Shadow Health: Focused Exam: Cough Results Danny Riviera

Model Documentation
Subjective Danny 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.
Objective 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 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.

Model Documentation

Subjective

Danny 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.

Objective

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 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.

Hello!	Question 12/15/19 7:10 AM MST
	Hi. I’m Preceptor Diana. I will explain the details of this assignment and your objectives, just as a preceptor would in real life. Pay close attention to this information as it will help guide your exam. At the end of this prebrief, you will answer a short question about the upcoming assignment. During the simulation, you may return to these instructions at any time by scrolling to the top of your transcript.
	What is the situation?	Question 12/15/19 7:11 AM MST
	Your patient is Danny Rivera, an 8-year-old Puerto Rican boy presenting with a cough in the Shadowville Elementary nurse’s office. Your role in this simulation is that of a healthcare provider who will perform a focused history and physical examination in order to collect data, assess Danny’s condition, and transfer care. In this simulation, you will be able to perform procedures not always typical to a school setting so you can gather as much data as possible.
	What are my objectives in this assessment?	Question 12/15/19 7:12 AM MST
	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.
	What else will this exam involve?	Question 12/15/19 8:12 PM MST
	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.
	How will I be evaluated?	Question 12/15/19 8:13 PM MST
	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.
	How does this assignment prepare me for the real world?	Question 12/15/19 8:14 PM MST
	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.
	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?
	play peek-a-boo or pretend to examine the child’s teddy bear	Statement 12/15/19 8:18 PM MST
	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).

ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT: Shadow Health: Focused Exam: Cough Results Danny Riviera

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.

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?

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.
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 ri

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Shadow Health: Focused Exam: Cough Results Danny Riviera