Shadow Health Focused Exams

Complete the ShadowHealth© Focused Exams – Special Populations: Chest Pain, Cough and Abdominal Pain assignments

After you have achieved at least 80% on the assignment(s) download, save and upload your LabPass document to the dropbox.

Professional Development

Write a 500-word APA reflection essay of your experience with the Shadow Health virtual assignment(s). At least two scholarly sources in addition to your textbook should be utilized. Answers to the following questions may be included in your reflective essay:

- What went well in your assessment?
- What did not go so well? What will you change for your next assessment?
- What findings did you uncover?
- What questions yielded the most information? Why do you think these were effective?
- What diagnostic tests would you order based on your findings?
- What differential diagnoses are you currently considering?
- What patient teaching were you able to complete? What additional patient teaching is needed?
- Would you prescribe any medications at this point? Why or why not? If so, what?
- How did your assessment demonstrate sound critical thinking and clinical decision making?

FocusedExam_ChestPainDOC.pdf
FocusedExam_AbdominalPainDOC.pdf
FocusedExam_Cough_DOC.pdf
FocusedExam_AbdominalPain_EDEMPATHY.pdf
FocusedExam_ChestPain_EDandEmpathy_ShadowHealth.pdf
FocusedExam_AbdominalPain_transcript.pdf
FocusedExam_ChestPain_transcript_ShadowHealth.pdf

ShadowHealthFocusedExamsTURNITIN.pdf

Focused Exam: Chest Pain Results | Turned In Advanced Physical Assessment – March 2020, advanced_physical_assessment__td8__031720__sect1

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Documentation / Electronic Health Record

Document: Provider Notes

Student Documentation Model Documentation

Subjective

Brain is a 58 you caucasian Male who presents with C/o chest pain in the middle of his chest over his heart, 3 times this month. His pain is 5/10 when the pain arises, no chest pain currently. Chest pain does not radiate to his arm, shoulder or neck. Aggravated chest pain when walking up the steps, and is relieved when he rests. Denies any heartburn, difficult breathing. No change in appetite but mentioned he gained some weight when his bike was stolen. Rare exercise at this moment, desires clearance for exercise since the onset of his chest pain. Never been seen for chest pain, and has not taken anything for chest pain. Medical history: HTN on Lopressor 100 mg/daily x1 year Hyperlipedmia on lipitor 20 mg daily x1 year Omega 3 daily No surgical history Family Medical hx: Father: htn/hyperlipdemia, obesity, died of colon cancer @ 75yo MGF: heart attack died @ 54 yo Sister: HTN and Diabetes type 2 Social hx: beer 3 drinks in a weekend denies tobacco or drug use

Pt. reports “I have been having some troubling chest pain in my chest now and then for the past month.” Experiencing periodic c pain with exertion such as yard work as well as with overeating. Points to midsternum as location. Describes pain as “tight and uncomfortable.” Denies radiation. Pain lasts for “a few” minutes goes away when he rests. Most recent episode was three days a after eating a large restaurant dinner. States “It has never gotten ‘really bad’” so didn’t think it was an emergency, but is concerne after three episodes in one month and wants his heart checked o Reports mild cramping in legs with activity. Denies shortness of breath, indigestion, heartburn. Denies chest pain at this time.

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Overview

Transcript

Subjective Data Collection

Objective Data Collection

Education & Empathy

Documentation

Document: Vitals Document: Provider Notes

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Student Documentation Model Documentation

Objective

Brian is a 58 year old Caucasian male appears to be well-groomed, is pleasant and answers questions clearly and appropriately. He maintains eye contact throughout the exam. He appears in no distress VSS: Bp 146/90 Skin warm to touch, dry, pink and intact. no tenting Heart: S1, s2, s3 and S4 with murmur Carotid pulse: positive Thrill, +3 on right: PMI: displaced laterally, briks and tapping, <3cm Breath sounds: clear in upper lobes, posterior lower lobes with crackles bilaterally. GI: no tenderness, no masses, guarding or distension. BS present at all quads, WNL Liver is palpable and nontender: spleen and kidneys are not palpable Extremties: No edema, Brachial and radial pulse neg for thrill at 2+ popliteal, tibal and dorsalis pedis pulse diminised at 1+. capillary refill less than 3 seconds on extremiteis. EKG: Regular sinus rhythm. No ST changes

• General Survey: 58 year old male is alert and oriented, with clea speech and in no acute distress. • Cardiac: S1, S2, without murmurs or rubs. PMI displaced latera S3 noted at mitral area. • Peripheral Vascular: Right side carotid bruit. JVP 3cm above ste angle. Right carotid pulse with thrill, 3+. Left carotid pulse withou thrill, 2+. Brachial, radial, femoral pulses without thrill, 2+. Poplite tibial, and dorsalis pedis pulses without thrill, 1+. Cap refill less t 3 seconds – 4 extremities. • Respiratory: Breathing is quiet and unlabored. Breath sounds a clear to auscultation in upper lobes and RML. Fine crackles/rales posterior bases of L/R lungs. • Gastrointestinal: Round, soft, non-tender with normoactive bow sounds in 4 quadrants; no abdominal bruits. No tenderness to lig or deep palpation. Tympanic throughout. Liver is 7 cm at the MC and 1 cm below the right costal margin. Spleen and bilateral kidn are not palpable. • Neuro: Alert and oriented x 3, follows commands, moves all extremities. • Skin: Warm, dry, pink, and intact. No tenting. • EKG (interpretation): Regular sinus rhythm. No ST changes.

Assessment

Coronary Artery disease Stable angina Carotid disease pericarditis Aortic aneurysm r/o GERD R/O Sarcodosis

Based on the abnormal findings during cardiovascular and respiratory auscultation, my differentials include coronary artery disease with stable angina; congestive heart failure; carotid disea aortic aneurysm; pericarditis; or GERD.

Plan

Blood work for cardiac enzyme, electrolytes, CBC, Lipid profile, liver function test, cxr, 12 lead EKG Consult with cardiologist Echocardiogram Exercise stress test Dopplers for carotid Patient should be tested with results on labs at the least, and not discharged home. Baby Asa upon arrival Ntiroglycerin if chest pain is present again Warning signs of when to seek medical help like another onset of chest pain, SOB, shoulder or arm pain

Mr. Foster should receive a 12-lead ECG, chest x-ray, and lab workup (cardiac enzymes, electrolytes, CBC, BNP, CMP, Hgb A1 lipid profile, and liver function tests) to confirm a diagnosis. He should be referred for an echocardiogram, exercise stress test, a carotid dopplers as well as a consult with a vascular surgeon for carotid evaluation. Mr. Foster should be prescribed diltiazem and diuretic in addition to his daily Lopressor and Lipitor. If needed, an ACE inhibitor to manage his hypertension and PRN nitroglycerin for chest pain that does not subside with rest.

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Focused Exam: Abdominal Pain Results | Turned In Advanced Physical Assessment – March 2020, advanced_physical_assessment__td8__031720__sect1

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Documentation / Electronic Health Record

Document: Provider Notes

Student Documentation Model Documentation

Subjective

Miss Park is a pleasant Korean 78 year old woman who presents to the clinic with complaints of abdominal pain for the past 5 days. She is oriented to person place and time. She answers the questions appropriately and maintains eye contact during the interview and exam. This with her daughter who assist with her Care at home. Pains are described as crampy, dull at her lower abdomen, with a pain scale of 6/10, mostly constant. Has had difficulty using the bathroom this past 5 days, which has affected her daily activites. She has been feeling more tired than usual, denies feeling fever chills or rectal pain. She drinks two glasses of water a day and eats well, although has had a decrease in appetite since her abdominal pain started. Her abominal pain Is aggravated with food and activity, pain is relieved with rest. Her stool is soft and brown, no current diarrhea. She has history of colonoscopy that was negative. She denies any vaginal bleeding or urinary difficulty. She denies any GERD, colon cancer or stomach issues. PMHx: HTN on accupril 10 mg daily Immunizations: updated: declines flu vaccination today. Surgical hx: choleystectomy at 42yo Cesarean delivery at 40yo: OB/GYN: G3P3L2: one stillbirth for cord accident. No hx of STI. Pap WNL 2010 Social hx: has a friend who she is intimate with, no tobacco use, no illicit drugs. Drinks once a week with white wine. Has stong family support. Visits her Son in Houston occasionally. Family Hx: Mother: DM and HTN: Deceased @ 88yo Father: HTN and hypercholestremia: deceased at 82yo MGP: HTN PGM: HTN/ CVA/obesity Brothers: HTN SOn: healthy daughter: Healthy

Ms. Park reports that she is “having pain in her belly.” She experienced mild diarrhea three days ago and has not had a bow movement since. She reports that she has been feeling some abdominal discomfort for close to a week, but the pain has increased in the past 2-3 days. She now rates her pain at 6 out o 10, and describes it as dull and crampy. She reports her pain lev the onset at 3 out of 10. She is also experiencing bloating. She d not feel her symptoms warranted a trip to the clinic but her daug insisted she come. She describes her symptoms primarily as generalized discomfort in the abdomen, and states that her lowe abdomen is the location of the pain. She denies nausea and vomiting, blood or mucus in stool, rectal pain or bleeding, or rece fever. She denies vaginal bleeding or discharge. Reports no histo of inflammatory bowel disease or GERD. Denies family history of disorders. Her appetite has decreased over the last few days and she is taking small amounts of water and fluids. Previously she reports regular brown soft stools every day to every other day.

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Overview

Transcript

Subjective Data Collection

Objective Data Collection

Education & Empathy

Documentation

Student Survey

Document: Vitals Document: Provider Notes

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Student Documentation Model Documentation

Objective

Alert and oriented x3: Some discomfort due to abdominal pain HEENT: moist mucus mambrane, normal skin turgor, no tenting Heart: S1 and S2 with no abnormal heart sounds Lungs; CTA Liver: 1cm below Rt costal margin: nontender Abdomen: BS present at all quads, normoactive, No bruits or friction sounds. Dullness on LLQ, Tender to touch, with guarding and distension. 2x4cm oblong mass palpated on LLQ. RUQ : with scar s/p choleystectomy, and al lower transverse abdominal scar from s/p cs no CVA tenderness Pelvic: neg Rectal: no hemorrhoids, strong spincter reflex, fecal mass detected in rectal vault Extremties: no edema: normal reflexes UA: clear but dark urine, neg for nitrites, wbc or ketones.

• General Survey: Uncomfortable and flushed appearing elderly woman seated on exam table grimacing at times. Appears stable mildly distressed. • HEENT: Mucus membranes are moist. Normal skin turgor; no tenting. • Cardiovascular: S1, S2, no murmurs, gallops or rubs; no S3, S4 rubs. No lower extremity edema. • Respiratory: Respirations quiet and unlabored, able to speak in sentences. Breath sounds clear to auscultation. • Abdominal: 6 cm scar in RUQ and 10 cm scar at midline in suprapubic region. An abdominal exam reveals no discoloration; normoactive bowel sounds in all quadrants; no bruits; no friction sounds over spleen or liver; tympany presides with scattered dullness over LLQ; abdomen soft in all quadrants; an oblong ma noted in the LLQ with mild guarding, distension; no organomega no CVA tenderness; liver span 7 cm @ MCL; no hernias. • Rectal: No hemorrhoids, no fissures or ulceration; strong sphinc tone, fecal mass in rectal vault. • Pelvic: No inflammation or irritation of vulva, abnormal discharg or bleeding; no masses, growths, or tenderness upon palpation. • Urinalysis: Urine clear, dark yellow, normal odor. No nitrites, WB RBCs, or ketones detected; pH 6.5, SG 1.017.

Assessment

Constipation causing abdominal mass Intestinal obstruction Diverticulitis Irritable bowel syndrome

Mrs. Park’s bowel sounds are normoactive in all quadrants, with bruits or friction sounds. Scattered dullness in LLQ during percussion is suggestive of feces in the colon; otherwise, her abdomen is tympanic. Her abdomen is soft to palpation; mild guarding and oblong mass suggesting feces were discovered in LLQ. No CVA tenderness; liver span 7 cm @ MCL; no splenic dullness. Digital rectal exam revealed a fecal mass in the rectal v No abnormalities were noted during the pelvic exam, so pelvic inflammatory disease is not suspected. Ms. Park’s urinalysis was normal, which rules out a urinary tract infection. No signs of dehydration or cardiovascular abnormalities. Mrs. Park’s sympto and health history suggest she has constipation. Differential diagnoses are constipation, diverticulitis, and intestinal obstructi

Plan

stool for occult blood CBC/ ESR with CRP Metabolic panel serum amylase abdominal sonogram or abdominal x-ray for to locate mass; Bowel rest if diverticulitis : if neg: increase po fluids, increase fiber, increase activity as tolerated. Creating a bowel regimen is encouraged.

Mrs. Park should receive diagnostic tests to rule out differentials CBC to assess for elevated WBCs associated with diverticulitis, electrolyte profile to evaluate electrolyte and fluid status, and a C scan to assess for obstruction. If Mrs. Park has diverticulitis I recommend IV fluids and bowel rest. If she has bowel obstructio recommend NPO, IV fluids, and general surgical consult. If she h constipation, I recommend that she increase fluids, increase fibe and increase activity as tolerated.

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Focused Exam: Cough Results | Turned In Advanced Physical Assessment – March 2020, advanced_physical_assessment__td8__031720__sect1

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Documentation / Electronic Health Record

Document: Provider Notes

Student Documentation Model Documentation

Subjective

Dany is a 8 year old hispanic boy, brought into clinic by his grandmother. He is able to answer the questions independently and maintains eye contact. He reports a gurgly watery cough for the last 4-5 days. His throat is hurting with the cough, and is feeling tired. Difficult sleeping due to the cough. His mother gave him a “purple medicine” this morning, for the cough, although he doesn’t know the name of it. It has helped, but then his cough presents itself again. He has c/o right ear pain, that started yesterday. He has had hx of ear infections when he was 2 yo. He denies fever or chills, or watery eyes but states he gets the “cold” frequently. Denies chest pain or difficult breathing No allergies to meds or pollen Immunizations: updated PMHx; ear infections at childhood Surgical hx: none Social hx: Lives with parents, grandmother assists with care, when parents are at work. does not smoke, exposed to 2nd hand smoke from his Papi. Washes hands before eating or after restroom. No family history of asthma or allergies.

Danny reports a cough lasting four to five days. He describes the cough as “watery and gurgly.” He reports the cough is worse at n and keeps him up. He reports general fatigue due to lack of slee He reports pain in his right ear. He is experiencing mild soreness his throat. He reports his mother treated his cough symptoms wi over-the-counter medicine, but it was only temporarily effective. reports frequent cold and runny nose, and he states that he had frequent ear infections as a child. He reports a history of pneumo in the past year. He reports normal bowel movements. He denies fever, headache, dizziness, trouble swallowing, nosebleed, phleg or sputum, chest pain, trouble breathing and abdominal pain. He denies cough aggravation with activity.

Objective

Daniel appears slightly tired, and has been coughing throughout the exam Vital signs stable Spirometer: FEV1: 3.15L FVC 3.91L/ 80.5% Head: Cervical lymph nodes enlarged and tender on right side; Sinus: no tenderness on frontal or maxillary eyes: pink in color, no discharge Ears: right ear redness and inflammed: no d/c nose: clear watery phlem, no odor Throat: oropharynix: cobberstone, redness with postnasal drip Lungs: CTA bilaterally: Breath sounds: clear bilaterally anterior and posterior. bronchophony: negative Chest: S1 and S2 audible, no murmurs or abnormal heart sounds

• General Survey: Fatigued appearing young boy seated on nurs station bench. Appears stable. • HEENT: Mucus membranes are moist, clear nasal discharge. Redness, cobblestoning in the back of throat. Eyes are dull in appearance, pink conjunctiva. Right Tympanic membrane is red inflamed. Right cervical lymph node enlarged with reported tenderness. • Cardiovascular: S1, S2, no murmurs, gallops or rubs. • Respiratory: Respiratory rate increased, but no acute distress. A to speak in full sentences. Breath sounds clear to auscultation. Negative bronchophony. Chest wall resonant to percussion. Expected fremitus, equal bilaterally. Spirometry: FEV1: 3.15 L, FV 3.91L (FEV1/FVC: 80.5%)

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Overview

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Subjective Data Collection

Objective Data Collection

Education & Empathy

Documentation

Document: Vitals Document: Provider Notes

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Student Documentation Model Documentation

Assessment

Differential diagnosis: 1. flu-like syndrome or cold 2. strep throat 3. Allergies 4. Allergic rhinitis

My differentials include cold, strep throat, rhinitis, allergies and asthma based on abnormal findings affecting the ears, upper respiratory tract and lymphatic region.

Plan

Discuss hand hygiene and hygiene ettiquitte when coughing: cough in elbows, and hand hygiene. Strep culture Cough medication to help sleep at night and suppress cough Antihistamine to dry up secretions Encourage fluid intake, avoid dairy products that can make cough worse: phlem may get thicker Refer for allergy testing if antihistamine did not work Educate warning signs for immediate attention like difficult breathing, fever, chills, or cough worsening. Follow up in a week or telephone appt in 3 days to follwo up on progress Educate the family the importance of hand hygiene

Danny should be referred for an allergy test to rule out allergies a well as a lung function test to rule out asthma. He should receive strep culture to rule out strep throat. I recommend antitussive treatment at night to help with his sleep in addition to bed rest.

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Focused Exam: Abdominal Pain Results | Turned In Advanced Physical Assessment – March 2020, advanced_physical_assessment__td8__031720__sect1

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Education & Empathy : 6 of 7 (85.7%)

During the patient interview, there are a number of opportunities to provide patient education and empathy. The opportunities listed below ar those identified by nursing experts to be of particular importance to this patient. A Model Statement is provided as an example of an appropriate response to each opportunity.

Opportunities marked as Not Encountered are opportunities that were not elicited in the interview Opportunities marked as Not Followed Up are missed opportunities that were present in the interview, but where no statements were made Opportunities marked as Followed Up were followed up by students, and include the dialogue between student and patient

Description: Ms. Park describes staying socially active and exercising.

Is there anything that makes it worse Questio

03:07 PM MD

Yes. When I move around the house or try to garden, I feel more pain. And I did not go to my exercise classes. I was sure that would be too much. I prefer to be active, but my daughter wants me to rest.

Does the pain radiate anywhere in your body Questio

03:14 PM MD

Model Statement: “It sounds like you stay physically and socially active. That’s great!”

Your Results Lab Pass (/assignment_attempts/6709886/lab_pass.pd

Overview

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Subjective Data Collection

Objective Data Collection

Education & Empathy

Documentation

Student Survey

1 Symptoms Followed Up

2 Medications Followed Up

3 Diet Followed Up

4 Activity Level Not Followed Up

5 Medical History Followed Up

6 Sexual Activity Followed Up

7 Family and Support Followed Up

Comments

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Focused Exam: Chest Pain Results | Turned In Advanced Physical Assessment – March 2020, advanced_physical_assessment__td8__031720__sect1

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Education & Empathy : 5 of 6 (83.3%)

Description: Mr. Foster describes his past medical history of hypertension and high cholesterol.

What is your medical history Questio

07:07 PM MD

The doctors told me I have a little bit of high blood pressure and cholesterol, but that’s it.

Have you had any surgeries Questio

07:07 PM MD

I’ve never had any surgeries.

Are you allergic to any medication Questio

07:07 PM MD

I think I’m allergic to codeine. It makes me toss my cookies.

Model Statement: “It’s good that I know you have been diagnosed with hypertension and high cholesterol, because those conditions can cause additional heart problems. I would like to find out more about your diagnosis and treatment of those conditions.”

Your Results Lab Pass (/assignment_attempts/6701636/lab_pass.pd

Overview

Transcript

Subjective Data Collection

Objective Data Collection

Education & Empathy

Documentation

1 Symptoms Followed Up

2 Hypertension and High Cholesterol Not Followed Up

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3 Exercise Followed Up

4 Diet Followed Up

5 Weight Gain Followed Up

6 Family History Followed Up

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Focused Exam: Abdominal Pain Results | Turned In Advanced Physical Assessment – March 2020, advanced_physical_assessment__td8__031720__sect1

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Transcript

Started: Apr 22, 2020 | Total Time: 115 min

Question 04/22/20 3:02 PM MD

Question 04/22/20 3:03 PM MD

Question 04/22/20 3:04 PM MD

Question 04/22/20 3:05 PM MD

Your Results Lab Pass (/assignment_attempts/6709886/lab_pass.pd

Overview

Transcript

Subjective Data Collection

Objective Data Collection

Education & Empathy

Documentation

Student Survey

All Lines (271) Interview Questions (135) Statements (42) Exam Actions (94)

Hello.

Thank you for explaining that.

What brings you into the office today

I have some pain in my belly. . . and I’m having difficulty going to the bathroom. My daughter was worried about me.

Thank you.

What do you mean by difficult going to the bathroom (Clarified to What do you mean by difficulty going to the bathroom?.)

Well, for several days I’ve had to strain to even have a bowel movement, and I can’t make it happen. And the pain is there in my stomach. [AUDIO COMING SOON] (Clarified to what I mean by difficulty going to the bathroom.)

Thank you for explaining that.

What is your name and date of birth

My name is Esther Park, and I was born on January 7th . . . [Ms. Park reports correct birth year.]

Do you know where you’re at today

Yes. I am at Shadowville General Clinic.

Do you know what time it is (Clarified to What is todays date?.)

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Question 04/22/20 3:05 PM MD

Question 04/22/20 3:06 PM MD

Question 04/22/20 3:07 PM MD

Question 04/22/20 3:14 PM MD

Question 04/22/20 3:15 PM MD

Today must be . . . [Ms. Park reports the correct date]. (Clarified to what today’s date is.)

What time is it (No matching questions found.)

When did the pain start

The pain started as a general discomfort, about five days ago, when I started having the. . . difficulties going to the bathroom.

Where is the pain at

The pain and discomfort is down low in my belly.

How long is this been happening

I have not felt as energetic as usual for — I believe for the past week.

Describe your pain

I’d say it’s crampy and. . . a dull, crampy feeling.

Thank you.

Is there anything that makes it worse

Does the pain radiate anywhere in your body

I wouldn’t say that, no. It’s more of a general pain that stays in one place.

Does anything make the pain better

When I rest and try not to move much, I feel better. But the pain is still there.

can you Point to your pain (Clarified to Can you point to the location of your abdominal pain?.)

Well my whole belly is uncomfortable to some degree, but it’s mostly in the lower part, that’s where the pain is. Down in my lower belly. (Clarified to if I can point to where my abdominal pain is.)

Does your back hurt

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Question 04/22/20 3:16 PM MD

Question 04/22/20 3:19 PM MD

Question 04/22/20 3:20 PM MD

Question 04/22/20 3:21 PM MD

No. I think my exercising helps me avoid that.

What is your pain scale from 1 to 10

Right now. . . 6 out of 10.

What is the pain at its worst (Clarified to What would you rate your pain at its worst?.)

I’d say it’s as bad as it gets right now. . . about a 6 out of 10. (Clarified to how I would rate my pain at its worst.)

Is this all the time (No matching questions found.)

Is this constant pain (Clarified to Is your pain constant?.)

Yes. Certain things can make it a tiny bit better or a tiny bit worse, I suppose. But it’s always there. (Clarified to if the pain is constant.)

What makes it better

When I rest and try not to move much, I feel better. But the pain is still there.

Have you tried anything to help it

I’ve tried taking small sips of warm water, resting. The warm water does nothing. A friend suggested it, but it’s nonsense.

Are you taking any pain medication

I’m not taking anything for it.

Are you taking any laxatives (Clarified to Have you tried taking laxatives?.)

I haven’t tried laxatives. I don’t think they’re very good for you. [AUDIO COMING SOON] (Clarified to if I have tried taking laxatives.)

Thank you for explaining that.

Does eating make it worse (Clarified to Does eating anything make your pain worse?.)

Yes. The pain is there all the time, but eating can make it worse. (Clarified to if eating makes the pain worse.)

Is it worse when you’re walking around (Clarified to How are you getting around?.)

When I have to go somewhere that’s too far for me to walk, my daughter drives me. But usually, I get most places by walking. I usually like to do that whenever I can. (Clarified to how I am getting around.)

Question 04/22/20 3:22 PM MD

Question 04/22/20 3:23 PM MD

Question 04/22/20 3:24 PM MD

Question 04/22/20 3:26 PM MD

Thank you for explaining that.

Does this interfere with your daily activities (Clarified to Has the pain affected your usual activities?.)

Well, I don’t feel unnaturally tired or weak. But I have experienced low energy, like I need to rest more often. (Clarified to if my pain has affected my activities.)

Thank you.

Do you take naps (Clarified to Do you take vitamins or supplements?.)

No, I don’t take anything like that. (Clarified to if I take vitamins or supplements.)

Have you had any diarrhea

Yes, I did have a bout of diarrhea pretty recently. [AUDIO COMING SOON]

How often do you get diarrhea

I don’t have diarrhea often at all. . . the bout six months ago was the first time in a long while. [AUDIO COMING SOON]

When was your last diarrhea episode

That must have been six months ago. It lasted for a day. [AUDIO COMING SOON]

Do you have anything on your stool like mucus (No matching questions found.)

Do you have anything on your stool like blood or mucus (No matching questions found.)

Do you have bloody stools

No. I’ve never experienced that.

do you have mucus in your stool

No, I haven’t noticed anything like that.

Are you avoiding okay

No.

Do you have trouble peeing

No, no trouble.

Question 04/22/20 3:26 PM MD

Question 04/22/20 3:27 PM MD

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Question 04/22/20 3:29 PM MD

Question 04/22/20 3:30 PM MD

What color is your urine

Yellow and. . . maybe a bit darker than usual.

Do you have blood in your urine

No, it seems normal enough to me. Maybe a little darker than usual.

How much fluids are you taking Daily

Usually I drink, oh, two glasses of water a day. But it’s been difficult to drink much in the last few days. [AUDIO COMING SOON]

Thank you for explaining that.

Do you drink caffeinated drinks

No. I avoid caffeinated drinks altogether.

Do you drink soda

No, I never do.

What is your typical bowel movement routine

What has been happening with my. . . digestion. . . is new. I’m usually fairly regular, but I haven’t moved my bowels in about five days. [AUDIO COMING SOON]

What color is your stool

Brown. A normal shade of brown. Like. . . oh, I don’t know. Cardboard.

Is it soft or hard (No matching questions found.)

is your stool soft or hard

My stool? Usually it’s brown, not too hard. Solid. Not watery.

Are you allergic to any medication

No, not that I’m aware of.

Do you have any food allergies

No.

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Question 04/22/20 3:30 PM MD

Question 04/22/20 3:31 PM MD

Question 04/22/20 3:32 PM MD

Are you allergic to anything

I have an allergy to latex.

What happens with latex

I get an itchy skin rash.

Do you see the doctor regularly

Yes. I usually see Dr. Keller, here–at Shadowville Primary Care. But I was told she’s out today.

When was your last pap smear

A pap smear? I haven’t had one in years. Ten years, at least.

define your health today

I haven’t been feeling well lately.

Have you ever had a colonoscopy

I’ve had two colonoscopies. The last one was ten years ago.

What was your results (Clarified to What was the result of your colonoscopy?.)

They had nothing to report. [AUDIO COMING SOON] (Clarified to what the result of my colonoscopy was.)

What was your result for your last pap smear

A pap smear? I haven’t had one in years. Ten years, at least.

what is your result for your pap smear (Clarified to What was the result of your last smear test?.)

It was years ago, so I don’t remember anything about it. I’m sure it was fine. (Clarified to what the result of my last pap smear was.)

Have you ever had any sexual transmitted infections (Clarified to Do you have a history of STD?.)

No, I’ve never had anything… like that. (Clarified to if I have had an STD.)

Are you still sexually active

I have a gentleman friend and, yes… We are intimate.

Question 04/22/20 3:33 PM MD

Question 04/22/20 3:34 PM MD

Question 04/22/20 3:35 PM MD

Question 04/22/20 3:36 PM MD

Question 04/22/20 3:37 PM MD

Does it burn or hurt with urination (Clarified to Do you feel burning when you urinate?.)

No, my urination has felt normal. (Clarified to if it burns when I urinate.)

Thank you for explaining that.

do you take any blood pressure medications

Yes.

Have you had trouble with your blood pressure lately

Yes, I have been diagnosed with high blood pressure. But I take very good care of that.

Thank you for explaining that.

Have you had any surgeries

I’ve had two operations, both many years ago.

What was the reason for your surgery (Clarified to What type of surgery did you have?.)

I’ve had two. I had my gallbladder out, and I had a C-section. Both in my early 40s. (Clarified to what surgery I had.)

Have you been hospitalized before

Yes. I had a couple surgeries years ago. And of course I stayed in the hospital briefly when Jennifer and Timothy were born.

Are you taking any over-the-counter medication

No. Those over-the-counter medicines. . . Tylenol–they say it’s very bad for the stomach.

Difficult with daily activities (Clarified to Have you required assistance in performing daily activities?.)

Usually I don’t need much help. But since I’ve been sick, my daughter has been helping me, doing things around the house–gardening, cleaning, making sure I eat a little something. She’s very busy with her job, and it’s very sweet of her to help me. (Clarified to if I have needed help with daily activities.)

Are you able to dress yourself

No — I had to miss my exercise classes this week — I didn’t have the energy for them. That’s unusual for me.

Do you need help eating

Question 04/22/20 3:37 PM MD

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Question 04/22/20 3:40 PM MD

I don’t need any help right now. Thank you.

Do you have difficult walking (Clarified to Is it hard for me to walk?.)

I can walk just fine. (Clarified to if it is hard for me to walk.)

Do you need help bathing

No, I can do that myself.

Are you able to get in and out of a chair

Any kind of movement makes my abdominal discomfort worse, but I don’t usually have problems with that.

Tell me about your diet (Clarified to What is your diet like?.)

I usually eat low fat foods, healthy proteins. . . on holidays our family gets together, so I make traditional dishes then. Korean dishes. But usually I eat very light. (Clarified to what my diet is like.)

Do you eat three meals a day

Usually three, but sometimes I skip breakfast. I don’t eat snacks.

What are you eating habits (Clarified to What are your eating habits?.)

Hm. Toast for breakfast. For lunch. . . usually soup. But I don’t always have lunch. And for dinner I eat fish, or sometimes chicken, and rice. [AUDIO COMING SOON] (Clarified to what my eating habits are.)

Thank you for explaining that.

Have you had any change in weight

No, not that I’ve noticed.

Have you had any fever or chills

No, I haven’t been feverish or chilly. [AUDIO COMING SOON]

Have you had night sweats

No. That is not a problem for me.

so you see swelling in your extremities or face

Question 04/22/20 3:40 PM MD

Question 04/22/20 3:41 PM MD

Question 04/22/20 3:42 PM MD

Nothing is swelling that I know of.

Do you smoke

I’ve never smoked a cigarette in my life. What a sad habit.

Do you drink alcohol

Yes, but very little.

How often and what type of alcohol

Very little.

How often do you drink alcohol

Very little.

Do you take illicit drugs

I have never used drugs of any kind.

Thank you for explaining that.

How much alcohol do you drink

Very little.

How often do you drink in a week

On Sundays, I have my only drink for the week.

What kind of alcohol do you drink

I always have one glass of wine. A dry white wine.

Do you live alone

No. I live with my daughter, Jennifer.

Do you have family around besides Jennifer

Two wonderful grown-up children. Jennifer and Timothy.

Question 04/22/20 3:42 PM MD

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Question 04/22/20 3:45 PM MD

Question 04/22/20 3:46 PM MD

Do you have grandchildren

Oh, I would have loved to have had grandchildren. Both of my children… Everything is about their careers. But I supposed–some of my friends, their children are grown–in their 40s, 50s– and they never found their way. So I’m very lucky.

Thank you.

Do you travel

My late husband Shin and I went on a few vacations with the kids–Florida, once to St. Thomas in the Caribbean. And once I went to Munich, Germany where Shin was doing a lecture. But since he died, I’ve only gone on one trip–to Houston, to see my son.

Thank you.

Have you had been physically abused

No, never.

Have you ever been sexually abused (No matching questions found.)

have you been abused sexually

No.

Have you been emotionally abused

No, the people in my life–they treat me very well.

Are you okay with your finances

No. My daughter handles the bills.

Is that going well for you (No matching questions found.)

Thank you.

Do you have trouble sleeping

No, usually I sleep right through the night.

Have you ever had a history of appendicitis (No matching questions found.)

Question 04/22/20 3:46 PM MD

Question 04/22/20 3:47 PM MD

Question 04/22/20 3:49 PM MD

Have you ever had appendicitis

No.

Have you had any stomach cancer (Clarified to Have you had stomach cancer?.)

No. (Clarified to if I have had stomach cancer.)

Is there a family history of stomach cancer

No.

Do you or your family have liver disease

No, not that I know of.

Have you ever had GERD

No. I don’t get indigestion, heartburn, nothing like that.

Do you have a family history of ulcer (Clarified to Do your family members have health problems?.)

Let’s see. . . high cholesterol and diabetes. My father was an overweight man. My two older brothers, they live in California. One of them has high cholesterol and now prostate cancer, but he’s not having the surgery. His doctor says his cancer is very slow growing. Both. . . Yes, both have high blood pressure. Both my parents had high blood pressure, and so do I, so you might say that runs in my family. (Clarified to if my family members have health problems.)

Thank you for explaining that.

Have you ever had any palpitation

No. My heart rate has always been normal.

Have you ever had chest discomfort (Clarified to Have you ever had chest pain?.)

No, I don’t ever experience chest pain. (Clarified to if I have ever had chest pain.)

Have you ever felt your heart rate was going fast

No. My heart rate has always been normal.

Do you have any sore throat

No. My throat is fine.

Question 04/22/20 3:50 PM MD

Question 04/22/20 3:51 PM MD

Question 04/22/20 3:52 PM MD

Do you have any cough

No, I haven’t been coughing at all.

Do you have difficulty swallowing

No. I am able to swallow without any problems.

Do you have difficulty breathing (Clarified to Do you have breathing problems?.)

No. I can breathe well. My lungs feel very healthy. (Clarified to if I have breathing problems.)

Do you have any bloating

Yes. Quite a bit.

Are you gassy

Hm. I have been experiencing some of that.

Do you feel nauseous

No. I haven’t vomited or had any nausea. It’s more of a problem with pain. . . and difficulty going to the bathroom.

Have you had food poisoning

Years ago I eat some bad shellfish. . . this doesn’t feel like that.

Do you have vomiting

Very rarely. The last time I vomited. . . I had a stomach virus a few years ago. One of those nasty, 24-hour bugs.

Do you have bladder problems

No.

You have any history of bladder cancer (Clarified to Have you had a bladder infection?.)

No, never. (Clarified to if I have had a bladder infection.)

Have you ever had problem gynecological

I haven’t had any.

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Question 04/22/20 3:52 PM MD

Question 04/22/20 4:00 PM MD

Question 04/22/20 4:07 PM MD

Question 04/22/20 4:08 PM MD

Do you have vaginal bleeding

No.

Do you have menopause (Clarified to How long ago did you have menopause?.)

Oh my. . . it was twenty years or more ago. . . I think I was 54. (Clarified to how long ago I underwent menopause.)

Do you have any kidney problems

No, I’ve never had any kidney trouble.

Thank you.

Thank you for explaining that.

the stethoscope may be cold (No matching questions found.)

Thank you for explaining that.

Is that tender (No matching questions found.)

Is that tender to touch (No matching questions found.)

did that hurt (No matching questions found.)

Thank you for explaining that.

Question 04/22/20 4:27 PM MD

Question 04/22/20 4:28 PM MD

Question 04/22/20 4:31 PM MD

Thank you for explaining that.

That feels alright.

Mmm, it feels sore there.

Thank you.

Thank you for explaining that.

That feels alright.

Ooo, that–that’s sore right there.

Thank you for explaining that.

Bart would you like a flu injection (No matching questions found.)

Miss Park would you like to have a flu injection

Not today. Maybe I’ll get one at my next check-up, if my doctor recommends it.

Thank you for explaining that.

How many pregnancies have you had

I’ve had three pregnancies… I have two wonderful grown children.

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Question 04/22/20 4:31 PM MD

Question 04/22/20 4:32 PM MD

Did you have a miscarriage

No, not a miscarriage. When I was forty I had a baby, delivered by C-section. It was what they called an umbilical cord accident–where the cord wraps around the baby’s neck. It was a stillbirth.

Thank you.

Do you have any depression

I don’t struggle with depression, thankfully. I feel positive about my life.

Did you have resources for the loss of your child (No matching questions found.)

Did you need therapy for the loss of your child (No matching questions found.)

Are you coping with the loss of your child

I like to think so. I think I’m good at letting things go–not holding onto resentments, things that make me sad. Between my friends, my daughter, and. . . and also my gentleman friend, I have good people around me.

Thank you for explaining that.

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Focused Exam: Chest Pain Results | Turned In Advanced Physical Assessment – March 2020, advanced_physical_assessment__td8__031720__sect1

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Transcript

Started: Apr 21, 2020 | Total Time: 113 min

Question 04/21/20 6:58 PM MD

Question 04/21/20 6:59 PM MD

Question 04/21/20 7:00 PM MD

Your Results Lab Pass (/assignment_attempts/6701636/lab_pass.pd

Overview

Transcript

Subjective Data Collection

Objective Data Collection

Education & Empathy

Documentation

All Lines (238) Interview Questions (87) Statements (30) Exam Actions (121)

Good morning.

What brings you into the clinic today

I have been having some troubling chest pain in my chest now and then for the past month.

Thanks. I appreciate that.

When did this chest pain start

I first noticed it earlier this month. I thought it might just be heartburn and it passed after a couple of minutes.

Can you tell me the location of your pain

When the pain happens, I feel it mostly in the middle of my chest, over my heart.

Desert pain radiate to your arm (Clarified to Is your pain radiating?.)

The pain doesn’t radiate anywhere. It’s mostly just right in the middle of my chest. (Clarified to if the pain is radiating.)

Does it radiate to your arm (Clarified to Does the pain travel down your arm?.)

No, my pain doesn’t seem to travel. (Clarified to if the pain travels down my arm.)

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Question 04/21/20 7:00 PM MD

Question 04/21/20 7:01 PM MD

Question 04/21/20 7:02 PM MD

Question 04/21/20 7:03 PM MD

Do you have shoulder pain with it (No matching questions found.)

Do you have shoulder pain

No, the pain hasn’t been in my shoulder.

Good to know. Thank you.

Do you have any back pain

I haven’t had back pain, no.

Do you have any neck pain

My neck’s been fine.

How long does it pain happen

When I feel it, it seems to get better over the course of a couple of minutes or so.

Does anything happen that causes it to happen (Clarified to Does anything trigger the pain?.)

Well, the pain seems to start when I’m doing something physical . . . the first time it happened while I was doing yard work, and the second time . . . I had to take the stairs at work because the elevator broke. Both times it got better if I took a break or sat down to rest. (Clarified to if anything triggers the pain.)

Is there anything that makes it better

Well . . . it seemed to subside a little bit when I sat down to rest for a few minutes.

How frequent is your pain

Well, it has happened three times the past month. It usually goes away after about a couple minutes.

Have you tried any treatment (No matching questions found.)

Have you tried anything to help your pain

This is the first I’m seeing anyone about the pain, so not much has been done yet.

Describe from 0 to 10 Pain Scale (Clarified to How would you rate your chest pain on a scale?.)

I’d say maybe a . . . 5? It’s just really uncomfortable . . . like there’s nothing I can do about it. Right now it’s like a zero though. (Clarified to how I would rate my chest pain on a scale.)

Question 04/21/20 7:03 PM MD

Question 04/21/20 7:04 PM MD

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Question 04/21/20 7:06 PM MD

Can you describe the characteristic of your pain

Light yellow? Yellowish clear? The normal color, I guess.

Can you describe your pain

Well, it mostly feels tight and uncomfortable right in the middle of my chest.

Does it feel like someone standing on your chest

It’s more tight and uncomfortable than anything. I’ve had the feeling . . . maybe three times this month?

Is it a crushing pain

No, it’s more tight and uncomfortable.

Is it a burning pain

Not really.

Is the pain worse when you eat spicy food

I don’t think spicy foods have anything to do with it.

Is the pain worse when you’re eating (Clarified to Does the pain get worse after you eat?.)

I don’t think eating has anything to do with it. One episode did happen when my wife and I were out for dinner, but it seemed to happen before we even settled. The episodes don’t seem all that related, to be honest. (Clarified to if the pain is worse after I eat.)

Are you taking any medication for your pain

I take Ibuprofen for various aches and pains every now and then. That’s about it.

What aches and pains are you having (No matching questions found.)

How often do you get aches and pain

I usually drink water all day at work. At least four glasses, probably more. [AUDIO COMING SOON]

Do you get a chest pain

Well, it doesn’t hurt right now, but I have been having chest pain now and then for the past month.

Question 04/21/20 7:07 PM MD

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Question 04/21/20 7:11 PM MD

Do you have breathing problems

My breathing’s fine.

What is your medical history

The doctors told me I have a little bit of high blood pressure and cholesterol, but that’s it.

Have you had any surgeries

I’ve never had any surgeries.

Are you allergic to any medication

I think I’m allergic to codeine. It makes me toss my cookies.

What happens with codeine (Clarified to What is your reaction to codeine?.)

It makes me nauseous and I vomit. (Clarified to what my reaction to codeine is.)

Have you ever been diagnosed with angina

I’ve never been diagnosed with angina. [AUDIO COMING SOON]

Do you have any coronary heart disease

My grandfather on my mom’s side died of a heart attack. He was in his mid-fifties.

Thanks. I appreciate that.

Do you have diabetes

No, I’ve avoided it but my mother and sister both have it.

High blood pressure

Yes, I supposedly have moderately high blood pressure.

What medication are you taking

Yeah, let’s see, I take atorvastatin for cholesterol, metoprolol for blood pressure. . . Oh yeah, and I take fish oil too. I hear that’s good for your cholesterol. [AUDIO COMING SOON]

Have you ever been admitted for your high blood pressure (Clarified to How do you control your blood pressure?.)

Question 04/21/20 7:11 PM MD

Question 04/21/20 7:12 PM MD

Question 04/21/20 7:13 PM MD

Question 04/21/20 7:14 PM MD

Well, my healthcare provider started me on metoprolol a year ago to get my blood pressure under control. [AUDIO COMING SOON] (Clarified to how I control my blood pressure.)

Have you been hospitalized for high blood pressure

Yes, I supposedly have moderately high blood pressure.

Do you check your blood pressure daily

I usually only get it checked when I visit the doctor.

What you normal readings are for your BP

Um, let’s see . . . For breakfast I usually eat a granola bar and drink an instant breakfast shake. I’ve been doing that a while since it saves time in the morning. Most days for lunch I get a sandwich from the sub shop near work. That’s usually a turkey sub, but sometimes I get a spicy Italian sub. My wife and I grill a lot, and usually have some grilled meat with veggies for dinner.

Good to know. Thank you.

Do you exercise

Well I used to ride my bike a lot but it got stolen a couple years ago. I guess I haven’t had much regular exercise since then. I want to get a new bike if the doctor says it is OK to exercise with this chest pain I’ve been having.

Good to know. Thank you.

Have you had any cardiac testing like an EKG

I’ve had . . . well, I guess I’ve had the EKG a few times and they give me an annual stress test.

How are your results (Clarified to What were the results of your heart tests?.)

I’m not sure, all the doctor ever tells me is, “everything looks good.” (Clarified to what the results of my heart tests were.)

Good to know. Thank you.

Are you taking any medication for your cholesterol

I take atorvastatin. [AUDIO COMING SOON]

What is your dosage of all your medications let’s review your medications

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Question 04/21/20 7:14 PM MD

Question 04/21/20 7:15 PM MD

Question 04/21/20 7:16 PM MD

Question 04/21/20 7:17 PM MD

The atorvastatin’s 20 mg a day, and the other one, metoprolol, is 100 mg daily. [AUDIO COMING SOON]

Are you taking any over-the-counter medication

Oh, just ibuprofen or Tylenol occasionally for pain.

Does it help you with your pain

I haven’t taken anything for the chest pain yet.

How much fluid are you drinking a day

I usually drink water all day at work. At least four glasses, probably more. [AUDIO COMING SOON]

Do you drink any caffeine

I drink a cup or two of coffee almost every day. Not much else.

This is make your heart beat fast

No, I haven’t noticed anything like that.

Do you drink any soda

Once in a blue moon maybe. I avoid it 99% of the time.

do you Drink alcohol

Sure, but never more than two or three beers on a weekend.

Do you take illicit drugs

Nope.

Do you smoke cigarettes

Nope, I had a lot of friends who did but I never started.

Do you smoke e-cigarettes

Nope, I had a lot of friends who did but I never started.

Do you have any fever

Question 04/21/20 7:17 PM MD

Question 04/21/20 7:18 PM MD

Question 04/21/20 7:19 PM MD

I haven’t had a fever, no.

Do you have any chills

I haven’t had chills, no.

Have you had any blood clots or bleeding problems

Not that I know of.

Do you bruise easy

I don’t bruise easily, no.

Do you have circular problems (No matching questions found.)

Deer swimming on your feet (No matching questions found.)

Do you have swelling in your feet

I haven’t noticed any swelling.

Have you had any night sweats

Nope, no night sweats.

Any recent weight loss

Not exactly . . . I’ve gained about fifteen to twenty pounds in the last couple years.

Good to know. Thank you.

Does your heart ever beat fast

No, I haven’t noticed anything like that.

Do you get dizzy or lightheadedness

I haven’t felt faint or even lightheaded really.

Do you have difficulty breathing

My breathing’s fine.

Question 04/21/20 7:20 PM MD

Question 04/21/20 7:21 PM MD

Question 04/21/20 7:22 PM MD

Have you had a cough

I don’t have a cough.

Do you get any shortness of breath

No, I can usually breathe just fine. Unless I have a cold or something, but that’s rare.

Do you have a change in taste

I can still taste things fine.

Do you have difficulty swallowing

I haven’t had any trouble swallowing.

Germany sore throat

I haven’t had a sore throat in a long time.

Do you have any nausea or vomiting

No, I haven’t felt nauseous. I just had pain in my chest.

Any diarrhea or constipation

I’m not having either of those problems.

Do you get gassy or bloated

No, I wish this was only gas but it feels different.

Do you have any heartburn or GERD

No, I’ve never had problems with heartburn. I sure hope that’s all this is, but it’s pretty intense if it’s heartburn.

Do you have any family history of a heart attack

Well, my mom’s dad died of a heart attack. He was pretty young too.

How old was your grandfather (Clarified to How old was your maternal grandfather when he passed?.)

It’s not a great time to realize this, but he died of a heart attack in his fifties. I think he was 54. (Clarified to how old my maternal grandfather lived to be.)

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Question 04/21/20 7:22 PM MD

Question 04/21/20 7:23 PM MD

Question 04/21/20 7:25 PM MD

Question 04/21/20 7:27 PM MD

Question 04/21/20 7:28 PM MD

Question 04/21/20 7:42 PM MD

Any family history of stroke

No, none that I know of.

Anybody with respiratory problems (Clarified to Do you have a family history of lung problems?.)

Nobody has had anything wrong with their lungs. (Clarified to if I have a family history of lung problems.)

Is there anything that you haven’t told me that I should know

Thankfully, no.

Good to know. Thank you.

Do you have any headaches right now

No, my head feels okay.

Good to know. Thank you.

Do you feel like your pail (No matching questions found.)

Good to know. Thank you.

Im going to look at your abdomen (No matching questions found.)

Good to know. Thank you.

Having trouble breathing (Clarified to Are you having difficulty breathing right now?.)

My breathing’s fine. (Clarified to if I am having difficulty breathing now.)

Question 04/21/20 7:49 PM MD

Good to know. Thank you.

I am checking your femoral pulses (No matching questions found.)

Good to know. Thank you.

Thanks. I appreciate that.

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Yes. We have posted over our previous orders to display our experience. Since we have done this question before, we can also do it for you. To make sure we do it perfectly, please fill out our Order Form. Filling the order form correctly will assist our team in referencing, specifications, and future communication.

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1. Click on the “Order Now” on the Main Menu and a new page will appear with an order form to be filled.

2. Fill in your paper’s requirements in the “PAPER INFORMATION” section and the system will calculate your order price/cost.

3. Fill in your paper’s academic level, deadline, and the required number of pages from the drop-down menus.

4. Click “FINAL STEP” to enter your registration details and get an account with us for record-keeping and then, click on “PROCEED TO CHECKOUT” at the bottom of the page.

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5. From there, the payment sections will show, follow the guided payment process and your order will be available for our writing team to work on it.

We will process your orders through multiple stages and checks to ensure that what we are delivering to you, in the end, is something that is precise as you envisioned it. All of our essay writing service products are 100% original, ensuring that there is no plagiarism in them. The sources are well-researched and cited so it is interesting. Our goal is to help as many students as possible with their assignments, i.e. our prices are affordable and services premium.

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