Accurate Diagnosis: Essential for Quality Healthcare Delivery - Research Paper

Introduction

Accurate diagnosis is pivotal in delivering quality healthcare to all patients. Moreover, it is crucial for all healthcare providers to put into consideration all possible causes of patient's symptom and accompany this with a laboratory investigation before making conclusions on the cause of these clinical presentations (Sillman et al., 2017). Such vigorous investigations will not only ensure accurate patient outcome but will also help curb deaths that come as a result of wrong or skewed patient outcomes. Therefore, this paper oversees a critical discussion on the clinical process of investigating possible determinants of patient diagnosis outcome.

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In the case study under investigation, the patient presented with chest pain and a non-productive cough. The patient describes the pain as sharp in nature, constantly present but made worse with inspiration and movement, with radiation to the base of the neck. His blood pressure in the right arm and other vital signs were however normal. Physical examination was then made, and after observation for an hour, the patient was diagnosed with viral pleurisy and sent home on non-steroidal analgesics. No laboratory confirmation or other possible causes of patient symptom were considered; the patient later died. Therefore, this essay attempts to analyze critically other possible causes of the patient clinical presentations, which may have resulted to a different diagnosis and patient outcome as well l as laboratory investigation, which should have been conducted to confirm the possible diagnosis.

Four main factors are responsible for causing most if not all severe chest pains including pain when breathing, coughing among other chest-related symptoms. The four leading causes of chest pains are cardiac, pulmonary gastrointestinal and musculoskeletal conditions, which present themselves in the form of severe chest pains just as the patient in question, experienced.

Cardiac Causes of Chest Pains

Angina Pectoris

Angina pectoris is a term used to refer to a specific type of chest pain characterized by chest pain, which feels as though the chest is squeezed or put under severe pressure. The pain that results from this condition may also be felt at the neck, shoulders, jaws, arms, and upper back (Sillman et al., 2017). This condition occurs when there is less blood flow to the muscles of the heart due to blockage or narrowing of cardiac arteries is resulting in an insufficient supply of oxygen to the heart muscles.

Angina pectoris can be diagnosed using Chest X rays. Chest X rays help rule out other possible causes of chest pain such as TB, Pneumonia among others, chest CT scans, magnetic resonance imaging, which help determine how blood is flowing through the heart vessels, and Catheter angiography, which is an invasive form of diagnosis that allows the doctors to visualize internal tissues of the heart.

Aortic Dissection

Aortic dissection is a cardiac condition in which the innermost layer of aorta is injured thus allowing blood to flow in between other aortic layers, with time, the layers are forced apart a condition called dissection (Harrington et al., 2017). If this persists, the entire aortic layer may burst to result in severe internal hemorrhage. The condition is characterized by severe chest pain, which radiates to the neck, shoulders, and most of upper back, the patient feels a sharp pain as though something is being torn or ripped apart from within the chest (Sillman et al., 2017). Aortic Dissection is diagnosed by magnetic resonance angiogram: allow medics to view a pictorial presentation of the chest making it easy to determine the anomaly. Transesophageal echocardiogram: produces an image of the heart making it easier to see where the problem lies.

Pulmonary Causes of Chest Pains

Chronic Obstructive Lung Disease, Pneumonia, Asthma

These conditions are characterized by chest pains, which worsen on inspiration especially for pneumonia, chest congestion/tightness, difficulty in breathing among others (Campbell et al., 2017). These conditions can be diagnosed through, chest X-rays, spirometry, complete blood count, pulse oximetry, sputum test CT scans and MRI.

PleuritisPleuritis is the term given to the swelling/ inflammation of the membrane covering the lung (pleural membrane). The condition is featured by sharp pain when breathing which worsens when an individual cough, walks, talks, or sneeze, characterizes the condition. Pleuritis can be caused by infections especially viral infection, autoimmune disorders, or pulmonary embolism to mention a few (Campbell et al., 2017). The condition can be diagnosed through ultrasound: used to investigate whether a patient has pleural effusion, blood test aimed at detecting autoimmune disorders, which is one of the causes of this condition, and Chest X rays.

Gastrointestinal Causes of Chest Pain

Esophagitis

Esophagitis refers to the inflammation or swelling of the oesophagus characterized by severe chest pains, which mimics angina pectoris and the pain usually last longer. The condition can be diagnosed by endoscopy, Barium X-ray, a biopsy of tissues obtained from oesophagus for laboratory tests aimed at testing for any viral or fungal infection (Campbell et al., 2017).

Musculoskeletal Causes of Chest Pains

Musculoskeletal causes of chest pains are chest related conditions, which are associated with the chest wall, which often is a result of conditions is affecting muscles, bones, and nerves of the chest. The condition is often characterized by severe chest pain, which often mimics those of cardiovascular conditions accompanied by coughs. Diagnosis of Musculoskeletal causes of chest pains includes x-ray, endoscopy, CT scan which are mainly done to rule out hear related causes of chest pain.

Conclusion

In summary, having a list of potential causes of a patients clinical presentation/symptoms is vital in coming up with an accurate outcome which is backed with concrete laboratory tests. Accurate diagnosis is important in coming up with accurate therapeutic regimen which will ensure a successful treatment of the patient

References

Campbell, K. A., Madva, E. N., Villegas, A. C., Beale, E. E., Beach, S. R., Wasfy, J. H., ... & Huffman, J. C. (2017). Non-cardiac chest pain: a review for the consultation-liaison psychiatrist. Psychosomatics, 58(3), 252-265. https://www.sciencedirect.com/science/article/pii/S0033318216301712

Harrington, J., Mody, P., Blankstein, R., Nasir, K., Blaha, M. J., & Joshi, P. H. (2017). Coronary Artery Calcium Testing in Patients with Chest Pain: Alive and Kicking. Current Cardiovascular Risk Reports, 11(6), 18. https://link.springer.com/article/10.1007/s12170-017-0542-9

Sillman, C., Morin, J., Thomet, C., Barber, D., Mizuno, Y., Yang, H. L., & Balon, Y. (2017). Adult congenital heart disease nurse coordination: Essential skills and role in optimizing team-based care a position statement from the International Society for Adult Congenital Heart Disease (ISACHD). International journal of cardiology, 229, 125-131. https://www.sciencedirect.com/science/article/pii/S0167527316324111