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;