Shadow Health - Tina Jones Health History Simulation: A Guide for Healthcare Providers, Exams of Nursing

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Shadow Health - Tina Jones, Health

History with correct answers

Health History Tips & Tricks: - correct answer Student: Hello! - correct answer 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? - correct answer 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? - correct answer 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? - correct answer 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? - correct answer 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? - correct answer 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? - correct answer Student: So that you understand if there are any problems related to their chief complaint. Also, to help treat their current condition. Diana Shadow: Time to begin. - correct answer Patient Exam - Vital Signs: - correct answer Height: 170 cm, Weight: 90 kg, BMI: 31, Random blood glucose: 238, Temperature: 102.4° F, Blood pressure: 138/90 mmHg, Heart rate: 90, Respiratory rate: 18, O2 sat: 98%

Student: What did you do to treat your foot after your accident? - correct answer Tina Jones: I made sure to clean it and keep it bandaged. And I put Neosporin on it. Student: How effective was the Neosporin? - correct answer Tina Jones: Well, I'm here, so I guess it didn't do its job. Student: Can you walk with your foot being injured? - correct answer Tina Jones: No, I can't. I can't put any weight on it without like, shooting pain. Student: What preexisting medical conditions do you have? - correct answer 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, but I need to know this information to make sure I take care of the problem correctly. - correct answer Tina Jones: Thanks. Student: When were you diagnosed with diabetes? - correct answer Tina Jones: I was diagnosed when I was 24. Student: What do you do to manage your asthma? - correct answer 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? - correct answer Tina Jones: It was metformin. Student: Do you currently take medicine for your diabetes? - correct answer Tina Jones: No, I don't take anything for my diabetes anymore. Student: What made you stop taking medication for your diabetes? - correct answer 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? - correct answer Tina Jones: I have a monitor at home, but to be honest I don't really use it that often. Student: How frequently do you urinate? - correct answer Tina Jones: I don't know. Every hour or two when I'm awake? Student: What is your current diet? - correct answer Tina Jones: It's pretty good, I think. I'm not a huge health nut or anything. Student: Have you had any change in appetite? - correct answer Tina Jones: Yeah, lately I've definitely been much hungrier than usual. Student: Has your weight changed? - correct answer Tina Jones: Yeah, I've lost some weight recently. Student: Do you know why you lost weight? - correct answer Tina Jones: I don't know what caused it, I just lost weight. Student: How often do you have asthma exacerbations? - correct answer Tina Jones: I haven't had a full attack in years. But my breathing definitely acts up.. .not always. Max twice a week. Student: What asthma symptoms have you experienced? - correct answer Tina Jones: My chest and throat get tight, and I start to wheeze. It feels like I can't take in air, like I can't get enough air into my lungs. Student: How many puffs do you take when using your asthma inhaler? - correct answer Tina Jones: I usually use two puffs from my inhaler, but sometimes I need three. [Nurse confirmed with Pharmacy: albuterol 90mcg/spray MDI]

Student: Have you had any gastrointestinal problems? - correct answer Tina Jones: No. I've never really had stomach or bowel problems. Student: Do you have a family history of psychiatric illness? - correct answer Tina Jones: No. They're crazy, but nobody's diagnosed with anything. Student: Do you have any neck, throat or gland problems? - correct answer Tina Jones: No, not that I noticed. Student: Do you have any problems with your head? - correct answer Tina Jones: I don't think I have any problems. I get headaches sometimes, but that's all. Student: Any problems with your ears? - correct answer Tina Jones: No. Student: Any problems with your eyes and vision? - correct answer 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: Any problems with your nose? - correct answer Tina Jones: My nose is fine right now. Sometimes it runs, but not very often. Student: Do you have problems with your mouth? - correct answer Tina Jones: No. Student: Do you have a history of cardiovascular problems? - correct answer Tina Jones: My heart's fine, thank God! Student: Any problems with your heart? - correct answer Tina Jones: No, my heart's always been fine.

Student: Have you had any problems with your breasts? - correct answer Tina Jones: I haven't noticed any pain there. Student: Have you had any reproductive problems? - correct answer Tina Jones: I don't think I have problems in that area. I just get really bad periods, that's all. Student: Have you had any neurological problems? - correct answer Tina Jones: No, I haven't. Student: Have you had any musculoskeletal problems? - correct answer Tina Jones: No. Student: Do you have a history of skin disease? - correct answer Tina Jones: Um, I have acne, if that counts. Student: Does your paternal grandfather have any health problems? - correct answer 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: Does your mother have any health problems? - correct answer Tina Jones: Mom has high cholesterol and blood pressure, I think. She seems to be doing okay though. Student: Does your father have any health problems? - correct answer Tina Jones: Well, he passed away. But he had a couple things... Type 2 diabetes, like me, and high cholesterol and blood pressure. Student: How did your father die? - correct answer Tina Jones: He died in a car accident. Student: Where is your wound located? - correct answer Tina Jones: It's on the ball of my foot.

Student: How is your maternal grandmother's health? - correct answer 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: How is your brother's health? - correct answer Tina Jones: He's a healthy guy. Kind of big like me. Student: How is your sister's health? - correct answer 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? - correct answer 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 thyroid issue? - correct answer Tina Jones: No, I don't think so. Student: Does your family have a history of substance abuse? - correct answer Tina Jones: One person in the family, my dad's brother, has an alcohol problem, but we never see him. Student: Does your family have a history of headaches? - correct answer Tina Jones: No, not that I know of. Student: How much alcohol do you drink? - correct answer Tina Jones: I only have a few drinks when I go out. Student: What is your level of education? - correct answer Tina Jones: Well, I'm finishing up my bachelor's degree right now. Student: What are stressors? - correct answer Tina Jones: I feel really stressed out right now! Honestly, I didn't realize that I'd be admitted to the hospital for my foot. I don't want to miss

work or school but now it looks like I'll have to. And I want my foot to stop hurting. I know I need sleep, too. Student: We are going to take care of everything as quickly as possible. - correct answer Tina Jones: Thanks. Student: Where do you live? - correct answer Tina Jones: Right now, I'm living at my mom's place, which is out in the suburbs a bit. It's like a half hour from here. Student: What is your belief system? - correct answer Tina Jones: I'm Baptist. My faith is a big part of my life--when things get hard like they've been this past year, I know I can trust that God's looking out for me. I've been going to the same church since I was a kid, too, so the people at church are practically part of my family. Student: Have you experienced abuse? - correct answer Tina Jones: I've never had been in any kind of situation like that... It's scary to think about. Student: Have you used illicit drugs? - correct answer Tina Jones: Well, I used to smoke pot... but I don't do that anymore. Student: What type of drugs did you use? - correct answer Tina Jones: Um...I've smoked pot before. In high school, and after high school... I definitely don't anymore, though. Student: Have you used drugs other than marijuana? - correct answer Tina Jones: No. Student: When did you last use drugs? - correct answer Tina Jones: I haven't smoked pot since I was twenty or twenty-one. Student: Have you ever smoked cigarettes? - correct answer Tina Jones: No. I think it's gross.

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. - correct answer 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. - correct answer Example Question: What's causing your pain? History of Presenting Illness - correct answer Finding: Asked to rate current pain level on a scale - correct answer 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. - correct answer Example Question: Can you rate the pain on a scale of 0 to 10? Finding: Asked for details about the pain - correct answer 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. - correct answer 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. - correct answer 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. - correct answer 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. - correct answer 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. - correct answer Example Question: Can you bear weight on your foot? Finding: Asked location of wound - correct answer Finding: Reports right foot is injured (Found)Pro Tip: Confirming which extremity an injury is located is a best practice for your patient's safety. - correct answer Example Question: Which foot is in pain? Finding: Reports wound is on the plantar surface of her foot (Found)Pro Tip: Confirming where a wound is located ensures you are aware of your patient's biggest complaint. - correct answer Example Question: Where is the wound? Finding: Asked details of the injury - correct answer Finding: Reports she scraped foot on bottom rung of a step stool (Found)Pro Tip: Discovering how an injury happened helps to assess your patient's risk factors for injury. - correct answer Example Question: How did your injury happen? Finding: Reports injury occurred 1 week ago (Available)Pro Tip: Discovering how long ago the pain began is the first step in understanding whether the pain is chronic or acute. - correct answer Example Question: When did your injury occur? Finding: Denies other injuries besides foot wound (Available)Pro Tip: Discovering additional injuries can reveal more information about the circumstances that caused the presenting injury.

• correct answer Example Question: Did you injure anything besides your foot?

Finding: Denies odor from the wound (Available)Pro Tip: The odor of discharge from a wound can provide insight into its severity and characteristics. - correct answer Example Question: Does the wound have an odor? Finding: Asked about home treatment of foot wound - correct answer 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. - correct answer 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. - correct answer 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. - correct answer Example Question: Did you use any ointment on the wound? Finding: Followed up on effectiveness of ointment - correct answer 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. - correct answer Example Question: Did the ointment help? Finding: Asked about other foot wound symptoms - correct answer

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. - correct answer 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. - correct answer 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. - correct answer Example Question: Did you notice any redness around the wound? Finding: Reports that the wound feels warm (Found)Pro Tip: Asking about warmth will help you understand the timeline for the infection progression. - correct answer Example Question: Does the wound feel warm? Finding: Explored impact of patient's foot injury on activities of daily living - correct answer Finding: Reports pain affects ability to walk (Available)Pro Tip: Understanding the impact of your patient's wound on daily activities helps inform your plan for care. With a foot wound, it is imperative to discern if a patient can walk or not, as a lack of mobility can compromise quality of life. - correct answer Example Question: Does your injury impact your ability to walk? Finding: Reports pain affects ability to stand at work for long periods of time (Available)Pro Tip: Understanding the impact of your patient's wound on daily activities helps inform your plan for care. With a foot wound, it is imperative to discern if a patient can stand or not, as this can compromise quality of life and impact job performance. - correct answer Example Question: Does your foot pain affect your work? Finding: Reports pain prevented her from being able to walk to class (Available)Pro Tip: For patients who are also students, you can find out what schoolwork they are missing, and help them make accommodations so they don't fall behind. - correct answer Example Question: Has your injury prevented you from going to class?

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. - correct answer Example Question: Do you drink sugary drinks? Finding: Asked about current diabetes medication use - correct answer 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. - correct answer Example Question: Do you take prescribed medication for your diabetes? Finding: Asked about past diabetes medication use - correct answer 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. - correct answer 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. - correct answer 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. - correct answer Example Question: When was the last time you took your diabetes medication on a regular basis?

Finding: Followed up on stopping diabetes regimen - correct answer 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. - correct answer 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. - correct answer Example Question: What's preventing you from taking your diabetes medication? Finding: Asked about blood glucose monitoring - correct answer Finding: Reports infrequent blood glucose monitoring (Found)Pro Tip: Your patient's blood sugar monitoring habits are an important part of her health literacy and home treatment. - correct answer Example Question: Tell me about your blood sugar monitoring. Finding: Reports she last checked blood sugar a month ago (Available)Pro Tip: Your patient's blood sugar monitoring habits are an important part of her health literacy and home treatment.

• correct answer Example Question: How often do you check your blood sugar? Finding: Reports confusion about what the numbers mean (Available)Pro Tip: Your patient's blood sugar monitoring habits are an important part of her health literacy and home treatment. If you find gaps in the patient's literacy, that is your opportunity to provide education. - correct answer Example Question: What are your usual blood sugar levels? Finding: Asked about thirst - correct answer Finding: Reports increased thirst (Found)Pro Tip: Your patient's thirst can offer insight into underlying medical conditions. Knowing that Tina is diabetic, you will want to explore this classic