Priority Questions and Assessment
The first thing to do in the assessment of the patient was to determine the chief complaint, which the patient reported as sporadic chest pain. Assessment questions are essential in determining the severity and pattern of the pain, which will form the basis of the diagnosis (Javis, 2015). The priority questions asked included:
When was the onset of the pain? The patient reported that the pain began three weeks ago.
What is the exact location of the pain? The patient reported that he experienced the pain at the center of the chest, which sometimes radiated to the shoulder or back.
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How long do the pain episodes last? The patient reported that each episode lasted an average of six minutes.
What is the duration between the pain episodes? The pain has occurred four times in the past three weeks, making its frequency about 5 days.
What is the severity and character of the pain? On a scale of 10, the most severe episode has been 7 out of 10.
Assessment
The chest is symmetrical on physical assessment, with no visible abnormal findings. The patient does not exhibit visible signs of pain, coughing, or difficulty breathing. There are no abnormal chest sounds. The heartbeat rate is normal. The patient denies history of circulatory problems or angina, but says that he had experienced the pain episodes a few years ago which resolved on administration of analgesics. On further assessment, the patient says he has had a history of hypertension in his childhood, and confirms use of hypertension medication.
Differences in Assessment Approaches
Performing the auscultation of the mitral and tricuspid valve regions on Brian was easier than doing the assessment on Tina. Also, the palpitation of the apical impulse on the later was easier. In practice experience, it is relatively easy to conduct a cardiac physical exam on male patients than on females ( Chakkalakal et al., 2013). Maneuvers closes to the breast often present the biggest challenge in females.
References
Chakkalakal, R. J., Higgins, S. M., Bernstein, L. B., Lundberg, K. L., Wu, V., Green, J., Long, Q., & Doyle, J. P. (2013). Does patient gender impact resident physicians' approach to the cardiac exam?. Journal of general internal medicine , 28 (4), 561–566. https://doi.org/10.1007/s11606-012-2256-5
Jarvis, C. (2015). Physical examination and health assessment (7th ed.). St. Louis, MO: Saunders. http://93.174.95.29/_ads/48B51C3D0FFB283BB03C10025FBD0038
