Shadow Health Focused Exam Chest Pain Discussion Paper
SUBJECTIVE DATA:
Chief Complaint (CC): chest pain
History of Present Illness (HPI): BF is a 58-year-old Caucasian man who suffers from recurring chest pain that has occurred three times in the last month. The patient reports that the pain is lessened by sitting or laying down and that it worsens with activity. The patient also claims that the discomfort is greater while they are standing or walking. There is a 5/10 degree of discomfort reported by the patient in each episode lasting around 5 minutes. When asked where he feels the pain, the patient says it is “tight and uncomfortable” in the centre of his chest. Denies the existence of pain that is spreading to the arm or back, as well as the neck. Denies having any breathing difficulties. The client is presently denying that he is experiencing any chest pain and rating their level of pain as 0 out of 10. Shadow Health Focused Exam Chest Pain Discussion Paper
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Medications:
Lisinopril 20mg daily
Omega-3 Fish Oil 1200mg BID
Atorvastatin 20mg QHS
Allergies:
Codeine- nausea, vomiting,
Past Medical History (PMH):
Hyperlipidemia
Hypertension
Denies history of hospitalizations
Past Surgical History (PSH): Denies surgical history
Sexual/Reproductive History: Identifies as heterosexual and is in a monogamous relationship. Has two children.
Personal/Social History: Denies tobacco or illicit drug use. Reports occasional alcohol use.
Immunization History:
Tdap 10/2014.
Influenza 10/2021.
COVID-19 2021
Significant Family History:
Father- deceased from colon cancer, history of obesity, hypertension, and hyperlipidemia,
Mother – diabetes, Hypertension,
Sister- diabetes, hypertension
Paternal grandmother-died from pneumonia
Maternal grandfather-died from stroke.
Maternal grandmother-died from breast cancer.
Review of Systems:
General: Denies weight change, fatigue , or fever.
Cardiovascular/Peripheral Vascular: Reports pain in the middle of the chest. Denies palpitations or swelling.
Respiratory: Denies wheezing, cough, or shortness of breath.
Gastrointestinal: Denies diarrhea, constipation, vomiting, nausea, or abdominal pain.
Musculoskeletal: Denies muscle pain, or injury. Denies joint pain or injury. Denies history of sprains or fractures.
Psychiatric: Denies history of anxiety, depression or other mental illnesses.
OBJECTIVE DATA:
Physical Exam:
Vital signs: 146/90, P-104, R-19, T-36.7C. Ht- 5’11. Wt 197lbs. BMI 27.5
General: Alert and oriented x 4. Appears well-dressed, well-nourished, and well-groomed. Able to maintain eye contact. Cooperative. Clear and coherent speech
Cardiovascular/Peripheral Vascular: S1, S2, S3 noted with gallops. No murmurs or rubs. PMI displaced laterally at mitral area. Capillary refill less than 3 seconds. EKG-normal sinus rhythm with no ST elevations.
Respiratory: Breath sounds clear to auscultation. Unlabored breathing noted.. Fine crackles in right middle lobe and posterior left lower lobe.
Gastrointestinal: Symmetric, round, soft abdomen, no abnormalities. No abdominal bruits Normoactive bowel sounds. All areas are generally tympanic on percussion. No tenderness to both light and deep palpitation..
Musculoskeletal: 5/5 strength and Full ROM in both extremities.
Neurological: Alert and oriented x 4. Cranial Nerves grossly intact. DTR’s intact
Skin: no visible abnormalities in nails. No cyanosis, skin tenting, or lesion noted
Diagnostic Test/Labs:
EKG- Normal rate and rhythm. No ST elevation.
ASSESSMENT: Shadow Health Focused Exam Chest Pain Discussion Paper
Angina Pectoris (Stable Angina): This particular kind of chest pain is brought on by an inadequate supply of blood to the heart. It is a sign that you may be suffering from coronary artery disease. People often use words like “squeezing,” “pressure,” “heaviness,” “tightness,” and “pain” to describe the sensation that they experience in their chests. There is a possibility that it may seem like a big weight is resting on the chest. It’s possible that your angina pectoris is a new discomfort that needs to be checked out by a medical professional, or it might be a reoccurring pain that goes away after you get treatment for it. It is not always easy to differentiate angina pectoris from other forms of chest pain, such as the discomfort caused by indigestion, despite the fact that angina pectoris is rather prevalent (Gillen & Goyal, 2021).
Congestive Heart Failure: This is a condition that manifests itself when the muscle of the heart fails to pump blood as effectively as it should. When anything like this takes place, the body’s blood supply often reverses, and fluid may accumulate in the lungs, leading to a sensation of being unable to catch one’s breath. Certain cardiac disorders, such as restricted arteries in the heart or high blood pressure, can progressively leave the heart unable to fill and pump blood adequately because it will become too weak or stiff (Malike et al, 2021). Symptoms include things like exhaustion, shortness of breath, swelling legs, and a racing pulse.
Coronary Artery Disease: This is a condition that is brought on by a restriction in the blood flow via the coronary arteries, which is often brought on by atheromas. There are a number of clinical symptoms, some of which include silent ischemia, angina pectoris, acute coronary syndromes, and sudden cardiac death. The diagnosis is made based on the patient’s symptoms, as well as the results of an electrocardiogram, stress test, and sometimes, coronary angiography (Shahjehan & Bhutta, 2021).
References
Gillen, C., & Goyal, A. (2021). Stable Angina. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK559016/
Malik, A., Brito, D., Vaqar, S., & Chhabra, l. (2021). Congestive heart failure. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK430873/
Shahjehan, R.D., & Bhutta, B.S. (2021). Coronary artery disease. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK564304/
History of Present Illness (HPI): This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. You need to start EVERY HPI with age, race, and gender (i.e. 34-year-old AA male). You must include the 7 attributes of each principal symptom:
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- Location
- Quality
- Quantity or severity
- Timing, including onset, duration, and frequency
- Setting in which it occurs
- Factors that have aggravated or relieved the symptom
- Associated manifestations
Medications: Include over the counter, vitamin, and herbal supplements. List each one by name with dosage and frequency.
Allergies: Include specific reactions to medications, foods, insects, and environmental factors.
Past Medical History (PMH): Include illnesses (also childhood illnesses), hospitalizations, and risky sexual behaviors.
Past Surgical History (PSH): Include dates, indications, and types of operations.
Sexual/Reproductive History: If applicable, include obstetric history, menstrual history, methods of contraception, and sexual function.
Personal/Social History: Include tobacco use, alcohol use, drug use, patient’s interests, ADL’s and IADL’s if applicable, and exercise and eating habits.
Immunization History: Include last Tdp, Flu, pneumonia, etc.
Significant Family History: Include history of parents, Grandparents, siblings, and children.
Review of Systems: From head-to-toe, include each system that covers the Chief Complaint, History of Present Illness, and History)Shadow Health Focused Exam Chest Pain Discussion Paper. Remember that the information you include in this section is based on what the patient tells you. You will only need to cover systems pertinent to your CC, HPI (N/A, UNKNOWN is not acceptable, make up the information if you need to). To ensure that you include all essentials in your case, refer to Chapter 2 of the Sullivan text.
General: Include any recent weight changes, weakness, fatigue, or fever, but do not restate HPI data here.
Cardiovascular/Peripheral Vascular:
Respiratory:
Gastrointestinal:
Musculoskeletal:
Psychiatric:
OBJECTIVE DATA: From head-to-toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History unless you are doing a total H&P. Do not use WNL or normal. You must describe what you see.
Physical Exam:
Vital signs: Include vital signs, ht, wt, temperature, and BMI and pulse oximetry.
General: Include general state of health, posture, motor activity, and gait. This may also include dress, grooming, hygiene, odors of body or breath, facial expression, manner, level of conscience, and affect and reactions to people and things.
Cardiovascular/Peripheral Vascular: Always include the heart in your PE.
Respiratory: Always include this in your PE.
Gastrointestinal:
Musculoskeletal:
Neurological:
Skin:
Diagnostic Test/Labs: Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses with rationale for each one documented OR ones that were mentioned during the SH assignment.
ASSESSMENT: List your priority diagnosis(es). For each priority diagnosis, list at least 3 differential diagnoses, each of which must be supported with evidence and guidelines. For holistic care, you need to include previous diagnoses and indicate whether these are controlled or not controlled.
Take a moment to observe your breathing. Notice the sensation of your chest expanding as air flows into your lungs. Feel your chest contract as you exhale. How might this experience be different for someone with chronic lung disease or someone experiencing an asthma attack? In order to adequately assess the chest region of a patient, nurses need to be aware of a patient’s history, potential abnormal findings, and what physical exams and diagnostic tests should be conducted to determine the causes and severity of abnormalities. In this DCE Assignment, you will conduct a focused exam related to chest pain using the simulation too, Shadow Health. Consider how a patient’s initial symptoms can result in very different diagnoses when further assessment is conducted. To Prepare Review this week’s Learning Resources and the Advanced Health Assessment and Diagnostic Reasoning media program and consider the insights they provide related to heart, lungs, and peripheral vascular system. Review the Shadow Health Resources provided in this week’s Learning Resources specifically the tutorial to guide you through the documentation and interpretation with the Shadow Health platform. Review the examples also provided. Review the DCE (Shadow Health) Documentation Template for Focused Exam: Chest Pain found in this week’s Learning Resources and use this template to complete your Documentation Notes for this DCE Assignment. Access and login to Shadow Health using the link in the left-hand navigation of the Blackboard classroom. Review the Week 7 DCE Focused Exam: Chest Pain Rubric provided in the Assignment submission area for details on completing the Assignment in Shadow Health. Consider what history would be necessary to collect from the patient. Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis? Shadow Health Focused Exam Chest Pain Discussion Paper
**Below is the transcript to create Soap note. Hi Mr Foster, My name is , I am going to examine you today. Greet 10/05/20 1:18 PM MDT Brian Foster Good morning. Your avatar What brought you here today ? Question 10/05/20 1:18 PM MDT Brian Foster I have been having some troubling chest pain in my chest now and then for the past month. Your avatar Oh I’m sorry to hear that, it should be very uncomfortable to have that pain for a whole month. Empathize 10/05/20 1:22 PM MDT Brian Foster Thanks. I appreciate that. Your avatar ? (No matching questions found.) Question 10/05/20 1:22 PM MDT Your avatar What is the onset of your pain ? Question 10/05/20 1:23 PM MDT Brian Foster I first noticed it earlier this month. I thought it might just be heartburn and it passed after about a couple of minutes. Your avatar What is the exact location of the pain ? Question 10/05/20 1:24 PM MDT Brian Foster When the pain happens, I feel it mostly in the middle of my chest, over my heart. Your avatar When did you chest pain start ? Question 10/05/20 1:25 PM MDT Brian Foster I first noticed it earlier this month. I thought it might just be heartburn and it passed after a couple of minutes.NURS6512 Week 7 – Focused Exam: Chest Pain Brian Foster Results Your avatar What is the exact location of the pain ? Question 10/05/20 1:25 PM MDT Brian Foster When the pain happens, I feel it mostly in the middle of my chest, over my heart. Your avatar Sorry to hear that Empathize 10/05/20 1:26 PM MDT Brian Foster Thanks. I appreciate that. Your avatar Easter pain radiates anywhere ? (Clarified to Is your pain radiating?.) Question 10/05/20 1:26 PM MDT Brian Foster The pain doesn’t radiate anywhere. It’s mostly just right in the middle of my chest. Shadow Health Focused Exam Chest Pain Discussion Paper
(Clarified to if the pain is radiating.) Your avatar If your arm hurts (Clarified to Do you have pain in your arm?.) Question 10/05/20 1:26 PM MDT Brian Foster No, when I am having the chest pain, it’s mostly just in middle of my chest. (Clarified to if I have pain in my arm.) Your avatar Do you have a pain in your shoulder ? Question 10/05/20 1:27 PM MDT Brian Foster No, the pain hasn’t been in my shoulder. Your avatar Do you have a back pain ? Question 10/05/20 1:27 PM MDT Brian Foster I haven’t had back pain, no. Your avatar Can you tell me the duration of the pain ? (No matching questions found.) Question 10/05/20 1:28 PM MDT Your avatar Can you describe the duration of the pain ? (Clarified to Can you tell me what the pain is like?.) Question 10/05/20 1:28 PM MDT Brian Foster Well, it mostly feels tight and uncomfortable right in the middle of my chest. (Clarified to if I can tell you what the pain is like.) Your avatar How often pain occurs ? (Clarified to How often do you have pain?.) Question 10/05/20 1:29 PM MDT Brian Foster Well, it has happened three times the past month. It usually goes away after about a couple of minutes. (Clarified to how often I have pain.) Your avatar Can you describe your pain from 0 to 10 scale ? Question 10/05/20 1:29 PM MDT Brian Foster I’d say maybe a . . . 5? It’s just really uncomfortable . . . like there’s nothing I can do about it. Right now it’s like a zero though. Your avatar Sorry to hear that Empathize 10/05/20 1:30 PM MDT Brian Foster Thanks. I appreciate that. Your avatar Can you describe your pain ? Question 10/05/20 1:31 PM MDT Brian Foster Well, it mostly feels tight and uncomfortable right in the middle of my chest. Your avatar ASA pain crashing ? (Clarified to Do you take aspirin?.) Question 10/05/20 1:31 PM MDT Brian Foster I usually just take Tylenol or ibuprofen. (Clarified to if I take aspirin.) Shadow Health Focused Exam Chest Pain Discussion Paper
Your avatar What is the dosage of Tylenol are you taking ? Question 10/05/20 2:35 PM MDT Brian Foster Just whatever the bottle recommends for an adult. Your avatar What is the dosage of ibuprofen you taking ? (Clarified to What is the strength of the ibuprofen you take?.) Question 10/05/20 2:35 PM MDT Brian Foster Just whatever the bottle recommends for an adult. (Clarified to What strength ibuprofen I take.)NURS6512 Week 7 – Focused Exam: Chest Pain Brian Foster Results Your avatar Is it Tylenol helps ? Question 10/05/20 2:35 PM MDT Brian Foster Just a couple when I get a headache, which is not very often. Your avatar How often do you take Tylenol ? Question 10/05/20 2:36 PM MDT Brian Foster I took some today . . . maybe every couple days for mild pain. Your avatar What is the reason you’re taking ibuprofen ? Question 10/05/20 2:36 PM MDT Brian Foster Just when I need it for various aches and pains. Probably not more than 3 or 4 times a month. Your avatar Where else do you have a pain ? Question 10/05/20 2:36 PM MDT Brian Foster No, when I am having the chest pain, it’s mostly just in middle of my chest. Your avatar Do you have a pain somewhere else in your body ? Question 10/05/20 2:37 PM MDT Brian Foster No, when I am having the chest pain, it’s mostly just in middle of my chest. Your avatar What is the aggravating factors ? (Clarified to Are there any aggravating factors?.) Question 10/05/20 2:37 PM MDT Brian Foster Well, the pain seems to start when I’m doing something physical . . . the first time it happened while I was doing yard work, and the second time . . . I had to take the stairs at work because the elevator broke. Both times it got better if I took a break or sat down to rest. (Clarified to if there are aggravating factors.) Your avatar What activity triggers pain ? Question 10/05/20 2:39 PM MDT Brian Foster If I’m up and moving around I definitely notice it more and it makes me feel like I should sit down and take a deep breath or something. Your avatar He’s a pain worse when you eat ? Question 10/05/20 2:40 PM MDT Brian Foster I don’t think eating has anything to do with it. One episode did happen when my wife and I were out for dinner, but it seemed to happen before we even settled. The episodes don’t seem all that related, to be honest. Your avatar It can be a lot of triggers in your diet which would aggravate and trigger your pain Mr.Foster. Educate 10/05/20 2:43 PM MDT Brian Foster Good to know. Thank you. Your avatar Do you like spicy food ? Question 10/05/20 2:43 PM MDT Brian Foster Sure, I like spicy food. I don’t eat it very often, though. Maybe once or twice a month. Your avatar Do you like high-fat food ? Shadow Health Focused Exam Chest Pain Discussion Paper
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(Clarified to Do fatty foods cause the pain?.) Question 10/05/20 2:44 PM MDT Brian Foster I don’t think that has anything to do with it, but I guess I don’t know. (Clarified to if fatty foods cause the pain.) Your avatar What relieves your pain ? Question 10/05/20 2:44 PM MDT Brian Foster I’m not sure. I think lying still seems to help a little. Your avatar Take anything for chest pain ? Question 10/05/20 2:46 PM MDT Brian Foster No, not yet. Your avatar Do you take medication for hypertension ? Question 10/05/20 2:46 PM MDT Brian Foster I take metoprolol, yes. [AUDIO COMING SOON] Your avatar Is a dosage of Metoprolol ? (Clarified to What dose of Lopressor do you take?.) Question 10/05/20 2:47 PM MDT Brian Foster I think it’s 100 mg, once a day. (Clarified to what dose of Lopressor I take.) Your avatar Do you take any medication for hyperlipidemia ? Question 10/05/20 2:47 PM MDT Brian Foster I take atorvastatin. [AUDIO COMING SOON] Your avatar What is the dosage of atorvastatin are you taking ? Question 10/05/20 2:48 PM MDT Brian Foster I think it’s twenty milligrams a day. Your avatar Do you take over-the-counter medications ? Question 10/05/20 2:48 PM MDT Brian Foster Oh, just ibuprofen or Tylenol occasionally for pain. Your avatar Do you take any supplements ? Question 10/05/20 2:48 PM MDT Brian Foster I take fish oil, that’s it. Your avatar How frequently you take medication for hyperlipidemia ? (Clarified to Do you take cholesterol medication?.) Question 10/05/20 2:49 PM MDT Brian Foster I take atorvastatin. [AUDIO COMING SOON] (Clarified to if I take cholesterol medication.)NURS6512 Week 7 – Focused Exam: Chest Pain Brian Foster Results Your avatar How often do you take atorvastatin ? Question 10/05/20 2:50 PM MDT Brian Foster I take them daily. I’m pretty good about following the doctor’s orders. Your avatar When have you been diagnosed with high blood pressure ? Question 10/05/20 2:51 PM MDT Brian Foster Yes, I supposedly have moderately high blood pressure. Your avatar When you started to take metoprolol ? Question 10/05/20 2:51 PM MDT Brian Foster I think it’s been about one year. Your avatar When have you been diagnosed with hyperlipidemia ? (Clarified to Do you have an anxiety disorder?.) Question 10/05/20 2:51 PM MDT Brian Foster I’ve never had any anxiety problems before. [AUDIO COMING SOON] (Clarified to if I have an anxiety disorder.) Your avatar When have you been diagnosed with hyperlipidemia ? (Clarified to Are you diagnosed with high blood pressure?.) Question 10/05/20 2:52 PM MDT Brian Foster Yes, I supposedly have moderately high blood pressure. (Clarified to if I have been diagnosed with hypertension.) Your avatar I’m sorry to hear that Empathize 10/05/20 2:52 PM MDT Brian Foster Thanks. I appreciate that. Your avatar Do you do exercise ? Question 10/05/20 2:53 PM MDT Brian Foster Well I used to ride my bike a lot but it got stolen a couple years ago. I guess I haven’t had much regular exercise since then. I want to get a new bike if the doctor says it is OK to exercise with this chest pain I’ve been having. Your avatar I’m sorry to hear that your bike was stolen Empathize 10/05/20 2:53 PM MDT Brian Foster Thanks. I appreciate that. Your avatar When did the exercise last time ? Question 10/05/20 2:53 PM MDT Brian Foster Well I used to ride my bike a lot but it got stolen a couple years ago. I guess I haven’t had much regular exercise since then. I want to get a new bike if the doctor says it is OK to exercise with this chest pain I’ve been having. Your avatar What type of food do you like ? Question 10/05/20 2:54 PM MDT Brian Foster Um, let’s see . . . For breakfast I usually eat a granola bar and drink an instant breakfast shake. I’ve been doing that a while since it saves time in the morning. Most days for lunch I get a sandwich from the sub shop near work. Shadow Health Focused Exam Chest Pain Discussion Paper
That’s usually a turkey sub, but sometimes I get a spicy Italian sub. My wife and I grill a lot, and usually have some grilled meat with veggies for dinner. Your avatar United include a lot of processed and fast food which is not good for your body. To have the same fast food diet may affect you over the time. You need to change your diet.NURS6512 Week 7 – Focused Exam: Chest Pain Brian Foster Results Educate 10/05/20 2:57 PM MDT Brian Foster Good to know. Thank you. Your avatar You need to exercise.Not essential to do that with a bike. You can do sit ups, running or just simple indoor exercises in your home. Educate 10/05/20 2:59 PM MDT Brian Foster Good to know. Thank you. Your avatar Did you lose any weight ? (Clarified to Have you lost weight?.) Question 10/05/20 2:59 PM MDT Brian Foster Not exactly . . . I’ve gained about fifteen to twenty pounds in the last couple years. (Clarified to if I have lost weight.) Your avatar It’s not good to gain the weight. You need to change the diet and start doing the exercises. Educate 10/05/20 3:10 PM MDT Brian Foster Good to know. Thank you. Your avatar What’s what’s your fathers health ? Question 10/05/20 3:14 PM MDT Brian Foster He really wasn’t doing so great in the last few years. He died when he was 75 of colon cancer, but even before that, his weight and his blood pressure and cholesterol were getting the best of him. It was rough. He didn’t last too long after the cancer diagnosis, unfortunately. I think he was tired of fighting. Your avatar I’m sorry to hear that it should be very difficult to lose the father Empathize 10/05/20 3:15 PM MDT Brian Foster Thanks. I appreciate that. Your avatar How did you cope with a losing father ? (No matching questions found.) Question 10/05/20 3:15 PM MDT Your avatar How did you cope after you lost your father ? Question 10/05/20 3:16 PM MDT Brian Foster Yeah. He died of colon cancer. He also had high blood pressure and high cholesterol. Your avatar Sorry to hear that Empathize 10/05/20 3:16 PM MDT Brian Foster Thanks. I appreciate that. Your avatar Who’s your mother’s health ? Question 10/05/20 3:16 PM MDT Brian Foster She has type 2 diabetes and some high blood pressure, but I think she’s doing pretty well for 80. Your avatar Do you have a brothers and sisters ? Question 10/05/20 3:17 PM MDT Brian Foster I have a sister, and I had a brother but he died many years ago. Your avatar Sorry to hear that Empathize 10/05/20 3:17 PM MDT Brian Foster Thanks. I appreciate that. Your avatar How was your maternal grandmother ? (Clarified to How is the health of your maternal grandmother?.) Question 10/05/20 3:17 PM MDT Brian Foster She had breast cancer. She was in her 60s when she died. (Clarified to how my maternal grandmother’s health is.) Your avatar About maternal grandfather ? Question 10/05/20 3:18 PM MDT Brian Foster My grandfather on my mom’s side died of a heart attack. He was in his mid-fifties. Your avatar Sorry to hear that Empathize 10/05/20 3:18 PM MDT Brian Foster Thanks. I appreciate that. Your avatar How is your paternal grandfather ? Question 10/05/20 3:18 PM MDT Brian Foster He was healthy right up until he died. He went in his sleep at 85, and we just called it old age. Your avatar Sorry to hear that Empathize 10/05/20 3:19 PM MDT Brian Foster Thanks. I appreciate that. Your avatar How about fraternal grandmother ? (No matching questions found.) Question 10/05/20 3:19 PM MDT Your avatar How about paternal grandmother ? Question 10/05/20 3:19 PM MDT Brian Foster She died of pneumonia when she was almost 80. 78 or 79, I think. Your avatar Sorry to hear that Empathize 10/05/20 3:20 PM MDT Brian Foster Thanks. I appreciate that. Your avatar Do you have children ? Question 10/05/20 3:20 PM MDT Brian Foster Yes, I have two great kids. Well, they’re not kids. Sam is 26 and Allie is 19. Your avatar Does it have any medical conditions ? Question 10/05/20 3:20 PM MDT Brian Foster The doctors told me I have a little bit of high blood pressure and cholesterol, but that’s it. Your avatar Is your daughter healthy ? Question 10/05/20 3:21 PM MDT Brian Foster Allie’s doing great. She has asthma, but she’s got a handle on it. [AUDIO COMING SOON] Your avatar How is your son doing ? Question 10/05/20 3:21 PM MDT Brian Foster He’s 26. Your avatar Do you smoke ? Question 10/05/20 3:21 PM MDT Brian Foster Nope, I had a lot of friends who did but I never started. Your avatar Do you drink ? Question 10/05/20 3:21 PM MDT Brian Foster Sure, but never more than two or three beers on a weekend. Your avatar Do you do drugs ? Question 10/05/20 3:22 PM MDT Brian Foster Nope. Your avatar Do you have any hobby ? Question 10/05/20 3:22 PM MDT Brian Foster I like to fish, I like sports . . . let’s see, I do some small electronics repair sometimes, and I go to my son’s bodybuilding competitions when I can. Your avatar Did you have any surgeries ? Question 10/05/20 3:23 PM MDT Brian Foster I’ve never had any surgeries. Your avatar It is very good that you dont have any surgeries Empathize 10/05/20 3:23 PM MDT Brian Foster Thanks. I appreciate that. Your avatar Do you have any allergy ? Question 10/05/20 3:24 PM MDT Brian Foster No, well . . . I’ve had a bad reaction to codeine before, but that is all I know of.NURS6512 Week 7 – Focused Exam: Chest Pain Brian Foster Results Your avatar What type of reaction do you have to codeine ? Question 10/05/20 3:24 PM MDT Brian Foster It makes me nauseous and I vomit. Your avatar How was your immunizations ? (Clarified to What immunizations have you had?.) Question 10/05/20 3:25 PM MDT Brian Foster I don’t remember exactly . . . maybe it’s on my chart. (Clarified to what vaccines I have had.) Shadow Health Focused Exam Chest Pain Discussion Paper
Your avatar She hasn’t been told that your cholesterol is always high ? Question 10/06/20 6:29 AM MDT Brian Foster I’ve been told it’s moderately high. I’ve never noticed any actual symptoms from that though. Your avatar Have you been tested for diabetes ? Question 10/06/20 6:29 AM MDT Brian Foster My mom and my sister both have diabetes, but I don’t have it. Your avatar Have you been monitoring your blood pressure ? Question 10/06/20 6:29 AM MDT Brian Foster Not usually. They check it when I get checkups. My doctor has never seemed overly concerned about it. Your avatar Do you remember your last blood pressure reading ? (Clarified to Do you know your blood pressure number?.) Question 10/06/20 6:30 AM MDT Brian Foster No, not offhand. (Clarified to if I know my blood pressure number.) Your avatar You need to monitor your blood pressure and you need to know your Baseline. Educate 10/06/20 6:30 AM MDT Brian Foster Good to know. Thank you. Your avatar Have you done any EKG recently ? (No matching questions found.) Question 10/06/20 6:31 AM MDT Your avatar Did your doctor do any EKG ? (No matching questions found.) Question 10/06/20 6:31 AM MDT Your avatar Any electrocardiogram ? (No matching questions found.) Question 10/06/20 6:32 AM MDT Your avatar EKG done ? (Clarified to When was your last EKG?.) Question 10/06/20 6:32 AM MDT Brian Foster I had one about three months ago. They usually put one on me at my annual physical. (Clarified to when my last EKG was.) Your avatar Well, EKG shows your heart monitoring, it will give us an idea how is your heart works. Educate 10/06/20 6:34 AM MDT Brian Foster Good to know. Thank you. Your avatar What was the result of EKG ? Question 10/06/20 6:34 AM MDT Brian Foster I don’t remember the actual results, but as far as I know, it was normal. Your avatar Do you have a primary care provider ? Question 10/06/20 6:34 AM MDT Brian Foster Dr. Melinda Smith. Your avatar It is Good that you have one. Educate 10/06/20 6:35 AM MDT Brian Foster Good to know. Thank you. Your avatar When your last visit your primary care provider ? Question 10/06/20 6:35 AM MDT Brian Foster I had a physical about 3 months ago. Your avatar Do you have stress ? Question 10/06/20 6:36 AM MDT Brian Foster Not usually, but I’m feeling pretty anxious not knowing what’s going on with my chest. Your avatar I’m sorry to hear that Empathize 10/06/20 6:36 AM MDT Brian Foster Thanks. I appreciate that. Your avatar Do your exercise ? Question 10/06/20 6:37 AM MDT Brian Foster Well I used to ride my bike a lot but it got stolen a couple years ago. I guess I haven’t had much regular exercise since then. I want to get a new bike if the doctor says it is OK to exercise with this chest pain I’ve been having. Your avatar I’m sorry that chest pain makes you not exercise Empathize 10/06/20 6:37 AM MDT Brian Foster Thanks. I appreciate that. Your avatar Do you drink water regularly ? Question 10/06/20 6:37 AM MDT Brian Foster I usually drink water all day at work. At least four glasses, probably more. Shadow Health Focused Exam Chest Pain Discussion Paper
[AUDIO COMING SOON] Your avatar Let’s go to take water Educate 10/06/20 6:38 AM MDT Brian Foster Good to know. Thank you. Your avatar Do you drink alcohol ? Question 10/06/20 6:39 AM MDT Brian Foster Sure, but never more than two or three beers on a weekend. Your avatar That’s moderate drinking Educate 10/06/20 6:39 AM MDT Brian Foster Good to know. Thank you. Your avatar Do you have a fever ? Question 10/06/20 6:40 AM MDT Brian Foster I haven’t had a fever, no. Your avatar They have a chills ? Question 10/06/20 6:40 AM MDT Brian Foster I haven’t had chills, no. Your avatar Do you have fatigue ? Question 10/06/20 6:40 AM MDT Brian Foster I’m not more tired than normal. Your avatar Do you have night sweats ? Question 10/06/20 6:41 AM MDT Brian Foster Nope, no night sweats. Your avatar Do you have thought the dacianpalpitations ? Question 10/06/20 6:41 AM MDT Brian Foster Nah, I don’t think about stuff like that. I’m happy with my life. Your avatar Do you have palpitations ? Question 10/06/20 6:41 AM MDT Brian Foster I don’t think so. I haven’t noticed any. Your avatar Do you have angina ? Question 10/06/20 6:42 AM MDT Brian Foster I’ve never been diagnosed with angina. [AUDIO COMING SOON] Your avatar Have you ever had edema ? Question 10/06/20 6:42 AM MDT Brian Foster I haven’t noticed any swelling. Your avatar Have you had any blood clots ? Question 10/06/20 6:42 AM MDT Brian Foster Not that I know of. Your avatar Any history of rheumatic fever ? Question 10/06/20 6:43 AM MDT Brian Foster No, I never had that. Your avatar Any history of heart murmur ? Question 10/06/20 6:43 AM MDT Brian Foster No, none that I know of. Your avatar ? (No matching questions found.) Question 10/06/20 6:43 AM MDT Your avatar Do you have a cough ? Question 10/06/20 6:43 AM MDT Brian Foster I don’t have a cough. Your avatar Do you have difficulty breathing ? Question 10/06/20 6:44 AM MDT Brian Foster My breathing’s fine. Your avatar Do you have sore throat ? Question 10/06/20 6:44 AM MDT Brian Foster I haven’t had a sore throat in a long time. Your avatar Do you have change in sense of taste ? Question 10/06/20 6:45 AM MDT Brian Foster I can still taste things fine. Your avatar Do you have any dysphasia ? (No matching questions found.) Question 10/06/20 6:45 AM MDT Your avatar Do you have problem with swallowing ? Question 10/06/20 6:45 AM MDT Brian Foster I haven’t had any trouble swallowing. Your avatar Do you have nausea ? Question 10/06/20 6:45 AM MDT Brian Foster No, I haven’t felt nauseous. I just had pain in my chest. Your avatar Do you have diarrhea ? Question 10/06/20 6:46 AM MDT Brian Foster I have, but it is very rare for me. Your avatar Do you have constipation ? Question 10/06/20 6:46 AM MDT Brian Foster I haven’t had problems with that. I wish it were only that. Your avatar Do you have any family history of heart attack ? Question 10/06/20 6:46 AM MDT Brian Foster Well, my mom’s dad died of a heart attack. He was pretty young too. Your avatar Do you have a family history of a stroke ? Question 10/06/20 6:47 AM MDT Brian Foster No, none that I know of. Your avatar Measured vitals Exam Action 10/06/20 6:49 AM MDT Your avatar Mr. Foster, Thank you for answering my questions now I’m going to do physical examination Educate 10/06/20 6:49 AM MDT Brian Foster Good to know. Thank you. Your avatar Tested blood pressure in left arm with cuff Exam Action 10/06/20 6:51 AM MDT Your avatar Tested blood pressure in right arm with cuff Exam Action 10/06/20 6:51 AM MDT Your avatar Measured vitals Exam Action 10/06/20 6:51 AM MDT Your avatar Inspected face Exam Action 10/06/20 6:51 AM MDT Your avatar Inspected for jugular venous distension: No jugular venous distention; JVP 3 cm above sternal angle Exam Action 10/06/20 6:52 AM MDT Your avatar Inspected anterior chest wall Exam Action 10/06/20 6:52 AM MDT Your avatar Inspected left side of abdomen Exam Action 10/06/20 6:53 AM MDT Your avatar Inspected front of abdomen Exam Action 10/06/20 6:53 AM MDT Your avatar Inspected left side of abdomen Exam Action 10/06/20 6:53 AM MDT Your avatar Inspected right hand: no visible abnormal findings Exam Action 10/06/20 6:54 AM MDT Your avatar Inspected left hand: no visible abnormal findings Exam Action 10/06/20 6:54 AM MDT Your avatar Inspected fingernails of right hand Exam Action 10/06/20 6:55 AM MDT Your avatar Inspected fingernails of left hand Exam Action 10/06/20 6:55 AM MDT Your avatar Inspected left leg Exam Action 10/06/20 6:56 AM MDT Your avatar Inspected right leg Exam Action 10/06/20 6:56 AM MDT Your avatar Inspected toenails on left foot Exam Action 10/06/20 6:56 AM MDT Your avatar Inspected toenails on right foot Exam Action 10/06/20 6:57 AM MDT Your avatar Inspected left leg Exam Action 10/06/20 6:57 AM MDT Your avatar Inspected right leg Exam Action 10/06/20 6:57 AM MDT Your avatar Inspected right leg for edema: No edema Exam Action 10/06/20 6:58 AM MDT Your avatar Inspected left leg for edema: No edema Exam Action 10/06/20 6:58 AM MDT Your avatar Checked capillary refill in fingernails Exam Action 10/06/20 6:58 AM MDT Your avatar Checked capillary refill in fingernails Exam Action 10/06/20 6:58 AM MDT Your avatar Checked capillary refill in fingernails Exam Action 10/06/20 6:58 AM MDT Your avatar Checked capillary refill in fingernails Exam Action 10/06/20 6:58 AM MDT Your avatar Checked capillary refill in fingernails Exam Action 10/06/20 6:59 AM MDT Your avatar Checked capillary refill in fingernails Exam Action 10/06/20 6:59 AM MDT Your avatar Checked capillary refill in fingernails Exam Action 10/06/20 6:59 AM MDT Your avatar Auscultated right carotid pulse: Bruit present Exam Action 10/06/20 6:59 AM MDT Your avatar Auscultated left carotid pulse Exam Action 10/06/20 6:59 AM MDT Your avatar Auscultated right carotid pulse: Bruit present Exam Action 10/06/20 6:59 AM MDT Your avatar Auscultated left carotid pulse Exam Action 10/06/20 7:00 AM MDT Your avatar Auscultated right carotid pulse: Bruit present Exam Action 10/06/20 7:00 AM MDT Your avatar Auscultated aortic area with the bell Exam Action 10/06/20 7:01 AM MDT Your avatar Auscultated pulmonic area with the bell Exam Action 10/06/20 7:01 AM MDT Your avatar Auscultated Erb’s point with the bell Exam Action 10/06/20 7:01 AM MDT Your avatar Auscultated tricuspid area with the bell Exam Action 10/06/20 7:01 AM MDT Your avatar Auscultated mitral area with the bell Exam Action 10/06/20 7:01 AM MDT Your avatar Auscultated breath sounds in anterior right upper lobe Exam Action 10/06/20 7:02 AM MDT Your avatar Auscultated breath sounds in anterior left upper lobe Exam Action 10/06/20 7:02 AM MDT Your avatar Auscultated breath sounds in anterior right middle lobe Exam Action 10/06/20 7:02 AM MDT Your avatar Auscultated breath sounds in anterior left mid-chest (upper lobe) Exam Action 10/06/20 7:02 AM MDT Your avatar Auscultated breath sounds in anterior right lower lobe Exam Action 10/06/20 7:02 AM MDT Your avatar Auscultated breath sounds in anterior left lower lobe Exam Action 10/06/20 7:02 AM MDT Your avatar Auscultated aorta in abdomen Exam Action 10/06/20 7:03 AM MDT Your avatar Auscultated right renal pulse Exam Action 10/06/20 7:03 AM MDT Your avatar Auscultated left renal pulse Exam Action 10/06/20 7:04 AM MDT Your avatar Auscultated right iliac pulse Exam Action 10/06/20 7:04 AM MDT Your avatar Auscultated left iliac pulse Exam Action 10/06/20 7:04 AM MDT Your avatar Auscultated left femoral pulse Exam Action 10/06/20 7:04 AM MDT Your avatar Auscultated right femoral pulse Exam Action 10/06/20 7:04 AM MDT Your avatar Auscultated right upper quadrant Exam Action 10/06/20 7:04 AM MDT Your avatar Auscultated left upper quadrant Exam Action 10/06/20 7:04 AM MDT Your avatar Auscultated left lower quadrant Exam Action 10/06/20 7:04 AM MDT Your avatar Auscultated right lower quadrant Exam Action 10/06/20 7:04 AM MDT Your avatar Auscultated over liver Exam Action 10/06/20 7:05 AM MDT Your avatar Auscultated over spleen Exam Action 10/06/20 7:05 AM MDT Your avatar Palpated right carotid pulse: Thrill, 3+ Exam Action 10/06/20 7:05 AM MDT Your avatar Palpated left carotid pulse: No thrill, 2+ Exam Action 10/06/20 7:06 AM MDT Your avatar Palpated PMI: Displaced laterally; brisk and tapping; less than 3 cm Exam Action 10/06/20 7:06 AM MDT Your avatar Palpated right brachial pulse: No thrill, 2+ Exam Action 10/06/20 7:07 AM MDT Your avatar Palpated left brachial pulse: No thrill, 2+ Exam Action 10/06/20 7:07 AM MDT Your avatar Palpated right radial pulse: No thrill, 2+ Exam Action 10/06/20 7:18 AM MDT Your avatar Palpated left radial pulse: No thrill, 2+ Exam Action 10/06/20 7:19 AM MDT Your avatar Palpated right femoral pulse: No thrill, 2+ Exam Action 10/06/20 7:19 AM MDT Your avatar Palpated left femoral pulse: No thrill, 2+ Exam Action 10/06/20 7:19 AM MDT Your avatar Palpated right popliteal pulse: No thrill, 1+ Exam Action 10/06/20 7:20 AM MDT Your avatar Palpated left popliteal pulse: No thrill, 1+ Exam Action 10/06/20 7:20 AM MDT Your avatar Palpated right tibial pulse: Shadow Health Focused Exam Chest Pain Discussion Paper
No thrill, 1+ Exam Action 10/06/20 7:22 AM MDT Your avatar Palpated right tibial pulse: No thrill, 1+ Exam Action 10/06/20 7:23 AM MDT Your avatar Palpated left tibial pulse: No thrill, 1+ Exam Action 10/06/20 7:23 AM MDT Your avatar Palpated right dorsalis pedis pulse: No thrill, 1+ Exam Action 10/06/20 7:23 AM MDT Your avatar Palpated left dorsalis pedis pulse: No thrill, 1+ Exam Action 10/06/20 7:23 AM MDT Your avatar Palpated right upper quadrant with light pressure: No tenderness reported; no masses, guarding, or distension Exam Action 10/06/20 7:25 AM MDT Your avatar Palpated left upper quadrant with light pressure: No tenderness reported; no masses, guarding, or distension Exam Action 10/06/20 7:26 AM MDT Your avatar Palpated left lower quadrant with light pressure: No tenderness reported; no masses, guarding, or distension Exam Action 10/06/20 7:26 AM MDT Your avatar Palpated right lower quadrant with light pressure: No tenderness reported; no masses, guarding, or distension.NURS6512 Week 7 – Focused Exam: Chest Pain Brian Foster Results Exam Action 10/06/20 7:26 AM MDT Your avatar Percussed right upper quadrant Exam Action 10/06/20 7:27 AM MDT Your avatar Percussed left upper quadrant Exam Action 10/06/20 7:27 AM MDT Your avatar Percussed right lower quadrant Exam Action 10/06/20 7:27 AM MDT Your avatar Percussed left lower quadrant Exam Action 10/06/20 7:27 AM MDT Your avatar Percussed spleen Exam Action 10/06/20 7:27 AM MDT Your avatar Percussed for liver span: 7 cm in the mid-clavicular line Exam Action 10/06/20 7:28 AM MDT Your avatar Performed EKG Exam Action 10/06/20 7:28 AM MDT Your avatar Thank you Mr. Foster. I’m done with physical evaluation Educate 10/06/20 7:30 AM MDT Brian Foster Good to know. Thank you. Your avatar Houston Foster how old are you ? (No matching questions found.) Question 10/07/20 4:13 AM MDT Your avatar Mr.Foster how old are you ? Question 10/07/20 4:13 AM MDT Brian Foster I’m 58 going on 30. Your avatar Early happy birthday Empathize 10/07/20 4:14 AM MDT Brian Foster Thanks. I appreciate that. Your avatar Is it physical activity activates the pain ? Question 10/07/20 4:53 AM MDT Brian Foster Well I used to ride my bike a lot but it got stolen a couple years ago. I guess I haven’t had much regular exercise since then. I want to get a new bike if the doctor says it is OK to exercise with this chest pain I’ve been having. Your avatar Sorry to hear that Empathize 10/07/20 4:53 AM MDT Brian Foster Thanks. I appreciate that. Your avatar What aggravates your pain ? Question 10/07/20 4:54 AM MDT Brian Foster Well, I think it’s when I’m doing something physical most of the time. The first time it happened, my chest started hurting after I was doing some yard work. The second time happened when the elevator broke at work so I had to take the stairs. My office is on the 5th floor. Your avatar Do you like red meat ? Question 10/07/20 5:59 AM MDT Brian Foster Yes, yes I do. Your avatar Do you like vegetables and fruits ? Educate 10/07/20 5:59 AM MDT Brian Foster Good to know. Thank you. Your avatar Do you like fruits and vegetables ? (No matching questions found.) Question 10/07/20 5:59 AM MDT Your avatar If your diet include fruits and vegetables ? (No matching questions found.) Question 10/07/20 6:00 AM MDT Your avatar You need to cut to read me like a beef pork and lamb because this meat is saturated with a bad cholesterol or fat. More than chicken and fish. Saturated and transfat can raise your blood cholesterol and make your heart disease worse.NURS6512 Week 7 – Focused Exam: Chest Pain Brian Foster Results Educate 10/07/20 6:05 AM MDT Brian Foster Good to know. Shadow Health Focused Exam Chest Pain Discussion Paper
Thank you. Your avatar You can replace the red meat by chicken or fish like a salmon which has a good cholesterol which which will help you to reduce your bad cholesterol and help you with your heart and cholesterol problems. Educate 10/07/20 6:07 AM MDT Brian Foster Good to know. Thank you. Your avatar You need to start light exercising. Educate 10/07/20 6:07 AM MDT Brian Foster Good to know. Thank you. Your avatar You need to include fresh vegetables and fruit in your diet. Educate 10/07/20 6:08 AM MDT Brian Foster Good to know. Thank you. Your avatar You also need to continue taking your medications as prescribed. Educate 10/07/20 6:08 AM MDT Brian Foster Good to know. Thank you. Your avatar You also need to wait yourself daily in the same clothes in the same time. Educate 10/07/20 6:09 AM MDT Brian Foster Good to know. Thank you. Your avatar You need to do light exercise has three to four times a week. Educate 10/07/20 6:09 AM MDT Brian Foster Good to know. Thank you. Your avatar Mister Foster you need to follow up with a primary care physician and a cardiologist. (No matching questions found.) Question 10/07/20 6:10 AM MDT Your avatar Mister Foster you need to follow up with a primary care physician and a cardiologist. Educate 10/07/20 6:10 AM MDT Brian Foster Good to know. Thank you. Your avatar You also need to eliminate you alcoholic beverages. Educate 10/07/20 6:11 AM MDT Brian Foster Good to know. Thank you. Your avatar What is your height and weight ? Question 10/07/20 6:13 AM MDT Brian Foster I’m five foot eleven. Your avatar What is your weight ? Question 10/07/20 6:14 AM MDT Brian Foster As of this morning, a buck ninety-seven. Your avatar I am done with your exam Mr.Foster. Thank you for letting me to examine you. Have a good day. (No matching questions found.) Question 10/09/20 7:43 AM MDT Your avatar I am done with your exam Mr.Foster. Thank you for letting me to examine you. Have a good day. Educate 10/09/20 7:43 AM MDT Brian Foster EducateSpeech Your avatar Mr. Foster I just wanted to partially examine you again (No matching questions found.) Question 10/12/20 1:39 AM MDT Your avatar Mr. Foster I just wanted to partially examine you again Educate 10/12/20 1:40 AM MDT Brian Foster EducateSpeech Your avatar Auscultated over liver Exam Action 10/12/20 1:40 AM MDT Your avatar Auscultated over spleen Exam Action 10/12/20 1:41 AM MDT Your avatar Auscultated over liver Exam Action 10/12/20 1:41 AM MDT Your avatar Percussed right upper quadrant Exam Action 10/12/20 1:43 AM MDT Your avatar Percussed left upper quadrant Exam Action 10/12/20 1:43 AM MDT Your avatar Percussed right lower quadrant Exam Action 10/12/20 1:43 AM MDT Your avatar Percussed left lower quadrant Exam Action 10/12/20 1:43 AM MDT Your avatar Thank you Mr. Foster. I am done. Educate 10/12/20 1:50 AM MDT Brian Foster EducateSpeech Your avatar Percussed spleen Exam Action 10/18/20 5:58 PM MDT Your avatar Percussed spleen Exam Action 10/18/20 5:58 PM MDT Your avatar Inspected left leg Exam Action 10/18/20 6:24 PM MDT Your avatar Inspected right leg Exam Action 10/18/20 6:24 PM MDT Your avatar Inspected toenails on left foot Exam Action 10/18/20 6:24 PM MDT Your avatar Inspected left leg Exam Action 10/18/20 6:24 PM MDT Your avatar Inspected right leg Exam Action 10/18/20 6:24 PM MDT Your avatar Inspected toenails on right foot Exam Action 10/18/20 6:25 PM MDT Your avatar Inspected left leg Exam Action 10/18/20 6:25 PM MDT Your avatar Inspected right leg Exam Action 10/18/20 6:25 PM MDT Your avatar Inspected toenails on left foot Exam Action 10/18/20 6:25 PM MDT Your avatar Inspected right leg for edema: No edema Exam Action 10/18/20 6:25 PM MDT Your avatar Inspected left leg for edema: No edema Exam Action 10/18/20 6:25 PM MDT Your avatar Auscultated aortic area with the bell Exam Action 10/18/20 6:26 PM MDT Your avatar Auscultated pulmonic area with the bell Exam Action 10/18/20 6:26 PM MDT Your avatar Auscultated Erb’s point with the bell Exam Action 10/18/20 6:26 PM MDT Your avatar Auscultated tricuspid area with the bell Exam Action 10/18/20 6:26 PM MDT Your avatar Auscultated mitral area with the bell Exam Action 10/18/20 6:26 PM MDT Your avatar Auscultated aortic area with the bell Exam Action 10/18/20 6:27 PM MDT Your avatar Auscultated pulmonic area with the bell Exam Action 10/18/20 6:27 PM MDT Your avatar Auscultated Erb’s point with the bell Exam Action 10/18/20 6:27 PM MDT Your avatar Auscultated tricuspid area with the bell Exam Action 10/18/20 6:27 PM MDT Your avatar Auscultated mitral area with the bell Exam Action 10/18/20 6:27 PM MDT Your avatar Percussed right upper quadrant Exam Action 10/18/20 6:28 PM MDT Your avatar Percussed left upper quadrant Exam Action 10/18/20 6:28 PM MDT Your avatar Percussed right lower quadrant Exam Action 10/18/20 6:28 PM MDT Your avatar Percussed left lower quadrant Exam Action 10/18/20 6:28 PM MDT Your avatar Inspected left leg Exam Action 10/18/20 6:31 PM MDT Your avatar Inspected right leg Exam Action 10/18/20 6:31 PM MDT Your avatar Inspected toenails on left foot Exam Action 10/18/20 6:31 PM MDT Your avatar Inspected toenails on right foot Exam Action 10/18/20 6:31 PM MDT Your avatar Inspected toenails on left foot Exam Action 10/18/20 6:32 PM MDT Your avatar Inspected toenails on right foot Exam Action 10/18/20 6:32 PM MDT Your avatar Inspected left leg Exam Action 10/18/20 6:32 PM MDT Your avatar Inspected right leg Exam Action 10/18/20 6:32 PM MDT Your avatar Inspected right leg for edema: No edema Exam Action 10/18/20 6:32 PM MDT Your avatar Inspected left leg for edema: No edema Exam Action 10/18/20 6:32 PM MDT Your avatar Measured vitals Exam Action 10/18/20 6:39 PM MDT Your avatar Palpated right carotid pulse: Thrill, 3+ Exam Action 10/18/20 6:39 PM MDT Your avatar Palpated left carotid pulse: No thrill, 2+ Exam Action 10/18/20 6:39 PM MDT Your avatar Palpated right carotid pulse: Thrill, 3+ Exam Action 10/18/20 6:40 PM MDT Your avatar Palpated right carotid pulse: Thrill, 3+ Exam Action 10/18/20 6:41 PM MDT Your avatar Palpated left carotid pulse: No thrill, 2+ Exam Action 10/18/20 6:41 PM MDT Your avatar Palpated left carotid pulse: No thrill, 2+ Exam Action 10/18/20 6:41 PM MDT Your avatar Auscultated aortic area with the bell Exam Action 10/18/20 6:42 PM MDT Your avatar Auscultated pulmonic area with the bell Exam Action 10/18/20 6:42 PM MDT Your avatar Auscultated Erb’s point with the bell Exam Action 10/18/20 6:42 PM MDT Your avatar Auscultated tricuspid area with the bell Exam Action 10/18/20 6:42 PM MDT Your avatar Auscultated mitral area with the bell Exam Action 10/18/20 6:42 PM MDT Your avatar Auscultated mitral area with the diaphragm Exam Action 10/18/20 6:42 PM MDT Your avatar Auscultated mitral area with the bell Exam Action 10/18/20 6:42 PM MDT Your avatar Auscultated tricuspid area with the bell Exam Action 10/18/20 6:42 PM MDT Your avatar Auscultated Erb’s point with the bell Exam Action 10/18/20 6:42 PM MDT Your avatar Auscultated pulmonic area with the bell Exam Action 10/18/20 6:42 PM MDT Your avatar Auscultated aortic area with the bell Exam Action 10/18/20 6:42 PM MDT Your avatar Auscultated pulmonic area with the bell Exam Action 10/18/20 6:42 PM MDT Your avatar Auscultated Erb’s point with the bell Exam Action 10/18/20 6:42 PM MDT Your avatar Auscultated tricuspid area with the bell Exam Action 10/18/20 6:43 PM MDT Your avatar Auscultated tricuspid area with the diaphragm Exam Action 10/18/20 6:43 PM MDT Your avatar Auscultated mitral area with the diaphragm Exam Action 10/18/20 6:43 PM MDT Your avatar Auscultated mitral area with the bell Exam Action 10/18/20 6:43 PM MDT Your avatar Auscultated tricuspid area with the bell Exam Action 10/18/20 6:43 PM MDT Your avatar Auscultated Erb’s point with the bell Exam Action 10/18/20 6:43 PM MDT Your avatar Auscultated pulmonic area with the bell Exam Action 10/18/20 6:43 PM MDT Your avatar Auscultated aortic area with the bell Exam Action 10/18/20 6:43 PM MDT Your avatar Measured vitals Exam Action 10/18/20 6:44 PM MDT Your avatar Inspected right hand: no visible abnormal findings Exam Action 10/18/20 6:44 PM MDT Your avatar Inspected left hand: no visible abnormal findings Exam Action 10/18/20 6:44 PM MDT Your avatar Inspected left leg Exam Action 10/18/20 6:44 PM MDT Your avatar Inspected right leg Exam Action 10/18/20 6:44 PM MDT Your avatar Inspected toenails on left foot Exam Action 10/18/20 6:44 PM MDT Your avatar Inspected toenails on right foot Exam Action 10/18/20 6:44 PM MDT Your avatar Inspected right hand: no visible abnormal findings Exam Action 10/18/20 6:45 PM MDT Your avatar Inspected left hand: no visible abnormal findings Exam Action 10/18/20 6:45 PM MDT Your avatar Inspected fingernails of left hand Exam Action 10/18/20 6:45 PM MDT Your avatar Inspected fingernails of right hand Exam Action 10/18/20 6:45 PM MDT Your avatar Inspected fingernails of left hand Exam Action 10/18/20 6:46 PM MDT Your avatar Inspected fingernails of right hand Exam Action 10/18/20 6:46 PM MDT Your avatar Inspected right hand: no visible abnormal findings Exam Action 10/18/20 7:19 PM MDT Your avatar Inspected left hand: no visible abnormal findings Exam Action 10/18/20 7:19 PM MDT Your avatar Inspected left leg Exam Action 10/18/20 7:20 PM MDT Your avatar Inspected right leg Exam Action 10/18/20 7:20 PM MDT Your avatar Are you working ? Question 10/18/20 9:42 PM MDT Brian Foster I work at a civil engineering firm here in town. Your avatar Do your sit a lot at work ? (Clarified to Do you sit down for long periods of time at work?.) Question 10/18/20 9:43 PM MDT Brian Foster Well, yes, that’s the job. Unless I’m on site. [AUDIO COMING SOON] (Clarified to if I spend a lot of time sitting at work.)NURS6512 Week 7 – Focused Exam: Chest Pain Brian Foster Results Your avatar What is the hours of working ? Shadow Health Focused Exam Chest Pain Discussion Paper
Question 10/18/20 9:46 PM MDT Brian Foster I’m an engineer. Your avatar What is the working hours ? Question 10/18/20 9:46 PM MDT Brian Foster My work life is pretty stable and generally low stress, I’d say. Your avatar It’s really good Empathize 10/18/20 9:46 PM MDT Brian Foster EmpathizeSpeech Your avatar Do you like your job ? Question 10/18/20 9:47 PM MDT Brian Foster Yeah, I like it. I’ve been there sixteen years. Your avatar It’s awesome Empathize 10/18/20 9:47 PM MDT Brian Foster EmpathizeSpeech Your avatar Do you have a friends ? Question 10/18/20 9:47 PM MDT Brian Foster Yep. Your avatar What type of social support do you have ? (No matching questions found.) Question 10/18/20 9:48 PM MDT Your avatar Where your socialize ? Question 10/18/20 9:48 PM MDT Brian Foster My social life is mostly my family now. My wife and I are together all the time, and my son and his family lives in town. My daughter is in college so she’s home at least once a month. We try to have big family dinners when she’s home. I go fishing with my friend Smitty and his brother every once in a while. Your avatar How often do you go to fishing ? (Clarified to How often do you go to church?.) Question 10/18/20 9:51 PM MDT Brian Foster I don’t usually go unless it’s on a holiday when my mother is in town. (Clarified to how often I go to church.) Your avatar How often do mother comes in town ? Question 10/18/20 9:51 PM MDT Brian Foster I think I pee a normal amount. Every couple of hours or so Shadow Health Focused Exam Chest Pain Discussion Paper