case portrays a poor patient outcome after a misdiagnosis

Case scenario

A previously healthy 35-year-old lawyer presents to a primary care office with a chief complaint of chest pain and a non-productive cough. The pain started suddenly 2 hours prior to coming to the office while the patient was sitting at his desk. The patient describes the pain as sharp in nature, constantly present but made worse with inspiration and movement, and with radiation to the base of the neck. His blood pressure in the right arm and other vital signs are normal.

On physical

examination
 the only findings of note are chest wall tenderness and a faint cardiac murmur. The ECG in the office is normal. The patient is observed for an hour in the office and assessed. He is diagnosed with viral pleurisy and sent home on non-steroidal analgesics.

The following day the patient collapses at home and cannot be resuscitated by the paramedic service. An autopsy reveals a Type 1 aortic dissection with pericardial tamponade.

Written Assignment:

Developing a list of possible conditions that might produce a patient’s symptoms and signs is an important part of

clinical
 reasoning.

  1. As an NP in primary

    care
     what would you have done differently?
  2. Discuss the importance of creating a list of differentials for this patient. How could it have changed this outcome?

If a serious diagnosis comes to mind based on a patient’s symptoms:

  • Ask yourself; Have you considered the likelihood of it and whether it needs to be ruled out by testing or referral?
  • Because many serious disorders are challenging to diagnose, have you considered ruling out the worst case scenario?
  • Ask yourself: Do you have sufficient understanding of the clinical presentation to offer an opinion on the diagnosis?
  • What

    other diagnosis
     could it be? How might the treatment to date have altered the patient outcome?
  • What other diagnostic and laboratory or imaging was needed in order to make a complete differential list? What support tools would you consider using in helping to create a differential diagnosis list?
  • Are you familiar with the current clinical practice guidelines for the investigation of a suspected condition such as chest pain?

To view the Grading Rubric for this Assignment, please visit the Grading Rubrics section of the Course Resources.

Assignment Requirements:

Before finalizing your work, you should:

  • be sure to read the Assignment description carefully (as displayed above);
  • consult the Grading Rubric (under the Course Resources) to make sure you have included everything necessary; and
  • Utilize spelling and grammar check to minimize errors.

Your

writing
 Assignment should:

  • follow the conventions of Standard English (correct grammar, punctuation, etc.);
  • be

    well ordered
    ,     logical, and unified, as well as original and insightful;
  • display superior content, organization, style, and mechanics; and
  • use APA 6th Edition format as outlined in the APA Progression Ladder.
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