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