AACN clinical issues
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Chest pain is the initial symptom of many life-threatening disease processes. Pain may arise from any structure located in the thoracic cavity. ⋯ Diseases that require immediate attention and intervention are myocardial infarction/unstable angina, dissecting aortic aneurysm, pericarditis, pulmonary embolism, pneumothorax, pneumonia, and acute chest syndrome. In order to evaluate a patient with the complaint of chest pain, the advanced practice nurse must be familiar with the differential diagnosis approach to acute chest pain.
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Agitation is a frequent clinical problem that adds significant morbidity to the hospital course. Agitation is usually part of an ambiguous constellation of cognitive and psychiatric symptoms, with a fluctuating clinical course. Observation of vastly different symptoms occurring at different times leads to misdiagnosis or underrecognition of serious underlying disorders. ⋯ Risk factors attributable to hospitalization include pain, anxiety, and stressors endemic to intensive care. Agitated states may have multiple causes, and each potential contributor must be pursued and treated independently. Definitive diagnosis is dependent on a comprehensive history, patient observation, physical examination, and selective diagnostic studies.
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Advanced practice nurses are responsible for diagnosing and treating patients with acute onset hypotension. The potential diagnostic hypotheses for hypotension are related to a wide variety of pathophysiologic processes. ⋯ The clinician bases these decisions on information contained in a subjective and objective database and on recognizing patterns in the central findings. However, treatment of hypotension may be necessary before or during the diagnostic process, depending on the severity of the patient's symptoms.