Sample Answer for NUR-631 Topic 16 DQ 2 Included After Question
Based on the following information, create a list of three differential diagnoses and explain why you would include them on your list. Use the format displayed in the “Discussion Forum Sample.”
History
C.R., a 34-year-old man, came to your clinic with an episode of chest pain. He has a previous history of occasional stabbing chest pain for 2 years. The current pain had come on 4 hours earlier at 8 p.m. and has been persistent since then. It is central in position, with some radiation to both sides of the chest. It is not associated with shortness of breath or palpitations. The pain is relieved by sitting up and leaning forward. Two Tylenol tablets taken earlier at 9 p.m. did not make any difference to the pain.
The previous chest pain had been occasional, lasting a second or two at a time and with no particular precipitating factors. It has usually been on the left side of the chest although the position has varied.
Two weeks previously he had mild to moderate symptoms of COVID-19 which lasted 14 days. This consisted of a sore throat, low-grade fever, loss of taste and smell, and a cough. His wife and two children were ill at the same time with similar symptoms but have been well since then. He has a history of migraines. In the family history, his father had a myocardial infarction at the age of 51 years and was found to have a marginally high cholesterol level. His mother and two sisters, aged 36 and 38 years, are well. After his father’s infarct, he had his lipids measured; the cholesterol was 5.1 mmol/L (desirable range < 5.5 mmol/L). He is a nonsmoker who drinks two 12-packs of beer per week.
Examination
His pulse rate is 75/min, blood pressure 124/78 mmHg. His temperature is 37.8C. There is nothing abnormal to find in the cardiovascular and respiratory systems. The ECG findings include diffuse concave-upward ST-segment elevation and, occasionally, PR-segment depression.
A Sample Answer For the Assignment: NUR-631 Topic 16 DQ 2
Title: NUR-631 Topic 16 DQ 2
Case Study
Mr. C.R. 34 y/o Hispanic Male: presents w/ complained of chest discomfort over the course of two years, but he has been experiencing central chest pain for the last four hours that has been persistent and has radiated to both sides of his chest. And yet, neither palpitations nor shortness of breath accompany his chest discomfort. Mr. C.R.’s discomfort is alleviated by sitting up and leaning forward, but two Tylenol pills have not helped. In addition, patients with recent (+) hx of COVID will (+) mild- moderate symptoms and no need for supplemental O2 nor hospitalization.
PMH– Migraines, HLD
Family Hx– mother, father, and two sisters all have high cholesterol, and his father had a heart attack when he was 51.
Social Hx– Mr.C.R. Non Smoker nor 2nd smoking at home nor work
(+) ETOH 24 beers/ week
LAB -Cholesterol levels of 5.1 mmol/L are over the upper limit of normal.
EKG-Generalized concave-upward ST-segment elevation and, in rare cases, PR-segment depression is seen on electrocardiograms.
VS-Temperature of 37.8 degrees (100.04 degrees Fahrenheit) with a blood pressure reading of 124/78, P 75/min.
1) Differential Dx; Pericarditis- central chest pain or retrosternal pain, sharp stabing pain relative localized, PC also tends to invade the pleura and cause pain, and one of the most key factors is the that pericardial pain is positional, postural, laying down makes it worst, siting up and leaning forward pain is relieved or reduced. Furthermore, labs tend to be Normal but ECG will demonstrate ST-segment elevation and occasionally PR-segment depression present is seen (Western, 2022).
2) Myocardial infarction 2’ given the family hx and behaviors on ETOH; the client is young but obvious signs of insults to the body.
3) ACS- Given the hx of information and HLD the underline truth is that Mr. CR has a serious medical condition and needs immediate attention from a specialist.
McCance, K. L., & Huether, S. E. (2018). Pathophysiology – e-book (8th ed.). Elsevier Health Sciences.
REPLY
Pericarditis: The most common symptom of pericarditis is chest pain, which typically presents as sharp or stabbing. However, some individuals may experience dull, achy, or pressure-like chest discomfort. The pain associated with pericarditis usually originates behind the breastbone or on the left side of the chest. It might radiate to the left shoulder and neck, intensify during coughing, lying down, or deep breathing, and alleviate when sitting up or leaning forward. Additional signs and symptoms may encompass a cough, fatigue, a sense of general weakness or illness, leg swelling, low-grade fever, a pounding or racing heartbeat, shortness of breath when reclining, and abdominal swelling. The patient described their pain as centered and with some extension to both sides of the chest. They noted that the pain is relieved by assuming an upright position and leaning forward.
Acute Coronary Syndrome: Considering the family history of heart attack, pericarditis emerges as a plausible diagnosis. Serial troponin assessments could provide insights into the potential diagnosis of acute coronary syndrome (ACS). Echocardiography will unveil indicators of pericardial effusion or pericarditis, myocardial function, and valve health. A negative outcome for pericarditis might suggest that ACS is a more likely diagnosis, necessitating further investigation. Diagnostic procedures could encompass cardiac catheterization and angiography if the patient’s chest pain continues to escalate.
Myocardial Infarction: Heart attacks can manifest a range of symptoms, some of which are more prevalent than others. Men and women might experience distinct heart attack symptoms. The symptoms most frequently reported by individuals during a heart attack include angina or chest pain. This discomfort can be mild, resembling discomfort or pressure, or severe, resembling intense pain or pressure. It may originate in the chest and radiate to other areas such as the left arm (or both arms), shoulder, neck, jaw, back, or downward toward the waist. Other symptoms may encompass shortness of breath, fatigue, insomnia, nausea, stomach discomfort, heart palpitations, anxiety, sweating, dizziness, or a sensation of impending doom (Cleveland Clinic, 2022). The patient indicated that their current pain began four hours ago and has been persistent since then. The pain is centered in position, with some extension to both sides of the chest. It is not accompanied by shortness of breath or palpitations.
Ismail T. F. (2020). Acute pericarditis: Update on diagnosis and management. Clinical medicine (London, England), 20(1), 48–51. https://doi.org/10.7861/clinmed.cme.20.1.4
Mayo Foundation for Medical Education and Research. (2022, April 30). Pericarditis. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/pericarditis/symptoms-causes/syc-20352510
REPLY
Hi Marco,
I wanted to add to your discussion on pericarditis.
Pericarditis is inflammation of the pericardial sac and is the most common pathologic process involving the pericardium (Dababneh, 2023). The 2015 ESC guidelines for the diagnosis and management of pericardial diseases divided the etiology of acute pericarditis into two main groups, infectious causes, and non-infectious causes (Dababneh, 2023). Viruses are considered the most common infective agents, and include coxsackieviruses A and B, echovirus, adenoviruses, parvovirus B19, HIV, influenza as well as multiple herpes viruses such as EBV and CMV (Dababneh, 2023). Bacterial causes of pericarditis occur infrequently in the developed world, however tuberculosis infection is still very prevalent in the developing countries, and is cited as the most common cause of pericarditis in the endemic parts of the world (Dababneh, 2023).
Trauma may also cause pericarditis with early onset following injury, or as more frequently encountered in clinical practice, result in a delayed inflammatory reaction (Dababneh, 2023).
Multiple medications have been implicated in drug-induced pericarditis, with a long list of possible culprits, but the incidence remains rare (Dababneh, 2023). Certain medications, such as procainamide, hydralazine, and isoniazid were historically cited to cause medication-induced systemic lupus erythematosis, with associated serositis and pericardial involvement manifesting as pericarditis (Dababneh, 2023).
The pericardium serves multiple functions (Dababneh, 2023). It acts as an anchor to the heart within the thoracic cavity, forms a barrier to extrinsic infection, and enhances dynamic interaction between the cardiac chambers (Dababneh, 2023).
The overall prognosis of acute pericarditis is excellent, with most patients experiencing a complete recovery (Dababneh, 2023).
However, the risk of constriction increases with specific etiologies, especially purulent bacterial or tuberculosis pericarditis, and maybe as high as 30% (Dababneh, 2023). Cardiac tamponade as the most feared acute complication rarely occurs following idiopathic pericarditis but is more frequently encountered in association with malignancy and infectious causes of pericarditis (Dababneh, 2023).
Dababneh, E. (2023, August 8). Pericarditis. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK431080/
