Category: Nursing

  • Danny Rivera Pediatric Cough Shadow Health Assessment Objective Data

    Danny Rivera Pediatric Cough Shadow Health Assessment Objective Data

    Objective Data Collection: 12.4 of 13 (95.38%)

     Correct

     Partially correct

     Incorrect

     Missed

     Inspected eyes and orbital area

    1 of 1 point

    Orbital Area 
    (1/4 point)

     SCORE 100% ON YOUR SHADOW HEALTH ASSESSMENT

     No visible abnormal findings

     Ptosis

     Eyelid edema

     Lesion

     Allergic shiners

    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

    Danny Rivera Pediatric Cough Shadow Health Assessment Objective Data

     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

    0.8 of 1 point

    Right: Auditory Canal Color 
    (No point)

     Pink

     Erythemic

     Pallor

    Right: Tympanic Membrane Color 
    (No 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

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    WE WILL HAVE YOU SCORE 100%,

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    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

    0.6 of 1 point

    Oral Mucosa 
    (1/5 point)

     Moist and pink

     Dry appearance

     Erythema

    Tonsils 
    (No point)

     No visible abnormal findings

     Edema

     Erythema

    Posterior Oropharynx Color 
    (No 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

     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

     Palpated lymph nodes

    1 of 1 point

     Palpated fremitus

    1 of 1 point

     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

    Danny Rivera Pediatric Cough Shadow Health Assessment Objective Data

     Auscultated for bronchophony

    1 of 1 point

     Auscultated heart sounds

    1 of 1 point

     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

    Danny Rivera Pediatric Cough Shadow Health Assessment Objective Data

  • NURS 6512 Week 1 Discussion example

    NURS 6512 Week 1 Discussion example

    NURS 6512 Week 1 Discussion

    The history should be structured to include the chief concern, history of present illness (HPI), past medical history, family history, personal and social history and review of systems (ROS) (Ball et al, 2015).  With many Electronic Medical Records (EHR’s) many of these items are readily available in the system. They should be reviewed during the history taking portion of the exam.

    ORDER A PLAGIARISM-FREE PAPER HERE

    Communication and Interviewing Techniques

    To enhance patient response I would use open ended questions, direct questions and leading question (Ball et al, 2015). The patient history is important to identify potential genetic risks as well as to establish a sense of the patient’s reliability (Ball et al, 2015) NURS 6512 Week 1 Discussion example .  The technique used by the clinician is almost as important as what they are asking. It is important to ask probing questions for more information, set the scene for an open dialogue, and avoid the use of jargon,

    Targeted Questions

    The history portion of the exam helps the practitioner to identify what targeted questions should be asked. In an article by Lushniak, B. (2015) they state that the family health history is the most cost effective genetic screening tool. They found that for all diseases of public health significance, individuals with a family history of the disease have a higher risk of developing the disease than those without a family history. NURS 6512 Week 1 Discussion example

    Health risk assessments provide an opportunity to encourage health promotion and disease prevention (Wu, R. and Orlando, L.(2015).  HRA’s assist in bringing guidelines and risk assessments into one tool to assist in assess the risk and recommended management of disease.

    Scenario

               
    In building a health history for a new patient who is 16 years old, pregnant and living in an inner city neighborhood. I would plan to conduct a basic health history that consists of a chief complaint, HPI, past medical history, personal and social history and ROS. The medical and family history would include targeted questions about genetic birth defects, to ensure proper prenatal testing occurs. It would be important to include health assessment tool such as the HITS screen for domestic violence, the five P’s of sexual practice and the HEADESSS (screening tool for adolescent issues.

    Assessment Questions

    What brings you in to the clinic today?

    What symptoms have you been experiencing in the last month?

    Can you tell me about who lives at home with you?

    Do you feel safe in your home? At school?

    Can you tell me at what age you had your first period?

    Have you ever missed or had a late period before?

    Are you currently sexually active? NURS 6512 Week 1 Discussion example

    How many partners have you had in the past year?

    What kind of contraception do you use? Do you use it every time?

    References

    Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015).
    Seidel’s guide to physical examination
    (8th ed.). St. Louis, MO: Elsevier Mosby.

    Lushniak, B. D. (2015). Surgeon General’s Perspectives.
    Public Health Reports
    ,
    130
    (1), 3–5.

    Wu RR, Orlando LA.  (2015). Implementation of health risk assessments with family health history: barriers and benefits. 
    Postgraduate Medical Journal
    ;91:508-513. NURS 6512 Week 1 Discussion example

  • Danny Rivera Pediatric Cough Shadow Health Assessment Transcript

    Danny Rivera Pediatric Cough Shadow Health Assessment Transcript

    Transcript

    Started:
     Apr 08, 2020 | 
    Total Time:
    74 min

    All Lines (176)
    Interview Questions (58)
    Statements (19)
    Exam Actions (99)

    Hello. My name is Pam and I will be interviewing today and later do a physical examination.

    Greet

    04/08/20 9:01 PM PDT

    Hi.

    What is your name?

    Question

    04/08/20 9:01 PM PDT

    My name is Daniel Rivera, but I just go by Danny.

    What brings you to the clinic today?

     SCORE 100% ON YOUR SHADOW HEALTH ASSESSMENT

    Question

    04/08/20 9:01 PM PDT

    My Abuela brought me here because I’ve been feeling sick. I have been coughing a lot. . . and I feel kinda tired.

    Am sorry to hear that you are sick .

    Empathize

    04/08/20 9:02 PM PDT

    Thank you.

    Do you have a cough?

    Question

    04/08/20 9:03 PM PDT

    I guess I’m kind of sick. . . I’ve been coughing a lot.

    How long have you had a cough?

    Question

    04/08/20 9:03 PM PDT

    I think the cough started four. . . No, it started five days ago. Danny Rivera Pediatric Cough Shadow Health Assessment Transcript

    Is your cough a wet or a dry one?

    Question

    04/08/20 9:03 PM PDT

    My cough seems kind of gurgly and watery.

    That sounds like a wet cough

    Educate

    04/08/20 9:04 PM PDT

    Oh, OK.

    Do yxxx

    Question

    04/08/20 9:05 PM PDT

    Isxxx

    Am sorry to hear this.

    Empathize

    04/08/20 9:05 PM PDT

    Thank you.

    Howxxx

    Question

    04/08/20 9:06 PM PDT

    I jxx

    Do thexxx

    Question

    04/08/20 9:07 PM PDT

    Most timesxxx

    Am sorry to hear this.

    Empathize

    04/08/20 9:08 PM PDT

    Thank you.

    Do youxxx

    Question

    04/08/20 9:08 PM PDT

    No way! I knowxxx

    True, xxx

    Educate

    04/08/20 9:09 PM PDT

    Oh, OK.

    Are you ever aroundxxxx

    Question

    04/08/20 9:13 PM PDT

    Well . . . sometimes xxx

    Am sorry about that, i xxx

    Question

    04/08/20 9:14 PM PDT

    Am sorry about that, i understand your concerns.

    Empathize

    04/08/20 9:14 PM PDT

    Thank you.

    What makes your coughs worse?

    Question

    04/08/20 9:15 PM PDT

    My cough mostly stays the same no matter what I do. It seems to get worse at night though.

    Have you triedxxx

    Question

    04/08/20 9:15 PM PDT

    I had somexxx. [AUDIO COMING SOON]

    What is the xxx

    Question

    04/08/20 9:16 PM PDT

    I don’t know whatxxx

    Who xxx

    Question

    04/08/20 9:17 PM PDT

    My xxx

    how muchxxx

    Question

    04/08/20 9:17 PM PDT

    I just hadxxx

    How xxx

    Question

    04/08/20 9:18 PM PDT

    I only xxx. [AUDIO COMING SOON]

    Apart from thexxx

    Question

    04/08/20 9:18 PM PDT

    Do youxxx

    Question

    04/08/20 9:20 PM PDT

    Oh yeah, I xxx

    I understand, its xxx

    Educate

    04/08/20 9:21 PM PDT

    Oh, OK.

    Are you usually active?

    Question

    04/08/20 9:22 PM PDT

    I have gym class every day. I do all my exercises there. And there’s a park right next to my house where I play after school, or sometimes on the weekends, if it’s nice outside. [AUDIO COMING SOON]

    Great, keep exercising, its healthy.

    Educate

    04/08/20 9:23 PM PDT

    Oh, OK.

    Does the cough make you less active?

    Question

    04/08/20 9:24 PM PDT

    No, that doesn’t help my cough.

    Are you able to focus in class?

    Question

    04/08/20 9:24 PM PDT

    I can focus normally, but I couldn’t sleep very well last night because of my coughing, so it was harder than normal. Plus, it’s harder to pay attention when you keep having to cough. [AUDIO COMING SOON]

    Am sorry to hear that the cough is disturbing you sometimes. (No matching questions found.)

    Question

    04/08/20 9:24 PM PDT

    Am sorry to hear that the cough is disturbing you sometimes.

    Empathize

    04/08/20 9:25 PM PDT

    Thank you.

    Do you xxx

    Question

    04/08/20 9:28 PM PDT

    My xx

    Am sorry about this

    Empathize

    04/08/20 9:28 PM PDT

    Thank you.

    Have you xxx

    Question

    04/08/20 9:28 PM PDT

    I don’t xxx

    what xxx

    Question

    04/08/20 9:29 PM PDT

    You mean likexxxx

    Yes, that one. Ok, thanks.

    Educate

    04/08/20 9:30 PM PDT

    Oh, OK.

    How consistent is xxx

    Question

    04/08/20 9:38 PM PDT

    It’s kind of xxx

    xx

    Question

    04/08/20 9:41 PM PDT

    My xxx . . . my left one is OK though.

    Am sorry to hear this Danny

    Empathize

    04/08/20 9:42 PM PDT

    Thank you.

    Do you havexxx

    Question

    04/08/20 9:42 PM PDT

    No, xxxkind of hurts.

    Do you have xxx problems?

    Question

    04/08/20 9:42 PM PDT

    A lady came to my school to xx . . . Danny Rivera Pediatric Cough Shadow Health Assessment Transcript

    Great, its good to have a test done whenever there is a chance.

    Educate

    04/08/20 9:43 PM PDT

    Oh, OK.

    Do you have soar throat?

    Question

    04/08/20 9:44 PM PDT

    It feels a little bit sore, yeah.

    Does it xxx

    Question

    04/08/20 9:45 PM PDT

    No, I can xxxx

    Sorry about that Danny

    Empathize

    04/08/20 9:45 PM PDT

    Thank you.

    Have you xxx

    Question

    04/08/20 9:46 PM PDT

     

    Do you have difficulty breathing?

    Question

    04/08/20 9:58 PM PDT

    I can breathe OK, yeah . . . my nose is a little bit runny though.

    Thank you for answering the questions Danny. I will now do the physical examination.

    Question

    04/08/20 9:59 PM PDT

    I don’t have any questions really.

    Thank you for answering the questions, i will now do the physical examination on you.

    Educate

    04/08/20 10:00 PM PDT

    Oh, OK.

     Checked vitals

    Exam Action

    04/09/20 11:08 AM PDT

     Tested lung capacity with spirometer: FEV1: 3.15 L, FVC 3.91L (FEV1/FVC: 80.5%) Danny Rivera Pediatric Cough Shadow Health Assessment Transcript

    Exam Action

    04/09/20 11:12 AM PDT

     Inspected upper conjunctiva

    Exam Action

    04/09/20 11:14 AM PDT

     Inspected upper conjunctiva

    Exam Action

    04/09/20 11:14 AM PDT

     Inspected upper conjunctiva

    Exam Action

    04/09/20 11:14 AM PDT

     Inspected lower conjunctiva

    Exam Action

    04/09/20 11:14 AM PDT

     Inspected right orbital area and sclera

    Exam Action

    04/09/20 11:14 AM PDT

     Inspected left orbital area and sclera

    Exam Action

    04/09/20 11:15 AM PDT

     Performed otoscopic examination of right naris

    Exam Action

    04/09/20 11:15 AM PDT

     Performed otoscopic examination of left naris

    Exam Action

    04/09/20 11:15 AM PDT

     Performed otoscopic examination of right ear

    Exam Action

    04/09/20 11:16 AM PDT

     Performed otoscopic examination of left ear

    Exam Action

    04/09/20 11:16 AM PDT

     Inspected mouth

    Exam Action

    04/09/20 11:16 AM PDT

     Inspected front of neck

    Exam Action

    04/09/20 11:16 AM PDT

     Inspected right side of neck

    Exam Action

    04/09/20 11:17 AM PDT

     Inspected front of neck

    Exam Action

    04/09/20 11:17 AM PDT

     Inspected left side of neck

    Exam Action

    04/09/20 11:17 AM PDT

     Inspected back of neck

    Exam Action

    04/09/20 11:17 AM PDT

     Inspected anterior chest wall

    Exam Action

    04/09/20 11:17 AM PDT

     Inspected posterior chest wall

    Exam Action

    04/09/20 11:17 AM PDT

     Inspected anterior chest wall

    Exam Action

    04/09/20 11:17 AM PDT

     Palpated frontal sinuses: No tenderness reported

    Exam Action

    04/09/20 11:19 AM PDT

     Palpated maxillary sinuses: No tenderness reported

    Exam Action

    04/09/20 11:20 AM PDT

     Palpated cervical lymph nodes: Enlarged and reported tenderness on the right side

    Exam Action

    04/09/20 11:23 AM PDT

     Palpated supraclavicular lymph nodes: Not palpable

    Exam Action

    04/09/20 11:23 AM PDT

     Palpated axillary lymph nodes: Not palpable

    Exam Action

    04/09/20 11:23 AM PDT

     Palpated axillary lymph nodes: Not palpable

    Exam Action

    04/09/20 11:23 AM PDT

     Palpated fremitus in anterior upper chest wall: Expected fremitus, equal bilaterally

    Exam Action

    04/09/20 11:24 AM PDT

    Ninety-nine.

     Palpated fremitus in anterior lower chest wall: Expected fremitus, equal bilaterally

    Exam Action

    04/09/20 11:24 AM PDT

    Ninety-nine.

     Palpated fremitus in posterior upper chest wall: Expected fremitus, equal bilaterally

    Exam Action

    04/09/20 11:24 AM PDT

    Ninety-nine.

     SCORE 100% ON YOUR SHADOW HEALTH ASSESSMENT 

     Palpated fremitus in posterior middle chest wall: Expected fremitus, equal bilaterally

    Exam Action

    04/09/20 11:24 AM PDT

    Ninety-nine.

     Palpated fremitus in posterior lower chest wall: Expected fremitus, equal bilaterally

    Exam Action

    04/09/20 11:24 AM PDT

    Ninety-nine.

     Auscultated breath sounds in anterior left upper lobe

    Exam Action

    04/09/20 11:25 AM PDT

     Auscultated breath sounds in anterior right upper lobe

    Exam Action

    04/09/20 11:25 AM PDT

     Auscultated breath sounds in anterior right middle lobe

    Exam Action

    04/09/20 11:26 AM PDT

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

    Exam Action

    04/09/20 11:26 AM PDT

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

    Exam Action

    04/09/20 11:26 AM PDT

     Auscultated breath sounds in anterior right middle lobe

    Exam Action

    04/09/20 11:26 AM PDT

     Auscultated breath sounds in anterior right lower lobe

    Exam Action

    04/09/20 11:26 AM PDT

     Auscultated breath sounds in anterior left lower lobe

    Exam Action

    04/09/20 11:27 AM PDT

     Auscultated breath sounds in posterior left upper lobe

    Exam Action

    04/09/20 11:27 AM PDT

     Auscultated breath sounds in posterior right upper lobe

    Exam Action

    04/09/20 11:27 AM PDT

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

    Exam Action

    04/09/20 11:27 AM PDT

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

    Exam Action

    04/09/20 11:27 AM PDT

     Auscultated breath sounds in posterior right lower lobe near spine

    Exam Action

    04/09/20 11:28 AM PDT

     Auscultated breath sounds in posterior left lower lobe near spine

    Exam Action

    04/09/20 11:28 AM PDT

     Auscultated breath sounds in posterior left lower lobe on side

    Exam Action

    04/09/20 11:28 AM PDT

     Auscultated breath sounds in posterior left lower lobe

    Exam Action

    04/09/20 11:28 AM PDT

     Auscultated breath sounds in posterior right lower lobe

    Exam Action

    04/09/20 11:28 AM PDT

     Auscultated breath sounds in posterior right lower lobe on side

    Exam Action

    04/09/20 11:28 AM PDT

     Auscultated voice sounds in anterior right upper lobe

    Exam Action

    04/09/20 11:29 AM PDT

    Ninety-nine.

    Ninety-nine.

     Auscultated voice sounds in anterior left upper lobe

    Danny Rivera Pediatric Cough Shadow Health Assessment Transcript

    Exam Action

    04/09/20 11:29 AM PDT

    Ninety-nine.

    Ninety-nine.

    Ninety-nine.

    Ninety-nine.

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

    Exam Action

    04/09/20 11:29 AM PDT

    Ninety-nine.

    Ninety-nine.

     Auscultated voice sounds in anterior right middle lobe

    Exam Action

    04/09/20 11:29 AM PDT

    Ninety-nine.

    Ninety-nine.

    Ninety-nine.

     Auscultated voice sounds in anterior right middle lobe

    Exam Action

    04/09/20 11:30 AM PDT

    Ninety-nine.

    Ninety-nine.

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

    Exam Action

    04/09/20 11:30 AM PDT

    Ninety-nine.

     Auscultated voice sounds in anterior left lower lobe

    Exam Action

    04/09/20 11:30 AM PDT

    Ninety-nine.

     Auscultated voice sounds in anterior right lower lobe

    Exam Action

    04/09/20 11:30 AM PDT

    Ninety-nine.

    Ninety-nine.

    Ninety-nine.

     Auscultated voice sounds in posterior left upper lobe

    Exam Action

    04/09/20 11:30 AM PDT

    Ninety-nine.

    Ninety-nine.

     Auscultated voice sounds in posterior right upper lobe

    Exam Action

    04/09/20 11:30 AM PDT

    Ninety-nine.

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

    Exam Action

    04/09/20 11:30 AM PDT

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

    Exam Action

    04/09/20 11:30 AM PDT

    Ninety-nine.

    Ninety-nine.

    Ninety-nine.

     Auscultated voice sounds in posterior left lower lobe near spine

    Exam Action

    04/09/20 11:30 AM PDT

    Ninety-nine.

     Auscultated voice sounds in posterior right lower lobe near spine

    Exam Action

    04/09/20 11:30 AM PDT

    Ninety-nine.

    Ninety-nine.

    Ninety-nine.

     Auscultated voice sounds in posterior right lower lobe on side

    Exam Action

    04/09/20 11:30 AM PDT

    Ninety-nine.

     Auscultated voice sounds in posterior right lower lobe

    Exam Action

    04/09/20 11:31 AM PDT

    Ninety-nine.

     Auscultated voice sounds in posterior left lower lobe

    Exam Action

    04/09/20 11:31 AM PDT

    Ninety-nine.

    Ninety-nine.

     Auscultated voice sounds in posterior left lower lobe on side

    Exam Action

    04/09/20 11:31 AM PDT

    Ninety-nine.

    Ninety-nine.

    Ninety-nine.

     Auscultated aortic area with the bell

    Exam Action

    04/09/20 11:31 AM PDT

     Auscultated aortic area with the diaphragm

    Exam Action

    04/09/20 11:31 AM PDT

     Auscultated aortic area with the bell

    Exam Action

    04/09/20 11:31 AM PDT

     Auscultated aortic area with the diaphragm

    Exam Action

    04/09/20 11:31 AM PDT

     Auscultated aortic area with the bell

    Exam Action

    04/09/20 11:31 AM PDT

     Auscultated aortic area with the diaphragm

    Exam Action

    04/09/20 11:31 AM PDT

     Auscultated pulmonic area with the diaphragm

    Exam Action

    04/09/20 11:31 AM PDT

     Auscultated pulmonic area with the bell

    Exam Action

    04/09/20 11:31 AM PDT

     Auscultated Erb’s point with the bell

    Exam Action

    04/09/20 11:31 AM PDT

     Auscultated Erb’s point with the diaphragm

    Exam Action

    04/09/20 11:32 AM PDT

     Auscultated tricuspid area with the diaphragm

    Exam Action

    04/09/20 11:32 AM PDT

     Auscultated tricuspid area with the bell

    Exam Action

    04/09/20 11:32 AM PDT

     Auscultated mitral area with the bell

    Exam Action

    04/09/20 11:32 AM PDT

     Auscultated mitral area with the diaphragm

    Exam Action

    04/09/20 11:32 AM PDT

     Percussed anterior right upper lobe

    Exam Action

    04/09/20 11:32 AM PDT

     Percussed anterior right middle lobe

    Exam Action

    04/09/20 11:32 AM PDT

     Percussed anterior left upper lobe

    Exam Action

    04/09/20 11:32 AM PDT

     Percussed anterior left mid-chest (upper lobe)

    Exam Action

    04/09/20 11:32 AM PDT

     Percussed anterior left lower lobe

    Exam Action

    04/09/20 11:32 AM PDT

     Percussed anterior right lower lobe

    Exam Action

    04/09/20 11:32 AM PDT

     Percussed posterior left upper lobe

    Exam Action

    04/09/20 11:33 AM PDT

     Percussed posterior left mid-back (lower lobe)

    Exam Action

    04/09/20 11:33 AM PDT

     Percussed posterior right mid-back (lower lobe)

    Exam Action

    04/09/20 11:33 AM PDT

     Percussed posterior right upper lobe

    Exam Action

    04/09/20 11:33 AM PDT

     Percussed posterior left lower lobe

    Exam Action

    04/09/20 11:33 AM PDT

     Percussed posterior left lower lobe on side

    Exam Action

    04/09/20 11:33 AM PDT

     Percussed posterior left lower lobe near spine

    Exam Action

    04/09/20 11:33 AM PDT

     Percussed posterior right lower lobe near spine

    Exam Action

    04/09/20 11:33 AM PDT

     Percussed posterior right lower lobe

    Exam Action

    04/09/20 11:33 AM PDT

     Percussed posterior left right lobe on side

    Exam Action

    04/09/20 11:33 AM PDT

     Inspected mouth

    Danny Rivera Pediatric Cough Shadow Health Assessment Transcript

    Exam Action

    04/09/20 11:58 AM PDT

  • NURS 6512: Assessment of Abdomen and Gastrointestinal System Episodic/Focused SOAP Note

    NURS 6512: Assessment of Abdomen and Gastrointestinal System Episodic/Focused SOAP Note

    NURS 6512: Advanced Health Assessment and Diagnostic Reasoning

    Week Seven: Assessment of Abdomen and Gastrointestinal System

    Review of case study #2

    Scenario: A 50-year-old male complains of burning pain starting at the abdomen and rising to the middle of his chest. He describes the pain as a gnawing feeling that begins after meals, especially when lying down.

    Episodic/Focused SOAP Note for Throat Exam

    Patient Information: V.S.     Age: 50 y.o.        Sex: Male          DOB: 8/7/1967

    S
    .

    ORDER A PLAGIARISM-FREE PAPER HERE

    Chief Complaint/Reason for Visit:

    The patient reported abdominal discomfort for the past two days that feels like “burning sensation in his chest.”

    History of Present Illness:

    Mr. V.S. is a 50 y/o Caucasian male with h/o hyperlipidemia, hypothyroidism, hypertension, DM Type II, presenting with c/o abdominal discomfort ranging from 5 to 6 out of 10 for two days. According to the patient, his stomach discomfort has however been ongoing for the past two days and describes it as burning pain starting at the mid-abdomen and rising to the middle of his chest. He reported that the pain usually begins when he eats and worsens when lying down but subsides when he walks. Patient denies constipation or diarrhea. His last meal was at 14:00 today. According to the patient, he recently started taking aspirin once a day as advised by his primary care physician. NURS 6512: Assessment of Abdomen and Gastrointestinal System Episodic/Focused SOAP Note

    Current Medications:

    Atorvastatin (Lipitor) 40 mg tablet Take 40 mg nightly

    Levothyroxine (SYNTHROID) 100 mcg once daily

    Metformin (GLUCOPHAGE) 500 mg tablet two times daily (with breakfast & dinner)

    Aspirin 81mg once daily

    Allergies: No known allergies

    PMHx:

    Diabetes mellitus (managed by diet and medication)

    Diabetes type 2, controlled with diet and medication

    Hyperlipidemia (currently on medication)

    Hypothyroidism (managed by medication)

    Fam Hx: Reported both parents are alive, father with hypertension, mother with diabetes.

    Personal/Social History: Drinks ETOH occasionally. Consumes 2-3 cans of beer two times per week. Denies smoking, and illicit drug use.

    Review of Systems:

    Constitutional:  A&O x4, pleasant and cooperative. Reports abdominal pain 5-6/10. No acute distress. Denies weight loss, weakness, or fatigue.

    HEENT:  Denies headache, sore throat or changes in hearing.

    SKIN:  No rash or itching.

    CARDIOVASCULAR:  Reported burning sensation on his chest when lying down.

    RESPIRATORY:  Denies shortness of breath or cough.

    GASTROINTESTINAL:  Reported abdominal discomfort for the past two days ranging from 5-6/10. Described as “gnawing” and “burning.” Denies nausea or vomiting. No change in bowel pattern.

    GENITOURINARY:  Denies dysuria or hematuria.

    NEUROLOGICAL:  Denies focal loss of strength or loss of sensation.

    MUSCULOSKELETAL:  Denies focal weakness, facial droop, or joint swelling.

    HEMATOLOGIC:  No anemia, bleeding or bruising. NURS 6512: Assessment of Abdomen and Gastrointestinal System Episodic/Focused SOAP Note

    LYMPHATICS:  No enlarged nodes. No cervical lymphadenopathy

    ALL OTHER SYSTEMS REVIEWED AND NEGATIVE OF PERTINENT FINDINGS

    O.

    Physical exam: Vital signs: B/P 117/59, Pulse 108 (strong and regular); Temp 98.3F orally; RR 18; non-labored; SpO2: 96% room air;

    Height 1.575 m (5′ 2″), weight 73.5 kg (162 lb),

    General: A&O x4, pleasant and cooperative. Not in any acute distress.

    HEENT: Normocephalic and atraumatic. Sclera anicteric, No conjunctival erythema, PERRLA, oropharynx red, moist mucous membranes.

    Neck: Supple. No JVD. Trachea midline. No pain, swelling or palpable nodules.

    Chest/Lungs: Clear to auscultation bilaterally. No wheezing, crackles or rhonchi. No accessory muscle use.

    Heart/Peripheral Vascular: Regular rate and rhythm noted. No murmurs. No palpitation. No peripheral edema to palpation bilaterally.  NURS 6512: Assessment of Abdomen and Gastrointestinal System Episodic/Focused SOAP Note

    ABD: Reports of 5-6/10 pain. Soft, nontender, nondistended. Hyperactive BS. No palpable hepatosplenomegaly

    Genital/Rectal: continent of bladder and bowel.

    Musculoskeletal: Normal range of motion. Regular muscle mass for age. No swelling or joint deformities.

    Neuro: Alert and oriented x4. Strength and sensation intact.

    Skin/Lymph Nodes: No cervical lymphadenopathy. No rashes, or erythema. No lesions. NURS 6512: Assessment of Abdomen and Gastrointestinal System Episodic/Focused SOAP Note

    Diagnostic results:

    EKG: NSR

    Laboratory studies:

    CBC – WBC 9.4; H/H: 14.3/41.0; PLT: 289.

    Chemistry Panel: BUN/Crea: 19/0.52; Glucose: 117*

    Pylori serology: negative

    Esophageal pH Test: pending

    NURS 6512: Assessment of Abdomen and Gastrointestinal System Episodic/Focused SOAP Note

     

    A
    .

    Differential Diagnoses (DD):

    Gastroesophageal Reflux Disease (GERD): backward flow of gastric contents, which are typically acidic, into the esophagus (Ball, Dains, Flynn, Solomon, & Stewart, 2015, p. 400).

    –    Patient with reports of burning, gnawing pain in the mid-epigastrium that worsens with recumbency (Baumann, Dains, & Scheibel, 2016, p. 27).

    –    Risk factors for GERD include obesity, pregnancy, smoking, eating large meals or eating late at night, eating certain foods (triggers) such as fatty or fried foods, drinking certain beverages such as alcohol or coffee, taking certain medications, such as aspirin (Mayo Foundation for Medical Education and Research, 2017).

    –    Due to the reported symptoms, alcohol consumption, and recent changes in the patient’s medication, GERD is the primary diagnosis for the patient. NURS 6512: Assessment of Abdomen and Gastrointestinal System Episodic/Focused SOAP Note

    Acute coronary syndrome: may have heartburn or a bitter taste in the mouth due to stomach fluid “coming up” which usually occurs after eating and gastroesophageal reflux disease (GERD) is the most common cause of non-cardiac chest pain (The Cleveland Clinic Foundation, 2015).

    Peptic Ulcer: associated with reports of burning or gnawing pain that occurs most often with an empty stomach, stress, and alcohol intake which is relieved with food intake (Baumann, Dains, & Scheibel, 2016, p. 27).

    Achalasia: a condition where the esophagus is unable to move food into the stomach as the lower esophageal sphincter stays closed during swallowing, back up of food results and symptoms include vomiting undigested food, chest pain, heartburn and weight loss (The Cleveland Clinic Foundation, 2017).

    Gastritis: is a constant burning pain in the epigastric area that can be accompanied by nausea, vomiting, diarrhea, or fever and alcohol, nonsteroidal inflammatory drugs and salicylates make the pain worse (Baumann, Dains, & Scheibel, 2016, p. 27).

    Hiatal Hernia with esophagitis: is a condition where part of the stomach passes through the esophageal hiatus in the diaphragm and into the chest cavity with symptoms of epigastric pain or heartburn that worsens with lying down and is resolved by sitting up or antacids (Ball, Dains, Flynn, Solomon, & Stewart, 2015, p. 401).

     

    References

    Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

    Baumann, L. C., Dains, J. E., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby. NURS 6512: Assessment of Abdomen and Gastrointestinal System Episodic/Focused SOAP Note

    Mayo Foundation for Medical Education and Research. (2017, November). Gastroesophageal reflux disease (GERD). Retrieved from https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940

    The Cleveland Clinic Foundation. (2015, June). Non-Cardiac Chest Pain: GERD. Retrieved from https://my.clevelandclinic.org/health/diseases/15851-gerd-non-cardiac-chest-pain

    The Cleveland Clinic Foundation. (2017, July). Swallowing Problems: Achalasia. Retrieved from https://my.clevelandclinic.org/health/diseases/17534-swallowing-problems-achalasia/symptoms–diagnosis?view=print NURS 6512: Assessment of Abdomen and Gastrointestinal System Episodic/Focused SOAP Note

  • Danny Rivera Pediatric Cough Shadow Health Assessment Subjective Data

    Danny Rivera Pediatric Cough Shadow Health Assessment Subjective Data

    Subjective Data Collection: 20 of 20 (100.0%)

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    Patient Data
     items below to reveal important information, including 
    Pro Tips
     and 
    Example Questions
    .

    Found:

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    Available:

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    Scored Items

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

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    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. Danny Rivera Pediatric Cough Shadow Health Assessment Subjective Data

    Chief Complaint

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    Finding:

    Established chief complaint

    Finding:

    Reports cough

    (Found)

    Pro Tip: Asking about the characteristics of your patient’s cough and voice quality should guide your assessment. Danny Rivera Pediatric Cough Shadow Health Assessment Subjective Data

    Example Question:

    Do you have a cough?

    History of Present Illness

    Finding:

    Asked about onset of cough

    Finding:

    Reports cough started 5 days ago

    (Found)

    Pro Tip: Whenever you are assessing a symptom or a health condition, inquiring about onset assesses the severity and the progression of the problem.

    Example Question:

    How long have you had a cough?

    Finding:

    Asked about frequency and duration of cough

    Finding:

    Reports coughing every couple minutes

    (Found)

    Pro Tip: Establishing a timeline for Danny’s coughing will illustrate how long he has been suffering these particular symptoms and might indicate possible triggers. Danny Rivera Pediatric Cough Shadow Health Assessment Subjective Data

    Example Question:

    How frequently have you been coughing?

    Finding:

    Asked about character of cough

    Finding:

    Reports cough is wet

    (Found)

    Pro Tip: Asking about the characteristics of your patient’s cough and voice quality should guide your assessment. Danny Rivera Pediatric Cough Shadow Health Assessment Subjective Data

    Example Question:

    Is your cough a wet cough?

    Finding:

    Reports clear sputum with cough

    (Found)

    Pro Tip: Asking if your patient’s cough is productive should guide your assessment.

    Example Question:

    Do you produce any phlegm or sputum with your cough? Danny Rivera Pediatric Cough Shadow Health Assessment Subjective Data

    Finding:

    Asked about aggravating factors for cough

    Finding:

    Reports cough is worse at night

    (Found)

    Pro Tip: Establishing a timeline for Danny’s coughing will illustrate how long he has been suffering these particular symptoms and might indicate possible triggers.

    Example Question:

    Is your cough worse at night?

    Finding:

    Reports exposure to secondhand smoke

    (Found)

    Pro Tip: Tobacco use puts the patient at risk for many medical conditions. Asking about all types of tobacco products assesses this risk factor.

    Example Question:

    Do you smoke?

    Finding:

    Reports not knowing specific triggers that make the cough worse

    (Found)

    Pro Tip: Follow-up questions will enable Danny to more fully and specifically describe his condition, experience, or symptoms. Establishing what makes Danny’s cough worse will allow you to more effectively treat his symptoms.

    Example Question:

    What makes your cough worse?

    Finding:

    Asked about relieving factors for cough

    Finding:

    Reports cough “stays the same” with rest

    (Available)

    Pro Tip: Asking what relieves the patient’s chief complaint will determine the efficacy of possible treatment and may provide important insight into the condition itself.

    Example Question:

    Does resting help your cough?

    Finding:

    Reports cough “stays the same” despite drinking water

    (Available)

    Pro Tip: Asking what relieves the patient’s chief complaint will determine the efficacy of possible treatment and may provide important insight into the condition itself. Danny Rivera Pediatric Cough Shadow Health Assessment Subjective Data

    Example Question:

    Does drinking water help your cough?

    Finding:

    Asked about nasal symptoms

    Finding:

    Reports current runny nose

    (Found)

    Pro Tip: Asking your patient if his nose is running will allow you to determine the symptoms he is experiencing and possible triggers. Danny Rivera Pediatric Cough Shadow Health Assessment Subjective Data

    Example Question:

    Do you have a runny nose?

    Finding:

    Denies sneezing

    (Found)

    Pro Tip: Asking your patient if he has been sneezing will allow you to determine the symptoms he is experiencing and possible triggers.

    Example Question:

    Have you been sneezing?

    Finding:

    Reports frequent rhinorrhea

    (Found)

    Pro Tip: Establishing how frequently your patient experiences symptoms, like a runny nose, will most effectively enable you to treat your patient’s symptoms.

    Example Question:

    Do you get runny noses often?

    Finding:

    Followed up on nasal discharge

    Finding:

    Reports nasal discharge is clear

    (Found)

    Pro Tip: Asking your patient about their specific symptoms and the way that they manifest, like the character of his nasal discharge, will help you to understand his symptoms.

    Example Question:

    What color is your snot?

    Finding:

    Reports nasal discharge is thin

    (Found)

    Pro Tip: Asking your patient about their specific symptoms and the way that they manifest, like the character of his nasal discharge, will help you to understand his symptoms.

    Example Question:

    Is your snot thin?

    Finding:

    Asked about ear symptoms

    Finding:

    Reports pain in right ear

    (Found)

    Pro Tip: Ear pain can suggest an ear infection, during which the middle of the ear becomes clogged with fluid and mucous, which can affect hearing. Danny Rivera Pediatric Cough Shadow Health Assessment Subjective Data. Asking Danny if he has ear pain might indicate a possible ear infection and a reason for changes in his hearing.

    Example Question:

    Do you have any ear pain?

    Finding:

    Followed up on ear pain

    Finding:

    Reports ear pain started yesterday

    (Available)

    Pro Tip: It is important to know how long your patient has suffered pain to determine how urgently treatment is needed.

    Example Question:

    How long have you had ear pain?

    Finding:

    Reports pain rating of 3 for ear pain

    (Available)

    Pro Tip: It is important to determine the severity of your patient’s paint to determine how urgently treatment is needed and how best to address it.

    Example Question:

    How bad is your ear pain?

    Finding:

    Denies ear discharge

    (Found)

    Pro Tip: Asking your patient about their specific symptoms and the way that they manifest, like if he has ear discharge, will help you to understand his symptoms. Danny Rivera Pediatric Cough Shadow Health Assessment Subjective Data.

    Example Question:

    Do you have any ear discharge?

    Finding:

    Asked about throat symptoms

    Finding:

    Reports sore throat

    (Found)

    Pro Tip: Asking about the patient’s mouth and throat should guide your assessment.

    Example Question:

    Is your throat sore?

    Finding:

    Reports “a little” pain with swallowing

    (Found)

    Pro Tip: Asking your patient about their specific symptoms and the way that they manifest, like if he has ear discharge, will help you to understand his symptoms.

    Example Question:

    Does it hurt when you swallow?

    Medical History

    Finding:

    Confirmed use of medications

    Finding:

    Confirms medications

    (Found)

    Pro Tip: Determining what, if any, medications a patient is taking is a crucial element of a thorough health history and will help you avoid unwanted drug interactions.

    Example Question:

    What medications do you take?

    Finding:

    Reports taking a daily vitamin

    (Found)

    Pro Tip: Asking specifically about vitamin or supplement use is important, because patients don’t always consider these a “medication.”

    Example Question:

    Do you take vitamins?

    Finding:

    Reports taking cough medicine

    (Found)

    Pro Tip: Asking specifically about medications to relieve a condition is a good way to check that a patient is remembering all of his medications Danny Rivera Pediatric Cough Shadow Health Assessment Subjective Data.

    Example Question:

    Are you taking medication for your cough?

    Finding:

    Followed up on cough medicine

    Finding:

    Reports cough medicine was purple

    (Found)

    Pro Tip: Asking about how the patient has been managing their pain assesses their current condition and their approach to self-care. The results of their previous treatment may be helpful in your diagnosis and the development of their new treatment plan, as well as a good opportunity to educate the patient on effective self-care practices.

    Example Question:

    What color was the cough medicine?

    Finding:

    Reports taking one spoonful of cough medicine

    (Found)

    Pro Tip: Asking about how the patient has been managing their pain assesses their current condition and their approach to self-care. The results of their previous treatment may be helpful in your diagnosis and the development of their new treatment plan, as well as a good opportunity to educate the patient on effective self-care practices.

    Example Question:

    How much cough medicine did you take?

    Finding:

    Reports mother gave him the medicine

    (Found)

    Pro Tip: Asking about how the patient has been managing their pain assesses their current condition and their approach to self-care. The results of their previous treatment may be helpful in your diagnosis and the development of their new treatment plan, as well as a good opportunity to educate the patient on effective self-care practices.

    Example Question:

    Who gave you the cough medicine?

    Finding:

    Reports cough medicine provided temporary relief

    (Available)

    Pro Tip: Asking about how the patient has been managing their pain assesses their current condition and their approach to self-care. The results of their previous treatment may be helpful in your diagnosis and the development of their new treatment plan, as well as a good opportunity to educate the patient on effective self-care practices. Danny Rivera Pediatric Cough Shadow Health Assessment Subjective Data.

    Example Question:

    Did the cough medicine make you feel better?

    Finding:

    Asked about allergies

    Finding:

    Denies seasonal allergies

    (Found)

    Pro Tip: Seasonal allergies can cause symptoms like runny nose, cough, and discomfort. Asking Danny if he has seasonal allergies can help you to ascertain possible triggers for symptoms.

    Example Question:

    Do you have seasonal allergies?

    Finding:

    Denies food allergies

    (Found)

    Pro Tip: Knowing if your patient has food allergies is important and relevant medical history. Asking your patient about food allergies will allow you to most effectively treat him.

    Example Question:

    Do you have food allergies?

    Finding:

    Denies medication allergies

    (Found)

    Pro Tip: Knowing if your patient has allergies to medicine is important and relevant medical history. Asking your patient about medicine allergies will allow you to most effectively treat him.

    Example Question:

    Are you allergic to any medicine?

    Finding:

    Denies allergies to animals

    (Available)

    Pro Tip: Asking about allergies to animals is important for a child with respiratory problems, because the issue could be caused or exacerbated by a family pet or recent exposure to an animal.

    Example Question:

    Are you allergic to animals?

    Finding:

    Denies latex allergy

    (Available)

    Pro Tip: Confirming absence or presence of a latex allergy is essential in a hospital setting, where some instruments have latex parts.

    Example Question:

    Are you allergic to latex?

    Finding:

    Asked about relevant medical history

    Finding:

    Denies asthma diagnosis

    (Found)

    Pro Tip: Asthma is a serious medical condition that can be life-threatening if not managed appropriately. Regardless of the patient’s presenting illness, it is critical to identify current medical conditions in order to treat the patient appropriately. Danny Rivera Pediatric Cough Shadow Health Assessment Subjective Data. Specific questions should be asked about previous medical problems, even if the patient doesn’t notice current symptoms.

    Example Question:

    Do you have asthma?

    Finding:

    Reports immunizations as current

    (Found)

    Pro Tip: A health assessment should include an evaluation of the patient’s immunization status in order to identify diseases to which the patient is vulnerable.

    Example Question:

    Do you have current immunizations?

    Finding:

    Reports past pneumonia and frequent coughs

    (Found)

    Pro Tip: Respiratory conditions extremely limit one’s ability to function in normal life activities. It’s important to identify the patient’s health conditions in order to care for her safely and effectively. Danny Rivera Pediatric Cough Shadow Health Assessment Subjective Data.

    Example Question:

    Do you have a history of respiratory problems?

    Finding:

    Denies past hospitalizations

    (Available)

    Pro Tip: Asking about previous hospitalizations will give you a broader understanding of the patient’s medical history in addition to guiding your assessment of their chief complaint.

    Example Question:

    Have you ever been to the hospital?

    Social History

    Finding:

    Asked about exposure to secondhand smoke

    Finding:

    Reports father smokes cigars

    (Found)

    Pro Tip: Secondhand smoke puts the patient at risk for many medical conditions may exacerbate breathing problems associated with a respiratory complaint. Knowing about household exposure to irritants such as smoke will help you know about potential sources of Danny’s complaint.

    Example Question:

    Who smokes at home?

    Finding:

    Reports father sometimes forgets to take cigars outside

    (Available)

    Pro Tip: Secondhand smoke puts the patient at risk for many medical conditions may exacerbate breathing problems associated with a respiratory complaint. Knowing about household exposure to irritants such as smoke will help you know about potential sources of Danny’s complaint.

    Example Question:

    Where does your father smoke?

    Review of Systems

    Finding:

    Asked about general symptoms

    Finding:

    Reports frequent colds

    (Found)

    Pro Tip: Asking about the patient’s susceptibility to colds is should guide your assessment.

    Example Question:

    Do you have unusually frequent colds?

    Finding:

    Denies fever

    (Found)

    Pro Tip: Soliciting a shallow history of your patient’s symptoms will help you to most effectively treat him. Asking Danny if he has a fever will illustrate the way his symptoms manifest.

    Example Question:

    Do you have a fever?

    Finding:

    Denies chills

    (Found)

    Pro Tip: Soliciting a shallow history of your patient’s symptoms will help you to most effectively treat him. Asking Danny if he has chills will illustrate the way his symptoms manifest. Danny Rivera Pediatric Cough Shadow Health Assessment Subjective Data Danny Rivera Pediatric Cough Shadow Health Assessment Subjective Data

    Example Question:

    Do you have chills?

    Finding:

    Reports reports feeling “kind of tired”

    (Found)

    Pro Tip: Soliciting a shallow history of your patient’s symptoms will help you to most effectively treat him. Asking Danny if he has fatigue will illustrate the way his symptoms manifest.

    Example Question:

    Do you have fatigue?

    Finding:

    Denies night sweats

    (Found)

    Pro Tip: Soliciting a shallow history of your patient’s symptoms will help you to most effectively treat him. Asking Danny if he has night sweats will illustrate the way his symptoms manifest.

    Example Question:

    Do you have night sweats?

    Finding:

    Denies weight loss

    (Available)

    Pro Tip: Soliciting a shallow history of your patient’s symptoms will help you to most effectively treat him. Asking Danny if he has lost weight will illustrate the way his symptoms manifest.

    Example Question:

    Have you lost weight?

    Finding:

    Denies appetite loss

    (Available)

    Pro Tip: Soliciting a shallow history of your patient’s symptoms will help you to most effectively treat him. Asking Danny about his appetite will illustrate the way his symptoms manifest.

    Example Question:

    Have you lost your appetite?

    Finding:

    Asked about review of systems for HEENT

    Finding:

    Denies ear popping or crackling

    (Available)

    Pro Tip: Asking your patient about their specific symptoms and the way that they manifest, like if he has any ear popping, will help you to understand his symptoms.

    Example Question:

    Do you hear any popping sounds?

    Finding:

    Reports history of frequent ear infections

    (Available)

    Pro Tip: Asking your patient about their specific symptoms and the way that they manifest, like if he has ear infections, will help you to understand his symptoms.

    Example Question:

    Have you ever had ear infections?

    Finding:

    Denies ear surgery or ear tubes

    (Available)

    Pro Tip: It is important to ask your patient about past surgeries to better understand the scope of previous treatment as well as rule out possible complications that may be resulting in the patient’s condition.

    Example Question:

    Have you ever had surgery on your ears?

    Finding:

    Denies headaches

    (Found)

    Pro Tip: Headaches are a common complaint that can be caused by a variety of benign conditions. However, headaches can be an indicator of serious underlying neurological conditions such as cerebral hemorrhage, meningitis, or brain tumors. They may also be a symptom of sinus infection.

    Example Question:

    Do you get headaches?

    Finding:

    Denies nosebleeds

    (Found)

    Pro Tip: Infected sinuses can manifest as nose problems. Asking Danny about his nasal symptoms solicits information about his sinuses and possible sinus problems. Danny Rivera Pediatric Cough Shadow Health Assessment Subjective Data.

    Example Question:

    Do you have nosebleeds?

    Finding:

    Denies vision problems

    (Found)

    Pro Tip: Eye or vision problems can lower one’s ability to function and can be a major safety risk.

    Example Question:

    Do you have any problems with your vision?

    Finding:

    Denies dizziness

    (Found)

    Pro Tip: Asking about dizziness assesses for inner ear, neurological, or cardiovascular problems.

    Example Question:

    Do you have any dizziness?

    Finding:

    Denies watery eyes

    (Found)

    Pro Tip: Eye or vision problems can lower one’s ability to function and can be a major safety risk.

    Example Question:

    Do you have watery eyes?

    Finding:

    Denies eye redness

    (Found)

    Pro Tip: Eye or vision problems can lower one’s ability to function and can be a major safety risk.

    Example Question:

    Do you have eye redness?

    Finding:

    Denies eye pain

    (Found)

    Pro Tip: Sinusitis can create pressure behind the eyes, causing eye pain. Asking Danny whether he is experiencing eye pain solicits information about possible symptoms.

    Example Question:

    Do you have any eye pain?

    Finding:

    Denies sinus pain

    (Found)

    Pro Tip: Infected sinuses can manifest as nose problems. Asking Danny about his nasal symptoms solicits information about his sinuses and possible sinus problems.

    Example Question:

    Do you have any sinus pain?

    Finding:

    Denies hearing problems

    (Found)

    Pro Tip: Asking your patient about their specific symptoms and the way that they manifest, like if he has hearing problems, will help you to understand his symptoms.

    Example Question:

    Do you have any hearing problems?

    Finding:

    Asked about review of systems for respiratory

    Finding:

    Denies difficulty breathing

    (Found)

    Pro Tip: It’s important to ask about episodes of shortness of breath because ineffective breathing can be life-threatening. Shortness of breath can be caused by respiratory or cardiac conditions, allergies, or exercise.

    Example Question:

    Do you have difficulty breathing?

    Finding:

    Denies chest tightness

    (Found)

    Pro Tip: Chest pain may indicate cardiac conditions, muscular inflammation, gastric upset, or respiratory distress. If chest tightness is present, asking about its location, characteristics, and related factors helps to determine the cause of the discomfort. Danny Rivera Pediatric Cough Shadow Health Assessment Subjective Data.

    Example Question:

    Do you have chest tightness?

    Finding:

    Denies chest pain

    (Found)

    Pro Tip: Chest pain may indicate cardiac conditions, muscular inflammation, gastric upset, or respiratory distress. If chest pain is present, asking about its location, characteristics, and related factors helps to determine the cause of the discomfort.

    Example Question:

    Do you have any chest pain?

    Finding:

    Reports no history of inhaler use or breathing treatments

    (Available)

    Pro Tip: Respiratory conditions extremely limit one’s ability to function in normal life activities. It’s important to identify the patient’s health conditions in order to care for her safely and effectively.

    Example Question:

    Have you ever used a medicine that you inhaled?

    Family History

    Finding:

    Asked about relevant family history

    Finding:

    Reports not being around anyone ill at home

    (Available)

    Pro Tip:

    Example Question:

    Is anyone sick at your house?

    Finding:

    Reports father had asthma as a child

    (Found)

    Pro Tip: Medical problems that are present in a patient’s immediate family can represent increased risk factors to many medical conditions for the patient.

    Example Question:

    Do you have a family history of asthma?

    Finding:

    Denies family history of allergies

    (Found)

    Pro Tip: Medical problems that are present in a patient’s immediate family can represent increased risk factors to many medical conditions for the patient. Danny Rivera Pediatric Cough Shadow Health Assessment Subjective Data.

    Example Question:

    Do you have a family history of allergies?

    Finding:

    Denies pets at home

    Danny Rivera Pediatric Cough Shadow Health Assessment Subjective Data

  • NR451 – Apply the components of the iCARE concept to interprofessional teams

    NR451 – Apply the components of the iCARE concept to interprofessional teams

    Title

    Your Name

    Chamberlain College of Nursing

    NR451 RN Capstone Course

    Term and Year

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    Your title here

    This paragraph(s) is to introduce the paper.
    Explain the type of work setting you are discussing and whether interprofessional teams are present. If present, indicate a team function that could be improved.  If not present, indicate what type of team you think might work well in this setting and how it might function.
    Remember this is a scholarly APA assignment so you cannot use first person. Remember also that you will keep all the bolded headings and just remove the non-bolded content when you start your paper. NR451 – Apply the components of the iCARE concept to interprofessional teams

    Compassion

    In this paragraph, describe
    a nursing action that could contribute to compassion
    through interprofessional team support; describe how this might impact the culture of your unit or organization; and possible impact on patient outcomes.

    Advocacy

    In this paragraph, describe
    a nursing action that could contribute to advocacy
    through interprofessional team support; describe how this might impact the culture of your unit or organization; and possible impact on patient outcomes. NR451 – Apply the components of the iCARE concept to interprofessional teams

    Resilience

    In this paragraph, describe
    a nursing action that could contribute to resilience
    through interprofessional team support; describe how this might impact the culture of your unit or organization; and possible impact on patient outcomes.

    Evidence-Based Practice

    In this paragraph, describe
    a nursing action that could contribute to evidence-based

    practice
    through interprofessional team support; how this might impact the culture of your unit or organization; and possible impact on patient outcomes. NR451 – Apply the components of the iCARE concept to interprofessional teams

    Summary

    Provide a clear and concise summary. Include a summary statement of how iCARE components can support interprofessional teams and patient outcomes through nursing actions.  Address how you may be able to influence this process of support for interprofessional teams on your unit or in your organization.

     

    References

    Select at least one scholarly nursing article from CINAHL as a resource for your paper. Additional scholarly sources can be used but are optional.

     

    Purpose

    The purpose of the iCARE Paper assignment is to explore the concept of interprofessional teams and patient outcomes. Nursing supportive actions of compassion, advocacy, resilience, and evidence-based practice will serve as a way to apply care concepts.

    Course Outcomes

    This assignment enables the student to meet the following course outcomes:

    CO1: Applies principles of nursing, theories, and the care philosophies to self, colleagues, individuals, families, aggregates and communities throughout the healthcare system. (PO#1)

    CO6: Plans clinical practice activities that integrate professional nursing standards in accordance with the Nursing Code of Ethics and the American Nurses’ Association (ANA) standards of practice. (PO#6) NR451 – Apply the components of the iCARE concept to interprofessional teams

    Points

    The assignment is worth 200 points.

    Due Date

    Submit your completed assignment by Sunday end of Week 5 by 11:59 p.m. MT.

    Directions

    Please review the infographic as way to guide you in getting started with your assignment: Developing an Assignment with Integrity (Links to an external site.)

    Getting Started: Interprofessional teams are part of practice trends we see developing in all aspects of care delivery. Consider you own work environment (or recent clinical setting).

    • For this assignment, consider the concept of interprofessional teamwork and patient outcomes.

    • Look to your current workplace as an example. (If you are not currently employed, look to a past workplace or clinical practice area.) NR451 – Apply the components of the iCARE concept to interprofessional teams

    • Apply the components of the iCARE concept to interprofessional teams in a short paper. (Body of the paper to be 3 pages, excluding the title page and references page)

    • iCARE components are:

    C ompassion

    A dvocacy

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    R esilience

    E vidence-Based Practice (EBP)

    • How could you contribute to an interprofessional team and patient outcomes through nursing actions of: compassion, advocacy, resilience, and evidence-based practice?

    • Select one scholarly nursing article from CINAHL as a resource for your paper. Additional scholarly sources can be used but are optional. When searching in the CINAHL database, please limit your search word to one component of the paper you wish to emphasize, such as ‘Resilience’. Searching for the term iCARE will not produce the results you need. NR451 – Apply the components of the iCARE concept to interprofessional teams

    • Use APA format throughout, particularly in citations and on the References page.

    • Please paraphrase throughout. One short quote is permitted.

    • The prepared paper template is RECOMMENDED for this assignment.

    Download the assignment template here:

    iCare Assignment Template (Links to an external site.) – APA 6th edition

    iCare Assignment Template (Links to an external site.) – APA 7th edition

    A short tutorial with tips for completing this assignment may be viewed here: iCARE Paper Tutorial (Links to an external site.)

    Elements of iCARE paper

    • Title page

    • Below are the headings to be used for this assignment.

    • Introduction: (No heading needed here in APA) Explain the type of work setting you are discussing and whether interprofessional teams are currently present. If interprofessional teams are present, indicate a team function that could be improved. If interprofessional teams are NOT present, indicate what type of team you think might be possible in the setting. NR451 – Apply the components of the iCARE concept to interprofessional teams

    Describe a nursing action item for each component below that could contribute to: interprofessional team support; how this might impact the culture of your unit or organization; and possible impact on patient outcomes.

    • Compassion

    • Advocacy

    • Resilience

    • Evidence-Based Practice

    • Summary: Include a summary statement of how iCARE components can support interprofessional teams and patient outcomes. Address how you may be able to influence this process of support for interprofessional teams overall in your unit or organization.

    • References page: List any references used in APA format. NR451 – Apply the components of the iCARE concept to interprofessional teams

  • Supportive Psychotherapy Versus Interpersonal Psychotherapy

    Supportive Psychotherapy Versus Interpersonal Psychotherapy

    Briefly describe how supportive and interpersonal psychotherapies are similar.

    Explain at least three differences between these therapies. Include how these differences might impact your practice as a mental health counselor.

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    Explain which therapeutic approach you might use with clients and why. Support your approach with evidence-based literature. Supportive Psychotherapy Versus Interpersonal Psychotherapy.

  • Practicum: Decision Tree

    Practicum: Decision Tree

    For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat adult and older adult clients presenting symptoms of a mental health disorder.

    Learning Objectives

    Students will:

    Evaluate clients for treatment of mental health disorders

    Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders

    Examine Case 2: You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical, as well as mental factors that might impact the client’s diagnosis and treatment. Practicum: Decision Tree

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    At each Decision Point stop to complete the following:

    Decision #1: Differential Diagnosis

    Which Decision did you select?

    Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

    What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources. Practicum: Decision Tree

    Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?

    Decision #2: Treatment Plan for Psychotherapy

    Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

    What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

    Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?

    Decision #3: Treatment Plan for Psychopharmacology

    Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

    What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources. Practicum: Decision Tree

    Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

    Also include how ethical considerations might impact your treatment plan and communication with clients and their family.

    Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. Practicum: Decision Tree

    // A young woman with Depression

    Case #2

    A young woman with Depression

    SUBJECTIVE

    Stefanie is a 32-year-old female from Puerto Rico who presents to your office today with complaints of difficulty sleeping. You learn that Stefanie can go for a few days with minimal sleep (about 3 hours/night), but does not seem to be fatigued the next day. Stefanie explains that after 3 days with minimal sleep, she “crashes” and has a good night’s sleep. She states that sleep will be “alright” for a few days, even a few weeks, and then she will have a similar issue with sleep.

    You learn throughout the assessment process that Stefanie has had this problem for years. She noticed that it began in college and thought it was just because of the workload and academic demands. However, she found that it persisted after college. She also notices that she has periods where she will engage in increased amounts of goal-directed activity. She states that things will just “pile up” at work and she gets this burst of energy to “make everything right.” She states that these bursts will last most of the day. She states that these periods show up probably every 2 to 3 weeks. Practicum: Decision Tree

    Stefanie also confesses to problems with being “down in the dumps.” She states that when she has her episodes in which she endeavors to “make everything right,” she feels fantastic and on top of the world. However, when these periods of energy end, she reports that she feels “depressed”—but then states: “well, maybe not depressed, but I definitely feel sad and empty.” She also endorses feelings of fatigue and a decreased ability to concentrate when she is feeling sad. She finally tells you: “I have lived with this for so long, I have to admit that it is finally a relief to tell someone how I feel!”

    OBJECTIVE

    Stefanie is dressed appropriately to the weather. She has no gait abnormalities. Physical assessment is unremarkable. Gross neurological assessment is within normal limits.

    MENTAL STATUS EXAM

    Stefanie is alert and oriented × 4 spheres. Her speech is clear, coherent, goal directed, and spontaneous. Self-reported mood is “sad.” Affect does appear consistent with dysphoria. Eye contact is normal. Speech is clear, coherent, and goal directed. She denies visual or auditory hallucinations. No overt evidence of paranoid or delusional thought processes noted. She denies suicidal or homicidal ideation and is future oriented.

    At this point, please discuss any additional diagnostic tests you would perform on Stefanie.

    Decision Point One Practicum: Decision Tree

    BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PSYCHIATRIC/MENTAL HEALTH NURSE PRACTITIONER (PMHNP) GIVE TO STEFANIE?

    In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis. Practicum: Decision Tree

    Bipolar I, current phase, depressed

    Bipolar II, current phase, hypomanic

    Cyclothymic disorder

    Decision Point One

    Bipolar I, current phase, depressed

    Bipolar I, current phase, depressed

    Decision Point Two

    BASED ON THIS DIAGNOSIS, SELECT YOUR CHOICE OF ACTIONS:

    Begin Latuda 40 mg orally daily

    Lamictal 100 mg orally daily

    Begin psychotherapy using a psychodynamic approach

    Decision Point One

    BipBipolar II, current phase, hypomanic

    olar II, current phase, hypomanic

    Decision Point Two

    BASED ON THIS DIAGNOSIS, SELECT YOUR CHOICE OF ACTIONS:

    Begin Lithium 300 mg orally twice a day

    Begin Olanzapine 10 mg orally at bedtime

    Begin Abilify 10 mg orally daily Practicum: Decision Tree

    Cyclothymic disorder

    Cyclothymic disorder

    Decision Point Two

    BASED ON THIS DIAGNOSIS, SELECT YOUR CHOICE OF ACTIONS:

    Begin Depakote 250 mg orally three times daily

    Begin Abilify 10 mg orally daily

    Arrange to see Stefanie every 3 months for routine follow-up Practicum: Decision Tree

  • “Captain of the Ship” Project – Obsessive-Compulsive Disorders

    “Captain of the Ship” Project – Obsessive-Compulsive Disorders

    In earlier weeks, you were introduced to the concept of the “captain of the ship.” In this Assignment, you become the “captain of the ship” as you provide treatment recommendations and identify medical management, community support resources, and follow-up plans for a client with an obsessive-compulsive disorder.

    Students will:

    • Recommend psychopharmacologic treatments based on therapeutic endpoints for clients with obsessive-compulsive disorders “Captain of the Ship” Project – Obsessive-Compulsive Disorders

    • Recommend psychotherapy based on therapeutic endpoints for clients with obsessive-compulsive disorders

    • Identify medical management needs for clients with obsessive-compulsive disorders

    • Identify community support resources for clients with obsessive-compulsive disorders

    • Recommend follow-up plans for clients with depression disorders

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    To prepare for this Assignment:

    • Select an adult or older adult client with an obsessive-compulsive disorder you have seen in your practicum.

    In 3–4 pages, write a treatment plan for your client in which you do the following:

    • Describe the HPI and clinical impression for the client.

    • Recommend psychopharmacologic treatments and describe specific and therapeutic endpoints for your psychopharmacologic agent. (This should relate to HPI and clinical impression.)

    • Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices. “Captain of the Ship” Project – Obsessive-Compulsive Disorders.

    • Identify medical management needs, including primary care needs, specific to this client.

    • Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client.

    • Recommend a plan for follow-up intensity and frequency and collaboration with other providers.

    “Captain of the Ship” Project – Obsessive-Compulsive Disorders

    In earlier weeks, you were introduced to the concept of the “captain of the ship.” In this Assignment, you become the “captain of the ship” as you provide treatment recommendations and identify medical management, community support resources, and follow-up plans for a client with an obsessive-compulsive disorder.

    Students will:

    • Recommend psychopharmacologic treatments based on therapeutic endpoints for clients with obsessive-compulsive disorders

    • Recommend psychotherapy based on therapeutic endpoints for clients with obsessive-compulsive disorders

    • Identify medical management needs for clients with obsessive-compulsive disorders. “Captain of the Ship” Project – Obsessive-Compulsive Disorders.

    • Identify community support resources for clients with obsessive-compulsive disorders

    • Recommend follow-up plans for clients with depression disorders

    To prepare for this Assignment:

    • Select an adult or older adult client with an obsessive-compulsive disorder you have seen in your practicum.

    In 3–4 pages, write a treatment plan for your client in which you do the following:

    • Describe the HPI and clinical impression for the client.

    • Recommend psychopharmacologic treatments and describe specific and therapeutic endpoints for your psychopharmacologic agent. (This should relate to HPI and clinical impression.)

    • Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices. “Captain of the Ship” Project – Obsessive-Compulsive Disorders

    • Identify medical management needs, including primary care needs, specific to this client.

    • Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client.

    • Recommend a plan for follow-up intensity and frequency and collaboration with other providers. “Captain of the Ship” Project – Obsessive-Compulsive Disorders

  • Professionalism and Social Media Essay

    Professionalism and Social Media Essay

    Social media plays a significant role in the lives of nurses in both their professional and personal lives. Additionally, social media is now considered a mainstream part of the process for recruiting and hiring candidates. Inappropriate or unethical conduct on social media can create legal problems for nurses as well as the field of nursing.

    Login to all social media sites in which you engage. Review your profile, pictures and posts. Based on the professional standards of nursing, identify items that would be considered unprofessional and potentially detrimental to your career and that negatively impact the reputation of the nursing field. Professionalism and Social Media Essay

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    In 500-750 words, summarize the findings of your review. Include the following:

    Describe the posts or conversations in which you have engaged that might be considered inappropriate based on the professional standards of nursing Professionalism and Social Media Essay.

    Discuss why nurses have a responsibility to uphold a standard of conduct consistent with the standards governing the profession of nursing at work and in their personal lives. Include discussion of how personal conduct can violate HIPAA or be considered unethical or unprofessional. Provide an example of each to support your answer.

    Based on the analysis of your social media, discuss what areas of your social media activity reflect Christian values as they relate to respecting human value and dignity for all individuals. Describe areas of your social media activity that could be improved.

    Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

    This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

    You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance. Professionalism and Social Media Essay