Brian Foster Chest Pain Shadow Health Assessment

Brian Foster Chest Pain Shadow Health Assessment

1. Explain the clinical reasoning behind your decisions and tasks.
2. Explain the tasks you undertook to complete this exam.
3. What data did you base your decisions on for this patient assessment?

Digital Clinical Experience

Digital Clinical Experience (DCE) is a digital standardized patient that allows students to practice and refine their assessment skills. Students will replicate patient education, empathy, and communication found in real-life patient interaction.

DCE allows students to engage in interactions with their patients that are meaningful and educational. The student will then be able to reflect on the interaction and develop clinical reasoning skills.

Brian Foster Chest Pain Shadow Health Assessment Assignment

Digital Clinical Experiences strengthen your understanding of different body systems and help refine your assessment skills. The most value with this program will be achieved if the assignment is done shortly after you have had the content area.

Please keep this in mind when completing the assignments. You will receive 5pts for each assignment if completed by the due date with a 75% or greater. The final due date for this experience is at the end of the PN 127 course.

Requirements For Completion

• You will receive 5pts for each assignment. These points are only achieved if you complete the assignment, prep sheet, and submit your lab pass on time.
•  All assignments are due by 8 am on the date assigned above. No exceptions will be made for points if the assignment is late.
• All assignments must be completed to pass the course.

What Do I Need to Do the Complete Each Assignment

• Complete the prep sheet (no questions left blank)
• Complete the DCE Module from start to finish.
• Review your exam report. You must achieve a 75% or redo it until you do achieve a 75%. –so don’t wait until the last minute to do these.
• You need to review your transcript. You must have used all three communication techniques – Ask, Educate, & Empathize.
• Finally, submit your prep sheet and lab pass into the assigned drop box.

Contributor Lake Area Technical Institute, Watertown, SD

Brian Foster Vitals

Consortium for Healthcare Education Online project material by CHEO Project TAACCCT

Round 2 is licensed under a Creative Commons Attribution 4.0 International License.

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Introduction And Pre-Brief

This assignment provides the opportunity to conduct a focused exam on Brian Foster, who presents with recent episodes of chest pain in a non-emergency setting. Interview Mr. Foster and thoroughly assess the cardiovascular system and related body systems to compile a list of differential diagnoses.

This case study allows you to evaluate Mr. Foster’s family history of heart disease and identify lifestyle risk factors. During the physical examination, thoroughly examine the cardiovascular system and carefully evaluate and document the patient’s heart sounds.

Tips And Tricks

The sounds in the Shadow Health Concept Labs and Physical Assessment Assignments are medically accurate.

• Distinguishing normal from abnormal heart sounds requires practice and carefully listening for sometimes subtle and easily missed sounds. Before beginning this assignment, take advantage of the Cardiovascular Concept Lab to sharpen your skills.
• Optimize your listening experience by using headphones with your computer and listening to both normal and abnormal sounds multiple times to improve your proficiency in recognizing subtle differences.

Often patients present with a specific complaint or problem. However, a new problem may be discovered during the history and physical examination that takes precedence during the visit. Be alert to such a situation with this case study assignment.

Purposes

The purposes of the Shadow Health Physical Assessment Assignments are to:

• Increase knowledge and understanding of advanced practice physical assessment skills and techniques, conduct focused and comprehensive histories and physical assessments for various patient populations, Adapt or modify your physical assessment skills and techniques to suit the individual needs of the patient
• Apply assessment skills and techniques to gather subjective and objective data
• Differentiate normal from abnormal physical examination findings
• Summarize, organize, and appropriately document findings using correct professional terminology
• Practice developing primary and differential diagnoses
• Practice creating treatment plans which include diagnostics, medication, education, consultation/referral, and follow-up planning
• Analyze and reflect on your own performance to gain insight and foster knowledge.  

Subjective Data Collection: 30 Of 30 (100.0%)

Hover To Reveal…

Hover over the Patient Data items below to reveal important information, including Pro Tips and Example Questions.

• Found: Indicates an item that you found.
• Available: Indicates an item that is available to be found.

Category

Scored Items

• Experts selected these topics as essential components of a thorough interview with this patient.

Patient Data

Not Scored

• 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 sporadic chest pain

(Found)

Pro Tip: Chest pain can be a sign of many serious and less serious health problems. It is important to follow up with the discovery of chest pain by asking about its characteristics and severity.

Example Question:

Do you have chest pain?

History Of Present Illness

Finding: Asked about the onset of pain

Finding:

Reports chest pain started appearing in the past month

(Found)

Pro Tip: Establishing the onset of a patient’s pain is essential in diagnosing its severity as well as the comfort of the patient.

Example Question:

When did your chest pain start?

Finding: Asked about the location of the pain

Finding:

Reports pain is in the center 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, and how best to treat it.

Example Question:

Where is the pain?

Finding:

Reports pain does not radiate

(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 sign that the complaint may be cardiac.

Example Question:

Are you experiencing arm pain?

Finding:

Denies shoulder pain

(Found)

Pro Tip: When combined with chest pain, shoulder pain can be a sign that the complaint may be cardiac.

Example Question:

Are you experiencing shoulder pain?

Finding:

Denies back pain

(Found)

Pro Tip: When combined with chest pain, back pain can be a sign that the complaint may be cardiac.

Example Question:

Are you experiencing back pain?

Finding:

Denies neck pain

(Found)

Pro Tip: When combined with chest pain, neck pain can be a sign that the complaint may be cardiac.

Example Question:

Are you experiencing neck pain?

Finding: Asked about the duration of pain episodes

Finding:

Reports each episode lasted “several” minutes

(Found)

Pro Tip: Knowing the duration of a patient’s pain gives you a complete picture of its severity and potential impact on their health.

Example Question:

How long does your chest pain last?

  Finding: Asked about the frequency of pain

Finding:

Reports 3 episodes in the past month

(Found)

Pro Tip: Establishing a timeline for a patient’s symptoms can help you to diagnose his condition better and most effectively treat him.

Example Question:

How many times in the last month have you had chest pain?

Finding:

Reports that episodes did not seem related

(Available)

Pro Tip: Asking your patient if the episodes seem associated can point to possible factors that aggravate the episodes or trigger symptoms and help narrow your diagnosis.

Example Question:

Did the episodes seem associated?

Finding:

Asked about the severity of the pain

Finding:

Reports current pain is 0 out of 10

(Found)

Pro Tip: For many patients, it is difficult to clearly describe the pain. Asking Brian to rate his pain on a scale from 0 to 10 develops a consistent measure of pain

severity.

Example Question:

How would you rate your pain on a scale of zero to ten?

Finding:

Reports pain severity at its worst is 5 out of 10

(Found)

Pro Tip: For many patients, it is difficult to describe the pain clearly. Asking Brian to rate his pain at its worst gives a clearer picture of its severity.

Example Question:

How would you rate your pain on a scale of zero to ten? ■   Finding: Asked about the character of pain

Finding:

Describes pain as tight and uncomfortable

(Found)

Pro Tip: Asking Brian to describe his pain helps identify his discomfort’s cause and severity. Patients may not know how to answer, so you may need to suggest words like sharp, dull, crushing, gnawing, or burning.

Example Question:

Can you describe your pain?

Finding:

Denies crushing pain

(Found)

Pro Tip: Asking Brian to describe his pain helps identify his discomfort’s cause and severity. 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 crushing?

Finding:

Denies gnawing pain

(Found)

Pro Tip: Asking Brian to describe his pain helps identify his discomfort’s cause and severity. 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 gnawing?

Finding:

Denies burning pain

(Found)

Pro Tip: Asking Brian to describe his pain helps identify his discomfort’s cause and severity. 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 aggravating factors

Finding:

Reports pain is aggravated by activity

(Found)

Pro Tip: Aggravating factors reveal further information about the nature of the pain and the body systems affected.

Example Question:

What makes the pain worse?

Finding:

Pain occurred with yard work and taking stairs

(Found)

Pro Tip: Determining the activity that may have caused the patient’s complaint is crucial because it may reveal the root cause of the complaint.

Example Question:

What activity triggered the pain?

Finding:

Pain does not worsen with eating

(Available)

Pro Tip: It is important to ask about the patient’s diet and its impact on his complaint because cardiac complaints and gastrointestinal pain can be very similar and are frequently conflated. Ruling out one or the other can assist your diagnosis.

Example Question:

Is the pain worse when you eat?

Finding:

Pain does not worsen after spicy foods

(Available)

Pro Tip: It is important to ask about the patient’s diet and its impact on his complaint because cardiac complaints and gastrointestinal pain can be very similar and are frequently conflated. Ruling out one or the other can assist your diagnosis.

Example Question:

Is the pain worse after you eat spicy food?

Finding:

Pain does not worsen after high-fat foods

(Found)

Pro Tip: It is important to ask about the patient’s diet and its impact on his complaint because cardiac complaints and gastrointestinal pain can be very similar and are frequently conflated. Ruling out one or the other can assist your diagnosis.

Example Question:

Is the pain worse after you eat high-fat foods? ■   Finding: Asked about relieving factors

Finding:

Reports pain relief with a brief periods of rest

(Found)

Pro Tip: It’s important to assess the nature of pain by asking about relief. Relieving factors can help narrow the body system and assist in a more accurate diagnosis.

Example Question:

What relieves your pain?

Finding:

Reports no medication to treat chest pain

(Found)

Pro Tip: It’s important to assess the nature of pain by asking about relief. Discovering any pain medication Brian takes can help you assess the nature and severity of his pain and avoid any unwanted medication interactions.

Example Question:

Did you take anything for chest pain?