In order to adequately assess the chest region of a patient, nurses need to be aware of a patient's
history, potential abnormal findings, and what physical exams and diagnostic tests should be conducted
to determine the causes and severity of abnormalities.
In this DCE Assignment, you will conduct a focused exam related to chest pain using the simulation too,
Shadow Health. Consider how a patient's initial symptoms can result in very different diagnoses when
further assessment is conducted.
Take a moment to observe your breathing. Notice the sensation of your chest expanding as air flows
into your lungs. Feel your chest contract as you exhale. How might this experience be different for
someone with chronic lung disease or someone experiencing an asthma attack?
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
• Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel's guide to
physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
o Chapter 14, “Chest and Lungs”
This chapter explains the physical exam process for the chest and lungs. The authors
also include descriptions of common abnormalities in the chest and lungs.
o Chapter 15, “Heart”
The authors of this chapter explain the structure and function of the heart. The text also
describes the steps used to conduct an exam of the heart.
o Chapter 16, “Blood Vessels”
This chapter describes how to properly conduct a physical examination of the blood
vessels. The chapter also supplies descriptions of common heart disorders.
• Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.
o Chapter 107, “X-Ray Interpretation: Chest (pp. 480–487) (specifically focus on pp. 480–
• Chapter 107, “X-Ray Interpretation: Chest (pp. 480–487)Download “X-Ray Interpretation: Chest
• Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical
diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by
Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of
Mosby via the Copyright Clearance Center.
• Chapter 8, “Chest Pain”Download Chapter 8, “Chest Pain”
This chapter focuses on diagnosing the cause of chest pain and highlights the importance of first
determining whether the patient is in a life-threatening condition. It includes questions that can
help pinpoint the type and severity of pain and then describes how to perform a physical
examination. Finally, the authors outline potential laboratory and diagnostic studies.
• Chapter 11, “Cough”Download Chapter 11, “Cough”
A cough is a very common symptom in patients and usually indicates a minor health problem.
This chapter focuses on how to determine the cause of the cough by asking questions and
performing a physical exam.
• Chapter 14, “Dyspnea”Download Chapter 14, “Dyspnea”
The focus of this chapter is dyspnea, or shortness of breath. The chapter includes strategies for
determining the cause of the problem through evaluation of the patient’s history, through
physical examination, and through additional laboratory and diagnostic tests.
• Chapter 26, “Palpitations”Download Chapter 26, “Palpitations”
This chapter describes the different causes of heart palpitations and details how the specific
cause in a patient can be determined.
• Chapter 33, “Syncope”Download Chapter 33, “Syncope”
This chapter focuses on syncope, or loss of consciousness. The authors describe the difficulty of
ascertaining the cause, because the patient is usually seen after the loss of consciousness has
happened. The chapter includes information on potential causes and the symptoms of each.
• Bansal, M. (2020). Cardiovascular disease and COVID-19. Links to an external site. Diabetes &
Metabolic Syndrome: Clinical Research & Reviews, 14(3), 247–250.
Links to an external site.
• Jolobe, O. M. (2021). Differential diagnosis of the association of gastrointestinal symptoms and
ST segment elevation, in the absence of chest pain. Links to an external site. The American
Journal of Emergency Medicine, 49, 137–141. https://doi.org/10.1016/j.ajem.2021.05.067
Links to an external site.
Shadow Health Support and Orientation Resources
Use the following resources to guide you through your Shadow Health orientation as well as other
• Shadow Health. (2021). Welcome to your introduction to Shadow Health. Links to an external
• Shadow Health. (n.d.). Shadow Health help desk. Links to an external site.Retrieved from
• Shadow Health. (2021). Walden University quick start guide: NURS 6512 NP students Download
Walden University quick start guide: NURS 6512 NP students. Links to an external
• Document: DCE (Shadow Health) Documentation Template for Focused Exam: Chest Pain (Word
document)Download DCE (Shadow Health) Documentation Template for Focused Exam: Chest
Pain (Word document)
Use this template to complete your Assignment 1 for this week.
• Review this week's Learning Resources and the Advanced Health Assessment and Diagnostic
Reasoning media program and consider the insights they provide related to heart, lungs, and
peripheral vascular system.
• Review the Shadow Health Resources provided in this week’s Learning Resources specifically the
tutorial to guide you through the documentation and interpretation with the Shadow Health
platform. Review the examples also provided.
• Review the DCE (Shadow Health) Documentation Template for Focused Exam: Chest Pain found
in this week’s Learning Resources and use this template to complete your Documentation Notes
for this DCE Assignment.
• Access and login to Shadow Health using the link in the left-hand navigation of the Blackboard
• Review the Week 7 DCE Focused Exam: Chest Pain Rubric provided in the Assignment
submission area for details on completing the Assignment in Shadow Health.
• Consider what history would be necessary to collect from the patient.
• Consider what physical exams and diagnostic tests would be appropriate to gather more
information about the patient's condition. How would the results be used to make a diagnosis?
DCE FOCUSED EXAM: CHEST PAIN ASSIGNMENT:
Complete the following in Shadow Health:
• Cardiovascular Concept Lab (Required)
• Respiratory(Recommended but not required)
• Cardiovascular (Recommended but not required)
• Episodic/Focused Note for Focused Exam (Required): Chest Pain