Tina Jones NUR-634 HEENT (Subjective Data Collection: 28 of 28 (100.0%)

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HEENT Results | Turned In Advanced Health Assessment - August 2018, NUR-634 Subjective Data Collection: 28 of 28 (100.0%) Hover To Reveal... Hover over the Patient Data items below to reveal impo... rtant information, including Pro Tips and Example Questions.  Found: Indicates an item that you found.  Available: Indicates an item that is available to be found. Category 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 sore throat (Found) Pro Tip: Initially establishing a chief complaint allows the patient to express their reason for seeking care, primary concerns, or condition they are presenting with. Example Question: Is your throat sore?  Finding: Reports itchy throat (Found) Pro Tip: Initially establishing a chief complaint allows the patient to express their reason for seeking care, primary concerns, or condition they are presenting with. Example Question: Is your throat itchy?  Finding: Reports itchy eyes (Found) Pro Tip: Initially establishing a chief complaint allows the patient to express their reason for seeking care, primary concerns, or condition they are presenting with. Example Question: Are your eyes itchy?  Finding: Reports runny nose (Found) Pro Tip: Initially establishing a chief complaint allows the patient to express their reason for seeking care, primary concerns, or condition they are presenting with. Example Question: Do you have a runny nose? History of Present Illness  Finding: Asked about onset of symptoms  Finding: Reports sore throat began "about a week ago" (Found) Pro Tip: Follow-up questions will enable Tina to more fully and specifically describe her condition, experience, or symptoms. Establishing a timeline for how long Tina's throat has been sore will also aid in treating her sore throat. Example Question: How long has your throat been sore?  Finding: Reports runny nose began "about a week ago" (Found) Pro Tip: Establishing a timeline for how long Tina's nose has been running will illustrate how long she has been suffering these particular symptoms and might indicate possible triggers. Example Question: When did your nose start running?  Finding: Reports itchy eyes began "about a week ago" (Found) Pro Tip: Follow-up questions will enable Tina to more fully and specifically describe her condition, experience, or symptoms. Establishing a timeline for how long Tina's eyes have been itching will also aid in treating her itchy eyes. Example Question: When did your eyes start itching?  Finding: Asked about aggravating factors for throat symptoms  Finding: Reports throat pain is constant (Found) Pro Tip: Follow-up questions will enable Tina to more fully and specifically describe her condition, experience, or symptoms. Establishing a timeline for how long Tina's throat has been sore will also aid in treating her sore throat. Example Question: Is the throat pain constant?  Finding: Reports throat pain is worse in the morning (Found) Pro Tip: Follow-up questions will enable Tina to more fully and specifically describe her condition, experience, or symptoms. Establishing a timeline for how long Tina's throat has been sore will also aid in treating her sore throat. Example Question: When does your sore throat feel the worst?  Finding: Reports some soreness with swallowing (Available) Pro Tip: Follow-up questions will enable Tina to more fully and specifically describe her condition, experience, or symptoms. Example Question: Does it hurt when you swallow?  Finding: Asked severity of throat discomfort  Finding: Describes sore throat as mild to moderate (Found) Pro Tip: Pain severity might change for a variety of reasons. Asking Tina to rate the severity of her pain on a scale of 1-10 will provide a quantified and relative measurement of her condition. Example Question: Can you rate your sore throat on a scale of 0 to 10?  Finding: Asked about frequency and duration of runny nose  Finding: Reports nose is runny "pretty much all day" (Found) Pro Tip: Establishing a timeline for how long Tina's nose has been running will illustrate how long she has been suffering these particular symptoms, when the symptoms are worst, and possible triggers. Example Question: How often does your nose run?  Finding: Asked about character of nasal symptoms  Finding: Denies itchy nose (Available) Pro Tip: Follow-up questions will enable Tina to more fully and specifically describe her condition, experience, or symptoms. Example Question: Does your nose itch?  Finding: Denies sinus pain (Found) Pro Tip: Follow-up questions will enable Tina to more fully and specifically describe her condition, experience, or symptoms. Example Question: Do you feel any sinus pain?  Finding: Denies sinus pressure (Available) Pro Tip: Follow-up questions will enable Tina to more fully and specifically describe her condition, experience, or symptoms. Example Question: Do you feel any sinus pressure?  Finding: Denies sneezing (Available) Pro Tip: Infected sinuses can manifest as nose problems. Asking Tina about her nasal symptoms solicits information about her sinuses and possible sinus problems. Example Question: Have you been sneezing?  Finding: Followed up about character of nasal discharge  Finding: Reports clear discharge (Found) Pro Tip: Follow-up questions will enable Tina to more fully and specifically describe her condition, experience, or symptoms. Example Question: What color is your mucus?  Finding: Reports thin discharge (Available) Pro Tip: Follow-up questions will enable Tina to more fully and specifically describe her condition, experience, or symptoms. Example Question: Is the mucus thick?  Finding: Denies purulent discharge (Found) Pro Tip: Follow-up questions will enable Tina to more fully and specifically describe her condition, exp [Show More]

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