Focused Exam: Chest Pain Results

11/18/20 : Chest Pain | Completed
19

Focused Exam: Chest Pain Results | Turned In
Advanced Health Assessment - NGR 5035
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Your
Lab Pass
Results


Transcript
Overview

Transcript
Started: Nov 18, 2019 | Patient Exam Time: 245 min
Subjective Data
All Lines (236) Interview Questions (104) Statements (28) Exam Actions (104)
Collection Objective
Greet
Data Collection Hello my name is Jay I'm nurse practitioner student I will do
11/18/19 1:13 PM
interview and assessment on you today. Is that ok?
EST
Education & Empathy

Documentation Good morning.


Question
Can you tell me your name and date of birth 11/18/19 1:14 PM
please? EST



My name is Brian Robert Foster and I was born
August 17.


Empathize
Thank you 11/18/19 1:14 PM
EST



Thanks. I appreciate that.


Question
What girls do in to the clinic 11/18/19 1:16 PM
today? EST


I have been having some troubling chest pain in my chest
now and then for the past month.


I'm sorry you are having this symptoms chest pain can be Empathize
uncomfortable and stressful. It's good that you came in 11/18/19 1:18 PM
today so we can see what is causing your discomfort. EST




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Thanks. I appreciate that.



Question
Your chest pain started about months ago?
11/18/19 1:19 PM
EST

I first noticed it earlier this month. I thought it might just be heartburn and it passed after




Question
Describe my place your chest pain?
11/18/19 1:19 PM
EST

Well, it mostly feels tight and uncomfortable right in the middle of my chest.




Question
How long does your pain last?
11/18/19 1:20 PM
EST

When I feel it, it seems to get better over the course of a couple of minutes or so.




Empathize
Sorry to hear that you have having pain.
11/18/19 1:20 PM
EST


Thanks. I appreciate that.



Question
How often are you having pain?
11/18/19 1:20 PM
EST

Well, it has happened three times the past month. It usually goes away after about a coup




Is it going to be in the same every time? (No matching questions found.) Question
11/18/19 1:21 PM
EST


Question
He's a pain similar of the time? (No matching questions found.)
11/18/19 1:21 PM
EST


Question
Is a pain similar of the time? (No matching questions found.)
11/18/19 1:22 PM
EST


Question
Is your pain the same every time?
11/18/19 1:22 PM
EST



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It's hard to say. Each time it's happened, the pain has been similar. It's not even pain so




Question
How would you rate your pain on a scale of 0 to 10?
11/18/19 1:23 PM
EST

I'd say maybe a . . . 5? It's just really uncomfortable . . . like there's nothing I can do about




Question
Does a pain burn?
11/18/19 1:23 PM
EST


Not really.



Question
Tell me about characteristic of the pain?
11/18/19 1:26 PM
EST

Well, it mostly feels tight and uncomfortable right in the middle of my chest.




Educate
This is like sharp or crashing
11/18/19 1:27 PM
EST


Good to know. Thank you.



Is it pain like crashing? (Clarified to Do you have pain when you breathe?.) Question
11/18/19 1:27 PM
EST


My breathing's fine. (Clarified to if it hurts to breathe.)



Question
Do you have any tearing pain? (No matching questions found.)
11/18/19 1:32 PM
EST


Question
Do you have any gnawing pain?
11/18/19 1:32 PM
EST


No, it's not like that. [AUDIO COMING SOON]



Could you show me where is pain located. (Clarified to Where is the pain?.) Question
11/18/19 1:33 PM
EST




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, 11/18/20 : Chest Pain | Completed
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When the pain happens, I feel it mostly in the middle of my chest, over my heart. (Clarifi




It is essential to determining where is the pain located and how best to treated
Educate
11/18/19 1:35 PM
EST


Good to know. Thank you.



Is your pain radiate in your shoulder? (Clarified to Is your pain radiating?.) Question
11/18/19 1:36 PM
EST

The pain doesn't radiate anywhere. It's mostly just right in the middle of my chest. (Clarifie




Do you have slight pain in your left shoulder? (Clarified to Do you have pain Question
in your left arm
11/18/19 1:36 PM
EST

No, when I am having the chest pain, it's mostly just in middle of my chest. (Clarified to if I




Question
Any back pain?
11/18/19 1:37 PM
EST


I haven't had back pain, no.



Question
Any jaw pain?
11/18/19 1:37 PM
EST


I haven't had any jaw pain.



Educate
Jaw pain can be related with cardiac in nature.
11/18/19 1:39 PM
EST


Good to know. Thank you.



Question
Any neck pain?
11/18/19 1:39 PM
EST


My neck's been fine.


What aggravate your pain?




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