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Shadow Health Focused Brian Foster Exam Chest Pain Brian
Foster Complete.
Experience Overview
FOCUSED EXAM: CHEST PAIN
Patient: Brian Foster
Grade: 100%
Subjective Data Collection
23 out of 23
Objective Data Collection
21 out of 21
Time
183 minutes total spent in assignment
Objective Data Collection: 21 of 21 (100%)
Inspected face 1 of 1 point
Appearance (1/1 point)
- No visible abnormal findings
- Rash or lesion
- Cyanosis
- Pallor
- Redness or flushing
- Evidence of trauma (scar, laceration, or bruising)
Inspected for jugular venous distension 1 of 1 point
Height Of Venous Pressure (1/1 point)
- 4 cm or less above the sternal angle
- More than 4 cm above the sternal angle
Inspected chest 1 of 1 point
Symmetry (1/2 point)
Appearance (1/2 point)
- No visible abnormal findings
- Rash or lesion
- AP diameter abnormal
- Intercostal retraction while breathing
- Excessive use of accessory muscles while breathing
- Pectus excavatum
- Skin growths (freckles or moles)
- Evidence of skin trauma (scar, laceration, or bruising)
Inspected hands and fingernails 1 of 1 point
Right: Appearance (1/4 point)
- No visible abnormal findings
- Redness
- Moles or skin tags
- Masses (warts, cysts, or tumors)
- Freckles, birthmark, or other discoloration
- Excessive dry or flaking skin
- Purpura
- Scarring
- Laceration, lesion, or wound
- Bruising
- Rash Left: Appearance (1/4 point)
- No visible abnormal findings
- Redness
- Moles or skin tags
- Masses (warts, cysts, or tumors)
- Freckles, birthmark, or other discoloration
- Excessive dry or flaking skin
- Purpura
- Scarring
- Laceration, lesion, or wound
- Bruising
- Rash Right: Nail Changes (1/4 point)
- No visible abnormal findings
- Pallor
- Cyanosis
- Splinter hemorrhages
- Clubbing Left: Nail Changes (1/4 point)
- No visible abnormal findings
- Pallor
- 4+ Very deep pit that lasts 2 to 5 minutes Left: Edema (1/4 point)
- No edema
- Pitting
- Non-pitting Left: Severity Of Edema (1/4 point)
- No edema
- 1+ Slight pitting
- 2+ Deeper pit, disappears in 10 to 15 seconds
- 3+ Noticeably deep pit that lasts more than a minute
- 4+ Very deep pit that lasts 2 to 5 minutes
Tested capillary refill time 1 of 1 point
Fingers (1/2 point)
- Less than 3 seconds
- Greater than 3 seconds Toes (1/2 point)
- Less than 3 seconds
- Greater than 3 seconds
Palpated carotid arteries 1 of 1 point
Right: Vibration (1/4 point)
- No thrill
- Thrill Right: Amplitude (1/4 point)
- 0 Absent
- 1+ Diminished or barely palpable
- 2+ Expected
- 3+ Increased
- 4+ Bounding pulse Left: Vibration (1/4 point)
- No thrill
- Thrill Left: Amplitude (1/4 point)
- 0 Absent
- 1+ Diminished or barely palpable
- 2+ Expected
- 3+ Increased
- 4+ Bounding pulse
Palpated PMI 1 of 1 point
Location (1/3 point)
- Present at midclavicular line and 5th intercostal space
- Displaced laterally Diameter (1/3 point)
- Less than 3 cm
- Greater than 3 cm Amplitude (1/3 point)
- Brisk and tapping
- Increased amplitude (hyperkinetic)
Palpated brachial arteries 1 of 1 point
Right: Vibration (1/4 point)
- No thrill
- Thrill Right: Amplitude (1/4 point)
- 0 Absent
- 1+ Diminished or barely palpable
- 2+ Expected
- 3+ Increased
- 4+ Bounding pulse Left: Vibration (1/4 point)
- No thrill
- Thrill Left: Amplitude (1/4 point)
- 0 Absent
- 1+ Diminished or barely palpable
- 2+ Expected
- 3+ Increased
- 4+ Bounding pulse
Palpated radial arteries 1 of 1 point
Right: Vibration (1/4 point)
- No thrill
- Thrill Right: Amplitude (1/4 point)
- 0 Absent
- 1+ Diminished or barely palpable
- 2+ Expected
- 3+ Increased
- 4+ Bounding pulse Left: Vibration (1/4 point)
- No thrill
- 0 Absent
- 1+ Diminished or barely palpable
- 2+ Expected
- 3+ Increased
- 4+ Bounding pulse
Palpated tibial arteries 1 of 1 point
Right: Vibration (1/4 point)
- No thrill
- Thrill Right: Amplitude (1/4 point)
- 0 Absent
- 1+ Diminished or barely palpable
- 2+ Expected
- 3+ Increased
- 4+ Bounding pulse Left: Vibration (1/4 point)
- No thrill
- Thrill Left: Amplitude (1/4 point)
- 0 Absent
- 1+ Diminished or barely palpable
- 2+ Expected
- 3+ Increased
- 4+ Bounding pulse
Palpated dorsalis pedis arteries 1 of 1 point
Right: Vibration (1/4 point)
- No thrill
- Thrill Right: Amplitude (1/4 point)
- 0 Absent
- 1+ Diminished or barely palpable
- 2+ Expected
- 3+ Increased
- 4+ Bounding pulse Left: Vibration (1/4 point)
- No thrill
- Thrill Left: Amplitude (1/4 point)
- 0 Absent
- 1+ Diminished or barely palpable
- 2+ Expected
- 3+ Increased
- 4+ Bounding pulse
Auscultated carotid arteries 1 of 1 point
Right (1/2 point)
- No bruit
- Bruit Left (1/2 point)
- No bruit
- Bruit
Auscultated heart sounds 1 of 1 point
Heart Sounds (1/2 point)
- S1 and S2 audible
- S1, S2, and S3 audible
- S1, S2, and S4 audible
- S1, S2, S3, and S4 audible Extra Heart Sounds (1/2 point)
- No extra sounds
- Gallops
- Murmur
- Friction rub
- Valve clicks
Auscultated abdominal aorta 1 of 1 point
Sounds (1/1 point)
Auscultated abdominal and lower extremity arteries 1 of 1 point
Right: Renal (1/6 point)
- No bruit
- Bruit Right: Iliac (1/6 point)
- No bruit
- Bruit Right: Femoral (1/6 point)
- No bruit
Subjective Data Collection: 23 of 23 (100.0%)
A combination of open and closed questions will yield better patient data. The following details are facts of the patient's case.
Chief Complaint
Finding:
Established chief complaint
Finding:
Reports chest pain
(Found)
Pro Tip: Asking a patient broadly about their chief complaint allows them to answer in their own words and confirm information that you may have already received from another source.
Example Question:
Do you have chest pain?
History of Presenting Illness
Finding:
Asked about onset and duration of chest pain
Finding:
Reports chest pain started about five minutes ago
(Found)
Pro Tip: Establishing the onset of a patient's chest pain is essential in diagnosing its severity as well as the comfort of the patient.
Example Question:
When did the chest pain start?
Finding:
Reports chest pain has been constant since it began
(Available)
Pro Tip: Knowing the duration of a patient's pain gives you a more complete picture of its severity and potential impact on the patient's health.
Example Question:
How long does the chest pain last?
Finding:
Reports sitting in bed when pain began
(Found)
Pro Tip: A patient's position and posture when their pain began can inform you as to the nature of the pain, as pain upon exertion often has different causes than pain upon resting.
Example Question:
Were you sitting when the pain began?
Finding:
Asked to rate chest pain on a scale
Finding:
Reports current pain is 6/
(Found)
Pro Tip: For many patients, it is difficult to clearly describe pain. Asking Brian to rate his pain on a scale from 0 to 10 develops a consistent measure of pain severity.
Example Question:
On a scale of 0 to 10 how would you rate the chest pain?
Finding:
Denies burning pain
(Found)
Pro Tip: Asking Brian to describe his pain helps identify the cause and the severity of his discomfort. Patients may not know how to answer, so you may need to suggest words like sharp, dull, crushing, gnawing, or burning.
Example Question:
Is the pain burning?
Finding:
Asked about location of the pain
Finding:
Reports pain location is in middle of the chest
(Found)
Pro Tip: Identifying the location of a patient's pain is essential in determining which body systems are affected, the underlying cause of the pain, and how best to treat it.
Example Question:
Where is the pain?
Finding:
Reports slight pain in left shoulder
(Found)
Pro Tip: Pain radiation is an important symptom that can be helpful in understanding the cause of pain and narrowing the diagnosis.
Example Question:
Does the pain radiate?
Finding:
Denies arm pain
(Found)
Pro Tip: When combined with chest pain, arm pain can be a telling sign that the complaint may be cardiac in nature.
Example Question:
Do you have arm pain?
Finding:
Denies back pain
(Found)
Pro Tip: When combined with chest pain, back pain can be a telling sign that the complaint may be cardiac in nature.
Example Question:
Do you have back pain?
Finding:
Denies jaw pain
(Found)
Pro Tip: When combined with chest pain, jaw pain can be a telling sign that the complaint may be cardiac in nature.
Example Question:
Do you have jaw pain?
Finding:
Denies neck pain
(Found)
Pro Tip: When combined with chest pain, neck pain can be a telling sign that the complaint may be cardiac in nature.
Example Question:
Do you have a history of anxiety?
Finding:
Denies history of panic attacks
(Available)
Pro Tip: Symptoms such as chest pain can be caused or exacerbated by episodes of anxiety. Asking Brian if he's ever had a panic attack can point to underlying stressors or triggers.
Example Question:
Have you ever had a panic attack?
Past Medical History
Finding:
Asked relevant health history
Finding:
Reports high blood pressure
(Found)
Pro Tip: Hypertension is the most important risk factor for stroke. Soliciting a health history from Brian will allow you to assess his risk of cardiovascular disease.
Example Question:
Do you have high blood pressure?
Finding:
Reports high cholesterol
(Found)
Pro Tip: High cholesterol can lead to cardiovascular disease. Asking Brian whether he's had a history of high cholesterol reveals important details about his cardiovascular health.
Example Question:
Do you have high cholesterol?
Finding:
Denies history of pulmonary embolism
(Available)
Pro Tip: Pulmonary embolism is one of many cardiac risk factors to ask about that can help you form a more complete picture of Brian's cardiovascular health.
Example Question:
Have you ever had a pulmonary embolism?
Finding:
Denies history of angina
(Available)
Pro Tip: A history of angina can weaken the heart and lead to further cardiovascular complications. Asking Brian about angina helps you understand his overall cardiovascular health.
Example Question:
Do you have a history of angina?
Finding:
Denies history of rheumatic fever
(Available)
Pro Tip: Rheumatic fever early in life can cause fibrosis of the heart valves and can weaken the cardiovascular system. Finding out if Brian has a history of rheumatic fever is crucial to understanding his complete heart health.
Example Question:
Do you have a history of rheumatic fever?
Finding:
Denies history of heart murmur
Pro Tip: The current dose of any patient's high blood pressure medication is important to learn about because it provides useful information about the patient's treatment plan as well as potential medication interactions.
Example Question:
What dose of medication do you take for high blood pressure?
Finding:
High blood pressure medication is taken once daily
(Available)
Pro Tip: The frequency with which a patient takes his high blood pressure medications is an essential element of the complete picture of his medication treatment plan.
Example Question:
How frequently do you take medication for high blood pressure?
Finding:
Followed up on high cholesterol treatment
Finding:
Reports taking high cholesterol medication
(Found)
Pro Tip: The medication that a patient takes for their high cholesterol will indicate how well controlled their condition is and how well they comply with treatment regimens.
Example Question:
Do you take medication for cholesterol?
Finding:
Reports high cholesterol medication is Atorvastatin (Lipitor)
(Found)
Pro Tip: Discovering what specific high cholesterol medication a patient takes helps you assess his health conditions, effectiveness of treatment, and guards against unwanted medication interactions.
Example Question:
What medication do you take for cholesterol?
Finding:
Reports high cholesterol medication dose is 20mg
(Available)
Pro Tip: The current dose of any patient's high cholesterol medication is important to learn about because it provides useful information about the patient's treatment plan as well as potential medication interactions.
Example Question:
What dose of medication do you take for cholesterol?
Finding:
Reports high cholesterol medication is taken once daily
(Available)
Pro Tip: The frequency with which a patient takes his high cholesterol medications is an essential element of the complete picture of his medication treatment plan.
Example Question:
How frequently do you take medication for cholesterol?
Finding:
Asked history of cardiac tests
Finding:
Reports recent EKG test
(Found)
