Objective Data – Brian foster chest pain shadow health assessment
Objective Data – Brian foster chest pain shadow health assessment
Objective Data Collection: 30 of 33 (90.91%)
Correct
Partially correct
Incorrect
Missed
Inspected face
1 of 1 point
Appearance (1/1 point)
No visible abnormal findings
Rash or lesion
Cyanosis
Pallor
Redness or flushing
Evidence of trauma (scar, laceration, or bruising)
Objective Data – Brian foster chest pain shadow health assessment
Inspected for jugular venous distension
1 of 1 point
Height Of Venous Pressure (1/1 point)
4 cm or less above the sternal angle
More than 4 cm above the sternal angle
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Inspected chest
1 of 1 point
Symmetry (1/2 point)
Symmetric
Asymmetric
Appearance (1/2 point)
No visible abnormal findings
Rash or lesion
AP diameter abnormal
Intercostal retraction while breathing
Excessive use of accessory muscles while breathing
Pectus excavatum
Skin growths (freckles or moles)
Evidence of skin trauma (scar, laceration, or bruising)
Objective Data – Brian foster chest pain shadow health assessment
Inspected abdomen
0.67 of 1 point
Symmetry (1/3 point)
Symmetric
Asymmetric
Contour (No point)
Flat
Rounded
Protuberant
Hollowed
Appearance (1/3 point)
No visible abnormal findings
Rash
Striae
Bulging around umbilicus
Distension
Visible masses (warts, cysts, or tumors)
Freckles, birthmark, or discoloration
Excessive hair growth
Visible scars
Laceration, lesion or wound
Bruising
Inspected hands and fingernails
1 of 1 point
Right: Appearance (1/4 point)
No visible abnormal findings
Redness
Moles or skin tags
Masses (warts, cysts, or tumors)
Freckles, birthmark, or other discoloration
Excessive dry or flaking skin
Purpura
Scarring
Laceration, lesion, or wound
Bruising
Rash
Right: Nail Changes (1/4 point)
No visible abnormal findings
Pallor
Cyanosis
Splinter hemorrhages
Clubbing
Left: Appearance (1/4 point)
No visible abnormal findings
Redness
Moles or skin tags
Masses (warts, cysts, or tumors)
Freckles, birthmark, or other discoloration
Excessive dry or flaking skin
Purpura
Scarring
Laceration, lesion, or wound
Bruising
Rash
Left: Nail Changes (1/4 point)
No visible abnormal findings
Pallor
Cyanosis
Splinter hemorrhages
Clubbing
Inspected lower extremities and toenails
1 of 1 point
Right: Appearance (1/4 point)
No visible abnormal findings
Visible distortion or swelling
Brownish pigmentation
Skin thickening
Ulceration
Varicose veins
Right: Nail Changes (1/4 point)
No visible abnormal findings
Pallor
Cyanosis
Splinter hemorrhages
Clubbing
Left: Appearance (1/4 point)
No visible abnormal findings
Visible distortion or swelling
Brownish pigmentation
Skin thickening
Ulceration
Varicose veins
Left: Nail Changes (1/4 point)
No visible abnormal findings
Pallor
Cyanosis
Splinter hemorrhages
Clubbing
Inspect lower extremities for edema
1 of 1 point
Right: Edema (1/4 point)
No edema
Pitting
Non-pitting
Right: Severity Of Edema (1/4 point)
No edema
1+ Slight pitting
2+ Deeper pit, disappears in 10 to 15 seconds
3+ Noticeably deep pit that lasts more than a minute
4+ Very deep pit that lasts 2 to 5 minutes
Objective Data – Brian foster chest pain shadow health assessment
Left: Edema (1/4 point)
No edema
Pitting
Non-pitting
Left: Severity Of Edema (1/4 point)
No edema
1+ Slight pitting
2+ Deeper pit, disappears in 10 to 15 seconds
3+ Noticeably deep pit that lasts more than a minute
4+ Very deep pit that lasts 2 to 5 minutes
Tested capillary refill time
1 of 1 point
Fingers (1/2 point)
Less than 3 seconds
Greater than 3 seconds
Toes (1/2 point)
Less than 3 seconds
Greater than 3 seconds
Auscultated carotid arteries
0.5 of 1 point
Right (No point)
No bruit
Bruit
Left (1/2 point)
No bruit
Bruit
Auscultated heart sounds
0.5 of 1 point
Heart Sounds (No point)
S1 and S2 audible
S1, S2, and S3 audible
S1, S2, and S4 audible
S1, S2, S3, and S4 audible
Extra Heart Sounds (1/2 point)
No extra sounds
Gallops
Murmur
Friction rub
Valve clicks
Auscultated breath sounds
0.33 of 1 point
Breath Sounds (1/3 point)
Present in all areas
Diminished in some areas
Absent in some areas
Adventitious Sounds (No point)
No adventitious sounds
Wheezing
Fine crackles
Stridor
Rhonchi
Course crackles
Location (No point)
All areas clear
Adventitious sounds in anterior right upper lobe
Adventitious sounds in anterior right middle lobe
Adventitious sounds in anterior right lower lobe
Adventitious sounds in anterior left upper lobe
Adventitious sounds in anterior left lower lobe
Adventitious sounds in posterior right upper lobe
Adventitious sounds in posterior right lower lobe
Adventitious sounds in posterior left upper lobe
Adventitious sounds in posterior left lower lobe
Objective Data – Brian foster chest pain shadow health assessment
Auscultated abdominal aorta
1 of 1 point
Sounds (1/1 point)
No bruit
Bruit
Auscultated abdominal and lower extremity arteries
1 of 1 point
Right: Renal (1/6 point)
No bruit
Bruit
Left: Renal (1/6 point)
No bruit
Bruit
Right: Iliac (1/6 point)
No bruit
Bruit
Left: Iliac (1/6 point)
No bruit
Bruit
Right: Femoral (1/6 point)
No bruit
Bruit
Left: Femoral (1/6 point)
No bruit
Bruit
Auscultated bowel sounds
1 of 1 point
Bowel Sounds (1/2 point)
Absent
Hypoactive
Normoactive
Hyperactive
Location Of Non Normoactive Bowel Sounds (1/2 point)
All quadrants normoactive
Right upper quadrant
Right lower quadrant
Left upper quadrant
Left lower quadrant
Palpated carotid arteries
0.5 of 1 point
Right: Vibration (No point)
No thrill
Thrill
Right: Amplitude (No point)
0 Absent
1+ Diminished or barely palpable
2+ Expected
3+ Increased
4+ Bounding pulse
Left: Vibration (1/4 point)
No thrill
Thrill
Left: Amplitude (1/4 point)
0 Absent
1+ Diminished or barely palpable
2+ Expected
3+ Increased
4+ Bounding pulse
Palpated PMI
1 of 1 point
Location (1/3 point)
Present at midclavicular line and 5th intercostal space
Displaced laterally
Diameter (1/3 point)
Less than 3 cm
Greater than 3 cm
Amplitude (1/3 point)
Brisk and tapping
Increased amplitude (hyperkinetic)
Palpated brachial arteries
1 of 1 point
Right: Vibration (1/4 point)
No thrill
Thrill
Right: Amplitude (1/4 point)
0 Absent
1+ Diminished or barely palpable
2+ Expected
3+ Increased
4+ Bounding pulse
Left: Vibration (1/4 point)
No thrill
Thrill
Left: Amplitude (1/4 point)
0 Absent
1+ Diminished or barely palpable
2+ Expected
3+ Increased
4+ Bounding pulse
Palpated radial arteries
1 of 1 point
Right: Vibration (1/4 point)
No thrill
Thrill
Right: Amplitude (1/4 point)
0 Absent
1+ Diminished or barely palpable
2+ Expected
3+ Increased
4+ Bounding pulse
Left: Vibration (1/4 point)
No thrill
Thrill
Left: Amplitude (1/4 point)
0 Absent
1+ Diminished or barely palpable
2+ Expected
3+ Increased
4+ Bounding pulse
Palpated femoral arteries
1 of 1 point
Right: Vibration (1/4 point)
No thrill
Thrill
Right: Amplitude (1/4 point)
0 Absent
1+ Diminished or barely palpable
2+ Expected
3+ Increased
4+ Bounding pulse
Left: Vibration (1/4 point)
No thrill
Thrill
Left: Amplitude (1/4 point)
0 Absent
1+ Diminished or barely palpable
2+ Expected
3+ Increased
4+ Bounding pulse
Palpated popliteal arteries
0.5 of 1 point
Right: Vibration (1/4 point)
No thrill
Thrill
Right: Amplitude (No point)
0 Absent
1+ Diminished or barely palpable
2+ Expected
3+ Increased
4+ Bounding pulse
Left: Vibration (1/4 point)
No thrill
Thrill
Left: Amplitude (No point)
0 Absent
1+ Diminished or barely palpable
2+ Expected
3+ Increased
4+ Bounding pulse
Palpated tibial arteries
1 of 1 point
Right: Vibration (1/4 point)
No thrill
Thrill
Right: Amplitude (1/4 point)
0 Absent
1+ Diminished or barely palpable
2+ Expected
3+ Increased
4+ Bounding pulse
Left: Vibration (1/4 point)
No thrill
Thrill
Left: Amplitude (1/4 point)
0 Absent
1+ Diminished or barely palpable
2+ Expected
3+ Increased
4+ Bounding pulse
Palpated dorsalis pedis arteries
1 of 1 point
Right: Vibration (1/4 point)
No thrill
Thrill
Right: Amplitude (1/4 point)
0 Absent
1+ Diminished or barely palpable
2+ Expected
3+ Increased
4+ Bounding pulse
Left: Vibration (1/4 point)
No thrill
Thrill
Left: Amplitude (1/4 point)
0 Absent
1+ Diminished or barely palpable
2+ Expected
3+ Increased
4+ Bounding pulse
Palpated abdomen – light
1 of 1 point
Tenderness (1/3 point)
None reported
Tenderness reported
Location Of Tenderness (1/3 point)
No quadrants tender
Right upper quadrant
Right lower quadrant
Left upper quadrant
Left lower quadrant
Observations (1/3 point)
No additional observations
Masses
Guarding
Distension
Muscle resistance
Rigidity
Palpated abdomen – deep
1 of 1 point
Presence Of Unexpected Mass (1/2 point)
No palpable mass
Palpable mass
Location Of Mass (1/2 point)
No palpable mass
Right upper quadrant
Right lower quadrant
Left upper quadrant
Left lower quadrant
Around umbilicus
Palpated liver
1 of 1 point
Detection (1/1 point)
Not palpable
Palpable
Palpated spleen
1 of 1 point
Detection (1/1 point)
Not palpable
Palpable
Palpated kidneys
1 of 1 point
Right (1/2 point)
Not palpable
Palpable
Left (1/2 point)
Not palpable
Palpable
Tested skin turgor
1 of 1 point
Observations (1/1 point)
No tenting
Tenting
Auscultated organs
1 of 1 point
Liver (1/2 point)
No friction rub
Audible friction rub
Spleen (1/2 point)
No friction rub
Audible friction rub
Percussed abdomen
1 of 1 point
Observations (1/1 point)
All areas generally tympanic
Some areas dull, some tympanic
Some areas resonant
Objective Data – Brian foster chest pain shadow health assessment
Percussed spleen
1 of 1 point
Spleen (1/1 point)
Tympany
Dullness
Percussed liver
1 of 1 point
Liver Span (1/1 point)
Smaller than 6 cm
Between 6 and 12 cm
Greater than 12 cm
Performed EKG
1 of 1 point
Sinus Rhythm (1/2 point)
Regular
Irregular
St Changes (1/2 point)
No ST elevation
ST elevation present
Objective Data – Brian foster chest pain shadow health assessment
