Poor Patient Outcome After a Misdiagnosis Case Paper

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Health Medical

Description

Poor Patient Outcome

Relying solely on the classic features of a disease may be misleading. That's because the clinical presentation of a disease often varies: the symptoms and signs of many conditions are non-specific initially and may require hours, days, or even months to develop.

Generating a differential diagnosis; that is, developing a list of the possible conditions that might produce a patient's symptoms and signs — is an important part of clinical reasoning. It enables appropriate testing to rule out possibilities and confirm a final diagnosis.

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.

Written Assignment:

Developing a list of possible conditions that might produce a patient's symptoms and signs is an important part of clinical reasoning.

  1. As an NP in primary care what would you have done differently?
  2. 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 it 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 sufficient understanding of the clinical presentation to offer an opinion on the diagnosis?
  • What other diagnosis could it be? How might the treatment to date have altered the patient 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?

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Explanation & Answer

Attached.

Running head: POOR PATIENT OUTCOMES

Poor Patient Outcomes
Student’s Name
Institutional Affiliations

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POOR PATIENT OUTCOMES

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Poor Patient Outcomes

As an NP in primary care, I would have conducted a thorough and complete assessment
that involves a systematic examination of the patient as a whole. The assessment would have
included an initial assessment and secondary assessment. The initial assessment would have
generated a general impression and identified instant life-threatening conditions while the
secondary assessment that includes a comprehensive physical examination would have identified
and measured changes in the conditions of the patient (Morais, Manuel & M Cáceres-Loriga,
2016). I would have repeated these assessments since the patient in the case study has a
presentation with various possible causes of chest pain and a dry cough. The systematic and
comprehensive assessment would have allowed me to consider possible causes and differential
diagnoses of the patient's condition and then carried out various suitable actions while evaluating
the results of the actions. Differential diagnosis would have enabled me to consider various
conditions that may cause the symptom described by the patient and follow the elimination
process to rule them out. When an NP employs differential diagnosis in establishing a patient’s
condition, one is using his or her knowledge about pathophysiology and apply it with the
findings of the assessment and the patient's history (Ghani, 2015).
In this case, the patient had Type 1 aortic dissection but had been misdiagnosed with viral
pleurisy. As a primary care provider attending to the patient, I would assess aortic dissection risk
factors through collecting a comprehensive history. I would inquire about the patient's
underlying conditions, such as preexisting aortic aneurysm, atherosclerosis, or hypertension.
Family history of the condition would also be considered as a risk factor (Morais, Manuel & M
Cáceres-Loriga, 2016). As an NP, I could have conducted a physical examination to get a clue of
the condition. I would have measured the blood pressure of both the right and left arm or legs
since blood pressure differential above 10mm Hg of systolic or diastolic pressure may be a sign

POOR PATIENT OUTCOMES

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of aortic dissection. A chest X-ray could also have been conducted since it reveals mediastinal
widening and potential heart failure, cardiomegaly, or pleural effusion if the patient...


Anonymous
Really useful study material!

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