Category: Nursing

  • NURS-6512N DIVERSITY AND HEALTH ASSESSMENTS DISCUSSION

    NURS-6512N DIVERSITY AND HEALTH ASSESSMENTS DISCUSSION

    BY DAY 3 OF WEEK 2

    Post
     an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks

    CASE STUDY 1

    John Green, 33 year-old Caucasian male, presents to the office to establish as a new patient. John’s natal sex is female but he identifies as a male. He transitioned from female to male 2 years ago. He has made a full transition with family and socially last year. He just moved back home and is unemployed at this time. He has been obtaining testosterone from the internet to give to himself. He has not had any health care since he decided to change other than getting his suppression medications through Telehealth 3 months ago. His past medical history includes smoking 2 packages of cigarettes per day for the last 10 years, smokes 3-6 marijuana joints every weekend (has an active green card), and does suffer from depression episodes. He is HIV positive for the last 3 years but remains virally suppressed at his last blood draw 6 months ago. He has been feeling very weak over the last few weeks which prompted him to move back home with his parents. He takes Biktarvy once daily that comes in the mail for free, tolerates it well, and 100 mg Testosterone IM every 7 days. His PMH is non-contributory. No past medical history. He has never been married. No significant family history. He is worried since moving back home and unemployed he will be a burden on his family, and he thinks his health may be declining.

    CASE STUDY 2

    Shawn Billings, a 28 year-old African American patient comes in to the clinic today. He has been deemed a “frequent flyer” by the staff at the clinic and was at the clinic last week and 4 days ago with a migraine, given a shot of Toradol and Ativan and sent home. He is here today again for an extreme headache. He is very agitated today. He is here with his father and worried that he will not get any medication.

    BY DAY 6 OF WEEK 2

    Respond on or before Day 6
     
    on 2 different days
     to at least
     two
     of your colleagues who were assigned a different patient than you. Critique your colleague’s targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to your patient, and why.

    NURS-6512N DIVERSITY AND HEALTH ASSESSMENTS DISCUSSION  Case Study #1: 33-year-old Caucasian male

    Introduction

    For health assessments to be productive and support the health of the patient, advanced practice registered nurses (APRNs) must consider the impact of factors such as cultures and developmental circumstances. It is also important to note that different populations, cultures, and groups have a variety of beliefs and practices that impact their health in a diverse arena. With that said, APRNs must gain the skill of adapting their health assessment methods and techniques to support the diversity they will encounter. The purpose of this discussion is to explain the socioeconomic, spiritual, lifestyle, and other cultural factors associated with the assigned patient case study, the issues that the APRN would need to be sensitive to when interacting the patient and providing target questions to build a health history and assess the patient’s health risks.

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    Socioeconomic, Spiritual, Lifestyle & Cultural Factors

    The patient is a 33-year-old single Caucasian who identifies as male, although female at birth. The patient made his transition roughly two years ago and has announced this change with his family and friends. He is currently unemployed and is planning to move back home with his parents. He is a known heavy smoker – tobacco and marijuana – over the past several years, suffers from depression, and has a history of Human Immunodeficiency Virus (HIV). Although diagnosed with HIV three years ago, the patient has remained virally suppressed for six months according to his last blood draw. He currently takes testosterone every seven days, in which he is getting from the internet, and Biktarvy once daily that has been free of cost to the patient. The patient has not had any health care in the past, other than his telehealth visit three months ago to obtain his suppression medications. The patient presents to the office to establish as new patient as well as address his symptom of feeling very weak over the last few weeks, which essentially prompted him to move back home with his parents. The patient does not have any contributory past medical history or family history. The patient remains worried about his declining health, unemployment, and dependence on his family for support.

    Sensitive Issues

    Under these known circumstances, the APRN would need to be sensitive to various factors while gathering the patient’s health history. First, the APRN must approach the initial interview in a non-judgmental fashion to ensure the patient feels comfortable and is able to establish rapport to ensure as much information is gathered as possible. It is important the APRN does not classify the patient in a stereotypical fashion as those pre-conceived thoughts could hinder cultural competence. The APRN could classify this patient as a minority due to his sexual identification, therefore the APRN would need to acknowledge her implicit biases towards the patient’s physical preferences. If not, there could be a large divide in the APRNs ability to connect with the patient and gather pertinent information to the patient’s health history. Secondly, the APRN must be mindful of conversation surrounding the patient’s choice of testosterone purchasing in relation to possible drug interactions and safety concerns. Although the patient’s choice of hormone-therapy purchasing is not suggested, he does remain dedicated to his transition with his commitment to administering weekly self-injections. Giving credit where credit is due is important, however, in this situation the APRN also needs to be careful how she educates the patient but also ensures the patient understands the safety risks. Perhaps providing the patient with resources that allow him to purchase testosterone from a reputable and regulated source would be best. Next, in knowing the patient has not received health care prior to his telehealth visit three months ago, the APRN must gently ask questions to better understand why the patient has neglected to see a health care provider. Education on consistent healthcare guidance could also be discussed here. It is important for the APRN to get a better understanding of where the patient is as far as being open to healthcare. Furthermore, the APRN could educate herself on gender, transgender, and sexuality terminology prior to the patient interview. This will allow the practitioner to be more fluid in conversation and ensure the patient is addressed appropriately. Moreover, the APRN should also be sensitive to the patient’s emotional status and address his depressive episodes as a priority. According to Kirubarajan et al. (2021), the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community in the United States is at risk for numerous adverse health outcomes with various disparities including an increased risk for suicide, HIV, sexually transmitted infections (STIs), and mental health issues, which is likely due to a lack of provider education on LGBTQ needs. Understanding where the patient’s stresses lie and empathizing with him of why he feels the way he does will be crucial in connecting with the patient to better comprehend his needs. Additionally, this gives the APRN the ability to deliver optimal care and reduce negative outcomes among the LGBTQ community NURS-6512N DIVERSITY AND HEALTH ASSESSMENTS DISCUSSION . The APRN could also provide the patient with various resources and recommendations to help support his mental and emotional needs, such as seeing a counselor if pharmacological support is not necessarily warranted. Finally, to reduce disparities in healthcare, the APRN could focus on achieving cultural humility by striving to incorporate ways to respond thoughtfully to the patient’s concerns and complaints while considering the health literacy of the patient (Ball et al., 2019). In combination, these efforts will allow the patient to feel vulnerable without being judged, humiliated, or taken less seriously for his current condition and situation. This way, the APRN will be better able to build the patient’s health history and gather the patient’s health risks to best care for the patient.

    Target Questions: Health History & Health Risks

    In preparing to ask the patient questions to build a health history and address health risks, the APRN should ensure patient-centered care, cultural competence, and cultural humility are kept at the forefront and overlap at best. Patient-centered care allows practitioners to curb hindering behavior, understand the stages of the medical interview, and attend to health promotion and disease prevention (Ball et al., 2019). Cultural competence requires healthcare providers to remain sensitive to patient’s heritage, sexual orientation, socioeconomic status, ethnicity, and cultural beliefs (Ball et al., 2019). Cultural humility is the ability of practitioners to recognize their limitations surrounding knowledge and cultural perspective while being open to new perspectives (Ball et al., 2019). Viewing the patient as an individual rather than in a group allows the practitioner to develop a more solid and productive patient-practitioner relationship. Together, these three concepts ensure the APRN is interested in the patient as their own unique person, respects patient values, beliefs, and preferences, conveys unconditional positive regard, and provides education tailored to the patient’s needs and level of understanding (Ball et al., 2019). The APRN could also utilize the RESPECT model – rapport, empathy, support, partnership, explanations, cultural competence, and trust (Ball et al., 2019) – to assist in building the patient’s health history. This model is an excellent tool for cross-cultural communication and patient-centered care, therefore creating respect for patients in diverse cultures. To start, the APRN could ask the below target questions to create a foundation in building the patient’s health history and identifying his health risks:

    What are your healthcare goals? What are you hoping to achieve today?

    How is your transition is going so far? Are there any challenges you’ve struggled with? What is going well?

    How are you feeling today? Can you describe your lows, highs, and moments of comfort?

    How long have you experienced your current symptoms?

    How often are you taking your medications? Do you have a routine or schedule with your medications?

    Can you demonstrate how you administer your testosterone intramuscular (IM) injections? I want to be sure you can receive safe-needle handling education if you are interested or there is a need for it.

    How many sexual partners have you had in the last six months?

    Conclusion

    “A culturally competent healthcare provider adapts to the unique needs of patients of backgrounds and cultures that differ from his or her own” (Ball et al., 2019, p. 22). Crossing the cultural divide allows APRNs to open their minds and be more mindful of how they can best treat and support their patients while respecting their cultural differences. Being fluid in cultural diversity and working towards becoming culturally competent evolves over time as “individuals and organization are at various levels of awareness, knowledge, and skills along the culture competence continuum” (Centers for Disease Control and Prevention, 2020, para. 5). To build a strong health history, APRNs must understand themselves well enough where they are able to use probing questions to avoid viewing the patient as a stereotype. Overall, prejudices and attitudes are often generated from cultural perspectives, so it is important for practitioners to understand themselves to better understand their patients. Being able to adapt to each patient and their individual needs allows the APRN to have genuine intentions to make strides toward cultural competence.

     

    References

    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.

    Centers for Disease Control and Prevention. (2020). Cultural competence in health and human

    services. https://npin.cdc.gov/pages/cultural-competence.

    Kirubarajan, A., Patel, P., Leung, S., Park, B., & Sierra, S. (2021). Cultural competence in fertility care for

    lesbian, gay, bisexual, transgender, and queer people: a systematic review of patient and provider

    perspectives. 
    Fertility and Sterility
    , 
    115
    (5), 1294–1301. https://doi.org/10.1016/j.fertnstert.2020.12.002.

    NURS-6512N DIVERSITY AND HEALTH ASSESSMENTS DISCUSSION  response

     you did a fantastic job on this weeks discussion. I enjoyed reading your post. The five questions you selected cover various topics to get a strong health history for the transexual patient specifically. According to Vermeir et al. (2018), when providing care to a trans patient, the healthcare provider should remain open and respectful and ask sensitive questions. In one of your questions, you openly ask how the patient’s transition has been for them and ask them to describe the lows and the highs. I believe that by asking about challenges and triumphs, let the patient know you are interested in their transition and open to discussing it with them. This openness and level of care allow you to obtain information and develop a therapeutic relationship with the patient. You also ask the patient to describe their mood. Trans patients often suffer severe stress, anxiety, and depression (Shires et al., 2018). You have worded your question to ask the patient what they are feeling instead of asking a specific question such as do you feel depressed? This way of communicating the question allows the patient to express themselves fully and ensures that all areas of mental well-being do not go unaddressed.

     

    References

    Shires, D. A., Stroumsa, D., Jaffee, K. D., & Woodford, M. (2018). Primary care providers’ willingness to continue gender-affirming hormone therapy for transgender patients. 
    Family Practice
    , 
    35
    (5), 576–581. 
    https://doi.org/10.1093/fampra/cmx119
    Links to an external site.

    Vermeir, E., Jackson, L. A., & Marshall, E. G. (2018). Improving Healthcare Providers’ Interactions with Trans Patients: Recommendations to Promote Cultural Competence. 
    Healthcare Policy
    , 
    14
    (1), 11–18. 
    https://doi.org/10.12927/hcpol.2018.25552
    Links to an external site.

     
    Reply

    NURS-6512N DIVERSITY AND HEALTH ASSESSMENTS DISCUSSION  sample post 2

    Initial Post

    Diversity and Health Assessments

    Description of Case Scenario and cultural and socioeconomic factors associated with this patient.

    In the given scenario, the patient is a
    33-year-old unmarried Caucasian male
    , who transitioned from his natal female sex to male, presenting to the office to establish as a new patient. He smokes 2 packs of cigarettes per day for the last 10 years, smokes 3-6 marijuana joints every weekend, suffers from depression, is unemployed, and is HIV positive, but virally suppressed. He takes Biktarvy once a day and injection testosterone 100mg weekly. No past medical history and family history of any diseases. He lives with his family and thinks that he would be a burden to his family.

    In this scenario, the patient is seeking establishment of care. The factors that can be affected are his race/ ethnicity, transition from female to male, unemployment and staying with family, smoking and drug use, history of HIV, and depression episodes. In any case, in the first visit, a thorough history collection and detailed physical examination is important. It includes identification, chief complaint, history of present illness, past medical history, family history, social history, review of systems, physical examination, lab data, problem list from most severe to least severe, assessments, differential diagnoses, and a treatment plan. (Sullivan, 2019). The information should be asked of patients or their caretakers and should never be gathered by observation alone. It should be collected upon patient registration to ensure that appropriate fields are completed when patient begins treatment. Questions about race and ethnicity, English language proficiency, language preferences are needed for effective communication. Patient’s concerns should be addressed when the information is being obtained. (Ulmer et al.)

    The issues need to be sensitive when interacting with the patient.

    Age, gender, race, ethnicity, cultural attitudes, regional difference, and socioeconomic status influence the way patients seek medical care and the way health care providers collect history from. For example, the black and Latino patients are less likely to receive treatment for depression. (Ball et al.) Caucasians are less likely to believe that mental health professionals can help individuals with schizophrenia, and depression. (Anglin et al). This may be due to the inequalities in the quality of care received, socioeconomic status, psychosocial explanations of cultural mistrust and stigma. (Anglin et al.). Here, the patient has depression, so care should be taken when collecting history about depression. Particular attention should also be given to patients who self-identify as being lesbian, gay, transgender or bisexual. (Ball et al.) In this case, the patient transitioned from female to male. So, special responsibilities include providing a welcoming and safe environment, gathering a history with sensitivity and compassion, and performing a physical examination using ‘gender-affirming’ approach. Also, the provider should identify the other health topics that the patient may be sensitive to such as HIV, and unemployment in this case, any restrictions to exposure of body parts, and discussion of sexual health, and the attitude towards mental illness. (Ball et al.). The provider should keep in mind that compliance with complicated therapies such as those for HIV, can be differed in various ethnicity, but can be better with education.

    The RESPECT model can help in effective, patient-centered, Cross-cultural communication which include Rapport, Empathy, Support, Partnership, Explanations, Cultural competence, and Trust.

    Targeted questions

    In this case, the patient suffers from depressive episodes, and is worried that he will be a burden to his family and thinks that his health is declining. So, suicide and depression screening are important. Questions can be asked include,

    Do you feel sad or down more than usual?

    Are you bored all the time?

    Are you having trouble getting sleep?

    Have you thought about hurting yourself or someone else?

    Does it seem that you have lost interest in things that you used to really enjoy?

    Would you rather just be by yourself most of the time?

    Have you ever tried to kill yourself?

    Have you ever had to hurt yourself?

    Since this patient has a history of smoking and drug use, this history can be obtained by using National Institute on Drug Abuse Modified Alcohol, Smoking and Substance Involvement Screening Test (NIDA Modified ASSIST). The questions can include,

    Do any of your friends use tobacco? Alcohol? other drugs?

    Do you use tobacco? Alcohol? Other drugs?

    How many packs of cigarettes do you smoke?

    Have you ever thought of cutting down the number of cigarettes you smoke?

    Are you unable to stop smoking or using drugs when you want to?

    Have you ever experienced withdrawal symptoms?

    Do you ever feel guilty or bad about your drug use?

    Since this patient is suffering from HIV, sexual history should be collected and it can be obtained by using 5 Ps, partners, practices, protection from STDs, past history of STDs, and prevention of pregnancy.

    Tell me about the people you have dated?

    What does the term safe sex mean to you?

    Are you interested in boys? Girls? Both?

    How many sexual partners you had altogether?

    The employment history can be collected by asking, what are your employment plans?

    Have you ever been suspended? Terminated?

    How well do you get along with the people at work?

    Do you feel as if you belong at your workplace?

     

    References

    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 
    (9
    th
     ed.) St. Louis, MO: Elsevier

    Mosby

    Sullivan, D. D. (2019).
     Guide to clinical documentation 
    (3
    rd
     ed.). Philadelphia. PA: F.A. Davis.

    Ulmer, C., McFadden, B., & Nerenz, D. R. (2009). 
    Improving data collection across the health

    care system-race, ethnicity, and language data
    . National academic press.

    https://www.ncbi.nlm.nih.gov/books/NBK219747
    Links to an external site.

     

    NURS-6512N DIVERSITY AND HEALTH ASSESSMENTS DISCUSSION  case study 2 post

    Discussion

    The post explore the specific socioeconomic, spiritual, lifestyle, and cultural factors associated with
    Shawn Billings, a 28-year-old African American patient
    who frequently visits the clinic with migraines. Shawn Billings is an African American patient who is likely to experience socioeconomic disparities, given the historical and current systemic racism and discrimination faced by African Americans in the United States. According to the U.S. Census Bureau (2019), African Americans have a poverty rate of 18.8%, compared to the national average of 10.5%. This may impact Shawn’s ability to access healthcare, obtain medication, and follow recommended treatment plans.

    Shawn’s spiritual beliefs and practices may also play a significant role in his healthcare decisions and outcomes. African American patients are more likely to value religion and spirituality as a coping mechanism for stress and illness (Holt et al., 2019). Therefore, healthcare providers need to consider and respect Shawn’s spiritual beliefs when interacting with him and providing care. Several lifestyle factors may contribute to Shawn’s recurring migraines, including stress, diet, and sleep patterns. It is crucial for healthcare providers to ask Shawn about his daily routines and habits to gain a better understanding of his lifestyle and potential triggers for his migraines. As an African American patient, Shawn may have cultural beliefs and practices that impact his healthcare experiences and decisions. For example, African Americans have a higher prevalence of hypertension and diabetes, which may be attributed to cultural dietary practices and limited access to healthy foods (Crawley et al., 2020). Therefore, healthcare providers need to be aware of and respect Shawn’s cultural beliefs when providing care.

    When interacting with Shawn, healthcare providers need to be sensitive to the potential biases and stigmatization associated with labeling him as a “frequent flyer.” This label may create assumptions and judgments about Shawn’s behavior and medical history, leading to suboptimal care. Healthcare providers also need to be mindful of any potential racial bias or discrimination and provide equitable care. Targeted questions for health history and risk assessment include:

    Can you describe your typical daily routine and habits, including your sleep patterns, dietary practices, and physical activity levels?

    Have you noticed any specific triggers for your migraines, such as stress or certain foods?

    How do you typically manage your migraines, and have you noticed any patterns in your response to medication?

    Do you have any spiritual beliefs or practices that impact your healthcare decisions or preferences?

    Have you experienced any difficulties accessing healthcare or medication in the past, and if so, how did you address these challenges?
    NURS-6512N DIVERSITY AND HEALTH ASSESSMENTS
    DISCUSSION

    Thus, healthcare providers need to consider several socioeconomic, spiritual, lifestyle, and cultural factors when providing care to Shawn Billings, an African American patient with recurring migraines. By understanding and addressing these factors, healthcare providers can provide equitable and effective care to Shawn and improve his healthcare outcomes.

    References

    Crawley, L. M., Ahn, D. K., & Winkleby, M. A. (2020). Perceptions of a healthy diet are associated with major food group consumption in African American women. Journal of Racial and Ethnic Health Disparities, 7(6), 1057-1068. 
    https://doi.org/10.1093/jc/dks199
    Links to an external site.

    Holt, C. L., Caplan, L., Schulz, E., Blake, V., Southward, V. L., & Buckner, A. V. (2019). Role of religion in cancer coping among African Americans: A qualitative examination. Journal of Psychosocial Oncology, 34(3), 179-199. https://doi.org/10.1097/01.NAQ.0000305946.31193.61

    U.S. Census Bureau. (2019). 
    Income and Poverty in the United States: 2018.
     
    https://www.census.gov/library/publications/2019/demo/p60-266.html
    Links to an external site.

    NURS-6512N DIVERSITY AND HEALTH ASSESSMENTS DISCUSSION  response

    Thank you for the informative post. The health disparities faced by the African American population are at the forefront of this case study. In addition to the disparities you mentioned, there is evidence that Black Americans with darker skin tones have poorer physical and mental health than Black Americans with lighter skin tones (Dent et al., 2020). Black Americans with darker skin tones are more likely to be diagnosed with hypertension and to have higher blood pressure, greater body mass index, and a greater smoking prevalence (Dent et al., 2020). Though the patient’s skin tone is not mentioned, if he is a darker-toned Black American, the migraines could be caused by undiagnosed hypertension and risk factors for migraines, such as smoking and alcohol intake. Instead of the healthcare providers calling the patient a “frequent flyer,” they should explore the patient’s health further rather than giving him a temporary solution to a recurring problem.

    Another important aspect of this case is that the patient continually seeks treatment via clinic care and not primary care. The healthcare providers, in this case, should inquire whether the patient has a primary care provider and, if not, provide a referral to the patient. One study found that only 62% of Black American adults have regular primary care providers compared with 77% of White Non-Hispanic American adults (Ahad et al., 2019). The providers in this scenario should have asked the patient at the first visit whether he had a primary care provider. Further visits to the clinic could have been prevented if the patient had a primary care provider managing his health.

    Thank you,

     

    References

    Ahad, F. B., Zick, C. D., Simonsen, S. E., Mukundente, V., Davis, F. A., & Digre, K. (2019). Assessing the likelihood of having a regular health care provider among African American and African immigrant women. 
    Ethnicity & Disease
    , 
    29
    (2), 253–260. 
    https://doi.org/10.18865/ed.29.2.253
    Links to an external site.

    Dent, R. B., Hagiwara, N., Stepanova, E. V., & Green, T. L. (2020). The role of feature-based discrimination in driving health disparities among Black Americans. 
    Ethnicity & Health
    , 
    25
    (2), 161–176. 
    https://doi.org/10.1080/13557858.2017.1398314
    Links to an external site.

     

    NURS-6512N DIVERSITY AND HEALTH ASSESSMENTS DISCUSSION  response 2

    Thank you for your discussion post regarding your assigned case study. It is alarming how much of the African American population struggle with access to healthcare in the United States. It would make sense that there would be a lack of consistent healthcare and patient compliance associated with this racial group due to the known challenges that come with poverty. You make a valid point about the spirituality factors in this situation. It is very interesting the information you found surrounding spirituality beliefs and practices in relation to seeking healthcare. Although these values and beliefs need to be respected and understood, at the same time this is where the APRN can be of great assistance by providing education surrounding ways to seek medical care and explain the risks if medical care is delayed. I agree with you that the patient’s triggers with his migraines remain important details to note as this may drive home a root cause of why the patient is presenting in this much pain as often as he is. Regardless of the patient’s decisions, it is crucial the APRN remains non-judgmental and does not let her biases get in the way of being able to establish a rapport with the patient to build a thorough health history. Understanding the patient’s health risks will also be important to identify to help prevent further complications or health concerns in the future. This patient should be viewed as a unique being who is seeking assistance for true symptoms rather than manipulative or drug-seeking behaviors. Even labeling the patient as a “frequent flyer” could create unrealistic or minimized provider efforts, which could in turn harm the patient or cause a delay in care. According to Osmancevic, Großschädl, and Lohrmann (2023), “Effective interventions, such as educational training, need to be implemented in order to deliver culturally competent care and potentially reduce disparities in healthcare and improve patient outcomes” (p. 1).

    I appreciate your target questions as they are significantly important. I like that you are asking questions in relation to sleep. Getting appropriate rest is so vital to proper healing, disease management, illness prevention, and optimal systemic functioning. Rest is often undervalued and overlooked in Western medicine in my experience, so I was thrilled to see that you incorporated that into your questions. Also, I appreciate your interest in the patient’s culture and how his beliefs tie into his current healthcare efforts and decision making. From the information you provided in your discussion post, it is known that this racial group often delays seeking treatment for illness due to their cultural practices. With that said, it is important for the APRN to empathize with the patient, but also could be an eye opener for the practitioner, especially if the patient is presenting to the office so frequently. With his symptoms being this severe, a comprehensive workup would be warranted if nothing else could explain the severity and frequency.

    Depending on how severe the patient’s pain is, it would be important for the APRN to gauge how engaging the patient would be during the health history interview. This may prompt the APRN to ask the target questions in order from most important to least important. This way, the APRN gathers the most pertinent information before the patient feels too overwhelmed or stimulated. Target questions one, four, and five would be most appropriate in my assigned case study as the patient’s routine, health habits, and cultural and spiritual practices are equally as important in the case of a transgender male. Just like the African American culture having their own practices and beliefs as to why they do not always seek medical care, the LGBTQ community has been known to “not seek medical attention because of fear of discrimination and a history of previous negative experiences with medical professionals” (Marchand & Selter, 2022, p. 1). As APRNs, it is our duty to break that cycle and provide the best patient-centered care possible, allowing all cultures to feel confident and comfortable that they will not be judged but only cared for with equality and respect.

     

    References

    Marchand, K., & Selter, S. (2022). LGBTQ+ ALLY FOR COMPASSIONATE CARE…47th Annual Oncology

    Nursing Society Congress, April 27-May 1, 2022, Anaheim, CA. 
    Oncology Nursing Forum
    , 
    49
    (2), E35.

    https://doi.org/10.1188/22.ONF.E2.

    Osmancevic, S., Großschädl, F., & Lohrmann, C. (2023). Cultural competence among

    nursing students and nurses working in acute care settings: a cross-sectional study. 
    BMC Health Services 

    Research
    , 
    23
    (1), 1–7. https://doi.org/10.1186/s12913-023-09103-5.NURS-6512N DIVERSITY AND HEALTH ASSESSMENTS DISCUSSION

  • Shawn Billings, a 28 year-old African American patient

    CASE STUDY 2

    Shawn Billings, a 28 year-old African American patient comes in to the clinic today. He has been deemed a “frequent flyer” by the staff at the clinic and was at the clinic last week and 4 days ago with a migraine, given a shot of Toradol and Ativan and sent home. He is here today again for an extreme headache. He is very agitated today. He is here with his father and worried that he will not get any medication.

     

    Module 2 Week 2 Discussion: Main Post

    Mr. Billings has presented to the clinic today for another migraine. The clinic staff has deemed him a frequent flyer. However, Mr. Billings is suffering from chronic migraines. He worries about receiving medication and has brought his father to the visit today. According to Henderson et al. (2020), as a healthcare provider, one must look at the whole patient when providing care, which includes embracing their beliefs, values, and expectations to provide high-quality care. Based on the information provided, which is limited, the patient has received medication to treat his migraines. However, little has been done to investigate the cause or help manage a chronic condition. African Americans suffering from chronic pain are undertreated more severely when compared to non-Hispanic Whites (Maly & Vallerand, 2018). Unfortunately, African Americans suffer more from health disparities or social determinants of health than other ethnic groups. According to Singu et al. (2020), African Americans are more likely to live in poverty, have limited access to healthy foods, live in areas with higher levels of pollution, and experience stress at a higher level due to socioeconomic status. These health disparities and SDOH could present potential causes for the development of migraines.

    Regarding the patient’s father attending the appointment with him, the healthcare provider should include the father in the patient’s care. Family members of African American patients are more likely to participate in patient support methods using personal or spiritual care (Núñez et al., 2021). Excluding the father would prevent supportive methods and further increase the patient’s agitation. This action would negatively impact the patient’s care and experience.

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    Health History Assessment

    To collect an accurate health history on Mr. Billings, I would inquire about health disparities or SDOH that may cause chronic migraines. Before asking the questions, I would explain to Mr. Billings that an accurate assessment of health disparities may reveal the source or sources of his physical concern. Without explanation, Mr. Billings agitation may become worse. For example, the patient may take offense to questions about poverty or income, especially when he is being seen for a migraine. Without explanation, the patient may feel as if the provider is placing judgment.

     

    Questions to ask:

    What do you do for work?

    Do you make enough money to pay your bills?

    Do you have access to healthy food?

    What is the highest level of education that you completed?

    Do you experience stress?

     

           By asking these questions, it would help the healthcare provider determine areas of need or potential causes for the physical symptoms the patient is experiencing. Furthermore, it could help the provider rule out health disparities or SDOH as a cause. Indicating the need for further testing, change in treatment, or referral to a specialist that can provide appropriate long-term management for migraines. 

     

    References

    Henderson, S., Horne, M., Hills, R., & Kendall, E. (2018). Cultural competence in healthcare in the community: A concept analysis. 
    Health & Social Care in the Community
    , 
    26
    (4), 590–603. 
    https://doi.org/10.1111/hsc.12556
    Links to an external site.

    Maly, A., & Vallerand, A. H. (2018). Neighborhood, Socioeconomic, and Racial Influence on Chronic Pain. 
    Pain Management Nursing
    , 
    19
    (1), 14–22. 
    https://doi.org/10.1016/j.pmn.2017.11.004
    Links to an external site.

    Núñez, E., Villa, G., McFadden, R., Palmisciano, A., Lanini, I., O’Mahony, S. M., Curtis, J. R., Levy, M. M., & Amass, T. (2021). Differences in Family Involvement in the Bedside Care of Patients in the ICU Based on Self-Identified Race. 
    Critical Care Explorations
    , 
    3
    (3), e0365. 
    https://doi.org/10.1097/cce.0000000000000365
    Links to an external site.

    Singu, S., Acharya, A., Challagundla, K. B., & Byrareddy, S. N. (2020). Impact of Social Determinants of Health on the Emerging COVID-19 Pandemic in the United States. 
    Frontiers in Public Health
    , 
    8
    . 
    https://doi.org/10.3389/fpubh.2020.00406
    Links to an external site.

    Discussion 2_Resonse 1

    Great post, Kasondra. Pain is subjective, and it is what the patient says it. Chronic migraine is debilitating; it affects the person’s ability to function normally in the community (Dahlhamer et al., 2018). The patient’s physical and psychological conditions must be considered, in addition to the impact of chronic pain on the patient’s quality of life(Dahlhamer et al., 2018). Indeed, there is a need to do a comprehensive health history and physical assessment so that the nature of pain can be determined and treated accordingly. Sometimes, like today, I had migraines. In general, it affects me when I do not sleep enough. Migraines are excruciating.

    Moreover, a migraine that evolves into chronic migraine is intolerable. The pathophysiology of migraine involves the peripheral and central parts of the trigeminal system as well as several subcortical and cortical of the brain structure (Coppola et al., 2020). Mungoven et al. (2022), using a functional magnetic resonance in their research, found that the variation of brainstem pain modulatory regions by higher cortical zones may be abnormal when pain occurs, and these changes in this descending modulatory route display only before the development of a migraine attack. From their data, the authors derived that understanding the functional changes of the descending pain modulation may lead to the development of treatment methods that will contribute to reducing pain before a migraine attack.

    References

    Coppola, G., Parisi, V., Di Renzo, A., & Pierelli, F. (2020). Cortical pain processing in migraine. 
    Journal of Neural Transmission (Vienna, Austria: 1996)
    , 
    127
    (4), 551–566. 
    https://doi.org/10.1007/s00702-019-02089-7
    Links to an external site.

    Dahlhamer, J., Lucas, J., Zelaya, C., Nahin, R., Mackey, S., DeBar, L., Kerns, R., Von Korff, M., Porter, L., & Helmick, C. (2018). Prevalence of chronic pain and high-impact chronic pain among adults – United States, 2016. 
    MMWR. Morbidity and mortality weekly report
    , 
    67
    (36), 1001–1006. https://doi.org/10.15585/mmwr.mm6736a2

    Mungoven, T. J., Marciszewski, K. K., Macefield, V. G., Macey, P. M., Henderson, L. A., & Meylakh, N. (2022). Alterations in pain processing circuitries in episodic migraine. 
    The Journal of Headache and Pain
    , 
    23
    (1), 9. https://doi.org/10.1186/s10194-021-01381-w

     

    response 2

    Your post was informative and highlighted some stressors contributing to this patient’s migraines. A lack of the basic necessities for living, such as clean water, healthy food, financial security, housing, education, and access to quality healthcare creates health disparities that can severely influence a patient’s health outcomes. African Americans face health disparities due to poverty, racism, low education level, a lack of medical insurance, and mistrust of healthcare providers (Nair & Adetayo, 2019). Mistrust with healthcare providers results in avoidance to seek out primary care services and contributes to more emergency room visits by African American patients (Alsan et al., 2019). In the US, migraine headaches affect approximately 1 million African American men and can be severely disabling (Charleston et al., 2020). Taking the time to properly address this patient’s concerns, while also being sensitive to his cultural and social differences can help build more trust and fewer feelings of judgment (Andermann, 2016). Getting an official diagnosis of “migraines” for this patient can put him on the path to receiving appropriate evidence-based treatment and neurological care for this condition to prevent or reduce these episodes (Eigenbrodt et al., 2021).

    I thought your questions were probative and will be helpful in gathering information for your health assessment. As healthcare providers, I feel we sometimes can become so busy that we rush through things and do not take the time to explain that our questions are not meant to offend or be judgmental but to help find solutions and provide the best care for our patients. So, I love that you included taking the time to explain the importance of your questions so as not to further aggravate the patient. Having the patient’s father present during the assessment (as long as there is patient consent) can help provide information about family history that the patient may not know. Great post! I really enjoyed your perspective on this case scenario.

    References

    Alsan, M., Garrick, O., & Graziani, G. (2019). Does diversity matter for health? Experimental evidence from Oakland. 
    American Economic Review
    , 
    109
    (12), 4071–4111. 
    https://doi.org/10.1257/aer.20181446
    Links to an external site.

    Andermann, A. (2016). Taking action on the social determinants of health in clinical practice: A framework for health professionals. 
    Canadian Medical Association Journal
    , 
    188
    (17-18), E474–E483. 
    https://doi.org/10.1503/cmaj.160177
    Links to an external site.

    Charleston, L., Spears, R. C., & Flippen, C. (2020). Equity of African American men in headache in the United States: A perspective from African American headache medicine specialists (part 1). 
    Headache: The Journal of Head and Face Pain
    , 
    60
    (10), 2473–2485. 
    https://doi.org/10.1111/head.14004
    Links to an external site.

    Eigenbrodt, A. K., Ashina, H., Khan, S., Diener, H.-C., Mitsikostas, D. D., Sinclair, A. J., Pozo-Rosich, P., Martelletti, P., Ducros, A., Lantéri-Minet, M., Braschinsky, M., del Rio, M., Daniel, O., Özge, A., Mammadbayli, A., Arons, M., Skorobogatykh, K., Romanenko, V., Terwindt, G. M.,…Ashina, M. (2021). Diagnosis and management of migraine in ten steps. 
    Nature Reviews Neurology
    , 
    17
    (8), 501–514. 
    https://doi.org/10.1038/s41582-021-00509-5
    Links to an external site.

    Nair, L., & Adetayo, O. A. (2019). Cultural competence and ethnic diversity in healthcare. 
    Plastic and Reconstructive Surgery – Global Open
    , 
    7
    (5), e2219. 
    https://doi.org/10.1097/gox.0000000000002219
    Links to an external site.

  • John Green, 33 year-old Caucasian male

    CASE STUDY 1

    John Green, 33 year-old Caucasian male, presents to the office to establish as a new patient. John’s natal sex is female but he identifies as a male. He transitioned from female to male 2 years ago. He has made a full transition with family and socially last year. He just moved back home and is unemployed at this time. He has been obtaining testosterone from the internet to give to himself. He has not had any health care since he decided to change other than getting his suppression medications through Telehealth 3 months ago. His past medical history includes smoking 2 packages of cigarettes per day for the last 10 years, smokes 3-6 marijuana joints every weekend (has an active green card), and does suffer from depression episodes. He is HIV positive for the last 3 years but remains virally suppressed at his last blood draw 6 months ago. He has been feeling very weak over the last few weeks which prompted him to move back home with his parents. He takes Biktarvy once daily that comes in the mail for free, tolerates it well, and 100 mg Testosterone IM every 7 days. His PMH is non-contributory. No past medical history. He has never been married. No significant family history. He is worried since moving back home and unemployed he will be a burden on his family, and he thinks his health may be declining.

    BY DAY 3 OF WEEK 2

    Post
     an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks

    Introduction

                
    I was assigned to case study 1. The patient in the case study is a 33-year-old Caucasian male who presents to the office to establish new patient care. The patient is a transgender male who transitioned two years ago and fully transitioned with family and socially last year. He had just moved back home to live with his parents after he felt his health was declining, as he had become very weak over the last few weeks. He is unemployed and worries about being a burden to his parents. He has been obtaining testosterone from the internet for the past three months. He has smoked two packs of cigarettes daily for the last ten years and smokes 3-6 marijuana joints every weekend (active green card). He has depressive episodes. He has been HIV+ for the last three years and is virally suppressed demonstrated by his last blood draw six months ago. He takes Biktarvy once daily, which he receives for free via mail. There are several culturally sensitive factors to consider for this patient.

    ORDER A PLAGIARISM-FREE PAPER OR SHADOW HEALTH HERE

    Patient-Specific Cultural and Sensitive Factors

    To begin, the patient is a transgender male. Transgender individuals have no history of having good experiences with healthcare professionals. A qualitative report conducted in 2017 demonstrated that 45.7% of transgender and gender non-conforming patients within the emergency department witnessed medical personnel gossiping, mocking, or telling jokes (Mehta & Warner II, 2021). A zero-tolerance policy for these behaviors must be enacted and practiced in all healthcare facilities if effective and safe patient-centered care is to be delivered.

    The healthcare provider must begin the health assessment interview by addressing the patient with their preferred pronoun; it should never be assumed, and the healthcare provider should directly ask the patient how they wish to be addressed (Ball et al., 2019). Beginning the interview this way demonstrates to the patient that their needs are at the forefront of the clinician’s treatment plan. It is essential that the patient feels comfortable and confident with their healthcare provider and plan of care for effective patient outcomes. The prudent healthcare provider should know that transgender individuals have higher unemployment rates, poverty, homelessness, discrimination, psychological distress, HIV infection, substance abuse, suicide, and violence (Mehta & Warner II, 2021). These topics should be discussed during the initial meeting and regularly followed up on.

    There are high rates of uninsured transgender individuals or a lack of coverage for transgender-related services (Mehta & Warner II, 2021). The healthcare provider should discuss insurance coverage with the patient, especially since he is unemployed and recently moved back in with his parents. It may be necessary to guide the patient to the local Department of Health Services office to inquire about public assistance. The healthcare provider should also inquire about whether the patient expects to continue receiving his testosterone and Biktarvy through the mail and whether these will continue to be offered for free to the patient. It may be necessary to provide the patient with drug discount coupons. The patient has been feeling weaker over the past couple of weeks, and a more thorough assessment of medication habits is warranted. The patient should be asked if he has been taking the Biktarvy as prescribed. It is possible that the patient is not taking Biktarvy as prescribed, which could lead to the patient being weaker. It is necessary to determine who is prescribing and dispensing the testosterone and Biktarvy for the patient to assess for authenticity and accreditation. Obtaining new labs to assess whether values have changed is also essential.

    The patient is prescribed Biktarvy, an antiretroviral medication for the treatment of HIV. Antiretroviral medications can cause adverse effects on the liver, including idiosyncratic reactions, direct cholestatic injury, mitochondrial dysfunction, nonalcoholic steatohepatitis, or isolated hyperbilirubinemia (Parmar et al., 2023). Therefore, ordering liver functioning labs would be necessary when diagnosing the patient’s cause of weakness.

    The patient is HIV+, another sensitive issue that the provider must discuss with the patient. Though the patient in the case study is a transgender male, transgender women have a 34.2 times higher risk of HIV infection than the US population (Stevens & Fajardo, 2021). This data is vital to this case as it represents the transgender community and demonstrates how this population is particularly vulnerable. Due to previous poor experiences, the patient may be hesitant to share intimate details about his sexual history; however, the provider must inquire about these details to assess the patient’s current risk status. Building a solid rapport before this conversation would likely aid in a more productive conversation. The provider and patient must come to an agreed-upon treatment plan to manage HIV+ sensitively.

    Targeted Questions

    How would you like me to address you? What is your preferred pronoun? Is there any information that you feel uncomfortable discussing?

    Tell me about your lifestyle prior to moving back with your parents.

    Where did you live? Did you live with anyone? Was the location in a safe place?

    What did you do for work previously? Do you plan on searching for employment while staying here?

    Where do you obtain your prescriptions from? Do you know the prescriber of the medications? What pharmacy do the medications come from? Will you continue receiving the medications for free, or do you need assistance?

    What is your relationship status? How many partners have you been with? Is your current partner aware of your HIV+, and do they regularly get tested?

     

     

    References

    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.

    Mehta, A. H., & Warner II, D. M. (2021). Identifying and addressing barriers to transgender healthcare: Where we are and what we need to do about it. 
    JGIM: Journal of General Internal Medicine
    , 
    36
    (11), 3559–3561. 
    https://doi.org/10.1007/s11606-021-07001-2
    Links to an external site.

    Parmar, K., Mekraksakit, P., Nugent, K., & Nichols, J. (2023). A possible case of bictegravir-associated severe unconjugated hyperbilirubinemia. 
    AIDS Research & Therapy
    , 
    20
    (1), 1–5. 
    https://doi.org/10.1186/s12981-023-00501-7
    Links to an external site.

    Stevens, G. A., & Fajardo, F. J. (2021). LGBTQ+ health research guides at North American health sciences libraries: A survey and content analysis. 
    Journal of the Medical Library Association
    , 
    109
    (3), 406–413. 
    https://doi.org/10.5195/jmla.2021.1189
    Links to an external site.

    BY DAY 6 OF WEEK 2

    Respond on or before Day 6
     
    on 2 different days
     to at least
     two
     of your colleagues who were assigned a different patient than you. Critique your colleague’s targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to your patient, and why.

    Thank you XX

    Your post has a lot of great considerations for addressing this population of patients. It is so important for providers to be aware and non judgemental. One thing you didn’t mention that I feel is essential to discuss and evaluate with this patient is his depression level and risk for suicide. Suicide rate and suicidal tendencies among transgender persons are considerably high compared to general population. This patient admits to feeling like a burden, is unemployed, ill and weak, and admits to depression symptoms currently. These could be precursors to a suicide attempt if the patient isn’t given the support he needs. The high prevalence of depression and suicidal tendencies among transgender persons seems to be highly influenced by societal stigma, lack of social support, HIV status, all of which possibly applies for this patient.

     

    Virupaksha, H. G., Muralidhar, D., & Ramakrishna, J. (2016). Suicide and suicidal behavior among transgender persons. Indian journal of psychological medicine. Retrieved March 9, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5178031/

     

    RESPONSE 2

    Great job on your post! I liked how you questioned how this patient obtains his prescriptions and then inquire on where he gets this from. Obtaining this information can help us comply an accurate health history and identify pertains health risks this patients has the potential for developing. A journal article by (Warner & Mehta, 2021) identified that, “Structural barriers to transgender healthcare include high uninsured rates or lack of coverage for transgender-related services, inadequate training of physicians on transgender-sensitive care, and limited access to providers who offer transgender-related care” (para. 2). In addition, (Gorton, 2007) concluded that “the United States is the only developed nation without universal health insurance and among uninsured Americans, the majority are uninsured for transgender care because of policy exclusion” (para.1). Because of this, uninsured transgender patients have a more difficult time obtaining the necessary prescriptions needed to optimize their health.

    Gorton, R. N. (2007). 
    Transgender health benefits: Collateral damage in the resolution of the National Health Care Financing Dilemma – Sexuality Research and Social Policy
    . SpringerLink. Retrieved March 8, 2023, from https://link.springer.com/article/10.1525/srsp.2007.4.4.81#citeas

    Warner, D. M., & Mehta, A. H. (2021). 
    Identifying and addressing barriers to transgender healthcare: Where we are and what we need to do about it – journal of general internal medicine
    . SpringerLink. Retrieved March 8, 2023, from 
    https://link.springer.com/article/10.1007/s11606-021-07001-2#citeas
    Links to an external site.

    Response 3

    This was a thorough analysis of the case study on the 33-year-old Caucasian transgender person who presents to the office to establish new patient care, and who has a history of HIV, spanning back to three years back. Your position holds that the healthcare provider must address the patient with their preferred pronoun, should be aware of the needs of transgender individuals, and must discuss insurance coverage and treatment plans with the patient. In light of this, It is agreeable the healthcare provider should be aware of the needs of transgender individuals and should be cognizant of the potential for discrimination and poor experiences with healthcare personnel (Klein et al., 2018). Additionally, it is important that the healthcare provider is aware of the patient’s financial and insurance situation, to ensure that the patient is able to receive the necessary care in a timely and affordable manner. Also, it is necessary to add that the healthcare provider should also be aware of the patient’s mental health needs, as transgender individuals are at a higher risk for depression and suicidal ideation (Klein et al., 2018). This is particularly important in light of the patient’s history of depressive episodes. It is also important for the provider to address these mental health issues with the patient, recognize the patient’s feelings of being a burden to their parents, and ensure that the patient is connected with appropriate mental health services.

    Furthermore, it is also important to recognize the patient’s lifestyle prior to moving in with their parents, as this can provide context for the patient’s current health status. As the patient is HIV+ and has been receiving medications from the mail, it is important to inquire about the prescriber and the pharmacy of the medications to ensure that the patient is receiving medications from a legitimate source and that the medications are authentic. According to the CDC, it is important to be aware of the potential for counterfeit medications, as “counterfeit medications can include products with the wrong ingredients, without active ingredients, with incorrect amounts of active ingredients, or with fake packaging.” (“Counterfeit Medication,” 2021). In addition, it is also important to ask questions about the patient’s sexual history, as this can provide insight into their HIV status and risk factors. Overall, this was a comprehensive analysis of the patient’s case study, and the questions provided are appropriate and necessary in order to provide effective patient care.

    References

    Counterfeit Medication. (2021). Centers for Disease Control and Prevention. Retrieved from https://wwwnc.cdc.gov/travel/page/counterfeit-medicine

    Klein, D. A., Paradise, S. L., & Goodwin, E. T. (2018). Caring for transgender and gender-diverse persons: what clinicians should know. American family physician, 98(11), 645-653.

  • Focused Exam: Chest Pain, Brian Foster Shadow health transcript

    Focused Exam: Chest Pain, Brian Foster Shadow health transcript

    Transcript

    Hello

    Greet

    04/15/23 1:09 PM EDT

    Good morning.

    What brings you in today?

    Question

    04/15/23 1:09 PM EDT

    I have been having some troubling chest pain in my chest now and then for the past month.

    Sorry for the chest problem

    Empathize

    04/15/23 1:10 PM EDT

    Thanks. I appreciate that.

    When did the chest pain start?

    Question

    04/15/23 1:11 PM EDT

    I first noticed it earlier this month. I thought it might just be heartburn and it passed after a couple of minutes.

    How is the pain like

    Question

    04/15/23 1:13 PM EDT

    Well, it doesn’t hurt right now, but I have been having chest pain now and then for the past month.

    Where is the pain located?

    Question

    04/15/23 1:13 PM EDT

    When the pain happens, I feel it mostly in the middle of my chest, over my heart.

    Does the chest pain radiate?

    Question

    04/15/23 1:14 PM EDT

    The pain doesn’t radiate anywhere. It’s mostly just right in the middle of my chest.

    Do you have back pain?

    Question

    04/15/23 1:15 PM EDT

    I haven’t had back pain, no.

    How frequent are the chest pains?

    Question

    04/15/23 1:16 PM EDT

    Well, it has happened three times the past month. It usually goes away after about a couple of minutes.

    What relieves the chest pain?

    Question

    04/15/23 1:17 PM EDT

    I’m not sure. I think lying still seems to help a little.

    What makes the pain worse

    Question

    04/15/23 1:17 PM EDT

    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.

    can you rate the pain on a scale

    Question

    04/15/23 1:18 PM EDT

    I’d say maybe a . . . 5? It’s just really uncomfortable . . . like there’s nothing I can do about it. Right now it’s like a zero though.

    Have you taken any medications for the chest pain

    Question

    04/15/23 1:20 PM EDT

    No, not yet.

    Which medications do you take currently (Clarified to What medications do you take?.)

    Question

    04/15/23 1:21 PM EDT

    Yeah, let’s see, I take atorvastatin for cholesterol, lisinopril for blood pressure. . . Oh yeah, and I take fish oil too. I hear that’s good for your cholesterol. (Clarified to what medications I am taking.)

    Thats good for your cholesterol, continue taking it

    Educate

    04/15/23 1:22 PM EDT

    Good to know. Thank you. Focused Exam: Chest Pain, Brian Foster Shadow health transcript

    Any allergies

    Question

    04/15/23 1:23 PM EDT

    No, well . . . I’ve had a bad reaction to codeine before, but that is all I know of.

    Any history of chronic illness?

    Question

    04/15/23 1:24 PM EDT

    Besides a little high blood pressure and cholesterol, no.

    Have you done EKG test recently?

    Question

    04/15/23 1:24 PM EDT

    I had one about three months ago. They usually put one on me at my annual physical.

    What were the results of the EKG?

    Question

    04/15/23 1:25 PM EDT

    I don’t remember the actual results, but as far as I know, it was normal.

    Do you have a primary care provider?

    Question

    04/15/23 1:25 PM EDT

    Dr. Melinda Smith.

    Great

    Educate

    04/15/23 1:26 PM EDT

    Good to know. Thank you.

    When did you last visit your care provider

    Question

    04/15/23 1:26 PM EDT

    I had a physical about 3 months ago.

    Any palpitations?

    Question

    04/15/23 1:27 PM EDT

    I don’t think so. I haven’t noticed any.

    Any history of heart illness? (Clarified to Do you have a history of heart problems?.)

    Question

    04/15/23 1:27 PM EDT

    All I know is I have high blood pressure and cholesterol, but that’s pretty well-controlled by medicine as far as I know. (Clarified to if I have a history of heart problems.)

    Do you feel stressed?

    Question

    04/15/23 1:28 PM EDT

    Not usually, but I’m feeling pretty anxious not knowing what’s going on with my chest.

    I’m sorry about that

    Empathize

    04/15/23 1:28 PM EDT

    Thanks. I appreciate that.

    Do you have hypertension?

    Question

    04/15/23 1:29 PM EDT

    Yes, I supposedly have moderately high blood pressure.

    Do you exercise?

    Question

    04/15/23 1:29 PM EDT

    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.

    I’m sorry you’ve not been able to exercise

    Empathize

    04/15/23 1:29 PM EDT

    Thanks. I appreciate that.

    What is your typical diet

    Question

    04/15/23 1:30 PM EDT

    I try to stay conscious of my diet. You know, I watch the fat. I watch the sodium . . . but I’m a dyed-in-the-wool carnivore too. Steaks and burgers find their way in there every once in a while.

    Do you drink water regularly?

    Question

    04/15/23 1:30 PM EDT

    I usually drink water all day at work. At least four glasses, probably more.

    Do you smoke cigarette?

    Question

    04/15/23 1:31 PM EDT

    Nope, I had a lot of friends who did but I never started.

    Smoking is bad for the health

    Educate

    04/15/23 1:32 PM EDT

    Good to know. Thank you.

    Do you take alcohol? Focused Exam: Chest Pain, Brian Foster Shadow health transcript

    Question

    04/15/23 1:32 PM EDT

    Sure, but never more than two or three beers on a weekend.

    Do you feel fatigued?

    Question

    04/15/23 1:33 PM EDT

    I’m not more tired than normal.

    Any dizziness?

    Question

    04/15/23 1:33 PM EDT

    No, I haven’t felt dizzy.

    Do you have Angina?

    Question

    04/15/23 1:33 PM EDT

    I’ve never been diagnosed with angina.

    Do you have edema?

    Question

    04/15/23 1:34 PM EDT

    I haven’t noticed any swelling.

    Have you has blood clots?

    Question

    04/15/23 1:34 PM EDT

    Not that I know of.

    Any fever?

    Question

    04/15/23 1:35 PM EDT

    I haven’t had a fever, no.

    Do you cough?

    Question

    04/15/23 1:35 PM EDT

    I don’t have a cough.

    Any difficulty breathing?

    Question

    04/15/23 1:35 PM EDT

    My breathing’s fine.

    Any sore throat?

    Question

    04/15/23 1:35 PM EDT

    I haven’t had a sore throat in a long time.

    Do you have diarrhea?

    Question

    04/15/23 1:36 PM EDT

    I have, but it is very rare for me.

    Do you have constipation?

    Question

    04/15/23 1:37 PM EDT

    I haven’t had problems with that. I wish it were only that.

    Any heartburn?

    Question

    04/15/23 1:37 PM EDT

    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.

    Any family history of hear attack?

    Question

    04/15/23 1:37 PM EDT

    No, nobody had that.

    Have you been monitoring your blood pressure?

    Question

    04/15/23 1:38 PM EDT

    Not usually. They check it when I get checkups. My doctor has never seemed overly concerned about it.

     Measured vitals

    Exam Action

    04/15/23 1:39 PM EDT

     Tested blood pressure in left arm with cuff

    Exam Action

    04/15/23 1:39 PM EDT

     Tested blood pressure in right arm with cuff

    Exam Action

    04/15/23 1:39 PM EDT

     Measured vitals

    Exam Action

    04/15/23 1:39 PM EDT

     Inspected face

    Exam Action

    04/15/23 1:39 PM EDT

     Inspected for jugular venous distension: No jugular venous distention; JVP 3 cm above sternal angle

    Exam Action

    04/15/23 1:40 PM EDT

     Inspected anterior chest wall

    Exam Action

    04/15/23 1:40 PM EDT

     Inspected right side chest wall

    Exam Action

    04/15/23 1:40 PM EDT

     Inspected posterior chest wall

    Exam Action

    04/15/23 1:40 PM EDT

     Inspected left side chest wall

    Exam Action

    04/15/23 1:40 PM EDT

     Inspected left side of abdomen

    Exam Action

    04/15/23 1:40 PM EDT

     Inspected front of abdomen

    Exam Action

    04/15/23 1:40 PM EDT

     Inspected right hand: no visible abnormal findings

    Exam Action

    04/15/23 1:41 PM EDT

     Inspected left hand: no visible abnormal findings

    Exam Action

    04/15/23 1:41 PM EDT

     Inspected fingernails of left hand Focused Exam: Chest Pain, Brian Foster Shadow health transcript

    Exam Action

    04/15/23 1:41 PM EDT

     Inspected right hand: no visible abnormal findings

    Exam Action

    04/15/23 1:41 PM EDT

     Inspected left hand: no visible abnormal findings

    Exam Action

    04/15/23 1:41 PM EDT

     Inspected fingernails of right hand

    Exam Action

    04/15/23 1:41 PM EDT

     Inspected left leg

    Exam Action

    04/15/23 1:41 PM EDT

     Inspected right leg Focused Exam: Chest Pain, Brian Foster Shadow health transcript

    Exam Action

    04/15/23 1:41 PM EDT

     Inspected toenails on left foot

    Exam Action

    04/15/23 1:41 PM EDT

     Inspected toenails on right foot

    Exam Action

    04/15/23 1:41 PM EDT

     Inspected left leg

    Exam Action

    04/15/23 1:41 PM EDT

     Inspected right leg

    Exam Action

    04/15/23 1:41 PM EDT

     Inspected right leg for edema: No edema

    Exam Action

    04/15/23 1:42 PM EDT

     Inspected left leg for edema: No edema

    Exam Action

    04/15/23 1:42 PM EDT

     Checked capillary refill in fingernails

    Exam Action

    04/15/23 1:42 PM EDT

     Checked capillary refill in fingernails

    Exam Action

    04/15/23 1:42 PM EDT

     Checked capillary refill in fingernails

    Exam Action

    04/15/23 1:42 PM EDT

     Auscultated right carotid pulse: Bruit present

    Exam Action

    04/15/23 1:43 PM EDT

     Auscultated left carotid pulse

    Exam Action

    04/15/23 1:43 PM EDT

     Auscultated aortic area with the bell

    Exam Action

    04/15/23 1:43 PM EDT

     Auscultated aortic area with the diaphragm

    Exam Action

    04/15/23 1:43 PM EDT

     Auscultated pulmonic area with the diaphragm

    Exam Action

    04/15/23 1:43 PM EDT

     Auscultated pulmonic area with the bell

    Exam Action

    04/15/23 1:43 PM EDT

     Auscultated Erb’s point with the bell

    Exam Action

    04/15/23 1:43 PM EDT

     Auscultated Erb’s point with the diaphragm

    Exam Action

    04/15/23 1:43 PM EDT

     Auscultated tricuspid area with the diaphragm

    Exam Action

    04/15/23 1:43 PM EDT

     Auscultated tricuspid area with the bell

    Exam Action

    04/15/23 1:43 PM EDT

     Auscultated tricuspid area with the diaphragm

    Exam Action

    04/15/23 1:43 PM EDT

     Auscultated mitral area with the diaphragm

    Exam Action

    04/15/23 1:43 PM EDT

     Auscultated mitral area with the bell

    Exam Action

    04/15/23 1:43 PM EDT

     Auscultated breath sounds in anterior right upper lobe

    Exam Action

    04/15/23 1:44 PM EDT

     Auscultated breath sounds in anterior left upper lobe

    Exam Action

    04/15/23 1:44 PM EDT

     Auscultated breath sounds in anterior right middle lobe

    Exam Action

    04/15/23 1:44 PM EDT

     Auscultated breath sounds in anterior left mid-chest (upper lobe)

    Exam Action

    04/15/23 1:44 PM EDT

     Auscultated breath sounds in anterior right lower lobe

    Exam Action

    04/15/23 1:44 PM EDT

     Auscultated breath sounds in anterior left lower lobe

    Exam Action

    04/15/23 1:44 PM EDT

     Auscultated breath sounds in posterior left upper lobe

    Exam Action

    04/15/23 1:44 PM EDT

     Auscultated breath sounds in posterior right upper lobe

    Exam Action

    04/15/23 1:44 PM EDT

     Auscultated breath sounds in posterior left mid-back (lower lobe)

    Exam Action

    04/15/23 1:44 PM EDT

     Auscultated breath sounds in posterior right mid-back (lower lobe)

    Exam Action

    04/15/23 1:44 PM EDT

     Auscultated breath sounds in posterior left lower lobe

    Exam Action

    04/15/23 1:45 PM EDT

     Auscultated breath sounds in posterior right lower lobe

    Exam Action

    04/15/23 1:45 PM EDT

     Auscultated breath sounds in posterior left lower lobe on side

    Exam Action

    04/15/23 1:45 PM EDT

     Auscultated breath sounds in posterior right lower lobe on side

    Exam Action

    04/15/23 1:45 PM EDT

     Auscultated aorta in abdomen

    Exam Action

    04/15/23 2:12 PM EDT

     Auscultated right renal pulse

    Exam Action

    04/15/23 2:13 PM EDT

     Auscultated left renal pulse

    Exam Action

    04/15/23 2:13 PM EDT

     Auscultated right iliac pulse

    Exam Action

    04/15/23 2:13 PM EDT

     Auscultated left iliac pulse

    Exam Action

    04/15/23 2:13 PM EDT

     Auscultated right femoral pulse

    Exam Action

    04/15/23 2:13 PM EDT

     Auscultated left femoral pulse

    Exam Action

    04/15/23 2:13 PM EDT

     Auscultated right upper quadrant

    Exam Action

    04/15/23 2:13 PM EDT

     Auscultated left upper quadrant

    Exam Action

    04/15/23 2:13 PM EDT

     Auscultated right lower quadrant

    Exam Action

    04/15/23 2:13 PM EDT

     Auscultated left lower quadrant

    Exam Action

    04/15/23 2:13 PM EDT

     Auscultated over liver Focused Exam: Chest Pain, Brian Foster Shadow health transcript

    Exam Action

    04/15/23 2:13 PM EDT

     Auscultated over spleen

    Exam Action

    04/15/23 2:13 PM EDT

     Palpated right carotid pulse: Thrill, 3+

    Exam Action

    04/15/23 2:14 PM EDT

     Palpated right carotid pulse: Thrill, 3+

    Exam Action

    04/15/23 2:14 PM EDT

     Palpated PMI: Displaced laterally; brisk and tapping; less than 3 cm

    Exam Action

    04/15/23 2:15 PM EDT

     Palpated right brachial pulse: No thrill, 2+

    Exam Action

    04/15/23 2:15 PM EDT

     Palpated left brachial pulse: No thrill, 2+

    Exam Action

    04/15/23 2:15 PM EDT

     Palpated right radial pulse: No thrill, 2+

    Exam Action

    04/15/23 2:15 PM EDT

     Palpated left radial pulse: No thrill, 2+

    Exam Action

    04/15/23 2:15 PM EDT

     Palpated right femoral pulse: No thrill, 2+

    Exam Action

    04/15/23 2:16 PM EDT

     Palpated left femoral pulse: No thrill, 2+

    Exam Action

    04/15/23 2:16 PM EDT

     Palpated right popliteal pulse: No thrill, 1+

    Exam Action

    04/15/23 2:16 PM EDT

     Palpated left popliteal pulse: No thrill, 1+

    Exam Action

    04/15/23 2:16 PM EDT

     Palpated right tibial pulse: No thrill, 1+

    Exam Action

    04/15/23 2:16 PM EDT

     Palpated left tibial pulse: No thrill, 1+

    Exam Action

    04/15/23 2:16 PM EDT

     Palpated right dorsalis pedis pulse: No thrill, 1+

    Exam Action

    04/15/23 2:17 PM EDT

     Palpated left dorsalis pedis pulse: No thrill, 1+

    Exam Action

    04/15/23 2:17 PM EDT

     Palpated right upper quadrant with light pressure: No tenderness reported; no masses, guarding, or distension

    Exam Action

    04/15/23 2:17 PM EDT

     Palpated left upper quadrant with light pressure: No tenderness reported; no masses, guarding, or distension

    Exam Action

    04/15/23 2:17 PM EDT

     Palpated right lower quadrant with light pressure: No tenderness reported; no masses, guarding, or distension

    Exam Action

    04/15/23 2:17 PM EDT

     Palpated left lower quadrant with light pressure: No tenderness reported; no masses, guarding, or distension

    Exam Action

    04/15/23 2:17 PM EDT

     Palpated right upper quadrant with deep pressure: No masses

    Exam Action

    04/15/23 2:18 PM EDT

     Palpated left upper quadrant with deep pressure: No masses

    Exam Action

    04/15/23 2:18 PM EDT

     Palpated right lower quadrant: with deep pressure: No masses

    Exam Action

    04/15/23 2:18 PM EDT

     Palpated left lower quadrant with deep pressure: No masses

    Exam Action

    04/15/23 2:18 PM EDT

     Palpated liver: Palpable 1 cm below right costal margin

    Exam Action

    04/15/23 2:18 PM EDT

     Palpated for spleen: Not palpable

    Exam Action

    04/15/23 2:19 PM EDT

     Palpated for right kidney: Not palpable

    Exam Action

    04/15/23 2:19 PM EDT

     Palpated for left kidney: Not palpable

    Exam Action

    04/15/23 2:19 PM EDT

     Tested skin turgor

    Exam Action

    04/15/23 2:19 PM EDT

     Percussed right upper quadrant

    Exam Action

    04/15/23 2:20 PM EDT

     Percussed left upper quadrant

    Exam Action

    04/15/23 2:20 PM EDT

     Percussed right lower quadrant

    Exam Action

    04/15/23 2:20 PM EDT

     Percussed left lower quadrant

    Exam Action

    04/15/23 2:20 PM EDT

     Percussed spleen

    Exam Action

    04/15/23 2:21 PM EDT

     Percussed for liver span: 7 cm in the mid-clavicular line Focused Exam: Chest Pain, Brian Foster Shadow health transcript

    Exam Action

    04/15/23 2:21 PM EDT

  • Focused Exam: Cough, Danny Rivera Shadow health

    Focused Exam: Cough, Danny Rivera Shadow health

    Objective Data Collection: 13 of 13 (100%)

     Correct

     Partially correct

     Incorrect

     Missed

     Inspected eyes and orbital area

    1 of 1 point

    Orbital Area 
    (1/4 point)

     No visible abnormal findings

     Ptosis

     Eyelid edema

     Lesion

     Allergic shiners

    Focused Exam: Cough, Danny Rivera Shadow health

    Sclera 
    (1/4 point)

     White

     Jaundice

     Injection

     Icterus

    Conjunctiva 
    (1/4 point)

     Moist and pink

     Pale

     Dry appearance

     Erythema

     Edema

    Conjunctival Discharge 
    (1/4 point)

     No discharge

     Clear, watery discharge

     Purulent discharge

    Focused Exam: Cough, Danny Rivera Shadow health

     Inspected nasal cavities

    1 of 1 point

    Color 
    (1/4 point)

     Pink

     Erythemic

     Bluish

    Discharge 
    (1/4 point)

     No discharge

     Clear discharge

     Bloody discharge

     Purulent discharge

    Turbinate Patency 
    (1/4 point)

     Patent

     Decreased patency

     Not patent

    Observations 
    (1/4 point)

     No additional visible abnormal findings

     Foreign body present

     Polyp

     Septum perforated

     Septum deviated

     Lesion

     Inspected ears

    1 of 1 point

    Right: Auditory Canal Color 
    (1/10 point)

     Pink

     Erythemic

     Pallor

    Right: Tympanic Membrane Color 
    (1/10 point)

     Pearly gray

     Erythemic

     Opaque

     Yellow

     Not visible because of cerumen

    Right: Tympanic Membrane Appearance 
    (1/10 point)

     No visible abnormal findings

     Fluid observed

     Visible scars

     Bulging

     Perforation

     Retraction

    Right: Cone Of Light 
    (1/10 point)

     5:00

     Cone of light distorted

    Right: Discharge 
    (1/10 point)

     No discharge

     Cerumen

     Clear discharge

     Bloody discharge

     Purulent discharge

    Left: Auditory Canal Color 
    (1/10 point)

     Pink

     Erythemic

     Pallor

    Left: Tympanic Membrane Color 
    (1/10 point)

     Pearly gray

     Erythemic

     Opaque

     Yellow

     Not visible because of cerumen

    Left: Tympanic Membrane Appearance 
    (1/10 point)

     No visible abnormal findings

     Fluid observed

     Visible scars

     Bulging

     Perforation

     Retraction

    Left: Cone Of Light 
    (1/10 point)

     7:00

     Cone of light distorted

    Left: Discharge 
    (1/10 point)

     No discharge

     Cerumen

     Clear discharge

     Bloody discharge

     Purulent discharge

     Inspected mouth and throat

    1 of 1 point

    Oral Mucosa 
    (1/5 point)

     Moist and pink

     Dry appearance

     Erythema

    Tonsils 
    (1/5 point)

     No visible abnormal findings

     Edema

     Erythema

    Posterior Oropharynx Color 
    (1/5 point)

     Pink

     Erythemic

    Posterior Oropharynx Texture 
    (1/5 point)

     No abnormal findings

     Cobblestoning

     Exudate

    Post Nasal Drip 
    (1/5 point)

     No discharge

     Clear discharge

     Purulent discharge

     Inspected neck

    1 of 1 point

    Symmetry 
    (1/2 point)

     Symmetric

     Asymmetric

    Appearance 
    (1/2 point)

     No visible abnormal findings

     Swelling

     Visible pulsation

     Visible mass

     Discoloration

     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)

     Palpated sinuses

    1 of 1 point

    Frontal 
    (1/2 point)

     None reported

     Tenderness reported

    Maxillary 
    (1/2 point)

     None reported

     Tenderness reported

     Palpated lymph nodes

    1 of 1 point

    Cervical 
    (1/3 point)

     No palpable nodes

     Palpable nodes on right side

     Palpable nodes on left side

    Supraclavicular 
    (1/3 point)

     No palpable nodes

     Palpable nodes on right side

     Palpable nodes on left side

    Axillary 
    (1/3 point)

     No palpable nodes

     Palpable nodes on right side

     Palpable nodes on left side

    Focused Exam: Cough, Danny Rivera Shadow health

     Palpated fremitus

    1 of 1 point

    Symmetry 
    (1/2 point)

     Equal bilaterally

     Unequal bilaterally

    Vibration 
    (1/2 point)

     Expected fremitus

     Decreased fremitus

     Auscultated breath sounds

    1 of 1 point

    Breath Sounds 
    (1/3 point)

     Present in all areas

     Diminished in some areas

     Absent in some areas

    Adventitious Sounds 
    (1/3 point)

     No adventitious sounds

     Wheezing

     Fine crackles

     Stridor

     Rhonchi

     Rales

    Location 
    (1/3 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

    Focused Exam: Cough, Danny Rivera Shadow health

     Auscultated for bronchophony

    1 of 1 point

    Bronchophony 
    (1/1 point)

     Positive

     Negative

     Auscultated heart sounds

    1 of 1 point

    Heart Sounds 
    (1/2 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

     Percussed chest wall

    1 of 1 point

    Observations 
    (1/2 point)

     All areas resonant

     Some areas dull, some resonant

     Some areas hyperresonant, some resonant

    Location 
    (1/2 point)

     No areas of dullness

     Dullness, anterior right upper lobe

     Dullness, anterior right middle lobe

     Dullness, anterior right lower lobe

     Dullness, anterior left upper lobe

     Dullness, anterior left lower lobe

     Dullness, posterior right upper lobe

     Dullness, posterior right lower lobe

     Dullness, posterior left upper lobe

     Dullness, posterior left lower lobe

    Focused Exam: Cough, Danny Rivera Shadow health

  • NURS 6512n Week 3 – Digital Clinical Experience Orientation – Patient: Tina Jones

    Open Text Question
    Activity Time: 3 min

    Please describe what you look forward to most in your upcoming activities within the DCE.

    Student Response:
    I look forward to completing a head-to-toe assessment and communicating with the patient.
     

    Model Note:
     There are many opportunities to learn and practice your clinical skills within the DCE, and we hope you are looking forward to all of them!

    Transcript

    Started:
    May 22, 2022 |
    Total Time:
    104 min

    All Lines (109)
    Interview Questions (52)
    Statements (13)
    Exam Actions (44)

    Hello my name is xx . I’m here to interview and examine you

    Greet

    03/12/23 8:13 PM EDT

    Hey.

    how are you today?

    Question

    03/12/23 8:13 PM EDT

    Not so great… My foot really hurts right now.

    Tell me what’s going on ?

    Question

    03/12/23 8:14 PM EDT

    I got this scrape on my foot a while ago, and I thought it would heal up on its own, but now it’s looking pretty nasty. And the pain is killing me!

    on a scale of 0 to 10 how can you rate your pain? (Clarified to On a scale of 0-10 how would you rate the pain in your right foot?.)

    Question

    03/12/23 8:15 PM EDT

    I’d say a 7. It hurts a lot, and the pain pills haven’t kicked in yet. (Clarified to how I would rate my foot pain on a scale.)

    how long has this being going on?

    Question

    03/12/23 8:16 PM EDT

    Well, I got the scrape a week ago, but the scrape and the pain got a lot worse in the last few days.

    How does this happen?

    Question

    03/12/23 8:17 PM EDT

    I was going down the back steps, and I tripped. . . I caught the railing, but I guess I kind of turned my ankle a little bit. And I scraped up my foot on the edge of the step.

    What have you been using on the your foot (Clarified to What have you been doing for the scrape?.)

    Question

    03/12/23 8:18 PM EDT

    I made sure to clean it and just keep it bandaged. And I put Neosporin on it. (Clarified to what I have been doing for the scrape.)

    Are you taking anything for the pain ?

    Question

    03/12/23 8:19 PM EDT

    Yeah, I had to start taking pain medication.

    what pain medication are you taking?

    Question

    03/12/23 8:19 PM EDT

    It’s called tramadol.

    besides the medication what else do you do to manage your pain?

    Question

    03/12/23 8:21 PM EDT

    I just watch what I eat and try to stay away from sweets.

    Tell me more about you medical history?

    Question

    03/12/23 8:21 PM EDT

    I’ve had asthma since I was little, and I have sugar diabetes, too.

    How long have you been diabetic

    Question

    03/12/23 8:22 PM EDT

    I was diagnosed when I was 24.

    what medications are you taking for your diabetes

    Question

    03/12/23 8:22 PM EDT

    I don’t take medicine for it anymore.

    I’m sorry you have to go through this pain but will see how i can help you feel better

    Empathize

    03/12/23 8:24 PM EDT

    Thanks.

    you welcome (No matching questions found.)

    Question

    03/12/23 8:24 PM EDT

    you are welcome (No matching questions found.)

    Question

    03/12/23 8:24 PM EDT

    are you able to move you foot

    Question

    03/12/23 8:25 PM EDT

    Um, my ankle’s starting to hurt when I move it.

    have you had any x-ray of you ankle

    Question

    03/12/23 8:25 PM EDT

    Yeah, they did.

    what was the result (Clarified to Do you know what the X-ray of your injured foot showed?.)

    Question

    03/12/23 8:26 PM EDT

    The x-ray was normal. Nothing broken. (Clarified to what the foot xray showed.)

    great (No matching questions found.)

    Question

    03/12/23 8:26 PM EDT

    are you have fever

    Question

    03/12/23 8:27 PM EDT

    I don’t feel feverish right now, but last night I had a high temperature.

    what was your temperature last night

    Question

    03/12/23 8:27 PM EDT

    Last night it got up to 102.

    did you take any medication for your fever

    Question

    03/12/23 8:28 PM EDT

    I really didn’t do much for it at home.

    have you noticed any discharge on your wound (Clarified to Does your scrape have pus?.)

    Question

    03/12/23 8:28 PM EDT

    Yeah, there’s definitely pus. (Clarified to if my scrape has pus.)

    how often do you change your wound dress a day (Clarified to How often do you change your bandage?.)

    Question

    03/12/23 8:29 PM EDT

    Every morning and night. I was keeping an eye on it. (Clarified to how often I change my bandage.)

    whats the color of the drainage

    Question

    03/12/23 8:30 PM EDT

    It’s… white or maybe off-white.

    ok (No matching questions found.)

    Question

    03/12/23 8:30 PM EDT

    have you taken any antibiotic for your wound

    Question

    03/12/23 8:34 PM EDT

    No, the ER only prescribed the pain meds.

    are you experiencing pain anywhere else besides your ankle (Clarified to Do you have pain elsewhere than your foot?.)

    Question

    03/12/23 8:35 PM EDT

    The pain’s worse in my foot, but I feel it moving up into my ankle, too. (Clarified to if I have pain elsewhere than my foot.)

    are you able to wiggle your toes?

    Question

    03/12/23 8:36 PM EDT

    I guess I can wiggle my toes a little, but it really hurts a lot to move my foot any.

    is you foot warm or cool to touch

    Question

    03/12/23 8:36 PM EDT

    Yeah, it feels pretty warm.

    describe your pain

    Question

    03/12/23 8:37 PM EDT

    It’s throbbing and like, sharp if I try to put weight on it.

    what other conditions have you been diagnosed with (Clarified to What is your past medical history?.)

    Question

    03/12/23 8:39 PM EDT

    I’ve had asthma since I was little, and I have sugar diabetes, too. (Clarified to what health problems I have had.)

    does the pain wake you up at night

    Question

    03/12/23 8:41 PM EDT

    I feel the pain at night, but I have been able to get to sleep.

    do your pain keep you from participate in activities or things you enjoy

    Question

    03/12/23 8:42 PM EDT

    Well, with my church friends, we do Bible study or we have a meal. With my other friends, I’ll go over to one of their houses to watch our shows or just hang out. And on the weekends, we’ll go out to a bar or go dancing.

    How has the pain making you feel about yourself (Clarified to How do you feel about your appearance?.)

    Question

    03/12/23 8:44 PM EDT

    I am who I am, you know? I don’t like stressing out about what I look like or anything like that. (Clarified to how I feel about my appearance.)

    are you still able to get out and socialize like you usually do (No matching questions found.)

    Question

    03/12/23 8:46 PM EDT

    have your family and friends been helpful (No matching questions found.)

    Question

    03/12/23 8:47 PM EDT

    keep the bandages dry between change

    Educate

    03/12/23 8:50 PM EDT

    Thanks for telling me.

    clean wound wound with a soapy washcloth. you may do this in the shower (Clarified to How are you cleaning the wound?.)

    Question

    03/12/23 8:51 PM EDT

    Since it happened, I’ve been washing it with soap and water, and if it seemed irritated, I would put some peroxide on there and then rinse it off. (Clarified to how I am cleaning the wound.)

    wash wound with soapy washcloth (No matching questions found.)

    Question

    03/12/23 8:52 PM EDT

    are you allergic to any medications

    Educate

    03/12/23 8:53 PM EDT

    Thanks for telling me.

    Are you allergic to any medication?

    Question

    03/12/23 8:53 PM EDT

    Yeah, I’m allergic to penicillin.

    any food allergies

    Question

    03/12/23 8:54 PM EDT

    Nope, no food allergies that I know of.

    are you allergic to latex

    Question

    03/12/23 8:54 PM EDT

    Nope.

    what pharmacy do you use

    Question

    03/12/23 8:55 PM EDT

    I always fill my inhaler prescription at the pharmacy near Mom’s house.

    do you know the name of the pharmacy (No matching questions found.)

    Question

    03/12/23 8:55 PM EDT

    what pharmacy do you get your medications from?

    Question

    03/12/23 8:56 PM EDT

    I always fill my inhaler prescription at the pharmacy near Mom’s house.

    I want you to wash your wound with soapy water

    Educate

    03/12/23 8:59 PM EDT

    Thanks for telling me.

    dry wound gently with clean towel (No matching questions found.)

    Question

    03/12/23 8:59 PM EDT

    dry wound gently with clean towel

    Educate

    03/12/23 9:00 PM EDT

    Thanks for telling me.

    apply antibiotic ointment to wound

    Educate

    03/12/23 9:00 PM EDT

    Thanks for telling me.

    apply a dry clean bange

    Educate

    03/12/23 9:01 PM EDT

    Thanks for telling me.

    do wound care twice a day

    Question

    03/12/23 9:02 PM EDT

    I made sure to clean it and just keep it bandaged. And I put Neosporin on it.

    take your medications , monitor your temperature , eat a balance meal, drink lots of fluids and plenty of rest

    Educate

    03/12/23 9:04 PM EDT

    Thanks for telling me.

    lets talk about your diabetes (Clarified to Tell me more about your diabetes..)

    Question

    03/12/23 9:05 PM EDT

    I don’t think there’s a lot to say about it . . . it seems pretty under control, and it’s just type 2 anyway. (Clarified to to tell you about my diabetes.)

    when was the last time you had a asthma attack

    Question

    03/12/23 9:09 PM EDT

    It’s really rare for me to have an attack now. Three days ago I had some breathing problems, but I guess probably my last full attack was in high school.

    what did you take when you had the breathing problem (Clarified to Can you describe your breathing problems?.)

    Question

    03/12/23 9:09 PM EDT

    When my asthma acts up, I feel like my chest is tight, like I can’t really take in air. And I usually wheeze. (Clarified to to describe my breathing problems.)

    what medication are you taking for your Asthma

    Question

    03/12/23 9:10 PM EDT

    It’s just a regular Proventil inhaler.

    how often do you use your inhaler

    Question

    03/12/23 9:10 PM EDT

    Not often. Maybe two or three times a week.

    sorry about you have to go throw this

    Empathize

    03/12/23 9:14 PM EDT

    Thanks.

    Treating high cholesterol helps lower your risk of stroke

    Educate

    03/12/23 9:15 PM EDT

    Thanks for telling me.

    It sounds like that was a challenging time for you

    Empathize

    03/12/23 9:16 PM EDT

    Thanks.

     Examined right eye.

    Exam Action

    03/12/23 9:20 PM EDT

     Examined left eye.

    Exam Action

    03/12/23 9:20 PM EDT

     Percussed posterior left upper chest wall

    Exam Action

    03/12/23 9:22 PM EDT

     Percussed posterior right upper chest wall

    Exam Action

    03/12/23 9:22 PM EDT

     Percussed posterior right middle chest wall

    Exam Action

    03/12/23 9:22 PM EDT

     Percussed posterior left middle chest wall

    Exam Action

    03/12/23 9:22 PM EDT

     Percussed posterior left lower chest wall

    Exam Action

    03/12/23 9:22 PM EDT

     Percussed posterior right lower chest wall

    Exam Action

    03/12/23 9:22 PM EDT

     Percussed posterior right lower chest wall

    Exam Action

    03/12/23 9:23 PM EDT

     Percussed posterior left lower chest wall

    Exam Action

    03/12/23 9:23 PM EDT

     Percussed posterior left lower chest wall

    Exam Action

    03/12/23 9:23 PM EDT

     Percussed posterior right lower chest wall

    Exam Action

    03/12/23 9:23 PM EDT

     Percussed anterior right upper chest wall

    Exam Action

    03/12/23 9:23 PM EDT

     Percussed anterior left upper chest wall

    Exam Action

    03/12/23 9:23 PM EDT

     Percussed anterior right middle chest wall

    Exam Action

    03/12/23 9:23 PM EDT

     Percussed anterior left middle chest wall

    Exam Action

    03/12/23 9:23 PM EDT

     Percussed anterior right lower chest wall

    Exam Action

    03/12/23 9:23 PM EDT

     Percussed anterior left lower chest wall

    Exam Action

    03/12/23 9:23 PM EDT

     CompletedOrientation

    Exam Action

    03/12/23 9:27 PM EDT

    hello my name is isatu, i’m here to interview and examine you

    Greet

    03/13/23 6:50 PM EDT

    Hey.

    what brings you in today?

    Question

    03/13/23 6:50 PM EDT

    I got this scrape on my foot a while ago, and I thought it would heal up on its own, but now it’s looking pretty nasty. And the pain is killing me!

    treating high cholesterol help lower your risk of stroke

    Educate

    03/13/23 6:52 PM EDT

    Thanks for telling me.

    It sounds like that was a challenging time for you

    Empathize

    03/13/23 6:53 PM EDT

    Thanks.

     Examined right eye.

    Exam Action

    03/13/23 6:55 PM EDT

     Examined left eye.

    Exam Action

    03/13/23 6:55 PM EDT

     Percussed posterior left upper chest wall

    Exam Action

    03/13/23 6:57 PM EDT

     Percussed posterior right upper chest wall

    Exam Action

    03/13/23 6:57 PM EDT

     Percussed posterior left middle chest wall

    Exam Action

    03/13/23 6:57 PM EDT

     Percussed posterior right middle chest wall

    Exam Action

    03/13/23 6:57 PM EDT

     Percussed posterior left lower chest wall

    Exam Action

    03/13/23 6:57 PM EDT

     Percussed posterior right lower chest wall

    Exam Action

    03/13/23 6:57 PM EDT

     Percussed posterior left lower chest wall

    Exam Action

    03/13/23 6:57 PM EDT

     Percussed posterior right lower chest wall

    Exam Action

    03/13/23 6:57 PM EDT

     Percussed posterior left lower chest wall

    Exam Action

    03/13/23 6:57 PM EDT

     Percussed posterior right lower chest wall

    Exam Action

    03/13/23 6:57 PM EDT

     Percussed posterior right lower chest wall

    Exam Action

    03/13/23 6:58 PM EDT

     Percussed posterior left lower chest wall

    Exam Action

    03/13/23 6:58 PM EDT

     Percussed posterior right lower chest wall

    Exam Action

    03/13/23 6:58 PM EDT

     Percussed posterior left lower chest wall

    Exam Action

    03/13/23 6:58 PM EDT

     Percussed anterior right upper chest wall

    Exam Action

    03/13/23 6:58 PM EDT

     Percussed anterior left upper chest wall

    Exam Action

    03/13/23 6:58 PM EDT

     Percussed anterior right middle chest wall

    Exam Action

    03/13/23 6:58 PM EDT

     Percussed anterior left middle chest wall

    Exam Action

    03/13/23 6:58 PM EDT

     Percussed anterior right lower chest wall

    Exam Action

    03/13/23 6:59 PM EDT

     Percussed anterior left lower chest wall

    Exam Action

    03/13/23 6:59 PM EDT

     Percussed anterior left lower chest wall

    Exam Action

    03/13/23 6:59 PM EDT

     Percussed anterior right lower chest wall

    Exam Action

    03/13/23 6:59 PM EDT

     CompletedOrientation

    Exam Action

    03/13/23 7:53 PM EDT

  • NURSING PAPER FORMAT AND APA REFERENCING GUIDE

    Nursing paper format and APA referencing guide

     

    Title of the Paper in Full Goes Here

    Student Name Here

    Program Name or Degree Name, Walden University

    Course Number, Section, and Title

    (Example: NURS 0000 Section 01, Title of Course)

    Instructor Name

    Month, Day, Year

    (enter the date submitted to instructor)

     

     

    Title of the Paper

    This is your introductory paragraph designed to inform the reader of what you will cover in the paper. (
    BSN Students
    –
    Carefully follow your course-specific Grading Rubric concerning the content that is required for your assignment and the Academic Writing Expectations [AWE] level of your course.)
    This template’s formatting—Times New Roman 12-point font (other options include Calibri 11, Arial 11, Lucida Sans Unicode 10, and Georgia 11), double spacing, 1” margins, 1/2” indentations beginning of each paragraph, page numbers, and page breaks—is set for you, and you do not need to change it. Do not add any extra spaces between the heading and the text (you may want to check
    Spacing
    under Paragraph, and make sure settings are all set to “0”). The ideas in this paper should be in your own words and supported by credible outside evidence. Cite the author, year of publication, and page number, if necessary, per APA. The introductory paragraph should receive no specific heading because the first section functions as your paper’s introduction. Build this paragraph with the following elements:

    Briefly detail what has been said or done regarding the topic.

    Explain the problem with what has been said or done.

    Create a purpose statement (also commonly referred to as a
    thesis statement
    ) as the last sentence of this paragraph: “The purpose of this paper is to describe…”.

    Level 1 Heading (Name According to the Grading Rubric Required Content)

    This text will be the beginning of the body of the paper. Even though this section has a new heading, make sure to connect this section to the previous one so the reader can follow along with the ideas and research presented. The first sentence, or topic sentence, in each paragraph should transition from the previous paragraph and summarize the main point in the paragraph. Make sure each paragraph addresses only one topic. When you see yourself drifting to another idea, make sure you break into a new paragraph. Avoid long paragraphs that are more than three-fourths of a page. Per our program recommendations, each paragraph should be at least 3-4 sentences in length and contain a topic sentence, evidence, analysis, and a conclusion or lead out sentence. See the
    MEAL plan
    (Main idea, Evidence, Analysis, and Lead out) in the Writing Center. In your paragraphs, synthesize your resources/readings into your own words and
    avoid using direct quotations
    . In the rare instances you do use a direct quotation of a historical nature from a source, the page or paragraph numbers are also included in the citation. For example, Leplante and Nolin (2014) described burnout as “a negative affective response occurring as result of chronic work stress” (p. 2). When you transition to a new idea, you should begin a new paragraph Nursing paper format and APA referencing guide.

    Another Level 1 Heading (Name According to the Grading Rubric Required Content)

    Here is another Level 1 heading. Again, the topic sentence of this section should explain how this paragraph is related to or a result of what you discussed in the previous section. Consider using transitions between sentences to help readers see the connections between ideas.

    Be sure to credit your source(s) in your paper using APA style. The APA Manual 7
    th
    edition and the Walden Writing Center are your best citation resources. Writing Center resources are available at
    https://academicguides.waldenu.edu/writingcenter/apa/citations
    . You must appropriately and correctly cite all works used in your document.

    ORDER A PLAGIARISM-FREE PAPER HERE

    The following paragraph provides examples of in-text citation examples. According to Leplante (2019), employers cause burnout when employees are stressed by too much work. Or you might write and cite in this manner: Employers cause burnout when employees are stressed by too much work (Leplante, 2019). When paraphrasing, the author name and year of publication in citations is required by APA to direct the reader to a specific source in the reference list.
    Personal communications
    are not listed in the reference page but are noted in text as (S. Wall, personal communication, May 24, 2019). This should immediately follow the content of the interview. Also, go to

    Another Level 1 Heading (Name According to the Grading Rubric Required Content)

    APA can seem difficult to master, but following the general rules becomes easier with use. The Writing Center also offers numerous
    APA resources on its website
    and can answer your questions via
    email
    . Prior to submitting your paper for grading, submit your draft to SafeAssign Drafts found in the left column of your course.

    And so forth until the conclusion….

    Conclusion

    The conclusion section should recap the major points of your paper. Do not introduce new ideas in this paragraph; the conclusion should interpret what you have written and what it means in the bigger picture.

     

     

    References

    Please note that the following references are intended as examples only. List your own references in alphabetical order. Also, these illustrate different types of references; you are responsible for any citations not included in this list. In your paper, be sure every reference entry matches a citation, and every citation refers to an item in the reference list Nursing paper format and APA referencing guide.

    Journal Article; Two Authors; DOI

    Leplante, J. P. & Nolin, C. (2014). Consultas and socially responsible investing in Guatemala: A case study examining Maya perspectives on the Indigenous right to free, prior, and informed consent.
    Society & Natural Resources
    ,
    27
    (4), 231–248.
    https://doi.org/10.1080/08941920.2013.861554

    Journal Article, Two Authors; URL

    Eaton, T. V., & Akers, M. D. (20007). Whistleblowing and good governance.
    CPA Journal
    ,
    77
    (6), 66–71.
    http://archives.cpajournal.com/2007/607/essentials/p58.htm

    Journal Article, More Than Twenty Authors; DOI

    Wiskunde, B., Arslan, M., Fischer, P., Nowak, L., Van den Berg, O., Coetzee, L., Juárez, U., Riyaziyyat, E., Wang, C., Zhang, I., Li, P., Yang, R., Kumar, B., Xu, A., Martinez, R., McIntosh, V., Ibáñez, L. M., Mäkinen, G., Virtanen, E., . . . Kovács, A. (2019). Indie pop rocks mathematics: Twenty One Pilots, Nicolas Bourbaki, and the empty set. 
    Journal of Improbable Mathematics
    , 
    27
    (1), 1935–1968.
    https://doi.org/xxx/xxxxxx

    Book; One Author

    Weinstein, J. A. (2019).
    Social change
    (3rd ed.). Rowman & Littlefield.

     

     

    Book; Chapter in an Edited Book

    Christensen, L. (2020). For my people: Celebrating community through poetry. In B. Bigelow, B. Harvey, S. Karp, & L. Miller (Eds.),
    Rethinking our classrooms: Teaching for equity and justice
    (Vol. 2; pp. 16–17). Rethinking Schools.

    Professional Organization Web page

    Centers for Disease Control and Prevention. (2018).
    Back to school.
     
    https://www.cdc.gov/features/teens-back-to-school/index.html

    Professional Organization Book

    American Nurses Association. (2010).
    Nursing: Scope and standards of practice
    (2nd ed.).

    Two or more works by same author in the same year

    Wall, S. (2018a). Effects of friendship on children’s behavior.
    Journal of Social Psychology, 4
    (1), 101–105.

    Wall, S. (2018b). Trials of parenting adolescents with deviant behaviors.
    Journal of Child Psychology, 4
    (12), 161–167.

    Government Article

    National Institute of Mental Health. (1990).
    Clinical training in serious mental illness
    (DHHS Publication No. ADM 90-1679). U.S. Government Printing Office.

    Lecture Notes

    Health effects of exposure to forest fires [Lecture notes]. (2019). Walden University Blackboard.
    https://class.waldenu.edu

    Personal Communication (Only Goes in Body of Paper and not in References)

     

     

    Video

    Walden University. (2009).
    Title of video here
    [Video]. Walden University Blackboard.
    https://class.waldenu.edu

    Television (Audio)

    Important, I. M. (Producer). (1990, November 1).
    The nightly news hour
    [TV series episode]. Central Broadcasting Service.

    APA Resources

    You have other several options to assist you in the formulation of your reference page.

    Your American Psychological Association (APA) Manual is your best reference resource. Use the current edition with a copyright date of 2020.

    The Walden Writing Center also a great place for referencing advice at
    https://academicguides.waldenu.edu/writingcenter/apa/references
    .

    Citation and reference examples are provided in the ‘BSN TOP Ten References and Citations” handout found in the Writing Resources tab of the course. This document covers the 10 most commonly used reference and citation formats. You are responsible for looking up any that are not included on this list. Nursing paper format and APA referencing guide

  • Capstone project template example

    Capstone project template example

     

    Title of the Capstone

    Student Name

    Program Name or Degree Name (e.g., Bachelor of Science in Psychology), Walden University

    COURSE XXX: Title of Course

    Instructor Name

    Month XX, 202X

     

     

    Title of the Capstone

    Do not add any extra spaces between your heading and your text (check Spacing under Format, Paragraph in your word processor, and make sure that it’s set to 0”); just use a standard double space, and indent the first line of each paragraph a full ½ inch (preferably using the tab button). Your
    introduction
    should receive no specific heading because it is assumed that your first section is your introduction section.

    After considering these Capstone project template example formatting issues, you will need to construct a
    thesis statement
    , which lets readers know the argument you will be supporting and developing in your paper. This statement provides readers with a lens for understanding the
    evidence
    you will present in the body of your essay (each
    paragraph
    and thus evidence within those paragraphs you include should support and apply to this thesis statement).

    ORDER CAPSTONE PROJECT HELP HERE

    Once you have established your thesis, begin constructing the introduction. Introductions are usually organized from broad to narrow, with the broadest, general information around your topic going first, then narrowing to provide more specific details until you end with your thesis statement. An easy template for writing an introduction follows:

    Start with what’s been said/done regarding your topic of interest.

    Explain the problem with what’s been said or done.

    Offer your solution, your thesis statement (one that can be supported by the evidence).

    Level 1 Head
    ing

    This text will be the beginning of the body of the essay. Even though this section has a new heading, make sure to connect this section to the previous one so readers follow your ideas and evidence. The first sentence in each paragraph should start with a
    topic sentence
    , which summarizes the main point in the current paragraph. Make sure each paragraph contains only one topic, which helps establish a
    clear scope for your paragraph
    . When you see yourself drifting to another idea, make sure you break into a new paragraph. You can use the
    MEAL plan
    as a way to conceptualize and organize your paragraphs. In short, think about our paragraphs in this way: new idea, new paragraph.

    Level 2 Heading

    The Level 2 heading designates a subsection of the previous section. Using headings is a great way to organize a paper and increase its readability, so see section 2.27 of APA 7 and the Writing Center’s
    Heading Levels webpage
    for details on heading formatting (APA 7 also has a chart detailing heading formatting in the inside front cover). For shorter papers, using one or two levels is all that is needed. You would use Level 1 (centered, bold font with title case) and Level 2 (left aligned, bold, title case).

    Level 3 Heading

    The number of headings you need in a particular paper is not set, but for longer papers, you may need another heading level. You would then use Level 3 (left-aligned, bold, italicized, title case).

    One crucial area in APA is learning how to cite. Make sure to
    cite source information throughout your paper
    to avoid plagiarism. This practice is critical: you need to give credit to your sources and avoid copying others’ work. Look at Chapter 8 of APA 7 and the Writing Center’s
    Plagiarism Prevention Resource Kit
    for guidelines on citing source information in your writing.

    Level 1 Heading

    The
    conclusion
    section should recap the major points of your paper. A conclusion can be one paragraph, but it can also be a few paragraphs, depending on the length of your paper. However, perhaps more importantly, the conclusion should also interpret what you have written and what it means in the bigger picture. To help write your conclusion, consider asking yourself these questions: What do you want to happen with the information you have provided? What do you want to change? What is your ultimate goal in using this information? What would it mean if the reader of your paper took and used the suggestions in your paper?

     

     

     

    Reference
    s

    (Note that the following references are intended as examples only. These entries illustrate different types of references but are not cited in the body of this template. In your paper, be sure every reference entry matches a citation, and every citation refers to an item in the reference list.

    For additional information, examples, and help with reference entries, see Chapter 9 of APA 7 and the Writing Center’s
    References section of the website
    , particularly the
    Common Reference List Examples page
    .)

    American Counseling Association. (n.d.).
    About us.

    https://www.counseling.org/about-us/about-aca

    Anderson, M. (2018). Getting consistent with consequences.
    Educational Leadership, 76
    (1), 26-33 Capstone project template example.

    Bach, D., & Blake, D. J. (2016). Frame or get framed: The critical role of issue framing in nonmarket management.
    California Management Review, 58
    (3), 66-87.
    https://doi.org/10.1525/cmr.2016.58.3.66

    Burgess, R. (2019).
    Rethinking global health: Frameworks of Power.
    Routledge.​

    Herbst-Damm, K. L., & Kulik, J. A. (2005). Volunteer support, marital status, and the survival times of terminally ill patients.
    Health Psychology, 24
    (2), 225–229.
    https://doi.org/10.1037/0278-6133.24.2.225

    Johnson, P. (2003).
    Art: A new history.
    HarperCollins.
    https://doi.org/10.1037.0000136-000
    ​

    Lindley, L. C., & Slayter, E. M. (2018). Prior trauma exposure and serious illness at end of life: A national study of children in the U.S. foster care system from 2005 to 2015.
    Journal of Pain and Symptom Management, 56
    (3), 309–317.
    https://doi.org/10.1016/j.jpainsymman.2018.06.001

    Osman, M. A. (2016, December 15).
    5 do’s and don’ts for staying motivated.
    Mayo Clinic.
    https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/5-dos-and-donts-for-staying-motivated/art-20270835

    Sue, D. W., & Sue, D. (2016).
    Counseling the culturally diverse: Theory and practice
    (7th ed.). Wiley.

    Walden University Library. (n.d.).
    Anatomy of a research article
    [Video].
    https://academicguides.waldenu.edu/library/instructionalmedia/tutorials#s-lg-box-7955524

    Walden University Writing Center. (n.d.).
    Writing literature reviews in your graduate coursework
    [Webinar].
    https://academicguides.waldenu.edu/writingcenter/webinars/graduate#s-lg-box-18447417

    World Health Organization. (2018, March).
    Questions and answers on immunization and vaccine safety.

    https://www.who.int/features/qa/84/en/ 
     Capstone project template example

  • Liam Fitzgerald Shadow Health Telehealth Follow Up Sick Visit Subjective Data Collection

    Liam Fitzgerald Shadow Health Telehealth Follow Up Sick Visit Subjective Data Collection

    Subjective Data Collection: 71 of 75 (94.7%)

    Hover To Reveal…

    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:

     Indicates an item that is available to be found.

    Category

    Scored Items

    Experts selected these topics as essential components of a strong, thorough interview with this patient.

    Patient Data

    Not Scored

    A combination of open and closed questions will yield better patient data. The following details are facts of the patient’s case.

    Telehealth Protocol

    Finding:

    Asked patient if they are in an appropriate environment for a visit

    Finding:

    Confirms they are at a space where the visit can be conducted

    (Found)

    Pro Tip: Telehealth visits conducted through video and audio tools require specific considerations to maintain standards of practice. Asking a patient about their ability to conduct the visit in a private space, addressing the confidentiality of the visit, and asking about any audio or visual accessibility issues are important steps for conducting a telehealth visit and maintaining standards of care Liam Fitzgerald Shadow Health Telehealth Follow Up Sick Visit Subjective Data Collection.

    Example Question:

    Are you in a place where you can conduct a telehealth visit?

    ORDER SHADOWHEALTH OR ESSAY WRITING HELP HERE 

    Finding:

    Asked if they can hear provider

    Finding:

    Confirms they are able to hear provider

    (Found)

    Pro Tip: Telehealth visits conducted through video and audio tools require specific considerations to maintain standards of practice. Asking a patient about their ability to conduct the visit in a private space, addressing the confidentiality of the visit, and asking about any audio or visual accessibility issues are important steps for conducting a telehealth visit and maintaining standards of care.

    Example Question:

    Can you hear me OK?

    Finding:

    Inform the patient this is a confidential protected visit

    Finding:

    Acknowledges that they are aware that this is a confidential protected visit

    (Found)

    Pro Tip: Telehealth visits conducted through video and audio tools require specific considerations to maintain standards of practice. Asking a patient about their ability to conduct the visit in a private space, addressing the confidentiality of the visit, and asking about any audio or visual accessibility issues are important steps for conducting a telehealth visit and maintaining standards of care.

    Example Question:

    Have you been informed that this is a confidential protected visit?

    Episodic Heart Failure Questionnaire

    Finding:

    Asked how patient is doing

    Finding:

    Reports doing well

    (Found)

    Pro Tip: For heart failure patients, it is essential to monitor any daily changes in a patient’s chronic condition to prevent the exacerbation of heart failure and promote the patient’s overall health. By asking a wide range of questions, you can determine if the patient is experiencing worsening heart failure, which may be indicated by chest pain, shortness of breath, cough, edema, as well as changes in weight or vitals. Additionally, scope of practice is important to keep in mind in order to determine if the patient’s worsening condition warrants a referral to their cardiologist or immediate hospitalization.

    Example Question:

    How are you doing?

    Finding:

    Asked about taking vital signs

    Finding:

    Reports taking vitals daily

    (Found)

    Pro Tip: For heart failure patients, it is essential to monitor any daily changes in a patient’s chronic condition to prevent the exacerbation of heart failure and promote the patient’s overall health. By asking a wide range of questions, you can determine if the patient is experiencing worsening heart failure, which may be indicated by chest pain, shortness of breath, cough, edema, as well as changes in weight or vitals. Additionally, scope of practice is important to keep in mind in order to determine if the patient’s worsening condition warrants a referral to their cardiologist or immediate hospitalization Liam Fitzgerald Shadow Health Telehealth Follow Up Sick Visit Subjective Data Collection.

    Example Question:

    Have you been taking your vital signs daily?

    Finding:

    Reports taking vitals at the same time each day

    (Available)

    Pro Tip: For heart failure patients, it is essential to monitor any daily changes in a patient’s chronic condition to prevent the exacerbation of heart failure and promote the patient’s overall health. By asking a wide range of questions, you can determine if the patient is experiencing worsening heart failure, which may be indicated by chest pain, shortness of breath, cough, edema, as well as changes in weight or vitals. Additionally, scope of practice is important to keep in mind in order to determine if the patient’s worsening condition warrants a referral to their cardiologist or immediate hospitalization.

    Example Question:

    Have you been taking your vital signs at the same time each day?

    Finding:

    Reports no problems with equipment

    (Available)

    Pro Tip: For heart failure patients, it is essential to monitor any daily changes in a patient’s chronic condition to prevent the exacerbation of heart failure and promote the patient’s overall health. By asking a wide range of questions, you can determine if the patient is experiencing worsening heart failure, which may be indicated by chest pain, shortness of breath, cough, edema, as well as changes in weight or vitals. Additionally, scope of practice is important to keep in mind in order to determine if the patient’s worsening condition warrants a referral to their cardiologist or immediate hospitalization.

    Example Question:

    Have you had any issues with your equipment?

    Finding:

    Asked about respiratory symptoms

    Finding:

    Denies cough

    (Available)

    Pro Tip: For heart failure patients, it is essential to monitor any daily changes in a patient’s chronic condition to prevent the exacerbation of heart failure and promote the patient’s overall health. By asking a wide range of questions, you can determine if the patient is experiencing worsening heart failure, which may be indicated by chest pain, shortness of breath, cough, edema, as well as changes in weight or vitals. Additionally, scope of practice is important to keep in mind in order to determine if the patient’s worsening condition warrants a referral to their cardiologist or immediate hospitalization.

    Example Question:

    Do you have a cough?

    Finding:

    Denies wheezing

    (Available)

    Pro Tip: For heart failure patients, it is essential to monitor any daily changes in a patient’s chronic condition to prevent the exacerbation of heart failure and promote the patient’s overall health. By asking a wide range of questions, you can determine if the patient is experiencing worsening heart failure, which may be indicated by chest pain, shortness of breath, cough, edema, as well as changes in weight or vitals. Additionally, scope of practice is important to keep in mind in order to determine if the patient’s worsening condition warrants a referral to their cardiologist or immediate hospitalization.

    Example Question:

    Do you have any respiratory symptoms?

    Finding:

    Denies shortness of breath or trouble breathing

    (Found)

    Pro Tip: For heart failure patients, it is essential to monitor any daily changes in a patient’s chronic condition to prevent the exacerbation of heart failure and promote the patient’s overall health. By asking a wide range of questions, you can determine if the patient is experiencing worsening heart failure, which may be indicated by chest pain, shortness of breath, cough, edema, as well as changes in weight or vitals. Additionally, scope of practice is important to keep in mind in order to determine if the patient’s worsening condition warrants a referral to their cardiologist or immediate hospitalization.

    Example Question:

    Do you have shortness of breath?

    Finding:

    Denies any trouble breathing with activity

    (Available)

    Pro Tip: For heart failure patients, it is essential to monitor any daily changes in a patient’s chronic condition to prevent the exacerbation of heart failure and promote the patient’s overall health. By asking a wide range of questions, you can determine if the patient is experiencing worsening heart failure, which may be indicated by chest pain, shortness of breath, cough, edema, as well as changes in weight or vitals. Additionally, scope of practice is important to keep in mind in order to determine if the patient’s worsening condition warrants a referral to their cardiologist or immediate hospitalization.

    Example Question:

    Do you have trouble breathing with activity?

    Finding:

    Asked about cardiovascular symptoms

    Finding:

    Denies chest pain

    (Found)

    Pro Tip: For heart failure patients, it is essential to monitor any daily changes in a patient’s chronic condition to prevent the exacerbation of heart failure and promote the patient’s overall health. By asking a wide range of questions, you can determine if the patient is experiencing worsening heart failure, which may be indicated by chest pain, shortness of breath, cough, edema, as well as changes in weight or vitals. Additionally, scope of practice is important to keep in mind in order to determine if the patient’s worsening condition warrants a referral to their cardiologist or immediate hospitalization.

    Example Question:

    Do you have any chest pain?

    Finding:

    Denies palpitations

    (Found)

    Pro Tip: For heart failure patients, it is essential to monitor any daily changes in a patient’s chronic condition to prevent the exacerbation of heart failure and promote the patient’s overall health. By asking a wide range of questions, you can determine if the patient is experiencing worsening heart failure, which may be indicated by chest pain, shortness of breath, cough, edema, as well as changes in weight or vitals. Additionally, scope of practice is important to keep in mind in order to determine if the patient’s worsening condition warrants a referral to their cardiologist or immediate hospitalization.

    Example Question:

    Do you have any palpitations?

    Finding:

    Reports swelling

    (Found)

    Pro Tip: For heart failure patients, it is essential to monitor any daily changes in a patient’s chronic condition to prevent the exacerbation of heart failure and promote the patient’s overall health. By asking a wide range of questions, you can determine if the patient is experiencing worsening heart failure, which may be indicated by chest pain, shortness of breath, cough, edema, as well as changes in weight or vitals. Additionally, scope of practice is important to keep in mind in order to determine if the patient’s worsening condition warrants a referral to their cardiologist or immediate hospitalization.

    Example Question:

    Do you have any swelling?

    Finding:

    Asked about location of swelling

    Finding:

    Reports swelling in feet and ankles

    (Found)

    Pro Tip: For heart failure patients, it is essential to monitor any daily changes in a patient’s chronic condition to prevent the exacerbation of heart failure and promote the patient’s overall health. By asking a wide range of questions, you can determine if the patient is experiencing worsening heart failure, which may be indicated by chest pain, shortness of breath, cough, edema, as well as changes in weight or vitals. Additionally, scope of practice is important to keep in mind in order to determine if the patient’s worsening condition warrants a referral to their cardiologist or immediate hospitalization.

    Example Question:

    Where is your swelling located?

    Finding:

    Asked about onset of swelling

    Finding:

    Reports noticing swelling within the last 24 hours

    (Available)

    Pro Tip: For heart failure patients, it is essential to monitor any daily changes in a patient’s chronic condition to prevent the exacerbation of heart failure and promote the patient’s overall health. By asking a wide range of questions, you can determine if the patient is experiencing worsening heart failure, which may be indicated by chest pain, shortness of breath, cough, edema, as well as changes in weight or vitals. Additionally, scope of practice is important to keep in mind in order to determine if the patient’s worsening condition warrants a referral to their cardiologist or immediate hospitalization.

    Example Question:

    When did the swelling start?

    Finding:

    Asked about character of swelling

    Finding:

    Reports feet and ankles are puffy

    (Available)

    Pro Tip: For heart failure patients, it is essential to monitor any daily changes in a patient’s chronic condition to prevent the exacerbation of heart failure and promote the patient’s overall health. By asking a wide range of questions, you can determine if the patient is experiencing worsening heart failure, which may be indicated by chest pain, shortness of breath, cough, edema, as well as changes in weight or vitals. Additionally, scope of practice is important to keep in mind in order to determine if the patient’s worsening condition warrants a referral to their cardiologist or immediate hospitalization.

    Example Question:

    Can you describe the swelling?

    Finding:

    Reports socks left indentation on ankle

    (Available)

    Pro Tip: For heart failure patients, it is essential to monitor any daily changes in a patient’s chronic condition to prevent the exacerbation of heart failure and promote the patient’s overall health. By asking a wide range of questions, you can determine if the patient is experiencing worsening heart failure, which may be indicated by chest pain, shortness of breath, cough, edema, as well as changes in weight or vitals. Additionally, scope of practice is important to keep in mind in order to determine if the patient’s worsening condition warrants a referral to their cardiologist or immediate hospitalization.

    Example Question:

    Can you describe the swelling?

    Finding:

    Asked about integumentary symptoms

    Finding:

    Denies itchy, dry skin

    (Found)

    Pro Tip: For heart failure patients, it is essential to monitor any daily changes in a patient’s chronic condition to prevent the exacerbation of heart failure and promote the patient’s overall health. By asking a wide range of questions, you can determine if the patient is experiencing worsening heart failure, which may be indicated by chest pain, shortness of breath, cough, edema, as well as changes in weight or vitals. Additionally, scope of practice is important to keep in mind in order to determine if the patient’s worsening condition warrants a referral to their cardiologist or immediate hospitalization.

    Example Question:

    Do you have any integumentary symptoms?

    Finding:

    Asked about taking daily weight logs

    Finding:

    Reports taking daily weight logs

    (Available)

    Pro Tip: For heart failure patients, it is essential to monitor any daily changes in a patient’s chronic condition to prevent the exacerbation of heart failure and promote the patient’s overall health. By asking a wide range of questions, you can determine if the patient is experiencing worsening heart failure, which may be indicated by chest pain, shortness of breath, cough, edema, as well as changes in weight or vitals. Additionally, scope of practice is important to keep in mind in order to determine if the patient’s worsening condition warrants a referral to their cardiologist or immediate hospitalization.

    Example Question:

    Have you been taking daily weight logs?

    Finding:

    Reports weighing self at the same time everyday

    (Available)

    Pro Tip: For heart failure patients, it is essential to monitor any daily changes in a patient’s chronic condition to prevent the exacerbation of heart failure and promote the patient’s overall health. By asking a wide range of questions, you can determine if the patient is experiencing worsening heart failure, which may be indicated by chest pain, shortness of breath, cough, edema, as well as changes in weight or vitals. Additionally, scope of practice is important to keep in mind in order to determine if the patient’s worsening condition warrants a referral to their cardiologist or immediate hospitalization.

    Example Question:

    Have you been weighing yourself at the same time everyday?

    Finding:

    Reports wearing same type of clothing to weigh self everyday

    (Available)

    Pro Tip
    : For heart failure patients, it is essential to monitor any daily changes in a patient’s chronic condition to prevent the exacerbation of heart failure and promote the patient’s overall health. By asking a wide range of questions, you can determine if the patient is experiencing worsening heart failure, which may be indicated by chest pain, shortness of breath, cough, edema, as well as changes in weight or vitals. Additionally, scope of practice is important to keep in mind in order to determine if the patient’s worsening condition warrants a referral to their cardiologist or immediate hospitalization.

    Example Question:

    Are you wearing the same clothes to weigh yourself everyday?

    Finding:

    Asked about changes to weight

    Finding:

    Reports weight gain

    (Found)

    Pro Tip: For heart failure patients, it is essential to monitor any daily changes in a patient’s chronic condition to prevent the exacerbation of heart failure and promote the patient’s overall health. By asking a wide range of questions, you can determine if the patient is experiencing worsening heart failure, which may be indicated by chest pain, shortness of breath, cough, edema, as well as changes in weight or vitals Liam Fitzgerald Shadow Health Telehealth Follow Up Sick Visit Subjective Data Collection. Additionally, scope of practice is important to keep in mind in order to determine if the patient’s worsening condition warrants a referral to their cardiologist or immediate hospitalization.

    Example Question:

    Have there been any recent changes to your weight?

    ORDER SHADOWHEALTH OR ESSAY WRITING HELP HERE 

    Finding:

    Reports gaining 4-5 lbs

    (Found)

    Pro Tip: For heart failure patients, it is essential to monitor any daily changes in a patient’s chronic condition to prevent the exacerbation of heart failure and promote the patient’s overall health. By asking a wide range of questions, you can determine if the patient is experiencing worsening heart failure, which may be indicated by chest pain, shortness of breath, cough, edema, as well as changes in weight or vitals. Additionally, scope of practice is important to keep in mind in order to determine if the patient’s worsening condition warrants a referral to their cardiologist or immediate hospitalization.

    Example Question:

    Have there been any recent changes to your weight?

    Finding:

    Asked about timing of weight gain

    Finding:

    Reports noticing weight gain within the past 24 hrs Liam Fitzgerald Shadow Health Telehealth Follow Up Sick Visit Subjective Data Collection

    (Available)

    Pro Tip: For heart failure patients, it is essential to monitor any daily changes in a patient’s chronic condition to prevent the exacerbation of heart failure and promote the patient’s overall health. By asking a wide range of questions, you can determine if the patient is experiencing worsening heart failure, which may be indicated by chest pain, shortness of breath, cough, edema, as well as changes in weight or vitals. Additionally, scope of practice is important to keep in mind in order to determine if the patient’s worsening condition warrants a referral to their cardiologist or immediate hospitalization.

    Example Question:

    When did you notice the weight gain?

    Finding:

    Asked about pain status

    Finding:

    Denies pain

    (Available)

    Pro Tip: For heart failure patients, it is essential to monitor any daily changes in a patient’s chronic condition to prevent the exacerbation of heart failure and promote the patient’s overall health. By asking a wide range of questions, you can determine if the patient is experiencing worsening heart failure, which may be indicated by chest pain, shortness of breath, cough, edema, as well as changes in weight or vitals. Additionally, scope of practice is important to keep in mind in order to determine if the patient’s worsening condition warrants a referral to their cardiologist or immediate hospitalization.

    Example Question:

    Do you have any pain?

    Finding:

    Asked about typical diet

    Finding:

    Reports limiting sodium intake

    (Found)

    Pro Tip: For heart failure patients, it is essential to monitor any daily changes in a patient’s chronic condition to prevent the exacerbation of heart failure and promote the patient’s overall health. By asking a wide range of questions, you can determine if the patient is experiencing worsening heart failure, which may be indicated by chest pain, shortness of breath, cough, edema, as well as changes in weight or vitals. Additionally, scope of practice is important to keep in mind in order to determine if the patient’s worsening condition warrants a referral to their cardiologist or immediate hospitalization.

    Example Question:

    Do you limit your sodium intake?

    Finding:

    Reports typical breakfast as oatmeal with fruit

    (Found)

    Pro Tip: For heart failure patients, it is essential to monitor any daily changes in a patient’s chronic condition to prevent the exacerbation of heart failure and promote the patient’s overall health. By asking a wide range of questions, you can determine if the patient is experiencing worsening heart failure, which may be indicated by chest pain, shortness of breath, cough, edema, as well as changes in weight or vitals. Additionally, scope of practice is important to keep in mind in order to determine if the patient’s worsening condition warrants a referral to their cardiologist or immediate hospitalization.

    Example Question:

    What do you typically eat for breakfast?

    Finding:

    Reports typical lunch as salads, homemade soups, pasta with grilled chicken and vegetables
    Liam Fitzgerald Shadow Health Telehealth
    Follow Up Sick Visit Subjective Data Collection

    (Found)

    Pro Tip: For heart failure patients, it is essential to monitor any daily changes in a patient’s chronic condition to prevent the exacerbation of heart failure and promote the patient’s overall health. By asking a wide range of questions, you can determine if the patient is experiencing worsening heart failure, which may be indicated by chest pain, shortness of breath, cough, edema, as well as changes in weight or vitals. Additionally, scope of practice is important to keep in mind in order to determine if the patient’s worsening condition warrants a referral to their cardiologist or immediate hospitalization.

    Example Question:

    What do you typically eat for lunch?

    Finding:

    Reports typical dinner as grilled chicken or fish with roasted vegetables, brown rice

    (Found)

    Pro Tip: For heart failure patients, it is essential to monitor any daily changes in a patient’s chronic condition to prevent the exacerbation of heart failure and promote the patient’s overall health. By asking a wide range of questions, you can determine if the patient is experiencing worsening heart failure, which may be indicated by chest pain, shortness of breath, cough, edema, as well as changes in weight or vitals. Additionally, scope of practice is important to keep in mind in order to determine if the patient’s worsening condition warrants a referral to their cardiologist or immediate hospitalization.

    Example Question:

    What do you typically eat for dinner?

    Finding:

    Reports typical snack as no-salt almond butter with apple, no-salt air popped popcorn Liam Fitzgerald Shadow Health Telehealth Follow Up Sick Visit Subjective Data Collection

  • Telehealth Follow Up Sick Visit: Liam Fitzgerald Shadow Health Treatment Plan

    Telehealth Follow Up Sick Visit: Liam Fitzgerald Shadow Health Treatment Plan

    Treatment Plan: 34 of 36 (94.44%)

    Problem Selection

    12 out of 13

    Primary Diagnosis

    Review your answers for the Problem Selection activities. You receive one point for each correct diagnosis, and one point for each correct evidence linked to a correct diagnosis. If there are multiple correct diagnoses, you will also receive a point for correctly selecting which diagnosis is the primary diagnosis.

    Learner Selection

    Model Documentation

     Diagnosis: 
    xx

    Evidences:

    Weight gain

     
    Elevated systolic pressure

    Fatigue with activity

    Pitting edema

    Learner Rationale:

    The above evidence confirm the diagnosis of xx

    Score: 5
     
    out of6

     Diagnosis: 
    xx

    Primary: 
    xx

    Evidences:

    Fatigue with activity

    Pitting edema

    Report of increased sodium consumption

    Weight gain

    Model Rationale:

    Mr. Fitzgerald’s primary diagnosis is xx, with a secondary diagnosis of acute on xx. The xxxx has exacerbated his chronic condition. Mr. Fitzgerald’s signs and symptoms of weight pain, pitting edema, fatigue with activity, and self-reported sodium increase have contributed to his xxx. His elevated diastolic and systolic pressures confirm a worsening condition. For patients with co-morbidities and chronic conditions, examining signs and symptoms at the root of the cause will help you determine why the chronic condition is worsening. Mr. Fitzgerald’s xx is exacerbated and secondary to the xx he is experiencing.

    Additional Diagnosis

    Learner Selection

    Model Documentation

     Diagnosis: 
    xx

    Evidences:

     
    Elevated diastolic pressure

     
    Elevated systolic pressure

     
    Fatigue with activity

     
    Pitting edema

     
    Report of increased sodium consumption

     
    Weight gain

    Learner Rationale:

    Patient reports the above symptoms,

    Score: 
    7 
    out of
     7

     Diagnosis: 
    xx

    Evidences:

    Elevated diastolic pressure

    Elevated systolic pressure

    Fatigue with activity

    Pitting edema

    Report of increased sodium consumption

    Weight gain

    Model Rationale:

    Mr. Fitzgerald’s primary diagnosis is xx with diastolic dysfunction. The fluid volume overload has exacerbated his chronic condition. Mr. Fitzgerald’s signs and symptoms of weight pain, pitting edema, fatigue with activity, and self-reported sodium increase have contributed to his Telehealth Follow Up Sick Visit: Liam Fitzgerald Shadow Health Treatment Plan. His elevated diastolic and systolic pressures confirm a worsening condition. For patients with co-morbidities and chronic conditions, examining signs and symptoms at the root of the cause will help you determine why the chronic condition is worsening. Mr. Fitzgerald’s CHF is exacerbated and secondary to the fluid volume overload he is experiencing.

    Plan of Care

    6 out of 7

    ORDER SHADOWHEALTH OR ESSAY WRITING HELP HERE 

    Review your answers for the Plan of Care activity. You must select “Yes” or “No” for each of the seven care actions. You will receive one point for determining the correct answer for each care action.

    Learner Selection

    Model Documentation

    Pharmacological Intervention

    Selected:
     Yes

    Learner Rationale:

    Patient needs heart medications

    Score: 
    0 
    out of
     1

    Recommended:
     No

    Mr. Fitzgerald does not require any new pharmacological interventions at this time because the necessary medications have already been prescribed. Mr. Fitzgerald now needs to recognize when it is appropriate to use his PRN medications furosemide 20 mg and potassium chloride tablet 10 mEq.

    Non-Pharmacological Intervention

    Selected:
     Yes

    Learner Rationale:

    Diet plan

    Score: 
    1 
    out of
     1

    Recommended:
     Yes

    You should advise Mr. Fitzgerald on strategies to determine and remember when to use his PRN medications furosemide 20 mg and potassium chloride tablet 10 mEq.

    Educate Patient

    Selected:
     Yes

    Learner Rationale:

    Patient education on healthy lifestyle

    Score: 
    1 
    out of
     1

    Recommended:
     Yes

    You will need to educate Mr. Fitzgerald about his activity level, diet, medications, and signs and symptoms in the next treatment plan activity.

    Preventive Screening and Intervention

    Selected:
     No

    Learner Rationale:

    No preventive interventions on my side

    Score: 
    1 
    out of
     1

    Recommended:
     No

    At this time, it is not appropriate to conduct any preventative screenings or interventions for the patient as he is being treated for a sick visit. Recommending preventative screens and interventions at this time are beyond the scope of this visit. Preventative screenings and interventions can be recommended during an annual wellness visit or another visit.

    Diagnostic Testing: Labs and Imaging

    Selected:
     No

    Learner Rationale:

    No diagnostics needed

    Score: 
    1 
    out of
     1

    Recommended:
     No

    As the patient’s diagnosis is evident, no further diagnostic testing is needed.

    Referral of Care

    Selected:
     Yes

    Learner Rationale:

    Refer to cardiologist

    Score: 
    0 
    out of
     1

    Recommended:
     No

    There’s no evidence that the patient requires any referral to another healthcare provider at this time. Telehealth Follow Up Sick Visit: Liam Fitzgerald Shadow Health Treatment Plan

    Continued Care and Follow-up

    Selected:
     Yes

    Learner Rationale:

    Treatment evaluation in 2 weeks

    Score: 
    1 
    out of
     1

    Recommended:
     Yes

    You should inform Mr. Fitzgerald to follow up on his chronic condition with his cardiologist and to schedule an additional follow-up telehealth appointment in two to three weeks for continued monitoring of his congestive heart failure. It is also good practice to remind patients to schedule their annual physicals and wellness visits.

    Education

    15 out of 16

    Topic: 
    Activity

    Learner Selection

    Model Documentation

    It is important that you maintain your activity level; however, if you notice that you are having difficulty completing your daily activities or get fatigued, have chest pain, or shortness of breath during exercise, discontinue the exercise until you follow-up with your cardiologist.

    It is important that you maintain your activity level; however, if you notice that you are having difficulty completing your daily activities or get fatigued, have chest pain, or shortness of breath during exercise, discontinue the exercise until you follow-up with your cardiologist.

    Score: 
    1
     out of 
    1

    Topic: 
    Diet

    Learner Selection

    Model Documentation

    Do not consume more than 500 ml of alcohol within a 24 hour period.

    You should adhere to your low-sodium diet as much as possible. Pay attention to labels and avoid foods high in sodium so you are aware of your level of sodium consumption.

    You should avoid drinking alcohol since it can impact fluid volume overload.

    You should avoid drinking alcohol since it can impact fluid volume overload. Telehealth Follow Up Sick Visit: Liam Fitzgerald Shadow Health Treatment Plan