Essay on Chronic Fatigue & Chest Pain: Heterogeneous Presentation Requires Patient's Perspective

Introduction

Chronic fatigue and mild chest pain present complex symptoms that may fluctuate with time, depending on the individual patient. This heterogeneous presentation implies that healthcare providers should seek the patient's perspectives on their symptoms during the diagnosis (Maclachlan & Watson, 2017). The presented patient will provide additional information mainly on past medical history, possible heart disease as well as family background. Past consultations about coronary artery disease ought to be outlined as part of the diagnosis procedure. If healthcare attention were sought before, it would be crucial for the patient to state the medical interventions that were undertaken by the healthcare provider.

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The patient will also provide additional subjective data about pain occurrence. The patient will provide information about whether the pain occurs while resting, whether the pain relieves after taking rests or whether the pain occurs while performing the work. The subjective data about the nature of the pain, for example, whether the pain is stabbing and spreads in other body parts such as the upper back, jaw, and left arm. The rationale that will be used for the assessment is the PQRST pain scale. In this scale, the patent explains the factors that lead to the pain. An excellent illustration is the climbing of the ladder for the patient. Apart from that, the patient will describe the quality of pain. The pain could be mild discomfort or sharp pain that comes from time to time or continuous pain. The area or region that is affected by the pain is also supposed to be explained. The region could be around the chest, as in the case study. Besides, the severity of pain should be described. The scale will move from mild to extreme pain. A scale of 0 to ten will be used where 0 is no pain at all, and 10 is extreme pain. Finally, the duration that the patient has had the pain will be stated. It is based on the time that the patient started experiencing it. Having this information will help the practitioner to rule out whether the patient is suffering from angina.

Objective data is a crucial component of any diagnostic procedure as it could help in backing up the subjective data given by the patient. Blood pressure examination will tell more about patient's whether patients have hypotension and hypertension condition. The data about arrhythmias will tell about the possible bradycardia, supraventricular tachycardia, atrial fibrillation conditions. The data about the patient's skin should also be examined to determine whether it is pale. Syncope data will be needed to determine the patient's blood pressure. Other objective data to consider will be decreased SpO2, bradycardia, indications of decreased perfusion, tachycardia, hypotension, and EKG changes.

Guidelines/Evidence

The National Guidelines are effective in helping healthcare practitioners to provide the right interventions and decisions in several medical cases (AFYA, Inc., 2011). Through the guidelines, the healthcare practitioner can recommend the right treatment for the patients. Based on the diagnosis of the patient, the applicable National Guidelines comprises of Noninvasive for Testing for Coronary Artery Disease, Step by Step, Improving Heart Health in America, and Mortality Risk Reduced Among COPD Patients Who Use Bilevel Positive Airway Pressure Machines. One of the most common sources of stable angina is the blockage information of a plaque on the coronary artery. Being that it is the only artery that feeds the heart with blood, the heart gets insufficient amounts of food and oxygen. The condition may be triggered by any activity that increases the energy and oxygen needs of the heart. An activity that the body is not used to, such as exercise, stress, intake of large amounts of food, and alterations in weather are likely to lead to the pain in the chest. The cause of the pain in the patient described above is climbing a ladder. In the time of the angina attack, the patient may also experience additionals signs sich as fatigue as the patient complained of being ever tired. Anxiety also attacks manifest, along with dizziness and nausea. The three guidelines are related to heart disease and would be suitable to intervene in the possible coronary artery disease that might have contributed to angina pectoris.

Some of the factors that predispose one to the illness include being overweight and not exercising. As noted in the data that the patient gave, the man suffers from hyperlipidemia. Noninvasive Testing for Coronary Artery Disease helps the healthcare provider to evaluate the effectiveness of using noninvasive technology in diagnosing coronary artery disease. The patient portrays the symptoms of coronary artery disease, which results in chronic fatigue and chest pains. Although the diagnosis shows that the patient has Stable Angina Pectoris, it is essential to find whether it has been caused by coronary artery disease. Noninvasive tests are crucial for providing diagnostic and prognostic information for effective risk stratification and guide the practitioners in subsequent interventions and testing (Pacific Northwest Evidence-based Practice Center, 2016). The test provides additional information that can be overlooked by other tests, for example, whether the symptoms are related to ischemia.

Step by Step, Improving the Heart Health in America aligns with the National Guidelines attempt to mitigate the heart-related cases in America. The guideline helps ensure those who are in risks well monitored, and those who are ailing heart conditions receive the right care (Meyers, 2019). The Stable Angina Pectoris is usually associated with blocked heart arteries. Therefore, the patient might be at risk or ailing from heart disease, calling for the application of Step by Step, Improving the Heart Health in America recommendations.

Mortality Risk Reduced Among COPD Patients Who Use Bilevel Positive Airway Pressure Machines guideline presents to healthcare practitioners with the right tool to use while dealing the patients ailing from chronic conditions such as obstructive pulmonary disease (AHRQ, 2020). The chronic fatigue and chest pain experienced by the patient might lead to difficulties in breathing. As such, recommending the patient to use Bilevel Positive Airway Pressure Machine will reduce his probability of dying since the research has shown that the said technology reduces the mortality rate.

Diagnostics

To assist in diagnosing the patient's condition, I will order an electrocardiogram (ECG) and blood tests. The ECG test will be valuable in ascertaining the patient heart's electrical activity. I will use the ECG test results to determine whether the patient's heart is working normally. The blood tests will be crucial to establish cholesterol level and triglycerides that are associated with coronary artery disease. The possibility of a coronary artery can also be identified through testing troponin enzyme in the blood that is produced after suffering severe angina. The painful chest suggests that the patient might have chest injuries or heart diseases. As such, I will order chest CT, chest x-ray, coronary angiography, cardiac MRI, and Coronary CT angiography.

The tests that I would order for the differential diagnosis are urinalysis, thyroid function tests, erythrocyte sedimentation rate (ESR), and complete blood count. The urinalysis tests will help in ruling out diseases such as hypertension and diabetes. The thyroid function tests are necessary for the exclusion of thyroid diseases: hyperthyroidism and hypothyroidism. ESR will serve as a differential diagnosis for rheumatologic conditions, whereas the complete blood count will help in ruling out the conditions that affect blood cells such as anemia.

Stable Angina Pectoris is might be linked to various heart diseases. The chronic fatigue and other signs portrayed by the patient also call for the opinions of other practitioners. Therefore, I would consult other medical practitioners, especially from the high-rank ones and specialists in various areas. I will seek detailed guidance about both the subjective and objective data as well as the management of the condition by consulting a General Physician (GP). For the specialists, I will seek the help of a cardiologist since the patient has shown the signs of Stable Angina Pectoris, which is linked directly to coronary artery disease. A psychiatrist's advice will be useful since the patient has reported a history of anxiety. I will also speak to a gastroenterologist as the patient presents major digestion problems and has had cholecystectomy performed on him. The patient is overweight and has a high BMI that ought to be lowered. The patient was before advised to check on his diet to control his hyperlipidemia.

Some of the tests that may be used to ensure that it is not unstable angina include blood tests for creatine Kinase. The heart patterns can also be scanned for patterns that show reduced blood flow in the body. Checking the frequency of the attacks is also a good way to ensure that the physician is sure that it is stable angina.If the attacks are frequent and predictable, then it is stable. On the other hand, if the attacks attack randomly and do not last for relatively equal times, then it is unstable angina.

While medical diagnosis helps in managing the actual disease or medical condition, nursing diagnosis seeks to address the patient's response to the given condition (Chiffi & Zanotti, 2014). The medical diagnosis in the given case will be based on the three tests: electrocardiogram, coronary angiogram, and exercise stress test. If the patient shows positive results on the three tests that there is a high likelihood, he is ailing from Stable Angina Pectoris.

Various ethical and legal dilemmas present in the interactions with the patients suffering from dreadful diseases. There are many types of anginas, and the healthcare practitioner might end up recommending the wrong one to the patient. The healthcare providers have to provide many diagnostic procedures to exclude some medical conditions or diseases that have similar symptoms. Considering the case of the patient, various diseases have to be eliminated. For instance, the patient presents symptoms that could be linked to Unstable Angina Pectoris, diabetes, or MS. As the healthcare provider, I will have to be careful not to misdiagnose the patient, a fact that could lead to the administration of wrong treatment to the actual condition.

Patients who are recommended for lifestyle changes often feel dissatisfied with the medical care that they get. They may feel distressed or even disbelieved at times. Healthcare providers who do not have a basic understanding of the condition may dismiss the patients, ignore the challenges that they are facing or doubt the legitimacy of the symptoms (Blease & Geraghty, 2016). As a result, the patients end up being marginalized and neglected from mainstream medicine. I will explain to the patient the importance of observing a healthy lifestyle and why he needs to consume a low-fat diet.

Treatment Plan

The plan of care for the treatment will be based on the guidelines and will comprise of a medical plan of care, nursing plan of care, and therapy.

Medical Plan of Care

The medical plan will be based on the Noninvasive Testing for Coronary Artery Disease results that may suggest the patient has coronary artery disease. The possible medication will consist of drugs and surgery. Drugs such as nitrates, calcium channel blockers, beta-blockers, statins, and aspirin will help the patient to relieve pain as well as unblock the coronary artery to allow blood to flow in the heart.

The surgery of the coronary...