brian foster chest pain shadow health assessment Transcript
Brian foster chest pain shadow health assessment Transcript
Transcript
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Hello. I am June and will be interviewing you today, and later conduct a physical exam
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Greet |
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Good morning.
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Please let me know your name (Clarified to Can you verify your identity please?.)
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Brian Robert Foster. (Clarified to to confirm what is my name.)
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Welcome Mr Foster. What brings you to the clinic today?
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I have been having some troubling chest pain in my chest now and then for the past month.
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I am sorry that you have been having the chest pain. brian foster chest pain shadow health assessment Transcript
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Empathize |
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Thanks. I appreciate that.
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Please tell me what the pain you have been having is like (Clarified to Can you tell me what the pain is like?.)
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Well, it mostly feels tight and uncomfortable right in the middle of my chest. (Clarified to if I can tell you what the pain is like.)
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when did the pain start?
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I first noticed it earlier this month. I thought it might just be heartburn and it passed after about a couple of minutes.
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does the chest pain radiate?
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The pain doesn’t radiate anywhere. It’s mostly just right in the middle of my chest.
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Do you feel pain in your arm?
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No, when I am having the chest pain, it’s mostly just in middle of my chest.
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do you feel pain in your shoulder?
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No, the pain hasn’t been in my shoulder.
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do you have back pain?
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I haven’t had back pain, no.
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do you have neck pain.
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My neck’s been fine.
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how long does the chest pain last ?
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When I feel it, it seems to get better over the course of a couple of minutes or so.
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what is the frequency of the chest pain?
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Well, it has happened three times the past month. It usually goes away after about a couple of minutes.
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Were episodes of your chest pains related? (Clarified to What were you doing the last time you had chest pain?.)
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Well, the pain seems to start when I’m doing something physical . . . the first time it happened while I was doing yard work, and the second time . . . I had to take the stairs at work because the elevator broke. Both times it got better if I took a break or sat down to rest. (Clarified to what I was doing when I had chest pain last.)
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how do you feel when in pain? (No matching questions found.)
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am sorry about that? (No matching questions found.)
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How would you rate the chest pain?
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When I’m having it, it’s really tight and uncomfortable. Maybe like a 5 out of 10. Right now it’s like a zero.
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is the pain crushing ?
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No, it’s more tight and uncomfortable.
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Am sorry about that. (No matching questions found.)
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Am sorry about that.
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Empathize |
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Thanks. I appreciate that.
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is the pain gnawing?
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No, it’s not like that. [AUDIO COMING SOON]
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is the pain burning ?
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Not really.
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is the pain aggravated by activity?
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Well, I think it’s when I’m doing something physical most of the time. The first time it happened, my chest started hurting after I was doing some yard work. The second time happened when the elevator broke at work so I had to take the stairs. My office is on the 5th floor.
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Thats understandable (No matching questions found.)
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Thats understandable
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Empathize |
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Thanks. I appreciate that.
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does eating make your pain get worse ? (Clarified to Do certain foods make the pain worse?.)
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I don’t think that has anything to do with it, but I guess I don’t know. (Clarified to if certain foods make the pain worse.)
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does lying down help your pain?
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I’m not sure. I think lying still seems to help a little.
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Have you taken medication for the pain?
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No, not yet.
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Have you taken any anxiety medication?
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I’ve never taken anxiety meds. My life is pretty easy. [AUDIO COMING SOON]
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Have you taken any medication?
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Yeah, let’s see, I take atorvastatin for cholesterol, metoprolol for blood pressure. . . Oh yeah, and I take fish oil too. I hear that’s good for your cholesterol. [AUDIO COMING SOON]
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True, that good for your cholesterol, continue taking it.
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Good to know. Thank you.
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What dosage of metoprolol do you take?
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I think it’s 100 mg, once a day.
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what about the dose of atorvastatin medication? (No matching questions found.)
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what is the dose of atorvastatin medication?
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I think it’s twenty milligrams a day.
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How long have you been taking atorvastatin and metoprolol? (No matching questions found.)
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How long have you been taking atorvastatin?
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I think about a year. [AUDIO COMING SOON]
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How long have you taken metoprolol?
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I think it’s been about one year.
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Are you allergic?
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No, well . . . I’ve had a bad reaction to codeine before, but that is all I know of.
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Have you been diagnosed with hypertension?
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Yes, I supposedly have moderately high blood pressure.
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Am sorry to hear this?
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Empathize |
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Thanks. I appreciate that.
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have you been told your cholesterol is high?
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I’ve been told it’s moderately high. I’ve never noticed any actual symptoms from that though.
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Have you been tested for diabetes?
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My mom and my sister both have diabetes, but I don’t have it.
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Did you have any treatment for chest pain?
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I don’t have any shortness of breath, just the chest pain.
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Have you been monitoring your blood pressure?
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Not usually. They check it when I get checkups. My doctor has never seemed overly concerned about it.
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do you remember your last blood pressure readings?
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I don’t remember. I don’t think it was too bad, though.
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have you done an EKG test recently?
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I had one about three months ago. They usually put one on me at my annual physical.
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well, an EKG test is all about blood pressure monitoring.
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Good to know. Thank you.
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what was the result of the EKG?
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I don’t remember the actual results, but as far as I know, it was normal.
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Do you have a primary care provider?
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Dr. Melinda Smith.
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Great.
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Educate |
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Good to know. Thank you.
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When did you last visit your care provider?
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I had a physical about 3 months ago.
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Do you have stress?
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Not usually, but I’m feeling pretty anxious not knowing what’s going on with my chest.
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Am sorry about this.
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Empathize |
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Thanks. I appreciate that.
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Do you exercise?
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Well I used to ride my bike a lot but it got stolen a couple years ago. I guess I haven’t had much regular exercise since then. I want to get a new bike if the doctor says it is OK to exercise with this chest pain I’ve been having.
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Am sorry that the chest pain makes you not exercise.
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Empathize |
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Thanks. I appreciate that.
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what is your typical breakfast?
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I usually have something. Most days I drink an instant breakfast, or I’ll have a granola bar. Sometimes Maria will make a big breakfast on weekends with eggs, pancakes, bacon, hash browns, that kind of stuff.
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what is your typical lunch?
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There’s a sub shop near the office, so I usually get a turkey or Italian sub from there. Sometimes a salad if I’m feeling healthy . . . or guilty.
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what is your typical dinner?
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My wife and I like to grill. We usually have some grilled meats and veggies for dinner.
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do you take salt? (No matching questions found.)
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Do you drink water regularly?
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I usually drink water all day at work. At least four glasses, probably more. [AUDIO COMING SOON]
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Its good to take water, continue.
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Good to know. Thank you.
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Do you smoke cigarettes?
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Nope, I had a lot of friends who did but I never started.
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Do you take alcohol?
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I rarely drink during the week. If I drink at all it’s a couple beers on the weekend while I’m grilling or watching football. Maybe a little bourbon occasionally.
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thats moderate drinking.
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Good to know. Thank you.
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Do you have fever?
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I haven’t had a fever, no.
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do you have chills?
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I haven’t had chills, no.
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Do you have fatigue?
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I’m not more tired than normal.
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do you have night sweats ?
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Nope, no night sweats.
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Do you feel dizzy?
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No, I haven’t felt dizzy.
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Do you have palpitations?
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I don’t think so. I haven’t noticed any.
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Have you had angina?
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I’ve never been diagnosed with angina. [AUDIO COMING SOON]
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have you ever had edema?
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I haven’t noticed any swelling.
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have you had blood clots?
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Not that I know of.
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Any history of of rheumatic fever?
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No, I never had that.
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do you have history of heart murmur?
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No, none that I know of.
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do you have a cough?
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I don’t have a cough.
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do you have difficulty breathing?
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My breathing’s fine.
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Do you have orthopnea?
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Orthopnea? That sounds like the name of a weird bird. [AUDIO COMING SOON]
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Well, Thats shortness of breath?
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Good to know. Thank you.
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Do you have shortness of breath?
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My breathing’s fine.
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Do you have sore throat?
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I haven’t had a sore throat in a long time.
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Do you have change in sense of taste?
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I can still taste things fine.
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Do you have dysphagia?
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I haven’t had any trouble swallowing.
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Do you have nausea?
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No, I haven’t felt nauseous. I just had pain in my chest.
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do you have diarrhea ?
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I have, but it is very rare for me.
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Do you have constipation?
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I haven’t had problems with that. I wish it were only that.
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do you have heartburn or GERD?
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No, I’ve never had problems with heartburn. I sure hope that’s all this is, but it’s pretty intense if it’s heartburn.
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Do you have a family history of heart attack? brian foster chest pain shadow health assessment Transcript
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Well, my mom’s dad died of a heart attack. He was pretty young too.
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Do you have a family history of stroke?
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No, none that I know of.
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Do you have a family history of pulmonary embolism?
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No, nobody had that.
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Thank you Mr Foster for answering for answering my questions, I will now do the Physical examination. (No matching questions found.)
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Thank you Mr Foster for answering for answering my questions, I will now do the Physical examination. brian foster chest pain shadow health assessment Transcript
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Educate |
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Good to know. Thank you.
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Measured vitals
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Tested blood pressure in left arm with cuff
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Tested blood pressure in right arm with cuff
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Measured vitals
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Inspected face
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Inspected for jugular venous distension: No jugular venous distention; JVP 3 cm above sternal angle
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Inspected anterior chest wall
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Inspected left side of abdomen
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Inspected right hand: no visible abnormal findings
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Inspected left hand: no visible abnormal findings
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Inspected fingernails of left hand
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Inspected right hand: no visible abnormal findings
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Inspected left hand: no visible abnormal findings
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Inspected fingernails of right hand
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Inspected left leg
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Inspected right leg
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Inspected toenails on left foot
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Inspected toenails on right foot
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Inspected left leg
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Inspected right leg
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Inspected right leg for edema: No edema
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Inspected left leg for edema: No edema
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Checked capillary refill in fingernails brian foster chest pain shadow health assessment Transcript
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Checked capillary refill in fingernails
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Checked capillary refill in fingernails
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Checked capillary refill in fingernails
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Checked capillary refill in fingernails
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Checked capillary refill in fingernails
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Auscultated right carotid pulse: Bruit present
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Auscultated left carotid pulse
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Auscultated right carotid pulse: Bruit present
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Auscultated right carotid pulse: Bruit present
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Auscultated left carotid pulse
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Auscultated aortic area with the bell
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Auscultated aortic area with the diaphragm
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Auscultated aortic area with the bell
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Auscultated pulmonic area with the bell
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Auscultated pulmonic area with the diaphragm
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Auscultated Erb’s point with the diaphragm brian foster chest pain shadow health assessment Transcript
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Auscultated Erb’s point with the bell
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Auscultated Erb’s point with the diaphragm
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Auscultated tricuspid area with the diaphragm
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Auscultated tricuspid area with the bell
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Auscultated tricuspid area with the diaphragm
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Auscultated mitral area with the diaphragm
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Auscultated mitral area with the bell
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Auscultated mitral area with the diaphragm
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Auscultated breath sounds in anterior right lower lobe
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Auscultated breath sounds in anterior right middle lobe
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Auscultated breath sounds in anterior right upper lobe
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Auscultated breath sounds in anterior left upper lobe
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Auscultated breath sounds in anterior left mid-chest (upper lobe)
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Auscultated breath sounds in anterior left lower lobe
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Auscultated breath sounds in posterior left lower lobe on side
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Auscultated breath sounds in posterior left lower lobe
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Auscultated breath sounds in posterior left mid-back (lower lobe) brian foster chest pain shadow health assessment Transcript
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Auscultated breath sounds in posterior left upper lobe
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Auscultated breath sounds in posterior right upper lobe
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Auscultated breath sounds in posterior right mid-back (lower lobe)
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Auscultated breath sounds in posterior right lower lobe
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Auscultated breath sounds in posterior right lower lobe on side
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Auscultated aorta in abdomen
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Auscultated right femoral pulse
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Auscultated right iliac pulse
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Auscultated right renal pulse
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Auscultated left renal pulse
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Auscultated left iliac pulse
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Auscultated left femoral pulse
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Auscultated right upper quadrant
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Auscultated right lower quadrant
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Auscultated left upper quadrant
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Auscultated left lower quadrant
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Auscultated right lower quadrant
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Auscultated right upper quadrant
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Auscultated right lower quadrant
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Auscultated right upper quadrant
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Auscultated left upper quadrant
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Auscultated left lower quadrant
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Auscultated over liver
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Auscultated over spleen brian foster chest pain shadow health assessment Transcript
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Palpated right carotid pulse: Thrill, 3+
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Palpated left carotid pulse: No thrill, 2+
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Palpated PMI: Displaced laterally; brisk and tapping; less than 3 cm
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Palpated right brachial pulse: No thrill, 2+
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Palpated left brachial pulse: No thrill, 2+
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Palpated right radial pulse: No thrill, 2+
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Palpated left radial pulse: No thrill, 2+
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Palpated right femoral pulse: No thrill, 2+
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Palpated left femoral pulse: No thrill, 2+
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Palpated right popliteal pulse: No thrill, 1+
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Palpated left popliteal pulse: No thrill, 1+
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Palpated right tibial pulse: No thrill, 1+ brian foster chest pain shadow health assessment Transcript
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Palpated left tibial pulse: No thrill, 1+
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Palpated right dorsalis pedis pulse: No thrill, 1+
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Palpated left dorsalis pedis pulse: No thrill, 1+
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Palpated right lower quadrant with light pressure: No tenderness reported; no masses, guarding, or distension
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Palpated right upper quadrant with light pressure: No tenderness reported; no masses, guarding, or distension
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Palpated left lower quadrant with light pressure: No tenderness reported; no masses, guarding, or distension
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Palpated left upper quadrant with light pressure: No tenderness reported; no masses, guarding, or distension
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Palpated right upper quadrant with deep pressure: No masses
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Palpated right lower quadrant: with deep pressure: No masses
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Palpated left lower quadrant with deep pressure: No masses
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Palpated left upper quadrant with deep pressure: No masses
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Palpated liver: Palpable 1 cm below right costal margin
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Palpated for spleen: Not palpable
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Palpated for right kidney: Not palpable
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Palpated for left kidney: Not palpable
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Tested skin turgor
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Percussed right upper quadrant
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Percussed right lower quadrant
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Percussed left upper quadrant
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Percussed left lower quadrant
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Percussed spleen
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Percussed for liver span: 7 cm in the mid-clavicular line
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Performed EKG
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Inspected left side of abdomen
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Inspected front of abdomen
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Inspected left side of abdomen
brian foster chest pain shadow health assessment Transcript
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