Brian Foster Chest Pain Shadow Health Assessment
Brian Foster Chest Pain Shadow Health Assessment
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 be sure to thoroughly assess the cardiovascular system as well as related body systems in order to compile a list of differential diagnoses. This case study offers you the opportunity to evaluate Mr. Foster’s personal and family history with 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. Be sure to take advantage of the Cardiovascular Concept Lab to sharpen your skills prior to beginning this assignment. Brian Foster Chest Pain Shadow Health Assessment
Optimize your listening experience by using headphones with your computer and listen to both normal and abnormal sounds multiple times to improve your proficiency with recognizing subtle differences.
Often patients present with a specific complaint or problem. However, during the history and physical examination, a new problem may be discovered that takes precedence during the visit. Be alert to such a situation with this case study assignment.
Are you looking for a 100% score?
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Purposes
The purposes of the Shadow Health Physical Assessment Assignments are to: (a) increase knowledge and understanding of advanced practice physical assessment skills and techniques, (b) conduct focused and comprehensive histories and physical assessments for various patient populations, (c) adapt or modify your physical assessment skills and techniques to suit the individual needs of the patient, (d) apply assessment skills and techniques to gather subjective and objective data, (e) differentiate normal from abnormal physical examination findings, (f) summarize, organize, and appropriately document findings using correct professional terminology, (g) practice developing primary and differential diagnoses, (h) practice creating treatment plans which include diagnostics, medication, education, consultation/referral, and follow-up planning; and (i) analyze and reflect on own performance to gain insight and foster knowledge. Brian Foster Chest Pain Shadow Health Assessment.
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 strong, 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
 Subjective Action Pro Tip: Chest pain can be a sign of many health problems, some serious and some less serious. It is important to follow up with discovery of chest pain by asking about its characteristics and severity. Example Question: "Do you have chest pain?"” data-html=”true” data-title=”Reports sporadic chest pain (Found)” data-original-title=””>
Finding:
Reports sporadic chest pain
(Found)
Pro Tip: Chest pain can be a sign of many health problems, some serious and some less serious. It is important to follow up with discovery of chest pain by asking about its characteristics and severity. Brian Foster Chest Pain Shadow Health Assessment.
Example Question:
Do you have chest pain?
History of Present Illness
Finding:
Asked about onset of pain
 Subjective Action 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?"” data-html=”true” data-title=”Reports chest pain started appearing in the past month (Found)” data-original-title=””>
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 location of pain
 Subjective Action 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?"” data-html=”true” data-title=”Reports pain is in center of the chest (Found)” data-original-title=””>
Finding:
Reports pain is in 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 of the pain, and how best to treat it. Brian Foster Chest Pain Shadow Health Assessment.
Example Question:
Where is the pain?
 Subjective Action 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?"” data-html=”true” data-title=”Reports pain does not radiate (Found)” data-original-title=””>
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?
 Subjective Action Pro Tip: When combined with chest pain, arm pain can be a telling sign that the complaint may be cardiac in nature. Example Question: "Are you experiencing arm pain?"” data-html=”true” data-title=”Denies arm pain (Found)” data-original-title=””>
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:
Are you experiencing arm pain?
 Subjective Action Pro Tip: When combined with chest pain, shoulder pain can be a telling sign that the complaint may be cardiac in nature. Example Question: "Are you experiencing shoulder pain?"” data-html=”true” data-title=”Denies shoulder pain (Found)” data-original-title=””>
Finding:
Denies shoulder pain
(Found)
Pro Tip: When combined with chest pain, shoulder pain can be a telling sign that the complaint may be cardiac in nature.
Example Question:
Are you experiencing shoulder pain?
 Subjective Action Pro Tip: When combined with chest pain, back pain can be a telling sign that the complaint may be cardiac in nature. Example Question: "Are you experiencing back pain?"” data-html=”true” data-title=”Denies back pain (Found)” data-original-title=””>
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:
Are you experiencing back pain?
 Subjective Action Pro Tip: When combined with chest pain, neck pain can be a telling sign that the complaint may be cardiac in nature. Example Question: "Are you experiencing neck pain?"” data-html=”true” data-title=”Denies neck pain (Found)” data-original-title=””>
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:
Are you experiencing neck pain?
Finding:
Asked about duration of pain episodes
 Subjective Action 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 your chest pain last?"” data-html=”true” data-title=”Reports each episode lasted "several" minutes (Found)” data-original-title=””>
Finding:
Reports each episode lasted “several” minutes
(Found)
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 your chest pain last?
Finding:
Asked about frequency of pain
 Subjective Action Pro Tip: Establishing a timeline for a patient’s symptoms can help you to better diagnose his condition and most effectively treat him. Example Question: "How many times in the last month have you had chest pain?"” data-html=”true” data-title=”Reports 3 episodes in past month (Found)” data-original-title=””>
Finding:
Reports 3 episodes in past month
(Found)
Pro Tip: Establishing a timeline for a patient’s symptoms can help you to better diagnose his condition and most effectively treat him.
Example Question:
How many times in the last month have you had chest pain?
 Subjective Action Pro Tip: Asking your patient if the episodes seem associated can point to possible factors that aggravate the episodes or trigger symptoms, and can help narrow your diagnosis. Example Question: "Did the episodes seem associated?"” data-html=”true” data-title=”Reports that episodes did not seem related (Available)” data-original-title=””>
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 can help narrow your diagnosis. Brian Foster Chest Pain Shadow Health Assessment
Example Question:
Did the episodes seem associated?
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Finding:
Asked about severity of pain
 Subjective Action 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: "How would you rate your pain on a scale of zero to ten?"” data-html=”true” data-title=”Reports current pain is 0 out of 10 (Found)” data-original-title=””>
Finding:
Reports current pain is 0 out of 10
(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:
How would you rate your pain on a scale of zero to ten?
 Subjective Action Pro Tip: For many patients, it is difficult to clearly describe pain. Asking Brian to rate his pain at its worst gives a clearer picture of the pain’s severity. Example Question: "How would you rate your pain on a scale of zero to ten?"” data-html=”true” data-title=”Reports pain severity at its worst is 5 out of 10 (Found)” data-original-title=””>
Finding:
Reports pain severity at its worst is 5 out of 10
(Found)
Pro Tip: For many patients, it is difficult to clearly describe pain. Asking Brian to rate his pain at its worst gives a clearer picture of the pain’s severity.
Example Question:
How would you rate your pain on a scale of zero to ten?
Finding:
Asked about character of pain
 Subjective Action 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: "Can you describe your pain?"” data-html=”true” data-title=”Describes pain as tight and uncomfortable (Found)” data-original-title=””>
Finding:
Describes pain as tight and uncomfortable
(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:
Can you describe your pain?
 Subjective Action 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 crushing?"” data-html=”true” data-title=”Denies crushing pain (Found)” data-original-title=””>
Finding:
Denies crushing 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 crushing?
 Subjective Action 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 gnawing?"” data-html=”true” data-title=”Denies gnawing pain (Found)” data-original-title=””>
Finding:
Denies gnawing 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. Brian Foster Chest Pain Shadow Health Assessment
Example Question:
Is the pain gnawing?
 Subjective Action 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?"” data-html=”true” data-title=”Denies burning pain (Found)” data-original-title=””>
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 aggravating factors
 Subjective Action 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?"” data-html=”true” data-title=”Reports pain is aggravated by activity (Found)” data-original-title=””>
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?
 Subjective Action 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?"” data-html=”true” data-title=”Pain occurred with yard work and taking stairs (Found)” data-original-title=””>
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?
 Subjective Action 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?"” data-html=”true” data-title=”Pain does not worsen with eating (Available)” data-original-title=””>
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?
 Subjective Action Pro Tip: It is important to ask abo
