Describe how a 42-year-old female with chest pain should be evaluated
Assignment Details: Describe how a 42-year-old female with chest pain should be evaluated.
The patient’s evaluation should start with a thorough assessment of their vital signs including respiratory rate, blood pressure, temperature, oxygen saturation, and blood pressure to determine how stable they are and if immediate interventions are needed (Harskamp et al., 2019). A detailed medical history capturing the location, onset, characteristics, and duration of the chest pain should be recorded. Any associated symptoms including nausea, shortness of breath, and sweating should be noted (Harskamp et al., 2019). Inquiry about risk factors such as a family history of cardiovascular diseases, a history of smoking, or any previous heart problems should be done. Chest X-rays can be done to rule out pulmonary issues and other non-cardiac causes of the pain (Harskamp et al., 2019). A comprehensive physical examination of the patient’s cardiovascular system will be useful in checking for abnormalities including irregular heart rhythms, heart murmurs, and signs of acute distress.
How would a Past Medical History of Diabetes impact the approach?
A past medical history of diabetes would increase the patient’s risk of cardiovascular complications. This is because hyperglycemia and hypertension which often occur concomitantly with diabetes tend to damage the blood vessels increasing one’s risk of cardiovascular issues (Schmidt, 2019). Diabetes can also lead to irregular lipid profiles characterized by high cholesterol levels which are known risk factors for cardiovascular diseases (Schmidt, 2019).
How is cardiovascular risk calculated?
Information on the patient’s risk factors including age, blood pressure, gender, cholesterol levels, diabetes status, family history, and smoking status should be collected. A validated risk calculation algorithm such as the ASCVD risk calculator or Framingham Risk Score can be utilized to calculate the patient’s 10-year cardiovascular risk (Badawy et al., 2022). The tools assign each risk factor a score based on their contribution to cardiovascular risk. The combined score is expressed as a percentage and defines the likelihood of the patient experiencing a cardiovascular event in the next 10 years (Badawy et al., 2022). Based on the value, the patient can be at low risk, intermediate risk, or high risk with thresholds varying depending on the tool used (Badawy et al., 2022). The score helps in clinical decision-making to determine the most appropriate management route to take.
What evidence-based interventions are available to address smoking cessation?
Some of the available evidence-based interventions to address smoking cessation include behavioral counseling which can be done on an individual or group basis or over the telephone with trained counselors (Grech et al., 2020). Pharmacotherapy is another intervention that involves nicotine replacement therapy (NRT), prescription medication, or combination therapy to address withdrawal symptoms associated with nicotine addiction (Grech et al., 2020). Tobacco cessation programs that combine counseling and pharmacological interventions have also been found to be effective in addressing smoking cessation (Grech et al., 2020).
References
Badawy, M. A., Naing, L., Johar, S., Ong, S., Rahman, H. A., Tengah, D. S., Chong, C. L., & Tuah, N. A. (2022). Evaluation of cardiovascular diseases risk calculators for CVDs prevention and management: Scoping review. BMC Public Health, 22(1). https://doi.org/10.1186/s12889-022-13944-w
Grech, J., Sammut, R., Buontempo, M., Vassallo, P., & Calleja, N. (2020). Brief tobacco cessation interventions: Practices, opinions, and attitudes of healthcare professionals. Tobacco Prevention & Cessation, 6(August). https://doi.org/10.18332/tpc/125353
Harskamp, R. E., Laeven, S. C., Himmelreich, J. C., Lucassen, W. A., & Van Weert, H. C. (2019). Chest pain in general practice: A systematic review of prediction rules. BMJ Open, 9(2), e027081. https://doi.org/10.1136/bmjopen-2018-027081
Schmidt, A. M. (2019). Diabetes mellitus and cardiovascular disease. Arteriosclerosis, Thrombosis, and Vascular Biology, 39(4), 558-568. https://doi.org/10.1161/atvbaha.119.310961
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