NRS 420 Shadow Health Focused Exam Chest Pain

NRS 420 Shadow Health Focused Exam Chest Pain

In this GCU you will conduct a focused exam on a patient presenting with chest pain and requiring emergency intervention. Interview the patient, assess the related body systems, and then complete post-exam activities. Within the Shadow Health platform, complete Focused Exam: Chest Pain. On average, this assignment should take 75 minutes to complete. Students may need additional time.

You can attempt this assignment as many times as you would like. After completing this focused exam, you will be awarded a Digital Clinical Experience (DCE) score. The DCE score will appear on your Lab Pass which you will submit to the classroom drop box. The DCE score will be used as your percentage grade for this GCU.

You are not required to submit this assignment to LopesWrite.

Example Documentation

Or Student Documentation	Model Documentation
Subjective Pt presents today with complaints of chest pain off and on for the past month. Pt rates pain a 5 out of 10. Pt states pain is usually brought on by doing yard work and walking steps at work. Pt states nothing makes it worse, but resting makes it better. Describes pain as tight and uncomfortable in the center of his chest, non-radiating. Pt denies associated SOB, cough, or diaphoresis. Pts last episode was this week before eating dinner. Pt denies pain after eating. Pt denies associated dizziness, fatigue, fever chills or nausea. Pt denies easy bruising. Denies any issues with HEENT. Pt states pain at this time is 0. Last EKG 3 months ago, normal. Regular physician visits Q 6 months. Social: Pt states he used to ride a bike for exercise but does not anymore. Pt states he does not have any stress factors at work or at home. Pt lives with wife and older daughter, Son is not living in the home. Pt denies smoking history and states he drinks 1-2 beers on the weekends. Pts diet consist of granola bars, vegetables, grilled meats, breakfast shakes, and lunches are turkey or spicy italian sub sandwiches. Drinks 2 cups of cafffeinated coffee per day. Medications: Lipitor 20mg PO daily Lopressor 100mg PO daily OTC fish oil 1200mg PO daily Allergies: Codeine- nausea vomiting Medical history: HTN diagnosed 1 year ago Hyperliperdemia diagnosed 1 year ago No surgeries Flu shot this year Family history: Maternal grandfater died of heart attack, mid-fifties Father high cholesterol, obesity, died of colon cancer Family history of HTN states “everyone” ROS: General: denies fatigue, sweting, fever or chills HEENT: denies any vision, hearing, throat or nose issues. Denies headaches or dizziness. Respiratory; denies shortness of breath or coughing Cardiovascular: recent chest pain. No edema, palpitations, heart history, EKG 3 months ago. Psych: denies stress Skin: denies diaphoresis, rashes, lesions	Pt. reports “I have been having some troubling chest pain in my chest now and then for the past month.” Experiencing periodic chest pain with exertion such as yard work as well as with overeating. Points to midsternum as location. Describes pain as “tight and uncomfortable.” Denies radiation. Pain lasts for “a few” minutes and goes away when he rests. Most recent episode was three days ago after eating a large restaurant dinner. States “It has never gotten ‘really bad’” so didn’t think it was an emergency, but is concerned after three episodes in one month and wants his heart checked out. Reports mild cramping in legs with activity. Denies shortness of breath, indigestion, heartburn. Denies chest pain at this time.
Objective Pt is a 58 year old causcasion male in no distress and A x O x 4. Pt is pleasant and responds appropriately throughout the exam. Reports recent episodes of chest pain. Vitals BP 146/90 RA 146/88 LA P 104 RR 19 O2 98 T 36.7 ROS: Cardiac: S1 S2 no murmurs or rubs, gallops prese nt S3 noted at mitral. PMI displaced laterally, right side carotid bruit with palpable thrill, 3+. Left carotid pulse without thrill, 2+. JVD 3 cm above sternal angle. Brachial, radial and femoral pulses no thrill, 2+. Tibial, popiteal, and dorsalis pedis no thrill, 1+. Brachial and radial pulses 2+. Capi refill less than 3 second all extremities. No bruits to abdominal aorta, iliac or renal arteries. Respiratory: unlabored, breath sounds present bilaterally, fine crackles right and left posterior lobes. No cyanosis to feet or hands. GI: abdomen rounded, non-tender on light and deep palpation, soft. Normal bowel sounds all four quadrants. Liver span 12cm at the mid-clavicular line, spleen non-palpable no dullness, kidneys non-palpable with no masses. Skin: warm and dry, no lesions or rashes. No tenting. EKG: normal sinus rythm with no ST changes.	• General Survey: 58 year old male is alert and oriented, with clear speech and in no acute distress. • Cardiac: S1, S2, without murmurs or rubs. PMI displaced laterally. S3 noted at mitral area. • Peripheral Vascular: Right side carotid bruit. JVP 3cm above sternal angle. Right carotid pulse with thrill, 3+. Left carotid pulse without thrill, 2+. Brachial, radial, femoral pulses without thrill, 2+. Popliteal, tibial, and dorsalis pedis pulses without thrill, 1+. Cap refill less than 3 seconds – 4 extremities. • Respiratory: Breathing is quiet and unlabored. Breath sounds are clear to auscultation in upper lobes and RML. Fine crackles/rales in posterior bases of L/R lungs. • Gastrointestinal: Round, soft, non-tender with normoactive bowel sounds in 4 quadrants; no abdominal bruits. No tenderness to light or deep palpation. Tympanic throughout. Liver is 7 cm at the MCL and 1 cm below the right costal margin. Spleen and bilateral kidneys are not palpable. • Neuro: Alert and oriented x 3, follows commands, moves all extremities. • Skin: Warm, dry, pink, and intact. No tenting. • EKG (interpretation): Regular sinus rhythm. No ST changes.
Assessment Differential Diagnosis: 1. CHF 2. Angina 3. CAD Nursing diagnosis: Risk or decreased cardiac output as evidenced by chet pain and diminished periphreal pulses.	Based on the abnormal findings during cardiovascular and respiratory auscultation, my differentials include coronary artery disease with stable angina; congestive heart failure; carotid disease; aortic aneurysm; pericarditis; or GERD.
Plan Medication: Add nitroglycerin 0.4mg SL, up to three times 5 minutes apart PRN for angina Add furosemide 20mg PO QD Add diltiazem 60mg PO TID Possible ASA daily Labs: Cardiac enzymes, CBC, BNP, CMP, lipids, A1C, electrolytes Tests: echo, stress test, carotid doppler Referrals: cardiologist Education: Proper diet Exercise Signsan symptoms of worsening symptoms New medications Monitoring and recording BP readings Follow up: 3 weeks or if symptoms get worse return or call 911.	Mr. Foster should receive a 12-lead ECG, chest x-ray, and lab workup (cardiac enzymes, electrolytes, CBC, BNP, CMP, Hgb A1C, lipid profile, and liver function tests) to confirm a diagnosis. He should be referred for an echocardiogram, exercise stress test, and carotid dopplers as well as a consult with a vascular surgeon for carotid evaluation. Mr. Foster should be prescribed diltiazem and a diuretic in addition to his daily Lopressor and Lipitor. If needed, add an ACE inhibitor to manage his hypertension and PRN nitroglycerin for chest pain that does not subside with rest.

Also Read: NRS 420 Topic 5 DQ 1 Mr. Juarez, an 88-year-old man, broke his right tibia due to a fall.