Negligence of duty has led to several unpredicted outcomes in professional fields. In this case, it can be linked to the laxity of duty. The nurse practitioner should have taken more time than she did to reason out the possible illness that the patient had rather than making assumptions. In essence, the diagnosis of some rare diseases should be accorded an intensive analysis to rule out other possibilities. For various patients who have suffered from aortic dissection, the condition takes an extended period to manifest, thus, the physical symptoms can be misinterpreted. Therefore, there is need to pay keen attention to such diseases and their diagnosis.
How the Nurse Practitioner Should Have Responded
In this case, after conducting the physical examinations and the ECG, which were normal, a nurse practitioner should have suggested that the patient is provided with an immediate referral to a hospital with enhanced facilities for further examination. For example, medical tests such as cardiac enzymes, and imaging studies would be appropriate to carry out. Additionally, I would employ increased use of sophisticated cross-sectional imaging techniques, such as a computed tomographyscan (CTs), angiography, and magnetic resonance imaging (MRI) (Kolansky et al., 2017). The angiography will offer the interpretation of the imaging findings by the radiologist. These tests form an integral part of diagnosing acute aortic syndromes. Moreover, an accurate and early diagnosis of the aortic condition is vital to achieving the best patient outcomes. A timely diagnosis is important because the result indicates the location and extent of the dissection. Hence, the recognition of possible differential diagnosis is paramount.
Importance of List of Differentials for the Patient Diagnosis
Creating the list of differentials assists in looking at several possible conditions that could cause a patient’s symptoms and enable one to eliminate them through a rejection criterion(Roberts, 2017). Using the list enhances the process of obtaining an accurate and final diagnosis. Additionally, from the list of differentials, there could be a change of a patient’s diagnostic outcomes through determining his or her condition before clinicians use what they know. In a nutshell, pathophysiology will have to be applied jointly with the other findings during the patient assessment and the patient’s history. A list of the diseases of differential diagnoses would reveal the following, as described by Wedro (2015):
- Broken or bruised ribs
- Angina and heart attack
- Aorta and aortic dissection
- Pleuritic or pleurisy
- Pulmonary embolism
- Referred abdominal pain
The results and alternative options of the diagnosis would challenge the practitioner to think more deeply than usual. Going over the list aids a nurse practitioner to question his or her thoughts and assumptions regarding whether to conduct further tests in the current hospital premises or make referrals elsewhere.
Testing or Referrals in Aortic Diagnosis Cases
For cases where the necessary equipment for further testing is unavailable, a referral to another hospital is warranted. The recommendation is made to avoid delayed diagnosis that can affect a patient’s results drastically. However, the practitioner has to clarify the need for more specific clinical examination and the relevance of such tests to the diagnosis and treatment (Mancini, 2016). Lack of common symptoms such as pulse deficit and chest complications changes should not lead to general conclusions. Besides using highly technical equipment, nurse practitioners should take their time to exhaust all options of possible conditions from the list of symptoms (Delice, Çalık, Erkut, & Yeşilyurt, 2016, p. s82). Furthermore, the patient suffering from the disease should receive his or her treatment depending on the information provided regarding prior allergies and drug reactions.
In conclusion, the nurse practitioner should adopt both the testing criteria and referral for further examination after a proper analysis of a patient’s symptoms. The use of multiple examination procedures will result in an accurate response to the presenting symptoms and increased patient survival rate through allowing for critical judgment.
Delice, O., Çalık, E. S., Erkut, B., & Yeşilyurt, H. (2016). Aortic dissection in our emergency service. The American Journal of Cardiology, 117(1), S82. Retrieved from http://dx.doi.org/10.1016/j.amjcard.2016.04.221
Kolansky, D. M., Cuchel, M., Clark, B.J., Paridon, S., McCrindle, B.W., Wiegers, S.E., Araujo, L., Vohra, Y., Defesche, J.C., Wilson, J.M., &Rader, D.J. (2008) Longitudinalevaluation and assessment of cardiovascular disease in patients with homozygous familial hypercholesterolemia.American Journal of Cardiology, 102(11), 1438-43Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/19026292
Mancini, M. C. (2016, December 22). Aortic dissection: Practice essentials, background, anatomy. Medscape. Retrieved from https://emedicine.medscape.com/article/2062452-overview
Roberts, W. C. (2017). Cardiology 1919–1941 and cardiology today. American Journal of Cardiology, 120(6), 1040-1041. doi: 10.1016/j.amjcard.2017.06.038
Wedro, B. (2015, February 11). Chest pain: Get the facts about causes of this symptom. Retrieved from https://www.rxlist.com/chest_pain/article.htm