Diagnostic Test Performed When a Person Presents With Chest Pain

Case Scenario

  1. Diagnostic Test Performed When a Person Presents With Chest Pain

According to the scenario, Mr. Joseph Waters, a 76 –year- old man married to Carol and a father of two is admitted in the emergency department for further diagnosis for chest pains. According to the case, Joseph was brought into the ED with a medical history depicting that he had been suffering from (CAD), Hypertention, Hyperlipidaemia, Chronic Renal Impairment, Chronic Bronchitis, and Gastro-Oesophageal Reflux Disease (GORD), According to the report, he was under medication that included: Enalapril, Atorvastatin, Aspirin, Pantoprazole and Salbutamol. This paper therefore seeks to carry out an analysis of Mr. Joseph’s condition

Electrocardiogram (ECG): Performed to determine the electrical activity of a patient’s heart through the attachment of electrodes to the skin.

Blood Tests: Performed to check and increase in the level of enzymes found around the heart’s muscles. Damages to the heart cells may allow heart attacks to leak enzymes into the blood.

Chest X-rays: Allows a doctor to determine the condition of the lungs including the size and the shape of a patient’s heart and blood vessels.

Computerized Tomography (CT scan): Can be used to determine the blood clots in patient’s lungs or to check the aorta to ascertain a patient does not have aortic dissections.  

  • As determined, Mr. Water’s would be experiencing Epigastric chest symptoms from myocardial ischemia (Kiriş, Gülmen, Yılmaz, &Okutan, 2011). However, his condition may be ascribed to gastrointestinal (GI) that occurs in spite the existence of diaphoresis. The symptoms in this case that may make it challenging to consider this ailment as myocardial ischemia. Additionally, sharp pains witnessed by the patient may also be attributed to a musculoskeletal etiology.
  • CAD is primarily caused when cholesterol rich deposits build up along the linings of the artery thus causing the thickening of the arterial wall including the narrowing of the space between the arteries that allows blood flows to access the heart (Kiriş et.al.2011). This therefore limits the amount of blood being supplied to the heart muscles with oxygen, a factor that reduces the presence of atheromas.

As established in the patient’s medical history, CAD may result from the narrowing of the athermanous that subsequently occludes the vessels. An early contraction of Atheroma is considered to be prevalent from adulthood with the lipid core that is comprised of two constituents released from the necrotic cells thus depriving macrophages which migrates into the ingested lipids and intima (Kiriş et.al.2011).  In this case, the patients connective tissue matrix are derived from the organs smooth muscle cells that are considered to migrate from the media to the intima where they are bound to proliferate and change their nature into phonotypical fibrous capsules around the core of the lipid.

In a case where the plague produces a stenosis diameter of >50%, chances of a reduced blood flow are prevalent through the coronary artery, an aspect that may result in angina. As a result of this, acute coronary case is likely to arise as a result of the formation of thrombus that occurs as a result of the disruptions caused by the plague (Kiriş et.al.2011). When these plagues build up, the patient’s coronary arteries are narrowed, an aspect that decreases the manner in which blood flows to the heart. As a result of the decrease in blood flow, the patient is likely to suffer from chest pains also described as angina or other CAD symptoms. A complete blocking of the patients coronary arteries may result in a heart failure.

  • CAD is a heart illness that develops as a result of the narrowing of the arteries within the heart. When these arteries narrow, it becomes difficult for blood and oxygen to reach the muscles of the heart, a factor that result in the development of CAD that can lead to a heart failure (Kiriş et.al.2011). On the other hand, it is essential to consider that Ischemia refers to the restriction of blood flow and oxygen to the other parts of the body.

CAD and ischemic chest are related in terms of the consequences of results of arteries sclerosis that results from the hardening of the arteries and atherosclerosis that occurs as a result of the fatty deposits found within the arteries (Kiriş et.al.2011). In such an instance, the coronary arteries are affected by atherosclerosis of the arteries sclerosis, thus becoming occluded and resulting in the impairment of the blood supply to the hearts muscle.

  • Enalaprilas a medicine is mainly utilized in the treatment of high blood pressure in an adult and also the congestive heart failure. Additionally, this drug may also be used in treating the ventricles disorder that depicts the restrictions of the lower chambers of the heart in allowing blood flows to the heart (Kiriş et.al.2011). This disorder is known to decrease the capacity of the heart in pumping blood to the rest of the body. Considering that Mr. Waters experienced some Pain: 7/10 in left chest with a BP of 108/60 would indicate that he was suffering from the Left Ventricular Dysfunction as factor that resulted in the description of Enalapril  10 mg BD. This therefore requires that the patient is observed for a period of two hours until the blood pressure stabilizes.

Enalapril’s mechanism of action can be depicted in the case of this patient that results in the suppression of the renin-angiotensin-aldosterone systems, an aspect that results in the decrease of plasma angiotenisn II thus resulting in a decrease of the vasopressin activities and aldosterone secretions (Kiriş et.al.2011). In this case, treatment will incorporate the use of VASOTEC alone that will be conducted over 48 weeks with the aim of increasing the patient’s serum potassium levels.

  • Atorvastatin is a medicine that can be used in treating an elevated total cholesterol condition (LDL) with the aim of elevating HDL cholesterol. The primary aim of the use of this drug in Mr. Water’s condition was to lower the cholesterol levels of a prescription of Atorvastatin 40 mg daily. Atorvastatin is known as one of the efficient synthetic lipid-lowering agents that inhibits 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA). The use of this drug therefore catalyses the conversion of HMG-CoA to mevalonate, an aspect that is essential in the biosynthesis of cholesterol (Kiriş et.al.2011). When less cholesterol is produced, the liver is known to take more cholesterol from the patient’s bloodstream, an aspect that would result in the circulation of low levels of cholesterol in the blood.
  • Using the ABCDE framework to discuss Mr Waters current observations

The ABCDE framework in this case can be used as an observational tool through the consideration of the following principles (Halpin & Riggins, 2014):

Airway (A): Airway obstructions are considered as life threatening and would require immediate attention since they may result in hypoxia and damage the heart, kidney and the brain. In this case, it is important that:

            1.  An assessment is made on the signs of airway blockages on the patient.

2. The airway elements that block the airway are treated as a medical emergency

            3. The patient is gives Oxygen is at a higher concentration

Breathing (B): During the assessment process, it is vital to consider the patients breathing and diagnose the difficulties. Treatment should be directed to the life-threatening conditions.

Calculation (C): In the case of Mr. Waters, it is essential to take consideration of hypovolaemia which may result in shocks (Halpin & Riggins, 2014). In a case where there are no signs of a cardiac cause, it is advisable that Mr. Waters is put on intravenous fluid especially when his condition depicts a fast heart rate. Breathing problems are likely to lead to a problem in a patient’s circulatory state and should be treated as early as depicted.

Disability (D): There is a need of determining the patient’s conscious level through the use of an AVPU method. This determines the alertness and the manner in which the patient responds to painful stimuli or his unresponsiveness to all the stimuli’s (Halpin & Riggins, 2014). In order to determine Mr. Water’s response to painful stimuli, the application of a supra-orbital pressure would be effective.

Exposure (E): In order to determine Mr. Water’s full exposure to his body, it is imperative to minimize the aspect of heat loss as a way of respecting his dignity. In establishing the differences in the observations, it is important to consider that the patients HR increased to 115 from 113 with a BP of 110/63 from 108/60. On the other hand, the patients RR were irregular and increased to 31 from the original observation of 28.

  • Action to take while waiting to review Mr Waters
    • Conducting an assessment
    • Controlling the patients airways distress
    • Consider the precipitating factors
    • Completing the patients respiratory assessment
    • Monitor the patients deteriorating or improving symptoms
    • Consider an assessment on the patient’s family support and teach them how stress levels may exacerbate the ailments symptoms
  •  
    • Mr. Water’s current medication includes Salbutamol PRN. It is essential to determine that this drug belongs to the class of medicines also known as β2-adrenergic agonists and that are inhaled through the mouth to aid in opening bronchial tubes and allow the passage of air into the lungs (Halpin & Riggins, 2014).
    • The mechanism of action of salbutamol

Salbutamol would be used in the case of this patient to stimulate β2 adrenergic receptor considered as predominant in smoothing the bronchial muscles of the lung. This results in the activation of adenyl cyclase that results in the formation of the cyclic AMP (adenosine-mono-phosphate). The high levels of cyclic AMP have the capacity to relax the patient’s muscles, an aspect that decreases his airway resistance by lowering his intracellular concentrations of ionic calcium (Halpin & Riggins, 2014).

  1. Bronchopneumonia is an acute inflammation of the lungs, primarily characterized by foci that are surrounded by parenchyma.    This disease therefore produces a bacterium and affects the lobes being frequently determined as basal. Patients suffering from bronchopneumonia that is caused by bacteria as a result of invasions on the lungs parenchyma by the bacteria, an aspect that triggers the immune inflammatory response that fills the alveolar sacs with exudates (Halpin & Riggins, 2014). When the air sacs are filled with the exudates fluid through a process known as consolidation, the patient’s pulmonary lobes are affected.
  2.  
    1. Bacteria And Fungi
    1. Streptococcus Pneumonia
    1. Atypical Bacteria,
    1. Mycoplasma Pneumoniae
    1. Chlamydophila Pneumoniae
    1. Legionella Pneumophila
  3.  
  4. Amoxicillin in this case belongs to the  class of Amino penicillins that are considered as extended spectrum antibiotics
  5. As determined in Mr. Waters’s condition, in contracting a community acquired bronchopneumonia, it would be effective using amoxicillin in altering the actions of bacteria in the colon that encourages the growth of more bacteria which may result in the inflammation of the colon.
  6. Immediate actions in order of priorityEnsure the patient is calmed while you call for helpIt is important to Assess the patient’s failing organsAssess clues to determine the causeAct fast to clear blockagesIt is also essential to Reduce the patient’s anxietyStabilize the patient from the obstructions cause by spasm and edemaEnsure the situation does not worsen
  7. Cause of action in Mr. Waters case:

There is a need of determining the patient’s conscious level through the use of an AVPU method. This determines the alertness and the manner in which the patient responds to painful stimuli or his unresponsiveness to all the stimuli’s (Halpin & Riggins, 2014). In order to determine Mr. Water’s response to painful stimuli, the application of a supra-orbital pressure would be effective.

  1. The likely cause of Mr Waters’ septic shockWeakened Immune SystemsBacterial InfectionFungi and Viruses
  2. Clinical manifestations of septic shock Mr Waters is showing

As detailed, septic shock is referred to as a systematic inflammatory response syndrome (SIRS) that document another infection. The clinical manifestation and features of this condition depends with a patient. In the case of Mr. Waters, the elements of fatigue, irritability, anxiety, rigors and fevers and the difficulties in breathing and the grunts determine that he is in a septic shock,

  1.  

Stage 1: Non- progressive Shock: This shock occurs when blood flow is detected and several other systems are activated to maintain perfusion, the heart is prone to neat at a faster rate with the blood cells in the body turning smaller, a factor that restrains the circulation system thus resulting in a shock.

Stage II: Irreversible State: Occurs when the systems of the body fails to improve the process of perfusion and are reflected in the patients symptoms. As a result of this, oxygen is therefore deprived within the brain, a factor that results in the patient’s confusion and disorientation (Seymour & Rosengart, 2015). The deprivation of oxygen in the heart is likely to result in chest pains as well.

Stage III: This results when the heats functionality continues to go downwards, a factor that results in the shutting down of the kidneys thus injuring the body’s cells and tissues (Seymour & Rosengart, 2015). This stage may lead to a patient’s death.

  1. The overall treatment goal in shock

The primary goal of shock treatment is to achieve an adequate delivery of oxygen in the tissues especially in patients who present symptoms of septic shock.

  1. The medical management of septic shock

In this case, it is important to begin antibiotic therapies and proper dosages on the patient at an early stage. In order to correct the conditions of hypoxia, impaired tissue oxygenation and Hypertention, there is a need for resuscitating the patient (Seymour & Rosengart, 2015). It is also important that a physician identify the sources of infection and determine effective approaches of controlling them, through the maintenance of adequate functions on organ systems. This therefore can be guided through the use of a cardiovascular monitoring tool.

  • The nursing management of septic shock

Nurses should consider early resuscitation therapy on patients who undergo septic shock. The patients should be admitted in ED with clinical approaches to show there are no evidences of end-organ determined (Seymour & Rosengart, 2015). It is also essential to consider that these patients may not need an invasive hemodynamic monitoring and may not requite Intensive Care admissions.

References

Halpin, D. P., & Riggins, S. (2014). Management of coexistent carotid and coronary artery disease.Southern Medical Journal, 87(2), 187.

Kiriş, İ., Gülmen, Ş., Yılmaz, S., &Okutan, H. (2011). Management of Concomitant Coronary and Bilateral Carotid Artery Disease: A Case Report. Journal of Cardiac Surgery, 22(2), 149-151. doi:10.1111/j.1540-8191.2007.00358.

Seymour, C. W., &Rosengart, M. R. (2015).Septic Shock.JAMA: Journal of The American Medical Association, 314(7), 708-717. doi:10.1001/jama.2015.7885.

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