NSG 6001 Week 1 Discussion

Susan Johnston is a 60-year-old woman with an elevated BMI.
She has a history of
dyslipidemia and hypertension. She presents with a three-month history of intermittent chest pain
with SOB on exertion that is relieved on its own. She also has a family history of cardiac disease
and type 2 diabetes. She does not smoke and drinks rarely.
Onset: Can you describe when these symptoms started? The patient reported onset of symptoms
three months ago.
Location: Where is the pain located? Patient states it is right in the middle of the chest.
Duration: How long does the chest pain last? Patient states it goes away in 2-3 minutes.
Characteristics: Can you describe the pain? The patient states a burning pain and sometimes a
tingling sensation. She denies diaphoresis, nausea, vomiting, dyspepsia or belching, or
palpitations
Aggravating Factors: Aggravating factors reported by the patient are when she is active, like
climbing the stairs. The patient also states that chest pain sometimes occurs at rest.
Relieving Factors: Pain is relieved in 2-3 minutes.
Treatment: Have you taken anything to relieve the pain? Patient states she rests, and at one time
a glass of cold water relieved the symptoms.
Severity: On a scale of 1-10 how would you rate the severity of your pain? Do you feel the pain
spread to your neck, arm, or jaw? Does the chest pain change in severity? Mrs. Johnston’s states
pain is a six out of 10. Pain does not change with body positioning, is not radiating, and severity
does not vary.

Physical Examination
A physical examination would include vital signs, height, weight, auscultation of the
heart and lungs, as well as palpation of Mrs. Johnston’s peripheral pulses to see if they are
diminished. Patients with angina may present with hypertension, an S3 or S4 heart sounds, or a
heart murmur. A physical examination should also focus on abnormal findings suggesting non-
ischemic causes of angina, such as valvular aortic stenosis, cardiomyopathy, and pulmonary
hypertension (Alaeddini, 2017). According to the American Heart Association, recommended
blood tests include cardiac enzymes, c-reactive protein, fibrinogen, homocysteine, lipoproteins,
triglycerides, brain natriuretic peptide (BNP) and prothrombin (2017). I would also order a CBC
to test for anemia and a CMP to test for electrolytes. The AHA also recommends an EKG to be
done and a stress test.
Plan of Care, patient education, and follow-up
The plan of care for Mrs. Johnston would first be to educate her on lifestyle changes.
According to the AHA, Mrs. Johnson’s plan of care would be for her to start exercising regularly
and start eating a healthy diet to lower her BMI and cholesterol to help reduce her risk of cardiac
disease (2017). To manage Mrs. Johnston’s hypertension, she will start using anti-hypertensive
medications, like a beta-blocker or a calcium-channel blocker. She will continue taking her
lisinopril, hydrochlorothiazide, and aspirin. Mrs. Johnston’s stress test was positive, and a
coronary angiogram was ordered for a cardiac catheterization. Patient education and follow-up
would be to check her vital signs to see if her blood pressure has decreased, assess her lifestyle
changes, and educate Mrs. Johnston to continue taking her medications and evaluate for side
effects.
References
American Heart Association (2017). Angina (Chest Pain). Dallas, TX
Alaeddini, J. (2017). Angina Pectoris Clinical Presentation Retrieved from

https://emedicine.medscape.com/article/150215-clinical#b2
Great post Kami, I agree with your case study. I would also like to add that nitroglycerin
is used to treat stable angina. According to the American Heart Association, I would provide
patient education on this medication including the purpose, dose, frequency and side effects
(2018). I would also educate on the symptoms of a myocardial infarction and how to seek help if
one occurs. The AHA states that if chest discomfort lasts more than 2-3 minutes, the patient
should rest and stop all activity. If pain persists, to take nitroglycerin. If the pain is not relieved
within 5 minutes, another nitroglycerin can be taken, as well as a second and third dose at 5-
minute intervals. If pain lasts more than 15-20 minutes, call 911 and go to the nearest hospital
(2018).
References
American Heart Association (2018). ACC/AHA Guidelines for the Management of Patients with
Unstable Angina and Non–ST-Segment Elevation Myocardial Infarction: Executive
Summary and Recommendations. Dallas, TX

NSG 6001 Week 1 Discussion

Uploaded by

Copyright:

Available Formats

NSG 6001 Week 1 Discussion

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

NSG 6001 Week 1 Discussion

Uploaded by

Copyright:

Available Formats

Susan Johnston is a 60-year-old woman with an elevated BMI.

She has a history of

three months ago.

tingling sensation. She denies diaphoresis, nausea, vomiting, dyspepsia or belching, or

Relieving Factors: Pain is relieved in 2-3 minutes.

a glass of cold water relieved the symptoms.

does not vary.

hypertension (Alaeddini, 2017). According to the American Heart Association, recommended

done and a stress test.

Plan of Care, patient education, and follow-up

American Heart Association (2017). Angina (Chest Pain). Dallas, TX

Alaeddini, J. (2017). Angina Pectoris Clinical Presentation Retrieved from

Unstable Angina and Non–ST-Segment Elevation Myocardial Infarction: Executive

Summary and Recommendations. Dallas, TX

You might also like