Complaint of Chest Pain Case Study

Complaint of Chest Pain Case Study Jon Teegardin When assessing the patient with chest pain, it is important to pay attention to all of the information available from the patient. Not all chest pain is related to cardiac issues, and not all incidents of myocardial infarction present with classic chest pain symptoms. There are many possible causes of chest pain. The source of chest pain can be cardiac, respiratory, muscular, gastro-intestinal, or even psychological. This paper will discuss several causes of chest pain, and then address cardiac, circulatory, and respiratory assessments of a patient with a chief complaint of chest pain. Causes of chest pain Myocardial infarction or heart attack results when a blood clot disrupts the flow of blood to the heart muscle itself (Jarvis, 2012). Patients often describe a crushing, heavy feeling in the chest. Sometimes the pain radiates to the jaw or left arm. The pain can hit suddenly or build gradually. This type of pain is not reproducible and isn’t relieved by nitroglycerine. Angina is chest pain caused by a buildup of plaque in the arteries that supply the heart with blood. It is described as a tightness, squeezing, or burning in the chest. It can last anywhere from five to thirty minutes and can occur when the heart is working harder or when it is at rest (Jarvis, 2012). Angina is typically relieved with rest and medication. Aortic dissection occurs when the inner layers of the aorta separate. The pain occurs suddenly and is described as sharp, stabbing, or tearing in nature in the chest or back. The pain is not relieved by rest or medication and is a medical emergency that requires surgical intervention. Digestive causes of chest pain include heartburn, gallbladder, and pancreas issues. This type of pain is described as pain or burning in the epigastric area and is relieved by antacids, dietary changes, or pain medication. Chest pain can be associated with injury to the muscles and cartilage in the chest. An inflammation of the cartilage of the rib cage, known as costochondritis can cause pain. Sore muscles from overexertion or bruised and broken ribs can cause chest pain as well. These types of pain are reproducible and are not relieved by nitroglycerine. Chest pain related to respiratory problems include blood clots in the lung called pulmonary embolism that cause shortness of breath and chest pain. Pleurisy, which is an inflammation of the membrane covering the lung causes chest pain that is worse when coughing or inhaling. Pulmonary hypertension can also cause chest pain. Patient 1 The patient is a 56 year old male that arrives at the emergency room by EMS transport with a complaint of chest pain that began one hour ago. The patient also complains of shortness of breath, and is sweating profusely. EMS has initiated IV access, placed the patient on 2 liters per minute of oxygen, given 325 milligrams of aspirin, and given one sublingual 0.4 milligram nitro. A focused assessment is started. The patient is asked to describe his chest pain and what he was doing when the pain started. The patient reports that he was doing yard work when he became short of breath and started sweating profusely. He felt a crushing pain in his chest and the pain went up the left side of his neck into his jaw. The patient coughs several times while giving this information. He describes the pain as a crushing feeling in his chest. He also states that his left calf has been hurting for several days, but thinks it’s just muscle cramps. Vital signs are obtains and are as follows: Blood pressure is 189/98, pulse is 140 beats per minute. Respirations are labored at 24 per minute. O2 saturation is 95% with two liters per minute of oxygen applied by nasal cannula. The patient’s heart sounds are auscultated and normal S1 and S2 are noted. The apical pulse is bounding and tachycardic at 140 beats per minute. The lungs are auscultated and decreased breath sounds are noted in the right lower lobe. Crackles are noted bilaterally in the lower lobes as well. The brachial pulses are palpated bilaterally by pressing the artery against the bone on the anterior medial aspect of the right and left elbow (Jarvis, 2012). The pulses are strong and equal. The radial pulses are palpated bilaterally by again pressing the artery on the posterior medial aspect of each wrist. These pulses are also strong and equal. Turgor is assessed on each upper extremity by pinching a small fold of skin on the back of the hand. No tenting is observed. The color of the extremity is pink and feels warm to the touch. Capillary refill is assessed by pressing down on the fingernails of each hand and observing the blanching. The capillaries refill in less than 2 seconds. Next the lower extremity pulses are assessed. The femoral pulses are palpated by pressing deeply into the medial aspect of the upper thigh, below the inguinal ligament and about midway between symphysis pubis and anterior superior iliac spine (Jarvis, 2012). Two hands are used, one on top of the other to feel the femoral pulse on each leg. The pulses are even and regular. Moving down the lower extremities, the popliteal pulses are palpated by pressing down on the posterior medial aspect of the knee. The left pulse is slightly diminished compared to the right pulse. Next the posterior tibial pulses are palpated. The posterior tibial pulses are located on the posterior aspect of the ankle. Again, the left pulse is diminished significantly compared to the right pulse. Finally, the dorsalis pedis pulses are palpated on the top of each foot. The left pulses amplitude is low, the right pulse is normal. The left calf is warm and swollen compared to the right calf. The patient complains of pain when the left calf is palpated. Turgor is assessed on the top of each foot and no tenting is observed. Capillary refill is brisk and less than two seconds on the right foot, but is sluggish in the left foot. Decreased pulses in the lower left extremity, swelling and pain are indicative of a blood cl ot known as a deep vein thrombosis (National Institute of Health, 2011). SOAP S: The patient complains of shortness of breath and chest pain that began one hour ago. The patient also complains of left calf pain. O: The patient is hypertensive, tachycardic, is breathing rapidly, and is sweating profusely. Breath sounds are diminished in the right lower lobe. The pulses in the left lower extremity are diminished, the left calf warm, swollen, and tender. A: The patient appears to be suffering from a pulmonary embolism secondary to a deep vein thrombosis in the left lower extremity (Mayo Clinic, 2014). Blood and diagnostic tests are ordered as follows: complete blood count, complete metabolic panel, cardiac enzymes, d-dimer, PT/INR, PTT, ECG, ultrasound of left lower extremity, and CT of the chest with contrast. The results are listed below. Complete blood count is within normal limits. The metabolic panel is within normal limits. The cardiac enzymes are within normal limits, the most important being the troponin level which is less than 0.01, the d-dimer is elevated at 900 ng/ml (normal is P: Anticipate admission of this patient to the ICU. The patient will need to be accurately weighed in anticipation of administration of a heparin drip to prevent further clots and dissolve the clot in the lung and the clot in the left lower extremity. Pulmonary embolism is just one of many causes of chest pain. Although some causes are not medical emergencies it is important to seek medical attention. Early intervention and treatment, especially of cardiac related chest pain is essential in preventing continued or lasting damage to heart muscle. References Jarvis, C. (2012). Physical Examination and Health Assessment [VitalSouce bookshelf version].  Retrieved from http://digitalbookshelf.southuniversity.edu/books/978-1-4377-0151-7/outline/24 Mayo clinic. (2014). Pulmonary embolism. Retrieved November 4, 2014, from http://www.mayoclinic.org/diseases-conditions/pulmonary-embolism/basics/definition/con-20022849 Mayo Medical Laboratories. (2014). D-Dimer. Retrieved November 4, 2014, from http://www.mayomedicallaboratories.com/test-catalog/Clinical and Interpretive/9290 National Institute of Health. (2011). Deep Vein Thrombosis: Symptoms, Diagnosis, Treatment and Latest NIH Research | NIH MedlinePlus the Magazine. Retrieved November 4, 2014, from http://www.nlm.nih.gov/medlineplus/magazine/issues/spring11/articles/spring11pg20-21.html

death of a salesman :: essays research papers

BANG! Your father is dead. Within a few seconds, although he attempted many times, your father dies. He gave up. All the fights, all the disrespect, and all the struggles are behind you. However, all the hope, all the passion, and all the love is still there. In Arthur Miller’s Death of a Salesman, the main conflict is between Willy Lowman and his son Biff. Most of their struggles are based on disrespect; however, much of the tension throughout the play is also caused by the act of giving up.   Ã‚  Ã‚  Ã‚  Ã‚  Disrespectfulness is the cause of personal tension in this play. There are many occurrences where a character is being disrespectful, which triggers emotional and physical conflicts. Throughout the movie, Willy is extremely disrespectful to his wife Linda. He loses his patience every time she talks during a conversation that he is having. When he talks to Biff at the table about his new job opportunities, Linda adds some remarks like, â€Å"I’ll make breakfast,† (1853) and Willy loses his control. He turns to her quickly and tells her to shut up. Sometimes he even puts his finger angrily to her face, screaming at her to shut her mouth, even though she is just adding relative comments. Linda does not lose respect for Willy for his actions as much as Biff does. Biff cares about his mother dearly and does not like to see her being yelled at. He grinds his teeth when he sees his father yell at his mother, because he knows that if he argues, there will be that much more tension between him and his father. However, Biff cannot take it much longer because he is losing respect for his father. He knows his father should never get physical with his mother, and he finally takes action before it gets violent. He grabs Willy by the arm and screams at him not to yell at her. Willy gets angry at first, but then goes to bed guilt-ridden. Loss of respect can ruin a relationship. Biff left town for many reasons, but one important one had to do with Willy cheating on his wife. During a flashback in the play, Willy is in a room with a woman when Biff knocks on the door. The woman was actually in the washroom as Biff came in, but came out before Biff left. Biff saw the woman and knew that his father was not being loyal to his mother.

Ap Euro Essay 2-2

AP European Essay 2-2 The First World War brought about a phenomenon known as â€Å"total war†. Total war is a war fought on all fronts. A total war has the full support of the country and all human resources, from civilians to soldiers, are considered a part of the war effort. Total war during the first world war had a direct impact on the social, political, and economic structures of the European powers. Total war saw many changes in the social structures of Europe. With millions of men at the front unheard of numbers of jobs were available to those who had become accustomed to unemployment and poverty.This type of situation was seldom seen before 1914 where unemployment and poverty had been facts of everyday life. The role of women in everyday life changed immensely with the arrival of total war. With such large number of positions that were typically worked by men opening up many women took roles in society that they had never considered before, such as police officers, ma il carriers, and even industry workers. The presence of Total war also promoted social equality, blurring class lines and closing the gap between the rich and the poor.This greater social equality was very apparent in Great Britain where wartime hardships were never extreme and where the bottom one third of the population actually lived better than they had before the war. The advent of total war also brought about change in the political structure of the European powers. During the first two years of the war both soldiers and civilians supported their governments and saw their county as having a just cause for fighting in the war. European governments employed rigorous censorship and propaganda in order to control the public opinion and maintain popular support.By 1916 the stain of a total war began to wear on the people of Europe and some groups attempted to take advantage of this strain. One group who took advantage of this was the group of Irish nationalists in Dublin in who ros e up against British rule in the Easter rebellion. Similar strikes and protests flared up all over Europe due to inadequate food rations. Total war not only changed the economy of Europe but also helped to bring about a war economy that would have lasting effects.When the war began Germany went about setting up the War Raw Materials Board to ration and distribute raw materials. Under the direction of Walter Rathenau every useful material from foreign oil to barnyard manure was inventoried and rationed. Food also suffered from rationing with those who worked longer, harder days being allotted more food. This rationing of all useful resources facilitated the mobilization for total war and marked the first instance of state socialism functioning realistically rather than as a utopian program.Without these drastic economic changes the total war phenomenon would have never have come to fruition. The effort of both citizen and soldier were vital in bringing about the total war phenomenon. The social, political, and economic structures of the European powers were changed in great ways due to many nations embracing the ideas that make up total war. But through all of the many changes one thing was certain; war is a vital facet in the changing of societies and countries will shape themselves around it. Not only had the lives of Europeans changed due to total war, but war had changed.

Free Essays on Testosterone Levels In College Fraternities

Studies have shown that high testosterone levels are linked to delinquency and excess in human beings. When in group settings, people’s pre-existing characteristics are intensified through means of socialization. Because testosterone is so important in the lives of young men, levels of testosterone may be related tot he kid of groups to which they belong. Looking at college fraternities, the authors hypothesized that fraternities with low testosterone levels would be more intellectually oriented and socially responsible than those with high testosterone levels. The authors then proceeded to retrieve saliva samples from twelve fraternities, five from one university and seven from another. Along with saliva samples, the fraternities were also asked to fill out questionnaires asking about the fraternity’s current grade point average, its number of parties and community service projects during the past year, and the accolades it received during the past two years, if any. Photographs of the fraternity members were also examined as to whether the poser was smiling or not. Both universities showed significant mean differences in testosterone levels among the fraternities studied. At both universities there was less smiling in higher testosterone fraternities. At the first university, higher testosterone fraternities were lower in academics and achievement and community service and were less friendly. They also smiled less, had more parties, and were gregarious, but not warm. The second university showed that fraternities with high testosterone levels were boisterous and macho, while fraternities with low testosterone levels were attentive and helpful. In this university, testosterone did not seem to be related to academic achievement or community service. The authors concluded that while high-testosterone fraternities are rambunctious, low-testosterone fraternities are not necessarily responsible. They stated that â€Å"wel... Free Essays on Testosterone Levels In College Fraternities Free Essays on Testosterone Levels In College Fraternities Studies have shown that high testosterone levels are linked to delinquency and excess in human beings. When in group settings, people’s pre-existing characteristics are intensified through means of socialization. Because testosterone is so important in the lives of young men, levels of testosterone may be related tot he kid of groups to which they belong. Looking at college fraternities, the authors hypothesized that fraternities with low testosterone levels would be more intellectually oriented and socially responsible than those with high testosterone levels. The authors then proceeded to retrieve saliva samples from twelve fraternities, five from one university and seven from another. Along with saliva samples, the fraternities were also asked to fill out questionnaires asking about the fraternity’s current grade point average, its number of parties and community service projects during the past year, and the accolades it received during the past two years, if any. Photographs of the fraternity members were also examined as to whether the poser was smiling or not. Both universities showed significant mean differences in testosterone levels among the fraternities studied. At both universities there was less smiling in higher testosterone fraternities. At the first university, higher testosterone fraternities were lower in academics and achievement and community service and were less friendly. They also smiled less, had more parties, and were gregarious, but not warm. The second university showed that fraternities with high testosterone levels were boisterous and macho, while fraternities with low testosterone levels were attentive and helpful. In this university, testosterone did not seem to be related to academic achievement or community service. The authors concluded that while high-testosterone fraternities are rambunctious, low-testosterone fraternities are not necessarily responsible. They stated that â€Å"wel...

Independent Genitive †Definition and Examples

Independent Genitive s The independent genitive is a construction in which the noun following the possessive form is omitted (such as We stopped at Sams), usually because the context makes the meaning clear without it. English also has independent genitive pronouns  (also called strong  or  absolute  possessive pronouns):  mine, yours, his, hers, its, ours,  and  theirs. Unlike dependent genitive pronouns (or weak possessives), which serve as determiners in front of nouns, the independent genitive pronouns take the place of phrases. For example, in the sentence Thats her book, her is dependent on the noun book, while in the sentence Thats hers, hers is independent. Scholarly Examples and Observations Eternal blue neon, were never closed.When the world is asleep,Darling, come take a seat.You can always eat at Joes,Eat at Joes.(Gary Harrison and Matraca Maria Berg, Eat at Joes. Performed by Suzy Bogguss on Voices in the Wind, 1992)My mother learned that she was carrying me at about the same time the Second World War was declared; with the family talent for magic realism, she once told me she had been to the doctors on the very day.(Angela Carter, The Mother Lode. Shaking a Leg. Penguin, 1998)I like the dry cleaners. I like the sense of refreshment and renewal. I like the way dirty old torn clothes are dumped, to be returned clean and wholesome in their slippery plastic cases.(Fay Weldon, The Heart of the Country. Viking Penguin, 1988)Apples market share is bigger than BMWs or Mercedess or Porsches in the automotive market. Whats wrong with being BMW or Mercedes?(Steve Jobs, quoted by Jason D. OGrady  in Apple Inc. Greenwood, 2009)He crossed Fifth Avenue  at St. Patricks and   recalled walking through the church once - such a tourist thing to do - and watching Lois light a candle.(Rick Hamlin, Reading Between the Lines. Howard Books, 2006) Independent and Dependent Genitives An independent genitive is not followed by a noun: An independent genitive is often used in referring to relationships between people, as in these examples. Notice that this construction has a very specific meaning. The independent genitive a friend of Carolines does not mean the same as the dependent genitive Carolines friend: Independent: We met a friend of Carolines in Spain. Dependent: We met Carolines friend in Spain. The independent genitive means one of Carolines friends, who may or may not be known to the hearer. In contrast, the dependent genitive means one specific friend, who is assumed to be known to the hearer. Independent genitives are also used in reference to places and businesses: (Gerald Nelson, English: An Essential Grammar, 2nd ed.  Routledge, 2011) A friend of CarolinesA colleague of FranksAn old army pal of JimsShe stayed at Rebeccas Rebeccas houseI ran into Jim in Sainsburys Sainsburys supermarketI left my wallet in the barbers the barbers shop Independent Genitive Pronouns Note that most of the independent forms are distinguished from the dependent forms simply by the presence of a word-final -s. The exceptions are the 1st-person independent genitive (mine rather than *mys), and the masculine and neutral forms of the 3rd-person independent genitive (his, its), which are identical to the 3rd-person dependent genitive forms. These pronouns are often described as possessive forms. This is not the most useful label, since the meaning of these forms is not restricted to expressing possession. This is shown in the examples in (27), only the first of which can be said to involve the semantic relation of possession: (27a) I must clean my car. (27b) The professors were not surprised by his failure. (27c) Their hometown is Cambridge. (Martin J. Endley, Linguistic Perspectives on English Grammar. Information Age, 2010) There are four sorts of people. (1) He who says What’s mine is mine and what’s yours is yoursthis is the average sort. (And some say, This is the sort of Sodom.) (2) Whats mine is yours and whats yours is minethis is a boor. (3) Whats mine is yours and whats yours is yoursthis is a truly pious man. (4) Whats mine is mine and whats yours is minethis is a truly wicked man. (Tractate  Abot 5:10.  The Book of Jewish Wisdom: The Talmud of the Well-Considered Life, ed. by Jacob Neusner and Noam M. M. Neusner. Continuum, 1996)

Integrated Marketing Communications 2 Essay Example | Topics and Well Written Essays - 2500 words

Integrated Marketing Communications 2 - Essay Example As a result, classy, trendy and fresh branded outfits are the norm for this age bracket of which the importance can be judged by a statement from Branded- a book written by Quart, Alissa (2003) where she writes "Inspired by the commercialization of youth and also by the signs of resistance to it, I decided to write Branded. The term brand suggests both the ubiquity of logos in today's teen dreams and the extreme way these names now define teen identities."It is for this age group that our paper will look into the mechanisms of branding for a medium-sized company in order to ensure the success of the hosting company and its designer line among the growing market of the youths. One of the most noticeable apparel that a person displays is his or her dressing. This is in fact one of the primary concerns for most of the population especially for females in the ever more fashion and appearance oriented societies that we now live in (John 2009, p12). Moreover, there has been a tremendous leap towards the disposition of branded clothing during the past couple of years which means that companies nowadays are investing more resources towards developing, grooming and maintaining their branded clothes collection which ultimately find preference over the traditional unbranded attires. It is extremely important that companies undertake a well planned and thorough marketing activity to initiate their clothing line in order to be able to compete effectively in the market against other local and international clothing collections. Branding for the youth One of the most important ingredients of marketing that either make or break the designer line's name and his success is branding. The first step in any marketing activity is to identify the target markets which in our case are the youngsters'between the ages of 14-22. It is this age bracket in which the adolescents seem to be standing at an awkward age where neither they are too young to play with the toys nor have they groomed into adults. Understanding the target market, their way of thinking, their activities and the reasons for the true desire to embrace designer outfits with a knowledge of what the teens really want to wear and show off is tremendously important for framing the entire marketing plan and consequently developing the right brand name and image and positioning it in the way youngsters really want it (Knox 2004, p15). What is needed is basically to know exactly what the youth want and delivering according to it. The entire process of branding should focus on the you th and their needs and desires. Understanding the target market For the youth who are lingering somewhere between childhood and adulthood, the craving for dressing and clothing is more than the desire to eat. It is this passion for outfits ranging from classy to gothic to rib-tickling tops, bright primary colors and baggy or tight fitting pants that the medium sized firm needs to capitalize on in an intelligent and creative manner. (Corporate Image Marketing 2009, p1) Once identified with the overall target market, the company now needs to segment this age group on the basis of tastes, preferences and activities. Within the youth age bracket of 14-22, there are the party

Investigating Sustainable Tourism Research Paper

Investigating Sustainable Tourism - Research Paper Example Suriname is located in the northeast of South America, with influences from a variety of cultures, from African and Amerindian to Asian, Dutch, and Jewish (Turquoise.net 2010). Suriname is not dominated by many beach areas that can compare to surrounding areas of the Caribbean, but it is lined with rivers that create a great web of travel into the beauty of the interior jungles. This makes the area a great spot for eco-tourists to see the natural wonders of the rainforests and jungle areas that house an enormous array of wildlife. Since there is little in the way of tourism infrastructure, the resources of the country can be exploited to attract the growing number of eco-tourists that are wanting to explore the natural world on their vacations and holidays. The concept of eco-tourism is based on the idea that the adventure that is available from the beauty of nature is captured in a single experience or group of experiences designed for a period of time within a vacation. According to Ziffer (1989), ecotourism is an adventure that is designed around an indigenous culture, takes place in a relatively underdeveloped area, attempts to leave the area having left no mark upon the eco-system that has been visited while contributing to the local economy, an opportunity to gain an appreciation for the natural resources of the visited area, and represents a dedication by the host region to preserve the natural beauty they hold through funding provided by the ecotourism market (p. 6). One of the prime purposes of the availability of the adventure is to help preserve the natural environments that the tour has exploited so that urban development will not spoil the land. There are some problems with developing a sustainable tourist trade through the ecotourism travel tours.