You are the nurse working in the cardiac care unit. Ms. Franklin is a 54-year-old woman admitted to your unit with a myocardial infarction (MI) 3 days ago. She is alert, oriented, and gives a reliable history. She has been experiencing headaches and worsening burning chest pains which she interpreted as indigestion, along with left arm numbness and dyspnea on exertion. Her brother, age 66, who sustained an MI at age 45, encouraged her to go to the emergency room (ER) even though she could not believe her symptoms were cardiac. Ms. Franklin thought she was just exhausted from all the yard work she had been doing. She also has a history of cervical strain from a motor vehicle accident, which she thought was acting up and causing her arm numbness. She is divorced with a 25-year-old daughter who is on her own. Ms. Franklin is working as a high school teacher and sells cosmetics part-time to make ends meet. She admits to not eating well, having a lot of fast food and frozen dinners because she eats mostly alone between jobs. She is moderately obese and knows she has a high cholesterol level, but thought she could manage it by diet and fish oil capsules. She has not had a physical examination in 3 years because she is “too busy.” She has hypertension with an admission blood pressure of 176/110. She has had problems with intermittent premature ventricular contractions (PVCs), although it has not gone into ventricular tachycardia. Her work-up also revealed a systolic murmur, so she is scheduled for an echocardiogram tomorrow. As her primary nurse, it is your job to help her understand coronary artery disease, hypertension, hyperlipidemia, and all the lifestyle changes she must now make. You start with some focused questions.
What are the questions in the following that should be asked to the patient described above:
• “Do you have a family history of heart disease, rheumatic fever, or high blood pressure?”
• “Have you had indigestion, gallbladder disease, or irritable bowel syndrome?”
• “Did either of your parents or any siblings have a heart attack or die of a heart attack, and at what age?”
• “Have you had any unusual rashes or changes in moles?”
• “What type of diet do you eat?”
• “Have you taken any medication for these symptoms?”
• “Do you exercise regularly? How often and how much?”
• “Have you experienced any other chest pain or discomfort? If so, when and how was it relieved?”
• “Do your legs, feet, and ankles get swollen? If so, what do you do to help these symptoms?”
• “Do you experience shortness of breath? If so, when, and what relieves it?”
• “Do you have any burning on urination?”