Importance of Proper Differential Diagnosis and Clinical Reasoning
This 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.
Discussion Assignment:
Developing a list of possible conditions that might produce a patient's symptoms and signs is an important part of clinical reasoning.
As an NP in primary care, what would you have done differently? As a NP it is vital to provide high-quality care, and possess the knowledge and clinical competency to provide health care beyond novice registered nurse initial preparation. In this case
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 a serious diagnosis 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 a sufficient understanding of the clinical presentation to offer an opinion on the diagnosis?
What other diagnoses could it be? How might the treatment to date have altered the patient’s 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?
Please support with up-to-date evidence-based standard of care guidelines.
Case Study
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Understanding the various illnesses that can be determined from a set of symptoms is essential for any healthcare practitioner. It allows him to understand the possibilities better and promptly prepare the proper course of treatment as soon as possible. In line with the case at hand, the author believes that a list of differentials could have helped provide the best and prompt kind of treatment that could have saved the patient’s life. It must be noted that the autopsy revealed that an aortic dissection was present in the case. However, during the diagnosis period, the diagnosis of aortic dissection would require a balanced approach between promptness and accurateness. On the one hand, aortic dissection must be determined quickly and precisely because the patient’s survival rate is determined by the quickness of actions to address it (Manea, et al., 2019). On the other hand, however, the diagnosis of aortic dissection could also be taken with caution because it is relatively uncommon and shows similar symptoms with more common cardiothoracic illnesses...
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