1 ED526 Discussion 11 Assignment Task Part 1 · Select an article that focuses on one of the Mississippi College and Career Readiness Strands. Summarize and critically analyze the article in 300 words for classroom purposes and application.  · Critique the article by telling why you liked or disliked the article and pose a thought-provoking question to your peers.  · Make sure you provide the reference so your article can be retrieved by your peers.  Assignment Task Part 2 Respond to two peers and response must be in APA format, with citations and references.   Mr. Rosetti presented with left arm pain and chest pain that he has had for years. He came in today stating that his chest pain and arm pain has changed and over the past few days he has pain when he wakes up and intermittently throughout the day. He takes Procardia XL 60 mg every day for  blood pressure,  isosorbide dinitrate 40 mg three times a day for angina, and one or two nitroglycerine pills when he has chest pain." HE does not smoke, drink or do any drugs. He denies injury and denies shortness of breath or dyspnea. I assessed Mr. Rosetti and his exam was rather benign. S1/S2 heart sounds could be heard. Breath sounds were clear. I ordered an EKG, a cbc, cmp, and a troponin right away. I wanted to ensure that he was not having an NSTEMI. All of his labs were within normal limits. Next, I ordered a chest x-ray and a CT chest to ensure there was no pneumonia or PE that could be causing pain. Both of those tests were negative. I ordered an Echo to assess his heart function and his EF was 40-45%. Finally, I ordered a stress test in which he was unable to complete due to pain and tachycardia along with EKG changes. Based on all of these findings I have come up with three differential diagnoses which include but are not limited to: ·     Unstable angina: Tabor & Whitmore (2018), explain that unstable angina occurs due to an acute obstruction of the coronary artery without myocardial infarction. These patients can present with chest pain/burning, left arm pain/numbness/tingling, angina that becomes more frequent even when resting, shortness of breath and more. In order to properly diagnose angina, it is important to obtain a troponin (if first one is negative may want to repeat in 8-12 hours), a CK-MB level, Chest x-ray, Echocardiogram and a CT chest to ensure the patient is not experiencing a life-threatening aortic dissection.  Patients with unstable angina should be admitted to the hospital, given aspirin and Plavix for antiplatelet management and nitroglycerin for the pain if not hypotensive or have not used a phosphodiesterase type 5 inhibitor within 24-48 hours. If the patient is experiencing unstable angina along with an NSTEMI then they need to have a cardiac catheterization performed within 24-48 hours of being admitted into the hospital for and necessary PCI. ·     Pericarditis: occurs when the pericardium of the heart becomes inflamed causing fluid buildup and irri ...

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ED526 Discussion 11
Assignment Task Part 1
· Select an article that focuses on one of the Mississippi College
and Career Readiness Strands. Summarize and critically analyze
the article in 300 words for classroom purposes and
application.
· Critique the article by telling why you liked or disliked the
article and pose a thought-provoking question to your peers.
· Make sure you provide the reference so your article can be
retrieved by your peers.
Assignment Task Part 2
Respond to two peers and response must be in APA format, with
citations and references.
Mr. Rosetti presented with left arm pain and chest pain that he
has had for years. He came in today stating that his chest pain
and arm pain has changed and over the past few days he has
pain when he wakes up and intermittently throughout the
day. He takes Procardia XL 60 mg every day for blood
pressure, isosorbide dinitrate 40 mg three times a day for
angina, and one or two nitroglycerine pills when he has chest
pain." HE does not smoke, drink or do any drugs. He denies
injury and denies shortness of breath or dyspnea. I assessed Mr.
Rosetti and his exam was rather benign. S1/S2 heart sounds

2. could be heard. Breath sounds were clear. I ordered an EKG, a
cbc, cmp, and a troponin right away. I wanted to ensure that he
was not having an NSTEMI. All of his labs were within normal
limits. Next, I ordered a chest x-ray and a CT chest to ensure
there was no pneumonia or PE that could be causing pain. Both
of those tests were negative. I ordered an Echo to assess his
heart function and his EF was 40-45%. Finally, I ordered a
stress test in which he was unable to complete due to pain and
tachycardia along with EKG changes. Based on all of these
findings I have come up with three differential diagnoses which
include but are not limited to:
· Unstable angina: Tabor & Whitmore (2018), explain that
unstable angina occurs due to an acute obstruction of the
coronary artery without myocardial infarction. These patients
can present with chest pain/burning, left arm
pain/numbness/tingling, angina that becomes more frequent
even when resting, shortness of breath and more. In order to
properly diagnose angina, it is important to obtain a troponin (if
first one is negative may want to repeat in 8-12 hours), a CK-
MB level, Chest x-ray, Echocardiogram and a CT chest to
ensure the patient is not experiencing a life-threatening aortic
dissection. Patients with unstable angina should be admitted to
the hospital, given aspirin and Plavix for antiplatelet
management and nitroglycerin for the pain if not hypotensive or
have not used a phosphodiesterase type 5 inhibitor within 24-48
hours. If the patient is experiencing unstable angina along with
an NSTEMI then they need to have a cardiac catheterization
performed within 24-48 hours of being admitted into the
hospital for and necessary PCI.
· Pericarditis: occurs when the pericardium of the heart
becomes inflamed causing fluid buildup and irritation (Ismail,
2020). Patients that are suffering from pericarditis often
complain that they have chest pain when they take a deep breath
or lay down and it resolves if they sit up or lean forward. In
order to diagnose pericarditis an EKG can be performed
showing widespread saddle shaped ST elevation with PR

3. depression. Laboratory tests that can be performed are a c-
reactive protein as this will most often be elevated due to the
inflammation. Patient’s must have two of the following in order
to diagnose pericarditis: pericardial friction rub, widespread ST
elevation and/or PR depression and a new pericardial effusion.
Patients with pericardial effusions should be instructed to not
exercise for at least 3 months, NSAIDs (Ibuprofen 600mg TID
x1-2 weeks) and PPIs are used in conjunction to help with the
pain.
· GERD: Gastroesophageal reflux disease (GERD) can
present with the same symptoms that Mr. Rosetti was
experiencing. It is estimated that 18-28% of Americans have
GERD (Clarett & Hachem, 2018). GERD occurs when stomach
contents reflux into the esophagus and this can cause burning in
the chest/esophagus. GERD is most often diagnosed based on
the symptoms that the patient is having and are worse when the
patient is laying down. An EGD can be performed as well to
help confirm that the patient is suffering from GERD. In order
to treat GERD patients should be placed on either an H2 blocker
or a PPI to help reduce the acid that the patient is producing. If
those work the patient will not need a further work up.
Based on his diagnosis of Unstable angina Mr. Rosetti should
undergo a stress test and PCI to prevent further ischemic events
from occurring in the future. He will then need to follow closely
with his cardiologist to perform routine evaluations to ensure
that he does not have any new obstructions developing. Weight
loss and diet can also help decrease his cholesterol in turn
decreasing the plaque that is building up in his arteries and help
with blood pressure management. The patient can also be placed
on Plavix to help with preventing an MI from occurring in the
future.
References:
Clarrett, D., & Hachem, C. (2018). Gastroesophageal reflux
disease (GERD). Missouri medicine. Retrieved April 15, 2022,
from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140167/
Ismail, T. (2020, January). Acute pericarditis: Update on

4. diagnosis and management. Clinical medicine (London,
England). Retrieved April 15, 2022, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6964178/
Tabor, L., & Whitmore, T., (2018). Coronary Artery Disease.
Retrieved from https://app.careonpoint.com/Search.aspx