100%(30)30 out of 30 people found this document helpful
This preview shows page 3 - 6 out of 7 pages.
-IgM / IgG ELISA titers can potentially rule out a herpes zoster infection, but prior varicella infection can cause inconclusive results (CDC, n.d.).-Complete blood count with differential can be used to rule out an infectious cause such as pneumonia (Dains et al., 2016).-Hct/Hgb can be used to diagnose anemia (Dains et al., 2016) as suggested by the client’s pallor. Krajewska et al. (2017) also noted a potential relationship between atrial fibrillation and anemia.-Cardiac enzymes. To help in ruling out a cardiac-based cause for the pain, this client should have cardiac enzyme testing completed. Dains et al. (2016) noted this can include: creatine kinase (CK)
and troponin (T) testing to measure possible cardiac damage with T being the earliest and most specific marker.Other testing:-Electrocardiogram (12-lead ECG) will primarily rule our cardiac causes, especially when there are prior reading with which to compare the results (Dains et al., 2016) as for this client. The tachycardia and irregular pulse are also indications for ECG testing for this client. The completed ECG appears to demonstrate atrial tachycardia.-Computed tomography-pulmonary angiography (CTPA). Alhassan et al. (2016) recommended CTPA as the gold standard for diagnosing a pulmonary embolism with a sensitivity of 83% and specificity of 96%. Dains et al. (2016) reported this test can be used to diagnose a dissection as well. Alhassan et al.warned this test requires significant resources of time and cost as well as exposing the client to radiation and dye and should be undertaken only when a client meets criteria using a score such as Wells’ criteria to differentiate those at high and low risk. Per the Wells’ criteria (Alhassan et al., 2016). this client would score a 5.5 out of 12.5 possible points andtesting is recommended for those scoring > 4 points.-Chest x-ray. A chest x-ray can be used to diagnosis a pneumothorax or pneumonia; although it is not a definitive exam for a PE, it can demonstrate changes in the chest physiology such as infiltrates (Dains et al., 2016).-Compression ultrasonography. This test provides a non-invasive highly specific (98%) and sensitive (94%) method of diagnosing a first episode of deep vein thrombosis by compressing the femoral and popliteal veins (Huisman & Klok, 2013).Non-acute labs– follow-up should be made regarding the recent lipid panel completed at a health fair. Although the client’s pain may not originate from a cardiac cause, he has several risk factors for coronary artery disease and needs education and follow-up. A.presumptive diagnosis
This client’ pain is sudden and severe. Dains et al. (2016) noted acute pain often is the result of emergent conditions that need to be ruled out before looking at less significant issues such as musculoskeletal based pain or GERD. Respiratory rate is increased, but there is no history of chronic respiratory problems and AP diameter is less than the lateral diameter of chest.