Complete the assignment using the provided template ( see attachment – Week 7_Template) 

Week 7 – digital clinical experience: assessing the heart, lungs, and | NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning | Walden University

Assessment and Priority Diagnosis:

Brian Foster is a 58-year-old male who presents with shortness of breath, chest pain, and cough. He has a past medical history significant for hypertension and smoking. Brian reports that he has been feeling unwell for the past several weeks and his symptoms have progressively worsened.

Based on Brian’s symptoms and medical history, the priority diagnosis is Acute Coronary Syndrome (ACS). ACS is a term used to describe a range of clinical presentations that result from an acute interruption of myocardial blood supply (Morrow et al., 2019). ACS is a medical emergency that requires prompt diagnosis and management to prevent complications, such as myocardial infarction and death.

Differential Diagnoses:

1. Pulmonary Embolism (PE)

PE is a potentially life-threatening condition that occurs when a blood clot travels to the lungs and blocks blood flow. PE can present with shortness of breath, chest pain, and cough, which are similar to ACS symptoms. PE can be ruled out by performing a CT angiogram or a ventilation-perfusion scan (Konstantinides et al., 2020).

2. Aortic Dissection

Aortic dissection is a rare but potentially lethal condition that can present with chest pain, shortness of breath, and cough. Aortic dissection occurs when the inner layer of the aorta tears and blood enters the wall of the aorta, leading to the formation of a false lumen. Imaging studies, such as a CT scan or magnetic resonance imaging (MRI), can confirm the diagnosis (Erbel et al., 2014).

3. Pneumonia

Pneumonia is a common respiratory infection that can present with shortness of breath, cough, and chest pain. In patients with a history of smoking, pneumonia can be mistaken for ACS. A chest x-ray or a computed tomography (CT) scan can be used to confirm the diagnosis (Mandell et al., 2020).

4. Pericarditis

Pericarditis is the inflammation of the pericardium, which can present with chest pain, shortness of breath, and cough. The symptoms of pericarditis can mimic ACS. An electrocardiogram (ECG) can differentiate between the two conditions, as pericarditis usually presents with diffuse ST segment elevation (Imazio et al., 2015).

5. Gastroesophageal Reflux Disease (GERD)

GERD is a common digestive disorder that can present with chest pain, cough, and shortness of breath. The symptoms of GERD can mimic ACS, especially in patients with a history of hypertension and smoking. A trial of proton pump inhibitors (PPIs) can be used to confirm the diagnosis (Katz, 2018).

References:

Erbel, R., Aboyans, V., Boileau, C., Bossone, E., Bartolomeo, R. D., Eggebrecht, H., Evangelista, A., Falk, V., Frank, H., Gaemperli, O., Grabenwöger, M., Haverich, A., Iung, B., Manolis, A. J., Meijboom, F., Nienaber, C. A., Roffi, M., Rousseau, H., Sechtem, U., … Vahanian, A. (2014). ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). European Heart Journal, 35(41), 2873–292