The Patient with Non-Cardiac Chest Pain
Mark Hanson is a 70-year-old gentleman you visit at his home with your practice assessor. He is married to Julie and they have a 40-year-old daughter and 4 grandchildren.
He has recently been discharged from hospital after falling down the stairs at home. He is complaining of pain in his chest. This is not cardiac related; his discharge letter confirms that he has a fractured rib as a result of his fall. Mark has been seen this morning by his GP and has been prescribed analgesia. He is reluctant to take these regularly for fear that he will become addicted. He is speaking very slowly due to the pain and is finding it difficult to share information with you.
He worked as a pub landlord but retired a few years ago due to poor health. He used to have a very active social life but has not been able to go out for some time because of limited mobility. He has become withdrawn but enjoys seeing his grandchildren and close family members.

Observations
• Airway: Able to talk and responding to questions.
• Breathing: RR – 26 breaths per minute. SpO2 – 98% on air. Breathing is shallow as he finds it painful to take full breaths.
• Cardiovascular: HR 80 bpm, BP 130/90 mmhg, skin feels cold to touch.
• Disability: ACVPU Alert
• Exposure: Temperature 36.4°C.

Signs and Symptoms
• Pain in his chest (Pain score 8/10)
• Loss of appetite
• Low mood
• Constipation
• Limited mobility

Past Medical History
• Osteoarthritis
• Depression
• Hypertension
• CVA with residual left sided weakness

Current Medication
• Co-codamol 50/500mg, 2 tablets TDS
• Amlodipine 10mg once a day
• Atorvastatin 40mg once a day
• Fluoxetine 40mg once a day
• Multivitamins

Family History
• He has a brother addicted to pain killers and this is a concern for him.

Social History
• Smokes 5 cigarettes a day
• Occasionally drinks 2-3 units of beer
• Relies on Agnes to help with most of his activities of daily living but this is taking its toll on their marriage.
• Julie is very concerned and struggling to cope.

Assessment
• Critically evaluate the communication skills or strategy the nurse will engage in when caring for this patient.
• Provide a critical exploration of one psychological response of this sign or symptom including a coping strategy and one evidence-based strategy.
• Critically discuss the holistic role of the nurse in this scenario based on one evidence-based