LYMPHATICS
ROS:
GENERAL: No weight loss, fever, chills, weakness or fatigue.
Head: Symmetrical, no swollen lymph nodes, no signs of sinus infection
Eyes: Does wear glasses due to myopia, no blurred vision, double vision or yellow sclerae.
Ear: No hearing loss.
Nose: Cough present, no congestion, runny nose.
Throat: No sore throat or difficulty swallowing.
SKIN: No rash or itching. Some redness and swelling to right leg.
CARDIOVASCULAR: Right side chest pain, chest pressure, and chest discomfort. Racing heart palpitations.
RESPIRATORY: shortness of breath, chest tightening, increased pain when inhaling, labored breathing.
GASTROINTESTINAL: No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.
GENITOURINARY: Some frequency in urination, wakes twice at night to urinate.
NEUROLOGICAL: headaches and numbness and tingling of fingers. MUSCULOSKELETAL: No muscle, back pain, joint pain or stiffness.
HEMATOLOGIC: No anemia, bleeding or bruising.
LYMPHATICS: No enlarged nodes. No known history of splenectomy.
PSYCHIATRIC: Endorse feeling anxious
ENDOCRINOLOGIC: reports cold sweat
ALLERGIES: latex and mold
O.
General: steady gait. Flushed face with a facial grimace. Appears anxious
Vital signs:
Temperature: 97.9 oral
Respiratory rate: 32, labored
Heart rate: 112, tachycardic
BP right arm: 148/88
Oxygen saturation: 90% on room air
Weight: 210 lbs., stable
Height: 5’8”
Skin: Cool, diaphoretic
Thorax and lungs: Thorax symmetrical; diminished breath sounds right middle and lower lobes; no rales, rhonchi, or wheezes; breath sounds vesicular with no adventitious sounds to the left lung
Cardiovascular: Heart rate is irregular with good S1, S2; no S3 or S4; no murmur or jugular vein distention.
Abdomen: Protuberant with normoactive bowel sounds auscultated x4 quadrants
Peripheral vascular: Right calf with 2+ edema, erythema; warmth and tenderness
on palpation noted; left lower extremity without edema or erythema; 2+ dorsalis pedis pulses bilaterally
Neurologic: Anxious; awake, alert, and oriented to person, place, and time
Diagnostic results: EKG shows Atrial fibrillation. He is waiting to do an angiography, chest x-ray and a ventilation/perfusion scan (V/Q) to examine blood flow in the lungs. Labs for collection are complete blood count, complete metabolic panel, lipid panel, troponin, creatinine kinase, creatine phosphokinase. D-dimer test to check for DVT and pulmonary embolism are needed, and a cardiac MRI to fully view the heart. (Dains, et al., loc 3494. 2016)
A.
The provider states that the patient may have a pulmonary embolism. While this may be accurate, it is good to rule out other illnesses before giving a definitive diagnosis without proper analysis as misdiagnosis can cause a delay in treatment leading to great consequences. There are other possible differential diagnoses such as GERD, anxiety, and angina;