NRS 420 Shadow Health Focused Exam Chest Pain

NRS 420 Shadow Health Focused Exam Chest Pain – Step-by-Step Guide

The first step before starting to write the NRS 420 Shadow Health Focused Exam Chest Pain, it is essential to understand the requirements of the assignment. The first step is to read the assignment prompt carefully to identify the topic, the length and format requirements. You should go through the rubric provided so that you can understand what is needed to score the maximum points for each part of the assignment. 

It is also important to identify the audience of the paper and its purpose so that it can help you determine the tone and style to use throughout. You can then create a timeline to help you complete each stage of the paper, such as conducting research, writing the paper, and revising it to avoid last-minute stress before the deadline. After identifying the formatting style to be applied to the paper, such as APA, you should review its use, such as writing citations and referencing the resources used. You should also review how to format the title page and the headings in the paper.

How to Research and Prepare for NRS 420 Shadow Health Focused Exam Chest Pain

The next step in preparing for your paper is to conduct research and identify the best sources to use to support your arguments. Identify the list of keywords from your topic using different combinations. The first step is to visit the university library and search through its database using the important keywords related to your topic. You can also find books, peer-reviewed articles, and credible sources for your topic from PubMed, JSTOR, ScienceDirect, SpringerLink, and Google Scholar. Ensure that you select the references that have been published in the last words and go through each to check for credibility. Ensure that you obtain the references in the required format, for example, in APA, so that you can save time when creating the final reference list. 

You can also group the references according to their themes that align with the outline of the paper. Go through each reference for its content and summarize the key concepts, arguments and findings for each source. You can write down your reflections on how each reference connects to the topic you are researching about. After the above steps, you can develop a strong thesis that is clear, concise and arguable. Next you should create a detailed outline of the paper so that it can help you to create headings and subheadings to be used in the paper. Ensure that you plan what point will go into each paragraph.

How to Write the Introduction for NRS 420 Shadow Health Focused Exam Chest Pain

The introduction of the paper is the most crucial part as it helps to provide the context of your work, and will determine if the reader will be interested to read through to the end. You should start with a hook, which will help capture the reader’s attention. You should contextualize the topic by offering the reader a concise overview of the topic you are writing about so that they may understand its importance. You should state what you aim to achieve with the paper. The last part of the introduction should be your thesis statement, which provides the main argument of the paper.

How to Write the Body for NRS 420 Shadow Health Focused Exam Chest Pain

The body of the paper helps you to present your arguments and evidence to support your claims. You can use headings and subheadings developed in the paper’s outline to guide you on how to organize the body. Start each paragraph with a topic sentence to help the reader know what point you will be discussing in that paragraph. Support your claims using the evidence conducted from the research, ensure that you cite each source properly using in-text citations. You should analyze the evidence presented and explain its significance and how it connects to the thesis statement. You should maintain a logical flow between each paragraph by using transition words and a flow of ideas.

How to Write the In-text Citations for NRS 420 Shadow Health Focused Exam Chest Pain

In-text citations help the reader to give credit to the authors of the references they have used in their works. All ideas that have been borrowed from references, any statistics and direct quotes must be referenced properly. The name and date of publication of the paper should be included when writing an in-text citation. For example, in APA, after stating the information, you can put an in-text citation after the end of the sentence, such as (Smith, 2021). If you are quoting directly from a source, include the page number in the citation, for example (Smith, 2021, p. 15). Remember to also include a corresponding reference list at the end of your paper that provides full details of each source cited in your text. An example paragraph highlighting the use of in-text citations is as below:

The integration of technology in nursing practice has significantly transformed patient care and improved health outcomes. According to Smith (2021), the use of electronic health records (EHRs) has streamlined communication among healthcare providers, allowing for more coordinated and efficient care delivery. Furthermore, Johnson and Brown (2020) highlight that telehealth services have expanded access to care, particularly for patients in rural areas, thereby reducing barriers to treatment.

How to Write the Conclusion for NRS 420 Shadow Health Focused Exam Chest Pain

When writing the conclusion of the paper, start by restarting your thesis, which helps remind the reader what your paper is about. Summarize the key points of the paper, by restating them. Discuss the implications of your findings and your arguments. End with a call to action that leaves a lasting impact on the reader or recommendations.

How to Format the Reference List for NRS 420 Shadow Health Focused Exam Chest Pain

The reference helps provide the reader with the complete details of the sources you cited in the paper. The reference list should start with the title “References” on a new page. It should be aligned center and bolded, in sentence sentence care. The references should be organized in an ascending order alphabetically and each should have a hanging indent. If a source has no author, it should be alphabetized by the title of the work, ignoring any initial articles such as “A,” “An,” or “The.” If you have multiple works by the same author, list them in chronological order, starting with the earliest publication. 

Each reference entry should include specific elements depending on the type of source. For books, include the author’s last name, first initial, publication year in parentheses, the title of the book in italics, the edition (if applicable), and the publisher’s name. For journal articles, include the author’s last name, first initial, publication year in parentheses, the title of the article (not italicized), the title of the journal in italics, the volume number in italics, the issue number in parentheses (if applicable), and the page range of the article. For online sources, include the DOI (Digital Object Identifier) or the URL at the end of the reference. An example reference list is as follows:

References

Johnson, L. M., & Brown, R. T. (2020). The role of telehealth in improving patient outcomes. Journal of Nursing Care Quality, 35(2), 123-130. https://doi.org/10.1097/NCQ.0000000000000456Smith, J. A. (2021). The impact of technology on nursing practice. Health Press.

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.