determining if the presentation is emergent, urgent, or something that can be addressed in the
clinic with appropriate referrals.Chest pain Diagnosis and Treatment.
Priority Assessments
When the patient presents with chest pain, their general appearance is important. Are they pale, diaphoretic, short of breath, or
in apparent distres