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Shadow Health: Focused Exam: Cough Results Danny Riviera

Shadow Health: Focused Exam: Cough Results Danny Riviera

Model Documentation
SubjectiveDanny reports cough lasting two to three days. He described the cough as “watery and gurgly.” He reports the cough is worst at night and keeps him awake. He reported general tiredness because of sleep deprivation.He is experiencing mild soreness in his throat. He reports his mother gave him over-the-counter cough medicine, but it gave him temporal relieve from the cough .He reports frequent cold and runny nose, and states that he had frequent ear infections as a child. He reports a history of pneumonia in the past year. He reports normal bowel movements. He denies fever, headache, dizziness, ear pain nosebleed, trouble swallowing, sputum or phlegm, chest pain, trouble breathing and abdominal pain. He denies cough aggravation with activity.Danny reports a cough lasting two to three days. He describes the cough as “watery and gurgly.” He reports the cough is worse at night and keeps him up. He reports general fatigue due to lack of sleep. He is experiencing mild soreness in his throat. He reports his mother treated his cough symptoms with over-the-counter medicine, but it was only temporarily effective. He reports frequent cold and runny nose, and he states that he had frequent ear infections as a child. He reports a history of pneumonia in the past year. He reports normal bowel movements. He denies fever, headache, dizziness, ear pain, trouble swallowing, nosebleed, phlegm or sputum, chest pain, trouble breathing and abdominal pain. He denies cough aggravation with activity.
ObjectiveGeneral Survey: Fatigued appearing young boy seated on nursing station bench. Appears stable. HEENT: Mucus membranes are moist, nasal discharge, and boggy turbinate. Fine bumps on the togue. Cobblestoning in the back of throat. Eyes are dull in appearance, pink Conjunctiva. Cardiovascular: Mild tarchycardia. S1, S2, no murmurs, gallops or rubs. Respiratory: Respiratory rate increased, but no acute distress. Able to speak full sentences. Breath sounds clear to auscultation.• General Survey: Fatigued appearing young boy seated on nursing station bench. Appears stable. • HEENT: Mucus membranes are moist, nasal discharge, and boggy turbinate. Fine bumps on the tongue. Cobblestoning in the back of throat. Eyes are dull in appearance, pink conjunctiva. • Cardiovascular: Mild tachycardia. S1, S2, no murmurs, gallops or rubs. • Respiratory: Respiratory rate increased, but no acute distress. Able to speak in full sentences. Breath sounds clear to auscultation.

Within the Shadow Health platform, complete the Focused Exam: Cough Results. The estimated average time to complete this assignment each time is 1 hour and 15 minutes. Please note, this is an average time. Some students may need longer.

This clinical experience is a concentrated examination. Students must achieve the “Proficiency” level in the Shadow Health Digital Clinical Experience. Students have three chances to complete this assignment and earn a Proficiency level score. When finished, upload the lab pass to the assignment dropbox.

Assessment Description

Within the Shadow Health platform, complete the Focused Exam: Cough Results. The estimated average time to complete this assignment each time is 1 hour and 15 minutes. Please note, this is an average time. Some students may need longer.

This clinical experience is a focused exam. Students must score at the level of “Proficiency” in the Shadow Health Digital Clinical Experience. Students have three opportunities to complete this assignment and score at the Proficiency level. Upon completion, submit the lab pass through the assignment dropbox.

Students successfully scoring within the Proficiency level in the Digital Clinical Experience on the first attempt will earn a grade of 100 points; students successfully scoring at the Proficiency level on the second attempt will earn a grade of 90 points; and students successfully scoring at the Proficiency level on the third attempt will earn a grade of 80 points. Students who do not pass the performance-based assessment by scoring within the Proficiency level in three attempts will receive a failing grade (68 points).

If Proficiency is not achieved on the first attempt, it is recommended that you review your answers with the correct answers on the Experience Overview page. Review the report by clicking on each tab to the left titled Transcript, Subjective Data Collection, Objective Data Collection, Documentation, and SBAR to compare your work. Reviewing this overview and the course resources may help you improve your score.

Please review the assignment in the Health Assessment Student Handbook in Shadow Health prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to LopesWrite.

AttachmentsNRS-434VN-R-Childrens-functional-h

Hello!Question
12/15/19 7:10 AM MST
Diana Shadow.Hi. I’m Preceptor Diana. I will explain the details of this assignment and your objectives, just as a preceptor would in real life. Pay close attention to this information as it will help guide your exam. At the end of this prebrief, you will answer a short question about the upcoming assignment. During the simulation, you may return to these instructions at any time by scrolling to the top of your transcript.
Your Avatar.What is the situation?Question
12/15/19 7:11 AM MST
Diana Shadow.Your patient is Danny Rivera, an 8-year-old Puerto Rican boy presenting with a cough in the Shadowville Elementary nurse’s office. Your role in this simulation is that of a healthcare provider who will perform a focused history and physical examination in order to collect data, assess Danny’s condition, and transfer care. In this simulation, you will be able to perform procedures not always typical to a school setting so you can gather as much data as possible.
Your Avatar.What are my objectives in this assessment?Question
12/15/19 7:12 AM MST
Diana Shadow.Danny is very health literate and a good historian of his own health history; he can answer questions that not every child may be able to. In your interview with Danny, you will ask about the history of his presenting illness and the functioning of relevant systems in order to obtain subjective data related to his cough. If you discover any disease states, ask about symptoms and the patient’s experiences of them. Your questioning should cover a broad array of the symptoms’ characteristics. You will also inquire into the health history of Danny’s family so you can determine his genetic predisposition to any diseases. In addition to collecting subjective data, you will perform a physical exam on Danny to gather objective data about his health and physiology. While you should communicate with patients using accessible, everyday language, it is standard practice to use professional medical terminology everywhere else, such as in documenting physical findings and nursing notes. You may complete the exam activities in any order and move between them as needed.
Your Avatar.What else will this exam involve?Question
12/15/19 8:12 PM MST
Diana Shadow.Because Danny is a pediatric patient, you will also be required to make a phone call to his guardian’s home to gather additional information. You can document your findings, including vital signs, in the Electronic Health Record. This record provides necessary information for healthcare professionals who will continue patient care. After the exam, you will transfer care of the patient to me, Preceptor Diana, communicating key information about the Situation, Background, Assessment, and Recommendation, or SBAR. Activities other than Subjective and Objective Data Collection, such as Documentation and Education and Empathy, provide valuable practice for their real-world counterparts. However, they are not automatically graded by the simulation.
Your Avatar.How will I be evaluated?Question
12/15/19 8:13 PM MST
Diana Shadow.In this assignment, you will be evaluated on your Subjective and Objective Data Collection. The evaluation of your interview is dependent on how you word your questions therapeutically and precisely and explore all relevant topics with comprehensive breadth and depth. The evaluation of your physical exam is based on how successfully you report on your physical findings by selecting among clinical terms in the Electronic Health Record. This assignment takes on average between 40 and 60 minutes. You can pause and resume the assignment at any time; your work is always saved automatically.
Your Avatar.How does this assignment prepare me for the real world?Question
12/15/19 8:14 PM MST
Diana Shadow.In this assessment, you will become familiarized with the structure and content of a cough focused exam so that with real-life patients, you can: º ask effective and comprehensive questions º use therapeutic language º evaluate the patient’s risk of disease, infection, injury, and complications º obtain and assess objective data. º and transfer patient care using SBAR.
Diana Shadow.In 1 or 2 sentences, answer this question to help prepare for the upcoming exam: What strategies can you use to develop rapport with a pediatric patient?
Your Avatar.play peek-a-boo or pretend to examine the child’s teddy bearStatement
12/15/19 8:18 PM MST
Diana Shadow.Time to begin.

Each of you will be completing a Shadow Health Assessments each week. You will need to sign into the account, and please make sure you register under the correct date. You will get all your information under the Course Materials. If you have problems signing in, you will need to call the Help Desk for them. Make sure you are reading the rubric for each Shadow Health assignment, because sometimes you will only have 1 try to pass, and other times you may only have 3, but with significant point reduction each try.

You do not need a PIN to sign in. Go to PATH, then Course Material. You will see: Shadow Health Digital Clinical Experience. Go there and follow the instructions. Thanks

Please upload all assignment completions under your assignment due area. Thanks

Students successfully scoring within the Proficiency level in the Digital Clinical Experience on the first attempt will earn a grade of 10 points; students successfully scoring at the Proficiency level on the second attempt will earn a grade of 90 points; and students successfully scoring at the Proficiency level on the third attempt will earn a grade of 80 points. Students who do not pass the performance-based assessment by scoring within the Proficiency level in three attempts will receive a failing grade (68 points).

Each of you will be completing a Shadow Health Assessments each week. You will need to sign into the account, and please make sure you register under the correct date. You will get all your information under the Course Materials. If you have problems signing in, you will need to call the Help Desk for them. Make sure you are reading the rubric for each Shadow Health assignment, because sometimes you will only have 1 try to pass, and other times you may only have 3, but with significant point reduction each try.

You do not need a PIN to sign in. Go to PATH, then Course Material. You will see: Shadow Health Digital Clinical Experience. Go there and follow the instructions. Thanks

Please upload all assignment completions under your assignment due area. Thanks

If Proficiency is not achieved on the first attempt, it is recommended that you review your answers with the correct answers on the Experience Overview page. Review the report by clicking on each tab to the left titled Transcript, Subjective Data Collection, Objective Data Collection, Documentation, and SBAR to compare your work. Reviewing this overview and the course resources may help you improve your score.

Please review the assignment in the Health Assessment Student Handbook in Shadow Health prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to LopesWrite.

Children’s Functional Health Pattern Assessment

Functional Health Pattern Assessment (FHP) ToddlerErickson’s Developmental Stage: Preschool-AgedErickson’s Developmental Stage: School-AgedErickson’s Developmental Stage: 
Pattern of Health Perception and Health Management: List two normal assessment findings that would be characteristic for each age group.  List two potential problems that a nurse may discover in an assessment of each age group.     
     
Nutritional-Metabolic Pattern: List two normal assessment findings that would be characteristic for each age group.  List two potential problems that a nurse may discover in an assessment of each age group.     
     
Pattern of Elimination: List two normal assessment findings that would be characteristic for each age group.   List two potential problems that a nurse may discover in an assessment of each age group.     
     
Pattern of Activity and Exercise: List two normal assessment findings that would be characteristic for each age group.   List two potential problems that a nurse may discover in an assessment of each age group.     
     
Cognitive/Perceptual Pattern: List two normal assessment findings that would be characteristic for each age group.   List two potential problems that a nurse may discover in an assessment of each age group.     
     
Pattern of Sleep and Rest: List two normal assessment findings that would be characteristic for each age group.    List two potential problems that a nurse may discover in an assessment of each age group.     
     
Pattern of Self-Perception and Self-Concept: List two normal assessment findings that would be characteristic for each age group.  List two potential problems that a nurse may discover in an assessment of each age group.     
     
Role-Relationship Pattern: List two normal assessment findings that would be characteristic for each age group.  List 2 potential problems that a nurse may discover in an assessment of each age group.        
        
Sexuality – Reproductive Pattern: List two normal assessment findings that would be characteristic for each age group. List two potential problems that a nurse may discover in an assessment of each age group.    
    
Pattern of Coping and Stress Tolerance:List two normal assessment findings that would be characteristic for each age group. List wo potential problems that a nurse may discover in an assessment of each age group.    
    
Pattern of Value and Beliefs: List two normal assessment findings that would be characteristic for each age group.  List two potential problems that a nurse may discover in an assessment of each age group.     
     

Short Answer Questions

Address the following based on the above assessment findings. Expected answers will be 1-2 paragraphs in length. Cite and reference outside sources used.

  • Compare and contrast identified similarities as well as differences in expected assessment across the childhood age groups.
  • Summarize how a nurse would handle physical assessments, examinations, education, and communication differently with children versus adults. Consider spirituality and cultural differences in your answer.

SUBJECTIVE DATA

Scored Items

Experts selected these topics as essential components of a strong, thorough interview with this patient.
Patient Data
Not Scored

A combination of open and closed questions will yield better patient data. The following details are facts of the patient’s case.
Chief Complaint

Finding:
Established chief complaint

Finding:
Reports cough
(Found)
Pro Tip: Asking a patient broadly about their chief complaint allows them to answer in their own words and confirm information that you may have already received from another source.
Example Question:
Do you have a cough?

History of Presenting Illness

Finding:
Asked about onset of cough

Finding:
Reports cough started 3 days ago
(Found)
Pro Tip: Whenever you are assessing a symptom or a health condition, in this case the patient’s cough, inquiring about onset assesses the severity and the progression of the problem.
Example Question:
How long have you had a cough?

Finding:
Asked about characteristics of cough

Finding:
Reports cough is wet
(Available)
Pro Tip: The characteristics of a cough, such as whether it is dry or wet, can indicate key information about the type of illness the patient has.
Example Question:
Is your cough a wet cough?
Finding:
Reports clear sputum with cough
(Available)
Pro Tip: The characteristics of a cough, such as whether it is productive, can indicate key information about the type of illness the patient has.
Example Question:
Do you produce any phlegm or sputum with your cough?

Finding:
Asked about frequency and duration of cough

Finding:
Reports coughing every few minutes
(Available)
Pro Tip: Establishing how frequently Danny coughs will illustrate how long he has been suffering these particular symptoms and might indicate possible triggers.
Example Question:
How frequently are you coughing?
Finding:
Reports coughs last a few seconds
(Available)
Pro Tip: Establishing how long Danny’s coughs last will illustrate how long he has been suffering these particular symptoms and might indicate possible triggers.
Example Question:
How long do your coughs last?

Finding:
Asked about aggravating factors for cough

Finding:
Reports cough is worse at night
(Available)
Pro Tip: Establishing a timeline for Danny’s coughing will illustrate how long he has been suffering these particular symptoms and might indicate possible triggers.
Example Question:
Is the cough worse at night?
Finding:
Denies smoking
(Available)
Pro Tip: Tobacco use puts the patient at risk for many medical conditions. Asking even young patients about whether they consume tobacco products helps you assess this risk factor.
Example Question:
Do you smoke?
Finding:
Reports being exposed to secondhand smoke through father
(Available)
Pro Tip: Tobacco use puts the patient at risk for many medical conditions. Asking about whether a patient is exposed to secondhand smoke allows you to assess this risk factor.
Example Question:
Are you ever around cigarette smoke?
Finding:
Reports he doesn’t know what triggers the cough
(Available)
Pro Tip: Asking about aggravating factors of Danny’s cough will allow you to determine potential causes and educate the patient on what to avoid.
Example Question:
What makes your cough worse?

Finding:
Asked about relieving factors for cough

Finding:
Reports cough is temporarily relieved by cough medicine
(Found)
Pro Tip: Asking about how the patient has been managing their pain assesses their current condition and their approach to self-care. The results of their previous treatment may be helpful in your diagnosis and the development of their new treatment plan, as well as a good opportunity to educate the patient on effective self-care practices.
Example Question:
Have you done anything to treat your cough?

Finding:
Followed up on cough medicine

Finding:
Reports cough medicine was purple
(Available)
Pro Tip: The type of cough medicine a patient takes, and how they take it, can impact its effectiveness. Following up on the cough medicine’s color may help you identify the type of medication it is.
Example Question:
What color was the cough medicine?
Finding:
Reports taking one spoonful of cough medicine
(Available)
Pro Tip: The type of cough medicine a patient takes, and how they take it, can impact its effectiveness. Following up on the dose of cough medicine allows you to determine whether it is being taken correctly.
Example Question:
How much medicine did you take?
Finding:
Reports mother gave him the medicine
(Found)
Pro Tip: Children should only take medication under the supervision of an adult who can assure it is taken as directed. You should ask younger patients whether the medicine was given to them and by whom.
Example Question:
Who gave you the medicine for your cough?
Finding:
Reports only took the medicine this morning
(Found)
Pro Tip: The type of cough medicine a patient takes, and how they take it, can impact its effectiveness. Following up on the frequency Danny took cough medicine allows you to determine whether it is being taken correctly.
Example Question:
How many times have you taken the cough medicine? Shadow Health: Focused Exam: Cough Results Danny Riviera
Finding:
Denies home remedies
(Available)
Pro Tip: Patients sometimes try non-medicinal home remedies to treat coughs, such as breathing steam, or drinking tea with honey. Not all home remedies are effective or advisable, so it’s important to find out what remedies the patient has tried.
Example Question:
Have you tried any home remedies for your cough?

Finding:
Asked about typical medication use

Finding:
Denies taking medication
(Available)
Pro Tip: Knowing a patient’s current medication regimen helps you determine if any future treatments will be safe and effective.
Example Question:
Do you take any medications from a doctor?
Finding:
Reports taking daily vitamin
(Available)
Pro Tip: Some symptoms can occur as a result of a vitamin deficiency, and others as a result of vitamin excess. Vitamins can also interfere with some treatments, so it’s important to know what your patient is taking.
Example Question:
Do you take vitamins?

Finding:
Asked about activity level

Finding:
Reports typical high activity level
(Available)
Pro Tip: Establishing a patient’s typical activity level is an important baseline to help you determine how an illness is affecting his life.
Example Question:
Are you usually active?
Finding:
Reports activity level low since getting sick
(Available)
Pro Tip: Establishing a patient’s activity level, and whether it has been impacted since becoming ill, is an important baseline to help you determine how an illness is affecting his life.
Example Question:
Have you been less active since getting sick?
Finding:
Reports still able to run or play
(Available)
Pro Tip: Ability to remain active indicates that the patient’s breathing is not dangerously affected, and that the patient isn’t seriously fatigued.
Example Question:
Are you able to keep up when you play with your classmates?
Finding:
Reports focusing in class is difficult
(Available)
Pro Tip: Mental lethargy and difficulty concentrating are common symptoms when a patient is sick.
Example Question:
Are you able to focus in class?

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Shadow Health: Focused Exam: Cough Results Danny Riviera
Shadow Health: Focused Exam: Cough Results Danny Riviera

Finding:
Asked about nasal symptoms

Finding:
Reports current runny nose
(Found)
Pro Tip: Asking your patient if his nose is running will allow you to determine the symptoms he is experiencing and possible triggers.
Example Question:
Do you currently have a runny nose?
Finding:
Denies sneezing
(Available)
Pro Tip: Asking your patient if he has been sneezing will allow you to determine the symptoms he is experiencing and possible triggers.
Example Question:
Have you been sneezing?

Finding:
Followed up on nasal discharge

Finding:
Reports nasal discharge is clear
(Available)
Pro Tip: The color of a patient’s nasal discharge can provide you key information as to the type of condition the patient has.
Example Question:
What color is your snot?
Finding:
Reports nasal discharge is thin
(Available)
Pro Tip: The consistency of a patient’s nasal discharge can provide you key information as to the type of condition the patient has.
Example Question:
What is the consistency of your nasal discharge?

Finding:
Asked about ear symptoms

Finding:
Denies ear pain
(Available)
Pro Tip: Ear pain is often coincident with coughs and sinus problems. Asking about them allows you to ascertain if Danny needs follow-up care for his ears.
Example Question:
Do you have any ear pain?
Finding:
Reports history of frequent ear infections
(Available)
Pro Tip: Asking about Danny’s history of ear infections allows you to ascertain his risk for current and future ear infections.
Example Question:
Have you ever had ear infections?
Finding:
Denies ear discharge
(Available)
Pro Tip: Asking Danny about ear discharge, which are often coincident with of ear infections, allows you to ascertain his risk for current and future ear infections.
Example Question:
Do you have any ear discharge?
Finding:
Denies hearing problems
(Available)
Pro Tip: Simply talking with the patient assesses his hearing; however, some types of hearing loss are only apparent in specific settings such as noisy environments. Asking the patient about hearing problems identifies conditions that may not be readily apparent.
Example Question:
Do you have any hearing problems? Shadow Health: Focused Exam: Cough Results Danny Riviera

Finding:
Asked about throat symptoms

Finding:
Reports sore throat
(Available)
Pro Tip: Sore throats are often coincident with coughs and sinus problems. Asking about them allows you to ascertain if Danny needs follow-up care for his throat.
Example Question:
Is your throat sore?
Finding:
Reports a little pain with swallowing
(Available)
Pro Tip: Pain when swallowing helps you understand how severe the patient’s sore throat is.
Example Question:
Does it hurt when you swallow?

Past Medical History

Finding:
Asked about relevant medical history

Finding:
Reports frequent runny noses
(Available)
Pro Tip: Asking how often Danny experiences runny noses like the one he has now may help you determine the source of the problem.
Example Question:
Do you get runny noses often?
Finding:
Reports past frequent coughs
(Available)
Pro Tip: A patient experiencing a cough should be asked about their history of coughs so you can determine whether their current condition fits into a recurring pattern.
Example Question:
Do you have coughs very often?
Finding:
Reports past pneumonia
(Available)
Pro Tip: Pneumonia is a serious medical condition that can be life-threatening if not managed appropriately. Regardless of the patient’s presenting illness, it is critical to identify current medical conditions in order to treat the patient appropriately. Specific questions should be asked about previous medical problems, even if the patient doesn’t notice current symptoms.
Example Question:
Have you had pneumonia?
Finding:
Denies asthma diagnosis
(Available)
Pro Tip: Asthma is a serious medical condition that can be life-threatening if not managed appropriately. Regardless of the patient’s presenting illness, it is critical to identify current medical conditions in order to treat the patient appropriately. Specific questions should be asked about previous medical problems, even if the patient doesn’t notice current symptoms.
Example Question:
Do you have asthma?
Finding:
Reports immunizations as current
(Available)
Pro Tip: A health assessment should include an evaluation of the patient’s immunization status in order to identify diseases to which the patient is vulnerable.
Example Question:
Do you have current immunizations?

Finding:
Asked about allergies

Finding:
Denies seasonal allergies
(Available)
Pro Tip: Seasonal allergies can cause symptoms like runny nose, cough, and discomfort. Asking Danny if he has seasonal allergies can help you to ascertain possible triggers for symptoms.
Example Question:
Do you have seasonal allergies?
Finding:
Denies food allergies
(Available)
Pro Tip: Knowing if your patient has food allergies is important and relevant medical history. Asking your patient about food allergies will allow you to most effectively treat him.
Example Question:
Do you have food allergies?
Finding:
Denies medication allergies
(Available)
Pro Tip: Knowing if your patient has allergies to medicine is important and relevant medical history. Asking your patient about medicine allergies will allow you to most effectively treat him.
Example Question:
Are you allergic to any medication?

Finding:
Asked relevant family history

Finding:
Reports father has history of asthma
(Available)
Pro Tip: Medical problems such as asthma that are present in a patient’s immediate family can represent increased risk factors to respiratory conditions such as the ones the patient currently has.
Example Question:
Do you have a family history of asthma?
Finding:
Denies family history of allergies
(Available)
Pro Tip: Medical problems such as allergies that are present in a patient’s immediate family can represent increased risk factors to respiratory conditions such as the ones the patient currently has.
Example Question:
Do you have a family history of allergies?

Review of Systems

Finding:
Asked about constitutional health

Finding:
Denies chills
(Available)
Pro Tip: Soliciting a shallow history of your patient’s symptoms will help you to most effectively treat him. Asking Danny if he has chills will illustrate the way his symptoms manifest.
Example Question:
Do you have chills?
Finding:
Denies fever
(Available)
Pro Tip: Soliciting a shallow history of your patient’s symptoms will help you to most effectively treat him. Asking Danny if he has a fever will illustrate the way his symptoms manifest.

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Shadow Health: Focused Exam: Cough Results Danny Riviera
Shadow Health: Focused Exam: Cough Results Danny Riviera


Example Question:
Do you have a fever?
Finding:
Reports feeling somewhat fatigued
(Found)
Pro Tip: Soliciting a shallow history of your patient’s symptoms will help you to most effectively treat him. Asking Danny if he has fatigue will illustrate the way his symptoms manifest.
Example Question:
Do you have fatigue?
Finding:
Denies night sweats
(Available)
Pro Tip: Soliciting a shallow history of your patient’s symptoms will help you to most effectively treat him. Asking Danny if he has night sweats will illustrate the way his symptoms manifest.
Example Question:
Do you have night sweats?
Finding:
Reports cough makes it difficult to sleep
(Available)
Pro Tip: Soliciting a shallow history of your patient’s symptoms will help you to most effectively treat him. Asking Danny if he has had difficulty sleeping will illustrate the way his symptoms manifest.
Example Question:
Have you been sleeping okay?
Finding:
Denies swelling
(Available)
Pro Tip: Soliciting a shallow history of your patient’s symptoms will help you to most effectively treat him. Asking Danny if he has had swelling will illustrate the way his symptoms manifest.
Example Question:
Have you noticed any swelling?

Finding:
Asked about additional review of systems for HEENT

Finding:
Reports frequent colds
(Available)
Pro Tip: A patient such as Danny who is presenting with a cough and a runny nose may have a cold, so you should ask about his history of colds to determine whether this is part of a larger pattern.
Example Question:
Do you have unusually frequent colds?
Finding:
Denies headaches
(Available)
Pro Tip: Headaches are a common complaint that can be caused by a variety of benign conditions. However, headaches can be an indicator of serious underlying neurological conditions such as cerebral hemorrhage, meningitis, or brain tumors. They may also be a symptom of sinus infection.
Example Question:
Do you get headaches?
Finding:
Denies nosebleeds
(Available)
Pro Tip: When a patient presents with symptoms that are often seen with respiratory infections, you should ask about similar signs of respiratory infections such as nosebleeds.
Example Question:
Do you have nosebleeds?
Finding:
Denies vision difficulty
(Available)
Pro Tip: Eye or vision problems can lower one’s ability to function and can be a major safety risk.
Example Question:
Do you have any problems with your vision?
Finding:
Denies dizziness
(Available)
Pro Tip: Asking about dizziness helps you assess the risk for inner ear, neurological, or cardiovascular problems.
Example Question:
Do you have any dizziness?
Finding:
Denies watery eyes
(Available)
Pro Tip: Whether a patient has watery eyes may help you indicate the type of sinus problem he is experiencing.
Example Question:
Do you have watery eyes?
Finding:
Denies eye redness
(Available)
Pro Tip: Whether a patient has eye redness may help you indicate the type of sinus problem he is experiencing.
Example Question:
Do you have eye redness?
Finding:
Denies eye pain
(Available)
Pro Tip: Eye pain can lower one’s ability to function and can be a major safety risk.
Example Question:
Do you have any eye pain?
Finding:
Denies sinus pain
(Available)
Pro Tip: Patients with sinus problems such as a runny nose may be at greater risk for sinus pain.
Example Question:
Do you have any sinus pain?

Finding:
Asked about review of systems for respiratory

Finding:
Denies chest tightness
(Available)
Pro Tip: Chest pain may indicate cardiac conditions, muscular inflammation, gastric upset, or respiratory distress. If chest tightness is present, asking about its location, characteristics, and related factors helps to determine the cause of the discomfort.
Example Question:
Do you have chest tightness?
Finding:
Denies chest pain
(Available)
Pro Tip: Chest pain may indicate cardiac conditions, muscular inflammation, gastric upset, or respiratory distress. If chest pain is present, asking about its location, characteristics, and related factors helps to determine the cause of the discomfort.
Example Question:
Do you have any chest pain?
Finding:
Denies difficulty breathing. Shadow Health: Focused Exam: Cough Results Danny Riviera

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Questions for Discussion (DQ)

Initial DQ submissions should cover all aspects of the questions, include at least one scholarly source, and be at least 250 words long.
Successful comments are substantive (i.e., they bring something new to the conversation, they engage others in the conversation, and they have a well-developed idea) and contain at least one scholarly source.
Responses of one or two sentences, simple affirmations of agreement or “excellent post,” and off-topic responses will not be considered substantive. Responses should be at least 150 words long.
I encourage you to include (where appropriate) the readings from the week in your comments.

Participation on a weekly basis

Your initial responses to the obligatory DQ are scored individually and do not count toward participation.
You must post at least one reply to peers (or me) on three distinct days in addition to the DQ responses, for a total of three replies.
A scholarly source/citation is not required for participation posts (unless you cite someone else’s work).
Viewing the weekly announcement and attesting to watching it in the comments is part of your weekly involvement. These announcements are given to ensure that you are aware of all of the tasks that must be completed during the week.

Quality of Writing and APA Format

Familiarize yourself with the APA format and practice correctly applying it. It is utilized for the majority of your degree-related writing projects. For APA paper templates, citation examples, advice, and more, go to the Writing Center in the Student Success Center, which may be found under the Resources option in LoudCloud. Poor use of APA format or the lack of APA format will result in a deduction of points (if required).
Please cite all of your sources! Cite the source whenever possible. A citation is also required when paraphrasing.
I strongly advise you to use the 6th edition of the APA Publication Manual.

Utilization of Direct Quotes

At the Masters’ level, I discourage the use of direct quotes in DQs and assignments and deduct points accordingly.
It is crucial for you to be able to critically assess and comprehend information from journal articles and other sources as Masters’ level students. Simply repeating someone else’s words does not demonstrate comprehension or critical examination of the material.
It is preferable to paraphrase and cite your sources.

Policy of LopesWrite

Before you complete a “final submit” to me for tasks that need to be submitted to LopesWrite, please make sure you have got your report and SI percentage.
Please examine your report after you have got it. This report will highlight any grammatical, punctuation, or spelling mistakes that may be corrected quickly. Instead of being penalized for these errors, take a few extra minutes to review.
Examine your parallels. Did you forget to include a reference? Didn’t you do a good enough job of paraphrasing? Is your paper primarily composed of someone else’s ideas rather than your own?
For advice on boosting your paper and SI score, go to the Writing Center in the Student Success Center, which may be found under the Resources tab in LoudCloud.

Policy for Late Arrivals

The university’s late assignment policy is a 10% penalty PER DAY LATE. This holds true for late DQ responses as well.
If you think you’ll have to submit an assignment late, please let me know. With advance notice, I am happy to be flexible. Due to extenuating circumstances, we may be able to work out an extension.
The GCU late policy will apply if you do not communicate with me before submitting an assignment late.
Unless we have negotiated out an extension, I will not accept assignments that are two weeks or more late.
No assignments are accepted after the last day of class, as per policy. Any assignment submitted after the last day of class, at midnight, will not be graded.

Communication

The importance of communication cannot be overstated. You can reach out to me in a variety of ways:
This is a fantastic area to ask questions about course content or assignments in the Questions to Instructor forum. If you have a question, chances are that one of your classmates does as well. This is the class’s public forum.
This is a private forum where you may ask me questions or send me messages. At least once every 24 hours, this will be checked.

Care Plan : 9.5 of 10 (95.0%)

 Nursing Diagnosis3.5 out of 3.5

Nursing Diagnoses: Definitions & Classifications 2018-2020 © NANDA-International, 2017 used by arrangement with Thieme Medical Publishers, Inc., a division of the Thieme Group. All rights reserved. Authorized translation from the English language edition published by Thieme Medican Publishers Inc. No part of this material may be reproduced in any form without the written permission of the agent of the copyright holder, NANDA-International. Direct inquires to nanda-i@thieme.com. Link for more information: http://www.nanda.org/.

Status

Student ResponseModel AnswerExplanationPoints Earned
is at risk foris at risk forThe correct status for the nursing diagnosis is “is at risk for,” because Danny’s most pressing vulnerability is to an infection that he has not yet, but could, develop.0.5 out of 0.5

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Shadow Health: Focused Exam: Cough Results Danny Riviera
Shadow Health: Focused Exam: Cough Results Danny Riviera

Diagnosis

Student ResponseModel AnswerExplanationPoints Earned
infectioninfectionWhile a cough can be unpleasant, the most alarming thing it indicates about Danny’s health is that he is at risk for an infection.0.5 out of 0.5

Etiologies

Student ResponseModel AnswerExplanationPoints Earned
played w/ sick peerplayed w/ sick peerDanny Rivera is at risk for infection as evidenced by: his playing with a sick peer; how he touches his face often, especially his eyes/nose/mouth; how rarely he washes his hands; and his exposure to secondhand smoke.0.5 out of 0.5
touches face oftentouches face oftenDanny Rivera is at risk for infection as evidenced by: his playing with a sick peer; how he touches his face often, especially his eyes/nose/mouth; how rarely he washes his hands; and his exposure to secondhand smoke.0.5 out of 0.5
rare hand washingrare hand washingDanny Rivera is at risk for infection as evidenced by: his playing with a sick peer; how he touches his face often, especially his eyes/nose/mouth; how rarely he washes his hands; and his exposure to secondhand smoke.0.5 out of 0.5
secondhand smokesecondhand smokeDanny Rivera is at risk for infection as evidenced by: his playing with a sick peer; how he touches his face often, especially his eyes/nose/mouth; how rarely he washes his hands; and his exposure to secondhand smoke.0.5 out of 0.5

Signs & Symptoms

Student ResponseModel AnswerExplanationPoints Earned
N/AN/ABecause the infection that Danny may develop hasn’t happened yet, he is not currently presenting with any signs or symptoms, so the correct answer here is “N/A.”0.5 out of 0.5

 Self Assessment

Your answer is not automatically evaluated by the simulation, but may be reviewed by your instructor.

PromptStudent ResponseModel AnswerExplanation
Why would a nursing diagnosis of a cough be incorrect, compared to a risk for infection? Consider the difference between nursing and medical diagnoses.Whereas the cough can be unpleasant and a bother, it is a symptom of something more severe in the sense that it shows that the immune system could be at risk of getting an infection. The most effective nursing care you should prioritize is to educate the patient on avoiding the more serious outcome.While a cough can be unpleasant and frequent, it is actually a symptom of something more alarming: the immune system being at risk for an infection. The most effective nursing care you should prioritize is to educate your patient on avoiding this more serious outcome.Your nursing diagnosis should always take into account what condition is most serious, receiving the greatest benefit from your help. This diagnosis may not be the most obvious physical symptom to you or your patient, so always consider what is jeopardizing a patient’s health the most.

 Planning3.5 out of 4

Short-Term Goal

Student ResponseModel AnswerExplanationPoints Earned
To have patient report decreased discomfort and coughing by end of clinic visit.To have the patient and his guardian verbalize and agree to their instructions on how to avoid infection & practice respiratory hygiene, by end of the healthcare visit.A risk-based diagnosis does not require medical interventions as the problem is hypothetical; the goal that does suit the diagnosis involves teaching the patient and his guardian about risk-reduction methods.0 out of 0.5

Interventions

Student ResponseModel AnswerExplanationPoints Earned
Instruct family and patient on washing hands or using hand sanitizer before eating and after using the restroomInstruct family and patient on washing hands or using hand sanitizer before eating and after using the restroomMany of these instructions work toward shrinking the patient’s likelihood of contact with harmful pathogens, which can lead to infection. Some instructions here also help prevent illness being spread to Danny’s environment and family members, which promotes community health and reduces the patient’s risk of becoming sick again.0.5 out of 0.5
Instruct family and patient that patient should increase fluid intakeInstruct family and patient that patient should increase fluid intakeMany of these instructions work toward shrinking the patient’s likelihood of contact with harmful pathogens, which can lead to infection. Some instructions here also help prevent illness being spread to Danny’s environment and family members, which promotes community health and reduces the patient’s risk of becoming sick again.0.5 out of 0.5
Instruct family to keep their house smoke-free (reducing exposure to environmental pathogens)Instruct family to keep their house smoke-free (reducing exposure to environmental pathogens)Many of these instructions work toward shrinking the patient’s likelihood of contact with harmful pathogens, which can lead to infection. Some instructions here also help prevent illness being spread to Danny’s environment and family members, which promotes community health and reduces the patient’s risk of becoming sick again.0.5 out of 0.5
Instruct patient on washing hands or using hand sanitizer after coughing or being near someone sickInstruct patient on washing hands or using hand sanitizer after coughing or being near someone sickMany of these instructions work toward shrinking the patient’s likelihood of contact with harmful pathogens, which can lead to infection. Some instructions here also help prevent illness being spread to Danny’s environment and family members, which promotes community health and reduces the patient’s risk of becoming sick again.0.5 out of 0.5
Instruct patient to avoid touching fingers to eyes, nose, or mouthInstruct patient to avoid touching fingers to eyes, nose, or mouthMany of these instructions work toward shrinking the patient’s likelihood of contact with harmful pathogens, which can lead to infection. Some instructions here also help prevent illness being spread to Danny’s environment and family members, which promotes community health and reduces the patient’s risk of becoming sick again.0.5 out of 0.5
Instruct patient to cough into tissue, or sleeve if tissue is unavailableInstruct patient to cough into tissue, or sleeve if tissue is unavailableMany of these instructions work toward shrinking the patient’s likelihood of contact with harmful pathogens, which can lead to infection. Some instructions here also help prevent illness being spread to Danny’s environment and family members, which promotes community health and reduces the patient’s risk of becoming sick again.0.5 out of 0.5

Intervention Rationale

Your answer is not automatically evaluated by the simulation, but may be reviewed by your instructor.

PromptStudent ResponseModel AnswerExplanation
In 1 or 2 sentences, explain how your selected interventions work to accomplish your goal.Ask patients and family memebers to verbalize and agree to their instructions on infection prevention and respiratory hygiene.These interventions will teach Danny and his guardian how to keep their hands and lungs clean in a variety of ways, so that Danny’s risk for infection is reduced as pathogens are eliminated.Infection can be caused by multiple culprits, so it’s important that your patient teaching covers a thorough and specific array of anti-infection habits.

Data Collections

Student ResponseModel AnswerExplanationPoints Earned
Ask patient and family members to verbalize and agree to their instructions on infection prevention & respiratory hygieneAsk patient and family members to verbalize and agree to their instructions on infection prevention & respiratory hygieneIt is important that your patient and his guardian agree to their instructions, as changing lifestyle habits can be intimidating but necessary for the patient’s health. Having Danny and his father verbalize back their instructions also assures they remember and understand the details.0.5 out of 0.5

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Shadow Health: Focused Exam: Cough Results Danny Riviera
Shadow Health: Focused Exam: Cough Results Danny Riviera

 Discussion Of Care

Your answer is not automatically evaluated by the simulation, but may be reviewed by your instructor.

PromptStudent ResponseModel AnswerExplanation
Explain the rationale behind your nursing diagnosis.Hello Danny, since you have been feeling unwell for the last three days, it is my responsibility to ensure that you get in the habit of practicing hand hygiene. Because you are at risk for developing an upper respiratory infection. My goal to you is to you and your family to avoid unnecessary infections by following these instructions. Some of the things that make you sicker are being near sick friend, being exposed to second hand smoke, washing your hands more, and touching your face with hands. I know it sounds like a lot of things but working together, we can reduce the infections in an effective manner.Danny, given that you aren’t feeling well, we want to make sure you don’t develop an infection, which for you just means getting even sicker. We’re going to talk about the ways we can work to prevent that, especially focusing on your risk factors, which are just things that give you a bigger chance of being sick. Some of your risk factors are that you were near a sick friend, have been exposed to cigar smoke, could stand to wash your hands more, and have touched your face with your fingers. I know that sounds like a lot, but if we work together, reducing your risk factors for infection can be easy and effective.A patient should understand their nursing diagnosis and the rationale behind it to increase their sense of involvement and to identify areas for future improvement.
Explain your goal for Danny and the interventions and data collections through which you will achieve it.All right. In order to talk to you about how you are not going to get sicker, I will have a conversation with you and your father. Him, you and myself are going to work together to discuss and then have to agree to your goals. And then I am going to have you and your father repeat what you have learned so we can make sure that you have got it down pat.Let’s talk about how we’re going to help you not get sicker! So, I’m going to have a conversation with you and your father about things to do to ensure your health. You, he, and I will work together to discuss, and then have you agree to your goals. Then I’m going to have you and your father repeat what you’ve learned, so we can make extra sure you’ve got it down pat!You should communicate the Care Plan to the patient, allowing them to exercise involvement and agency in their own healthcare.
Explicitly ask for Danny’s consent to the Care Plan.Does this sound like a plan?Does this plan I just talked about sound good to you?A patient must consent to all interventions in their Care Plan. Disagreements are opportunities to provide further patient education and to consider alternative options.
Inform Danny you will now begin educating him and will then call to educate his guardian.Now, Danny, if you lack other questions, we can start now!Danny, if you don’t have any other questions, we can start our discussion now!It’s time to begin your education interventions, so let your patient know!

 Intervention & Evaluation2.5 out of 2.5

Student ResponseModel AnswerExplanationPoints Earned
PartiallyPartiallyWhile Danny correctly verbalizes and agrees to his instructions for reducing infection risks, his father only agrees to some of his instructions, expressing apprehension toward not smoking inside the house. Your goal has been partially achieved.2.5 out of 2.5

 Intervention & Evaluation Rationale

Your answer is not automatically evaluated by the simulation, but may be reviewed by your instructor.

PromptStudent ResponseModel AnswerExplanation
Did you achieve your goal for your patient and his guardian by the end of the visit, getting each of them to agree to and verbalize your instructions for avoiding infection and practicing respiratory hygiene?Whereas Danny agrees to his instructions and has verbalized a complete and correct understanding of what to do, his father expresses reluctance about reducing his smoking inside of his house. One of his instructions was to keep the house smoke free so as to reduce Danny’s risk of infection so this aspect of the goal has not been achieved. However, the paties verbally agree to most of the other interventions, which implies that the overall goal has been achieved partially.While Danny agrees to his instructions and has verbalized a complete and correct understanding of what to do, his father expresses reluctance about reducing his smoking inside of the house. One of his instructions was to keep the house smoke-free in order to reduce Danny’s risk of infection, so this aspect of your goal has not been achieved. However, both parties verbally agree to most of their other instructions, so your overall goal has been partially achieved.Even with progress being made in almost all aspects of your patient teaching, you must adhere to your goal and consider your work incomplete if certain agreements have not been reached.

Assessment Description

Within the Shadow Health platform, complete the Focused Exam: Cough Results. The estimated average time to complete this assignment each time is 1 hour and 15 minutes. Please note, this is an average time. Some students may need longer.

This clinical experience is a focused exam. Students must score at the level of “Proficiency” in the Shadow Health Digital Clinical Experience. Students have three opportunities to complete this assignment and score at the Proficiency level. Upon completion, submit the lab pass through the assignment dropbox.

Students successfully scoring within the Proficiency level in the Digital Clinical Experience on the first attempt will earn a grade of 100 points; students successfully scoring at the Proficiency level on the second attempt will earn a grade of 90 points; and students successfully scoring at the Proficiency level on the third attempt will earn a grade of 80 points. Students who do not pass the performance-based assessment by scoring within the Proficiency level in three attempts will receive a failing grade (68 points).

If Proficiency is not achieved on the first attempt, it is recommended that you review your answers with the correct answers on the Experience Overview page. Review the report by clicking on each tab to the left titled Transcript, Subjective Data Collection, Objective Data Collection, Documentation, and SBAR to compare your work. Reviewing this overview and the course resources may help you improve your score.

Please review the assignment in the Health Assessment Student Handbook in Shadow Health prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to LopesWrite.

AttachmentsNRS-434VN-R-Childrens-functional-healt

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