A 47-year-old obese female complains of pain in her right wrist, with tingling and numbness in the thumb and index and middle fingers for the past 2 weeks. She has been frustrated because the pain causes her to drop her hair-styling tools.

Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each

Please see the attached Case study.

All Case studies /assignments must be done in APA format with a separate sheet for references. 

Managing care in a Culturally Considerate manner

CASE STUDY 2

Patient Profile
F.M. is a 68-year-old white man who comes to the emergency department (ED) in the early afternoon with a 2-day history of severe chest pain. The pain started on wakening the previous day. The pain increased during the night, but his wife could not convince him to go to the hospital. He comes to the ED today because the pain is severe and no longer relieved by rest.

Subjective Data

• Describes recurring chest pain for the past 6 months that was relieved by rest; the pain is a feeling of heaviness in chest with no radiating pain to arm or jaw or accompanying complaints of nausea or dizziness
• Recently the chest pain has become severe and is no longer relieved by rest; is now complaining of being slightly nauseated
• His father died of a heart attack at age 62
• Denies alcohol or drug use
• Smokes one pack of cigarettes per day
• Describes his lifestyle as sedentary

Objective Data

Physical Examination

• Blood pressure 180/96, pulse 98, temperature 99.8° F, respirations 20
• Height 5’11”, weight 210 lbs, BMI 29.3 kg/m2
• Alert and oriented to person, place, and time
• Skin diaphoretic and clammy
• Heart rhythm regular, no murmurs or extra heart sounds
• Lungs are clear to auscultation

Diagnostic Studies

• Hemoglobin 14 g/dL
• Chemistry panel is normal
• Cardiac markers – pending
• Electrocardiogram showing changes that correlate with non-ST-segment-elevation myocardial infarction (NSTEMI)

Collaborative Care

• 9% NaCl infusing into IV catheter at 75 mL/hr
• Nitroglycerin and morphine given with relief of pain

1. What are F.M.’s modifiable risk factors for coronary artery disease (CAD)? What are his non-modifiable risk factors?
2. What is the difference between chronic stable angina pain and pain associated with myocardial infarction?
3. What are diagnostic studies indicated for F.M.?
4. F.M. is diagnosed as having a myocardial infarction (MI).
5. What is the priority nursing care for F.M.?
6. What other interventions do you anticipate for F.M. at this time?