Focused exam: Cough shadow health answers

Transcript
Started: February 04, 2023 | Total Time: 170 min

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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?

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 significant 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?

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:

– Ask effective and comprehensive questions
– Obtain and assess objective data
– Educate and empathize with the patient
– Develop a nursing diagnosis
– Create an effective and expedient care plan
– 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.

NRS-434VN Adolescence: Contemporary Issues and Resources

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

. . . I mean, my throat always feels like something is in there, and it’s just annoying. My mom made me drink honey, and that helped a little bit, but not a lot.

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

	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?	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	Exam Action 04/02/23 3:11 PM MDT
	Performed otoscopic examination of left ear	Exam Action 04/02/23 3:11 PM MDT
	Performed otoscopic examination of right naris	Exam Action 04/02/23 3:11 PM MDT
	Performed otoscopic examination of left naris	Exam Action 04/02/23 3:11 PM MDT
	Inspected mouth	Exam Action 04/02/23 3:11 PM MDT
	Inspected front of neck	Exam Action 04/02/23 3:11 PM MDT
	Inspected right side of neck	Exam Action 04/02/23 3:11 PM MDT
	Inspected back of neck	Exam Action 04/02/23 3:11 PM MDT
	Inspected left side of neck	Exam Action 04/02/23 3:11 PM MDT
	Inspected anterior chest wall	Exam Action 04/02/23 3:12 PM MDT
	Inspected posterior chest wall	Exam Action 04/02/23 3:12 PM MDT
	Palpated frontal sinuses: No tenderness reported	Exam Action 04/02/23 3:12 PM MDT
	Palpated maxillary sinuses: No tenderness reported	Exam Action 04/02/23 3:12 PM MDT
	Palpated lymph nodes of head and neck: Enlarged and reported tenderness on the right side	Exam Action 04/02/23 3:13 PM MDT
	Palpated supraclavicular lymph nodes: Not palpable	Exam Action 04/02/23 3:13 PM MDT
	Palpated axillary lymph nodes: Not palpable	Exam Action 04/02/23 3:13 PM MDT
	Palpated fremitus in anterior upper chest wall: Present and equal bilaterally	Exam Action 04/02/23 3:14 PM MDT
	Ninety-nine.
	Palpated fremitus in anterior lower chest wall: Present and equal bilaterally	Exam Action 04/02/23 3:14 PM MDT
	Ninety-nine.
	Palpated fremitus in posterior upper chest wall: Present and equal bilaterally	Exam Action 04/02/23 3:14 PM MDT
	Ninety-nine.
	Palpated fremitus in posterior middle chest wall: Present and equal bilaterally	Exam Action 04/02/23 3:14 PM MDT
	Ninety-nine.
	Palpated fremitus in posterior lower chest wall: Present and equal bilaterally	Exam Action 04/02/23 3:14 PM MDT
	Ninety-nine.
	Palpated chest expansion: Both sides rise symmetrically	Exam Action 04/02/23 3:14 PM MDT
	Auscultated breath sounds in anterior right upper lobe	Exam Action 04/02/23 3:15 PM MDT
	Auscultated breath sounds in anterior left upper lobe	Exam Action 04/02/23 3:15 PM MDT
	Auscultated breath sounds in anterior right upper lobe	Exam Action 04/02/23 3:15 PM MDT
	Auscultated breath sounds in anterior left middle lobe	Exam Action 04/02/23 3:15 PM MDT
	Auscultated breath sounds in anterior right middle lobe focused exam: cough shadow health answers	Exam Action 04/02/23 3:15 PM MDT
	Auscultated breath sounds in anterior left middle lobe	Exam Action 04/02/23 3:15 PM MDT
	Auscultated breath sounds in anterior right lower lobe	Exam Action 04/02/23 3:15 PM MDT
	Auscultated breath sounds in anterior left lower lobe	Exam Action 04/02/23 3:15 PM MDT
	Auscultated breath sounds in posterior left upper lobe	Exam Action 04/02/23 3:16 PM MDT
	Auscultated breath sounds in posterior right upper lobe focused exam: cough shadow health answers	Exam Action 04/02/23 3:16 PM MDT
	Auscultated breath sounds in posterior left mid-back (lower lobe)	Exam Action 04/02/23 3:16 PM MDT
	Auscultated breath sounds in posterior right mid-back (lower lobe)	Exam Action 04/02/23 3:16 PM MDT
	Auscultated breath sounds in posterior left lower lobe near spine	Exam Action 04/02/23 3:16 PM MDT
	Auscultated breath sounds in posterior right lower lobe near spine	Exam Action 04/02/23 3:16 PM MDT
	Auscultated breath sounds in posterior left lower lobe on side	Exam Action 04/02/23 3:16 PM MDT
	Auscultated breath sounds in posterior left lower lobe	Exam Action 04/02/23 3:16 PM MDT
	Auscultated breath sounds in posterior right lower lobe	Exam Action 04/02/23 3:16 PM MDT
	Auscultated breath sounds in posterior right lower lobe on side	Exam Action 04/02/23 3:16 PM MDT
	Auscultated voice sounds in anterior right upper lobe	Exam Action 04/02/23 3:16 PM MDT
	Ninety-nine.
	Ninety-nine.
	Auscultated voice sounds in anterior left upper lobe	Exam Action 04/02/23 3:16 PM MDT
	Ninety-nine.
	Auscultated voice sounds in anterior right upper lobe	Exam Action 04/02/23 3:16 PM MDT
	Ninety-nine.
	Auscultated voice sounds in anterior left mid-chest (upper lobe)	Exam Action 04/02/23 3:16 PM MDT
	Ninety-nine.
	Auscultated voice sounds in anterior right middle lobe	Exam Action 04/02/23 3:17 PM MDT
	Ninety-nine.
	Auscultated voice sounds in anterior left mid-chest (upper lobe)	Exam Action 04/02/23 3:17 PM MDT
	Ninety-nine.
	Auscultated voice sounds in anterior right lower lobe	Exam Action 04/02/23 3:17 PM MDT
	Ninety-nine.
	Auscultated voice sounds in anterior left lower lobe	Exam Action 04/02/23 3:17 PM MDT
	Auscultated voice sounds in posterior left upper lobe	Exam Action 04/02/23 3:17 PM MDT
	Ninety-nine.
	Ninety-nine.
	Ninety-nine.
	Auscultated voice sounds in posterior right upper lobe	Exam Action 04/02/23 3:17 PM MDT
	Ninety-nine.
	Ninety-nine.
	Ninety-nine.
	Auscultated voice sounds in posterior left mid-back (lower lobe)	Exam Action 04/02/23 3:17 PM MDT
	Ninety-nine.
	Auscultated voice sounds in posterior right mid-back (lower lobe)	Exam Action 04/02/23 3:17 PM MDT
	Ninety-nine.
	Auscultated voice sounds in posterior left lower lobe near spine	Exam Action 04/02/23 3:17 PM MDT
	Ninety-nine.
	Auscultated voice sounds in posterior right lower lobe near spine	Exam Action 04/02/23 3:17 PM MDT
	Ninety-nine.
	Auscultated voice sounds in posterior left lower lobe on side	Exam Action 04/02/23 3:17 PM MDT
	Ninety-nine.
	Auscultated voice sounds in posterior left lower lobe	Exam Action 04/02/23 3:17 PM MDT
	Ninety-nine.
	Auscultated voice sounds in posterior right lower lobe	Exam Action 04/02/23 3:17 PM MDT
	Ninety-nine.
	Ninety-nine.
	Ninety-nine.
	Auscultated aortic area with the bell	Exam Action 04/02/23 3:18 PM MDT
	Auscultated pulmonic area with the bell	Exam Action 04/02/23 3:18 PM MDT
	Auscultated Erb’s point with the bell	Exam Action 04/02/23 3:18 PM MDT
	Auscultated tricuspid area with the bell	Exam Action 04/02/23 3:18 PM MDT
	Auscultated mitral area with the bell	Exam Action 04/02/23 3:18 PM MDT
	Auscultated mitral area with the diaphragm focused exam: cough shadow health answers	Exam Action 04/02/23 3:18 PM MDT
	Auscultated aortic area with the diaphragm	Exam Action 04/02/23 3:18 PM MDT
	Auscultated pulmonic area with the diaphragm	Exam Action 04/02/23 3:18 PM MDT
	Auscultated Erb’s point with the diaphragm	Exam Action 04/02/23 3:18 PM MDT
	Auscultated tricuspid area with the diaphragm	Exam Action 04/02/23 3:18 PM MDT
	Auscultated mitral area with the diaphragm	Exam Action 04/02/23 3:18 PM MDT
	Percussed anterior right upper lobe	Exam Action 04/02/23 3:23 PM MDT
	Percussed anterior left upper lobe	Exam Action 04/02/23 3:23 PM MDT
	Percussed anterior right middle lobe	Exam Action 04/02/23 3:23 PM MDT
	Percussed anterior left mid-chest (upper lobe)	Exam Action 04/02/23 3:23 PM MDT
	Percussed anterior right lower lobe	Exam Action 04/02/23 3:23 PM MDT
	Percussed anterior left lower lobe	Exam Action 04/02/23 3:23 PM MDT
	Percussed posterior left upper lobe	Exam Action 04/02/23 3:23 PM MDT
	Percussed posterior right upper lobe	Exam Action 04/02/23 3:23 PM MDT
	Percussed posterior left mid-back (lower lobe)	Exam Action 04/02/23 3:23 PM MDT
	Percussed posterior right mid-back (lower lobe)	Exam Action 04/02/23 3:23 PM MDT
	Percussed posterior left lower lobe	Exam Action 04/02/23 3:23 PM MDT
	Percussed posterior right lower lobe	Exam Action 04/02/23 3:23 PM MDT
	Percussed posterior left lower lobe on side	Exam Action 04/02/23 3:23 PM MDT
	Percussed posterior left lower lobe near spine	Exam Action 04/02/23 3:23 PM MDT
	Percussed posterior right lower lobe near spine	Exam Action 04/02/23 3:23 PM MDT
	Percussed posterior left right lobe on side	Exam Action 04/02/23 3:23 PM MDT
	Measured diaphragmatic excursion: 3 cm	Exam Action 04/02/23 3:24 PM MDT
	Danny, we want to make sure you dont develop an infection and become more sick by taking you through the different that can prevent that and the focus will be on your risk factors. Some of your risk factors include you being close to a sick friend, exposure to cigar smoke, having touches your face with uncleaned fingers. They may sound a lot but by working together and mitigating your risk factors can be easy and effective	Educate 04/02/23 4:43 PM MDT
	OK. I get it!
	To make sure you dont become sicker, I will talk to you and your father and what must e done. The three of us will collaborate and agree to your health goals. Then both of you will repeat what you have learnt to be sure you have understood all which should be done.	Educate 04/02/23 4:48 PM MDT
	Alright.
	Does the plan sound good to you?	Educate 04/02/23 4:49 PM MDT
	We can do it! I love learning and I’m really a good learner.
	If you don’t have any other question, we can start our discussion.	Educate 04/02/23 4:49 PM MDT Dont wait until the last minute. Provide your requirements and let our native nursing writers deliver your assignments ASAP. Start My Order
	Okie dokie artichokey.

Focused exam: Cough shadow health answers