Palm Beach Atlantic University

Exam (elaborations) Florence Blackman (66 y/o female) – Chest Pain (NUR6104) • CC: Intermittent squeezing chest pain • MSAP: Exertional “squeezing” mid-chest pain radiating to left arm, relieved by rest, worse with cold • Associated dyspnea on exertion • History: HLD, HTN, previous smoker, family hx of heart disease • Stressful work History Questions: - How can I help you today? - Any other symptoms we should discuss? - Do you have any allergies? - Are you taking any...

GOOD QUESTIONS 1. How can I help you? 2. Do you have any other symptoms or concerns that we should discuss? 3. Do you have any problems with headaches that dont go away with aspirin or Tylenol….? 4. Do you have any problems with nervousness, depression, lack of interest…..? 5. Do you have problems with dizziness, fainting, spinning room….? 6. Do you have any allergies? 7. Are you taking any OTC or herbal medications? 8. Do you experience shortness of breath, wheeezing…..? 9. H...

Documentation Assignments 1. Document Vernon Watkins’ respiratory assessment that occurred in the case. Vernon Watkins respirations rate is 24 breath per minute and regular. His lungs were clear upon auscultation. 2. Document the actions during the acute respiratory distress episode. Patient’s respiration rate is 24 breaths per minute HR 110 Blood Pressure 156/70 Lungs were clear upon auscultation Capillary refill <2 seconds Skin is moist O2: 91% 3. Document the changes in Ver...