Question Answered step-by-step Mr. M., a 49-year-old African American schoolteacher, is brought to… Mr. M., a 49-year-old African American schoolteacher, is brought to the emergency department for evaluation of chest pain. He was shoveling snow from his driveway and finished half the work when he suddenly became short of breath and dizzy. He felt chest pain that he describes as “crushing and heavy” and ran down his left arm.He went inside, rested on the couch, and took two of his wife’s nitroglycerin tablets. After 10 minutes, the pain subsided somewhat, but his wife insisted on calling an ambulance. He is very upset and states, “I know what it is. My dad died of a heart attack when he was 53 and now it’s my turn.” While Mr. M. is having an ECG performed, his wife takes you aside and tells you that he had been treated for hypertension, high cholesterol levels, and diet-controlled diabetes but that he has refused all medication for the past year. He eats what he wants and does not get much exercise during the school year. According to his wife, Mr. M. is about 50 pounds overweight. She also tells you that he did stop smoking last summer. She says that she tries to cook healthy foods for him, but he “gets what he wants” when he is not at home and uses the salt shaker freely.You begin your assessment. His apical pulse is 118 beats per minute and regular; blood pressure is 166/98 mm Hg; and his level of chest pain is a “2” on a scale of 1 to 10. No visible pulsations, heaves, or lifts are evident over his precordium. No cyanosis is observed, and an apical impulse is palpable at the fifth left intercostal space. He states that the nitroglycerin tablets took away the severe pain but now his chest just “aches”. When he describes his previous pain, he clenches his fist to illustrate the pain. His skin is moist, and his clothes are damp from perspiration. He feels nauseated but has not vomited. He denies continued shortness of breath and pain elsewhere. He seems very upset and anxious and asks for his wife to be at his side.Question 1 What do you think is the cause of Mr. M.’s chest pain? Support your answer.Question 2 Does Mr. M. have any cardiac risk factors? If so, specify them.Question 3 Are there any cultural considerations to keep in mind in Mr. M.’s case?Question 4 Describe the best places to listen for heart sounds.Question 5 After his condition has stabilized, you assist Mr. M. in removing his boots. When you remove his socks, you see an ulcer on the lateral side of his left great toe. When you ask him about it, he looks surprised and says that he has not felt it. Further assessment reveals the following: Mr. M. has had calf pain, which he describes as “cramps,” when he walks long distances, such as from his classroom to his car. The pain is relieved when he sits down. He also avoids the stairs for this reason. The skin of his lower legs is cool, thin, and shiny, and hair is absent. The nails are thick and ridged. The ulcer measures 1.5 cm in length and 1 cm in width, and is covered with brownish-black tissue that does not ooze. On the basis of these assessment findings, what type of problem does this ulcer reflect?Question 6 What further assessments should you perform? Health Science Science Nursing NUR 205 Share QuestionEmailCopy link Comments (0)