A 66-year old woman complains of shortness of breath, numbness, and heaviness

A 66-year old woman complains of shortness of breath, numbness, and heaviness of her arms when walking up the hill to her house. The pain subsides when she stops to rest.
Subjective
CC: shortness of breath, numbness, and heaviness of her arms when walking up the hill to her house
Questions
When did you start experiencing these symptoms?
How long do the symptoms last?
How can you describe the pain? Stabbing, dull, sharp, or thumbing?
On a scale of 0 to 10, how would you rate your pain?
Does the pain radiate?
What triggers the pain? What makes it better?
Have you tried any medications?
Do you have a family history of cardiovascular diseases?
Do you have a family history of hypertension?
Do you exercise? If yes, how often?
How is your diet like?
Do you have stress?
Objective
Physical Exam Elements
Monitor blood pressure
Observe for Xanthomas under the skin
Assess the skin color for blood circulation
Feel pulses in all locations
Assessment
Working Diagnosis: Stroke- this is a condition associated with the reduced or interrupted supply of blood into the brain, implying that brain cells do not get sufficient nutrients and oxygen (Campbell et al., 2019). Some of the symptoms of this condition include communication problems, memory problems, paralysis or numbness of arms or one side of the face, and headache.
Pertinent positive: shortness of breath, numbness, and heaviness of her arms
Pertinent negatives: none present
Differential diagnosis: Pulmonary embolism- this is a condition associated with blockage of the pulmonary arteries in the lungs. It is majorly caused by blood clots. The warning signs and symptoms of this condition include shortness of breath, cough, and chest pain (Carson et al., 2020).
Pertinent positive: shortness of breath, numbness, and heaviness of her arms
Pertinent negatives: none present
Further Testing
CT Brain
CBC
Lipid Panel
Chest X-ray
EKG
Echocardiogram
Plan
OTC: tissue plasminogen activator (tPA) IV injection given intravenously given within 4.5 hours from when symptoms started (Campbell et al., 2019).
Complementary: Blood thinners or anticoagulants are effective for preventing the enlargement of existing clots. Heparin is one of these anticoagulants that can be given through the vein or injected under the skin. Thrombolytics may also be given to dissolve clots, if appropriate. 
Complementary: stroke recovery and rehabilitation- in this setting, patients have available to them dietitians, physical therapists, recreational therapists, and rehabilitation nurses.
Patient Education
Maintain a healthy body weight
Eat a diet rich in fruits and vegetables
Avoid diet high in sodium or fat
Exercise regularly
Stress management 
Avoid tobacco use (Carson et al., 2020)
Follow-up:
In 4 weeks. 
References
Carson, J. L., Kelley, M. A., Duff, A., Weg, J. G., Fulkerson, W. J., Palevsky, H. I., … & Terrin, M. L. (2020). The clinical course of pulmonary embolism. New England Journal of Medicine, 326(19), 1240-1245.
Campbell, B. C., De Silva, D. A., Macleod, M. R., Coutts, S. B., Schwamm, L. H., Davis, S. M., & Donnan, G. A. (2019). Ischaemic stroke. Nature Reviews Disease Primers, 5(1), 1-22.
 
Reflection
What were your strengths in this course?
Time management was one of my strengths in this course. I always made sure that I finished my assignments, discussions, and quizzes on time, and this lead me to not lose any points due to late submission. Another strength is that I am internet savvy. I did not have any challenges accessing information over the internet.
What was challenging?
This course was important in enhancing my clinical knowledge and experience. However, I experienced several challenges throughout the course. One of these challenges was completing the shadow health assignments. Performing a comprehensive patient assessment required a lot of time and critical thinking in order to determine the correct diagnosis for patients and the contributing factors.
What new learning or insight was developed?
Therapeutic communication is one of the new insights developed from this course. I developed competence in therapeutic communication with patients to identify their historical and current health information and the risk factors as well as the management practices to their current health conditions. Therapeutic communication is an essential requirement for success in the nursing profession because it facilitates a better understanding of patient’s health conditions.
What new clinical skills have you gained?
One of the essential skills gained from this course is critical thinking. Critical thinking is an essential skill for successful nurses. Through critical thinking, I am able to assess and examine patients in order to determine their underlying health conditions and associated factors and develop relevant diagnoses and interventions in order to help patients manage their health conditions.