FOCUSED EXAM: COUGH SHADOW HEALTH ANSWERS

Focused exam: Cough shadow health answers
Transcript

Started: February 04, 2023 | Total Time: 170 min focused exam: cough shadow health answers

All Lines (173)Interview Questions (61)Statements (16)Exam Actions (96)

Hello!

Question
04/02/23 2:08 PM MDT

Hi. I’m Preceptor Diana. I will explain the details of this assignment and your objectives, just as a preceptor would in real life. Pay close attention to this information as it will help guide your exam. At the end of this prebrief, you will answer a short question about the upcoming assignment. During the simulation, you may return to these instructions at any time by scrolling to the top of your transcript.

What is the situation?

Question
04/02/23 2:10 PM MDT

Your patient is Danny Rivera, an 8-year-old Puerto Rican boy presenting with a cough in the Shadowville Elementary nurse’s office. Your role in this simulation is that of a healthcare provider who will perform a focused history and physical examination in order to collect data, assess Danny’s condition, and transfer care. In this simulation, you will be able to perform procedures not always typical to a school setting so you can gather as much data as possible.

What are my objectives in this assessment?

ORDER SHADOW HEALTH HELP HERE

Question
04/02/23 2:11 PM MDT

Danny is very health literate and a good historian of his own health history; he can answer questions that not every child may be able to. In your interview with Danny, you will ask about the history of his presenting illness and the functioning of relevant systems in order to obtain subjective data related to his cough. If you discover any disease states, ask about symptoms and the patient’s experiences of them. Your questioning should cover a broad array of the symptoms’ characteristics. You will also inquire into the health history of Danny’s family so you can determine his genetic predisposition to any diseases. In addition to collecting subjective data, you will perform a physical exam on Danny to gather objective data about his health and physiology. Throughout the conversation, you should educate and empathize with Danny when appropriate to increase his health literacy and sense of well-being. While you should communicate with patients using accessible, everyday language, it is standard practice to use professional medical terminology everywhere else, such as in documenting physical findings and nursing notes. You may complete the exam activities in any order and move between them as needed.

What else will this exam involve?

Question
04/02/23 2:12 PM MDT

Because Danny is a pediatric patient, you will also be required to make a phone call to his guardian’s home to gather additional information. You can document your findings, including vital signs, in the Electronic Health Record. This record provides necessary information for healthcare professionals who will continue patient care. You will then move onto the Care Plan activity, in which you will synthesize your subjective and objective data to complete the nursing process. You will develop a nursing diagnosis for Mr. Rivera’s condition, identify a treatment goal, plan your interventions and evaluations, and finally assess if your goal was achieved. You may also need to call Danny’s guardian again to involve them in his treatments. The Care Plan is just as important as your assessment, and the patient’s well-being will be greatly affected by your diagnosis and interventions.

How will I be evaluated?

Question
04/02/23 2:12 PM MDT

The activities evaluated by the simulation are Subjective and Objective Data Collection, Education and Empathy, and the Care Plan activity. Nursing tasks and Documentation, while they provide valuable practice for their real-world counterparts, are not automatically evaluated by the simulation. The evaluation of your interview is dependent on how you word your questions therapeutically and precisely and explore all relevant topics with comprehensive breadth and depth. The evaluation of your physical exam is based on how successfully you report on your physical findings by selecting among clinical terms in the Electronic Health Record. Your success in Education and Empathy is based on whether you promptly respond after identifying a moment worthy of therapeutic communication. Your success in the Care Plan activity is based on whether you accurately identify Mr. Rivera’s nursing diagnosis, select a goal most immediately beneficial to him, select and prioritize the most effective treatments, and accurately evaluate your results. The Care Plan will make up a signficant part of your grade, so be sure to carefully choose your answers based on evidence. This assignment takes on average between 80 and 100 minutes. You can pause and resume the assignment at any time; your work is always saved automatically.

How does this assignment prepare me for the real world?

Question
04/02/23 2:13 PM MDT

In this assessment, you will familiarize yourself with the structure and content of a cough focused exam so that with real-life patients, you can: º ask effective and comprehensive questions º obtain and assess objective data º educate and empathize with the patient º develop a nursing diagnosis º create an effective and expedient care plan º and evaluate your results to determine your goal’s achievement.

In 1 or 2 sentences, answer this question to help prepare for the upcoming exam: What strategies can you use to develop rapport with a pediatric patient?

Being friendly with the patient

Statement
04/02/23 2:15 PM MDT

Time to begin.

Hello. xxx interview and examine you.

Greet
04/02/23 2:18 PM MDT

Hi.

What is your name? (Clarified to What is your name?.)

Question
04/02/23 2:24 PM MDT

My name is Daniel Rivera, but I just go by Danny. (Clarified to what is my name.)

What brings you to the clinic today?

Question
04/02/23 2:24 PM MDT

My music teacher Mr. Hillman sent me here because he said I look sick. I have been coughing a lot. . . and I feel kinda tired.

Am sorry to hear that you are sick.

Empathize
04/02/23 2:25 PM MDT

That is nice of you.

Do you have a cough?

Question
04/02/23 2:26 PM MDT

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

How long have you had a cough?

Question
04/02/23 2:27 PM MDT

I think the cough started two . . . No, it started three days ago.

Is your cough a wet or a dry one?

Question
04/02/23 2:27 PM MDT

My cough seems kind of gurgly and watery.

That sounds like a wet cough.

Empathize
04/02/23 2:28 PM MDT

Thanks for saying that.

Are you ever around cigarette smoke?

Question
04/02/23 2:28 PM MDT

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, and I don’t like that he is hurting himself. He could get sick.

Am sorry about that, I understand your concerns

Empathize
04/02/23 2:29 PM MDT

Thank you.

What makes your cough worse?

Question
04/02/23 2:29 PM MDT

I don’t think anything makes my cough be worse.

Have you tried to treat your cough?

Question
04/02/23 2:31 PM MDT

My mom gave me some medicine this morning. . . that helped my cough a little. I don’t remember what it was called though, sorry.

What is the name of the medicine?

Question
04/02/23 2:32 PM MDT

I don’t know. It was the purple one.

Who gave you the medicine?

Question
04/02/23 2:32 PM MDT

My mom gave it to me.

How much medicine do you take?

Question
04/02/23 2:32 PM MDT

It was just a spoonful.

Thanks for saying that.

Washed hands.

Exam Action
04/02/23 3:08 PM MDT

Measured blood pressure

Exam Action
04/02/23 3:09 PM MDT

Measured heart rate

Exam Action
04/02/23 3:09 PM MDT

Measured pulse oximetry

Exam Action
04/02/23 3:09 PM MDT

Measured respiratory rate

Exam Action
04/02/23 3:09 PM MDT

Measured temperature

Exam Action
04/02/23 3:09 PM MDT

Tested lung capacity with spirometer: FEV1: 1.549 L, FVC 1.78 L (FEV1/FVC: 87%)

Exam Action
04/02/23 3:10 PM MDT

Inspected upper conjunctiva

Exam Action
04/02/23 3:10 PM MDT

Inspected right orbital area and sclera

Exam Action
04/02/23 3:10 PM MDT

Inspected left orbital area and sclera

Exam Action
04/02/23 3:10 PM MDT

Inspected lower conjunctiva

Exam Action
04/02/23 3:10 PM MDT

Performed otoscopic examination of right ear