Medical Essay on Pains in the Chest and Muscles

History of Present Illness

It is the third time that Mr. Smith is reporting his medical worries to the hospital. He explains that he was in good health before he began experiencing the symptoms. He explains that he woke up one morning feeling sharp pains in his chest and muscles, but they were irregular. He assumed that his body was just tired and hence exhibiting the reaction. The pain in the muscles stopped after few days but remained consistent in the chest. However, the chest pains shifted from lasting a few seconds to more than five minutes. He reports that the pain also affected his neck by which he cannot turn his head without straining. The pain became more severe when he was cleaning his backyard by which he could not move for some time and assumed a bending position until someone came to his aid. He had worked for about twenty minutes before the onset of the pain. He explains that he experienced difficulty in breathing but was not nauseated or sweaty. The pain lasted for about ten minutes after he was taken back to her house and allowed to rest. He explains that four days ago, he experienced the pain that lasted for about twenty minutes when he was trying to make dinner. He had to call for help with the fear that the pain may affect him again. He felt a sharp pain in his left rib and hence prompting him to seek medical service immediately.

He explains that from the onset of the pain, he has never taken any medication and only took a rest whenever he felt any pain. From his explanation, no other signs have been exhibited apart from the pain. He explains that he has not experienced any pain in his joints but only the chest pains which have become consistent. He explains that he experienced little difficulty in breathing whenever the pain occurred. Nonetheless, he does not include orthopnea, paroxysmal nocturnal dyspnea or dyspnea. From his explanation, the pain was still the same during any movement; the pain did not associate with food in addition to the lack of palpable pain. According to his medical records, there were reports of joint pain, psychosocial/spiritual well-being (being embarrassed by his obesity), poor sleeping pattern, Cognitive/mental status and behavioral, nutrition and hydration, increased lab values like his sodium level (155 MEq/L) and his blood sugar (180mg/dl). Mr. Smith has also demonstrated several indicators of depression, namely irritability, lethargy and occasionally being unable to follow the dieticians plan.

On risk factors, she has never engaged in cigarette smoking or alcohol intake. However, his work at the bakery exposed him to plenty of pastry which explains his weight. His family history indicates premature CAD but not any cases of heart problems or cancer. He feeds on a healthy diet but not occasionally by which he requires supervision to ensure that he sticks to a healthy diet.

Narrative parallel chart

He is forty-one years old which makes him my uncles age. He layed on his bed with plenty of concern one Monday morning. I am familiar with that look especially among patients with the similar condition. He appeared to be in deep thought, and I knew that this was the right moment to distract him. I was among the nurses who were assigned to his care regarding his physical exercise with PT. At first, he complained a lot that the exercise was overwhelming and that he wished that there were drugs that could take away all the weight. He would at times fake a headache to ensure that he did not attend the exercise. Nonetheless, after spending plenty of time in the hospital and associating with the nurses and doctors, he appeared to be more relaxed. My uncle also had issues with his weight, and through support and adequate care, he was able to overcome his insecurities and discipline himself when it comes to dieting. Therefore, I could relate to Smiths medical and mental condition. I was given the role of following up with his daily plan with PT to ensure that he fully engaged in the exercise. I kept on reminding him that the exercise was to his advantage and that in the end, he would appreciate that he took part in the exercise.

I entered his room and asked him what he was thinking about. He stared at me and posed for about ten seconds and then told me that he was worried that the treatment was not working as expected. He felt that he was gaining more weight instead of losing. I am aware of this concern because my uncle also shared with me during his treatment. I showed him the picture of my uncle before the treatment and after the treatment which made him relax. I tried as much as to comfort him and provide him with the assurance that he will feel the changes soon enough. I then helped him out of bed and walk with him to the section where he is supposed to receive the PT exercise. I carefully note the changes and his behavior throughout the exercise and helped him back to his hospital bed. That is part of my daily routine until I see him the following day.

The following morning, I did not find him in his bed. I enquired about it and was told that he had experienced breathing difficulties which made it necessary to place him in the intensive care unit. All I could think of was whether I had misread some signs yesterday or ignored some information during our conversation. I was quite nervous especially as I was the one in charge of monitoring his progress. After five hours, I was informed that he was doing fine and that he needed to relax from any stressful factor that might interfere with his medical treatment but would remain in the ICU for some time. I made checks to ensure that his treatment plan was as expected and made necessary changes in his social environment by which I talked to his family members to make frequent visits to assist in reducing the depression levels. After getting out of the ICU and resuming his bed, I ensured that I noted any alarming issue and gave him treatment before further damage.

Narrative pathology

I just had to sit down because I got short of breath. I was at a restaurant earlier where the manager had to seat me at the counter because I couldnt fit in the booth. I have pain in my knees and my joints. I sleep with a breathing apparatus at night. And Im a great candidate for a heart attack. I hate it. I hate the way I feel. But Ive been overweight for so long that people assume I dont want to lose weight. Friends and family wonder why I dont just stop eating. But its an addiction for me. When I walk past a bakery, I feel the same way that an alcoholic must feel when he walks past a bar. But people seem to think that the alcoholic is unable to quit. And they think I choose not to. I eat to deal with stressful issues by which if I am surrounded with an issue which is overwhelming, I opt to eat as a defensive mechanism. I have always received criticism from my family members, and friends regarding my weight; an issue that has lowered my self-esteem and made me experience periods of depression. The criticism has also affected my self-perception by which I feel insecure whenever I go out. Furthermore, I have had periods where I cannot sleep at night because of my physical insecurities.

I have had issues forming relationships as a result and hence making food the only way that I can relieve stress. My family history lacks cases regarding obesity, and hence I dont believe that genetics influences my condition. Nonetheless, I feel that there is a need for changing my diet because of my health and mental problems which are affecting my progress. I have had issues with my breathing such that I cannot take long walks or stand for a long time. I also have periods of sleep apnea by which I snort a lot in addition to periods of joint and muscle pain. After seeking medical help, the physician indicated my poor sleeping status, my psychosocial wellbeing, my behavioral and mental status in addition to hydration and nutritional status in my diagnosis. At first, I was a bit reluctant since medication implied engaging in plenty of exercises, developing a dieting plan and acquiring services of a counselor. I was put on a dieting program and a regular PT exercise by which I had a nurse to monitor my progress and ensure that I was sticking to the plan. I found it challenging sticking to a diet filled with vegetables and less meat. I wanted to give up and accept myself for who I was and leave with the consequences. However, my health was at stake, and hence I had to follow all the instructions. My family has been quite supportive during this period by which the support has enabled me to gain confidence and get the motivation to abide by the treatment plan. The exercise has proven to be useful especially since I can take long walks these days without feeling tired after a short while. I am certain that with time my physical and mental health will improve especially with the daily help that I receive from nurses and the support from my family.

Response letter from Phinise

Patient: John Smith, D.O.B.04-09-76

Dear HN,

Thank you for your letter that we received regarding Mr. John Smith. The members of staff took note of the diagnosis and ensured that he received the same care that he was receiving in the home care. Handling Mr. Smiths condition was not difficult due to the prior care that he had received. More focus was put on his breathing problems, medical needs, personal needs and emotional needs as highlighted in your letter. You presented the view that he required the support of a dietician in addition to PT follow up to ensure that the goals of the PT plan are achieved as expected. The nurse in charge of the care noted the fact that Mr. Smith experienced barriers in finishing his daily PT exercises in addition to adjusting to his daily diet. She ensured that his diet was adequately structured and that it was balanced. She also kept him company during the PT exercises to ensure that he performed as expected in addition to noting the changes in the frequency of the associated activities.

The nurse explained that Smith cooperated throughout the session and did not oppose any of her suggestions regarding his treatment. The ADL was also included in the treatment but when the nurse felt the need for including it. The focus was put on the PT sessions as per the request of the family. The assigned nurse explained that he did not complain about the dietary plan and tried to keep away from media that displayed junk food. After every session, the nurse would engage John in a personal reflection session where they would reflect on the events of the day and identify any areas that required a change to improve his medication in addition to analyzing the progress. The family was also updated daily on his progress and advised on the needed care when the nurse was away. The nurse also kept checking his electrolyte and blood sugar levels that you highlighted that they showed the presence of hyperglycemia and hypernatremia. The tests were frequently conducted in regards to the view that he was at high risk of suffering from diabetes, muscle contractions in addition to hyperreflexia and thirst. You highlighted that some of his level changes included his sleeping status, his psychosocial wellbeing, his behavioral and mental status in addition to hydration and nutritional status. The nurse noted this area while delivering care and ensured that he received enough rest, balanced diet, and a conducive social environment. He received the air inflammatory therapy to assist him with the sleep apnea. She also took note of Mr. Smiths depression indicators that included not abiding by the p...