ASSIGNMENT 3

Assignment 3: Comprehensive Nursing History and Physical Assessment



Assignment 3: Comprehensive Nursing History and Physical Assessment

Introduction

Chest pain is a commonly occurring symptom affecting between 20 and 40% of the general population during their lifetime. Approximately 1.5% of the general population consults a primary care physician each year because of chest pain symptoms.  In the UK, a presenting complaint of chest pain makes up 1% of all primary care consultations. Furthermore, more than 5% of visits to emergency departments, and up to 40% of emergency admissions, are due to chest pain (Klinkman & Stevens, 1994).

Chest pain can be triggered by a range of different illnesses, including cardiac, gastrointestinal, musculoskeletal, psychological, malignant and pulmonary diseases. While life-threatening cardiac disease is of the greatest immediate concern to both patient and physician, cardiac disease is estimated to account for only a minority (8-18%) of all cases of chest pain. Chest pain patients in whom no underlying cause is diagnosed still remain anxious that they may have a potentially life-threatening disease, and experience impaired health-related quality of life as a result. The primary care physician is, therefore, faced with a complex diagnostic and therapeutic challenge (Murphy & MacIntyre et al. 2004). While forced to consider optimal utilization of health care resources, it is important that other potential causes of chest pain are considered, and that a correct diagnosis is provided to enable appropriate management of patients.

There is a shortage of information regarding the natural history, clinical course and management of chest pain in primary care. In order to gain further epidemiological insights into this symptom, the General Practice Research Database (GPRD) was used to compare demographics, health care use, comorbidity and mortality in patients with and without chest pain of unspecified type or origin in UK primary care.

Methods

Data source

Data for this study were extracted from the GPRD. The GPRD is a large longitudinal primary care database and contains information entered by about 1500 primary care physicians covering a population of ~3 million individuals representative of the UK general population. Each individual in the GPRD is registered with a single GP. The physicians hold the complete medical records of all individuals registered with them, including demographics, diagnosis (using OXMIS and READ codes), prescriptions and referrals. This information is anonymized and sent to the Medicines and Health care products Regulatory Agency (MHRA) for data management and use in research projects. A number of studies have validated the accuracy and completeness of the GPRD (Goodacre & Cross, 2005).

Study population

To identify patients with a new diagnosis of chest pain of unspecified type or origin in 1996, we first identified a study source population of all individuals aged 2-79 in 1996, who had been registered with the physician for at least 2 years and who had at least one entry in the GPRD in the previous 3 years (Fig. 1). Follow-up for each individual in the source population started on 1 January 1996. We excluded individuals who, before the start of the follow-up, had a prior history of cancer, ...