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Hi Danny my name is …., I am here to examine you today.
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Greet
10/03/20 12:38 PM MDT
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Hi.
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How are you doing today ?
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Question
10/03/20 12:38 PM MDT
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I don’t feel so good. I keep coughing and I feel a little bit tired.
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Oh, I’m sorry to hear that Danny
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Empathize
10/03/20 12:39 PM MDT
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Thank you.
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How is the characteristics of your cough ?
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Question
10/03/20 12:40 PM MDT
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My cough seems kind of gurgly and watery.
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Do you have a cough ?
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Question
10/03/20 12:48 PM MDT
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I guess I’m kind of sick. . . I’ve been coughing a lot.
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How often do you have a cough ?
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Question
10/03/20 12:48 PM MDT
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I just keep feeling like I have to cough every couple minutes or so. I think it gets worse at night.
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When it started ? (Clarified to When did the cough start?.)
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Question
10/03/20 12:49 PM MDT
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I think the cough started four. . . No, it started five days ago. (Clarified to when the cough started.)
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How frequently have you been coughing ?
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Question
10/03/20 12:50 PM MDT
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I just keep feeling like I have to cough every couple minutes or so. I think it gets worse at night.
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Is your cough wet cough ?
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Question
10/03/20 12:50 PM MDT
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Yeah . . . my cough seems kind of gurgly and watery.
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Do you have a sputum ?
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Question
10/03/20 12:51 PM MDT
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Sometimes I cough up this slimy, clear stuff.
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What aggravates your cough ?
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Question
10/03/20 12:51 PM MDT
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My cough mostly stays the same no matter what I do. It seems to get worse at night though.
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Do you smoke ?
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Question
10/03/20 12:52 PM MDT
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No way! I know smoking is really bad–even for grown-ups. Papi smokes cigars sometimes. I don’t like how they smell.
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Lisa poppy smokes at home around you (No matching questions found.)
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Question
10/03/20 12:52 PM MDT
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Lisa poppy smokes at home around you ? (No matching questions found.)
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Question
10/03/20 12:53 PM MDT
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Lisa Papi smokes at home around you ? (No matching questions found.)
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Question
10/03/20 12:53 PM MDT
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Is Papi smokes at home around you ?
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Question
10/03/20 12:54 PM MDT
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Yeah, sometimes Papi smokes cigars inside. He forgets to take them outside and my mom has to remind him. [AUDIO COMING SOON]
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It’s called secondary smoke When someone at home smokes they need to go to outside. Please don’t be around the people who smoking. It is called secondary smoke. If you see somebody smoking and have no intentions to leave or you coming to the place where somebody smoked please do not stay in the same area. You need to leave. It is called secondary smoking and may affect your lungs when you inhale the smoke.NURS6512 Week 5 – Focused Exam: Cough Danny Rivera
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Educate
10/03/20 1:00 PM MDT
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Oh, OK.
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Are there anything makes your cough worse ?
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Question
10/03/20 1:00 PM MDT
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My cough mostly stays the same no matter what I do. It seems to get worse at night though.
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What helps you cough ?
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Question
10/03/20 1:01 PM MDT
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I had some cough medicine this morning. [AUDIO COMING SOON]
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Resting helps you ? (Clarified to Does rest relieve your cough?.)
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Question
10/03/20 1:03 PM MDT
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My cough has just stayed the same. I’ve taken some naps, but it doesn’t seem to help. (Clarified to if rest relieves my cough.)
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Does drinking water helps your cough ?
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Question
10/03/20 1:03 PM MDT
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Drinking water doesn’t do anything to my cough.
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Do you have any nasal problems ?
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Question
10/03/20 1:04 PM MDT
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My nose doesn’t get stuffed up. Oh, sometimes it gets runny though.
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Do you sneeze ?
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Question
10/03/20 1:04 PM MDT
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I don’t usually have to sneeze. My nose gets runny a lot of times though, like I have a cold.
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Do you have rhinorrhea ?
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Question
10/03/20 1:05 PM MDT
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I don’t have a rhino. My mom won’t even let me get a lizard. [AUDIO COMING SOON]NURS6512 Week 5 – Focused Exam: Cough Danny Rivera
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Get runny nose often ?
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Question
10/03/20 1:06 PM MDT
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My nose is always a little bit runny… but ever since I started coughing it’s been worse, I think.
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Do you have a nasal discharge ?
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Question
10/03/20 1:06 PM MDT
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My nose is always a little bit runny… but ever since I started coughing it’s been worse, I think.
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Is there a discharge from your nose is clear ? (Clarified to Is the runny stuff from your nose clear?.)
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Question
10/03/20 1:07 PM MDT
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You mean like when I blow my nose? It’s clear. (Clarified to if my nasal discharge is clear.)
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Is this stuff coming out from your nose is thin ? (Clarified to Is the runny stuff from your nose thick?.)
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Question
10/03/20 1:08 PM MDT
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It’s kind of clear and, like, watery. (Clarified to if I have thick nasal discharge.)
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How about your ears ? (Clarified to How are your ears?.)
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Question
10/03/20 1:09 PM MDT
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My right ear is starting to hurt a little bit . . . my left one is OK though. (Clarified to how my ears are.)
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Do you have any ear pain ?
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Question
10/03/20 1:09 PM MDT
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My right ear is starting to hurt a little bit . . . my left one is OK though.
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Question
10/03/20 1:10 PM MDT
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My right ear just started hurting yesterday. I think it’s because I’m sick.
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What is European from 1 to 10 ? (Clarified to How would you rate your ear pain on a 0-10 scale?.)
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Question
10/03/20 1:10 PM MDT
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Oh, I think it just hurts a little bit . . . three? (Clarified to how I would rate my ear pain on a scale.)
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Do you have any discharge from your ears ?
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Question
10/03/20 1:11 PM MDT
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No, nothing comes out of my ears, but my right ear kind of hurts.
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Do you have any problem in your throat ?
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Question
10/03/20 1:11 PM MDT
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My throat is sore, but just a little bit.
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Do you have a pain when you swallow ?
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Question
10/03/20 1:11 PM MDT
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No, I can swallow OK. It hurts a little right now because my throat is kinda sore.
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What type of medication do you take ?
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Question
10/03/20 1:12 PM MDT
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I took some cough medicine this morning. [AUDIO COMING SOON]
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What does the name of cough medication ? (Clarified to Do you know what the cough medication’s name is?.)
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Question
10/03/20 1:12 PM MDT
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I don’t know what the name of the cough medicine is. It was purple. [AUDIO COMING SOON] (Clarified to if I know what the cough medicine is called.)
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You take vitamins ? (Clarified to Do you take a multivitamin every day?.)
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Question
10/03/20 1:12 PM MDT
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Oh yeah, I take vitamins every day! The gummy dinosaur kind. I don’t think I’m supposed to, but sometimes I sneak extra ones to be super healthy! (Clarified to if I take a vitamin every day.)NURS6512 Week 5 – Focused Exam: Cough Danny Rivera
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It’s not good to take the extra one because it is important medication or vitamins dosages and the excess amount may hurt you.
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Educate
10/03/20 1:14 PM MDT
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Oh, OK.
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How you taking medication for your cough ? (Clarified to Have you taken medicine for your cough?.)
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Question
10/03/20 1:14 PM MDT
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I had some cough medicine this morning. [AUDIO COMING SOON] (Clarified to if I have taken medicine for my cough.)
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What does the color of your cough medication ? (Clarified to Can you describe the cough medicine to me?.)
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Question
10/03/20 1:15 PM MDT
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Um, it was purple-ish. It tasted gross. (Clarified to to describe the cough medicine.)
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What is the amount of this medication you’re taking?
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Question
10/03/20 1:15 PM MDT
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I took some cough medicine this morning. [AUDIO COMING SOON]
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How much of cough medication you took ? (Clarified to How much did you take of the cough medication?.)
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Question
10/03/20 1:16 PM MDT
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I just had one spoonful of it. (Clarified to how much cough medicine I took.)
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Who give use a cough medicine ?
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Question
10/03/20 1:16 PM MDT
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My mom.
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It’s a cough medication makes you feel better ?
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Question
10/03/20 1:16 PM MDT
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It helped a bit when my mom gave it to me, but my cough came back anyway.
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Do you have any allergies ?
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Question
10/03/20 1:17 PM MDT
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I don’t really have any allergies. Tony has some though. He’s allergic to bees.
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Do you have any food allergies ?
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Question
10/03/20 1:17 PM MDT
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I’m not allergic to any foods I don’t think.
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Are you allergic to any animals ?
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Question
10/03/20 1:17 PM MDT
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I’m not allergic to any animals, which is good because I like them.
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Do you have any let latex allergy ?
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Question
10/03/20 1:18 PM MDT
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I don’t really have any allergies. Tony has some though. He’s allergic to bees.
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Who is Tony ?
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Question
10/03/20 1:18 PM MDT
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Tony’s my best friend.
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Do you have any past medical history ?
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Question
10/03/20 1:18 PM MDT
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Oh, well, I have been sick before and I’m sick now . . . I had pneumonia once. Last year. My mom was really scared. She says I used to get earaches a lot too.
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Do you have any asthma ?
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Question
10/03/20 1:19 PM MDT
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Is that when you have to use a, uh, an inhaler? My friend Tony does that sometimes, but I don’t have to.
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How was your immunizations ? (Clarified to What immunizations have you had?.)
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Question
10/03/20 1:19 PM MDT
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Like getting shots? It seems like I get shots whenever I go to the doctor. Mom says I need them for school, but I hate it. (Clarified to what vaccines I have had.)
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Have you ever been in the hospital ?
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Question
10/03/20 1:20 PM MDT
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I have never been to the hospital. My mom likes to watch doctor shows on TV, so I kind of know what it’s like.
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Who smokes at home ?
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Question
10/03/20 1:20 PM MDT
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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.
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Where does your father smoke ?
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Question
10/03/20 1:21 PM MDT
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Sometimes Papi forgets to go outside with his cigars. He’s usually in the kitchen or the living room when that happens.
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Do you have any unusual frequent colds ?
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Question
10/03/20 1:21 PM MDT
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I get colds a lot. My nose is always runny.
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Do you have a fever ?
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Question
10/03/20 1:21 PM MDT
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My mom said I didn’t have a fever this morning before Abuela took me here.
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Do you have a chills ?
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Question
10/03/20 1:21 PM MDT
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No, I haven’t felt that.
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Do you have a weakness ?
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Question
10/03/20 1:22 PM MDT
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I haven’t felt weak. . . I’m just kind of tired because my cough keeps me up at night.
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Do you have any night sweats ?
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Question
10/03/20 1:22 PM MDT
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I don’t sweat at night unless it gets really hot or something.
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Have you lost weight ?
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Question
10/03/20 1:22 PM MDT
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I guess I gained some weight actually. Some kids at recess called me chubby . . . My mom says I’m just growing though.
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How is your appetite ?
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Question
10/03/20 1:23 PM MDT
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I think my appetite is normal.
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Do you have any ear crackling or popping ?
|
Question
10/03/20 1:23 PM MDT
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No, I haven’t noticed any popping in my ears, but my right ear kind of hurts.
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Do you have any popping sounds ?
|
Question
10/03/20 1:23 PM MDT
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No, I haven’t noticed any popping in my ears, but my right ear kind of hurts.
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Have you ever had any ear infections ?
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Question
10/03/20 1:24 PM MDT
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The last time I had one was when I was little. Mom said I used to get them a lot. Maybe I was 2-years-old? Oh, my right ear kind of hurts now . . .
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Have you ever had any surgery on your ears?
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Question
10/03/20 1:24 PM MDT
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Mom says I used to get ear infections a lot when I was little, but I’m pretty sure I never had surgery for it.NURS6512 Week 5 – Focused Exam: Cough Danny Rivera
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Do you get headaches ?
|
Question
10/03/20 1:24 PM MDT
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I don’t usually get headaches.
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Do you have nose bleeds ?
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Question
10/03/20 1:24 PM MDT
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Just one time. Tony and I were kicking a ball at recess and I got hit in the nose.
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Do you get dizzy ?
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Question
10/03/20 1:25 PM MDT
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I only get dizzy if I’m spinning around a lot at recess.
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Your eyes getting watery ?
|
Question
10/03/20 1:25 PM MDT
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No, my eyes don’t tear up. Well, I guess if I get sad or Papi is chopping onions for dinner they might.
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Is your eyes getting red?
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Question
10/03/20 1:25 PM MDT
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I don’t think my eyes are ever red.
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Do you have eye pain?
|
Question
10/03/20 1:25 PM MDT
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No, my eyes don’t hurt, but they kind of feel like they do when I’m tired.
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Do you have any sinus pain?
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Question
10/03/20 1:26 PM MDT
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It doesn’t hurt there.
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Do you have hearing problems ?
|
Question
10/03/20 1:26 PM MDT
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A lady came to my school to give all the kids a hearing test. It was kind of cool! I was hoping I would have super hearing, but I think I was just normal . . .
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How was your breathing ?
|
Question
10/03/20 1:26 PM MDT
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My breathing seems good. My nose is kind of runny right now, but I can still breathe OK.
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Do you have any chest tightness?
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Question
10/03/20 1:26 PM MDT
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My chest feels okay.
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Do you have any chest pain ?
|
Question
10/03/20 1:27 PM MDT
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No, I don’t have pain in my chest. I would hate that!
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Have you ever had any medications at in you inhaled ? (Clarified to Have you used an inhaler?.)
|
Question
10/03/20 1:27 PM MDT
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No, I don’t use one of those. My friend Tony does though! (Clarified to if I have used an inhaler.)
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Is anybody sick in your house ?
|
Question
10/03/20 1:28 PM MDT
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Nobody at home is sick I don’t think.
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Do you have any family history of asthma ?
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Question
10/03/20 1:28 PM MDT
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Mom says Papi had asthma when he was a little kid.
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Anybody in your family has allergies ?
|
Question
10/03/20 1:28 PM MDT
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I don’t think so, but I guess I’m not sure.
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Do you have any pets at home ?
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Question
10/03/20 1:29 PM MDT
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No, but I keep asking my mom if I can get a lizard.
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Where do you go when you have a free time ? (No matching questions found.)
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Question
10/03/20 1:30 PM MDT
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What do you do when you have a free time ?
|
Question
10/03/20 1:30 PM MDT
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Usually I play video games or read or try to write stories. If Tony is here, we do that stuff together.
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How often you around smoking people ? (Clarified to How often are you around people who smoke?.)
|
Question
10/03/20 1:31 PM MDT
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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. (Clarified to how often I am around secondhand smoke.)
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Do you wash your hands ?
|
Question
10/03/20 1:38 PM MDT
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I wash my hands before I eat or after I go to the bathroom.
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How often do you wash your hands?
|
Question
10/03/20 1:39 PM MDT
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I wash my hands before I eat or after I go to the bathroom.
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Do you touch your nose often ?
|
Question
10/03/20 1:39 PM MDT
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My nose is always a little bit runny… but ever since I started coughing it’s been worse, I think.
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You need to wash your hands more often.When you come from somewhere.
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Educate
10/03/20 1:40 PM MDT
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Oh, OK.
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You need to wash your hands after you touch your nose. You may transfer a lot of infections or bacteria from your nose to door handles for example. If you dont wash your hands more often you can contaminate yourself or others with bacteria and possible viruses fro unwashed hands.NURS6512 Week 5 – Focused Exam: Cough Danny Rivera
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Educate
10/03/20 1:44 PM MDT
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Oh, OK.
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Checked vitals
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Exam Action
10/03/20 1:44 PM MDT
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Tested lung capacity with spirometer: FEV1: 1.78L, FVC 1.549L (FEV1/FVC: 87%)
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Exam Action
10/03/20 1:46 PM MDT
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Inspected mouth
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Exam Action
10/03/20 1:48 PM MDT
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Inspected front of neck
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Exam Action
10/03/20 1:48 PM MDT
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Inspected anterior chest wall
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Exam Action
10/03/20 1:48 PM MDT
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|
Palpated maxillary sinuses: No tenderness reported
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Exam Action
10/03/20 1:49 PM MDT
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Palpated frontal sinuses: No tenderness reported
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Exam Action
10/03/20 1:49 PM MDT
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Palpated maxillary sinuses: No tenderness reported
|
Exam Action
10/03/20 1:49 PM MDT
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Palpated cervical lymph nodes: Enlarged and reported tenderness on the right side
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Exam Action
10/03/20 1:50 PM MDT
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Palpated axillary lymph nodes: Not palpable
|
Exam Action
10/03/20 1:50 PM MDT
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|
Palpated axillary lymph nodes: Not palpable
|
Exam Action
10/03/20 1:50 PM MDT
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|
Palpated supraclavicular lymph nodes: Not palpable
|
Exam Action
10/03/20 1:50 PM MDT
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Palpated axillary lymph nodes: Not palpable
|
Exam Action
10/03/20 1:50 PM MDT
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Palpated supraclavicular lymph nodes: Not palpable
|
Exam Action
10/03/20 1:51 PM MDT
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Palpated fremitus in anterior upper chest wall: Expected fremitus, equal bilaterally
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Exam Action
10/03/20 1:51 PM MDT
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Ninety-nine.
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Palpated fremitus in anterior upper chest wall: Expected fremitus, equal bilaterally
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Exam Action
10/03/20 1:51 PM MDT
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Ninety-nine.
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Palpated fremitus in anterior lower chest wall: Expected fremitus, equal bilaterally
|
Exam Action
10/03/20 1:51 PM MDT
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Ninety-nine.
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Palpated fremitus in posterior upper chest wall: Expected fremitus, equal bilaterally
|
Exam Action
10/03/20 1:51 PM MDT
|
|
Ninety-nine.
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Palpated fremitus in posterior middle chest wall: Expected fremitus, equal bilaterally
|
Exam Action
10/03/20 1:51 PM MDT
|
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Ninety-nine.
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Palpated fremitus in posterior lower chest wall: Expected fremitus, equal bilaterally
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Exam Action
10/03/20 1:51 PM MDT
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Palpated fremitus in posterior lower chest wall: Expected fremitus, equal bilaterally
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Exam Action
10/03/20 1:51 PM MDT
|
|
Ninety-nine.
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Palpated fremitus in posterior lower chest wall: Expected fremitus, equal bilaterally
|
Exam Action
10/03/20 1:51 PM MDT
|
|
Ninety-nine.
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Palpated fremitus in posterior lower chest wall: Expected fremitus, equal bilaterally
|
Exam Action
10/03/20 1:51 PM MDT
|
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Ninety-nine.
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Auscultated breath sounds in anterior right upper lobe
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Exam Action
10/03/20 1:52 PM MDT
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Auscultated breath sounds in anterior left upper lobe
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Exam Action
10/03/20 1:52 PM MDT
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Auscultated breath sounds in anterior left mid-chest (upper lobe)
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Exam Action
10/03/20 1:52 PM MDT
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Auscultated breath sounds in anterior right middle lobe
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Exam Action
10/03/20 1:52 PM MDT
|
|
Auscultated breath sounds in anterior left mid-chest (upper lobe)
|
Exam Action
10/03/20 1:52 PM MDT
|
|
Auscultated breath sounds in anterior right middle lobe
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Exam Action
10/03/20 1:52 PM MDT
|
|
Auscultated breath sounds in anterior right lower lobe
|
Exam Action
10/03/20 1:53 PM MDT
|
|
Auscultated breath sounds in anterior left lower lobe
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Exam Action
10/03/20 1:53 PM MDT
|
|
Auscultated breath sounds in posterior right upper lobe
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Exam Action
10/03/20 1:53 PM MDT
|
|
Auscultated breath sounds in posterior left upper lobe
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Exam Action
10/03/20 1:53 PM MDT
|
|
Auscultated breath sounds in posterior left mid-back (lower lobe)
|
Exam Action
10/03/20 1:53 PM MDT
|
|
Auscultated breath sounds in posterior right mid-back (lower lobe)
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Exam Action
10/03/20 1:53 PM MDT
|
|
Auscultated breath sounds in posterior left lower lobe near spine
|
Exam Action
10/03/20 1:53 PM MDT
|
|
Auscultated breath sounds in posterior right lower lobe near spine
|
Exam Action
10/03/20 1:53 PM MDT
|
|
Auscultated breath sounds in posterior right lower lobe
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Exam Action
10/03/20 1:54 PM MDT
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Auscultated breath sounds in posterior left lower lobe
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Exam Action
10/03/20 1:54 PM MDT
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Auscultated breath sounds in posterior left lower lobe on side
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Exam Action
10/03/20 1:54 PM MDT
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Auscultated breath sounds in posterior right lower lobe on side
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Exam Action
10/03/20 1:54 PM MDT
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Auscultated breath sounds in anterior left upper lobe
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Exam Action
10/03/20 1:54 PM MDT
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Auscultated breath sounds in anterior right upper lobe
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Exam Action
10/03/20 1:54 PM MDT
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Auscultated breath sounds in anterior right middle lobe
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Exam Action
10/03/20 1:54 PM MDT
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Auscultated breath sounds in anterior left mid-chest (upper lobe)
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Exam Action
10/03/20 1:54 PM MDT
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Auscultated breath sounds in anterior right middle lobe
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Exam Action
10/03/20 1:54 PM MDT
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Auscultated breath sounds in anterior right lower lobe
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Exam Action
10/03/20 1:54 PM MDT
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Percussed anterior right upper lobe
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Exam Action
10/03/20 1:55 PM MDT
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Percussed anterior left upper lobe
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Exam Action
10/03/20 1:55 PM MDT
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Percussed anterior right middle lobe
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Exam Action
10/03/20 1:55 PM MDT
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Percussed anterior left mid-chest (upper lobe)
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Exam Action
10/03/20 1:55 PM MDT
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Percussed anterior left lower lobe
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Exam Action
10/03/20 1:55 PM MDT
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Percussed anterior right lower lobe
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Exam Action
10/03/20 1:55 PM MDT
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Percussed posterior right upper lobe
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Exam Action
10/03/20 1:55 PM MDT
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Percussed posterior left upper lobe
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Exam Action
10/03/20 1:55 PM MDT
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Percussed posterior left mid-back (lower lobe)
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Exam Action
10/03/20 1:55 PM MDT
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Percussed posterior right mid-back (lower lobe)
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Exam Action
10/03/20 1:55 PM MDT
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Percussed posterior right lower lobe
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Exam Action
10/03/20 1:55 PM MDT
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Percussed posterior right lower lobe near spine
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Exam Action
10/03/20 1:56 PM MDT
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Percussed posterior left right lobe on side
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Exam Action
10/03/20 1:56 PM MDT
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Percussed posterior left lower lobe near spine
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Exam Action
10/03/20 1:56 PM MDT
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Percussed posterior left lower lobe
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Exam Action
10/03/20 1:56 PM MDT
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Percussed posterior left lower lobe on side
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Exam Action
10/03/20 1:56 PM MDT
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Percussed posterior left lower lobe on side
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Exam Action
10/03/20 1:56 PM MDT
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Percussed posterior left lower lobe on side
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Exam Action
10/03/20 1:56 PM MDT
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Checked vitals
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Exam Action
10/03/20 1:56 PM MDT
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Do you have sick friends ?
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Question
10/03/20 5:03 PM MDT
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None of my friends are sick that I know of.
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Do you have anybody passing it around you ? (No matching questions found.)
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Question
10/03/20 5:04 PM MDT
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Do you have your friend Tony coughing around you ? (Clarified to Is tony sick?.)
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Question
10/03/20 5:04 PM MDT
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None of my friends are sick that I know of. (Clarified to if Tony is sick.)
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Are you touching your nose ? (No matching questions found.)
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Question
10/03/20 5:05 PM MDT
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How often do you touch your nose ? (Clarified to How often do you blow your nose?.)
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Question
10/03/20 5:05 PM MDT
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Probably a million-billion times a day. [AUDIO COMING SOON] (Clarified to how often I blow my nose.)
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Danny, signs you have been sick for last few days it’s very important that you practice strict hand hygiene and respiratory hygiene because you can develop upper respiratory infection. It is extremely important to prevent it.NURS6512 Week 5 – Focused Exam: Cough Danny Rivera
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Educate
10/03/20 5:10 PM MDT
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Oh, OK.
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Is anybody in your class sick ?
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Question
10/03/20 5:35 PM MDT
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Nobody I know is sick, I don’t think.
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How is the Tony feels ?
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Question
10/03/20 5:36 PM MDT
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None of my friends are sick that I know of.
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What type of diet do you have ?
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Question
10/03/20 5:39 PM MDT
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Mom says I’m picky. I can clean my plate… if I like the food. Yeah. I eat breakfast and I eat all my dinner.
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What do you like to eat for breakfast ?
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Question
10/03/20 5:39 PM MDT
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I have cereal with milk and fruit most mornings. Sometimes I have a waffle or eggs and bacon.
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Do you do exercises ?
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Question
10/03/20 5:39 PM MDT
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I have gym class every day. I do all my exercises there. And there’s a park right next to my house where I play after school, or sometimes on the weekends, if it’s nice outside. [AUDIO COMING SOON]
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Can you minimize the amount of waffle and bacon which is not good for your health. It is low in nutritions and high in fats and carbohydrates.
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Educate
10/03/20 5:44 PM MDT
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Oh, OK.
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Also I would like to recommend you to increase your fluid intake. It will help your body to be clean and to get rid of bacterias and infections.
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Educate
10/03/20 5:47 PM MDT
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Oh, OK.
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Inspected mouth
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Exam Action
10/04/20 3:15 AM MDT
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Can I take a look at your mouth again ?
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Question
10/04/20 3:16 AM MDT
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Sure.
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Performed otoscopic examination of right ear
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Exam Action
10/04/20 3:17 AM MDT
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Can I examine you more Danny ?
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Question
10/04/20 3:18 AM MDT
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Sure.
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Performed otoscopic examination of left ear
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Exam Action
10/04/20 3:18 AM MDT
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Performed otoscopic examination of right ear
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Exam Action
10/04/20 3:18 AM MDT
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Performed otoscopic examination of left ear
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Exam Action
10/04/20 3:19 AM MDT
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Inspected mouth
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Exam Action
10/04/20 3:29 AM MDT
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Danny how often you washing your hands ?
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Question
10/04/20 1:37 PM MDT
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I wash my hands before I eat or after I go to the bathroom.
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You need to wash your hands more often or to use hand sanitizer.
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Educate
10/04/20 1:38 PM MDT
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Oh, OK.
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Do you play with a sick peer ?
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Question
10/04/20 1:38 PM MDT
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I have a lot of girls that are friends, but no girlfriends really. Not yet! There are some girls I think are pretty though.
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When your cough started ?
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Question
10/04/20 1:39 PM MDT
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I think the cough started four. . . No, it started five days ago.
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Where do you have your pain ?
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Question
10/04/20 1:40 PM MDT
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My right ear kind of hurts . . . but it’s just my cough that has been keeping me up at night. Oh, well, my throat is a little bit sore.
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Do you have any discharge from your right ear ?
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Question
10/04/20 1:41 PM MDT
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No, nothing comes out of my ears, but my right ear kind of hurts.
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Do you have sore throat ?
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Question
10/04/20 1:41 PM MDT
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It feels a little bit sore, yeah.
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How would you describe your pain ?
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Question
10/04/20 1:41 PM MDT
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Um. . . I don’t know. It just hurts. But it’s not so bad.
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In a scale from 1 to 10 how would you describe your pain ? (Clarified to Can you rate your current pain level on a scale of 0 to 10?.)
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Question
10/04/20 1:41 PM MDT
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Well, I have a little pain . . . in my right ear. Maybe almost a 3. Yeah. It’s not too bad. (Clarified to how I would rate my pain on a scale.)
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Do you take something for pain ? (Clarified to Are you taking anything for pain?.)
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Question
10/04/20 1:42 PM MDT
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I don’t take medicine for pain. I only take the medicine my mom or Abuela give me. (Clarified to if I am taking pain medication.)
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Who is Abuela ?
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Question
10/04/20 1:42 PM MDT
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Abuela is my grandma . . . she’s my mom’s mom!
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Did you say your pain like watery and gurgle ? (No matching questions found.)NURS6512 Week 5 – Focused Exam: Cough Danny Rivera
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Question
10/04/20 1:43 PM MDT
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Did you say your pain like watery and gurgle ? (No matching questions found.)
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Question
10/04/20 1:43 PM MDT
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Did you say that your pain pills like watery ? (No matching questions found.)
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Question
10/04/20 1:44 PM MDT
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How was your pain in your throat feels like ?
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Question
10/04/20 1:44 PM MDT
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Um, it just feels kind of sore. I can feel it a little bit when I swallow.
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Oh, I am sorry to hear that Danny.
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Empathize
10/04/20 1:46 PM MDT
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Thank you.
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Danny how much water do you take ?
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Question
10/04/20 1:59 PM MDT
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I drink water a lot. . . whenever I’m not drinking it enough, Abuela always makes me drink more.
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How many cups of water do you drink per day ?
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Question
10/04/20 2:00 PM MDT
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I usually have 7 or 8 glasses of water a day.
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Is Tony used uses an inhaler ? (Clarified to Is Tony your brother?.)
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Question
10/04/20 2:07 PM MDT
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Tony’s my best friend. (Clarified to if Tony is my brother.)
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Do you know is Tony uses inhaler
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Question
10/04/20 2:08 PM MDT
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None of my friends are sick that I know of.
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Danny you need to stay away from sick people ok ?
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Educate
10/04/20 5:05 PM MDT
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Oh, OK.
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Danny, if you see that people around you coughing and sneezing you dont need to keep close communications with them. Also I will let your parents to provide you with hand sanitizer, you need to use it after using bathroom, if you touched some doors or any other interactions and touching other things.
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Educate
10/04/20 5:09 PM MDT
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Oh, OK.
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Also drink plenty of fluids are very important for your body. It will help to loosen the mucus in your nose and help congestion when you have symptoms of infections like you do now.
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Educate
10/04/20 5:13 PM MDT
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Oh, OK.
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When you cough, you need to cough into the tissue. If you dont have a tissue, use the sleeve to cover the mouth.
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Educate
10/04/20 5:15 PM MDT
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Oh, OK.
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I am going to tell your father not to smoke in the house. You remind him too if he forgets or go to other room. I will follow up about it.
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Educate
10/04/20 5:21 PM MDT
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Oh, OK.
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Danny I would like to communicate with your parents about todays recommendations and schedule follow up appointment. Are you ok with that ? (No matching questions found.)
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Question
10/04/20 5:24 PM MDT
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Danny, I would like to communicate with your parents about todays recommendations and schedule follow up appointment.NURS6512 Week 5 – Focused Exam: Cough Danny Rivera
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Educate
10/04/20 5:24 PM MDT
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Oh, OK.
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Also, please do not touch your face, nose, mouth, eyes with your hands. You can transmit more infection to yourself and others which we need to prevent. (No matching questions found.)
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Question
10/04/20 5:26 PM MDT
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|
Also, please do not touch your face, nose, mouth, eyes with your hands. You can transmit more infection to yourself and others which we need to prevent.
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Educate
10/04/20 5:26 PM MDT
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Oh, OK.
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Do you have a pain now ? (Clarified to Do you have pain right now?.)
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Question
10/04/20 5:27 PM MDT
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The only thing that really hurts is my right ear, but it just hurts a little bit. It just started . . . I’m not sure what will make it feel better. (Clarified to if I am in pain right now.)
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I’m sorry to hear that
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Empathize
10/04/20 5:27 PM MDT
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Thank you.
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How often do you said you are coughing ?
|
Question
10/04/20 5:27 PM MDT
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I just keep feeling like I have to cough every couple minutes or so. I think it gets worse at night.
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I’m sorry it must be really uncomfortable.
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Empathize
10/04/20 5:28 PM MDT
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Thank you.
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What type of medication are you taking for your cough ?
|
Question
10/04/20 5:47 PM MDT
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I took some cough medicine this morning. [AUDIO COMING SOON]
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What type of medication is this ? (Clarified to What medications do you take?.)
|
Question
10/04/20 5:47 PM MDT
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I took some cough medicine this morning. [AUDIO COMING SOON] (Clarified to what medications I am taking.)
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Do you know what is the name of this medication ? (Clarified to What is the name of the cough medicine you took?.)
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Question
10/04/20 5:48 PM MDT
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I don’t know what the name of the cough medicine is. It was purple. [AUDIO COMING SOON] (Clarified to what the name of the cough medicine is.)
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do you know the name of the medication for the cough ?
|
Question
10/04/20 5:49 PM MDT
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I don’t know what the name of the cough medicine is. It was purple. [AUDIO COMING SOON]
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ok, I can ask your mom about it. (No matching questions found.)
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Question
10/04/20 5:49 PM MDT
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How long does medication was relieving your symptoms ? (No matching questions found.)
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Question
10/04/20 5:50 PM MDT
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How long does cough medication was relieving your symptoms ?
|
Question
10/04/20 5:50 PM MDT
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My mom gave me some medicine and it helped my cough a little bit, but it started again.
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How long you tipped you feel better after taking this medication ? (Clarified to Did the medicine make your cough better?.)
|
Question
10/04/20 5:51 PM MDT
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It helped a bit when my mom gave it to me, but my cough came back anyway. (Clarified to if the medicine helped my cough.)
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