Evaluation and Care Plan for Marge with Generalized Bilateral Chest Pain

QUESTION

Marge is 28 years old and considers herself in good health. She takes oral contraceptives for birth control and escitalopram 10 mg for anxiety. She has come to your clinic today because she is having generalized bilateral chest pain. Her temp is 99.8 °F, her pulse is 90 and regular, her respiratory rate is 28, and her BP is 118/66. Her O₂ sat is 96% on room air. She states the pain is sharp and worse when she takes a deep breath or lays down on the unaffected side. It has been there for about four days. No one at home is sick. She works as a secretary for a tech company. She does not smoke.

1. What other questions would you ask Marge?
2. What components of the physical examination would you perform?
3. What differential diagnoses would you consider?
4. Would you order any tests for Marge? If so, what and why?

If one of your differential diagnoses is pleurisy or costochondritis, write a plan of care for Marge based on your diagnosis

ANSWER

Evaluation and Care Plan for Marge with Generalized Bilateral Chest Pain

Introduction

This essay discusses the assessment and care plan for Marge, a 28-year-old female who presents with generalized bilateral chest pain. The goal is to conduct a thorough evaluation, consider potential diagnoses, and develop a comprehensive plan of care based on the most likely diagnosis.

Assessment and Differential Diagnoses

Detailed Medical History: Inquire about Marge’s medical history, focusing on any past respiratory conditions, recent illnesses, or infections. Assess her medication use, including any recent changes or new medications.

Pain Characteristics: Further explore the nature of the chest pain, including its onset, duration, exacerbating and alleviating factors, and associated symptoms.

Occupational and Lifestyle Factors: Investigate Marge’s workplace environment and any potential exposures to irritants or allergens. Evaluate her lifestyle, stress levels, and sleep patterns.

Family History: Check for any relevant family history of respiratory conditions or cardiovascular diseases.

Physical Examination

Vital Signs: Monitor Marge’s temperature, pulse, respiratory rate, blood pressure, and oxygen saturation.

Respiratory Examination: Assess her lung sounds, chest wall movements, and respiratory effort.

Cardiovascular Examination: Evaluate her heart sounds, peripheral pulses, and signs of fluid overload.

Chest Examination: Palpate for any tenderness or inflammation in the chest wall.

Differential Diagnoses

Pleurisy: Inflammation of the pleura, often caused by respiratory infections or other underlying conditions.

Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone, typically caused by strain or injury.

Pneumonia: Infection of the lungs, which can cause sharp chest pain, fever, and respiratory symptoms.

Pulmonary Embolism: Blood clot in the lungs, leading to sudden onset chest pain and shortness of breath.

Diagnostic Tests

Chest X-ray: To assess the lung and chest wall for signs of inflammation or infection.

Complete Blood Count (CBC): To check for signs of infection or inflammation.

Electrocardiogram (ECG): To rule out any cardiac abnormalities.

D-Dimer Test: To assess for possible pulmonary embolism.

Plan of Care for Costochondritis

Pain Management: Prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to alleviate pain and inflammation.

Rest and Activity Modification: Advise Marge to avoid activities that worsen the pain and promote rest.

Warm Compress: Suggest applying warm compresses to the affected area to ease discomfort.

Breathing Techniques: Teach Marge deep breathing exercises to improve lung expansion and alleviate pain during deep breaths.

Follow-up: Schedule a follow-up appointment to reassess her symptoms and response to treatment.

Conclusion

By conducting a thorough assessment and considering the differential diagnoses, we can create an effective care plan tailored to Marge’s condition. Based on the most likely diagnosis of costochondritis, our plan of care focuses on pain management, activity modification, and breathing techniques to provide Marge with relief and support her recovery. Regular follow-up appointments will ensure that her symptoms are adequately managed and that her overall health is monitored effectively.