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SKINNY Reasoning
Part I: Recognizing RELEVANT Clinical Data
History of Present Problem:
JoAnn Smith is a 68-year-old woman who presents to the emergency department (ED) after having three days of
progressive weakness. She denies chest pain, but admits to shortness of breath (SOB) that increases with activity. She also
has epigastric pain with nausea that has been intermittent for 20-30 minutes over the last three days. She reports that her
epigastric pain has gotten worse and is now radiating into her neck. Her husband called 9-1-1 and she was transported to
the hospital by emergency medical services (EMS).
Personal/Social History:
JoAnn is a recently retired math teacher who continues to substitute teach part-time. She is physically active and lives
independently with her spouse in her own home. She has smoked 1 pack per day the past 40 years. JoAnn appears anxious
and immediately asks repeatedly for her husband upon arrival.
What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?
(Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
- 3 Days of progressive weakness - Signs & symptoms of angina
- Shortness of breath increase with - Been intermittent for 3 days
activity - Can progress to MI
- Intermittent epigastric pain for 3
days
- Epigastric pain radiating to the
neck
RELEVANT Data from Social History: Clinical Significance:
- History 40 years of smoking - Suggestive of Coronary Artery Disease
- Anxious - Increase risk for MI due to anxiety
- Retired but work part-time as - Financial burden due to missing income causing stress &
substitute teacher anxiety
Current VS: P-Q-R-S-T Pain Assessment (5th VS):
T: 99.2 F/37.3 C (oral) Provoking/Palliative: Nothing/Nothing
P: 128 (regular) Quality: Ache
R: 24 (regular) Region/Radiation: Left arm that radiates into neck
BP: 108/58 Severity: 5/10
O2 sat: 99% room air Timing: Intermittent-20-30" at a time
, What VS data are RELEVANT and must be recognized as clinically significant by the nurse?
RELEVANT VS Data: Clinical Significance:
- P: 128 - Tachycardia may be due to pain
- R: 24 - Tachypnea may be due to pain, SOB, pulmonary edema
- BP: 108/58 - Slight hypotensive, patient may have received nitroglycerin or
beta blockers
© 2018 Keith Rischer/www.KeithRN.com
Current Assessment:
GENERAL Anxious, appears uncomfortable, body tense
APPEARANCE:
RESP: Respirations labored, coarse crackles present in bases bilaterally anterior/posterior
CARDIAC: Pale, diaphoretic, no edema, heart sounds regular S1S2 with no abnormal beats,
pulses strong, equal with palpation at radial/pedal/post-tibial landmarks
NEURO: Alert & oriented to person, place, time, and situation (x4)
GI: Abdomen soft/non-tender, bowel sounds audible per auscultation in all 4 quadrants
GU: Voiding without difficulty, urine clear/yellow
SKIN: Skin integrity intact, skin turgor elastic, no tenting present
What assessment data is RELEVANT and must be recognized as clinically significant by the nurse?
RELEVANT Assessment Data: Clinical Significance:
- Anxious, appears - Patient has anxiety due to her current medical condition.
uncomfortable, body tense - Significant data for possible signs of pulmonary edema due to
- Respiration labored, coarse cardiogenic shock.
crackles present in bases - Not getting proper oxygen supply due to SOB.
bilaterally anterior/posterior
- Pale, diaphoretic
12 Lead EKG:
SKINNY Reasoning
Part I: Recognizing RELEVANT Clinical Data
History of Present Problem:
JoAnn Smith is a 68-year-old woman who presents to the emergency department (ED) after having three days of
progressive weakness. She denies chest pain, but admits to shortness of breath (SOB) that increases with activity. She also
has epigastric pain with nausea that has been intermittent for 20-30 minutes over the last three days. She reports that her
epigastric pain has gotten worse and is now radiating into her neck. Her husband called 9-1-1 and she was transported to
the hospital by emergency medical services (EMS).
Personal/Social History:
JoAnn is a recently retired math teacher who continues to substitute teach part-time. She is physically active and lives
independently with her spouse in her own home. She has smoked 1 pack per day the past 40 years. JoAnn appears anxious
and immediately asks repeatedly for her husband upon arrival.
What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?
(Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
- 3 Days of progressive weakness - Signs & symptoms of angina
- Shortness of breath increase with - Been intermittent for 3 days
activity - Can progress to MI
- Intermittent epigastric pain for 3
days
- Epigastric pain radiating to the
neck
RELEVANT Data from Social History: Clinical Significance:
- History 40 years of smoking - Suggestive of Coronary Artery Disease
- Anxious - Increase risk for MI due to anxiety
- Retired but work part-time as - Financial burden due to missing income causing stress &
substitute teacher anxiety
Current VS: P-Q-R-S-T Pain Assessment (5th VS):
T: 99.2 F/37.3 C (oral) Provoking/Palliative: Nothing/Nothing
P: 128 (regular) Quality: Ache
R: 24 (regular) Region/Radiation: Left arm that radiates into neck
BP: 108/58 Severity: 5/10
O2 sat: 99% room air Timing: Intermittent-20-30" at a time
, What VS data are RELEVANT and must be recognized as clinically significant by the nurse?
RELEVANT VS Data: Clinical Significance:
- P: 128 - Tachycardia may be due to pain
- R: 24 - Tachypnea may be due to pain, SOB, pulmonary edema
- BP: 108/58 - Slight hypotensive, patient may have received nitroglycerin or
beta blockers
© 2018 Keith Rischer/www.KeithRN.com
Current Assessment:
GENERAL Anxious, appears uncomfortable, body tense
APPEARANCE:
RESP: Respirations labored, coarse crackles present in bases bilaterally anterior/posterior
CARDIAC: Pale, diaphoretic, no edema, heart sounds regular S1S2 with no abnormal beats,
pulses strong, equal with palpation at radial/pedal/post-tibial landmarks
NEURO: Alert & oriented to person, place, time, and situation (x4)
GI: Abdomen soft/non-tender, bowel sounds audible per auscultation in all 4 quadrants
GU: Voiding without difficulty, urine clear/yellow
SKIN: Skin integrity intact, skin turgor elastic, no tenting present
What assessment data is RELEVANT and must be recognized as clinically significant by the nurse?
RELEVANT Assessment Data: Clinical Significance:
- Anxious, appears - Patient has anxiety due to her current medical condition.
uncomfortable, body tense - Significant data for possible signs of pulmonary edema due to
- Respiration labored, coarse cardiogenic shock.
crackles present in bases - Not getting proper oxygen supply due to SOB.
bilaterally anterior/posterior
- Pale, diaphoretic
12 Lead EKG:
