Assessment 2: Case Study

SNPG962 1
Assessment 2: Case study
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SNPG962 ASSESSMENT 2 CASE STUDY 2
Assessment 2: Case study
Analysis of findings
Health history
George is aged 45 years and currently married with three children. He has a BMI of 29
with a waist circumference of 100 cm. The BMI indicates that George is overweight, thus carries
several health risks. He has a sedentary lifestyle and does not participate in any kind of physical
activity. He has a family history of cardiovascular problems that resulted in death of both of his
parents, and his uncle. While his mother succumbed to stroke, his father and uncle died due to
heart attack and a heart surgery, following a cardiac attack, respectively. His presenting
complaints include flu like symptoms and on measuring the blood pressure, it was found to be
174/100, thus confirming hypertension. Furthermore, he also reported signs and symptoms of
severe pain in his arm and shoulder, and nausea, besides profusely sweating and appearing pale.
On being subjected to the PQRST method, it was found that his pain score was considerably high
(9/10) in left posterior shoulder that radiated to the arm, and increased on exertion. This called
for the need of conducting a focused clinical assessment in order to identify the underlying
conditions that lead to this health deterioration.
Focused assessment
The PQRST method of pain assessment acted as a valuable tool for accurately describing,
assessing and documenting pain of the patient (Mejin et al., 2019). Owing to the fact that the
patient reported severe pain in left posterior shoulder, the focused assessment that is most
suitable for the condition is the OLD CARTS framework. This assessment provides an indication
for the onset, location, duration, characteristics, associating factors, relieving factors, treatment,

SNPG962 ASSESSMENT 2 CASE STUDY 3
and severity of pain, thus providing a clear overview of the patient condition (Thomas &
Rassekh, 2018). On conducting this assessment, the patient was asked about the location of the
pain, the time it begun, and how long it lasted. He reported that the pain was of crushing or
stabbing nature and breathlessness, nausea and/or vomiting were the associating factors that
made his condition worse. Pain that gets generated on palpation, pleuritic or sharp pain, or that
will worsens during coughing or inspiration is questionable to be of ischaemic nature, though it
cannot be excluded (Quinlan-Colwell, 2017). Taking into consideration the fact that
differentiating chest pain acts as an important marker that facilitates diagnosis, the patient was
assessed for determining if the pain was prolonged or continuous.
Furthermore, he also reported that the pain ceased to occur when he sat forward. The
findings of this assessment suggests that the patient was suffering from angina pectoris,
commonly referred to as chest pain that occurred due to lack of sufficient blood flow to the
cardiac muscles. It can be suggested that the patient reported pain in the chest due to the presence
of an imbalance between the oxygen supply to the heart, and its oxygen demand (Tegn et al.,
2016). This imbalance of the respiratory gas can be accredited to atherosclerotic narrowing of the
coronary artery, particularly due to abnormal vasodilatation that resulted from an impairment in
endothelial functioning. Hence, the lack in oxygen forced the myocardial cells to switch over to
anaerobic metabolism. The condition might have been caused due to mechanical and chemical
stimulation of the sensory nerve endings located in the myocardium and coronary vessels.
Hence, an increase in afterload or left ventricular preload resulted in an increase in heart rate, and
subsequent elevated oxygen demand (Kaski, 2016).
The patient was administered aspirin owing to its inhibitory action on prostaglandin and
thromboxane production, in relation to inactivation of cyclooxygenase (COX). Low dose of