HISTORY:PNP301N1A – 2217 – Assignment: CASE STUDYPatient’s Chief Complaint:”I have severe chest pai

HISTORY:PNP301N1A – 2217 – Assignment: CASE STUDYPatient’s Chief Complaint:”I have severe chest pain and I can’t seem to catch my breath. I think that I may be having a heart attack.”Mrs. V.A. is a 30-year-old woman who presents to the hospital emergency room following 90 minutes of chest pain. She describes the severity of her pain as 8 on a scale of 10. An hour ago, she developed sharp and constant right-sided chest pain and right-sided mid-back pain. The pain became worse when she attempted to lie down or take a deep breath and improved a little when she sat down. She also has had difficulty breathing. She denies any fever, chills, or coughing up blood. She reports that she just returned home 36 hours ago following a 13-hour flight from Tokyo.PAST MEDICAL HISTORY:• Migraines with aura since age 23• Mild endometriosis for 5 years• Positive for Protein S deficiency• One episode of deep vein thrombosis 2 years ago; treated with warfarin for 1 year • Acute sinusitis 1 year ago• Orthopedic surgery for leg trauma at age 7 • Ovarian cyst removed 10 months agoFAMILY HISTORY:• Father has hypertension• Mother died from metastatic cervical cancer at age 49 • Brother is alive and well• No family history of venous thromboembolic diseaseSOCIAL HISTORY:• Patient lives with her husband and 8-year-old daughter• Monogamous relationship with her husband of 10 years; sexually active • 12 pack-year smoking history; currently smokes 1 pack per day• Business executive with active travel schedule• Negative for alcohol use or intravenous drug abuse• Occasional caffeine intakePAGE 1 OF 5MEDICATIONS:• 30 ?g ethinyl estradiol with 0.3 mg norgestrel for 4 years• Amitriptyline 50 mg po QHS• Cafergot 2 tablets po at onset of migraine, then 1 tablet po every 30 minutes PRN • Metoclopramide 10 mg po PRN• Ibuprofen 200 mg po PRN for cramps• Multiple vitamin 1 tablet po QD• Denies taking any herbal productsREVIEW OF SYSTEMS:• (-) cough or hemoptysis• (-) headache or blurred vision• (-) auditory complaints• (-) lightheadedness• (-) extremity or neurologic complaints • All other systems are negativeALLERGIES:• Demerol (“makes me goofy”)• Sulfa-containing products (widespread measles-like, pruritic rash)PHYSICAL EXAM & LABORATORY TESTS:GeneralThe patient is a well-developed Caucasian woman who appears slightly anxious, but otherwise is in no apparent distress.Vital SignsSkin• Fair complexion• Normal turgor• No obvious lesionsPatient Case Vital SignsBP 126/75RR 40, laboredWT 139 lbO2 SAT 99% on room airP 105, regularT 98.6°FHT 5’5″ PAGE 2 OF 5Head, Eyes, Ears, Nose, and Throat• Pupils equal, round, and reactive to light and accommodation • Extra-ocular muscles intact• Fundi are benign• Tympanic membranes clear throughout with no drainage• Nose and throat clear• Mucous membranes pink and moistNeck• Supple with no obvious nodes or carotid bruits • Normal thyroid• Negative for jugular vein distensionCardiovascular• Rapid but regular rate• No murmurs, gallops, or rubsChest/Lungs• No tenderness• Subnormal diaphragmatic excursion • No wheezing or cracklesAbdomen• Soft with positive bowel sounds• Non-tender and non-distended• No hepatomegaly or splenomegalyBreastsNormal with no lumpsGenital/Rectal• No masses or discharge• Normal anal sphincter tone • Heme-negative stoolPAGE 3 OF 5Musculoskeletal/Extremities• Prominent saphenous vein visible in left leg with multiple varicosities bilaterally • Peripheral pulses 1+ bilaterally• No cyanosis, clubbing, or edema• Strength 5/5 throughout• Both feet cool to touchNeurological• Alert and oriented to self, time, and place • Cranial nerves II-XII intact• Deep tendon patellar reflexes 2+Laboratory Blood Test ResultsPatient Case Laboratory Blood Test ResultsNa 141 meq/L(Normal: 135-145 meq/L) (Panic: <125 or >155 meq/L)HCO3 27 meq/L(Normal: 22-32meq/L) (Panic: <15 or >40 meq/L)Hb 11.9 g/dL(Normal: Males: 13.6-17.5 g/dL Females: 12.0-15.5 g/dL)(Panic: <7.1 g/dL)WBC 5,300/mm3(Normal: 4,800-10,800/ mm3) (Panic: <1,500/ mm3)K 4.3 meq/L(Normal: 3.5-5.0 meq/L) (Panic: <3.0 or >6.0 meq/L)BUN 17 mg/dL(Normal: 8-20 mg/dL)Hct 34.8%(Normal: Males: 39-49% Females: 35-45%)PTT 25.0 sec(Normal: 28.0-38.0 sec)Cl 110 meq/L(Normal: 101-112 meq/L)Cr 1.1 mg/dL(Normal: 0.6-1.2 mg/dL)Plt 306,000/mm3(Normal: 150,000-450,000/ mm3) (Panic: <25,000/mm3)PT 14.0 sec(Normal: 10.0-13.0 sec)ElectrocardiographySinus tachycardiaEchocardiographyVentricular wall movements within normal limitsLower Extremity Venous Duplex UltrasonographyBoth right and left lower extremities show abnormalities of venous narrowing, prominent collateral vessels, and incompressibility of the deep venous system in the popliteal veins. These findings are consistent with bilateral DVT.PAGE 4 OF 5V/Q ScanPerfusion defect at right base. Some mismatch between perfusion abnormality and ventilation of right lung, suggesting an intermediate probability for pulmonary embolus.Pulmonary AngiogramAbrupt arterial cut-off in peripheral vessel in right baseChest x-ray from patient who presented with chest pain, hypoxia, and lower limb deep vein thrombosis. (Reprinted with permission from Kahn GP and JP Lynch. Pulmonary Disease Diagnosis and Therapy: A Practical Approach. Philadelphia: Lippincott Williams & Wilkins, 1997.) questions  1. Are any of the patient’s vital signs consistent with pulmonary thromboembolism? Explain. 2. Are any of the patient’s laboratory blood tests significantly abnormal? Provide a reasonable explanation for each abnormal test Health Science Science Nursing COMP 701 Share QuestionEmailCopy link Comments (0)

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