Answer

Integrated Nursing: The Patient with Non-Cardiac Chest Pain 

Often, chest pains are associated with cardiovascular problems. Findings in considerable objective structured clinical examinations (OSCE) for chest pains reveal that many patients will have non-cardiac related chest pains. This paper examines the case of a 70-year-old man with chest pains influenced by a fall. The patient has a medical history of hypertension, depression and Osteoarthritis as well as Cerebrovascular Accident (CVA) with residual weakness on the left side. Further information reveal that the patient smokes at least 5 cigarettes each day and occasionally drinks about 2 to 3 units of beer.

Summative Assessment Strategy – OSCE and Pathophysiology

            While noting that the patient’s chest pain has been influenced by the fractured rib, it is important to focus on the ribs and the possible causes of the fall, withdrawal, loss of appetite, numbness as well as the weakness on the left side. Ribs fracture are major causes of mortality and morbidity across the United States (Campbell et al. 2017). One of the appropriate assessment will be to perform a multimodal Magnetic Resonance Imaging (MRI) to identify the degree of cerebral perfusion and the patency of intracranial vessels. MRI would also reveal severity of the historical Cerebrovascular accident (Whittaker et al. 2018). The assessment will focus on the presence of any ischemic penumbra. The assessment will also involve stabilization of the pathway and breathing rate.

            The underlying pathophysiology is the disruption of blood flow in to the brain that triggers various cellular metabolic events, which may lead to stroke and falls. Some of the risk factors of stroke include smoking, old age, hypertension, depression and excess cholesterol in the body (Whittaker et al. 2018). The presenting patient has a depressive history, hypertension and smoking factors. As such, focusing on a form of stroke is important to avoid continuing prescribing pain killers that the patient may end up not consuming or increase mental challenge because he fears being addicted to pain killers like his brother. Although focusing on hypertension or depression is important, giving much attention to cerebrovascular accident history can greatly contribute to successful care to the patient.

Communication Strategy that the Nurse will Engage

            Listening is among the most appropriate communication strategies that the nurse must engage during the entire patient care process. The nurse should carefully listen to the patient and the patient’s wife and other family members. Besides, the nurse must encourage interpersonal communication skills to influence the patient to disclose his concerns. Interpersonal communication skills combined with careful listening will highly allow the patient to provide accurate information about his past and current experiences for better diagnosis and treatment.

Psychological Response and Coping Strategy

            The psychological response to the scenario is to discuss the state of patient’s depression to ensure that the patient accesses an antidepressant therapy. Encouraging the patient to maintain a balance between resting and socialization can highly help to cope with the situation (Campbell et al. 2017). Notably, rest and breathing exercises are effective remedies for fractured ribs. Although the condition is very demanding, the spouse and other family members must be encouraged to continue providing support to the patient while giving positive reinforcement (Macheel et al., 2020).

Holistic Role of Nurse in the Scenario

            Nurses play significant role in promoting patient’s health. As such, the nurse will be engaged in alleviating chest pains by prescribing the best drugs and therapies. While noting that the patient heavily relies on the spouse, the nurse will heavily work to allow the patient achieve self-care while relieving perceptual and sensory deprivation that is making him withdraw from social activities. Most importantly, the nurse must continually teach the patient how to maintain balance while walking, standing or sitting. The patient must understand the best positions to prevent contractures.  Resting and breathing exercises are effective remedies of rib fracture.

Conclusion

 Non-cardiac chest pains require an objective structure clinical assessment of the patient. The nurse has a role to play to help the patient to improve the mobility, breathing and communication. Communication is a therapeutic strategy that may be employed by the patient. The nurse has a role to ensure that the patient gradually improves his talking or social interactions with the society.