A 52-year-old male patient who is a house painter presents to the
office reporting chronic fatigue and “mild” chest pain. When he is
painting, chest pain is relieved after taking a break. He reports that
the pain usually lasts 5 minutes or less and occasionally spreads to his
left arm before subsiding. The patient was last seen 3 years ago by
you, and you recommended diet changes to manage mild hyperlipidemia, but
the patient has gained 30 pounds since that time. The patient’s medical
history includes anxiety, vasectomy, cholecystectomy, and mild
hyperlipidemia. The patient does not smoke or use other tobacco or
nicotine products. The patient cares for his wife, who has multiple
sclerosis and requires 24-hour care. His daughter and grandson also live
with the patient. His daughter assists with the care of his wife, and
his job is the major source of income for the family. The initial vital
signs are: blood pressure 158/78, heart rate 87, respiratory rate 20,
and body mass index 32. As part of the diagnostic work-up, an ECG, lipid
levels, cardiac enzymes, and C-reactive protein (CRP) are ordered. The
patient reports that he does not have time to “be sick” and says that he
needs to take care of everything during this visit so he can return to
work and care for his wife. Discuss the following:

1. What additional information should you obtain about the pain the patient is experiencing?
2. What additional physical assessment needs to be performed with this patient?
3. What considerations are important to remember if the patient’s CRP level is elevated?
4. What differential diagnoses should be considered for the patient?
5. What patient teaching will be incorporated into the visit to modify the patient’s risk factors?
6. How will you respond to the patient’s statement that he does not
   have time to “be sick” and needs to take care of everything during this
   visit?

Submission Instructions:

Your initial post should be at least 500 words, formatted and cited

in current APA style with support from at least 2 academic sources.

A 52-year-old male patient who is a house painter presents to the
office reporting chronic fatigue and “mild” chest pain. When he is
painting, chest pain is relieved after taking a break. He reports that
the pain usually lasts 5 minutes or less and occasionally spreads to his
left arm before subsiding. The patient was last seen 3 years ago by
you, and you recommended diet changes to manage mild hyperlipidemia, but
the patient has gained 30 pounds since that time. The patient’s medical
history includes anxiety, vasectomy, cholecystectomy, and mild
hyperlipidemia. The patient does not smoke or use other tobacco or
nicotine products. The patient cares for his wife, who has multiple
sclerosis and requires 24-hour care. His daughter and grandson also live
with the patient. His daughter assists with the care of his wife, and
his job is the major source of income for the family. The initial vital
signs are: blood pressure 158/78, heart rate 87, respiratory rate 20,
and body mass index 32. As part of the diagnostic work-up, an ECG, lipid
levels, cardiac enzymes, and C-reactive protein (CRP) are ordered. The
patient reports that he does not have time to “be sick” and says that he
needs to take care of everything during this visit so he can return to
work and care for his wife. Discuss the following:

1. What additional information should you obtain about the pain the patient is experiencing?
2. What additional physical assessment needs to be performed with this patient?
3. What considerations are important to remember if the patient’s CRP level is elevated?
4. What differential diagnoses should be considered for the patient?
5. What patient teaching will be incorporated into the visit to modify the patient’s risk factors?
6. How will you respond to the patient’s statement that he does not
   have time to “be sick” and needs to take care of everything during this
   visit?

Submission Instructions:

Your initial post should be at least 500 words, formatted and cited

in current APA style with support from at least 2 academic sources.

The nurse practitioner (NP) is working at a health clinic in a  homeless shelter during the early evening. A 48-year-old African  American man approaches the practitioner and asks to have his blood  pressure taken, saying that he has not had it checked “in a while”.

The man appears to be in some type of distress and experiencing pain.  The man walks slowly, using a guarded manner, and he appears  diaphoretic. His mucous membranes also appear pale. The patient’s blood  pressure is 210/98. The patient reports that he has not been diagnosed  with hypertension previously. The patient reveals that he has severe  abdominal pain that is radiating to his back. The nurse finds a heart  rate of 110, respirations 30 with shallow inspirations, and temperature  102.2°F. The patient’s skin is cool and clammy.

The patient reports a history of alcoholism, homelessness, and lack  of access to health care. He says that the symptoms have been present  and worsening over 3 days. The man says he thinks he might have  pancreatitis again, which he had “a couple of years ago”. The NP  recommends that the man should be seen at a hospital for his condition,  but the patient says he does not have health insurance, so he does not  want to go.

The NP proceeds with a physical examination, finding severe abdominal  pain in the epigastric area, yellowed sclera, no abdominal distention,  and hypoactive bowel sounds. The clinic is equipped with basic materials  but no means to conduct lab or radiologic testing. Discuss the  following:

1. Considering the patient’s homelessness and lack of insurance, what action should the practitioner take?
2. When the patient asks why his condition cannot be managed outside of the hospital, how should the practitioner respond?
3. When the patient arrives at the hospital for further diagnostic  work-up, what tests will likely be performed to evaluate the patient’s  condition?
4. How will the severity of the pancreatitis be assessed when the patient is hospitalized?
5. How should the patient’s condition be managed when hospitalized?
6. What patient education should be included after the pancreatitis is resolved?

I’m working on a nursing case study and need guidance to help me understand better.

The nurse practitioner (NP) is working at a health clinic in a  homeless shelter during the early evening. A 48-year-old African  American man approaches the practitioner and asks to have his blood  pressure taken, saying that he has not had it checked “in a while”.

The man appears to be in some type of distress and experiencing pain.  The man walks slowly, using a guarded manner, and he appears  diaphoretic. His mucous membranes also appear pale. The patient’s blood  pressure is 210/98. The patient reports that he has not been diagnosed  with hypertension previously. The patient reveals that he has severe  abdominal pain that is radiating to his back. The nurse finds a heart  rate of 110, respirations 30 with shallow inspirations, and temperature  102.2°F. The patient’s skin is cool and clammy.

The patient reports a history of alcoholism, homelessness, and lack  of access to health care. He says that the symptoms have been present  and worsening over 3 days. The man says he thinks he might have  pancreatitis again, which he had “a couple of years ago”. The NP  recommends that the man should be seen at a hospital for his condition,  but the patient says he does not have health insurance, so he does not  want to go.

The NP proceeds with a physical examination, finding severe abdominal  pain in the epigastric area, yellowed sclera, no abdominal distention,  and hypoactive bowel sounds. The clinic is equipped with basic materials  but no means to conduct lab or radiologic testing. Discuss the  following:

1. Considering the patient’s homelessness and lack of insurance, what action should the practitioner take?
2. When the patient asks why his condition cannot be managed outside of the hospital, how should the practitioner respond?
3. When the patient arrives at the hospital for further diagnostic  work-up, what tests will likely be performed to evaluate the patient’s  condition?
4. How will the severity of the pancreatitis be assessed when the patient is hospitalized?
5. How should the patient’s condition be managed when hospitalized?
6. What patient education should be included after the pancreatitis is resolved?

The nurse practitioner (NP) is working at a health clinic in a homeless shelter during the early evening. A 48-year-old African American man approaches the practitioner and asks to have his blood pressure taken, saying that he has not had it checked “in a while”.

The man appears to be in some type of distress and experiencing pain. The man walks slowly, using a guarded manner, and he appears diaphoretic. His mucous membranes also appear pale. The patient’s blood pressure is 210/98. The patient reports that he has not been diagnosed with hypertension previously. The patient reveals that he has severe abdominal pain that is radiating to his back. The nurse finds a heart rate of 110, respirations 30 with shallow inspirations, and temperature 102.2°F. The patient’s skin is cool and clammy.

The patient reports a history of alcoholism, homelessness, and lack of access to health care. He says that the symptoms have been present and worsening over 3 days. The man says he thinks he might have pancreatitis again, which he had “a couple of years ago”. The NP recommends that the man should be seen at a hospital for his condition, but the patient says he does not have health insurance, so he does not want to go.

The NP proceeds with a physical examination, finding severe abdominal pain in the epigastric area, yellowed sclera, no abdominal distention, and hypoactive bowel sounds. The clinic is equipped with basic materials but no means to conduct lab or radiologic testing. Discuss the following:

1. Considering the patient’s homelessness and lack of insurance, what action should the practitioner take?
2. When the patient asks why his condition cannot be managed outside of the hospital, how should the practitioner respond?
3. When the patient arrives at the hospital for further diagnostic work-up, what tests will likely be performed to evaluate the patient’s condition?
4. How will the severity of the pancreatitis be assessed when the patient is hospitalized?
5. How should the patient’s condition be managed when hospitalized?
6. What patient education should be included after the pancreatitis is resolved?