Assignment 1: Digital Clinical Experience: Assessing the Heart, Lungs, and Peripheral Vascular System NURS 6512N-32

April 5, 2022
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Week 7: Assessment of the Heart, Lungs, and Peripheral Vascular System

Assignment 1: Digital Clinical Experience: Assessing the Heart, Lungs, and Peripheral Vascular System NURS 6512N-32

Assignment 1: Digital Clinical Experience: Assessing the Heart, Lungs, and Peripheral Vascular System NURS 6512N-32

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Cardiovascular disease (CVD) is the largest cause of death worldwide. Accounting for 610,000 deaths annually (CDC, 2017), CVD frequently goes unnoticed until it is

Assignment 1 Digital Clinical Experience Assessing the Heart, Lungs, and Peripheral Vascular System NURS 6512N-32

Assignment 1 Digital Clinical Experience Assessing the Heart, Lungs, and Peripheral Vascular System NURS 6512N-32

too late. Early detection and prevention measures can save the lives of many patients who have CVD. Conducting an assessment of the heart, lungs, and peripheral vascular system is one of the first steps that can be taken to detect CVD and many more conditions that may occur in the thorax or chest area.

This week, you will evaluate abnormal findings in the area of the chest and lungs. In addition, you will appraise health assessment techniques and diagnoses for the heart, lungs, and peripheral vascular system.

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Week 7              

Shadow Health Digital Clinical Experience Focused Exam: Chest Pain Documentation

 

SUBJECTIVE DATA:

Chief Complaint (CC): “I have been having some troubling chest pain in my chest for some time now.”

History of Present Illness (HPI):  A 58-year-old Caucasian male comes to the clinic. The patient reports, “I have been having some troubling chest pain in my chest for some time now.” The patient further reports that he has been having chest pains periodically, particularly when exerting himself in the yard or while overeating. The location of the pain is at the mid sternum region, and he scores it as a 5/10 whenever he experiences it. His description of the pain is “tight and uncomfortable.” The pain does not radiate. The pain does not last for long and disappears upon the patient’s resting. His latest chest pain episode occurred three days ago at a restaurant due to a large dinner. He did not think the pain required urgent attention; however, he demonstrates concern due to the three episodes within the month, and, as such, he needs the heart to be examined. He also states that his legs cramp mildly when engaged in inactivity. He rejects the presence of dyspnea, GERD, indigestion, and heartburn. He states there is no chest pain at the time of assessment.

Medications: The patient has a medical history of using omega three on a daily basis from fish oil, atorvastatin (20 mg) on a daily basis, for high cholesterol for the last one year, occasional use of ibuprofen. The patient takes metoprolol, 100 mg for high blood pressure.

 

Allergies: The patient confirms some allergies

 

Past Medical History (PMH): The patient last visited a primary care provider last three months ago. The patient has had treatments for high cholesterol and high blood pressure but reports no incidences of hospitalization.

 

Past Surgical History (PSH): no past surgical history was reported

 

Personal/Social History: while the patient denies using tobacco, he agrees that he consumes alcohol moderately, with the patient using two to three alcoholic drinks every week. The patient does not engage in any regular exercise in recent times as the last regular exercise was done the last time two years ago.

 

Immunization History: No immunization data was presented.

 

Significant Family History: The late father had obesity, hypertension, and hyperlipidemia, sister has diabetes type 2 and hypertension. Mother had a heart attack.

 

Review of Systems

General: The patient reports a recent weight gain since the loss of his bike. Denies any sweats, night sweats, chills, fever, and fatigue

            Cardiovascular/Peripheral Vascular: no edema, orthopnea, nor chest pain

            Respiratory:   no pneumonia, dyspnea, hemoptysis, wheezing, and cough

            Gastrointestinal: denies ulcers, eating disorders, hepatitis, constipation or

abdominal pain

            Musculoskeletal: no fracture, pain or stiffness, joint swelling or back pain

            Psychiatric: No suicidal attempts/ideation, sleeping difficulties, anxiety or

depression

 

OBJECTIVE DATA:

Physical Exam:

Vital signs:  BP : 105/78; T: 98.3; P: 117; R:22; Weight: 124lbs; Height: Height 5’

General Survey: The patient is a 58-year-old who demonstrates alertness and is proper orientation. He has clear speech and does not appear to be in any acute distress.

Cardiac: S1, S2, gallops do not have rubs or murmurs. The PMI has a lateral displacement. S3 is appearing at the mitral area.

Peripheral Vascular: He has a carotid bruit on the right side. His JVP appears above the sternal angle at 3cm. He has 3+ thrill at the right carotid. The pulse in the left carotid lacks thrill and has a 2+ expected amplitude. The femoral, radial, and brachial pulses lacked bruit ar 2+. Dorsalis pedis, tibial and popliteal pulses lack thrill at 1+. The capillary refill occurs below 3 seconds at all the four extremities.

Respiratory: The patient breathes quietly and unlabored. His breath sounds showed clarity to auscultation around the RML and the upper lobes. The patient produces fine rales/crackles in the bases of posterior regions of the left and right lungs.

Gastrointestinal: The abdomen is soft, round with a non-tender appearance. All four quadrants produce normoactive sounds. The abdomen lacks bruits. Both palpitations did not show tenderness. Tympany exists throughout the abdomen. The patient’s liver’s length is 7cm and 1 cm at the MCL and below the right costal margin, respectively. The bilateral kidneys and the spleen lack palpability.

Neuro: The patient is oriented everywhere and alert. He does not disobey commands. All of his extremities move when instructed.

Skin: The skin is intact, pink, and dry. It does not have tenting.

EKG: The interpretation of the EKG shows regular sinus rhythm. There are no changes in the ST as well. .

Diagnostics

The patient should undergo an X-ray examination of the chest (Ball et al., 2017). He should also have a fasting lab workup that includes liver function, BNP, CBC, Hgb A1C, electrolytes, cardiac enzymes, and lipid profile tests. These tests can be instrumental in confirming the exact illness troubling Mr. Foster.

ASSESSMENT

Priority diagnosis:  Coronary artery disease with stable angina

  1. Congestive heart failure
  2. Carotid artery disease
  • GERD

Coronary artery disease: The patient’s angina or chest pain could be resulting from plaque buildup in the arteries responsible for supplying blood to the heart (Shahjehan & Bhutta, 2020).  Coronary artery disease is among the most common conditions and causes blood flow impairment hence the delivery of oxygen to the myocardium. The patient’s significant history of hyperlipidemia and hypertension, as well as the family medical history of heart attacks, makes the patient be at risk of coronary artery disease (Regmi & Siccardi, 2020).

Congestive heart failure: The patient indicated that the chest pain is mid-sternum and tight and that when the pain comes, it occurs for a minimum of five minutes and a maximum of half an hour and can be triggered with some hard work. The patient also had a thrill and bruit on the right side and an S3 gallop which usually results from increase fluid (Colyar, 2015). These symptoms suggest heart failure, which limits physical activity to an extent. With the condition, the patient can feel comfortable while resting. However, heart failure symptoms occur upon engaging in ordinary physical activity (Dains et al., 2019).

Carotid artery disease: Carotid artery disease is one of the differential conditions considered for this patient because of the history of high cholesterol (Deeb et al.,2019). The patient also has a family history of both diabetes and hypertension. In addition, the patient has had a lack of exercise, which are all risk factors for carotid artery disease.

GERD: Patients with Gastroesophageal reflux disease usually present with various symptoms such as chest pain, one of the symptoms that the patient had, so it was considered as one of the differential diagnoses. The patient also uses alcohol, which is one of the risk factors.

Previous diagnosis

High blood pressure-controlled through the use of Lopressor

Hyperlipidemia: The patient is using atorvastatin to control the condition

Learning Objectives

Students will:

  • Evaluate abnormal cardiac and respiratory findings
  • Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for the heart, lungs, and peripheral vascular system

Learning Resources

Required Readings (click to expand/reduce)

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

 

  • Chapter 14, “Chest and Lungs”This chapter explains the physical exam process for the chest and lungs. The authors also include descriptions of common abnormalities in the chest and lungs.

 

  • Chapter 15, “Heart”The authors of this chapter explain the structure and function of the heart. The text also describes the steps used to conduct an exam of the heart.

 

  • Chapter 16, “Blood Vessels”This chapter describes how to properly conduct a physical examination of the blood vessels. The chapter also supplies descriptions of common heart disorders.

Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.

 

  • Chapter 107, “X-Ray Interpretation: Chest (pp. 480–487) (previously read in Week 6; specifically focus on pp. 480–481)

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.

Note: Download the Student Checklists and Key Points to use during your practice cardiac and respiratory examination.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Chest and lungs: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Chest and lungs: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Heart: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Heart: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

This study examines the medical decision making among Hispanics and non-Hispanic whites. The authors also analyze the preferred information sources used for making decisions in these populations.

This article describes the warning signs of impending deterioration of the respiratory system. The authors also explain the features of common respiratory conditions.

The authors of this article specify how to identify the major causes of acute breathlessness. Additionally, they explain how to interpret a variety of findings from respiratory investigations.

Shadow Health Support and Orientation Resources

Use the following resources to guide you through your Shadow Health orientation as well as other support resources:

Document: Student Acknowledgement Form (Word document)

Note: You will sign and date this form each time you complete your DCE Assignment in Shadow Health to acknowledge your commitment to Walden University’s Code of Conduct.

Document: DCE (Shadow Health) Documentation Template for Focused Exam: Chest Pain (Word document)

Use this template to complete your Assignment 1 for this week.

Optional Resource

LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.

 

  • Chapter 8, “The Chest: Chest Wall, Pulmonary, and Cardiovascular Systems; The Breasts” (Section 1, “Chest Wall, Pulmonary, and Cardiovascular Systems,” pp. 302–433)Note:Section 2 of this chapter will be addressed in Week 10.

This section of Chapter 8 describes the anatomy of the chest wall, pulmonary, and cardiovascular systems. Section 1 also explains how to properly conduct examinations of these areas.

Required Media (click to expand/reduce)

Assignment 1: Digital Clinical Experience: Assessing the Heart, Lungs, and Peripheral Vascular System

Photo Credit: [Squaredpixels]/[E+]/Getty Images

Take a moment to observe your breathing. Notice the sensation of your chest expanding as air flows into your lungs. Feel your chest contract as you exhale. How might this experience be different for someone with chronic lung disease or someone experiencing an asthma attack?

In order to adequately assess the chest region of a patient, nurses need to be aware of a patient’s history, potential abnormal findings, and what physical exams and diagnostic tests should be conducted to determine the causes and severity of abnormalities.

In this DCE Assignment, you will conduct a focused exam related to chest pain using the simulation too, Shadow Health. Consider how a patient’s initial symptoms can result in very different diagnoses when further assessment is conducted.

To Prepare
  • Review this week’s Learning Resources and the Advanced Health Assessment and Diagnostic Reasoning media program and consider the insights they provide related to heart, lungs, and peripheral vascular system.
  • Review the Shadow Health Resources provided in this week’s Learning Resources specifically the tutorial to guide you through the documentation and interpretation with the Shadow Health platform. Review the examples also provided.
  • Review the DCE (Shadow Health) Documentation Template for Focused Exam: Chest Pain found in this week’s Learning Resources and use this template to complete your Documentation Notes for this DCE Assignment.
  • Access and login to Shadow Health using the link in the left-hand navigation of the Blackboard classroom.
  • Review the Week 7 DCE Focused Exam: Chest Pain Rubric provided in the Assignment submission area for details on completing the Assignment in Shadow Health.
  • Consider what history would be necessary to collect from the patient.
  • Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
DCE Focused Exam: Chest Pain Assignment:

Complete the following in Shadow Health:

  • Cardiovascular Concept Lab (Recommended but not required)
  • Abdominal Concept Lab (Recommended but not required)
  • Episodic/Focused Note for Focused Exam: Chest Pain

Note: Each Shadow Health Assessment may be attempted and reopened as many times as necessary prior to the due date to achieve a total of 80% or better (this includes your DCE and your Documentation Notes), but you must take all attempts by the Week 7 Day 7 deadline.

Submission and Grading Information

By Day 7 of Week 7
  • Complete your Focused Exam: Chest Pain DCE Assignment in Shadow Health via the Shadow Health link in Blackboard.
  • Once you complete your Assignment in Shadow Health, you will need to download your lab pass and upload it to the corresponding Assignment in Blackboard for your faculty review.
  • (Note: Please save your lab pass as “LastName_FirstName_AssignmentName”.) You can find instructions for downloading your lab pass here: https://link.shadowhealth.com/download-lab-pass
  • Once you submit your Documentation Notes to Shadow Health, make sure to copy and paste the same Documentation Notes into your Assignment submission link below.
  • Downloadsigndate, and submit your Student Acknowledgement Form found in the Learning Resources for this week.
Grading Criteria

To access your rubric:

Week 7 Assignment 1 DCE Rubric

Submit Your Assignment by Day 7 of Week 7

To submit your Lab Pass:

Week 7 Lab Pass

To participate in this Assignment:

Week 7 Documentation Notes for Assignment 1

To Submit your Student Acknowledgement Form:

Submit your Week 7 Assignment 1 DCE Student Acknowledgement Form


Assignment 2: Lab Assignment (Optional): Practice Assessment: Cardiac and Respiratory Examination

It is crucial to diagnose cardiac and respiratory conditions early due to the critical nature of these organs. Before a cond

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