Shadow Health - Tina Jones: Health History Simulation, Exams of Nursing

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Shadow Health - Tina Jones, Health

History

Medications - Albuterol MDI, 2 puffs every 4 hours as needed for wheezing Acetaminophen 325 mg tabs by mouth, 2 tabs every 4 hours as needed for fever greater than 38.6C /101.5F Clindamycin 600mg/50ml every 6 hours intravenously 0.9 NaCl intravenously 100 ml/hr continuously x2 Liters Lortab 5mg 1-2 tabs by mouth as needed for pain Oxycodone 5mg 1 tab by mouth as needed Insulin glargine 10 units at bedtime Health History Tips & Tricks: - Student: Hello! - Diana Shadow: 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. Student: What is the situation? - Diana Shadow: Your patient is Tina Jones:, a 28-year-old African American woman who has just been admitted to Shadow General Hospital for a painful foot wound. Your role in this simulation is that of a healthcare provider who will take Ms. Jones' health history, a key component of her admission process. Student: What are my objectives in this assessment? - Diana Shadow: A health history requires you to ask questions related to Ms. Jones' past and present health, from her current foot wound to her pre- existing conditions. You will also want to review Ms. Jones' systems, psychosocial history, and family medical history. These assessments together will give you a comprehensive picture of Ms. Jones' overall health. 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. Throughout the conversation, you should educate and empathize with Ms. Jones when appropriate to increase her

health literacy and sense of well-being. Regardless of whether you have assessed Ms. Jones previously, ask all questions that are necessary for obtaining a complete health history. 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. After obtaining Ms. Jones' health history, you will complete an information processing activity. You will identify and prioritize diagnoses, then create a plan to address the identified diagnoses. Student: What else will this exam involve? - Diana Shadow: You will complete nursing tasks to protect the patients safety, privacy, and health. 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. Besides Subjective Data Collection, and Education and Empathy, there are activities within the simulation that provide valuable practice for their real-world counterparts, but they are not automatically graded by the simulation. Student: How will I be evaluated? - Diana Shadow: In this assignment, you will be evaluated on your Subjective Data Collection, as well as your Education and Empathy. Your success in Education and Empathy is based on whether you promptly respond after identifying a moment worthy of therapeutic communication. 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. You will also be evaluated on your ability to collect data and form nursing diagnoses in the information processing activity. This assignment takes on average between 90 and 110 minutes. This exam may take longer than in real life, because in this safe simulation, students of all experience levels can take time to hone and review their skills. You can pause and resume the assignment at any time; your work is always saved automatically. Student: How does this assignment prepare me for the real world? - Diana Shadow: In this assessment, you will become familiarized with the structure and content of a health history exam so that with real- life patients, you can: º ask effective and comprehensive questions º obtain a thorough health history º evaluate the patient's risk of disease, infection, injury, and complications º educate and empathize º reflect on your experience and identify areas to improve º identify and prioritize nursing diagnoses º and develop a plan to address nursing diagnoses. Diana Shadow: In 1 or 2 sentences, answer this question to help prepare for the upcoming exam: Why is it important to obtain a patient's complete health history? - Student: Getting a complete health history enables the nurse to make informed judgments about the client including formulating nursing diagnoses

Student: Can you rate your current pain level on a scale of 0 to 10? - Tina Jones: ...Like a 7. It hurts a lot, but whatever pain med the ER gave me is helping a little bit. Student: Can you describe the pain? - Tina Jones: It's throbbing and like, sharp if I try to put weight on it. Student: Have you had any other symptoms? - Tina Jones: I mean, it's all red and swollen, and there's pus, it feels hot, it hurts like hell... It's got all that going on. Student: When did you first notice the pus? - Tina Jones: I noticed it about 2 days ago. Student: What color was the pus? - Tina Jones: It's... white or maybe off-white. Student: Did your foot bleed? - Tina Jones: It bled a little after I injured it. Student: How have you been treating your foot? - Tina Jones: I made sure to clean it and keep it bandaged. And I put Neosporin on it. Student: How have you treated the wound? - Tina Jones: I've been taking Advil for my foot for a few days. Student: Was the Neosporin effective? - Tina Jones: Well, I'm here, so I guess it didn't do its job. Student: Can you walk on your injured foot? - Tina Jones: No, I can't. I can't put any weight on it without like, shooting pain. Student: How effective was your pain medication at home? - Tina Jones: Whatever pain medication the ER gave me is helping. Before I came in, I was just taking Advil. For the past few days, the Advil wasn't doing much for me -- it would only last a couple of hours.

Student: Have you had any fever at home? - Tina Jones: Yeah, I started to have one yesterday, and then it was a little better this morning. It kinda crept up all day. Student: Do you have any preexisting medical conditions? - Tina Jones: I mean, I have asthma and diabetes, but right I now I just care about my foot! Student: I understand your foot hurts. We have to ask a lot of questions, but it's to ensure we treat your injury and anything else that could contribute to the problem. - Tina Jones: That's kind of you. Student: When were you diagnosed with diabetes? - Tina Jones: I was diagnosed when I was 24. Student: How do you manage your asthma? - Tina Jones: I try to avoid things that give me breathing problems, but when my asthma starts to act up, I just use my inhaler. Student: What medications did you take for your diabetes? - Tina Jones: It was metformin. Student: Do you currently take medicine for your diabetes? - Tina Jones: No, I don't take anything for my diabetes anymore. Student: What made you stop taking medication for your diabetes? - Tina Jones: I guess I just got sick of feeling sick and gassy all the time, and it was overwhelming, remembering to take pills and check my sugar. I feel a lot better now that I'm just eating healthier than I did when I was taking the pills. Student: Do you monitor your blood glucose? - Tina Jones: I have a monitor at home, but to be honest I don't really use it that often. Student: Do you get thirsty often? - Tina Jones: You know, I did notice lately that I've been really thirsty.

Student: What allergies do you have? - Tina Jones: I'm allergic to cats. Student: How long have you had a cat allergy? - Tina Jones: For as long as I've been around. Student: What medication allergies do you have? - Tina Jones: I'm allergic to penicillin. Student: How old were you when you had an allergic reaction from penicillin? - Tina Jones: I don't remember....I was really young. I must have been sick or something. Student: Do you have any food allergies? - Tina Jones: Nope, no food allergies that I know of. Student: Are you allergic to latex? - Tina Jones: Nope. Student: Are you allergic to dust, mold, or pollen? - Tina Jones: Well... I don't know if it's allergies, but sometimes my asthma acts up around dust. Student: Are you up to date on all immunizations? - Tina Jones: I'm pretty sure my shots are current, yeah. Student: What immunizations have you received? - Tina Jones: I got a tetanus booster for work about a year ago. For the other kinds, I got all the required ones when I was a kid, and for college...I'm sure I have a record somewhere at home. Student: Have you received a flu vaccine? - Tina Jones: No. Student: The most effective way to prevent influenza is by getting a yearly influenza vaccine and using simple infection control measures such as washing your hands. There are also antiviral medicines that can also help prevent infection if you are exposed to the flu. - Tina Jones: ok thanks for the tip.

Student: The flu vaccine is especially recommended for adults and children with chronic diseases like diabetes, or chronic lung conditions like asthma. - Tina Jones: Gotcha. Student: Have you had any prior hospitalizations? - Tina Jones: Well, before this I went a bunch of times when I was little, for asthma attacks. This is the first time I've been in the hospital since I was probably sixteen, though. Student: What were you admitted to the hospital for previously? - Tina Jones: For my asthma Student: Have you had any gastrointestinal problems? - Tina Jones: No. I've never really had stomach or bowel problems. Student: Do you have a family history of psychiatric illness? - Tina Jones: No. They're crazy, but nobody's diagnosed with anything. Student: Do you have any neck, throat or gland problems? - Tina Jones: No, not that I noticed. Student: Any problems with your ears? - Tina Jones: No. Student: Any problems with your eyes and vision? - Tina Jones: I've actually been noticing problems lately. When I'm reading or studying I'll notice that things start to get kind of blurry. Student: Do you suffer from headaches? - Tina Jones: I get headaches sometimes, but that's all. Student: Do you wear glasses? - Tina Jones: No.

Student: When did your father's car accident happen? - Tina Jones: It was last year... I guess a little over a year ago. Student: Do you know what caused your dad's accident? - Tina Jones: He was driving to work, and it was raining...and his car hydroplaned. And hit a tree. So, it was really sudden. Student: How did you cope with your fathers death? - Tina Jones: Well, right after he died, after the funeral and everything, I just tried to get through that. Mom was having such a hard time, crying a lot, everything made her sad, she was kind of depressed. So, I guess at first I just focused on getting things done--groceries, laundry, insurance papers and stuff. Knowing that Mom needed me kind of helped me get through day by day. There was about a month where it was hard for us to get to church. Even getting up and ready for church was too overwhelming. But our church family helped us out and gave us rides to church and brought meals and all that, so they really helped build us back up. Things were only hard like that for a few months. Student: That must have been very tough for you and your family to go through. - Tina Jones: Student: Does your paternal grandfather have any health problems? - Tina Jones: Grandpa Jones had colon cancer, and that caused all kinds of problems for him. Plus, he had high blood pressure, and...I'm pretty sure he had diabetes. And high cholesterol like everyone else in my family. Student: How is your paternal grandmother's health? - Tina Jones: Granny's doing good. She's still living on her own. She's slowing down, but we help her out. She lives down the street from us, and she gets around okay. I think she takes some pills, maybe for blood pressure? She might have high cholesterol too. She seems happy. Student: How is your maternal grandfather's health? - Tina Jones: Well, Poppa died about five years ago. Student: How is your maternal grandmother's health? - Tina Jones: Nana was 73 when she died of a stroke about five years ago. I think she had high blood pressure and cholesterol, too.

Student: Do you have any siblings? - Tina Jones: I have two--a brother and my little sister. Student: Does your brother have any medical conditions? - Tina Jones: No, I don't think so. He's a healthy guy. Kind of big like me. Student: How is your sister's health? - Tina Jones: She's pretty healthy. She has asthma too, but she almost never has attacks. Student: Does your family have a history of obesity? - Tina Jones: No, I don't think so. My brother and my dad are kind of big, but I wouldn't say they were obese or anything. Student: Does your family have a history of diabetes? - Tina Jones: Dad had sugar diabetes, and I think my Grandpa Jones did too. Student: Does your family have a history of headaches? - Tina Jones: No, not that I know of. Student: Does your family have a history thyroid issue? - Tina Jones: No, I don't think so. Student: Does your family have a history of substance abuse? - Tina Jones: One person in the family, my dad's brother, has an alcohol problem, but we never see him. Student: Do you drink alcohol? - Tina Jones: I do sometimes when I go out with my friends. Student: How often do you drink? - Tina Jones: I only have a few drinks when I go out. Student: What is your level of education? - Tina Jones: Well, I'm finishing up my bachelor's degree right now.

Student: Have you ever smoked cigarettes? - Tina Jones: No. I think it's gross. Student: Have you been around people that are smoking? - Tina Jones: Some of my friend's smoke when we go out drinking. But I don't smoke, and nobody at home smokes. Student: Can you tell me about your father's health? - Tina Jones: He had high blood pressure and cholesterol. And diabetes -- we have diabetes in common. Student: Tell me about your father. - Tina Jones: Dad was a little stricter than Mom growing up... he would sometimes get kind of mad at us when we did something wrong. But he never hit us or anything. He would just get really calm and quiet and tell us to go to our rooms without supper, or that we were grounded when we were older. Or like, he'd make us rake the yard or wash his car or something. It's pretty sad to Student: How old was your father when he died? - Tina Jones: Last year when Dad passed, he was only

Subjective Data Collection - Checklist: - Chief Complaint - Finding: Established chief complaint - Finding: Reports pain (Found)Pro Tip: Initially establishing a chief complaint allows the patient to express their reason for seeking care, primary concerns, or condition they are presenting with. - Example Question: Do you have any pain? Finding: Reports foot wound (Found)Pro Tip: If a patient mentions pain, it's important to determine what specifically is causing her pain, if she knows. - Example Question: What's causing your pain?

History of Presenting Illness - Finding: Asked to rate current pain level on a scale - Finding: Reports current pain is 7/10 (Found)Pro Tip: Asking your patient to rate her pain on a scale of 0 to 10 is important to gauge how it ebbs and flows while she is in your care. - Example Question: Can you rate the pain on a scale of 0 to 10? Finding: Asked for details about the pain - Finding: Reports pain is throbbing (Found)Pro Tip: Determining how your patient describes the characteristics of the pain can be important data to support the cause of the pain. - Example Question: Can you please describe the pain? Finding: Reports pain is sharp when she attempts to stand (Found)Pro Tip: Determining what physical activities and movements exacerbate the patient's pain can help you better understand the problems and assess treatment needs. This can also alert you if a patient's activities of daily living are hindered. - Example Question: What is the pain like when you stand on your foot? Finding: Reports pain has increased in the past 2 days (Available)Pro Tip:Finding out how the patient's pain has changed will give you insight into the acceleration of infection. - Example Question: How has the pain changed over time? Finding: Reports feeling pain radiating into ankle (Available)Pro Tip: Asking about where else the patient's pain radiates can help determine the progression of infection. - Example Question: Does the pain radiate anywhere else? Finding: Reports pain prevents bearing weight on foot (Found)Pro Tip: Determining if your patient can bear weight on an injury is important to determine their risk for falls while in your care. - Example Question: Can you bear weight on your foot?

intervention will help you understand the progression of the wound. - Example Question: Have you seen a healthcare provider for this injury? Finding: Asked about drainage from the foot wound - Finding: Reports that the wound bled a little after sustaining the injury (Available)Pro Tip: Asking about bleeding helps you determine the characteristics of a wound. - Example Question: Did your foot bleed? Finding: Reports seeing pus draining from wound (Found)Pro Tip: Asking about discharge helps you determine the characteristics of a wound. - Example Question: Did you notice any discharge from the wound? Finding: Reports noticing pus 2 days ago (Available)Pro Tip: Pinpointing exactly when the patient noticed the arrival of pus gives you an important data point for when an active infection began. - Example Question: When did you first notice the pus? Finding: Followed up on drainage - Finding: Reports pus as white or yellow (Found)Pro Tip: The color of discharge from a wound can provide insight into its severity and characteristics. - Example Question: What color is the drainage from your wound? Finding: Denies odor from the wound (Available)Pro Tip: The odor of discharge from a wound can provide insight into its severity and characteristics. - Example Question: Does the wound have an odor? Finding: Asked about home treatment of foot wound - Finding: Reports wound care regimen of bandaging (Available)Pro Tip: Asking specifically how often a patient changed a bandage will let you know if an infection spread through improper hygiene, or for

other reasons such as uncontrolled blood sugar. - Example Question: How often do you change your bandage? Finding: Reports cleaning wound twice a day (Available)Pro Tip: Asking specifically how often a patient cleaned a wound will let you know if an infection spread through improper hygiene, or for other reasons such as uncontrolled blood sugar. - Example Question: How often did you clean the wound? Finding: Reports applying bacitracin, neomycin and polymyxin B (Neosporin) (Found)Pro Tip: Determining what products a patient used to sterilize or treat a wound establishes home care routines and health literacy. - Example Question: Did you use any ointment on the wound? Finding: Followed up on effectiveness of ointment - Finding: Reports bacitracin, neomycin and polymyxin B (Neosporin) was ineffective (Found)Pro Tip: Understanding the effect of a home medication can help you determine the severity of the wound. Tina's diabetes diagnosis will have a large impact on her body's healing ability, which should be taken into consideration during your exam. - Example Question: Did the ointment help? Finding: Asked about other foot wound symptoms - Finding: Reports swelling around foot wound (Found)Pro Tip: Asking about the presence of swelling helps you gather information about your patient's complaint, as well as potential related illnesses. - Example Question: Is there swelling around the wound? Finding: Reports swelling worsened in the past 2 days (Available)Pro Tip:Finding out how long swelling appeared will help you understand the timeline for the infection progression. - Example Question: How long have you noticed swelling around the wound? Finding: Reports redness around the wound (Found)Pro Tip: Asking about redness will help you understand the timeline for the infection progression. - Example Question: Did you notice any redness around the wound?

Finding: Reports asthma (Found)Pro Tip: It is important to identify any existing medical conditions, such as Tina's asthma, because that information is an integral part of her health history. Existing conditions can also inform your treatment and understanding of the patient's current health issues. - Example Question: Do you have any other conditions? Finding: Followed up on diabetes diagnosis - Finding: Reports specific age of diagnosis was 24 (Found)Pro Tip: Learning the diagnosis date of your patient's illness is an essential element of the illnesses history. - Example Question: At what age were you diagnosed with diabetes? Finding: Reports that her diabetes is Type 2 (Available)Pro Tip: The type of diabetes your patient has will drastically affect how you care for her. - Example Question: Do you know what type of diabetes you have? Finding: Asked about diabetes management through lifestyle changes - Finding: Reports staying away from sweets (Available)Pro Tip: Asking your patient specifically about sugar intake can help you understand the history of her diabetes as well as her health literacy. - Example Question: Tell me more about any sugars you consume. Finding: Reports drinking diet coke instead of regular (Available)Pro Tip: Particularly for diabetic patients, asking about intake of drinks that contain sugar can reveal additional sources of carbohydrates that the patient may not consider. - Example Question: Do you drink sugary drinks? Finding: Asked about current diabetes medication use - Finding: Reports that she does not currently take medication for diabetes (Found)Pro Tip: Asking about diabetes medication is important to understanding if your patient's disease is under control. - Example Question: Do you take prescribed medication for your diabetes?

Finding: Asked about past diabetes medication use - Finding: Reports that she used to take diabetes medication (Found)Pro Tip: Asking about Tina's medication history for asthma will provide a timeline of treatment. You will be able to see what has been effective and ineffective in the past, which will allow you to make a more informed decision about current treatment. - Example Question: Have you ever taken medication for your diabetes? Finding: Reports previous medication was prescription metformin (Found)Pro Tip: Asking about a patient's medication history for a particular condition, such as Tina's past prescription for metformin, will provide a timeline of her asthma treatment. You will be able to see what has been effective and ineffective in the past, which will allow you to make a more informed decision about current treatment.

• Example Question: Do you remember what you were prescribed for diabetes? Finding: Reports last use of medication was 3 years ago (Available)Pro Tip: It important to discover when Tina stopped taking any medications and what caused her to stop. Discovering her reason for noncompliance will allow you to make a more informed decision about current treatment. - Example Question: When was the last time you took your diabetes medication on a regular basis? Finding: Followed up on stopping diabetes regimen - Finding: Reports disliking diabetes medication side effects (Found)Pro Tip: Asking about side effects from medication can provide information about your patient's reaction to treatment. - Example Question: Did the metformin cause any side effects? Finding: Reports that she didn't like checking sugar and taking daily pills (Found)Pro Tip: Asking reasons for noncompliance can reveal information about your patient's health literacy, side effects, financial situation, and more. - Example Question: What's preventing you from taking your diabetes medication? Finding: Asked about blood glucose monitoring -