Canadian Respiratory Journal

HEALTH ASSESSMENT
AND ANALYSIS
Student name –
University name –

Patient profile
 Mrs. Amelia Kale is a 76-year-old retired
bank official with prolonged diuretic
therapy for hypertension

Presenting problem
 Beginning of "throbbing pain under her
breast bone" while sitting and staring at
the television
 The agony was depicted as "substantial"
and like "toothache"

How the patient described the symptoms
 It was not noted to emanate, nor
increment with the application of exertion
 She denied vomiting, nausea, palpitations,
diaphoresis, and loss of awareness or
dizziness
 She denies paroxysmal nighttime dyspnea,
syncope or ongoing chest pain

History of presenting problem
 Admitted to emergency clinic in May, 2019
complaining of discontinuous midsternal chest
pain
 electrocardiogram and chest X-ray demonstrated
first degree atrioventricular block, and a gentle
aspiratory blockage with cardiomegaly

History of presenting problem
 Daily routine of enalapril, and lasix, and
digoxin, for assumed congestive
cardiovascular failure was administered
 Regular follow-up with cardiologist
 Two-pillow orthopnea observed after admission
 Two blocks strolling causes dyspnea
 Delayed standing causes mild, chronic ankle
edema.
 No history of rheumatic fever, diabetes and
cardiovascular illnesses.

Key findings
 Blood Pressure was 170/90 mmHg
 Temperature was 99 degree
 Respiration Rate was 25 breaths per minute
 Heart Rate was 81 beats per minute
 Pulse was at 94 beats per minute.
 The pupils equally rounded and heavily
reactive to light

Key findings
 The patient had a hearing problem;
however, landmarks of tympanic
membrane were well visualized.
 There was no discharge or sputum
observed from the nose of the patient.
 When the mouth area was tested,
complete set of lower and upper
dentures are observed and a normal
reflex of gag was also observed.

Key findings
 No wheezing sound or difficulty in breathing
was observed during chest examination and
the diaphragm moved well during respiration.
 A systolic ejection murmur in grade II / VI is
detected without radiation at the left upper
sternal boundary.
 Pulses are noted for sharp upstrokes in the
carotid.
 No thrills or heaves with a regular rhythm
have been observed during the check.

Key findings
 Warm skin because of the high temperature
recorded
 1+ edema was observed to the knees
which are also very tender to palpation.
 No cyanosis or clubbing was observed.
 The patient was awake, fully oriented and
alert.
 Except for reduced hearing, the cranial
nerves III-XII are intact.

Key findings
 During the rectal examination,
prominent hemorrhoids have been
observed and felt externally
 However, the stool was brown in color
and did not count for blood.
 No history of pleurisy, wheezing, cough,
asthma, pulmonary emboli, hemoptysis,
pneumonia, TB or TB presentation.

Importance of assessments
 The first thing that was assessed were the
vital signs which included temperature,
pulse, respiration rate, heart rate and blood
pressure
 The head, ears, eyes, nose and throat
examinations were conducted
 No history of diabetes, hence no test for
blood glucose levels
 Patient was unstable because of which
pelvic examination was not conducted

Critical analysis and synthesis
 8 million emergency department visits are
related to calls for chest pain in Australia in a
year
 Of these, almost around 1 million may have an
intense coronary disorder (ACS) and about 33%
of these will have a myocardial infarction (MI)
 Patients complain with substernal chest pain
that is portrayed as "crushing" or "like-
pressure" (Varounis et al., 2017)

Critical analysis and synthesis
 Chest pain travels to arms and jaw and reduced
by rest or nitroglycerin
 It might be related with diaphoresis, weakness
or nausea or shortness of breath
 It as a rule endures minutes, not seconds or
hours (Albadri et al., 2015)
 It is once in a while sharp, positional, or pleuritic
 It is once in a while influenced by breathing
 Does not change in force with profound or
shallow breathing

Critical analysis and synthesis
 No single symptom can be utilized to
analyze myocardial infarction or ischemia
 1 of every 3 patients may have atypical
introduction of ACS regular chest pain
(Gibbons et al., 2015)
 1 out of 10 patients, they may have no
chest pain by any stretch of the imagination

Critical analysis and synthesis
 People encountering sternum pain stress
they might have coronary failure
 Sternum pain is caused because of
issues with the sternum itself or the
close by ligament
 Hypertensive individuals are likely to
experience chest pain (Smulders et al.,
2016)

Critical analysis and synthesis
 Persevering chest pain is likely to
transfer the pain to coronary failure
 Patient will not be able to recover fully

Critical analysis and synthesis
 Too much pressure on arteries causes hypertension
 Pressure is also generated because of fat and
cholesterol deposits
 It is also known as plaques
 Patient likely to be diagnosed with artherosclerosis
 Fat and cholesterol deposits make it difficult for the
blood to be transported

Critical analysis and synthesis
 Hence, the heart is devoid of oxygen and
stops functioning (Buys, Avila &
Cornelissen, 2015)
 Myocardial infarction happens when one
part of the heart muscle is damaged or
stopped functioning due to lack of oxygen
supply
 For Amelia, no cholesterol test was
conducted
 Hence, no conclusion could be reached for

Critical analysis and synthesis
 From the physical examination, the level
of cholesterol in the blood could not be
made out and should have been
considered by the medical staff.
 Heart murmurs are created because of
violent progression of blood sufficiently
able to deliver noise which is audible
(Gopalan, Blanchard & Auger, 2016).
 They are normally heard as a whooshing
sound.

Critical analysis and synthesis
 Grade II/VI of systolic ejection murmur
means that the murmur is perceptible
however delicate in its force.
 Stenosis of the aortic or pulmonic valves
will bring about a systolic murmur, as
blood is launched out through the limited
opening.
 A midsystolic mumble starts soon after
the S1 heart sound and ends not long
before the P2 heart sound, so S1 and S2
will be unmistakably perceptible.

Health priorities
 The first priority of the nurse is to
manage the blood pressure levels of the
patient
 The second priority is to monitor
continuously the condition and the
progress every 6-8 hours (Benza et al.,
2015)

Identification and justification of health
priorities
 Mrs. Kale is experiencing chest pain because
of her being a hypertensive patient
 Blood pressure management will help in
managing the chest pain and subsequent
heart attack
 Priorities are required to be set to establish
positive health outcome

Identification and justification of health
priorities
 Nurse’s responsibility to administer
medicines to Amelia such that symptoms do
not persist (Sen et al., 2015)
 Blood pressure was recorded to be high
because of her being a hypertensive patient

Identification and justification of health
priorities
 It is expected that with continuous
monitoring and administration of relevant
medications will help in observing an
improvement in the health condition of
the patient.

References
 Albadri, K., Jensen, J. M., Christiansen, E. H., Mellemkjær, S., & Nielsen-
Kudsk, J. E. (2015). Left main coronary artery compression in pulmonary
arterial hypertension. Pulmonary circulation, 5(4), 734-736.
 Benza, R. L., Raina, A., Abraham, W. T., Adamson, P. B., Lindenfeld, J.,
Miller, A. B., ... & Yadav, J. (2015). Pulmonary hypertension related to
left heart disease: insight from a wireless implantable hemodynamic
monitor. The Journal of Heart and Lung Transplantation, 34(3), 329-337.
 Sen, H., Lam, M. K., Löwik, M. M., Danse, P. W., Jessurun, G. A., van
Houwelingen, K. G., ... & de Man, F. H. (2015). Clinical events and
patient-reported chest pain in all-comers treated with Resolute Integrity
and Promus Element stents: 2-year follow-up of the DUTCH PEERS
(DUrable Polymer-Based STent CHallenge of Promus ElemEnt Versus
ReSolute Integrity) randomized trial (TWENTE II). JACC: cardiovascular
interventions, 8(7), 889-899.
 Smulders, M. W., Kietselaer, B. L., Schalla, S., Bucerius, J., Jaarsma, C.,
van Dieijen-Visser, M. P., ... & Crijns, H. J. (2016). Acute chest pain in the
high-sensitivity cardiac troponin era: A changing role for noninvasive
imaging?. American heart journal, 177, 102-111.

References
 Gopalan, D., Blanchard, D., & Auger, W. R. (2016).
Diagnostic evaluation of chronic thromboembolic
pulmonary hypertension. Annals of the American Thoracic
Society, 13(Supplement 3), S222-S239.
 Varounis, C., Katsi, V., Nihoyannopoulos, P., Lekakis, J., &
Tousoulis, D. (2017). Cardiovascular hypertensive crisis:
recent evidence and review of the literature. Frontiers in
cardiovascular medicine, 3, 51.
 Buys, R., Avila, A., & Cornelissen, V. A. (2015). Exercise
training improves physical fitness in patients with
pulmonary arterial hypertension: a systematic review and
meta-analysis of controlled trials. BMC pulmonary
medicine, 15(1), 40.
 Gibbons, E., Promislow, S., Davies, R. A., Chandy, G.,
Stewart, D. J., Contreras-Dominguez, V., ... & Mielniczuk, L.
M. (2015). Reversible pulmonary arterial hypertension