Brian Foster Shadow Health Assessment: Chest Pain Focused Exam
Brian Foster is a 54-year-old male patient in Shadow Health who presents with chest pain. As a nursing student, your task involves conducting a thorough assessment, including gathering a health history and performing a focused physical examination. The Brian Foster case challenges students to differentiate between cardiac and non-cardiac causes of chest pain, a critical skill for any future healthcare provider.
Brian Foster Chest Pain Focused Exam
DOCUMENTATION OF HISTORY AND PHYSICAL EXAM
Patient Name (Initials only): B.R DOB: March/10/1965 Gender:
| CHIEF COMPLAINT “My chest pains” | ||||||
| HISTORY OF PRESENT ILLNESS | ||||||
| Mr. B.R., a 58-year-old man, complained of chest pain in the middle of his chest when he arrived at the emergency room. It starts abruptly and does not radiate. Moving up the stairs and exertion exacerbate the tight, painful discomfort. Resting reduces the pain. The patient continues with everyday activities despite the pain, which is not severe. Mr. B.R. experiences periodic and intermittent chest pain. In one month, he has experienced three pain bouts. Three days ago was the most recent incident. According to the patient, the pain is related to leg cramps. He does not, however, admit to having heartburn, orthopnea, syncope, indigestion, nausea, vomiting, exhaustion, or shortness of breath. | ||||||
| PAST MEDICAL HISTORY | ||||||
| B.R. denies previous medical conditions. | ||||||
| The patient denies previous hospitalization, surgery, or trauma. | ||||||
| Medications None | ||||||
| Allergies/Adverse Reactions None | ||||||
| Immunizations: Flu – 2019, Pneumonia – 2009 Tdap – Denied Zoster – Denied, Covid – 2021, June | ||||||
| FAMILY HISTORY | ||||||
| The patient is the youngest of three siblings in a family of five. The father suffered from hypertension and coronary heart disease and died at 60. The mother had developed diabetes mellitus and high blood pressure and died at 68. His siblings are all still alive and well. | ||||||
| SOCIAL HISTORY The patient has a wife and kids. He is a call center manager and likes reading books and watching television. He does not smoke and occasionally drinks alcohol. Grilled meat, sandwiches, and vegetables are staples in his diet. Typically, he consumes grilled meat 4-5 times a week. On busy days, he eats fast food for lunch. Every day, he drinks 1-2 cups of coffee. | ||||||
| REVIEW OF SYSTEMS | ||||||
| Constitutional | ||||||
| Patient denies fatigue, dizziness, weakness, fever, and weight loss. | ||||||
| Eyes | ||||||
| B.R. denies visual impairment or blurry vision | ||||||
| Ears/Nose/Throat | ||||||
| Immunizations: Flu – 201,9, Pneumonia – 2009 Tdap – Denied Zoster – Denied, Covid – 2021, June | ||||||
| Mouth / Dental | ||||||
| Ears: denies hearing changes or ear pain. Nose: denies sneezing or change in the sense of smell, sinus pain, or pressure. Throat: denies difficulty swallowing- dry mouth, swollen lymph nodes | ||||||
| Breast | ||||||
| N/A | ||||||
| Cardiovascular The patient reports chest pain at the mid-sternum of the chest, causing discomfort. | ||||||
| Respiratory Denies cough or chest tightness, difficulty breathing except during asthma attacks, and dyspnea on exertion. | ||||||
| Gastrointestinal | ||||||
| Denies nausea or vomiting, abdominal pain, no changes in bowel or bladder pattern, or constipation; denies diarrhea. | ||||||
| Genito-Urinary | ||||||
| Denies change in urinary pattern; denies dysuria or incontinence. He is heterosexual. B.R. denies a history of STDs and reports being sexually active with his wife, who is under birth control. | ||||||
| Male Reproductive | ||||||
| Denies any erectile or urinary problems | ||||||
| Female Reproductive N/A | ||||||
| Denies tooth decay and gum disease; the last visit to the dentist was one year ago. B.R. denies speech problems, sinus drainage, taste, and snoring | ||||||
| Neurological | ||||||
| The patient denies syncopal episodes or dizziness, paresthesia, change in memory or thinking pattern, disturbances or problems with coordination, and seizure history. | ||||||
| Skin | ||||||
| Denies rashes, itching, or bruising. Denies changes in skin color. | ||||||
| Endocrine | ||||||
| B.R. denies polyurea, polyphagia, polydipsia, or fatigue. He denies heat or cold intolerance or shedding of hair. | ||||||
| Hematologic/Lymphatic: | ||||||
| B.R. denies bruising, bleeding, and anemia. He has no history of blood transfusion or thrombolytic disorders. | ||||||
| Psychiatric | ||||||
| He denies a history of anxiety or depression, apart from when his father and mother died from an illness. He denies fatigue, sleep disturbances, delusions, or mental health history. B.R. denies suicidal and homicidal history or ideation. | ||||||
| PHYSICAL EXAMINATION (Please describe your findings from inspection, palpation, percussion, & auscultation and use the term “deferred” if you did not examine that area.) | ||||||
| Vital signs | Ht: 5’8 | Wt 198 | BMI 30.1 | |||
| Temp: 98.2F | Pulse 85 | BP 110/68 | ||||
| R.R. 18 | Pain 4/10 | |||||
| General Appearance | ||||||
| The patient appears healthy, dressed appropriately for the season, clean and well-groomed, with well-kempt hair. BMI indicates obesity. | ||||||
| Head Normocephalic and atraumatic. Patient denies headaches | ||||||
| PHYSICAL EXAMINATION (Please describe your findings from inspection, palpation, percussion, & auscultation, and use the term “deferred” if you did not examine that area.) | ||||||
| Ears/Nose/Throat | ||||||
| Oropharynx red, moist mucous membranes | ||||||
| Mouth / Dental | ||||||
| Teeth appear healthy and aligned. No odor or teeth decay. | ||||||
| Neck Supple. No JVD. Trachea midline. No pain, swelling, or palpable nodules. | ||||||
| Eyes Sclera anicteric, no conjunctival erythema, PERRLA | ||||||
| Cardiovascular | ||||||
| Although the patient’s heartbeat and rhythm are regular, murmurs and other sounds are coming from her chest. The patient’s heart rate is constant, and capillaries refill in two seconds. S3 rub is noted at the mitral area. The JVP is 3cm above the sternal angle. A bruit was noted on the right carotid, which had a 3+ thrill. | ||||||
| Gastrointestinal No nausea or vomiting, no abdominal pain or bowel changes | ||||||
| Genitourinary/Gynecological No changes in urinary pattern, no dysuria or inconsistency, no STD, reports being sexually active with wife. | ||||||
| Gastrointestinal: No nausea or vomiting, no abdominal pain or bowel changes | ||||||
| Lymphatic: No axillary lymphadenopathy or swelling on palpation | ||||||
| Back, Extremities, Musculoskeletal | ||||||
| Skin: No rashes or bruising | ||||||
| No arthralgia and myalgia, no arthritis gout, or limitations in range of motion, no trauma or fractures | ||||||
| Psychiatric No anxiety or depressive report, fatigue, sleep disturbances, or suicidal or homicidal ideation. | ||||||
| Neurological: No syncopal episodes or dizziness, no paresthesia, no change in memory or thinking pattern, denies disturbances or problems with coordination. | ||||||
| List 3 Differential Diagnoses with Rationale (pertinent positive and negative) | ||||||
| Coronary artery disease with stable angina | ||||||
| Congestive heart failure | ||||||
| Costochondritis Rationale The chest pain that characterizes B.R.’s typical angina is typically brought on by a buildup of plaque in the arteries that supply the heart with blood. B.R. is at risk for coronary artery disease due to his history of hypertension, hyperlipidemia, and familial myocardial infarction. He described the pressure in his mid-sternum as his chest pain. Angina can happen while the heart is working harder or at rest, and it can continue for five to thirty minutes. Usually eased with nitrate and rest. Right-sided carotid bruit and thrill are B.R.’s first signs of heart failure. Typically, more fluid causes an S3 gallop. Additionally, the bilateral posterior bases of his lungs displayed fine crackles. These signs and symptoms all point to Class II heart failure ( Inamdar & Inamdar, 2019). Physical activity is slightly restricted in patients with class II heart failure, who are comfortable at rest but experience heart failure symptoms during routine physical exercise( Shahjehan & Bhutta, 2022). When the patient started pulling weeds, the first thing that came to mind was a musculoskeletal condition like costochondritis. When doing repetitive upper body movements, the strain on the upper chest costal cartilage can feel like angina in the upper to mid-sternum region. | ||||||
| ASSESSMENT ICD-10 code I25 Coronary artery disease with stable angina (Confirmed Diagnosis) A mismatch in supply and demand is what causes stable angina. Symptoms frequently appear when the myocardial oxygen demand momentarily surpasses the myocardial oxygen supply. Stable angina is caused by several factors, with coronary artery stenosis being the most common cause (Gillen & Goyal, 2021). An imbalance between the myocardial oxygen supply and the myocardial oxygen demand typically causes angina to emerge. Myocardial ischemia is most frequently caused by coronary artery stenosis. The stenosis prevents a sufficient delivery of cardiac oxygen during periods of high myocardial oxygen demand. The primary parameters affecting oxygen demand are heart rate, systolic blood pressure, myocardial wall tension, and myocardial contractility (Gillen & Goyal, 2021). The chest pain that characterizes B.R.’s typical angina is typically brought on by a buildup of plaque in the arteries that supply the heart with blood ( Schumann, Sood, & Parente, 2023). Angina can happen while the heart is working harder or at rest, and it can continue for five to thirty minutes. Usually eased with nitrate and rest. | ||||||
| REFERENCE (include at least one evidence-based guideline/peer-reviewed journal article to support the diagnosis and plan) Gillen, C., & Goyal, A. (2021). Stable Angina. In StatPearls [Internet]. StatPearls Publishing. Inamdar, A. A., & Inamdar, A. C. (2019). Heart Failure: Diagnosis, Management and Utilization. Journal of Clinical Medicine, 5(7), 62. https://doi.org/10.3390/jcm5070062 Schumann, J. A., Sood, T., & Parente J. J. (2023). Costochondritis. In: StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK532931/ Shahjehan, R. D., & Bhutta, B. S. (2022). Coronary artery disease. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK564304/ | ||||||
| REFERENCE (include at least one evidence-based guideline/peer-reviewed journal article to support the diagnosis and plan) Gillen, C., & Goyal, A. (2021). Stable Angina. In StatPearls [Internet]. StatPearls Publishing. Inamdar, A. A., & Inamdar, A. C. (2019). Heart Failure: Diagnosis, Management and Utilization. Journal of Clinical Medicine, 5(7), 62. https://doi.org/10.3390/jcm5070062 Schumann, J. A., Sood, T., & Parente, J. J. (2023). Costochondritis. In: StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK532931/ Shahjehan, R. D., & Bhutta, B. S. (2022). Coronary artery disease. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK564304/ | ||||||
Conducting the Focused Exam with Brian Foster
The focused exam for Brian Foster in Shadow Health concentrates on the cardiovascular system due to his presenting complaint of chest pain. During this exam, students should:
Initial Assessment
When you first meet Brian Foster in Shadow Health, begin by establishing rapport and identifying his chief complaint. Brian will describe his chest pain, which he might characterize as tight and uncomfortable. Students should ask Brian Foster to rate his chest pain on a scale of 1-10 and determine when his chest started hurting.
Health History
Collecting a comprehensive health history from Brian Foster is crucial. Key areas to explore include:
- Family History: Ask about any family history of heart conditions or high cholesterol.
- Personal Health History: Inquire about Brian’s history of angina, high blood pressure, or heart murmur.
- Medication Review: Document any cardiovascular medications like Lisinopril.
- Risk Factors: Assess for cardiovascular risk factors such as smoking, diet, and physical activity.
Brian Foster may mention that he has high blood pressure and high cholesterol. He might also share his family history of heart disease, which is relevant health information that could contribute to his current condition.
Physical Examination
During the physical examination of Brian Foster in Shadow Health, you should:
- Measure vital signs, including blood pressure
- Observe for any signs of distension in the neck veins
- Auscultate for heart murmurs or abnormal heart sounds
- Palpate the chest to identify areas of tenderness
- Assess for arm pain, back pain, or neck pain that might radiate from the chest
The Shadow Health platform allows you to perform these assessments virtually, providing feedback on your technique and findings.
Differential Considerations for Brian Foster’s Chest Pain
When working with Brian Foster in Shadow Health, consider various potential causes for his chest pain:
Cardiac Causes
- Angina
- Myocardial infarction
- Pericarditis
Non-Cardiac Causes
- Heartburn (Brian might mention “it might just be heartburn”)
- Pulmonary conditions (check for history of pulmonary embolism)
- Musculoskeletal pain
- Anxiety
Through careful questioning and examination, you’ll gather data to help determine the likely cause of Brian Foster’s chest pain. Shadow Health experts emphasize the importance of not jumping to conclusions before completing a thorough assessment.
Communication Strategies for the Brian Foster Case
Effective communication with Brian Foster in Shadow Health requires a balanced approach. Shadow Health recommends using a combination of open and closed questions when interviewing patients like Brian Foster:
- Open questions encourage Brian to share his experience in his own words
- Closed questions will yield better patient data for specific details like pain intensity
For example, you might start with an open question like “Can you tell me about your chest pain?” followed by more specific closed questions such as “Did your chest pain radiate to your arm?”
As you ask about the onset and duration of chest pain, maintain a conversational tone while systematically gathering necessary information. Brian Foster’s responses in Shadow Health are programmed to react to different questioning approaches, providing valuable feedback on your communication techniques.
Documenting the Brian Foster Encounter
Proper documentation of your encounter with Brian Foster in Shadow Health is essential for success in this simulation. Your documentation should include:
Subjective Data
Record what Brian Foster tells you about his chest pain and health history, including:
- Description of pain (tight and uncomfortable)
- Onset and duration of chest pain
- Associated symptoms
- Relevant health history, such as high blood pressure or history of angina
Objective Data
Document your physical findings and measurements:
- Vital signs, including blood pressure
- Heart and lung sounds
- Areas of tenderness upon palpation
- Observable signs of distress
Shadow Health provides a documentation system for recording your findings from the Brian Foster case, which then factors into your overall assessment grade.
Common Challenges in the Brian Foster Shadow Health Simulation
Many nursing students encounter similar challenges when working through the Brian Foster chest pain scenario in Shadow Health:
- Missing Key Questions: Failing to ask about critical aspects of chest pain, such as aggravating or alleviating factors
- Incomplete Physical Assessment: Not performing all necessary aspects of the cardiovascular examination
- Poor Documentation: Inadequately recording subjective and objective data
- Time Management: Spending too long on certain aspects of the assessment while neglecting others
To overcome these challenges, review resources like the focused exam guide and Shadow Health experts’ recommendations before beginning the Brian Foster simulation.
Preparing for the Brian Foster Shadow Health Assessment
Successful completion of the Brian Foster chest pain Shadow Health assessment requires preparation. Consider these strategies:
- Review Cardiovascular Assessment: Understand the components of a focused cardiovascular exam
- Study Chest Pain Differentials: Know the various causes of chest pain and their distinguishing features
- Practice Documentation: Familiarize yourself with proper documentation of subjective and objective data
- Utilize Available Resources: Many students study with Quizlet and memorize flashcards containing terms like angina, myocardial infarction, and other cardiovascular concepts.
Some students find it helpful to review peers’ experiences with the Brian Foster case through discussion boards or study groups, though they always maintain academic integrity by forming your assessment rather than copying others’ work.
Interpreting Your Results from the Brian Foster Case
After completing the Brian Foster chest pain Shadow Health assessment, you’ll receive feedback on your performance. This feedback evaluates:
- Thoroughness of your health history
- Accuracy of your physical examination techniques
- Appropriateness of your communication approach
- Completeness of your documentation
Shadow Health experts design this feedback to be educational rather than merely evaluative. Use insights from your performance with Brian Foster to strengthen your clinical reasoning skills for future patient encounters.
Applying Brian Foster Shadow Health Learning to Clinical Practice
The skills practiced in the Brian Foster Shadow Health simulation translate directly to clinical practice. When encountering real patients with chest pain, you’ll need to:
- Quickly establish the nature of the chief complaint
- Perform a targeted assessment based on presenting symptoms
- Think critically about potential causes
- Communicate findings effectively to the healthcare team
The experience of assessing Brian Foster in Shadow Health builds confidence for these real-world clinical situations. By mastering the virtual simulation, you develop muscle memory for the assessment process that will serve you well in actual patient care.
Beyond Brian Foster: Advanced Shadow Health Scenarios
After mastering the Brian Foster chest pain case in Shadow Health, students typically progress to more complex scenarios. These might include patients with multiple comorbidities or atypical presentations of common conditions.
The foundational skills learned through assessing Brian Foster—thorough history taking, focused physical examination, critical thinking, and clear documentation—support success in these advanced cases as well.
Conclusion
The Brian Foster chest pain case in Shadow Health offers nursing students a valuable opportunity to develop clinical assessment skills in a safe, virtual environment. By approaching this simulation with preparation and attention to detail, students can maximize learning and build confidence for future clinical encounters.
Remember that the goal of the Brian Foster Shadow Health experience extends beyond achieving a high grade—it’s about developing the clinical reasoning abilities that will make you an effective healthcare provider. Each interaction with Brian Foster and careful analysis of his chest pain contributes to your growth as a nursing professional.
Frequently Asked Questions
How can I improve my assessment of arm pain, back pain, and neck pain when evaluating Brian Foster’s chest pain in Shadow Health?
When assessing Brian Foster, thoroughly investigate any radiation of pain to the arms, back, or neck, as these can be important indicators of cardiac origins. Ask specific questions about when these pains occur in the chest and have Brian Foster describe their quality and intensity. Remember that pain radiation patterns often help differentiate between cardiac and non-cardiac causes.
What techniques should I use to palpate effectively during Brian Foster’s focused exam for chest pain?
When palpating during Brian Foster’s focused exam, use the pads of your fingers with gentle but firm pressure, systematically covering the precordial area while observing for facial expressions indicating discomfort. Pay special attention to areas where Brian Foster reports pain, and note any tenderness, masses, or abnormal pulsations that might relate to his chief complaint of chest pain.
How should I approach questions about heartburn versus angina when Brian Foster mentions “it might just be heartburn”?
When Brian Foster suggests his chest pain “might just be heartburn,” explore distinguishing characteristics between heartburn and angina through targeted questions about pain relief methods, relation to meals, and associated symptoms like nausea or acid reflux. Use this opportunity to educate Brian about the importance of not dismissing chest pain and the necessity of proper medical evaluation, even when it feels similar to previous heartburn episodes.
What is the significance of documenting a history of pulmonary embolism or a history of rheumatic fever when assessing Brian Foster in Shadow Health?
Documenting a history of pulmonary embolism or rheumatic fever is crucial as both conditions significantly impact differential diagnosis for Brian Foster’s chest pain. Pulmonary embolism history increases risk for recurrence and requires immediate consideration when chest pain presents, while rheumatic fever history suggests possible valvular heart disease that could contribute to cardiac-origin pain or complications like heart murmur, making these historical elements essential components of your comprehensive health assessment.