Assignment: Shadow Health Cardiovascular Assessment ESSAY

Assignment: Shadow Health Cardiovascular Assessment

Assignment: Shadow Health Cardiovascular Assessment

Subjective Data Collection: 17 of 19 (89.5%)
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Hover over the Patient Data items below to reveal important information, including Pro Tips and Example Questions.
• Found:
Indicates an item that you found.
• Available:
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Category
Scored Items

Experts selected these topics as essential components of a strong, thorough interview with this patient.
Patient Data
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A combination of open and closed questions will yield better patient data. The following details are facts of the patient’s case.
Chief Complaint
•
Finding:
Established chief complaint
•
Finding:
Reports recent episodes of palpitations
(Found)
Pro Tip: Broad questions like this one enable the patient to establish their chief complaint. Asking Tina if she’s had any problems with her heart will allow her to mention any concerns she’s recently had regarding her heart.
Example Question:
Have you ever had palpitations?
•
Finding:
Describes heart rate during episodes as feeling “faster than usual”
(Found)
Pro Tip: Broad questions like this one enable the patient to establish their chief complaint. Asking Tina if she’s had any problems with her heart will allow her to mention any concerns she’s recently had regarding her heart.
Example Question:
Have you had any problems with your heart?
History of Presenting Illness
•
Finding:
Asked about onset
•
Finding:
Reports first episode a month ago
(Found)
Pro Tip: Determining the onset of a health problem is the first step to understanding if the underlying condition is acute or chronic.
Example Question:
How long ago did you start having palpitations?
•
Finding:
Asked about frequency and duration of fast heartbeat episodes
•
Finding:
Reports episodes occur “about once a week”
(Found)
Pro Tip: Conditions, like palpitations, might change over time. Asking Tina when her palpitations began will give you a broader sense for her condition and her chief complaint.
Example Question:
When do the palpitations occur?
•
Finding:
Reports 3-4 episodes total
(Found)
Pro Tip: Symptoms often vary from patient to patient. Asking Tina how many palpitation episodes she’s experienced in the last month specifies the way her individual symptoms manifest.
Example Question:
How many palpitation episodes have you had?
•
Finding:
Reports fast heartbeat episodes last 5-10 minutes
(Found)
Pro Tip: Conditions, like palpitations, might change over time. Asking Tina about the duration of her palpitations recently will allow you to assess the recent severity of her condition.
Example Question:
How long do your palpitations last?
•
Finding:
Asked about character of palpitations
•
Finding:
Describes palpitations as “thumping” or “pounding”
(Found)
Pro Tip: Symptoms often vary from patient to patient. Asking Tina to describe her palpitations specifies the way her individual symptoms manifest.
Example Question:
How does your heart feel during the palpitations?
•
Finding:
Reports episodes accompanied by mild anxiety
(Available)
Pro Tip: Symptoms often vary from patient to patient. Asking Tina whether she is anxious during her palpitations specifies the way her individual symptoms manifest.
Example Question:
Do you feel anxious during the palpitations?
•
Finding:
Asked about aggravating factors
•
Finding:
Reports that palpitations seem to occur more often in the morning
(Found)
Pro Tip: Symptoms often vary from patient to patient. Asking Tina to describe when her palpitations began specifies the way her individual symptoms manifest.
Example Question:
When do you feel the palpitations?
•
Finding:
Reports episodes not exacerbated by exertion
(Available)
Pro Tip: Conditions, like palpitations, might change over time. Asking Tina if the palpitations are worse with exertion will allow you to assess the recent severity of her condition.
Example Question:
Do the palpitations get worse with exertion?
•
Finding:
Reports that episodes do not occur after eating
(Available)
Pro Tip: Some people experience palpitation after eating certain foods. Asking Tina whether she experiences palpitations after eating might indicate she is sensitive to certain foods (like foods that are spicy or contain MSG or caffeine).
Example Question:
Does food make your palpitations worse?
•
Finding:
Reports caffeine as a possible aggravating factor
(Available)
Pro Tip: Some people who drink caffeinated beverages have higher blood pressure than those who don’t drink caffeinated beverages. Asking Tina whether the caffeine is affecting her heart rate might point to the caffeine as a contributing factor to Tina’s palpitations.
Example Question:
Does the caffeine affect your heart rate?
•
Finding:
Asked about relieving factors
•
Finding:
Reports deep breathing and trying to relax
(Found)
Pro Tip: By asking Tina what relieves her palpitations you’re soliciting information about the way she treats, manages, or endures an uncomfortable symptom.
Example Question:
What relieves your palpitations?
•
Finding:
Denies medication or other treatment
(Found)
Pro Tip: Tina’s response to a question about the management of her palpitations will reveal the severity of her symptoms, her health literacy, and the way she’s complied with previous treatment plans.
Example Question:
What treatments have you tried for your palpitations?
Medical History
•
Finding:
Confirmed use of medications
•
Finding:
Confirms medications from previous visit
(Found)
Pro Tip: Determining what, if any, medications a patient is taking is a crucial element of a thorough health history and will help you avoid unwanted drug interactions.
Example Question:
Have you started any new medications?
•
Finding:
Reports new inhaler
(Available)
Pro Tip: Determining what, if any, medications a patient is taking is a crucial element of a thorough health history and will help you avoid unwanted drug interactions.
Example Question:
Do you use an inhaler?
•
Finding:
Followed up on new inhaler
•
Finding:
New inhaler is Flovent
(Available)
Pro Tip: You must find out the specific name or brand of a patient’s medication.
Example Question:
What is the name of your daily inhaler?
•
Finding:
Prescribed dose is two puffs
(Available)
Pro Tip: When you ask about the specific dosage that a patient is supposed to take, you learn more about their medication regiment, and their level of health literacy surrounding medication use.
Example Question:
How many puffs do you take of your inhaler?
•
Finding:
Inhaler is prescribed for daily use
(Available)
Pro Tip: Increased inhaler use, or using more puffs of an inhaler than prescribed, can indicate poorly managed asthma.
Example Question:
How often do you use your inhaler?
•
Finding:
Describes new inhaler regiment as effective
(Available)
Pro Tip: Finding out the patient’s perception of how effective an inhaler is gives you insight into how they feel their asthma is managed.
Example Question:
Is your inhaler working?
•
Finding:
Confirmed allergies
•
Finding:
Confirms allergies (no new allergies reported)
(Available)
Pro Tip: It’s best practice to ask a patient about her allergies each visit, even with an established patient, to uncover any new allergy triggers or symptoms.
Example Question:
Have you had any new allergies?
•
Finding:
Asked about personal history of hypertension
•
Finding:
Reports usual blood pressure “might be on the high side”
(Found)
Pro Tip: Blood pressure might change over time due to such factors as caffeine consumption, stress, diet, and exercise. Asking Tina what her usual blood pressure is will provide a baseline for comparing her last reading to her blood pressure now.
Example Question:
What is your usual blood pressure?
•
Finding:
Denies past diagnosis of hypertension
(Found)
Pro Tip: Cardiovascular disease can manifest in various conditions. Inquiring into Tina’s relevant history can reveal past diagnoses and previous conditions or concerns.
Example Question:
Have you been diagnosed with high blood pressure?
•
Finding:
Does not check BP regularly
(Found)
Pro Tip: Blood pressure might change over time due to such factors as caffeine consumption, stress, diet, and exercise. Asking Tina how frequently she checks her blood pressure will show how often she is monitoring her cardiovascular health.
Example Question:
How often do you check your blood pressure?
•
Finding:
Is aware of risk factors for hypertension
(Available)
Pro Tip: Family histories can suggest genetic predispositions to certain conditions. Asking Tina if she is aware that her family history of hypertension puts her at risk for cardiovascular disease indicates Tina’s health literacy.
Example Question:
Do you know your family history of high blood pressure is a risk factor for heart disease?
•
Finding:
Asked about possible contributing factors in health history
•
Finding:
Reports no known history of heart disease
(Available)
Pro Tip: Heart disease is the umbrella term to describe many conditions that might affect your heart. Asking Tina whether she has a history of heart disease is the first question in determining her specific cardiovascular concerns.
Example Question:
Do you have any history of heart disease
•
Finding:
Reports type 2 diabetes
(Available)
Pro Tip: Adults with diabetes are between two and four times more likely to suffer from cardiovascular disease. Determining whether Tina has diabetes will indicate if she is at a higher risk for heart disease.
Example Question:
Do you have diabetes?
•
Finding:
Reports no past diagnosis of high cholesterol
(Available)
Pro Tip: High cholesterol can lead to cardiovascular disease. Asking Tina whether she’s had a history of high cholesterol reveals her recent medical history.
Example Question:
Do you have high cholesterol?
•
Finding:
Reports no history of rheumatic fever
(Available)
Pro Tip: Rheumatic fever can cause irreversible damage to the heart. Asking Tina whether she’s had rheumatic fever would point to a condition that might have affected her cardiovascular health.
Example Question:
Do you have any history of rheumatic fever?
•
Finding:
Reports no history of heart murmur
(Available)
Pro Tip: Some heart murmurs can indicate a damaged or overworked heart valve. Asking Tina whether she’s experienced a heart murmur allows you to assess whether she’s noticed a symptom that indicates a heart condition.
Example Question:
Do you have any history of heart murmur?

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•
Finding:
Reports no EKG or other diagnostic cardiac tests
(Found)
Pro Tip: An EKG test checks for electrical problems with the heart. Asking Tina whether she’s had an EKG will reveal her recent medical history and medical literacy.
Example Question:
Have you ever had an EKG?
Social History
•
Finding:
Asked about stress and possible anxiety
•
Finding:
Reports occasional feelings of anxiety
(Found)
Pro Tip: Asking directly about anxiety can help you understand the patient’s mental health literacy.
Example Question:
Have you ever experienced anxiety?
•
Finding:
Reports recent increase in stress
(Found)
Pro Tip: The body’s response to stress might affect behaviors and factors that are linked to cardiac conditions. Asking Tina if she’s been more stressed lately will allow you to assess whether stress is a factor that puts her at risk for cardiac conditions.
Example Question:
Have you been more stressed lately?
•
Finding:
Reports stress related to school and work
(Found)
Pro Tip: People who are stressed, suffer from anxiety, take asthma medications, or have other cardiac conditions might be at risk for palpitations. Asking Tina what’s causing her stress solicits a broader medical history.
Example Question:
What causes you stress?
•
Finding:
Asked about typical diet
•
Finding:
Breakfast is usually a muffin or pumpkin bread
(Found)
Pro Tip: A healthy and balanced diet is crucial in the prevention of heart disease. Asking Tina about her typical breakfast will allow you to assess whether her eating habits put her at risk of cardiovascular disease.
Example Question:
What’s your usual breakfast?
•
Finding:
Lunch is usually a sandwich
(Found)
Pro Tip: A healthy and balanced diet is crucial in the prevention of heart disease. Asking Tina about her typical lunch will allow you to assess whether her eating habits put her at risk of cardiovascular disease.
Example Question:
What’s your usual lunch?
•
Finding:
Dinner is usually a home-cooked meat dish and side of vegetables
(Found)
Pro Tip: A healthy and balanced diet is crucial in the prevention of heart disease. Asking Tina about her typical dinner will allow you to assess whether her eating habits put her at risk of cardiovascular disease.
Example Question:
What’s your usual dinner?
•
Finding:
Snacks are pretzels or French fries
(Found)
Pro Tip: A healthy and balanced diet is crucial in the prevention of heart disease. Asking Tina about her typical snacks will allow you to assess whether her eating habits put her at risk of cardiovascular disease.
Example Question:
What’s your usual snack?
•
Finding:
Asked about caffeine consumption
•
Finding:
Reports increased caffeine consumption
(Available)
Pro Tip: Drinking more caffeine might point to underlying conditions like increased fatigue. Asking why Tina is drinking more caffeine will indicate a context for broader physical or mental health concerns.
Example Question:
Have you been drinking more caffeine lately?
•
Finding:
Reports consuming diet soda or energy drinks
(Found)
Pro Tip: Diet soda consumption has been linked to heart disease. Asking Tina if she drinks soda allows you to assess if her dietary habits put her at increased risk for cardiovascular disease.
Example Question:
Do you drink soda?
•
Finding:
Reports caffeine increase was over last month
(Available)
Pro Tip: Some people who drink caffeinated beverages have higher blood pressure than those who don’t drink caffeinated beverages. Asking Tina how long she has been drinking more caffeine might point to the caffeine as a contributing factor to Tina’s palpitations.
Example Question:
How long have you been drinking more caffeine?
•
Finding:
Typical drinks 2 energy drinks before class
(Found)
Pro Tip: Most energy drinks have more caffeine per ounce than caffeine found in coffee or tea. Asking Tina about her energy drink consumption will indicate whether she is consuming too many energy drinks.
Example Question:
How many energy drinks do you drink in a day?
•
Finding:
Reports caffeine “keeps me focused but sometimes makes me jittery”
(Found)
Pro Tip: Some people who drink caffeinated beverages have higher blood pressure than those who don’t drink caffeinated beverages. Asking Tina about how caffeine affects her will indicate whether Tina’s caffeine habits might be linked to her cardiac condition.
Example Question:
What effect does caffeine have on you?
•
Finding:
Asked about exercise and activity level
•
Finding:
Reports general low activity level
(Found)
Pro Tip: Regular exercise, when paired with a healthy diet, is one of the most effective ways to limit the risk of cardiovascular disease. Asking Tina whether she exercises will reveal her lifestyle and level of fitness, two factors that are fundamental to a healthy cardiovascular system.
Example Question:
Do you exercise?
•
Finding:
Asked about substance use
•
Finding:
Reports occasional consumption of alcohol
(Available)
Pro Tip: Alcohol consumption can cause palpitations in certain types of conditions. Asking about consumption can help you determine if it’s a factor in this patient’s case.
Example Question:
Do you ever drink alcohol?
•
Finding:
Last alcoholic drink was two weeks ago
(Available)
Pro Tip: Use of nicotine-containing products can cause cardiovascular problems. Asking about use can help you determine if it’s a factor in this patient’s case.
Example Question:
When did you last have alcohol?
•
Finding:
Denies history of tobacco use, including cigarettes
(Available)
Pro Tip: Tobacco affects the heart by reducing the amount of oxygen the blood is able to carry. Asking Tina if she uses tobacco will allow you to assess whether the condition is caused, in part, by tobacco use.
Example Question:
Do you use tobacco?
•
Finding:
Denies drug use
(Found)
Pro Tip: Many drugs affect the central nervous system or can cause cardiovascular complications. Asking Tina if she uses illicit drugs will indicate whether drug use is a factor in her palpitations.
Example Question:
Do you use drugs?
Review of Systems
•
Finding:
Asked about general symptoms
•
Finding:
Denies recent respiratory or other illness
(Available)
Pro Tip: Broad, open questions will allow Tina to describe, in her own words, the specific pain and discomfort that she is experiencing.
Example Question:
Have you been sick recently?
•
Finding:
Denies fever
(Found)
Pro Tip: The presence or absence of fever can indicate if an infection is approaching sepsis, a life-threatening condition.
Example Question:
Have you had any fever symptoms?
•
Finding:
Denies nausea or vomitting
(Available)
Pro Tip: Symptoms often vary from patient to patient. Asking Tina about the symptoms she is experiencing with her pain, like nausea, details the way her individual symptoms and pain manifest.
Example Question:
Have you had nausea or vomiting?
•
Finding:
Denies chills
(Available)
Pro Tip: Symptoms often vary from patient to patient. Asking Tina about the symptoms she is experiencing with her pain, like getting chills, details the way her individual symptoms and pain manifest.
Example Question:
Have you had chills?
•
Finding:
Reports low energy level
(Found)
Pro Tip: Symptoms often vary from patient to patient. Asking Tina about the symptoms she is experiencing with her pain, like fatigue, details the way her individual symptoms and pain manifest.
Example Question:
Are you fatigued?
•
Finding:
Denies night sweats
(Found)
Pro Tip: Symptoms often vary from patient to patient. Asking Tina about the symptoms she is experiencing with her injury, like night sweats, details the way her individual symptoms and pain manifest.
Example Question:
Have you had night sweats?
•
Finding:
Asked about review of systems for cardiovascular
•
Finding:
Denies shortness of breath
(Found)
Pro Tip: Conditions, like palpitations, might change over time. Asking Tina whether she has shortness of breath during palpitations will allow you to assess the recent severity of her condition.
Example Question:
Do you have any shortness of breath during the palpitations?
•
Finding:
Denies chest pain or tightness
(Found)
Pro Tip: Chest pain manifests in various ways, from a muted ache to a stabbing pain. Asking Tina whether she’s had chest pain can point to such conditions as angina or heart attack, among others.
Example Question:
Have you ever had any chest pain?
•
Finding:
Denies edema
(Found)
Pro Tip: When the heart weakens and pumps blood less effective, the resulting fluid that accumulates can lead to edema. Asking Tina whether she’s experienced edema allows you to assess if her heart is pumping less effectively.
Example Question:
Have you ever had any swelling?
•
Finding:
Denies circulation problems
(Available)
Pro Tip: Poor circulation is the result of other diseases like obesity, diabetes, or cardiac conditions. Asking Tina whether she’s experienced poor circulation indicates whether she might suffer from underlying cardiac concerns.
Example Question:
Have you ever had problems with circulation?
•
Finding:
Denies easy bleeding or bruising
(Found)
Pro Tip: Bleeding or bruising easily means that the capillaries under the skin break easily and often and can be indicative of a severe blood disorder. Asking Tina whether she has been bleeding easily allows you to assess other conditions that might be affecting her chief complaint.
Example Question:
Do you bleed easily?
•
Finding:
Denies dizziness, lightheadedness, or syncope
(Found)
Pro Tip: Lightheadedness might be a symptom of arrhythmias. Asking Tina whether she has a history of lightheadedness illustrates her medical history relating to her chief complaint.
Example Question:
Have you had any lightheadedness?
Family History
•
Finding:
Asked about relevant family history
•
Finding:
Reports family history of heart disease or CAD
(Available)
Pro Tip: Family histories can suggest genetic predispositions to certain conditions. Asking if Tina’s family has a history of high cholesterol might reveal her health literacy and predisposition to heart disease.
Example Question:
Do you have a family history of coronary artery disease?
•
Finding:
Reports family history of high cholesterol
(Available)
Pro Tip: Family histories can suggest genetic predispositions to certain conditions. Asking if Tina’s family has a history of hypertension might reveal her health literacy and predisposition to heart disease.
Example Question:
Do you have a family history of high cholesterol?
•
Finding:
Reports family history of hypertension
(Available)
Pro Tip: Family histories can suggest genetic predispositions to certain conditions. Asking if Tina’s family has a history of myocardial infarction might reveal her health literacy and predisposition to heart disease.
Example Question:
Do you have a family history of high blood pressure?
Reports family history of hypertension (Available)
Subjective Action

Pro Tip: Family histories can suggest genetic predispositions to certain conditions. Asking if Tina’s family has a history of myocardial infarction might reveal her health literacy and predisposition to heart disease.

Example Question: “Do you have a family history of high blood pressure?”
•
Finding:
Reports family history of myocardial infarction
(Found)
Pro Tip: Family histories can suggest genetic predispositions to certain conditions. Asking if Tina’s family has a history of coronary artery disease might reveal her health literacy and predisposition to heart disease.
Example Question:
Do you have a family history of heart attack?
•
Finding:
Reports family history of stroke
(Available)
Pro Tip: Family histories can suggest genetic predispositions to certain conditions. Asking if Tina’s family has a history of stroke might reveal her health literacy and predisposition to heart disease.
Example Question:
Do you have a family history of stroke?
•
Finding:
Reports family history of obesity

Document: Provider Notes

Student Documentation Model Documentation
Subjective

Ms. Jones is a pleasant 28-year-old African American woman who presented to the clinic with complaints of 3-4 episodes of rapid heart rate over the last month. She is a good historian. She describes these episodes as “thumping in her chest” with a heart rate that is “way faster than usual”. She does not associate the rapid heart rate with a specific event, but notes that they usually occur about once per week in the morning on her commute to class. The episodes generally last between 5 and 10 minutes and resolve spontaneously. She does not know her normal heart rate or her heart rate during these episodes. She denies chest pain during the episodes, but does endorse discomfort of 3/10 which she attributes to associated anxiety regarding her rapid heart rate. She denies shortness of breath. She denies any association of symptoms with exertion. She has no known cardiac history and has never had episodes prior to this last month. She has not attempted any treatment at home and states that she is only coming to the clinic today because her family has expressed concern regarding these episodes.

Social History: Ms. Jones has a job at a copy and shipping store and is a student at Shadowville Community College. She states that she has been feeling more “stressed” lately due to her school and work. She has been feeling tired at the end of the day. She denies any specific changes in her diet recently, but notes that she has not been drinking as much water as her normal. Breakfast is usually a muffin or pumpkin bread, lunch is a sandwich, dinner is a homemade meal of a meat and vegetable, snacks are French fries or pretzels. Over the past month she has increased her consumption of diet soda and “energy” drinks due to her feelings of tiredness. She generally drinks 2 energy drinks before class to “keep her focused” but states that they also make her “jittery”. She denies use of tobacco, alcohol, and illicit drugs. She does not exercise.

Review of Systems: General: Denies changes in weight, but complains of end of day fatigue. She denies fevers, chills, and night sweats. She complains of intermittent dizziness.
• Cardiac: Denies a diagnosis of hypertension, but states that she has been told her blood pressure was high in the past. She checks it at CVS periodically. At last check it was “140/80 or 90”. She denies known history of murmurs, angina, previous palpitations, dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, or edema. She has never had an EKG.
• Respiratory: She denies shortness of breath, wheezing, cough, sputum, hemoptysis, pneumonia, bronchitis, emphysema, tuberculosis. She has a history of asthma, last hospitalization was age 16 for asthma, last chest XR was age 16.
• Hematologic: She denies history of anemia, easy bruising or bleeding, petechiae, purpura, or blood transfusions.

Objective

• General: Ms. Jones is a pleasant, obese 28-year-old African American woman in no acute distress. She is alert and oriented. She maintains eye contact throughout interview and examination.

• Cardiovascular: PMI is non-displaced, brisk and tapping, diameter 2 cm. Regular rate and rhythm, S1 and S2 present, no murmurs, rubs, gallops, clinics, precordial movements. Pulses 2+ and equal bilaterally in upper extremities and lower extremities without thrills. No temporal, carotid, abdominal aorta, femoral, iliac, or renal bruits. No JVD. Capillary refill < 3 seconds. No peripheral edema. EKG with regular sinus rhythm, no ST changes. ABI is 0.97.

• Respiratory: Chest is symmetrical with respirations; no physical abnormalities present on chest wall. Lung sounds clear to auscultation without wheezes, crackles, or cough.

Assessment

Palpitations related to caffeine and/or anxiety

Plan

Encourage Ms. Jones to continue to monitor symptoms and log her episodes of palpitations with associated factors and bring log to next visit.
• Obtain EKG to rule out any cardiac abnormality and assess for symptom-correlated EKG changes. If inconclusive, consider ambulatory EKG monitoring and referral to cardiology.
• Encourage to decrease caffeine consumption and increase intake of water and other fluids.
• Educate on anxiety reduction strategies including deep breathing, relaxation, and guided imagery. Continue to monitor and explore the need for possible referral to social work/psychiatry or pharmacologic intervention.
• Discuss the need to maintain a stable blood pressure. Encourage Ms. Jones to continue to monitor her blood pressure when a cuff or machine is available.
• Educate Ms. Jones on when to seek emergent care including episodes of chest pain unrelieved by rest, palpitations that do not dissipate after anxiety related strategies were implemented, changes in vision, loss of consciousness, and sense of impending doom.
• Revisit clinic in 2-4 weeks for follow up and evaluation.

LifespanActivity Time: 29 min
Tina’s 5-year-old cousin comes into the clinic and you notice that her heart rate increases with inspiration and decreases with expiration. What is your differential diagnosis and treatment plan for this finding?
Student Response: This condition is common in children. Tina’s cousin differential diagnosis includes benign sinus dysrhythmia, increased intracranial pressure, and myocardial ischemia. For treatment, Patient’s blood pressure should be monitored to ensure perfusion. She should be assessed for other symptoms that may indicate an underlying problem. If their are no other symptoms then it could be that arrhythmia is benign since it is so common in children.
Model Note: Differential diagnosis includes benign sinus dysrhythmia, increased intracranial pressure, increased vagal tone, and myocardial ischemia. Her blood pressure should be monitored to ensure perfusion to rule out myocardial ischemia. She should be assessed for other symptoms that may indicate an underlying problem. With no other symptoms, it can be assumed that the dysrhythmia is benign since it is so common in children.
Tina’s 68-year-old paternal aunt struggles with controlling her hypertension and high cholesterol. What concerns might you have concerning all body systems, and how would this change your assessment? What teaching points would you review with Tina’s paternal aunt?
Student Response: Trina’s aunt has hypertension and high cholesterol. High cholesterol may cause atherosclerosis which worsens hypertension and increases the risk of cerebrovascular disease and thrombosis. High triglycerides can also lead to pancreatitis. Hypertension is often referred to as ” the silent killer”. Hypertension has detrimental effects on all body systems. A person with hypertension is at risk for cardiovascular/peripheral vascular disorders, renal failure, stroke , sleep neap and vision loss . Assessment should focus on perfusion and oxygenation to extremities, visual acuity and retinal health. Ms. Jones aunt should be educated and asked about sleep disturbances, morning headaches, and fatigue . Patient should be asked about chest pain, exercise habits and sexual health. Patient should be educated on importance of healthy eating, exercising regularly. She should be encouraged to comply with treatments and medication as well as clinical follow up visits to prevent life-threatening consequences of hypertension/ high cholesterol
Model Note: High cholesterol leads to atherosclerosis which worsens hypertension and increases the risk of cerebrovascular disease and thrombosis. High triglycerides leads to pancreatitis. Hypertension has detrimental effects on all body systems. Hypertension puts a person at risk for cardiovascular and peripheral vascular disorders, renal failure, stroke, dementia, vision loss, sleep apnea, bone loss, and sexual dysfunction. During the assessment, special attention should be directed to visual acuity, retinal health, and perfusion to extremities. The patient should be asked about sleep disturbances, morning headaches, and daytime fatigue to rule out sleep apnea. The provider should also ask about chest pain, forgetfulness, exercise habits and sexual health. The provider needs to stress the importance of healthy eating, exercising regularly, and complying to treatment plans to avoid life-threatening consequences of hypertension.

Review QuestionsActivity Time: 15 min
In order to determine which heart sound is S1, which of the following should you assess?
Correct: While auscultating for the heart, you should palpate the carotid artery because the carotid upstroke occurs just after S1. This technique can be helpful in identifying individual heart sounds.
• Apical pulse
• External jugular vein
• Internal jugular vein
• Carotid upstroke (Correct Response)
The assessment of Jugular Venous Pressure (JVP) correlates with:
Correct: JVP is directly related to central venous pressure (CVP). It is possible to estimate CVP by measuring the highest jugular pulsations.
• Central venous pressure (Correct Response)
• Left ventricular ejection fraction
• Left ventricular pressure
• Pulmonary artery pressure
Tina had brisk capillary refill (less than 3 seconds). What does this mean?
Correct: Capillary refill is a measure of arterial blood supply to the extremities. Capillary refill of less than 2 to 3 seconds is indicative of adequate and healthy arterial blood return.
• She does not have venous disease
• She is not anemic
• Arterial blood flow is sufficient (Correct Response)
• Her oxygen level is normal
Describe where on the body and when in the cardiac cycle you are most likely to auscultate a murmur caused by mitral valve prolapse.

Student Response: Murmurs caused by mitral valve prolapse usually occur in late systole just after a mid systolic click. They are best heard at the apex of the heart and the left lower sternal border when the patient is lying supine with legs raised or sitting up.
Model Note: Murmurs caused by mitral valve prolapse usually occur in late systole just after a mid systolic click. They are best heard at the apex of the heart and the left lower sternal border when the patient is lying supine with legs raised or sitting up.
Imagine you had heard a murmur on Tina. Why would it have been important to ask Tina to change positions while auscultating the heart?
Student Response: It is important for her to change position to determine which body position the murmur is most loudly and clearly heard. Some murmurs become inaudible upon change of body position. It is best to listen for a murmur when the patient is sitting, supine, or in a left lateral side-lying.
Model Note: When assessing a murmur, it is important to determine which body position the murmur is most loudly and clearly heard. Some murmurs become inaudible upon change of body position. Attempt to listen for a murmur when your patient is sitting, supine, and left lateral side-lying.
You decide to order an arterial blood gas on Tina. Which physical exam test should you perform before drawing blood from the radial artery?
Student Response: Before drawing up the blood from the radial artery , a modified Allen test must be performed. The Allen test is used to determine patency and blood flow from the ulnar artery.
Model Note: Before cannulating the radial artery to draw arterial blood for evaluation, a modified Allen test must be performed. The Allen test is used to determine patency and blood flow from the ulnar artery. If the Allen test is positive (meaning that blood return from the ulnar artery was inadequate), then the radial artery must not be compromised, and a different artery should be used for the blood draw.

Self-ReflectionActivity Time: 3 min
Explicitly describe the tasks you undertook to complete this exam.
Student Response: i was able to use clinical judgement to analyze the patient’s condition and complete a full health history and physical examination
Explain the clinical reasoning behind your decisions and tasks.
Student Response: i use the subjective data as well as objective data to determine the patient’s condition and plan the patient’s care accordingly
Identify how your performance could be improved and how you can apply “lessons learned” within the assignment to your professional practice.
Student Response: my performance could be improved by asking the patient more vital questions and gathering more subjective data

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