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In fact, signs and symptoms as headache and dyspnea can be extremely subjective and may significantly vary with each patient judgment. Furthermore, some conditions do not immediately present to instantly warrant a thorough investigation, only manifesting when much damage has already occurred to be clinically evident. Possible aggravation of a previously known condition also contributes to the complexity of the case. As such, arriving at a logical and rational medical diagnosis may at times be challenged with the inconsistencies of observed and reported manifestations by the patient compared with the results of diagnostic and laboratory procedures performed. Even so, appropriate education remains to be one of the most important roles of the nurse in meeting this patient’s physical and psychological needs and prepare her for the foreseen battery of tests necessary to confirm or refute a diagnosis. Maintaining physiological integrity through dependent and independent nursing interventions is necessary for a comprehensive patient care. Besides that, it is also imperative to maintain being an advocate so that the patient is not subjected to unnecessary danger during the performance of these tests (Best, 2002). Pathophysiology Although the patient’s manifestations strongly suggest an underlying heart condition, laboratory and diagnostic studies reveal otherwise. Radiographic results indicate dextroscoliosis and degenerative disc disease of the thoracic spine, degenerative bilateral arthritis of acromioclavicular joints, degenerative arthritis of the left glenohumeral joint, a normal heart size, and focal arteriosclerosis of the thoracic aorta. The constellation of these findings along with breathing problems implies a progression of a previously undiagnosed restrictive lung disease or a neuromuscular condition. Differential diagnosis should include an acute coronary syndrome and other cardiac condition. Direct causes of degenerative bone and joint diseases remain unknown, although metabolic, nutritional, and a history physical injury may contribute to the subsequent alteration of the connective tissues (Smeltzer & Bare, 2006). Degenerative diseases of the joints directly or indirectly affecting the neuro-musculoskeletal component of breathing can be very complicated because it can mimic several other pathologies. For instance, dextroscoliosis prevents optimum lung expansion, thus causing decreased oxygenation of the blood in the pulmonary circuit. Furthermore, damage to the intervertebral discs may impinge nerves crossing the tracts and can cause spasmic movements of the affected limbs. In some cases, motor nerves that supply the muscles of breathing may also be affected and can cause dyspnea. Moreover, arthritis of the acromioclavicular and glenohumeral joints can cause localized pain especially upon increased joint movement as in labored breathing, and thus may limit adequate lung expansion (Ignatavicius & Workman, 2006). Systemic consequences of inadequate oxygenation at the pulmonary level due to neuro-musculoskeletal causes can have tremendous effect even with minor physical activity like talking and ambulation. On the other hand, ACS and other cardiac condition usually manifest bold physical examination findings that correlate well with laboratory ...Show more
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Summary

Introduction R.D., 87 years old, female, was admitted to the health facility primarily due to onset of “jerky movements” in her upper extremities, occurring only brief and intermittent in the past three months. Further assessment revealed acute dyspnea after a physical activity, and headache and lightheadedness especially when the patient is in the recumbent position…
Author : mbreitenberg
CASE STUDY
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