Tag: Clinical-Nursing

SWOT and Cost analysis

A SWOT analysis provides an opportunity for an organization to consider its own strengths and weaknesses. It also requires a look at the organization’s environment, to consider opportunities and threats. A SWOT analysis can be a powerful tool to help leaders make decisions about which ideas to pursue as opportunities based on their current strengths and what is happening (or projected to happen) in the environment in which they operate.

This week, you examine how nurse leaders can use SWOT analyses to strengthen the business case for a proposed idea. You also examine how SWOT analyses can be combined with cost analyses to help provide insight that can impact budgets. SWOT and Cost analysis

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Learning Objectives

Students will:

Analyze the drivers of revenues and operating costs

Analyze the drivers of revenues and operating costs for healthcare products and service solutions

Learning Resources

Required Readings (click to expand/reduce)

Note: To access this week’s library resources, please click on the link to the Course Readings List found in your Syllabus.

Penner, S. J. (2016). Economics and financial management for nurses and nurse leaders (3rd ed.). New York, NY: Springer Publishing Company.

Chapter 8, “Reporting and Managing Budgets” (pp. 111–136)

Chapter 9, “Budget Planning” (pp. 141–161)

Ramsey, Z., Palter, J. S., Hardwick, J., Moskoff, J., Christian, E. L., & Bailitz, J. (2018). Decreased nursing staffing adversely affects emergency department throughput metrics. Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, 19(3), 496–500. doi:10.5811/westjem.2018.1.36327

Stonehouse, D. (2018). SWOT: What is it all about and how do you use it? British Journal of Healthcare Assistants, 12(12), 617–619. doi:10.12968/bjha.2018.12.12.617 SWOT and Cost analysis

Required Media (click to expand/reduce)

Using and Understanding Financial Analysis Tools

Examine some of the financial analysis tools that are employed by nurse leaders to help inform decision-making for nursing practice. Consider how these tools help nurse leaders make decisions to support both organizational performance and positive patient outcomes. (5m)

Accessible player

Discussion: SWOT and Cost Analysis

How well do you know your organization?

Many of us spend a great deal of time at our workplace, and this often leads us to feel that we know the organization very well. But when it comes to organizational familiarity, there are several levels of understanding. Leaders faced with decisions about investing resources often use tools such as SWOT and cost analyses to truly reflect on the company and on the appropriateness and potential of an investment. SWOT and Cost analysis

Photo Credit: Getty Images/Blend Images

In this Discussion, you will examine the use of these tools. You will reflect on your own proposal, and on the costs and potential revenue streams or other benefits associated with a healthcare product or service. You will also consider the environment in which your organization operates and potential relevant opportunities and threats.

To Prepare

Reflect on the strengths, weaknesses, opportunities, and threats associated with the healthcare product or service you have proposed. SWOT and Cost analysis

Reflect on the costs and potential revenue streams associated with the healthcare product or service you have proposed.

By Day 3 of Week 7

Post a brief description of what you believe to be the strengths, weaknesses, opportunities, and threats of the healthcare product or service you have proposed. Also include a statement considering where costs and revenues fall in your SWOT analysis. Are their weaknesses associated with the costs? In other words, are the costs high enough to represent budgetary issues? Do potential revenue streams represent a strength? Consult with your internal finance counselor, as appropriate. SWOT and Cost analysis

Diversity Project Kickoff Presentation

Overview

Create a 6 slide presentation (with detailed speaker’s notes) on how you would select, foster collaboration among, and educate a team dedicated to solving a diversity issue.

 

Assessment 2 is scenario-based, so you must complete them in the order in which they are presented. Diversity Project Kickoff Presentation

 

Finding, organizing, and motivating teams is a key leadership skill as is the ability to communicate and present information.

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SHOW LESS

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

 

Competency 1: Apply qualities, skills and practices used by effective healthcare leaders.

Outline goals and initial priorities that reasonably reflect the project.

Competency 2: Apply practices that facilitate effective interprofessional collaboration.

Outline a plan that effectively fosters interprofessional group collaboration.

Competency 3: Apply ethical codes and diversity best practices in health care organizations.

Define the composition of a team with characteristics that could effectively address a diversity issue.

Describe the basic characteristics of a diverse and inclusive workplace. Diversity Project Kickoff Presentation

Explain the benefits of promoting and supporting diversity within an organization using scholarly resources.

Competency 4: Produce clear, coherent, and professional written work, in accordance with Capella’s writing standards.

Create an organized presentation that clearly communicates all specified content.

 

 

Assessment Instructions

Overview

 

In this assessment you will continue your work on the project by creating a 6 slide PowerPoint presentation for the diversity project kickoff meeting.

 

Preparation

 

View the PowerPoint Presentation Instructions for guidelines and hints for an effective presentation.

Download the PowerPoint Template found in the resources and use it to complete this assessment.

Scenario

 

Imagine that Lynette follows up with you in an e-mail shortly after reading your views on leadership and collaboration: Diversity Project Kickoff Presentation

 

Hi,

 

Thanks for sending me your thoughts last week on the diversity issue at the clinic. Your next step is to select a team of professionals who can help you in this project and prepare an introduction of the project for a first meeting with them.

 

I want you to prepare a presentation to serve as a brief, but substantive introduction for the first meeting with a group of 4–5 members who will participate on the committee tasked with addressing the diversity issue. Once I review more information about the proposed team I can help you with the recruitment. The presentation should be 5–7 minutes and use 6–8 slides with detailed speaker’s notes so I can understand your approach. Not a lot of time or space, so keep things pretty high level. Do the following:

 

Briefly outline the project goals and highlight 2–3 of the initial priorities to be addressed by the group. Also, explain why they are important.

Explain the composition of the team and why you chose them. Note that you will not know the exact individuals yet, but assume we will recruit the people with the desired qualities and characteristics that you outline in the presentation. Consider the following:

Include a group of professionals you believe can help define the problem and ultimately make recommendations on how to address it.

Make sure each member is either trained in, sensitive to, or has experience with the concept of workplace diversity.

Give some thought to having some members from outside the organization.

Provide member profiles: their diversity, qualifications, experience, internal versus external, and so forth.

Explain your role and describe how the committee will work together and achieve effective interprofessional collaboration. Diversity Project Kickoff Presentation

Describe how the group will communicate. How and when they will meet.

Describe how ideas will be shared and decisions made.

Describe roles, group function, and structure.

Describe the basic characteristics of a diverse workplace.

Provide a convincing argument regarding the benefits of a diverse workforce using support from current research.

Thanks,

 

Lynette

 

Instructions

 

Create a 6 slide presentation in response to the content defined in the above scenario and submit it in the courseroom.

 

Presentation Guidelines

 

Length: 6 PowerPoint slides (not including title slide) that would accompany an approximately 5-minute oral presentation.

Notes: Prepare detailed speaker’s notes describing items on each slide so that the viewer can accurately interpret the deeper meanings and intentions that would have been conveyed orally. Support your claims, arguments, and conclusions with credible evidence from 2–3 current, scholarly or professional sources.

Visuals: Create visuals that are easily read and interpreted. Use colors, fonts, and formatting and other design principles that make the information clear and generally add to the aesthetic of the presentation.

Please refer to the scoring guide for details on how your assessment will be evaluated. Diversity Project Kickoff Presentation

Topic 1: Child and Adolescent Health Risks

As you discovered in this week’s lectures and readings, several populations face multiple health risks across their lifespan. Children and adolescents are a population that is at a higher health risk for obesity. A national movement is underway to reduce risk factors for developing obesity in children. Part of this movement is the ”Let’s Move!” campaign, which is a comprehensive and coordinated initiative to prevent childhood obesity. The initiative emphasizes four primary components: healthy schools, access to affordable and healthy food, raising children’s physical activity levels, and empowering families to make healthy choices. Review Healthy People 2020: Child and Adolescent Health Risks

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Identify risk factors for childhood obesity.

Do the risk factors differ and how do they differ between children and adolescents?

Identify objectives that will combat childhood and adolescent obesity.

Provide suggestions on how community health nurses can contribute to these national health objectives and accomplish the goal of decreasing obesity among this population.

Topic 1: Child and Adolescent Health Risks

As you discovered in this week’s lectures and readings, several populations face multiple health risks across their lifespan. Children and adolescents are a population that is at a higher health risk for obesity. A national movement is underway to reduce risk factors for developing obesity in children. Part of this movement is the ”Let’s Move!” campaign, which is a comprehensive and coordinated initiative to prevent childhood obesity. The initiative emphasizes four primary components: healthy schools, access to affordable and healthy food, raising children’s physical activity levels, and empowering families to make healthy choices. Review Healthy People 2020: Child and Adolescent Health Risks

Identify risk factors for childhood obesity.

Do the risk factors differ and how do they differ between children and adolescents?

Identify objectives that will combat childhood and adolescent obesity.

Provide suggestions on how community health nurses can contribute to these national health objectives and accomplish the goal of decreasing obesity among this population. Child and Adolescent Health Risks

Mrs. J. history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD)

It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.

Evaluate the Health History and Medical Information for Mrs. J., presented below.

Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.

Health History and Medical Information

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Health History

Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity, she continues to smoke two packs of cigarettes a day and has done so for 40 years. Three days ago, she had sudden onset of flu-like symptoms including fever, productive cough, nausea, and malaise. Over the past 3 days, she has been unable to perform ADLs and has required assistance in walking short distances. She has not taken her antihypertensive medications or medications to control her heart failure for 3 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD. Mrs. J. history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD)

Subjective Data

Is very anxious and asks whether she is going to die.

Denies pain but says she feels like she cannot get enough air.

Says her heart feels like it is ”running away.”

Reports that she is exhausted and cannot eat or drink by herself.

Objective Data

Height 175 cm; Weight 95.5kg.

Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.

Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint: all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation.

Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.

Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.

Intervention

The following medications administered through drug therapy control her symptoms:

IV furosemide (Lasix)

Enalapril (Vasotec)

Metoprolol (Lopressor)

IV morphine sulphate (Morphine)

Inhaled short-acting bronchodilator (ProAir HFA)

Inhaled corticosteroid (Flovent HFA)

Oxygen delivered at 2L/ NC

Critical Thinking Essay

In 750-1,000 words, critically evaluate Mrs. J.’s situation. Include the following:

Describe the clinical manifestations present in Mrs. J.

Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed.

Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.

Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend.

Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence.

Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale. Mrs. J. history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD)

Outline COPD triggers that can increase exacerbation frequency, resulting in return visits. Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered.

You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

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

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

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance. Mrs. J. history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD)

NURS 6512:
Advanced Health Assessment and Diagnostic Reasoning – Discussion Diversity and Health Assessments discussion essay examples 

Diversity and Health Assessments

Case #1: “I came for my annual physical exam, but do not want to be a burden to my daughter.” History of Present Illness (HPI): At-risk 86-year-old Asian male – who is physically and financially dependent on his daughter, a single mother who has little time or money for her father’s health needs. According to Dains, Baumann, and Scheibel (2016), an assessment begins with the patient stating their primary concern or reason for the visit. In the case of the 86-year-old Asian male, he is in for his annual physical exam but clearly states that he concerned about burdening his daughter. The patient requires a complete physical exam on this visit, but would also benefit from a comprehensive geriatric assessment (CGA) based on his age but also because of is comment. Functional and social vulnerabilities are challenges characteristic of older populations (Ramani, Furmedge, & Reddy, 2014). Discussion Diversity and Health Assessments discussion essay examples .

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The socioeconomic factor related to this patient is his dependency on his daughter for financial stability. The patient’s daughter is a single mother who does not have money to spend on her father’s health needs. The patient is 86 years old and physically dependent on his daughter, so is unable to contribute to the household both financially or physically. It is unclear if the daughter able to support for her father beyond his health needs. According to Yan, Chan, and Tiwari (2015), Asian cultures prescribe to adult children caring for their elderly parents providing financial support and showing them obedience Discussion Diversity and Health Assessments discussion essay examples . This is based on a Confucian teaching which, according to more recent studies, is being interpreted differently by younger generations who feel that it is dependent on their own circumstances (Yan, Chan, & Tiwari, 2015).

Subjective data obtained from the assessment identified a weight loss of 25 pounds over the past year, multiple bruises on the patient’s upper arms and back, and a history of two falls within the last 6 months. Objective data identified that the patient was hypertensive, even though taking medication for hypertension, and multiple bruises in different stages of healing on his upper arms and back. The patient also has arcus senilus bilaterally, which is common for this age population and does not require intervention. The bruises, weight loss, and hypertension need to be addressed. Discussion Diversity and Health Assessments discussion essay examples .

Sensitive Issues

The patient’s assessment is affected by cultural beliefs and behaviors and the relationship with the family should be explored (Ball, Dains, Flynn, Solomon, & Stewart, 2015). Ball et al. (2015) also indicate that older patients who are physically impaired are at higher risk for elder abuse. A conversation regarding the bruises is a sensitive subject particularly because Asian populations are hesitant to report elder abuse as it is considered a family matter (Yan, Chan, & Tiwari, 2015). According to Yan, Chan, and Tiwari (2015), discussing the potential elder abuse with a third party is considered shameful in Asian culture because the behavior may be seen as a reflection of poor parenting. Addressing the hypertension should include assessing if the patient is taking his medication, which may identify if the daughter is purchasing the medication or not Discussion Diversity and Health Assessments discussion essay examples . This is a sensitive issue because the patient does not want to burden his daughter and may not want to indicate that his daughter is neglecting his needs.

Older adults require health care that goes beyond medical management and includes evaluation of issues such as physical, financial, and environmental aspects that impact their health (Ramani, Furmedge, & Reddy, 2014). Identifying problems with the patient’s social support can aid in obtaining resources for the patient and choices can be made regarding outcomes most important to the patient and his daughter (Ramani, Furmedge, & Reddy, 2014). Lastly, the patient is functionally impaired and may qualify for state or local benefits depending on his income (Ramani, Furmedge, & Reddy, 2014) and since he is being supported by his daughter, this may alleviate the burden on her and improve his access to medications and care that he requires. Discussion Diversity and Health Assessments discussion essay examples .

Targeted Questions

How do you take your medications each day?

What do you normally eat and drink each day?

Are you able to get around okay at home?

Do you feel safe at home?

Would you like help with things at home such as bathing, dressing, and mobility?

Do you often feel sad or depressed?

Discussion Diversity and Health Assessments discussion essay examples

References

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

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). 
Advanced health assessment and clinical diagnosis in primary care 
(5th ed.). St. Louis, MO: Elsevier Mosby.

Ramani, L., Furmedge, D. S., & Reddy, S. H. (2014). Comprehensive geriatric assessment.
British Journal of Hospital Medicine (London, England: 2005)
,
75
(8), C122-C125.

Yan, E., Chan, K., & Tiwari, A. (2015). A Systematic Review of Prevalence and Risk Factors for Elder Abuse in Asia.
Trauma, Violence & Abuse
,
16
(2), 199-219 21p. doi:10.1177/152483801455503

 

 

NURS 6512: Advanced Health Assessment

Diversity and Health Assessment

     Cultural competence is the gradually developed capacity of nurses and healthcare providers to provide safe and quality healthcare to clients of different background (Duan-Ying, 2016). Cultural competence involves recognizing one’s own culture, values, and biases, and using effective patient-centered communication skills (Ball et al., 2015). To be culturally competent, the practitioner must be able to respond to the cultural diversity of her or his patients and adapt to the unique needs of patients from the cultural and spiritual background different from her or his own (Ball et al., 2015). For this forum, the cultural health assessment of MR, the 23-year-old Native American male will be discussed.

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Case 3: Culturally Competent Health Assessment of the 23-year-old Native American Male

MR, a 23-year-old Native American presents with complain of anxiety, history of smoking “pot,” alcoholism, a family history of diabetes, hypertension, and alcoholism. He is afraid of the adverse outcomes of his lifestyle choices. He is not currently on prescription medication and denies drug use. He needs some prescriptions to help him with his anxiety.

According to Espey at al. (2013), “American Indians in the United have long endured a legacy of injustice and discrimination with multiple negative manifestations, including alarming health disparities and inadequate healthcare.” Patterns of mortality among Native Americans are strongly influenced by the high incidence of diabetes, smoking prevalence, problem drinking, and social determinants (Epsey et al., 2013). For many young Native Indian Americans like MR, the problem of poor health, smoking, and alcohol abuse can be explained by poverty, unemployment, and lack of education. Sarche & Spicer (2008) state that more than one-quarter of American Indian and Alaskan Native is living in poverty, a rate that is more than double of that of the general population. The discrepancy in education and employment is also found and overall, there are fewer individuals within the American Indian and Alaska community who possess a high school diploma or GED (71% versus 80%) or a bachelor degree (11% versus 24.4%) (Sarche & Spicer, 2008). The social determinants of health including poor-socioeconomic status, poor education, low income as well as unhealthy lifestyle and poor access to healthcare services play a major role in MR’s anxiety, alcohol use, and “pot” smoking Discussion Diversity and Health Assessments discussion essay examples . MR health seeking behavior is related to his spiritual beliefs that he might not “get into heaven” if he continues to have an unhealthy lifestyle. This attitude is an excellent initiative towards a healthier lifestyle.

                           Addressing critical issues when interacting with the patient

According to scenario 3, MR has multiple health risks. He has a family history of hypertension, diabetes, and alcoholism. He is a current “pot” smoker, alcohol drinker, and a very anxious young man looking for prescriptions against anxiety. Anxiety is one the withdrawal symptoms and therefore, MR may have drug addiction issue. This patient may need a psychiatric consult for better assessment of his drug addiction status. He is also at risk for cardiovascular diseases and lung cancer related to “pot” smoking, hypertension and diabetes-related to family history and alcoholism. Discussion Diversity and Health Assessments discussion essay examples

Targeted Questions

1-    How are you doing today? How can I help you with your visit?

2-    You stated that you have been smoking “pot.” How long have you been smoking?

3-    What do you think is the cause of your anxiety?

4-    You stated that drinking alcohol can help cope with your anxiety. How many drinks do you have in one day?

5-    Have you ever felt you should cut down on your drinking? (CAGE questionnaire)

6-    Have people annoyed you by criticizing your drinking? (CAGE questionnaire) Discussion Diversity and Health Assessments discussion essay examples

7-    Have you felt bad or guilty about drinking?  (CAGE questionnaire) (Addiction & Recovery, 2018).

8-    Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover? (CAGE questionnaire)

9-    Do you have insurance coverage? Do you have concerns about how to cover your medical expenses?

10-    Before coming to this health center did you seek help from a family member, spiritual leader or a friend? Did they listen to you or provide any support?                                                                                                                                                                                                                                   Reference

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., Stewart, R. W. (2015).
Seidel’s Guide to          

          Physical Examination. (8
th
E.).
Elsevier, Mosby. St. Louis, Missouri
.

Addiction and Recovery (2018). CAGE Questionnaire
. Addiction Self-Assessment
.

Retrieved from https://addictionsandrecovery.org/addiction-self-test.htm

Duan-Ying, C. (2016). A Concept Analysis of Cultural Competence.
International Journal of

         Nursing Sciences.
Volume 3, Isuue3, pages 268-273.

https://doi.org/101016/j.ijnss.2016.08.00 Retrieved from

https://www.sciencedirect.com/science/article/pii/S2352013216300795

Espey, D. K., Jim, M. A., Cobb, N., Bartholomew, M., Becker, T., Haverkamp, D.,

Plescia, M. (2014). Leading Causes of Death and All-Cause Mortality in American

Indians and Alaska Natives.
American Public Health Association
.

Doi: 10.2105/AJPH.2013.3017.98 Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4035872/ Discussion Diversity and Health Assessments discussion essay examples

 

Sarche, M., Spicer, P. (2008). Poverty and Health Disparities for American Indian and Alaska

Native Children: Current Knowledge and Future Prospect.
American Indian and Alaska

            Native Programs.
Doi: 10.1196/annals.1425.017. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2567901/pdf/nihms58363.pdf Discussion Diversity and Health Assessments discussion essay examples

Danny Rivera Pediatric Cough Shadow Health Assessment Education & Empathy

Education & Empathy 
: 3 of 5 (60.0%)

During the patient interview, there are a number of opportunities to provide patient education and empathy. The opportunities listed below are those identified by nursing experts to be of particular importance to this patient. A 
Model Statement
 is provided as an example of an appropriate response to each opportunity.

Opportunities marked as 
Not Encountered
 are opportunities that were not elicited in the interview

Opportunities marked as 
Not Followed Up
are missed opportunities that were present in the interview, but where no statements were made. Danny Rivera Pediatric Cough Shadow Health Assessment Education & Empathy.

Opportunities marked as 
Followed Up
 were followed up by students, and include the dialogue between student and patient

WE ARE THE SHADOW HEALTH EXPERTS,

WE WILL HAVE YOU SCORE 100%,

CHAT US NOW

 1 Symptoms

Followed Up

 Description: 
Danny describes the symptoms that have been bothering him.

What brings you to the clinic today?

Question

09:01 PM PDT

My Abuela brought me here because I’ve been feeling sick. I have been coughing a lot. . . and I feel kinda tired. Danny Rivera Pediatric Cough Shadow Health Assessment Education & Empathy.

Am sorry to hear that you are sick .

Empathize

09:02 PM PDT

Thank you.

Do you have a cough?

Question

09:03 PM PDT

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

How long have you had a cough?

Question

09:03 PM PDT

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

Is your cough a wet or a dry one?

Question

09:03 PM PDT

My cough seems kind of gurgly and watery.

That sounds like a wet cough

Educate

09:04 PM PDT

Oh, OK.

Do you produce any sputum when you cough? (Clarified to: Do you produce any phlegm or sputum with your cough?)

Question

09:05 PM PDT

Is that the gross, slimy stuff? Yeah, I’ve been coughing some of that up. It’s not any strange color, though. It’s just clear. (Clarified to: if I produce phlegm or sputum when I cough)

Am sorry to hear this.

Empathize

09:05 PM PDT

Thank you.

How often is your cough?

Question

09:06 PM PDT

I just keep feeling like I have to cough every couple minutes or so. I think it gets worse at night.

Do the cough disturb your sleep at night?

Question

09:07 PM PDT

Most times I sleep OK, but I haven’t been able to sleep much because of my cough.

Am sorry to hear this.

Empathize

09:08 PM PDT

Thank you.

Are you able to focus in class?

Question

09:24 PM PDT

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

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

Empathize

09:25 PM PDT

Thank you.

Do you have a runny nose?

Question

09:28 PM PDT

My nose is always a little bit runny… but ever since I started coughing it’s been worse, I think.

Am sorry about this

Empathize

09:28 PM PDT

Thank you.

Have you been sneezing?

Question

09:28 PM PDT

I don’t usually have to sneeze. My nose gets runny a lot of times though, like I have a cold.

what colour is your snot?

Question

09:29 PM PDT

You mean like when I blow my nose? It’s clear.

Yes, that one. Ok, thanks.

Educate

09:30 PM PDT

Oh, OK.

How consistent is your nasal discharge?

Question

09:38 PM PDT

It’s kind of clear and, like, watery.

Do you have any ear pain?

Question

09:41 PM PDT

My right ear is starting to hurt a little bit . . . my left one is OK though.

Am sorry to hear this Danny

Empathize

09:42 PM PDT

Thank you.

Do you have any ear discharge?

Question

09:42 PM PDT

No, nothing comes out of my ears, but my right ear kind of hurts.

Do you have any hearing problems?

Question

09:42 PM PDT

A lady came to my school to give all the kids a hearing test. It was kind of cool! I was hoping I would have super hearing, but I think I was just normal . . . Danny Rivera Pediatric Cough Shadow Health Assessment Education & Empathy

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

Educate

09:43 PM PDT

Oh, OK.

Do you have soar throat?

Question

09:44 PM PDT

It feels a little bit sore, yeah.

Does it hurt when you swallow?

Question

09:45 PM PDT

No, I can swallow OK. It hurts a little right now because my throat is kinda sore.

Sorry about that Danny

Empathize

09:45 PM PDT

Thank you.

Are you fatigued?

Question

09:52 PM PDT

Yeah, I feel kind of tired. I think it’s because I couldn’t sleep much at night. My cough kept me from falling asleep.

Sorry about that.

Empathize

09:53 PM PDT

Thank you.

 Model Statement: 
“I’m sorry your ear and your throat hurt. I’ll take a look and we’ll see if we can help you feel better.”

 2 Medications

Not Followed Up

 3 Vitamins

Followed Up

 4 Secondhand Smoke

Followed Up

Danny Rivera Pediatric Cough Shadow Health Assessment Education & Empathy

 Description: 
Danny describes exposure to secondhand smoke at home.

Do you smoke?

Question

09:08 PM PDT

No way! I know smoking is really bad–even for grown-ups. Papi smokes cigars sometimes. I don’t like how they smell.

True, smoking is bad for everyone, you should never smoke.

Educate

09:09 PM PDT

Oh, OK.

Are you ever around cigarette smoke?

Question

09:13 PM PDT

Well . . . sometimes Papi smokes cigars in the house and my mom has to tell him to go outside. I breathe it a little bit then, but it’s not all the time or anything. I don’t like how it smells. Danny Rivera Pediatric Cough Shadow Health Assessment Education & Empathy.

Am sorry about that, i understand your concerns.

Empathize

09:14 PM PDT

Thank you.

 Model Statement: 
“That’s too bad your Papi smokes cigars at home. It sounds like it bothers you. Breathing in smoke isn’t very healthy, so it’s good to stay out rooms where you can smell cigar smoke.”

 5 Family History

Not Followed Up

 Description: 
Danny describes what he knows about his family health history.

Do you have a family history of asthma?

Question

09:51 PM PDT

Mom says Papi had asthma when he was a little kid.

Do you have a family history of allergies?

Question

09:51 PM PDT

I don’t think so, but I guess I’m not sure.

Do you have chills?

Question

09:52 PM PDT

No, I haven’t felt that.

Do you have fever?

Question

09:52 PM PDT

My mom said I didn’t have a fever this morning before Abuela took me here.

 Model Statement: 
“Thanks for telling me what you know about your family history. You did a good job remembering.” Danny Rivera Pediatric Cough Shadow Health Assessment Education & Empathy

NURS 6512 week 1 Building a Comprehensive Health History examples

Building a Comprehensive Health History

My post this week concerns a 76-year-old African American male with disabilities living in an urban setting. I will refer to him as Mr. B.

Interview and Communication Techniques

The appointment will start with the use of open-ended questions, such as “How are you feeling today?” and “What concerns or symptoms would you like to discuss in today’s appointment?” I would also ask Mr. B to relate his understanding of his disabilities and any health problems, as well as how he manages them. Open-ended questions encourages the patient to talk to the provider and not answer “yes” or “no.” I will get a feel for how well Mr. B understands his health issues and if they are being managed correctly. NURS 6512 week 1 Building a Comprehensive Health History examples.

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            The next step is to ask direct questions. This will give me specific information, such as the exact location of pain, when issues first started, and/or dosing instructions of current medications. After I have gathered all the necessary information from Mr. B, I will interpret what has been said. Ball, Dains, Flynn, Solomon, and Stewart (2015) state that to interpret is to repeat what you have heard to confirm the patient’s meaning. Next, I will ask Mr. B about his life situation NURS 6512 week 1 Building a Comprehensive Health History examples. I can establish if there are any unmet needs at home. This topic will be discussed further in the next section.

At the conclusion of the visit, I will reiterate what has been discussed during the appointment. I will express any need for further treatments or office visits. The last thing to do is find out if Mr. B’s expectations of the appointment have been met and if he has any further questions.

 

Risk Assessment

Numerous screening instruments have been developed to detect common geriatric problems (Sullivan 2012). The Katz Index of ADLs (activities of daily living) and Lawton IADL (instrumental activities of daily living) Scale are examples of tools used to screen a patient’s functional ability. The Katz Index addresses specific ADLs, such as bathing, dressing, toileting, transferring, continence, and feeding. NURS 6512 week 1 Building a Comprehensive Health History examples The Lawton Scale scores points on functionality in other areas, such as the ability to use a telephone, shopping, laundry, mode of transportation, food preparation, housekeeping, responsibility for own medications, and the ability to handle finances. According to Deck et al. (2015), the rationale behind a geriatric assessment is to assess how illness impacts functioning and what the social and medical needs are in order to develop a plan for treatment and follow-up, to manage the problems that were identified, and to prevent dependency. Five essential questions to ask are:

Can you perform basic ADLs? (as listed in the Katz Index of ADLs).

Do you live alone? If yes, do you have family and friends who can help in times of need?

Do you feel safe in your home and neighborhood?

Can you afford all your expenses, especially medication?

Are you able to prepare meals or have someone prepare them for you?

Older adults are a vulnerable population. People try to take advantage of them. They do not always provide accurate information to their healthcare provider for a variety of reasons. Healthcare providers need to spend extra time with older adults to get to the root of problems. NURS 6512 week 1 Building a Comprehensive Health History examples

 

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). 
Seidel’s

     guide to physical examination 
(8
th
 ed.). St. Louis, MO: Elsevier Mosby.

Deck, L., Akker, M., Daniels, L., DeJonge, E. T., Bulens, P., Tjan-Heijnen, V., …

Buntinx, F. (2015). Geriatric screening tools are of limited value to predict decline in

functional status and quality of life: results of a cohort study. 
BMC Family Practice,

     
16(30), 1-12. doi:10.1186/s12875-015-0241-x

Sullivan, D. D. (2012). 
Guide to clinical documentation 
(2
nd
 ed.). Philadelphia, PA:

A. Davis. NURS 6512 week 1 Building a Comprehensive Health History examples

 

Response

Excellent post on the assessment of building health information for the practitioner. I was appreciative of the way Wu and Orlando said the risk assessment should be addressed. Health risk assessments provide an opportunity to emphasize health promotion and disease prevention for individuals and populations at large (Wu & Orlando, 2015). Do you think that Mr. B will be receptive to the emphasis of health promotion and disease prevention? In a study on nutrition Hu et al., performed long-term, periodically collected dietary data in the NHS, with documented reliability and validity, have contributed extensively to our understanding of the dietary determinants of various diseases, informing dietary guidelines and shaping nutritional policy (2016) NURS 6512 week 1 Building a Comprehensive Health History examples. In this instance the guide lines can prevent issues from malnutrition and with a reliable data base can increase ability to prevent disease.

Respectfully,

J

 

References

Hu, F. B., Satija, A., Rimm, E. B., Spiegelman, D., Sampson, L., Rosner, B., … & Willett, W. C.

(2016). Diet assessment methods in the Nurses’ Health Studies and contribution to

evidence- based nutritional policies and guidelines. 
American journal of public health
, 
106

(9), 1567-1572. NURS 6512 week 1 Building a Comprehensive Health History examples

Wu, R. R., & Orlando, L. A. (2015). Implementation of health risk assessments with family

health history: barriers and benefits
. Postgraduate medical journal, 
postgradmedj-2014

 

 

Building a Comprehensive Health History

NURS 6512: Advanced Health Assessment and Diagnosis Reasoning

Building a Comprehensive Health History

Upon establishing a relationship and building a comprehensive health history, one must understand the importance of a thorough history document.  This document is often used as the basis for the entire course of medical management for a patient (Sullivan, 2012) NURS 6512 week 1 Building a Comprehensive Health History examples.  Everyone has a story, and the heath history document should paint an up-to-date and accurate account of the patient’s medical history and a comprehensive physical examination.  Any professional that reads the health history document should have a good overview of that patient.  According to Ball, Dains, Flynn, Solomon, & Stewart (2015), the initial meeting between the clinician and the patient sets the tone in the relationship for success, allows the patient to voice concerns, identifies expectations for a good outcome, and to build a partnership in one’s health care.   For this week’s discussion, the role of a clinician when building a comprehensive health history with a 16-year old white pregnant teenager living in an inner- city neighborhood will be identified.  In addition, review of communication techniques and a risk assessment tool is used with five or more targeted questions that could be asked in this particular situation.

 Interview and Communication Techniques

           
Adolescents is a time between childhood and adulthood where risky behaviors are experimented and where privacy and confidentiality are important to be less hesitant in discussing their concerns (Ball, et.al., 2015).  Effective communication with adolescents requires seeing the patient alone, tailoring the discussion to the individual patient, and understanding the role of the parents with confidentiality (Ham, & Allen, 2012) NURS 6512 week 1 Building a Comprehensive Health History examples.  According to Thompson (2010), obtaining a necessary ‘social history’ of each teenager can help to gain vital information about their relationships, assess the needs of the individual, and identify possible problems throughout the pregnancy.  There are a number of issues relevant to teenage parents, such as; age, emotional maturity, relationship with parents/partner, educational needs, looked after children, social situation, and supporting young fathers-to-be (Thompson, 2010).  The social history is a series of detailed questions creating the basis of the assessment and care plan.  The care plan and assessment information is updated throughout the pregnancy and the plan is altered as the situation demands (Thompson, 2010).

Questions should be open-ended so that feedback is prompted, yet, declining to answer should be acceptable as well (Ball, et.al., 2015).  For questions that are answered, further investigation can be encouraged to continue the evaluation of the situation. NURS 6512 week 1 Building a Comprehensive Health History examples. In addition, a screening tool or questionnaire at the pre-visit stage can also encourage a non-forced conversation by silently writing the concern rather than verbalizing the concern (Ball, et.al., 2015).  Questions should pertain to thorough evaluation of her partner(s), sexually transmitted infection (STI) history, last menstrual cycle, medical history, previous gynecological visits, social/personal history (including current/previous smoking, drug or alcohol use), family history, and current outlook on the pregnancy.  A time for the patient to ask any questions or express any concerns should be followed up, so that the patient is still involved and can feel in control and knowledgeable of the situation.  A full head to toe assessment should be completed, including fetal heart tones.  The patient-provider relationship should be respectful, useful, and effective with honest responses, making good eye contact, and maintaining non-judgmental respect of wishes.

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Risk Assessment Instruments

           
As above, obtaining a social history can not only assess risky behaviors, discussing general social behaviors can also help to open the door to a better patient-provider relationship. The use of the screening tools HEEADSSS and PACES can guide adolescent issues such as sex, drugs, smoking, alcohol, peer pressure, home environment, and school (Ball, et al., 2015).  The answers to these questions can help the provider obtain the knowledge and readiness of the patient’s needs for further educational needs and assistance from the provider (Ball, et al., 2015) NURS 6512 week 1 Building a Comprehensive Health History examples.

Health-Related Risk Potential

           
Other situations may arise that can be detrimental health concerns for the patient and the unborn child.  Due to age, teenagers are at risk for not obtaining adequate prenatal care.  This screens for medical problems in both mother and baby, monitors the baby’s growth, and deals quickly with any complications that arise.  Prenatal vitamins with folic acid (ideally taken before getting pregnant) are essential to help prevent certain birth defects, such as neural tube defects (CDC, 2010).  Pregnant teens have a higher risk of getting high blood pressure (pregnancy-induced hypertension) than pregnant women in their 20s or 30s (CDC, 2010).  They also have a higher risk of preeclampsia, which is a dangerous medical condition that combines high blood pressure with excess protein in the urine, swelling of a mother’s hands and face, and organ damage (CDC, 2010) NURS 6512 week 1 Building a Comprehensive Health History examples.  In addition, pregnant teens may be at higher risk of postpartum depression (CDC, 2010).

Target Questions

           
Several target questions may be used to help determine risks and build an up-to-date accurate health history.  These questions may also help to obtain sexual history, any violence or potential violence, family support, and any other potential high risk endeavors that may harm the fetus or the patient.  The questions below may be asked in a different sequence depending on the conversation and situation.

When was your last menstrual cycle?

Was this a planned pregnancy?

Have you had any previous pregnancies?

What is your current outlook on this pregnancy?

How many sex partners have you had?

Do you drink alcohol, smoke, or do recreational drugs? If so, how often?

Do you have a good relationship with your parents?

Have you ever been ‘in care’ or a ‘looked after child’?

How does your parents feel about you being pregnant?

Do you think your parents will support you?

How are you doing in school?

Do you have any questions for me?

Conclusion

Encouragement and education can go a long way with a teenager who is pregnant.  A practitioner that can listen and treat to the best of their ability without judgement is one who has built a relationship on trust, honesty, and respect with the patient, no matter the age or circumstance. NURS 6512 week 1 Building a Comprehensive Health History examples.  Thus, obtaining a health history that is accurate and reflects the patient’s situation, identifying the possible risk factors or complications that could arise.

References

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

Center for Disease Control and Prevention (CDC). (2010).
Reproductive Health: Teen Pregnancy.
Retrieved from: http://www.cdc.gov/TeenPregnancy/index.htm.

Ham, P., & Allen, C. (2012). Adolescent health screening and counseling.
American Family Physician, 86
(12), 1109-1116.

Sullivan, D. D. (2012).
Guide to clinical documentation
(2nd ed.). Philadelphia, PA: F. A. Davis.

Thompson, S. (2010). The complexities of supporting teenagers in pregnancy.
British Journal Of Midwifery
,
18
(6), 368-372. NURS 6512 week 1 Building a Comprehensive Health History examples.

Danny Rivera Pediatric Cough Shadow Health Assessment Objective Data

Objective Data Collection: 12.4 of 13 (95.38%)

 Correct

 Partially correct

 Incorrect

 Missed

 Inspected eyes and orbital area

1 of 1 point

Orbital Area 
(1/4 point)

 SCORE 100% ON YOUR SHADOW HEALTH ASSESSMENT

 No visible abnormal findings

 Ptosis

 Eyelid edema

 Lesion

 Allergic shiners

Sclera 
(1/4 point)

 White

 Jaundice

 Injection

 Icterus

Conjunctiva 
(1/4 point)

 Moist and pink

 Pale

 Dry appearance

 Erythema

 Edema

Conjunctival Discharge 
(1/4 point)

 No discharge

 Clear, watery discharge

 Purulent discharge

Danny Rivera Pediatric Cough Shadow Health Assessment Objective Data

 Inspected nasal cavities

1 of 1 point

Color 
(1/4 point)

 Pink

 Erythemic

 Bluish

Discharge 
(1/4 point)

 No discharge

 Clear discharge

 Bloody discharge

 Purulent discharge

Turbinate Patency 
(1/4 point)

 Patent

 Decreased patency

 Not patent

Observations 
(1/4 point)

 No additional visible abnormal findings

 Foreign body present

 Polyp

 Septum perforated

 Septum deviated

 Lesion

 Inspected ears

0.8 of 1 point

Right: Auditory Canal Color 
(No point)

 Pink

 Erythemic

 Pallor

Right: Tympanic Membrane Color 
(No point)

 Pearly gray

 Erythemic

 Opaque

 Yellow

 Not visible because of cerumen

Right: Tympanic Membrane Appearance 
(1/10 point)

 No visible abnormal findings

 Fluid observed

 Visible scars

 Bulging

 Perforation

 Retraction

Right: Cone Of Light 
(1/10 point)

 5:00

 Cone of light distorted

Right: Discharge 
(1/10 point)

 No discharge

 Cerumen

 Clear discharge

 Bloody discharge

 Purulent discharge

Left: Auditory Canal Color 
(1/10 point)

 Pink

 Erythemic

 Pallor

Left: Tympanic Membrane Color 
(1/10 point)

 Pearly gray

 Erythemic

 Opaque

 Yellow

 Not visible because of cerumen

Left: Tympanic Membrane Appearance 
(1/10 point)

 No visible abnormal findings

 Fluid observed

 Visible scars

 Bulging

 Perforation

 Retraction

WE ARE THE SHADOW HEALTH EXPERTS,

WE WILL HAVE YOU SCORE 100%,

CHAT US NOW

Left: Cone Of Light 
(1/10 point)

 7:00

 Cone of light distorted

Left: Discharge 
(1/10 point)

 No discharge

 Cerumen

 Clear discharge

 Bloody discharge

 Purulent discharge

 Inspected mouth and throat

0.6 of 1 point

Oral Mucosa 
(1/5 point)

 Moist and pink

 Dry appearance

 Erythema

Tonsils 
(No point)

 No visible abnormal findings

 Edema

 Erythema

Posterior Oropharynx Color 
(No point)

 Pink

 Erythemic

Posterior Oropharynx Texture 
(1/5 point)

 No abnormal findings

 Cobblestoning

 Exudate

Post Nasal Drip 
(1/5 point)

 No discharge

 Clear discharge

 Purulent discharge

 Inspected neck

1 of 1 point

 Inspected chest

1 of 1 point

Symmetry 
(1/2 point)

 Symmetric

 Asymmetric

Appearance 
(1/2 point)

 No visible abnormal findings

 Rash or lesion

 AP diameter abnormal Intercostal retraction while breathing

 Excessive use of accessory muscles while breathing

 Pectus excavatum

 Skin growths (freckles or moles)

 Evidence of skin trauma (scar, laceration, or bruising)

 Palpated sinuses

1 of 1 point

 Palpated lymph nodes

1 of 1 point

 Palpated fremitus

1 of 1 point

 Auscultated breath sounds

1 of 1 point

Breath Sounds 
(1/3 point)

 Present in all areas

 Diminished in some areas

 Absent in some areas

Adventitious Sounds 
(1/3 point)

 No adventitious sounds

 Wheezing

 Fine crackles

 Stridor

 Rhonchi

 Rales

Location 
(1/3 point)

 All areas clear

 Adventitious sounds in anterior right upper lobe

 Adventitious sounds in anterior right middle lobe

 Adventitious sounds in anterior right lower lobe

 Adventitious sounds in anterior left upper lobe

 Adventitious sounds in anterior left lower lobe

 Adventitious sounds in posterior right upper lobe

 Adventitious sounds in posterior right lower lobe

 Adventitious sounds in posterior left upper lobe

 Adventitious sounds in posterior left lower lobe

Danny Rivera Pediatric Cough Shadow Health Assessment Objective Data

 Auscultated for bronchophony

1 of 1 point

 Auscultated heart sounds

1 of 1 point

 Percussed chest wall

1 of 1 point

Observations 
(1/2 point)

 All areas resonant

 Some areas dull, some resonant

 Some areas hyperresonant, some resonant

Location 
(1/2 point)

 No areas of dullness

 Dullness, anterior right upper lobe

 Dullness, anterior right middle lobe

 Dullness, anterior right lower lobe

 Dullness, anterior left upper lobe

 Dullness, anterior left lower lobe

 Dullness, posterior right upper lobe

 Dullness, posterior right lower lobe

 Dullness, posterior left upper lobe

 Dullness, posterior left lower lobe

Danny Rivera Pediatric Cough Shadow Health Assessment Objective Data

NURS 6512 Week 1 Discussion example

NURS 6512 Week 1 Discussion

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

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Communication and Interviewing Techniques

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

Targeted Questions

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

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

Scenario

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

Assessment Questions

What brings you in to the clinic today?

What symptoms have you been experiencing in the last month?

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

Do you feel safe in your home? At school?

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

Have you ever missed or had a late period before?

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

How many partners have you had in the past year?

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

References

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

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

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

Danny Rivera Pediatric Cough Shadow Health Assessment Transcript

Transcript

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

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

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

Greet

04/08/20 9:01 PM PDT

Hi.

What is your name?

Question

04/08/20 9:01 PM PDT

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

What brings you to the clinic today?

 SCORE 100% ON YOUR SHADOW HEALTH ASSESSMENT

Question

04/08/20 9:01 PM PDT

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

Am sorry to hear that you are sick .

Empathize

04/08/20 9:02 PM PDT

Thank you.

Do you have a cough?

Question

04/08/20 9:03 PM PDT

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

How long have you had a cough?

Question

04/08/20 9:03 PM PDT

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

Is your cough a wet or a dry one?

Question

04/08/20 9:03 PM PDT

My cough seems kind of gurgly and watery.

That sounds like a wet cough

Educate

04/08/20 9:04 PM PDT

Oh, OK.

Do yxxx

Question

04/08/20 9:05 PM PDT

Isxxx

Am sorry to hear this.

Empathize

04/08/20 9:05 PM PDT

Thank you.

Howxxx

Question

04/08/20 9:06 PM PDT

I jxx

Do thexxx

Question

04/08/20 9:07 PM PDT

Most timesxxx

Am sorry to hear this.

Empathize

04/08/20 9:08 PM PDT

Thank you.

Do youxxx

Question

04/08/20 9:08 PM PDT

No way! I knowxxx

True, xxx

Educate

04/08/20 9:09 PM PDT

Oh, OK.

Are you ever aroundxxxx

Question

04/08/20 9:13 PM PDT

Well . . . sometimes xxx

Am sorry about that, i xxx

Question

04/08/20 9:14 PM PDT

Am sorry about that, i understand your concerns.

Empathize

04/08/20 9:14 PM PDT

Thank you.

What makes your coughs worse?

Question

04/08/20 9:15 PM PDT

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

Have you triedxxx

Question

04/08/20 9:15 PM PDT

I had somexxx. [AUDIO COMING SOON]

What is the xxx

Question

04/08/20 9:16 PM PDT

I don’t know whatxxx

Who xxx

Question

04/08/20 9:17 PM PDT

My xxx

how muchxxx

Question

04/08/20 9:17 PM PDT

I just hadxxx

How xxx

Question

04/08/20 9:18 PM PDT

I only xxx. [AUDIO COMING SOON]

Apart from thexxx

Question

04/08/20 9:18 PM PDT

Do youxxx

Question

04/08/20 9:20 PM PDT

Oh yeah, I xxx

I understand, its xxx

Educate

04/08/20 9:21 PM PDT

Oh, OK.

Are you usually active?

Question

04/08/20 9:22 PM PDT

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

Great, keep exercising, its healthy.

Educate

04/08/20 9:23 PM PDT

Oh, OK.

Does the cough make you less active?

Question

04/08/20 9:24 PM PDT

No, that doesn’t help my cough.

Are you able to focus in class?

Question

04/08/20 9:24 PM PDT

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

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

Question

04/08/20 9:24 PM PDT

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

Empathize

04/08/20 9:25 PM PDT

Thank you.

Do you xxx

Question

04/08/20 9:28 PM PDT

My xx

Am sorry about this

Empathize

04/08/20 9:28 PM PDT

Thank you.

Have you xxx

Question

04/08/20 9:28 PM PDT

I don’t xxx

what xxx

Question

04/08/20 9:29 PM PDT

You mean likexxxx

Yes, that one. Ok, thanks.

Educate

04/08/20 9:30 PM PDT

Oh, OK.

How consistent is xxx

Question

04/08/20 9:38 PM PDT

It’s kind of xxx

xx

Question

04/08/20 9:41 PM PDT

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

Am sorry to hear this Danny

Empathize

04/08/20 9:42 PM PDT

Thank you.

Do you havexxx

Question

04/08/20 9:42 PM PDT

No, xxxkind of hurts.

Do you have xxx problems?

Question

04/08/20 9:42 PM PDT

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

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

Educate

04/08/20 9:43 PM PDT

Oh, OK.

Do you have soar throat?

Question

04/08/20 9:44 PM PDT

It feels a little bit sore, yeah.

Does it xxx

Question

04/08/20 9:45 PM PDT

No, I can xxxx

Sorry about that Danny

Empathize

04/08/20 9:45 PM PDT

Thank you.

Have you xxx

Question

04/08/20 9:46 PM PDT

 

Do you have difficulty breathing?

Question

04/08/20 9:58 PM PDT

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

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

Question

04/08/20 9:59 PM PDT

I don’t have any questions really.

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

Educate

04/08/20 10:00 PM PDT

Oh, OK.

 Checked vitals

Exam Action

04/09/20 11:08 AM PDT

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

Exam Action

04/09/20 11:12 AM PDT

 Inspected upper conjunctiva

Exam Action

04/09/20 11:14 AM PDT

 Inspected upper conjunctiva

Exam Action

04/09/20 11:14 AM PDT

 Inspected upper conjunctiva

Exam Action

04/09/20 11:14 AM PDT

 Inspected lower conjunctiva

Exam Action

04/09/20 11:14 AM PDT

 Inspected right orbital area and sclera

Exam Action

04/09/20 11:14 AM PDT

 Inspected left orbital area and sclera

Exam Action

04/09/20 11:15 AM PDT

 Performed otoscopic examination of right naris

Exam Action

04/09/20 11:15 AM PDT

 Performed otoscopic examination of left naris

Exam Action

04/09/20 11:15 AM PDT

 Performed otoscopic examination of right ear

Exam Action

04/09/20 11:16 AM PDT

 Performed otoscopic examination of left ear

Exam Action

04/09/20 11:16 AM PDT

 Inspected mouth

Exam Action

04/09/20 11:16 AM PDT

 Inspected front of neck

Exam Action

04/09/20 11:16 AM PDT

 Inspected right side of neck

Exam Action

04/09/20 11:17 AM PDT

 Inspected front of neck

Exam Action

04/09/20 11:17 AM PDT

 Inspected left side of neck

Exam Action

04/09/20 11:17 AM PDT

 Inspected back of neck

Exam Action

04/09/20 11:17 AM PDT

 Inspected anterior chest wall

Exam Action

04/09/20 11:17 AM PDT

 Inspected posterior chest wall

Exam Action

04/09/20 11:17 AM PDT

 Inspected anterior chest wall

Exam Action

04/09/20 11:17 AM PDT

 Palpated frontal sinuses: No tenderness reported

Exam Action

04/09/20 11:19 AM PDT

 Palpated maxillary sinuses: No tenderness reported

Exam Action

04/09/20 11:20 AM PDT

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

Exam Action

04/09/20 11:23 AM PDT

 Palpated supraclavicular lymph nodes: Not palpable

Exam Action

04/09/20 11:23 AM PDT

 Palpated axillary lymph nodes: Not palpable

Exam Action

04/09/20 11:23 AM PDT

 Palpated axillary lymph nodes: Not palpable

Exam Action

04/09/20 11:23 AM PDT

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

Exam Action

04/09/20 11:24 AM PDT

Ninety-nine.

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

Exam Action

04/09/20 11:24 AM PDT

Ninety-nine.

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

Exam Action

04/09/20 11:24 AM PDT

Ninety-nine.

 SCORE 100% ON YOUR SHADOW HEALTH ASSESSMENT 

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

Exam Action

04/09/20 11:24 AM PDT

Ninety-nine.

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

Exam Action

04/09/20 11:24 AM PDT

Ninety-nine.

 Auscultated breath sounds in anterior left upper lobe

Exam Action

04/09/20 11:25 AM PDT

 Auscultated breath sounds in anterior right upper lobe

Exam Action

04/09/20 11:25 AM PDT

 Auscultated breath sounds in anterior right middle lobe

Exam Action

04/09/20 11:26 AM PDT

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

Exam Action

04/09/20 11:26 AM PDT

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

Exam Action

04/09/20 11:26 AM PDT

 Auscultated breath sounds in anterior right middle lobe

Exam Action

04/09/20 11:26 AM PDT

 Auscultated breath sounds in anterior right lower lobe

Exam Action

04/09/20 11:26 AM PDT

 Auscultated breath sounds in anterior left lower lobe

Exam Action

04/09/20 11:27 AM PDT

 Auscultated breath sounds in posterior left upper lobe

Exam Action

04/09/20 11:27 AM PDT

 Auscultated breath sounds in posterior right upper lobe

Exam Action

04/09/20 11:27 AM PDT

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

Exam Action

04/09/20 11:27 AM PDT

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

Exam Action

04/09/20 11:27 AM PDT

 Auscultated breath sounds in posterior right lower lobe near spine

Exam Action

04/09/20 11:28 AM PDT

 Auscultated breath sounds in posterior left lower lobe near spine

Exam Action

04/09/20 11:28 AM PDT

 Auscultated breath sounds in posterior left lower lobe on side

Exam Action

04/09/20 11:28 AM PDT

 Auscultated breath sounds in posterior left lower lobe

Exam Action

04/09/20 11:28 AM PDT

 Auscultated breath sounds in posterior right lower lobe

Exam Action

04/09/20 11:28 AM PDT

 Auscultated breath sounds in posterior right lower lobe on side

Exam Action

04/09/20 11:28 AM PDT

 Auscultated voice sounds in anterior right upper lobe

Exam Action

04/09/20 11:29 AM PDT

Ninety-nine.

Ninety-nine.

 Auscultated voice sounds in anterior left upper lobe

Danny Rivera Pediatric Cough Shadow Health Assessment Transcript

Exam Action

04/09/20 11:29 AM PDT

Ninety-nine.

Ninety-nine.

Ninety-nine.

Ninety-nine.

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

Exam Action

04/09/20 11:29 AM PDT

Ninety-nine.

Ninety-nine.

 Auscultated voice sounds in anterior right middle lobe

Exam Action

04/09/20 11:29 AM PDT

Ninety-nine.

Ninety-nine.

Ninety-nine.

 Auscultated voice sounds in anterior right middle lobe

Exam Action

04/09/20 11:30 AM PDT

Ninety-nine.

Ninety-nine.

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

Exam Action

04/09/20 11:30 AM PDT

Ninety-nine.

 Auscultated voice sounds in anterior left lower lobe

Exam Action

04/09/20 11:30 AM PDT

Ninety-nine.

 Auscultated voice sounds in anterior right lower lobe

Exam Action

04/09/20 11:30 AM PDT

Ninety-nine.

Ninety-nine.

Ninety-nine.

 Auscultated voice sounds in posterior left upper lobe

Exam Action

04/09/20 11:30 AM PDT

Ninety-nine.

Ninety-nine.

 Auscultated voice sounds in posterior right upper lobe

Exam Action

04/09/20 11:30 AM PDT

Ninety-nine.

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

Exam Action

04/09/20 11:30 AM PDT

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

Exam Action

04/09/20 11:30 AM PDT

Ninety-nine.

Ninety-nine.

Ninety-nine.

 Auscultated voice sounds in posterior left lower lobe near spine

Exam Action

04/09/20 11:30 AM PDT

Ninety-nine.

 Auscultated voice sounds in posterior right lower lobe near spine

Exam Action

04/09/20 11:30 AM PDT

Ninety-nine.

Ninety-nine.

Ninety-nine.

 Auscultated voice sounds in posterior right lower lobe on side

Exam Action

04/09/20 11:30 AM PDT

Ninety-nine.

 Auscultated voice sounds in posterior right lower lobe

Exam Action

04/09/20 11:31 AM PDT

Ninety-nine.

 Auscultated voice sounds in posterior left lower lobe

Exam Action

04/09/20 11:31 AM PDT

Ninety-nine.

Ninety-nine.

 Auscultated voice sounds in posterior left lower lobe on side

Exam Action

04/09/20 11:31 AM PDT

Ninety-nine.

Ninety-nine.

Ninety-nine.

 Auscultated aortic area with the bell

Exam Action

04/09/20 11:31 AM PDT

 Auscultated aortic area with the diaphragm

Exam Action

04/09/20 11:31 AM PDT

 Auscultated aortic area with the bell

Exam Action

04/09/20 11:31 AM PDT

 Auscultated aortic area with the diaphragm

Exam Action

04/09/20 11:31 AM PDT

 Auscultated aortic area with the bell

Exam Action

04/09/20 11:31 AM PDT

 Auscultated aortic area with the diaphragm

Exam Action

04/09/20 11:31 AM PDT

 Auscultated pulmonic area with the diaphragm

Exam Action

04/09/20 11:31 AM PDT

 Auscultated pulmonic area with the bell

Exam Action

04/09/20 11:31 AM PDT

 Auscultated Erb’s point with the bell

Exam Action

04/09/20 11:31 AM PDT

 Auscultated Erb’s point with the diaphragm

Exam Action

04/09/20 11:32 AM PDT

 Auscultated tricuspid area with the diaphragm

Exam Action

04/09/20 11:32 AM PDT

 Auscultated tricuspid area with the bell

Exam Action

04/09/20 11:32 AM PDT

 Auscultated mitral area with the bell

Exam Action

04/09/20 11:32 AM PDT

 Auscultated mitral area with the diaphragm

Exam Action

04/09/20 11:32 AM PDT

 Percussed anterior right upper lobe

Exam Action

04/09/20 11:32 AM PDT

 Percussed anterior right middle lobe

Exam Action

04/09/20 11:32 AM PDT

 Percussed anterior left upper lobe

Exam Action

04/09/20 11:32 AM PDT

 Percussed anterior left mid-chest (upper lobe)

Exam Action

04/09/20 11:32 AM PDT

 Percussed anterior left lower lobe

Exam Action

04/09/20 11:32 AM PDT

 Percussed anterior right lower lobe

Exam Action

04/09/20 11:32 AM PDT

 Percussed posterior left upper lobe

Exam Action

04/09/20 11:33 AM PDT

 Percussed posterior left mid-back (lower lobe)

Exam Action

04/09/20 11:33 AM PDT

 Percussed posterior right mid-back (lower lobe)

Exam Action

04/09/20 11:33 AM PDT

 Percussed posterior right upper lobe

Exam Action

04/09/20 11:33 AM PDT

 Percussed posterior left lower lobe

Exam Action

04/09/20 11:33 AM PDT

 Percussed posterior left lower lobe on side

Exam Action

04/09/20 11:33 AM PDT

 Percussed posterior left lower lobe near spine

Exam Action

04/09/20 11:33 AM PDT

 Percussed posterior right lower lobe near spine

Exam Action

04/09/20 11:33 AM PDT

 Percussed posterior right lower lobe

Exam Action

04/09/20 11:33 AM PDT

 Percussed posterior left right lobe on side

Exam Action

04/09/20 11:33 AM PDT

 Inspected mouth

Danny Rivera Pediatric Cough Shadow Health Assessment Transcript

Exam Action

04/09/20 11:58 AM PDT