Discussion: Chest Pain: Treatment of Pericardial Disease
Discussion: Chest Pain: Treatment of Pericardial Disease
Discussion: Chest Pain: Treatment of Pericardial Disease
4-1 Discussion: Chest Pain: You are caring for a 32-year-old male client who pushes his call light stating he is experiencing intermittent, sharp precordial chest pain that radiates to his neck since being admitted d+uring the night. He gets relief if he sits and leans forward, but the pain gets worse with swallowing. He rates the pain at 5 out of 10 on a numerical scale. He has not received any medication for the pain since admitted to your floor. On physical examination, a pericardial friction rub can be heard. From your morning report, you are aware that he had an upper respiratory tract infection two weeks ago.
Based on the client’s presenting symptoms and physical findings, discuss the most probable diagnosis that would support your response with evidence from the literature.
In your responses to your peers, discuss the probable diagnosis and whether it may affect cardiac performance or cardiac output. Identify if this client is at risk for other pathological conditions such as coronary artery disease and congestive heart failure. Explain your rationale, using evidence to support it.
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To complete this assignment, review the Discussion Rubric document.
On my shift today, I am taking care of a 32-year old male. I perform a thorough assessment after answering his call bell and he complains of intermittent, sharp chest pain, rating it a 5 out of 10 on a numeric scale. He describes the pain as radiating to his neck that worsens with swallowing but finds relief when he sits up and leans forward. He has not received any medication to manage his pain. Upon auscultation, I can hear a pericardial friction rub and recall being told in report that this patient had a viral URI about 2 weeks ago.
With the findings of my assessment, I think of a probable diagnosis being acute pericarditis, as the patient meets many of the symptoms associated with this condition. Acute pericarditis often is caused by a viral illness, and presentation begins with “the sudden onset of severe, retrosternal chest pain that worsens with respiratory movements and when assuming a recumbent position” (McCance & Huether, 2019, p. 1088). Patients with this condition may also have a low-grade fever, a friction rub, and the patient may experience pain that radiates to the back (McCance & Huether, 2019). Although there are procedures and invasive techniques to confirm diagnosis, an article published in the Cardiovascular Therapeutics journal states “extensive evaluation, including invasive procedures is generally unnecessary in a young, previously healthy adult who presents with a viral syndrome, typical pericardial chest pain, and a pericardial friction rub” (Azam & Hoit, 2011, p. 309).
As acute pericarditis is defined as “inflammation of the pericardium“, the treatment, understandably, relies on the administration of anti-inflammatory medications (McCance & Huether, 2019). A combination of nonsteroidal anti-inflammatories and colchicine have been found to be very effective in treating this condition (McCance & Huether, 2019). Studies have been done comparing treatments, and these studies have shown that patients treated with both aspirin and colchicine not only had symptom relief at 72 hours of the onset of treatment but also fewer rates of recurrence compared to treatments of aspirin alone (Azam & Hoit, 2011). Pain can be managed through the use of analgesics (McCance & Huether, 2019). With acute pericarditis, hs-CRP serum levels are elevated, and during treatment, these levels should be monitored and can help to determine the resolution of the condition when levels return to normal levels (McCance & Huether, 2019).
References
Azam, S., & Hoit, B. D. (2011). Treatment of Pericardial Disease. Cardiovascular Therapeutics, 29(5), 308–314. https://doi-org.ezproxy.snhu.edu/10.1111/j.1755-5922.2010.00151.x
McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th Ed.). St. Louis, MO: Elsevier.
Undergraduate Discussion Rubric
Overview
Your active participation in the discussions is essential to your overall success this term. Discussion questions will help you make meaningful connections
between the course content and the larger concepts of the course. These discussions give you a chance to express your own thoughts, ask questions, and gain insight from your peers and instructor.
Directions
For each discussion, you must create one initial post and follow up with at least two response posts.
For your initial post, do the following:
• Write a post of 1 to 2 paragraphs.
• In Module One, complete your initial post by Thursday at 11:59 p.m. Eastern.
• In Modules Two through Eight, complete your initial post by Thursday at 11:59 p.m. of your local time zone.
• Consider content from other parts of the course where appropriate. Use proper citation methods for your discipline when referencing scholarly or popular sources.
For your response posts, do the following:
• Reply to at least two classmates outside of your own initial post thread.
• In Module One, complete your two response posts by Sunday at 11:59 p.m. Eastern.
• In Modules Two through Eight, complete your two response posts by Sunday at 11:59 p.m. of your local time zone.
• Demonstrate more depth and thought than saying things like “I agree” or “You are wrong.” Guidance is provided for you in the discussion prompt.
Rubric
Critical Elements Exemplary Proficient Needs Improvement Not Evident Value
Comprehension Develops an initial post with an organized, clear point of view or
idea using rich and significant detail
(100%) Develops an initial post with a point of view or idea using adequate organization and
detail (85%) Develops an initial post with a point of view or idea but with some gaps in organization and
detail (55%) Does not develop an initial post with an organized point of view or idea (0%) 40
Timeliness N/A Submits initial post on time (100%) Submits initial post one day late (55%) Submits initial post two or more days late (0%) 10
Engagement Provides relevant and meaningful response posts with clarifying
explanation and detail (100%) Provides relevant response posts with some explanation
and detail (85%) Provides somewhat relevant response posts with some
explanation and detail (55%) Provides response posts that are generic with little
explanation or detail (0%) 30
Critical Elements Exemplary Proficient Needs Improvement Not Evident Value
Writing
(Mechanics) Writes posts that are easily understood, clear, and concise using proper citation methods
where applicable with no errors in
citations (100%) Writes posts that are easily understood using proper
citation methods where applicable with few errors in
citations (85%) Writes posts that are understandable using proper citation methods where
applicable with a number of
errors in citations (55%) Writes posts that others are not able to understand and does not use proper citation
methods where applicable (0%) 20
Total 100%
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