Module 3 Discussion
The patient is a 52-year-old male presenting with a complaint of chronic fatigue and mild chest pain. The patient is a painter and he states his chest pain is relieved after taking a break from painting. He states that the pain usually lasts about 5 minutes and will occasionally spread to his left arm, before it subsides. This patient was seen in the past and it was recommended to him that he implement diet changes and to work to better manage his hyperlipidemia. Since the last visit, the patient has gained about 30 pounds. The patient cares for his wife who is diagnosed with MS. His daughter and grandchild live with him as well. His initial blood pressure is 158/78, heart rate is 87, respiratory rate is 20 and BMI is 32.
In regards to obtaining more information about the patient’s pain, I would inquire about the onset of the pain, location of the pain, duration of the pain, specific characteristics of the pain, aggravating factors, relieving factors, and what works to help treat the pain. With this patient, I would make sure to complete a full physical assessment, including reviewing all labs, diagnostic tests, and procedure results. It is important to determine whether the pain is substernal, provoked by exertion, or relieved by rest or nitroglycerin. This helps to clarify whether the chest pain is typical anginal pain, atypical anginal pain, or nonanginal pain (Cayley, 2017).
A c-reactive protein test measures the level of c-reactive protein (CRP) in your blood. Normally, you have low levels of c-reactive protein in your blood. High levels may be sign of a serious infection or other disorder. If your results show a high level of CRP, it probably means you have some type of inflammation in your body. A higher than normal CRP level does not necessarily mean you have a medical condition needing treatment. There are other factors that can raise your CRP levels. These include smoking, obesity, and lack of exercise (U.S. National Library of Medicine).
With this patient, there are some possible differential diagnoses to consider. They include a musculoskeletal condition, GI disease, stable CAD, psychiatric disorders, pulmonary disease, and nonspecific chest pain (Cayley, 2017).
Hyperlipidemia is a common risk factor for the development of cardiovascular disease. Educating this patient about the risk factors for cardiovascular disease is essential. Educating the patient about diet changes and giving him a plan for follow up is also necessary. Because dietary approaches tend to lower total cholesterol, LDL cholesterol, and triglyceride levels, and exercise tends to raise HDL cholesterol levels and lower triglyceride levels, it seems logical to combine these approaches. Healthcare providers have many challenges to address in encouraging lifestyle changes to improve blood lipid profiles and other cardiovascular risks in their patients. These include patients’ health beliefs, motivations, and stage of change for new lifestyle behaviors (Kelly, 2020).
As far as the patient comment of needing to handle everything during this visit and that he does not have time to be sick, the patient needs to understand that his health issues are serious and he needs to make lifestyle changes. Goal setting is a key intervention for patients looking to make behavioral changes. Helping patients visualize what they need to do to reach their goals may make it more likely that they will succeed. Another effective strategy for facilitating a variety of behavioral changes involves self-monitoring, defined as regularly tracking some specific element of behavior or a more distal outcome (Hooker, 2018).
References
Cayley, W. (2017). Diagnosing the cause of chest pain. American Family Physician, 72(10). https://www.aafp.org/afp/2005/1115/p2012.html.
Hooker, S. (2018). Encouraging Health behavior change: Eight evidence-based strategies. Family Practice Management, 25(2). https://www.aafp.org/fpm/2018/0300/p31.html.
Kelly, R. (2020). Diet and exercise in the management of hyperlipidemia. American Family Physician, 81(9). https://www.aafp.org/afp/2010/0501/p1097.html.
U.S. National Library of Medicine. (2020, December 3). C-Reactive Protein (CRP) U.S. National Library of Medicine. https://medlineplus.gov/lab-tests/c-reactive-protein-crp-test/.
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