NR 509: Shadow Health Respiratory Physical Assessment Assignment
Shadow Health Respiratory Assessment Pre Brief
Tina had an asthma episode 2 days ago. At that time she used her albuterol inhaler and her symptoms decreased although they did not completely resolve. Since that incident she notes that she has had ten episodes of wheezing and has shortness of breath approximately every four hours. Tina presents with continued shortness of breath and wheezing. Be sure to ask pertinent questions during the interview about related body systems. This case study will provide the opportunity to carefully assess lung sounds during the physical examination. Be sure to appropriately document your findings using correct medical terminology.NR 509: Shadow Health Respiratory Physical Assessment Assignment
Reason for visit: Patient presents complaining of a recent asthma episode that is not fully resolved.
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SAMPLE Shadow Health Respiratory Assessment

Model Documentation

Subjective
HPI: Ms. Jones is a pleasant 28-year-old African American woman who presented to the clinic with complaints of shortness of breath and wheezing following a near asthma attack that she had two days ago. She reports that she was at her cousin’s house and was exposed to cats which triggered her asthma symptoms. At the time of the incident she notes that her wheezes were a 6/10 severity and her shortness of breath was a 7-8/10 severity and lasted five minutes. She did not experience any chest pain or allergic symptoms. At that time she used her albuterol inhaler and her symptoms decreased although they did not completely resolve. Since that incident she notes that she has had 10 episodes of wheezing and has shortness of breath approximately every four hours. Her last episode of shortness of breath was this morning before coming to clinic. She notes that her current symptoms seem to be worsened by lying flat and movement and are accompanied by a non-productive cough. NR 509: Shadow Health Respiratory Physical Assessment Assignment. She awakens with night-time shortness of breath twice per night. She complains that her current symptoms are beginning to interfere with her daily activities and she is concerned that her albuterol inhaler seems to be less effective than previous. Currently she states that her breathing is normal. Diagnosed with asthma at age 2.5 years. She has no recent use of spirometry, does not use a peak flow, does not record attacks, and does not have a home nebulizer or vaporizer. She has been hospitalized five times for asthma, last at age 16. She has never been intubated for her asthma. She does not have a current pulmonologist or allergist.NR 509: Shadow Health Respiratory Physical Assessment Assignment
Social History: She is not aware of any environmental exposures or irritants at her job or home. She changes her sheets weekly and denies dust/mildew at her home. She uses a hypoallergenic pillow cover and her mattress is one year old. She denies current use of tobacco, alcohol, and illicit drugs. She did smoke marijuana for 5 or 6 years, her last use was at age 21 years. She does not exercise.
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Respiratory Results | Turned In
Advanced Health Assessment – Chamberlain, NR509-June-2018
Return to Assignment
Your Results Lab Pass
Document: Provider Notes
Document: Provider Notes
Student Documentation Model Documentation
Subjective
Identifying and Reliability:
Ms. Jones is an obese 28-year-old female who is
presenting to the office today with an athma
exacerbation. She is the primary and only source of
personal and medical data. Pleasent, cooperative
and readily open to freely dissiminate health
information. Good eyeye contact, well-groomed,
good posture, and comunicates clearly with logical
flow of ideas.
General Survey:
Upon entering the patient’s examination room,
patient was found to be sitting straight and erect,
good posture, well-groomed, well nourished with a
pleasent demeanor and manner of communicating.
Reason for Visit:
“Breathing problems and my inhaler just isn’t
working the way it normally does.”
HPI: Ms. Tina Jones is a 28-year-old African
American woman who walked in to the clinic
complianing of SOB and wheezing after nearly
haveing a “bad” asthma attack two days ago. Pt.
Overview
Transcript
Subjective Data Collection
Objective Data Collection
Education & Empathy
Documentation
Student Pre-Survey
Lifespan
Review Questions
Self-Reflection
Documentation / Electronic Health Record
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reports allergies to cats which triggered her asthma
symptoms while she was visitn her cousins house.
Initially, at the time of the climax of her near asthma
attack, her SOB severity was a 7-8/10, wheezing
severity was initially a 6/10. It lasted for 5 minutes,
following the use of her rescue inhaler Provenol. Pt.
reports only chest tightness at the time, which has
continued to the present with no increase in
tightness. Pt. denies all other allergic symptoms
during the exaccerbation of her asthma. The inhalor
had amild to moderate effect, not fully resolving the
asthma symptoms. Pt. reports that since the initial
exacerbation, she has had ten similar asthma
episodes consisting of SOB, “not able to get
enough air in” to her lungs, chest tightness all occur
every 4 hours, even through the night, awakinging
her from sleep. Her symptomsare worsoned when
laying supine, including coughing fits each time she
lays down, which easily resolves once sitting
backup. Instead of using the prescribed 2 puffs of
albuterol, pt. has been using 3 puffs each
exacerbation with minimal to moderate relief. Most
recent episode was this morning prior to her arrival.
Asthma exacerbations are aggrevated by exposure
to cats, perhaps dust, and currently exacerbated by
exertion and laying supine with a subsequent
coughing fit. occur Cough is non-productive.
Pt. concerned her new albuterol inhaler is ineffective
compared to previous device. Her asthma has been
slowly interferring with her life the past year or so,
while still being manageable. Over the past 2 days,
her asthma has interferred with her daily life,
including her response that if she had not had these
past two days off of work, she “would have called in
sick for sure.” Pt. feels minimal asthma symptoms
curretly, following her albuterol use over an hour
ago.
Diagnosed with asthma at 2.5-years-old, She
frequented hospital visits and including five
hospitalizations before she was 16-years-old. Since
then she hasn’t been hospitalized. Pt. denies
spirometry inhalor, peak flow meter use, as well as
any other asthma medication use. Pt. doesn’t keep
asthma record of exacerbations and triggers; denies
asthma medication usage excet for albuterolresuce
inhaler. Pt. not currrently beingmanaged by a
pulmonologist or someone for her allergies. Pt.
denies using a vaporizer or nebulizer at home.
PMH:
Pt. reports Type 2 Diabetes, possible borderline
hypertension (no actual dx).
Allergies:
Cats: Develops itchy, watery eyes; an itchy, “runny
nose”; an itchy, sometimes a sore throat, and often
an asthma exacerbation – SOB, DOE, wheezing,
coughing, and chest tightness.
Dust: Develops a rash, no tiching.
Penicillin: “Rash, like, hives.”
HPI: Ms. Jones is a pleasant 28-year-old African
American woman who presented to the clinic with
complaints of shortness of breath and wheezing
following a near asthma attack that she had two
days ago. She reports that she was at her cousin’s
house and was exposed to cats which triggered her
asthma symptoms. At the time of the incident she
notes that her wheezes were a 6/10 severity and her
shortness of breath was a 7-8/10 severity and
lasted five minutes. She did not experience any
chest pain or allergic symptoms. At that time she
used her albuterol inhaler and her symptoms
decreased although they did not completely resolve.
Since that incident she notes that she has had 10
episodes of wheezing and has shortness of breath
approximately every four hours. Her last episode of
shortness of breath was this morning before coming
to clinic. She notes that her current symptoms seem
to be worsened by lying flat and movement and are
accompanied by a non-productive cough. She
awakens with night-time shortness of breath twice
per night. She complains that her current symptoms
are beginning to interfere with her daily activities
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Medications:
Rx: Provenal 90 mcg/spray, 2 puffs, for asthma.
OTC: Acetamet:aphen 1000 mg for occasional
headaches related to readingfor prolonged periods
of . Iburofen OTC
Social History:
Pt. reports fairly severe allegies to cats (urticaria,
asthma symptoms of SOB, a restrictive airway
sensation, wheezing and a non-productive cough);
A moderate allergic reaction to excessive dust
accumulation (allergy sx’s, sneezing, sometimes
asthma-like reaction); and Penicillin (report from
mom when pt.was a child, mother reports
development of a rash only; unknown if SOB, DOE,
urticara, puritis, dysphagia and angiophylaxis
occured as well. Pt. is meticullus about dust,
allergins, mildew accumulation; using hypoallergenic
practices with bed, sheets, pillows and spead.
Mattress is 12 months old. Pt. denies ever using
tabacco in any form, as well as illicit drugs and
prescription medicaton abuse. Pt. does report that
from 15-16-years old she smoked marijuana, but
hasn’t partaken in it since 21-years-old. Pt. states
she doesn’t exercise, eats “whatever”, with some
restrint in high sugar beverages and treats.
Family History: Pt. states sister has history of
asthma and hayfever.
Surgical History: Pt. denies previous surgeries.
ROS:
General: Pt. states recent changes in appetite as
she is “always hungry” even after she has eaten a
large meal. Reports exercise intolerance, usually
feels fatigued. Pt. denies recent weight changes,
fevers, chills. body aches, sweats. feels she is
generally a healthy person.
Skin: Pt. reports skin color and pigment changes
localized only around her neck – which has been
changeing the past couple of years now. Pt. reports
that moles on her back have not changed in size or
color.Skin is dryer than usual and feels dehydrated
and always thirsty. Denies sores, lesions, scabs.
Pulmonary: Pt. states that she has coughing fits
when exposed to allergens like dust adn especially
cats. Coughing also occurs when asthma “acts up”
and anytime she lays down in the past month she
begins to cough. Lately she will wake up twice a
night because of uncontrolable coughing which
resolves after she has been in a sitting or upright
position for a few minutes. Denies productive cough
or coughing up blood. Denies being exposed to
anyone sick, has not traveled.
Reports SOB when she has to hurry somewhere or
whan she climbs a large flight of stairs. Has
orthopnea twice a night with coughing fits. Denies
DVT/VTE, PE, COPD, enviromental exposures,
asbestos exposure, chronic bronchitis, history of
pneumonia or flu, and denies OSA.
Cardiovascular: Pt. state she may have borderline
and she is concerned that her albuterol inhaler
seems to be less effective than previous. Currently
she states that her breathing is normal. Diagnosed
with asthma at age 2.5 years. She has no recent use
of spirometry, does not use a peak flow, does not
record attacks, and does not have a home nebulizer
or vaporizer. She has been hospitalized five times
for asthma, last at age 16. She has never been
intubated for her asthma. She does not have a
current pulmonologist or allergist.
Social History: She is not aware of any
environmental exposures or irritants at her job or
home. She changes her sheets weekly and denies
dust/mildew at her home. She uses a hypoallergenic
pillow cover and her mattress is one year old. She
denies current use of tobacco, alcohol, and illicit
drugs. She did smoke marijuana for 5 or 6 years,
her last use was at age 21 years. She does not
exercise.
Review of Systems: General: Denies changes in
weight, fatigue, weakness, fever, chills, and night
sweats.
• Nose/Sinuses: Denies rhinorrhea with this episode.
Denies stuffiness, sneezing, itching, previous allergy,
epistaxis, or sinus pressure.
• Gastrointestinal: No changes in appetite, no
nausea, no vomiting, no symptoms of GERD or
abdominal pain
• Respiratory: Complains of shortness of breath and
cough as above. Denies sputum, hemoptysis,
pneumonia, bronchitis, emphysema, tuberculosis.
She has a history of asthma, last hospitalization was
age 16, last chest XR was age 16.
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hypertension. Pt. denies CAD, CHF, PVD, angina,
palpitations, tachycardia or racing heart, orthostatic
changes, edema, heart arrythmias and denies
sickle-cell disease.
Endocrine: Pt. reports having previous diagnosis of
diabetes type 2, polyuria, polyuria, polydipsia,
lethargy. Pt. reposrts having oliguria, dysmenorhea,
being overweight. Pt. denies changes in hair
pattern, weight changes, node enlargement, breast
changes, galactorhea, never been pregnant,
tremors.
GI: Pt. denies N/V, anorexia, diarhea, GERD, ulcers,
colonoscopy, constipation, hematamesis,
hematechezia, recent changes in bowel evacuation
habits, dysphagia, flatulance.
GU: Pt. reports increased frequency to urinate, feels
thirsty all the time now, drinks a lot of fluids which
doesn’t seem to quench thirst. She has now been
experiencing nocturia 2-3 times per night. Denies
flank pain hematuria, chronic or recent UTI’s, history
of or knowlingly being exposde to STI’s. Reports
haveing three sexual partners in her life, all of which
are men. Has been absinent for over a year now.
Denies incontinence.
Neurologic: Pt. denies changes in sensation,
weakness, light-headedness, dizziness, chronic
HA’s, epilepsy, stroke, TIA, changes in mentation,
long or short term memory, concussions, head
trauma, AMS.
HEENT: Pt. denies history of HA’s, except for
occassionally occuring when she reads too long adn
resolves with 1000mg of tylenol. No vision acuity
changes, except for “blurry eyes” after reading for
too long. Denies other visions problems, hearing
issues, nasal discharge, epistaxis, gingivitis, mouth
sores. Pt. doesn’t see dentist annually nor teetch
professionally cleaned – hasn’t been to the dentist
for “years.”
Objective
Tina is an obese 28-year-old African American
woman who does not seem to be in any acute
distress. Alert and oriented, sitting upright, ,
maintains appropriate eye contact, is
conversational, and answers questions approprietly.
Respiratory: Respiratory examination found Tina’s
chest expansion to be symetrical with respiration.
Bilaterally symetrical tactile fremitous, negative
broncophony anteriorly and posteriorly in all lung
fields. Chest resonent when percussed, devoid of
any dullness. Bilateral lower lobe expiratory
wheezing both anteriorly adn posteriorly. All other
lung fields clear to auscultation. No crackles,
rhonchi, coarseness noted in lung auscultation.
Muffled words bilaterally with prominent expiratory
wheezes in the posterior lower lobes only.
Spirometry yielded FVC 3.91, FEV/FVC ratio
80.56%, SaO2 97% on room air, HR 89, RR 20, BP
General: Ms. Jones is a pleasant, obese 28-year-old
African American woman in no acute distress. She
is alert and oriented and sitting upright on exam
table. She maintains eye contact throughout
interview and examination.
• Respiratory: Chest expansion is symmetrical with
respirations. Normal fremitus, symmetric bilaterally.
Chest resonant to percussion; no dullness. Bilateral
expiratory wheezes in posterior lower lobes.
Bilateral muffled words with notable expiratory
wheezes in posterior lower lobes. No crackles. In
office spirometry: FVC 3.91 L, FEV1/FVC ratio
80.56%. SpO2: 97%.
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140/81, Temperature 98.5 degrees Farenhiet.
Assessment
Mild-Persistent Asthma with Exacerbation. Mild-persistent asthma with exacerbation
Plan
Diagnostics: Obtain oxygen saturation and baseline
spirometry and peak flow readings.
Medication: NMI at office one time. Continue
albuterol rescue inhalor. Initiate step up inhaled
corticosteroid.
Education: Encourage Tina to log her asthma
symptoms and episodes of exacerbation every day
and bring log in to next visit. Monitor trigger
exposures adn resultant asthma symptoms and
severity of exacerbations. Encourage Tina to
remove and/or clean all possible harborers of
allergens, including bedding, seats, pillows carpet.
Change air filters in home and car to incrased
allergiin removal from the air. Encourage an incrase
in fluid consumption, especially water. Help guide
pt. indeveloping an asthma action plan and assess
effectiveness and apropriateness of plan in next
visit.
Orders: Order baseline PFT’s and perform PFT’s
after each exacerbation for purposes of comparison
and establishing pt. trends.
Instruct Tina to return to clinic if ongoing symptoms.
Also inform tTina to immedietly go to the ED if
worsoning asthma symptoms, SOB and DOE that is
unresolved by a short rest. Also go to ED is
unresolved chest tightness, wheezing not allevaited
bycorticosteroid and albuterol inhalor.
Follow-Up: Return to clinic in 3 weeks for follow-up
evaluation regarding coarse of illness, medication
use and needs, as well as medication effectivenss.
Diagnostics
• Obtain office oxygen saturation
Medication
• NMT in office x 1
• Initiate step-up medication therapy with inhaled
corticosteroid
• Continue albuterol inhaler
Education
• Encourage Ms. Jones to continue to monitor
symptoms and log her episodes of asthma
symptoms and wheezing with associated factors
and bring log to next visit
• Encourage to wash bedding and consider dust
mite covers to decrease allergic nighttime
symptoms
• Educate to increase intake of water and other
fluids
• Create Asthma Action Plan
Referral/Consultation
• Refer to allergy specialist for evaluation and testing
Follow-up Planning
• Order PFTs to be completed after exacerbation to
have baseline available for future comparison
• Instruct Ms. Jones on when to seek emergent care
including episodes of chest pain or shortness of
breath unrelieved by rest, worsening asthma
symptoms or wheezing, or the sense that rescue
inhaler is not helping
• Revisit clinic in 2-4 weeks for follow up and
evaluation
Comments
If your instructor provides individual feedback on this assignment, it will appear here.
Review of Systems:
General: Denies changes in weight, fatigue, weakness, fever, chills, and night sweats.

Nose/Sinuses: Denies rhinorrhea with this episode. Denies stuffiness, sneezing, itching, previous allergy, epistaxis, or sinus pressure.
Gastrointestinal: No changes in appetite, no nausea, no vomiting, no symptoms of GERD or abdominal pain
Respiratory: Complains of shortness of breath and cough as above. Denies sputum, hemoptysis, pneumonia, bronchitis, emphysema, tuberculosis. She has a history of asthma, last hospitalization was age 16, last chest XR was age 16.NR 509: Shadow Health Respiratory Physical Assessment Assignment

Objective                   
General: Ms. Jones is a pleasant, obese 28-year-old African American woman in no acute distress. She is alert and oriented and sitting upright on exam table. She maintains eye contact throughout interview and examination.

Respiratory: Chest expansion is symmetrical with respirations. Normal fremitus, symmetric bilaterally. Chest resonant to percussion; no dullness. Bilateral expiratory wheezes in posterior lower lobes. Bilateral muffled words with notable expiratory wheezes in posterior lower lobes. No crackles. In office spirometry: FVC 3.91 L, FEV1/FVC ratio 80.56%. SpO2: 97%.

Assessment                
Mild-persistent asthma with exacerbation
Plan
Diagnostics

Obtain office oxygen saturation Medication
NMT in office x 1
Initiate step-up medication therapy with inhaled corticosteroid
Continue albuterol inhaler. NR 509: Shadow Health Respiratory Physical Assessment Assignment

Education

Encourage Ms. Jones to continue to monitor symptoms and log her episodes of asthma symptoms and wheezing with associated factors and bring log to next visit
Encourage to wash bedding and consider dust mite covers to decrease allergic nighttime symptoms • Educate to increase intake of water and other fluids
Create Asthma Action Plan. NR 509: Shadow Health Respiratory Physical Assessment Assignment

Referral/Consultation

Refer to allergy specialist for evaluation and testing

 Follow-up Planning

Order PFTs to be completed after exacerbation to have baseline available for future comparison
Instruct Ms. Jones on when to seek emergent care including episodes of chest pain or shortness of breath unrelieved by rest, worsening asthma symptoms or wheezing, or the sense that rescue inhaler is not helping
Revisit clinic in 2-4 weeks for follow up and evaluation. NR 509: Shadow Health Respiratory Physical Assessment Assignment

Tina’s second cousin was diagnosed with asthma at age 5. What would be included in your treatment plan? What factors might concern you related to compliance?

The treatment plan for this child would be to treat the airways of inflammation using medication to prevent asthma attacks. Further, short-acting drugs will be used to treat the asthma attacks. Also, the child will have to avoid triggers of asthma. Lastly, the child will be advised to maintain normal activity levels.

Consider that Tina’s uncle is now 68 years old and has smoked heavily every day since he was fifteen. What would you expect to find in his respiratory assessment? How would this affect your oxygenation goals for this patient? NR 509: Shadow Health Respiratory Physical Assessment Assignment

Common significant deviations of the chest for older adults include marked dorsal curvature, kyphosis, increased AP diameter of the chest (barrel chest), and diminished chest expansion (Hogstel & Curry, 2005). Bones become thinner, more rigid, and change shape, and muscles may become weakened. This results in a lower oxygen level with less carbon dioxide removed from the body, and decreased ability to cough. Osteoporosis causes decreased thoracic vertebrae height. Aging also causes the alveoli to lose their shape causing shortness of breath. Due to diminished cough reflex with decreased sensitivity, large amounts of particles that are more difficult to expectorate can collect in the lungs. In addition, the brain is less sensitive to hypoxia (low oxygen) and hypercapnea (higher than normal carbon dioxide) and higher residual volume. As a result of these changes, older persons are at increased risk for pneumonia and bronchitis (Minaker, 2011; Sharma & Goodwin, 2006).NR 509: Shadow Health Respiratory Physical Assessment Assignment
In the respiratory assessment of this patient, I expect to find marked dorsal curvature, increased AP diameter of the chest, diminished chest expansion, and kyphosis. The weakened muscles will result in lower oxygen levels and lower elimination of carbon dioxide leading to decreased coughing capacity. Alveoli will also will also lose their shape leading to dypnea. Therefore, oxygenation goals will have to take in cognizance these realities and advise the patient accordingly. Consequently, efforts to increase exercise tolerance, treat complication, and relieve symptoms will be initiated.

If Tina had mentioned that she was just diagnosed with pneumonia, what would you have expected to find during percussion?

Hyopperesonance

If the results of Tina’s pulse oximetry had been 97%, which of the following would have been true?

Arterial hemoglobin saturation 97%

Suppose that, during your lung exam on Tina, you had heard bronchial breath sounds in the left lower lung posteriorly. What would you have suspected based on this finding?

Atelectasis

Suppose that while auscultating, you assessed a few scattered expiratory wheezes. Why would this be an expected finding for a patient with Tina’s history. NR 509: Shadow Health Respiratory Physical Assessment Assignment

Tina would be expected to have a milder obstruction of the airway.

When you observe a patient like Tina throughout an exam, there are many ways to determine whether a patient is experiencing respiratory distress. Identify one indicator of respiratory distress that can be assessed through observation alone.

A bluish color seen around the mouth, on the inside of the lips, as well as on the fingernails occur when an individual’s gets less than sufficient oxygen.NR 509: Shadow Health Respiratory Physical Assessment Assignment

Describe how you would assess Tina for dyspnea

Dyspnea can be assessed both subjectively and objectively by looking at a patient. A clinical assessment of the condition includes acquiring a complete history from the patient including its onset, effect of positioning, qualities, associated symptoms, allergy history among others. Further a physical assessment wherein attention is directed at specific signs of the condition such as dullness to percussion, decreased tactile femitus, elevated venous jugular pressure etc. follows history acquisition.

Explicitly describe the tasks you undertook to complete this exam.

The examination was completed by undertaking task in three sections of the assignment. The first section entailed acquiring a complete history from the patient by asking subjective questions. After the subjective data that included general information, review of systems and HPI, a physical assessment of the patient occurred. The physical assessment principally entailed examination of the respiratory system of the patient through various strategies.

Explain the clinical reasoning behind your decisions and tasks.

The various tasks and decisions undertaken here were to inform a differential diagnosis of the patient’s condition. The diagnosis specifically enabled me to eliminate some of the conditions that were suspected to have caused the asthma attacks on the patient. Therefore, the various tasks were necessary for reaching a proper decision on the type of asthma.NR 509: Shadow Health Respiratory Physical Assessment Assignment

Identify how your performance could be improved and how you can apply “lessons learned” within the assignment to your professional practice.

My performance could be improved by seeking more history from the patient. In terms of lessons learned, the present analysis will allow me to become even more aware of the nitty-gritties of respiratory assessment for future practice.NR 509: Shadow Health Respiratory Physical Assessment Assignment
NR 509 Week 1 Shadow Health History Assignment

Pre-brief
Obtaining an accurate history is the critical first step in determining the etiology of a patient’s problem. A large percentage of the time, you will actually be able to make a diagnosis based on the history alone. The value of the history, of course, will depend on your ability to elicit relevant information. Your sense of what constitutes important data will grow exponentially as you practice your interviewing skills and through increased exposure to patients and illness…………………… Interviewing patients is an art and should remain an essential skill for successful practice.
In this activity, you will interview Tina Jones to collect data to assess Ms. Jones’ condition. You will also have the opportunity to educate and empathize with Tina to engage in effective therapeutic communication; create a problem listusing evidence from the data you collected; prioritize the identified problems to differentiate immediate from non-immediate care; plan how to best address the most important concern with further assessment, interventions, and patient education; and compare your documentation to model documentation.NR 509: Shadow Health Respiratory Physical Assessment Assignment
Ms. Jones is a pleasant, 28-year-old obese African American single woman who presents to establish care and with a recent right foot injury. She is the primary source of the history. Ms. Jones offers information freely and without contradiction. Her speech is clear and coherent and she maintains eye contact throughout the interview.
Reason for visit: Patient presents for an initial primary care visit today complaining of an infected foot wound.

| Overview
| Transcript
| Subjective Data Collection
| Objective Data Collection
| Education & Empathy
| Documentation / Electronic Health Record
| Information Processing
| Lab Pass: Certificate of Completion . NR 509: Shadow Health Respiratory Physical Assessment Assignment

N 518 Module 2: THE GENERAL SURVEY AND HEENT
Module 2: Discussion Question

Start by reading and following these instructions:
You are responsible for minimally at least 3 posts for each question in your discussion boards; your initial post and reply to two of your classmates. Your initial post(s) should be your response to the questions posed in the discussion question. You should research your answer and cite at least one scholarly source when appropriate, and always use quality writing.The discussion board is never a place to use text language or emoticons. You will also be asked to respond to your classmates. This is designed to enhance the academic discussion around the topic. It is all right to disagree with something posted by another, however your responses should always be thoughtful and respectful and reflect your opinions professionally.
Discussion Question:
In your professional opinion, what is the difference between chronic and acute pain? How is the assessment for each type of pain different? What must you keep in mind when assessing acute pain? What must you keep in mind when assessing chronic pain?  Reflect upon a time when you assessed a patient in pain. What did you do well? What points could you have improved upon? How did the pain impact the patient? What specific treatments could have lessened the impact of the pain on the patient?NR 509: Shadow Health Respiratory Physical Assessment Assignment
Your initial posting should be 200 to 300 words in length and utilize at least one scholarly source other than the textbook. Please reply to at least two classmates. Replies to classmates should be at least 100 words in length. To properly “thread” your discussion posting, please click on REPLY.
When you are ready for the discussion, do the following:

Click on the discussion link above.
Start your answer by clicking “Start a New Thread” button with the title of your answer and the body of text following the guidance above.
To properly post your answer, please click on the “Post” button.
After posting your contribution, you must read what others have posted, reply to at least two of those posts, and respond (when appropriate) to those you have responded to you.NR 509: Shadow Health Respiratory Physical Assessment Assignment

To reply to a classmate’s post:

Click on the title of another student’s post.
Click “Reply to Thread” and type your response to the student.
Click the “Post” button to post your reply.

N 581 Module 2: Assignment
Remember to submit your work following the file naming convention FirstInitial.LastName_M01.docx. For example, J.Smith_M01.docx. Remember that it is not necessary to manually type in the file extension; it will automatically append.
Start by reading and following these instructions:
1. Quickly skim the questions or assignment below and the assignment rubric to help you focus.
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4. Create your Assignment submission and be sure to cite your sources, use APA style as required, check your spelling.NR 509: Shadow Health Respiratory Physical Assessment Assignment
Assignment:
Exercises: 

Complete the Shadow Health HEENT assessment.

Professional Development

Write a reflection essay of your experience with the Shadow Health virtual assessment. At least two scholarly sources in addition to your textbook should be utilized. Please be sure to address each of the following prompts:

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? What could you change to make it better?NR 509: Shadow Health Respiratory Physical Assessment Assignment
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N 581: SHADOW HEALTH ASSIGNMENT

Subjective
HPI: Ms.Jones is a 28 years olf african american women who is presented to the clinic with complaints of sore, itcy throat and running nose that wont stop for one week . She states that the throat pain is bad and rates it a 4/10 . she states that she has treated her throat pain with occcasional throat lozenges which has ” helped her a little” . patient mentions that it hurts to swallow and that her eyes are itchy . she denies taking anything to stop her nasal irritation and ichy eyes. patient denies exposure to sick individuals , denies symptoms of fever and chills. patient has never been diagnosed with seasonal allerges but states that her sister has ” hay fever” Social History: patient is unaware of any environmental exposure / irritants . she mention that she keeps the house ” pretty clean” . patient mentions that she used” pot when in highschool,and after highschool but definitely dont anymore ” she states she hasnt smoked pot since she was twenty one. patient does not excersie however is on her feet most of the time at work . Review systems : General – denies changes in weight, fever and chills. Head: denies history of trauma but mentions headches due to studying that last a few hours, takes Tylenol to help allivate pain. Eyes- patient denies wearing glasess or contacts however notes the vision is sort of blurry when reading and is currently getting worse Ears- denies hearing loss, tinnitus,vertigo or discharge. patieny states that her ears are ” fine” Nose- Denies any problems with nose proior to this issues, denies getting stuffiness, sneezing, previous allergies prior Mouth- denies bleeding gums, hoarseness, swollen lymph nodes Respirtory- patient denies shorness of breath, cough, history of tuberculosis, or bronchitis, patient has asthma and uses inhaler 2-3 times per week . He last chest x-ray wass in highschool .

HPI: Ms. Jones is a pleasant 28-year-old African American woman who presented to the clinic with complaints of sore, itchy throat, itchy eyes, and runny nose for the last week. She states that these symptoms started spontaneously and have been constant in nature. She does not note any specific aggravating symptoms, but states that her throat pain seems to be worse in the morning. She rates her throat pain as 4/10 and her throat itchiness as 5/10. She has treated her throat pain with occasional throat lozenges which has “helped a little”. She states that she has some soreness when swallowing, but otherwise no other associated symptoms. She states that her nose “runs all day” and is clear discharge. She has not attempted any treatment for her nasal symptoms. She states that her eyes are constantly itchy and she has not attempted any eye specific treatment. She denies cough and recent illness. She has had no exposures to sick individuals. She denies changes in her hearing, vision, and taste. She denies fevers, chills, and night sweats. She has never been diagnosed with seasonal allergies, but does note that her sister has “hay fever”. Social History: She is not aware of any environmental exposures or irritants at her job or home. She changes her sheets weekly and denies dust/mildew at her home. She denies use of tobacco, alcohol, and illicit drugs. She does not exercise. Review of Systems: General: Denies changes in weight, fatigue, weakness, fever, chills, and night sweats. • Head: Denies history of trauma or headaches. • Eyes: She does not wear corrective lenses, but notes that her vision has been worsening over the past few years. She complains of blurry vision after reading for extended periods. Denies increased tearing or itching prior to this past week. • Ears: Denies hearing loss, tinnitus, vertigo, discharge, or earache. • Nose/Sinuses: Denies rhinorrhea prior to this episode. Denies stuffiness, sneezing, itching, previous allergy, epistaxis, or sinus pressure. • Mouth/Throat: Denies bleeding gums, hoarseness, swollen lymph nodes, or wounds in mouth. No sore throat prior to this episode. • Respiratory: She denies shortness of breath, wheezing, cough, sputum, hemoptysis, pneumonia, bronchitis, emphysema, tuberculosis. She has a history of asthma, last hospitalization was age 16 for asthma, last chest XR was age 16. Her current inhaler use has been her baseline of 2-3 times per week.

Objective
patient c/o 4/10 pain in her throat, has been using drops and tylenol ovet the counter for pain patient also c/o headaches when reading or doing homework, hasn’t had an eye exam in years. Patient’s head normocephalic, acne bialaterally to cheeks. Eyes watery with clear drianage, PERRLA. Vision 20/20 in left and 2/30 in the right eye. patent reports blurry vision at times, when reading, denies glasses or contacts. Nares appear to be swollen, patient denies diffculty breathing, states that hher norse has been “runny” with clear drainage. patient denies any issues with hearing. Tympanci memrane intact and pink bilaterally. Mouth erythrmic with cabblestoning, gag reflex intact. Visible drainage- Clear. Denies dizziness, problems with gum, sinus infection or any recent cold symptoms. Patient denied any neck pain or stiffness- no palpable nodes on exam. Lungs sounds clear. Denies any shortness of breath/ diffculty breathing General : Patient Ms. Joes is a 28 year old aferican american women. o acute distress identified. Patient is alert and oriented. She maintains eye contact throughout examination/asessment Head: head is normocephalic and atraumatic. Scalp has no masses , normal hair distribution. Eye: Bilateral with equal hair distriibution,no lesions, no ptosis, no edma, conjectivia clear and injected. Extraocular movements intact bilateral. Pupils equal, round nad reactive bilaterally. Normal convergence. Left fundoscopic exam revals mild retinopathic changes. Left eys vision:20/20. Right eye vision :20/40 Ears: Ear shape equal bilaterally. External canals without inflammation bilaterally. Tympanic membranes pearly grey and intact with positive light reflex bilaterally. Reinne, weber and wisper test was normal bilaterally. Nose: Septum is midline, nasal mucosa is boggy and pale bilaterally. No pain palpations of frontal or maxillay sinuses Mouth/ throat – Moist buccal muccosa, no wounds identified. Adequate dental hygiene. Uvula midline. Tonsils 1 + and without evidence of inflammations. Posterior pharynx is slightly erythematous with mild cobblestoning Neck : No cervical, infraclavicular lymphadenopathy. Thyriods is smooth without nodules or goiter carotid pulses 2, no thrill . Jaw with no clicks, full range of motion. Bilateral carotid arty auscultation without bruit . Respirtory : Chest is symmetricall with respirations. Lungs sounds clear to ausculttion without wheezes, crackles or cough. No evidence of shortness of breath

General: Ms. Jones is a pleasant, obese 28-year-old African American woman in no acute distress. She is alert and oriented. She maintains eye contact throughout interview and examination. • Head: Head is normocephalic and atraumatic. Scalp with no masses, normal hair distribution. • Eyes: Bilateral eyes with equal hair distribution, no lesions, no ptosis, no edema, conjunctiva clear and injected. Extraocular movements intact bilaterally. Pupils equal, round, and reactive to light bilaterally. Normal convergence. Left fundoscopic exam reveals sharp disc margins, no hemorrhages. Right fundoscopic exam reveals mild retinopathic changes. Left eye vision: 20/20. Right eye vision: 20/40. • Ears: Ear shape equal bilaterally. External canals without inflammation bilaterally. Tympanic membranes pearly grey and intact with positive light reflex bilaterally. Rinne, Weber, and Whisper tests normal bilaterally. • Nose: Septum is midline, nasal mucosa is boggy and pale bilaterally. No pain with palpation of frontal or maxillary sinuses. • Mouth/Throat: Moist buccal mucosa, no wounds visualized. Adequate dental hygiene. Uvula midline. Tonsils 1+ and without evidence of inflammation. Posterior pharynx is slightly erythematous with mild cobblestoning. •Neck: No cervical, infraclavicular lymphadenopathy. Thyroid is smooth without nodules or goiter. Acanthosis nigricans present. Carotid pulses 2+, no thrills. Jaw with no clicks, full range of motion. Bilateral carotid artery auscultation without bruit. • Respiratory: Chest is symmetrical with respirations. Lung sounds clear to auscultation without wheezes, crackles, or cough.

Assessment
patient was acessed for sore throat and runny nose Inspection of the Head, eyes, nasal cavities, Ears, Mouth, Neck Palpation of the scalp, sinuses, temporal arteries, carotid arteries, Jaw, Lymph nodes, Thyroid Ascultation of breath sounds, Temporal arteries, and carotid arteries

Allergic Rhinitis

Plan
Refer patient for medical specialist examinination. Refer patient to ophthaltmologist for eye exam Rapid strep test obtained and throat culture for strep throat Possible need for antibitics however lab results required (culture and sensitivity rerquired ) Encourage Ms. Jones continues to monitor symptoms and cahrt episodes of allergic symptoms and other associated factors Start LORATADNE 10MG PO per MD order. NR 509: Shadow Health Respiratory Physical Assessment Assignment. Encourage fluid intake and proper hand hygiene Educate patients of techiques to aviod triggers and signs and symptoms to report Educates patient to seek advane care for worsening headaces or fever Refer patient for follow up evaluation in two weeks after reassessment by the physcian .

Shadow Health Physical Assessment Rubric

Shadow Health Physical Assessment Rubric

Criteria
Ratings
Pts

This criterion is linked to a Learning OutcomeSubjective Data, Organization, Communication, and Summary (DCE Score or transcript)

25.0 pts
Above Average- DCE Score greater than or equal to 93; Comprehensive introduction with expectations of exam verbalized; questions worded in a non-judgmental way; professional language exercised; questions well-organized; appropriate closing with summary of findings verbalized to patient.

21.0 pts
Average- DCE Score greater than or equal to 86-92; Adequate introduction; some questions worded in a non-judgmental way; professional language mostly exercised; questions generally organized; somewhat complete closing.

10.0 pts
Below Average- DCE Score greater than or equal to 80-85; Incomplete introduction; many questions worded in a judgmental way; some professional language exercised; questions somewhat organized; incomplete closing.

0.0 pts
Unsatisfactory- DCE Score less than or equal to 79; Introduction missing; questions worded in a judgmental way; little professional language; questions unorganized; closing missing.

25.0 pts

This criterion is linked to a Learning OutcomeObjective Data, Physical Examination, Interpretation of Findings, Assessment, and Documentation

20.0 pts
Above Average- Physical assessment documentation includes all relevant body systems; all pertinent normal and abnormal findings identified; documentation reflects professional language; treatment plan includes each of the following components: diagnostics, medication, education, consultation/referral, and follow-up planning.

16.0 pts
Average- Physical assessment documentation lacks sufficient details pertaining to one or two relevant body systems; or identifies ≥ 50% of the pertinent normal and abnormal findings; or documentation lacks professional language; or treatment plan lacks one or two components (diagnostics, medication, education, consultation/referral, or follow-up planning).

8.0 pts
Below Average- Physical assessment documentation lacks sufficient details pertaining to three or more relevant body systems; or identifies < 49% of the pertinent normal and abnormal findings; or documentation includes unprofessional language; or treatment plan lacks three or more components (diagnostics, medication, education, consultation/referral, or follow-up planning). 0.0 pts Unsatisfactory- No physical assessment documentation or no treatment plan. 20.0 pts This criterion is linked to a Learning OutcomeSelf-Reflection 5.0 pts Above Average- Responds to three of the three reflection post questions; and provides analysis of performance; and reflection posts written using professional language; and reflection posts demonstrate insight. 3.0 pts Average- Responds to two of the three reflection post questions; or provides limited self-analysis of performance; or reflection posts are somewhat unclear related to the assignment and the student's experience; or reflection posts lack insight. 2.0 pts Below Average- Responds to one of the three reflection post questions; or does not provide self-analysis of performance; or reflections are not related to the assignment and the student's experience; or does not provide insight 0.0 pts Unsatisfactory- No reflection posts for the assignment. 5.0 pts Total Points: 50.0 NR 509: Shadow Health Respiratory Physical Assessment Assignment shadow health respiratory transcriptshadow health respiratory transcript 5/11/2018 Respiratory | Completed | Shadow Health https://chamberlain.shadowhealth.com/assignment_attempts/3498304 1/23 Respiratory Results | Turned In Advanced Health Assessment - Chamberlain, NR509-April-2018 Return to Assignment Your Results LLaabb PPaassss Started: May 11, 2018 | Patient Exam Time: 168 min Transcript Greet 05/11/18 12:39 PM CDT Question 05/11/18 12:39 PM CDT Question 05/11/18 12:39 PM CDT Question 05/11/18 12:40 PM CDT Overview Transcript Subjective Data Collection Objective Data Collection Education & Empathy Documentation Student Pre-Survey Lifespan Review Questions Self-Reflection IInntteerrvviieeww QQuueessttiioonnss ((9911)) SSttaatteemmeennttss ((2211)) EExxaamm AAccttiioonnss ((6655)) Hello my name sara an FNP student and I will be interviewing you today. Hey. Can you please state your name for me? Tina Jones. Your date of birth? February 17th. Year of birth please? (Clarified to What year were you born.) I was born in . . . [Ms. Jones reports correct birth year.] [AUDIO COMING SOON] AAllll LLiinneess ((117777)) 5/11/2018 Respiratory | Completed | Shadow Health https://chamberlain.shadowhealth.com/assignment_attempts/3498304 2/23 Question 05/11/18 12:40 PM CDT Question 05/11/18 12:41 PM CDT Question 05/11/18 12:42 PM CDT Empathize 05/11/18 12:42 PM CDT Question 05/11/18 12:43 PM CDT Question 05/11/18 12:53 PM CDT Question 05/11/18 12:53 PM CDT How old are you ms. Jones? (Clarified to how old are you.) I'm 28. What brings you in today? I came in because I've been having breathing problems, and my inhaler just isn't working the way it normally does. Why did you decide to seek treatment? I came in because I've been having breathing problems, and my inhaler just isn't working the way it normally does. I'm sorry to hear that you're having breathing problems. Thanks for saying that. What medical problems do you have? Well. . . I've had asthma since I was really little, though for a while there it wasn't really much of a problem. And I have sugar diabetes, too. What medication do you use for asthma? It's just a regular Proventil inhaler. How often do you use your Proventil inhaler? I've been using it probably every. . . four hours or so, I'd say. When did your symptoms start? 5/11/2018 Respiratory | Completed | Shadow Health https://chamberlain.shadowhealth.com/assignment_attempts/3498304 3/23 Question 05/11/18 12:53 PM CDT Empathize 05/11/18 12:56 PM CDT Question 05/11/18 12:56 PM CDT Question 05/11/18 12:57 PM CDT Question 05/11/18 12:57 PM CDT Question 05/11/18 1:00 PM CDT Question 05/11/18 1:02 PM CDT I don't know if I'd call it an asthma attack, but my asthma started acting up two days ago at my cousin's house. She has cats, and I'm allergic, so I'm used to it being a problem there, but usually the inhaler fixes it. . . it doesn't feel totally under control, though. I'm sorry you're having difficulty with your breathing problems. Thanks. How long have you had breathing problems? My breathing's been acting up off and on for the past two days. How frequent are your shortness of breath episodes? Maybe as much as every four hours? It's a lot. And how long do your shortness of breath episodes last? (Clarified to how long does an episode last.) I haven't had a full attack in years, but usually once I use my inhaler it only takes a minute or two for my breathing to go back to normal. . . that's not what's been happening recently, though. How long did you last episode last? I haven't had a full attack in years, but usually once I use my inhaler it only takes a minute or two for my breathing to go back to normal. . . that's not what's been happening recently, though. How many times have you had breathing problems in the past 2 days? 5/11/2018 Respiratory | Completed | Shadow Health https://chamberlain.shadowhealth.com/assignment_attempts/3498304 4/23 Question 05/11/18 1:04 PM CDT Question 05/11/18 1:05 PM CDT Question 05/11/18 1:06 PM CDT Question 05/11/18 1:07 PM CDT Question 05/11/18 1:09 PM CDT Question 05/11/18 1:10 PM CDT Well. . . it's kind of hard to count because my breathing's been at least a little bad most of the past two days, but it's really acted up, like with wheezing and everything, probably every four hours or so-- like five times each day. Is your asthma keeping you up at night? My asthma doesn't usually wake me up, but it has the past couple nights. How severe are your symptoms? (Clarified to How bad was your asthma attack.) My asthma used to be really scary. I haven't had a full attack in years, and if you had asked me before this I would have said my asthma wasn't that bad anymore, but the last couple days I've had a lot of trouble breathing. How severe is your asthma? My asthma used to be really scary. I haven't had a full attack in years, and if you had asked me before this I would have said my asthma wasn't that bad anymore, but the last couple days I've had a lot of trouble breathing. Is there anything you can't do because of your asthma? There usually isn't anything I can't do because of my asthma. . . I guess I try to avoid things that make my breathing worse, but that's about it. The past couple days, though, it's been hard to do anything. Do you wheeze during an asthma exacerbation? During a full attack, I would wheeze a lot, like I couldn't breathe at all, but until the past couple days, I would usually just wheeze a little when I had breathing problems. Are you having any chest tightness? It's not so bad right this second, but it's been pretty tight lately, like I can't take in air. 5/11/2018 Respiratory | Completed | Shadow Health https://chamberlain.shadowhealth.com/assignment_attempts/3498304 5/23 Question 05/11/18 1:10 PM CDT Question 05/11/18 1:11 PM CDT Question 05/11/18 1:11 PM CDT Question 05/11/18 1:11 PM CDT Question 05/11/18 1:12 PM CDT Question 05/11/18 1:13 PM CDT Question 05/11/18 1:14 PM CDT Educate 05/11/18 1:14 PM CDT Have you been coughing? I've been coughing a lot, yeah. How long have you had the cough? Since my asthma acted up two days ago. How would you describe the cough? Um. . . I guess I'd describe it as a small, dry cough. What makes your cough better? Drinking some water helps a little, as long as the water isn't too cold. Have you tried to treat your cough? I haven't taken medicine for it or anything. Is your asthma worse at night? It has been the past couple nights, yeah. Does lying on your back make your asthma worse? Just recently lying on my back has definitely made my breathing worse. To try to help your breathing you may want to elevate your head with two pillows. 5/11/2018 Respiratory | Completed | Shadow Health https://chamberlain.shadowhealth.com/assignment_attempts/3498304 6/23 Exam Action 05/11/18 1:36 PM CDT Exam Action 05/11/18 1:43 PM CDT Exam Action 05/11/18 1:43 PM CDT Exam Action 05/11/18 1:44 PM CDT Exam Action 05/11/18 1:44 PM CDT Exam Action 05/11/18 1:44 PM CDT Exam Action 05/11/18 1:46 PM CDT Exam Action 05/11/18 1:48 PM CDT Exam Action 05/11/18 1:48 PM CDT Exam Action 05/11/18 1:50 PM CDT OK, I understand. Inspected anterior chest wall Inspected anterior chest wall Inspected left side chest wall Inspected anterior chest wall Inspected right side chest wall Inspected anterior chest wall Palpated chest expansion: Both sides rise symmetrically Palpated fremitus in anterior upper chest wall: Equal bilaterally, expected vibration Ninety-nine. Palpated fremitus in anterior lower chest wall: Equal bilaterally, expected vibration Ninety-nine. Palpated fremitus in posterior upper chest wall: Equal bilaterally, expected vibration Ninety-nine. 5/11/2018 Respiratory | Completed | Shadow Health https://chamberlain.shadowhealth.com/assignment_attempts/3498304 7/23 Exam Action 05/11/18 1:50 PM CDT Exam Action 05/11/18 1:50 PM CDT Exam Action 05/11/18 1:52 PM CDT Exam Action 05/11/18 1:52 PM CDT Exam Action 05/11/18 1:52 PM CDT Exam Action 05/11/18 1:52 PM CDT Exam Action 05/11/18 1:52 PM CDT Exam Action 05/11/18 1:52 PM CDT Exam Action 05/11/18 1:53 PM CDT Exam Action 05/11/18 1:53 PM CDT Exam Action 05/11/18 1:53 PM CDT Exam Action 05/11/18 1:53 PM CDT Palpated fremitus in posterior middle chest wall: Equal bilaterally, expected vibration Ninety-nine. Palpated fremitus in posterior lower chest wall: Equal bilaterally, expected vibration Ninety-nine. Percussed anterior left upper lobe Percussed anterior right upper lobe Percussed anterior left mid-chest (upper lobe) Percussed anterior right middle lobe Percussed anterior left lower lobe Percussed anterior right lower lobe Percussed posterior right upper lobe Percussed posterior left upper lobe Percussed posterior right mid-back (lower lobe) Percussed posterior left mid-back (lower lobe) 5/11/2018 Respiratory | Completed | Shadow Health https://chamberlain.shadowhealth.com/assignment_attempts/3498304 8/23 Exam Action 05/11/18 1:53 PM CDT Exam Action 05/11/18 1:53 PM CDT Exam Action 05/11/18 1:53 PM CDT Exam Action 05/11/18 1:53 PM CDT Exam Action 05/11/18 1:53 PM CDT Exam Action 05/11/18 1:53 PM CDT Exam Action 05/11/18 1:54 PM CDT Exam Action 05/11/18 1:55 PM CDT Exam Action 05/11/18 1:55 PM CDT Exam Action 05/11/18 1:55 PM CDT Exam Action 05/11/18 1:56 PM CDT Exam Action 05/11/18 1:56 PM CDT Exam Action 05/11/18 1:56 PM CDT Percussed posterior right lower lobe Percussed posterior left lower lobe Percussed posterior left lower lobe on side Percussed posterior left lower lobe near spine Percussed posterior right lower lobe near spine Percussed posterior right lower lobe on side Auscultated breath sounds in anterior left upper lobe Auscultated breath sounds in anterior right upper lobe Auscultated breath sounds in anterior right middle lobe Auscultated breath sounds in anterior left mid-chest (upper lobe) Auscultated breath sounds in anterior left lower lobe Auscultated breath sounds in anterior right lower lobe Auscultated breath sounds in posterior right upper lobe 5/11/2018 Respiratory | Completed | Shadow Health https://chamberlain.shadowhealth.com/assignment_attempts/3498304 9/23 Exam Action 05/11/18 1:56 PM CDT Exam Action 05/11/18 1:56 PM CDT Exam Action 05/11/18 1:56 PM CDT Exam Action 05/11/18 1:57 PM CDT Exam Action 05/11/18 1:57 PM CDT Exam Action 05/11/18 1:57 PM CDT Exam Action 05/11/18 1:57 PM CDT Exam Action 05/11/18 1:57 PM CDT Exam Action 05/11/18 1:57 PM CDT Exam Action 05/11/18 2:01 PM CDT Exam Action 05/11/18 2:01 PM CDT Auscultated breath sounds in posterior left upper lobe Auscultated breath sounds in posterior left mid-back (lower lobe) Auscultated breath sounds in posterior right mid-back (lower lobe) Auscultated breath sounds in posterior right lower lobe Auscultated breath sounds in posterior left lower lobe Auscultated breath sounds in posterior left lower lobe on side Auscultated breath sounds in posterior left lower lobe near spine Auscultated breath sounds in posterior right lower lobe near spine Auscultated breath sounds in posterior right lower lobe on side Auscultated voice sounds in anterior left upper lobe Ninety-nine. Ninety-nine. Auscultated voice sounds in anterior right upper lobe Ninety-nine. 5/11/2018 Respiratory | Completed | Shadow Health https://chamberlain.shadowhealth.com/assignment_attempts/3498304 10/23 Exam Action 05/11/18 2:01 PM CDT Exam Action 05/11/18 2:01 PM CDT Exam Action 05/11/18 2:01 PM CDT Exam Action 05/11/18 2:01 PM CDT Exam Action 05/11/18 2:01 PM CDT Exam Action 05/11/18 2:01 PM CDT Exam Action 05/11/18 2:01 PM CDT Ninety-nine. Ninety-nine. Auscultated voice sounds in anterior left upper lobe Auscultated voice sounds in anterior left mid-chest (upper lobe) Ninety-nine. Auscultated voice sounds in anterior right middle lobe Auscultated voice sounds in anterior right lower lobe Ninety-nine. Auscultated voice sounds in anterior left lower lobe Ninety-nine. Ninety-nine. Ninety-nine. Auscultated voice sounds in posterior right upper lobe Ninety-nine. Auscultated voice sounds in posterior left upper lobe 5/11/2018 Respiratory | Completed | Shadow Health https://chamberlain.shadowhealth.com/assignment_attempts/3498304 11/23 Exam Action 05/11/18 2:02 PM CDT Exam Action 05/11/18 2:02 PM CDT Exam Action 05/11/18 2:02 PM CDT Exam Action 05/11/18 2:02 PM CDT Exam Action 05/11/18 2:02 PM CDT Exam Action 05/11/18 2:02 PM CDT Exam Action 05/11/18 2:02 PM CDT Ninety-nine. Auscultated voice sounds in posterior right mid-back (lower lobe) Ninety-nine. Auscultated voice sounds in posterior left mid-back (lower lobe) Ninety-nine. Auscultated voice sounds in posterior right lower lobe Ninety-nine. Auscultated voice sounds in posterior left lower lobe Ninety-nine. Auscultated voice sounds in posterior left lower lobe on side Ninety-nine. Auscultated voice sounds in posterior left lower lobe near spine Ninety-nine. Auscultated voice sounds in posterior right lower lobe near spine Ninety-nine. 5/11/2018 Respiratory | Completed | Shadow Health https://chamberlain.shadowhealth.com/assignment_attempts/3498304 12/23 Exam Action 05/11/18 2:02 PM CDT Exam Action 05/11/18 2:08 PM CDT Exam Action 05/11/18 2:08 PM CDT Exam Action 05/11/18 2:12 PM CDT Exam Action 05/11/18 2:15 PM CDT Educate 05/11/18 2:16 PM CDT Question 05/11/18 2:16 PM CDT Educate 05/11/18 2:17 PM CDT Educate 05/11/18 2:17 PM CDT Educate 05/11/18 2:18 PM CDT Auscultated voice sounds in posterior right lower lobe on side Ninety-nine. Checked pulse oximetry using left hand Check pulse oximetry using right hand Checked spirometer Checked patient's inhaler Always make sure your inhaler is up-to-date Sure, I think I understand what you mean. Make sure to read all instructions and store as indicated (No matching questions found.) Make sure to read all instructions and store as indicated Alright, thanks for letting me know. Always shake well before using. Thanks for telling me. Also after every complete use you should always rinse out your mouth with water. 5/11/2018 Respiratory | Completed | Shadow Health https://chamberlain.shadowhealth.com/assignment_attempts/3498304 13/23 Question 05/11/18 2:19 PM CDT Question 05/11/18 2:20 PM CDT Question 05/11/18 2:20 PM CDT Question 05/11/18 2:21 PM CDT Question 05/11/18 2:21 PM CDT Question 05/11/18 2:22 PM CDT Question 05/11/18 2:22 PM CDT That makes sense. What medications do you take? My inhaler is the only prescription I always have, but I usually don't need it everyday, except for recently. . . When did you last use your inhaler? I had to use it early this morning. How is your inhaler prescribed? Yes. How often is your inhaler prescribed? Yes. How many times have you use your inhaler in the past 2 days? I've been needing my inhaler about every four hours, I'd say. How many puffs every 4 hours? (Clarified to how many puffs of your inhaler are you prescribed.) I'm supposed to just do two puffs. [Nurse confirmed with Pharmacy: albuterol 90mcg/spray MDI] How many puffs are you doing? I'm supposed to just do two puffs. [Nurse confirmed with Pharmacy: albuterol 90mcg/spray MDI] 5/11/2018 Respiratory | Completed | Shadow Health https://chamberlain.shadowhealth.com/assignment_attempts/3498304 14/23 Educate 05/11/18 2:22 PM CDT Question 05/11/18 2:23 PM CDT Question 05/11/18 2:24 PM CDT Question 05/11/18 2:24 PM CDT Question 05/11/18 2:25 PM CDT Question 05/11/18 2:26 PM CDT Question 05/11/18 2:27 PM CDT Make sure to follow the Proventil instructions as prescribed Thanks for telling me. Are you taking any other medications? No, all I really use is my inhaler. You take any over-the-counter medications? I take Tylenol for a headache sometimes, or Advil for cramps, but not often. How much Tylenol do you take? I just take a couple. I usually get them at night from reading-- squinting I guess--and so I take one and go to bed. [Nurse confirmed with Pharmacy: 1-2x acetaminophen 500mg] How much Advil do you take for cramps? I take three at a time. And I'd bet I take it up to three times a day. [Nurse confirmed with Pharmacy: 3-4x ibuprofen 200mg] Do you have any allergies? Yeah, I'm allergic to cats. Do you have any new allergies? No, not that I know of. When did your recent asthma problems start? (Clarified to What started your recent asthma problems? .) 5/11/2018 Respiratory | Completed | Shadow Health https://chamberlain.shadowhealth.com/assignment_attempts/3498304 15/23 Question 05/11/18 2:27 PM CDT Question 05/11/18 2:28 PM CDT Empathize 05/11/18 2:28 PM CDT Question 05/11/18 2:28 PM CDT Question 05/11/18 2:30 PM CDT Question 05/11/18 2:30 PM CDT Question 05/11/18 2:31 PM CDT This all started at my cousin's house. She has cats, and I'm allergic, so my asthma always goes crazy when I'm there. Does being around dust trigger asthma? Yeah, being around a lot of dust, especially hanging out in a really dusty house, can make my asthma act up. Sorry to hear that about your asthma Thanks for understanding. Does climbing stairs trigger asthma? Only when I'm in a rush and have to hurry up them. Do you have seasonal allergy triggers? (Clarified to do you have seasonal allergies.) A little while ago, I had some seasonal allergies, but it didn't really bother my asthma, and it's better now. Does anything at work make your asthma worse? Well. . . sometimes when there's dust at work it can make my asthma act up, but that doesn't happen very often. Do you see an asthma specialist? I used to go to Dr. Dewitt, but she moved her practice recently. Luckily she's still been able to call in refills of my inhaler, but I haven't actually been in to see her in about two years. 5/11/2018 Respiratory | Completed | Shadow Health https://chamberlain.shadowhealth.com/assignment_attempts/3498304 16/23 Educate 05/11/18 2:32 PM CDT Question 05/11/18 2:50 PM CDT Question 05/11/18 2:50 PM CDT Question 05/11/18 2:51 PM CDT Question 05/11/18 2:52 PM CDT Question 05/11/18 2:53 PM CDT Question 05/11/18 2:54 PM CDT Since you have asthma it is important to follow up on a regular basis with your asthma specialist Alright, thanks for letting me know. How long have you had asthma? I've had asthma a long time. . . since I was really little. How old were you when you were diagnosed with asthma? My doctor told me when I was pretty little... I think I was about two and a half? I used to have a lot of trouble with asthma attacks back then. Have you ever hospitalized for asthma? I went a bunch of times when I was little, for asthma attacks. When was the last time you were hospitalized for asthma? I used to go to the hospital a lot for asthma attacks, but not since I was sixteen. Have you ever been put on a breathing tube? You mean like, did they ever have to put me on a breathing machine? No, I haven't had an asthma attack that serious. Do you use a chart to monitor your asthma? Not really. . . Do you check your Peak flow regularly? 5/11/2018 Respiratory | Completed | Shadow Health https://chamberlain.shadowhealth.com/assignment_attempts/3498304 17/23 Question 05/11/18 2:54 PM CDT Question 05/11/18 2:55 PM CDT Educate 05/11/18 2:57 PM CDT Question 05/11/18 2:57 PM CDT Educate 05/11/18 2:57 PM CDT Question 05/11/18 2:58 PM CDT Educate 05/11/18 2:59 PM CDT Question 05/11/18 3:00 PM CDT I've heard of that, but no, I don't do it. Do you use a nebulizer? No, but I have before. We may consider a nebulizer for home treatments. That makes sense. Also a way to track your asthma symptoms and episodes. (No matching questions found.) Also a way to track your asthma symptoms and episodes. OK, I understand. Sending you home with a peak flow meter and document regularly. I've heard of that, but no, I don't do it. We will also teach you how to use nebulizer at home. Sure, I think I understand what you mean. How often do you change your sheets? I change my bedding once a week, I'd say. 5/11/2018 Respiratory | Completed | Shadow Health https://chamberlain.shadowhealth.com/assignment_attempts/3498304 18/23 Question 05/11/18 3:01 PM CDT Empathize 05/11/18 3:01 PM CDT Educate 05/11/18 3:02 PM CDT Question 05/11/18 3:02 PM CDT Empathize 05/11/18 3:02 PM CDT Question 05/11/18 3:03 PM CDT Educate 05/11/18 3:03 PM CDT Do you exercise? It's really not my thing. I get some exercise by being on my feet at work and walking around campus, that sort of thing. But jumping around in spandex is not my idea of a good time. I completely understand I appreciate you saying that. Is important to walk regularly or have some sort of regular exercise on a weekly basis. Thanks for telling me. Have you been able to exercise? Well, I don't exercise, really. I mean, I'm active -- I'm on my feet all day -- but I don't go running or stuff like that. I bet I'd get winded pretty fast, and I'd probably need my inhaler. I completely understand. I appreciate you telling me that. Have you noticed anything at home that aggravate your asthma? My asthma's almost always fine at home. . . I don't think it's anything there that's been making my asthma act up. We keep it pretty neat and tidy. I would like to recommend a hypoallergenic bedding set Sure, I think I understand what you mean. 5/11/2018 Respiratory | Completed | Shadow Health https://chamberlain.shadowhealth.com/assignment_attempts/3498304 19/23 Question 05/11/18 3:04 PM CDT Question 05/11/18 3:06 PM CDT Educate 05/11/18 3:07 PM CDT Question 05/11/18 3:07 PM CDT Question 05/11/18 3:08 PM CDT Question 05/11/18 3:09 PM CDT Question 05/11/18 3:09 PM CDT Question 05/11/18 3:12 PM CDT Do you have pets at home? No. . . I'm too busy to take care of a dog, and I can't have cats because of my allergies. Does anyone smoke in your house? No, nobody at home smokes. If exposed to secondhand smoke it is definitely a Asthma trigger. Alright, thanks for letting me know. Have you ever had eczema? No, I don't have that kind of skin problem. history of sinus problems? (Clarified to do you have a history of sinus problems?.) I don't really have a problem with my sinuses. Do you have gastroesophageal reflux disease? I don't know what that is, so I guess probably not? Have you ever been diagnosed with COPD? No. Have you ever smoke cigarettes? 5/11/2018 Respiratory | Completed | Shadow Health https://chamberlain.shadowhealth.com/assignment_attempts/3498304 20/23 Empathize 05/11/18 3:13 PM CDT Educate 05/11/18 3:13 PM CDT Question 05/11/18 3:13 PM CDT Question 05/11/18 3:13 PM CDT Question 05/11/18 3:14 PM CDT Question 05/11/18 3:15 PM CDT Question 05/11/18 3:17 PM CDT No, I've never done that. I think it's gross. I'm glad you think that Thanks for understanding. Smoking is a known trigger for asthma OK, I understand. Have you ever smoked marijuana Well, I used to smoke pot. . . but I don't do that anymore. When was the last time you smoke marijuana? I haven't smoked pot since I was twenty or twenty-one. Have you ever experimented with inhaled substances? No, no way. That's a nasty thing to do. Have you been sick recently? No, I'm usually healthy. Have you had any fever symptoms? No, I haven't had a fever. 5/11/2018 Respiratory | Completed | Shadow Health https://chamberlain.shadowhealth.com/assignment_attempts/3498304 21/23 Question 05/11/18 3:17 PM CDT Question 05/11/18 3:17 PM CDT Question 05/11/18 3:18 PM CDT Question 05/11/18 3:18 PM CDT Educate 05/11/18 3:19 PM CDT Question 05/11/18 3:20 PM CDT Question 05/11/18 3:20 PM CDT Question 05/11/18 3:20 PM CDT Have you had any nausea or vomiting? I haven't had thrown up, or even had an upset stomach, in a long time. Have you had chills? No, I haven't. Are you fatigued? I feel tired, yeah, probably because I haven't been able to sleep very well. Do you have any night sweats? I don't get sweaty, but sometimes I wake up hot and have to kick off my sheets. Sometimes night sweats maybe an indication of being sick That makes sense. Have you been coughing up anything? No, nothing's coming up. Have you had any problems swallowing? Nope. Do you have any nasal drainage? 5/11/2018 Respiratory | Completed | Shadow Health https://chamberlain.shadowhealth.com/assignment_attempts/3498304 22/23 Question 05/11/18 3:27 PM CDT Question 05/11/18 3:28 PM CDT Question 05/11/18 3:29 PM CDT Question 05/11/18 3:30 PM CDT Question 05/11/18 3:31 PM CDT Question 05/11/18 3:34 PM CDT Question 05/11/18 3:35 PM CDT Question 05/11/18 3:35 PM CDT No, my nose has been fine. Has anyone been sick at home? No, no one at home has been sick. Does anyone in your family have asthma? It's just me and my baby sister that have asthma, but she really doesn't have problems with it. Does anyone in your family have allergies? My sister has hay fever, I think, and it sometimes makes her asthma get pretty bad. Does anyone in your family have eczema? No. . . Do you have a family history of sinus problems? I don't think anyone in the family has sinus problems. Are you in any pain right now? It doesn't hurt. . . it's just hard to breathe, but there's no pain. Is there pain when you wheeze? (No matching questions found.) are you in pain when you wheeze? 5/11/2018 Respiratory | Completed | Shadow Health https://chamberlain.shadowhealth.com/assignment_attempts/3498304 23/23 Question 05/11/18 3:36 PM CDT Question 05/11/18 3:37 PM CDT Right now it doesn't sound too bad, but I've definitely been wheezing the past couple days. Any changes in your appetite? I wouldn't say it's changed recently, but I do feel hungry a lot. When was your last chest x-ray? The last time I went to the hospital for an asthma attack, when I was still in high school, they did a chest x-ray. Comments If your instructor provides individual feedback on this assignment, it will appear here. © Shadow Health 2018 ®