Summary Focused Exam Brian Foster Chest Pain Subjective Data Collection Results

Focused Exam: Chest Pain Results | Completed BSN 245 - Concepts of Nursing I - Health Assessment Content - January 2021, 20211bsn24607 Return to Assignment (/assignments//) Shadow Health will be undergoing scheduled maintenance on March 12th, 2021 between 07:00 AM ET and 07:30 AM ET. (/site_notice_dismissals?from_flash=true&site_notice_id=473) Attempts will be disabled during this time period. Once the maintenance window concludes, assignments will be available again. If you are using Safari and have issues with audio in your assignment, please click here for assistance. Click here for more (/site_notice_dismissals?from_flash=true&site_notice_id=283) information ( Subjective Data Collection: 23 of 23 (100.0%) Chief Complaint History of Presenting Illness Your Results Turn In (/assignment_attempts//choose) Lab Pass (/assignment_attempts//lab_) Overview Transcript Subjective Data Collection Objective Data Collection Education & Empathy Documentation Care Plan Student Survey Indicates an item that you found. 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. Established chief complaint Reports chest pain Asked about onset and duration of chest pain Reports chest pain started about five minutes ago Reports chest pain has been constant since it began Reports sitting in bed when pain began Asked to rate chest pain on a scale Reports current pain is 6/10 Asked about on characteristics of the pain Describes pain as tight and uncomfortable Denies crushing pain Denies gnawing or tearing pain Denies burning pain Asked about location of the pain Reports pain location is in middle of the chest Reports slight pain in left shoulder Denies arm pain Denies back pain Denies jaw pain Denies neck pain Hover To Reveal... Hover over the Patient Data items below to reveal important information, including Pro Tips and Example Questions. Support This study source was downloaded by from CourseH on :05:08 GMT -05:00 Past Medical History Asked about pain triggers Reports pain is aggravated by movement Asked about stress and anxiety Reports generally low stress lifestyle Denies history of anxiety Denies history of panic attacks Asked relevant health history Reports high blood pressure Reports high cholesterol Denies history of pulmonary embolism Denies history of angina Denies history of rheumatic fever Denies history of heart murmur Followed up on high blood pressure treatment Reports taking high blood pressure medication Reports high blood pressure medication is Lisinopril High blood pressure medication dose is 20mg High blood pressure medication is taken once daily Followed up on high cholesterol treatment Reports taking high cholesterol medication Reports high cholesterol medication is Atorvastatin (Lipitor) Reports high cholesterol medication dose is 20mg Reports high cholesterol medication is taken once daily Asked history of cardiac tests Reports recent EKG test Reports annual stress test Asked about results of cardiac tests Reports belief that EKG was normal Reports belief that stress test was normal Asked about substance use Denies illicit drug use Denies tobacco use Reports moderate alcohol consumption Followed up on alcohol consumption Reports drinking only on weekends Reports drinking 2-4 alcoholic drinks per week Reports 2-3 drinks in a single sitting Asked about exercise Denies having a regular exercise routine Asked about most recent meal Reports most recent meal was previous night at 8 p.m. Reports meal consisted of buffalo wings Asked about typical diet Reports typical breakfast is granola bar and instant breakfast shake Reports typical lunch is turkey sub Reports typical dinner is grilled meat and vegetables This study source was downloaded by from CourseH on :05:08 GMT -05:00 Denies moderating salt intake Review of Systems Family History Asked about review of cardiovascular system Denies palpitations Denies swelling Denies circulation problems Denies blood clots Denies easy bleeding Denies easy bruising Asked about constitutional health Denies fever Denies chills Denies fatigue Denies sleep issues Denies recent weight changes Denies night sweats Denies dizziness or lightheadedness Asked about review of respiratory system Denies cough Denies shortness of breath while lying down Denies blue skin Asked about throat problems Denies sore throat Denies difficulty swallowing Asked about review of gastrointestinal system Denies diarrhea Denies constipation Denies flatus Denies bloating Denies heartburn or GERD Reports earlier nausea Denies vomiting Asked relevant family history Reports family history of heart attack Denies family history of stroke Denies family history of pulmonary embolism