NR 546 Week 6 Case study
HISTORY OF PRESENT ILLNESS:
A 37-year-old male was brought to ED by his partner. The client has been
experiencing chest pain for 1 day, starting at 2:00 a.m. He is triaged to the
medical emergency department. A medical history is taken. The client has no
history of myocardial infarction(MI) or hypertension. The client is irritable and
hypervigilant. He repeatedly asks the nurse if “you know what you are
doing” and becomes increasingly guarded as the intern requests more
details about his medical history, replying suspiciously, “you don’t need to
know that.” He denies feeling depressed and says he is “just stressed
out.” He is cooperative with ECG but is restless.
The man’s partner asks if she can speak to the ED provider alone and says
that the clienttypically leaves his work as an investment banker on Friday
night and does not return home until the early morning hours on Saturday,
stays out late several nights a week, andhas great difficulty going to work on
time in the morning. On the weekends, he often sleeps 12-18 hrs. a day. She
also noticed some weight loss over the past few months.
Sometimes after a late-night working or socializing with co-workers, he
accuses her of cheating on him or talking about him behind his back. The
partner denies the client’s accusations and appears extremely concerned.
She acknowledges that he has been underincreased pressure at work to
perform and stay late; several friends at work have been laid off in the past
year.
PAST PSYCHIATRIC HISTORY:
The client denies any past psychiatric history; he has never been
hospitalized in a psychhospital or received psychiatric treatment. He
admits that he “dabbled” in drugs recreationally but it’s not a problem.
“I am here for chest pain.”
, PAST MEDICAL HISTORY:
The client denies any past or current medical problems.
MENTAL STATUS EXAM:
The client is alert and oriented and appears disheveled, dressed in unkempt
work clothes. His speech is rapid and mildly increased in volume but is not
pressured. He is restless andlooks around the room frequently, though he
does not exhibit psychomotor agitation.
Client describes his mood as “fine,” “just having chest pain,” but his
affect is extremely anxious, irritable, and guarded. Thought process is linear
and goal-directed, but thought content shows some paranoid ideation
toward his partner and ER staff. The client denieshallucinations and suicidal
or homicidal ideation. His cognition is intact. Insight and judgment are
deemed to be limited.
PHYSICAL EXAM:
VITAL SIGNS: HR=104/min.; B/P 170/95; Temp= 98.9F, resp.= 18/min.
The client is breathing comfortably and appears restless without obvious
signs of distress.The client appears somewhat thin, and there are traces of
dried blood noted in his left nostril. Cardiac exam reveals no signs or
murmurs, rubs, or gallops. The remainder of theexam was likewise
unremarkable.
HISTORY OF PRESENT ILLNESS:
A 37-year-old male was brought to ED by his partner. The client has been
experiencing chest pain for 1 day, starting at 2:00 a.m. He is triaged to the
medical emergency department. A medical history is taken. The client has no
history of myocardial infarction(MI) or hypertension. The client is irritable and
hypervigilant. He repeatedly asks the nurse if “you know what you are
doing” and becomes increasingly guarded as the intern requests more
details about his medical history, replying suspiciously, “you don’t need to
know that.” He denies feeling depressed and says he is “just stressed
out.” He is cooperative with ECG but is restless.
The man’s partner asks if she can speak to the ED provider alone and says
that the clienttypically leaves his work as an investment banker on Friday
night and does not return home until the early morning hours on Saturday,
stays out late several nights a week, andhas great difficulty going to work on
time in the morning. On the weekends, he often sleeps 12-18 hrs. a day. She
also noticed some weight loss over the past few months.
Sometimes after a late-night working or socializing with co-workers, he
accuses her of cheating on him or talking about him behind his back. The
partner denies the client’s accusations and appears extremely concerned.
She acknowledges that he has been underincreased pressure at work to
perform and stay late; several friends at work have been laid off in the past
year.
PAST PSYCHIATRIC HISTORY:
The client denies any past psychiatric history; he has never been
hospitalized in a psychhospital or received psychiatric treatment. He
admits that he “dabbled” in drugs recreationally but it’s not a problem.
“I am here for chest pain.”
, PAST MEDICAL HISTORY:
The client denies any past or current medical problems.
MENTAL STATUS EXAM:
The client is alert and oriented and appears disheveled, dressed in unkempt
work clothes. His speech is rapid and mildly increased in volume but is not
pressured. He is restless andlooks around the room frequently, though he
does not exhibit psychomotor agitation.
Client describes his mood as “fine,” “just having chest pain,” but his
affect is extremely anxious, irritable, and guarded. Thought process is linear
and goal-directed, but thought content shows some paranoid ideation
toward his partner and ER staff. The client denieshallucinations and suicidal
or homicidal ideation. His cognition is intact. Insight and judgment are
deemed to be limited.
PHYSICAL EXAM:
VITAL SIGNS: HR=104/min.; B/P 170/95; Temp= 98.9F, resp.= 18/min.
The client is breathing comfortably and appears restless without obvious
signs of distress.The client appears somewhat thin, and there are traces of
dried blood noted in his left nostril. Cardiac exam reveals no signs or
murmurs, rubs, or gallops. The remainder of theexam was likewise
unremarkable.
