Tag: Clinical-Nursing

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.

ORDER A PLAGIARISM-FREE PAPER OR SHADOW HEALTH HERE

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.

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

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

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

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

 

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

 

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

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

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

Nursing essays online

Do you need help with your nursing essays? Welcome to our nursing essays online support. With our professional and experienced nursing writers, you will achieve greatness in your nursing career.

Nursing essay writing can be challenging if you lack the time or necessary skills. Students often go online looking for help writing nursing essays. Most of them land in the wrong hands as they have no idea how to select the best website to help with nursing essays.

BUY ESSAY HERE

Benefits of getting nursing essays online help

What is the
best nursing essay writing service
? Many websites offer online nursing essay help. However, not all offer quality help to help you achieve your dream grades. Here are the reasons you should seek nursing essay writing help from our website;

Quality nursing papers

Professional writers

Timely delivery

Affordable nursing essays online

24/7 customer service availability

Easy communication

Money back guarantee

Reliable means of payment

Customer satisfaction guarantee

How do you start a nursing essay?

Understand the requirements of the essay

Find an interesting topic

Research

Create an outline

Write an introduction

Write the body paragraphs

Write the conclusion

Edit and proofread your nursing essay

Nursing essays help online

Online nursing essay assistance has become extremely popular among medical students. Considering the nature of medical and nursing education programs, you shouldn’t be surprised by this happening.

According to research, nursing essay aid can make your experience in the school of nursing smoother. We want to accompany you on this fantastic adventure. We ensure that your nursing career starts on the right foot by offering the support you require. We make sure to handle the theory portion of schooling while letting you focus on your practical classes.

Get online assignment help from experts

There are undoubtedly several companies that provide personalized nursing essays online. These websites additionally offer services like nursing papers. On the other hand, we have advanced this. With your needs in mind, we created our online medical essay assistance.

We now operate in a unique manner as a result of realizing how important grades are to your nursing program. For example, we have authors from nations that speak English as their first language, including the UK, Canada, and the US. Our authors ensure your work is written in the best possible English, with perfect grammar.

Have expert writers handling your nursing essays

We consciously tried to only work with highly qualified and experienced writers. We employ writers with a nursing bachelor’s degree, a master’s degree in Nursing, and even a PhD in Nursing as a component of our policy. No matter how complex or advanced they may be, all of your medical papers will be handled by us. In other terms, the nursing essay writers in our group are capable of handling your PhD, master’s, and bachelor’s level nursing papers. Because of this, be aware that only competent authors will be employed when you ask us for help with your nursing project.

You only have a finite amount of time as a student nurse to do a number of different things. You need to maintain a social life. Attending classes is required. Practical nursing tasks must be completed. Also, you must get ready for both sit-in and verbal exams. In total, these tasks must be completed in less than seven hours. Even if one is able to do this, fatigue will undoubtedly occur. It is crucial that one uses online nursing paper help services because of this.

Can you write my nursing paper online?

Indisputably yes, we have pledged as a business to take care of you no matter what you toss at us. When you pose such a query, you imply that we are incapable. Nonetheless, we can relate to you because doubt has always been a characteristic of humanity. Yet, as our customer reviews demonstrate, we have skilled nursing paper authors who can manage just about everything.

Do you need help with your nursing essays? Do you need to do a nursing thesis? With your nursing final project, are you concerned about your nursing lab report? Our team takes care of it all and more for you. Thus, don’t be frightened to buy today and use our professional nursing services without worrying.

How to get our nursing essays online help

How can I get help with my nursing essay? This is probably the question flowing into your mind now. We are glad to inform you that we are only a few clicks away from getting quality nursing essay help. Here are the steps;

Please create an account with us

Tell us the essay requirements

Choose a writer

Pay for online essay help

Track the process

Download your essay

Submit for marking

Is your nursing essay writing service secure?

One of the fundamental principles of our medical paper assignment help is protecting your privacy. We, therefore, promise that the fact that you have contacted us and any information you may have given throughout the process will never be disclosed to third parties.

The essential facts of the order are known to the skilled professional in your essay. Your private information is kept confidential. Please don’t hesitate to contact our customer care if you need more information about our privacy policy.

We do not ask for your personal information when placing an order with us. You only need to create an account using your name and email. Our website is well encrypted to ensure no authorized access can occur. You don’t have to be concerned about privacy when you tell us to help with your nursing essays.

The best writers for your nursing essays online

Request our writing assistance to guarantee that we will assign the best author for your assignment. Because they comprehend more complex ideas than someone who relies on research, our editing team prefers to work with writers with advanced nursing degrees. You can also ask about academic credentials. Another essential quality of our authors is their enthusiasm for helping our customers write persuasive essays which persuade the reader of their point of view.

Our expert writers can handle different forms of nursing essays, including expository, argumentative, and analytical essays, can be written by our essay writers. We also produce outstanding application essays for students applying to nursing programs.

How long should nursing essay be? Even if an essay is brief, it still needs to employ engaging vocabulary to draw readers in. Ask for our essay assistance, and we’ll put one of our skilled writers to work convincingly, introducing your point of view and convincing the reader of its validity.

Price includes;

Free unlimited revisions

Outline

Free title page

Free originality report

The best writer

Free formatting

Order nursing essays online to achieve dream grades

There are various ways to provide a service, but we have opted to offer it online because it’s more practical for our customers. You may find writing assistance for nursing essays anywhere. Also, we save money since the internet purchase process is straightforward. Locate us online and create an account with us.

After providing details about your nursing essay, such as the intellectual level, spacing, number of pages, and deadline, you will receive a pricing quote.

Online writing assistance makes learning more about our online writing services simple. A form for contacting us that includes options for an enquiry, an email address, and contact information. Inquiries will receive prompt attention. Customers can track the writing process online, submit any secondary sources, and obtain essays as soon as they finish.

Professional nursing essay writers are available to you!

Are you concerned about the nursing essay you must complete in a short while? Believe us and use our professional assignment assistance. The master’s and PhD trained writers with more than ten years of experience serving at our company are experts in their field and will make sure to pay close attention to your needs and demands.

No matter how quickly you need the task completed in 12 hours or 24. Our writers are highly qualified and skilled enough to provide excellent papers in just 3 hours. No matter how little time is available, the quality is always maintained! Why are you holding out? Contact us right away, and we’ll help you get excellent scores!

Get various nursing essays online

What should a nursing essay include? With our nursing essay help, you don’t need to worry about such concerns. Our nursing essay writers can help with any nursing essay. This includes;

Nursing essays

Nursing dissertations

Nursing theses

Nursing term paper

Nursing personal statement

Nursing research papers

Nursing research proposal

Nursing online papers

Buy nursing essays online now

Are you stuck writing your essay and feel like you need nursing essays online help? Search no more. We have a long-term solution for you. Get the best writers to help you achieve your dream grades in your nursing career. Click to place an order with us now.