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:
- What additional information should you obtain about the pain the patient is experiencing?
- What additional physical assessment needs to be performed with this patient?
- What considerations are important to remember if the patient’s CRP level is elevated?
- What differential diagnoses should be considered for the patient?
- What patient teaching will be incorporated into the visit to modify the patient’s risk factors?
- 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
Your initial post should be at least 500 words, formatted and cited
in current APA style with support from at least 2 academic sources.