Chronic Fatigue and Chest Pain Case Study

Research: (APA Assignment), Title Page, Introduction, Headings. Citation and reference page is required. Length: A minimum of 500 words, not including reference Citations: At least two high-level scholarly references in APA from within the last 5 years. Assignment Prompt A 52-year-old male patient who is a house painter presents to the office reporting chronic fatigue and “mild” chest pain. When he is painting, the chest pain is relieved after taking a break. He reports that the pain usually lasts 5 minutes or less and occasionally spreads to his left arm before subsiding. The patient was last seen 3 years ago by you, and you recommended diet changes to manage mild hyperlipidemia, but the patient has gained 30 pounds since that time. The patient’s medical history includes anxiety, vasectomy, cholecystectomy, and mild hyperlipidemia. The patient does not smoke or use other tobacco or nicotine products.Chronic Fatigue and Chest Pain Case Study.  The patient cares for his wife, who has multiple sclerosis and requires 24-hour care. His daughter and grandson also live with the patient. His daughter assists with the care of his wife, and his job is the major source of income for the family. The initial vital signs are: blood pressure 158/78, heart rate 87, respiratory rate 20, and body mass index 32. As part of the diagnostic work-up, an ECG, lipid levels, cardiac enzymes, and C-reactive protein (CRP) are ordered. The patient reports that he does not have time to “be sick” and says that he needs to take care of everything during this visit so he can return to work and care for his wife. 1. What additional information should you obtain about the pain the patient is experiencing? 2. What additional physical assessments need to be completed for this patient? 3. What considerations are important to remember if the CRP level is elevated for the patient? 4. What differential diagnoses should be considered for the patient (4 minimum)? 5. What patient teaching will be incorporated into the visit to modify the patient’s risk factors? 6. How will you respond to the patient’s statement that he doesn’t have time to “be sick” and needs to take care of everything during this visit? Chronic Fatigue and Chest Pain Case Study

Introduction

This is a case analysis for a 52 years old male who presents with chest pain and chronic fatigue. The patient is known to have hyperlipidemia, anxiety, cholecystectomy, and vasectomy. He is the sole breadwinner in the family and works as a painter. He denies smoking tobacco, use of alcohol, and other nicotine products. He is married and lives with his wife, his daughter, and his grandson. His blood pressure is at 158/78mmHg, pulse rate of 87 beats per minute, respiratory rate of 20 breaths per cycle, and body mass index of 32kilojoules. He is not consistent in the follow-up clinics. Ordered laboratory investigations are cardiac enzymes, lipid levels, and CRP.

What Additional Information Should You Obtain About The Pain The Patient Is Experiencing?

Ask about the site of the chest pain. It can be right-sided, left-sided, or middle of the chest. The onset of the pain can be sudden or acute and can be gradual or progressive. The pain is radiating to the back, the shoulder, jaw, or non-radiating. The aggravating factors to the pain can be exertion or physical activity (Poldervaart,et al, 2017). The relieving factors can be self-limiting, rest, or taking pain medication. The associated symptoms of chest pain can be difficulty in breathing, headache, syncope, easy fatigability, coughing, wheezing, dizziness, palpitations, orthopnea, and paroxysmal nocturnal dyspnea. Chronic Fatigue and Chest Pain Case Study

What Considerations Are Important To Remember If The CRP Level Is Elevated For The Patient?

CRP stands for –reactive proteins. It is a blood test marker for inflammation in the body. It may appear within one to two days after myocardial infarction and persist for up to three months. Other instances that cause elevated CRP are metabolic syndrome, tissue necrosis, metabolic syndrome, infection, post-surgery, burns, tobacco, and obesity (Huang,et al, 2020). In this patient, CRP is ordered because of the established risk of coronary heart disease. The risk factors of coronary heart disease are obesity, hyperlipidemia, and hypertension. The C-reactive protein elevation in this patient can be due to obesity, metabolic syndrome (hyperlipidemia and hypertension), post-surgery (vasectomy and cholecystectomy) acute or chronic inflammatory conditions, and ischemia.

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What Differential Diagnoses Should Be Considered For The Patient

The differential diagnoses are hypertension, coronary heart disease, metabolic syndrome, and malignant disease. The patient presents with risk factors for coronary heart disease which are anxiety, obesity, hypertension, hyperlipidemia, chest pain, and easy fatigability (Wirtz, et al, 2017). The patient could be hypertensive due to his elevated blood pressure and obesity. The patent has undergone a cholecystectomy. Indications of cholecystectomy are gallbladder cancer, complications of gallstones, and cholecystitis. Therefore, the patient could be having a gallbladder malignancy. Metabolic syndrome is a cluster of symptoms that increases the risk of heart disease. These symptoms are hypertension, anxiety, obesity, hyperlipidemia, and hypertension. Chronic Fatigue and Chest Pain Case Study

What Patient Teaching Will Be Incorporated into the Visit to Modify the Patient’s Risk Factors?

Patient education changes their health behaviors and risk-factor modification that help improve the health status of the patient. It enlightens about self-management especially in patients with chronic illnesses. Patient teachings include increased physical activity, healthy dietary habits, compliance with medication, and psychological well-being. A healthy diet and physical activity will help in weight loss, control hyperlipidemia, and hypertension (Wirtz, et al, 2017). Compliance to mediation and follow-up clinic will prevent the complication of the illness through regular monitoring.

How willyourespond To the Patient’s Statement That He Doesn’t Have Time to “Be Sick” And Needs to Take Care of Everything during This Visit?

As the nurse on duty, I would take time to educate the patient on the importance of seeking healthcare services and the need for follow-up. I would explain the presenting symptoms, the possible diseases associated, and the complications. This would help the patient know the importance of self-care. Patient education creates rapport between the healthcare provider and the patient. Therefore, patient complies to medication and follow-up clinic to improve the outcome of the disease. Chronic Fatigue and Chest Pain Case Study

References

Huang, I., Pranata, R., Lim, M. A., Oehadian, A., & Alisjahbana, B. (2020). C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta-analysis. Therapeutic advances in respiratory disease, 14, 1753466620937175.

Poldervaart, J. M., Reitsma, J. B., Backus, B. E., Koffijberg, H., Veldkamp, R. F., Ten Haaf, M. E., … & Hoes, A. W. (2017). Effect of using the HEART score in patients with chest pain in the emergency department: a stepped-wedge, cluster randomized trial. Annals of internal medicine, 166(10), 689-697.

Wirtz, P. H., & von Känel, R. (2017). Psychological stress, inflammation, and coronary heart disease. Current cardiology reports, 19(11), 111. Chronic Fatigue and Chest Pain Case Study