50 year-old female complaining of chest

[Doc]

1. 50 year-old female complaining of chest
pain BP = 138/92 Pulse = 80 Resp= 18
Temp= 98.6

Mental Checklist: Think about: MI, angina,
GERD, chostrochondritis, CHF, aortic
aneurysm, pericarditis, pulmonary embolus,
esophageal spasm, trauma.

HPI
How long have you had the chest pain
Can you tell me the character of the
chest pains? (Squeezing,
heaviness, sharp, burning)
Can you tell me where the pain is
located? (retrosternal, pin-point,epigastric)
Does the pain radiate? (down left arm to the back, to the shoulder,
to the jaw)Can you tell me the intensity from
1 to 10?
Timing? When do you feel chest
pain? (At rest, on exertion, after a
fatty meal/drinking alcohol)
Are there any aggravating factors?
What makes it worse? (Drinking,eating, exercise)
What do you do to alleviate the
pain? What makes it better? (rest,lay down, eat ant-acids)
Are you having any associated signs
or symptoms? (Nausea, vomiting,diarrhea, fever, headache, dizziness)
Do you have a hard time breathing?(Shortness of breath, orthopnea) r/o CHF
Any history of trauma to the chest.

Any changes in urine? (Blood,
frequency, polyuria) search for hx
of DM
Have you seen any changes in your
stool? (Blood, acholic, diarrhea)

Past Medical History

Have you had this type of episode before?
Have you been in the hospital for
anything before?
Have you ever had any surgery before?
Have you ever been sick
Are you on any type of medications? On
any OCP’s?

Social/Sexual History

How is your diet? (Fatty foods, spicy
foods, junk foods, no fiber)

Do you exercise? Do you smoke? Do you drink alcohol? Do you use illegal drugs? (cocaine)

Are you married/heterosexual?

Lifestyle stressors? (work, home)

Family Health History

Is there history of heart/lung disease or
DM in your family?

PE
Look for venous jugular distention

Palpate precordium(look for deviated
apical pulse)

Auscultate for heart sounds in 3-4 places
(S3/S4, murmurs, gallops)

Auscultate lungs in 4 places (look for
signs of congestion)

Auscultate abdomen for bruits in kidneys
(renal stenosis can cause HPN)

Check pulses

Palpate kidneys (Look for polycystic
kidneys)


Diagnostic Work-Up: ECG, cardiac enzymes,
CBC, Chest X-***.