Felipe Barbosa Sick Visit: Integumentary ShadowHealth Transcript

Transcript
Started: Feb 16, 2023 | Total Time: 102 min

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Greet
02/19/23 5:47 PM EST

Felipe Barbosa:
Hi.

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What is your name?

Question
02/19/23 5:47 PM EST

Felipe Barbosa:
Felipe Barbosa

Felipe Barbosa Sick Visit: Integumentary ShadowHealth Transcript

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What brings you here today?

Question
02/19/23 5:48 PM EST

Felipe Barbosa:
I’m here for this pain and rash on my back.

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I am sorry about that

Empathize
02/19/23 5:49 PM EST

Felipe Barbosa:
Thank you.

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How long have you had the pain and rash?

Question
02/19/23 5:51 PM EST

Felipe Barbosa:
The pain and rash has been going on for two days, though I had some tingling in the area four days ago . . . [AUDIO COMING SOON]

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Can you describe the rash?

Question
02/19/23 5:51 PM EST

Felipe Barbosa:
Yeah, the rash is red, has small blisters, and I feel a burning pain.

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How long does the pain last?

Question
02/19/23 5:52 PM EST

Felipe Barbosa:
The pain has been constant.

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How severe is your pain?

Question
02/19/23 5:53 PM EST

Felipe Barbosa:
Pain — 7 out of 10.

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Where is the rash located?

Question
02/19/23 5:53 PM EST

Felipe Barbosa:
The rash is on my right lower back. I have pain there too, but it’s not radiating.

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What relieves your symptoms?

Question
02/19/23 5:53 PM EST

Felipe Barbosa:
I took some ibuprofen for the pain — that helped a little. I tried an ice pack, but that did nothing. I didn’t try any ointments or anything for the rash.

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I’m glad that ibuprofen helped a little

Empathize
02/19/23 5:55 PM EST

Felipe Barbosa:
I appreciate that.

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What makes your symptoms worse

Question
02/19/23 5:56 PM EST

Felipe Barbosa:
Sweat and being hot make the pain feel worse. The pain is constant and in the area of the rash.

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What is your medical history?

Question
02/19/23 5:57 PM EST

Felipe Barbosa:
Aside from the rash and the pain, no other health issues.

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Any allergies?

Question
02/19/23 5:57 PM EST

Felipe Barbosa:
Nope, I don’t have allergies.

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Have you had a rash in the past?

Question
02/19/23 5:58 PM EST

Felipe Barbosa:
Yeah I have a rash and pain in my back.

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Are your immunizations up to date?

Question
02/19/23 5:58 PM EST

Felipe Barbosa:
Yup, I have all my shots.

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Any past history of skin conditions?

Question
02/19/23 5:59 PM EST

Felipe Barbosa:
I don’t have any skin conditions or other medical conditions. Just this rash. [AUDIO COMING SOON]

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Any history of chronic disease?

Question
02/19/23 6:02 PM EST

Felipe Barbosa:
Yeah, my family has some health issues — Dad has high cholesterol and hypertension. Mom has diabetes. They’re both living.

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Are you using any other medications?

Question
02/19/23 6:03 PM EST

Felipe Barbosa:
I don’t have any prescriptions. I just take ibuprofen.

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Have you been sexually active

Question
02/19/23 6:03 PM EST

Felipe Barbosa:
Not totally sure how that relates, but yes . . . I’m sexually active with my husband. Not since I got this rash, though. [AUDIO COMING SOON]

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Some skin conditions are spread through contact

Educate
02/19/23 6:05 PM EST

Felipe Barbosa:
I’ll make a note of that.

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Any fever?

Question
02/19/23 6:05 PM EST

Felipe Barbosa:
No, I haven’t had a fever.

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Any history of eczema?

Question
02/19/23 6:06 PM EST

Felipe Barbosa:
I don’t have any clinical mental health issues, but I’m grappling with a traumatic incident — my best friend died recently.

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Am sorry about that

Empathize
02/19/23 6:07 PM EST

Felipe Barbosa:
Thanks.

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Are you using any supplements?

Question
02/19/23 6:08 PM EST

Felipe Barbosa:
No, I don’t take vitamins or supplements.

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Any recent travel?

Question
02/19/23 6:09 PM EST

Felipe Barbosa:
We haven’t traveled recently. Not since our honeymoon a few years ago. [AUDIO COMING SOON]

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Any history of surgeries?

Question
02/19/23 6:09 PM EST

Felipe Barbosa:
Nope, I’ve never had surgery before.

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Any history of hospitalizations?

Question
02/19/23 6:10 PM EST

Felipe Barbosa:
Nope, no hospitalizations.

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Any recent exposure to chemicals?

Question
02/19/23 6:13 PM EST

Felipe Barbosa:
No, I haven’t touched any strange plants or anything. [AUDIO COMING SOON]

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What is your diet like?

Question
02/19/23 6:13 PM EST

Felipe Barbosa:
I usually do a protein shake for breakfast and load it up with lots of stuff — I use some super greens powder, or fresh greens if I have them on hand, some fruit, oatmeal, yogurt . . . they keep me pretty full in the morning before my workouts. Lunch is usually something quick like a salad and pizza, or grain bowl. Dinner I’ll have some steak or fish with pasta and roasted vegetables. I snack too . . . nuts, chips and guacamole, a good cheese plate, an occasional doughnut.

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Healthy diet is good for your skin

Educate
02/19/23 6:15 PM EST

Felipe Barbosa:
Ah, alright, thanks.

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Any family history of skin conditions?

Question
02/19/23 6:16 PM EST

Felipe Barbosa:
I don’t think any skin diseases run in

my family. [AUDIO COMING SOON]

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Any joint pain?

Question
02/19/23 6:18 PM EST

Felipe Barbosa:
I don’t have any joint issues.

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Any night sweats?

Question
02/19/23 6:18 PM EST

Felipe Barbosa:
I don’t get night sweats.

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Any vision problems?

Question
02/19/23 6:20 PM EST

Felipe Barbosa:
My eyes and vision are good. [AUDIO COMING SOON]

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Any numbness or tingling?

Question
02/19/23 6:21 PM EST

Felipe Barbosa:
I have some tingling sensations in the rash area. The tingling has been going on for about four days. The rash only showed up two days ago.

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Am sorry about that

Empathize
02/19/23 6:22 PM EST

Felipe Barbosa:
That’s nice of you.

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Any nausea?

Question
02/19/23 6:22 PM EST

Felipe Barbosa:
I haven’t been nauseated.

Auscultated breath sounds: Breath sounds present in all areas with no adventitious sounds

Exam Action
02/19/23 7:09 PM EST

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Auscultated heart sounds: S1 and S2 audible with no extra heart sounds

Exam Action
02/19/23 7:10 PM EST

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Assessed location of rash.

Exam Action
02/19/23 7:12 PM EST

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Assessed character of rash.

Exam Action
02/19/23 7:13 PM EST

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Palpated abdomen light

Exam Action
02/19/23 7:13 PM EST

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Palpated spine: Spine and accessory muscles were nontender to palpation.

Exam Action
02/19/23 7:14 PM EST

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Palpated rash: Patient verbalized pain by saying “Ouch” upon palpation

Exam Action
02/19/23 7:14 PM EST

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Tested sensation in left and right legs: Expected sensation in left and right legs

Exam Action
02/19/23 7:15 PM EST

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Tested sensation of left and right feet: Tested sensation in feet. Expected sensation in left and right feet

Exam Action
02/19/23 7:15 PM EST

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Tested spine range of motion: Full range of motion performed without discomfort

Exam Action
02/19/23 7:15 PM EST

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Are you able to work?

Question
02/19/23 7:22 PM EST

Felipe Barbosa:
Well I’m a firefighter and I’ve been on my off schedule. I guess I’ll find out tomorrow when I’m back on shift if the pain is going to get in the way . . . I’ll grit through the pain.

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Can you stand?

Question
02/19/23 7:25 PM EST

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Have the symptoms affected your sleep?

Question
02/19/23 7:25 PM EST

Felipe Barbosa:
Aside from the pain, I have a rash and I’ve been feeling a little tired.

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Any fatigue?

Question
02/19/23 7:26 PM EST

Felipe Barbosa:
Yeah, I’ve been tired lately.

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How many hours do you sleep per day?

Question
02/19/23 7:26 PM EST

Felipe Barbosa:
Usually 8 hours a night.

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Any sore throat?

Question
02/19/23 7:27 PM EST

Felipe Barbosa:
My throat feels fine.

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Any history of infection?

Question
02/19/23 7:28 PM EST

Felipe Barbosa:
Um . . . that’s sort of out of nowhere, but no, I don’t have an STD.

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Any stress?

Question
02/19/23 7:29 PM EST

Felipe Barbosa:
I recently lost my best friend . . . he died in the line of duty, he was a firefighter too. It’s been hard.

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Am sorry about that

Empathize
02/19/23 7:30 PM EST

Felipe Barbosa:
I appreciate it.

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Any history of back pain?

Question
02/19/23 7:34 PM EST

Felipe Barbosa:
Before the current pain in my right lower back, I haven’t had major back pain.

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Are you depressed?

Question
02/19/23 7:34 PM EST

Felipe Barbosa:
I don’t have clinical depression or anything, but . . . I lost my best friend recently, and I’ve been in mourning.

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Any history of HIV?

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Question
02/19/23 7:35 PM EST

Felipe Barbosa:
I don’t have an anxiety disorder . . . but . . . and I don’t know if “anxiety” is the right word . . . I lost my best friend recently, and I’ve definitely been on edge.

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Any history of childhood illnesses?

Question
02/19/23 7:36 PM EST

Felipe Barbosa:
Um, I had chickenpox as a kid.

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Does the pain radiate?

Question
02/19/23 7:42 PM EST

Felipe Barbosa:
The pain in the rash area is really only on my right lower back. It doesn’t go anywhere else.

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Do you work?

Question
02/19/23 7:43 PM EST

Felipe Barbosa:
Yeah, I’m a firefighter.