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Landon Smith Focused Exam Long Bone Fracture Shadow Health Experience Overview

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Landon Smith Focused Exam Long Bone Fracture Shadow Health Experience Overview Landon Smith Focused Exam Long Bone Fracture Shadow Health Experience Overview Patient: xxxxxxxxxx Digital Clinic... al Experience Score 96.6% This score measures your performance on the Student Performance Index in relation to other students in comparable academic programs. Your instructor has chosen to scale your Student Performance Index score so that the average score on the index is a 80.0%. This score may not be your final grade if your instructor chooses to include additional components, such as documentation or time spent. Student Performance Index 52.4 out of 60.5 Proficiency Level: Proficient • Beginning • Developing • Proficient Students rated as “proficient” demonstrate entry-level expertise in nursing competencies and clinical reasoning skills. In comparable nursing programs, the top 25% of students perform at the level of a proficient nurse. Subjective Data Collection 26 out of 26 Objective Data Collection 17.4 out of 18 Education and Empathy 4 out of 8 Care Plan 5 out of 8.5 Time 124 minutes total spent in assignment Interaction with patient 124 minutes Started: Sep 17, 2020 | Total Time: 124 min All Lines (218)Interview Questions (139)Statements (24)Exam Actions (55) Hello, I'll be your nurse today. Greet 09/17/20 9:01 AM CDT Hi. I can hear that you're crying, what happened? (No matching questions found.) Question 09/17/20 9:01 AM CDT Are you in a lot of pain? (No matching questions found.) Question 09/17/20 9:01 AM CDT Are you in pain? (Clarified to What is causing the pain?.) Question 09/17/20 9:01 AM CDT Moving or touching. I told Mommy not to touch it. [AUDIO COMING SOON] (Clarified to what is causing the pain.) I'm sorry it hurts, Landon> Empathize 09/17/20 9:02 AM CDT Thanks. What is your mom's name? (No matching questions found.) Question 09/17/20 9:02 AM CDT When did you get hurt? Question 09/17/20 9:02 AM CDT After naptime. Mommy wasn't home yet. What happened? Question 09/17/20 9:03 AM CDT My arm is hurting bad. I'm sorry your arm is hurting. Empathize 09/17/20 9:03 AM CDT Um, thank you. What happened to your arm? Question 09/17/20 9:03 AM CDT I fell. Do you need any ice? (Clarified to Do you need anything?.) Question 09/17/20 9:03 AM CDT No, I went to the bathroom already. [AUDIO COMING SOON] (Clarified to if I need anything.) Do you need some water? (No matching questions found.) Question 09/17/20 9:03 AM CDT Have you taken any pain medication? Question 09/17/20 9:03 AM CDT No, medicine is yucky. [AUDIO COMING SOON] Medicine can help with your pain. Educate 09/17/20 9:04 AM CDT OK. I'm sorry medicine tastes yucky. Empathize 09/17/20 9:04 AM CDT Thats nice. Putting ice on your pain can help too. Educate 09/17/20 9:04 AM CDT Yeah. Where is your pain? Question 09/17/20 9:04 AM CDT Umm . . . [Landon reports pain in his upper left arm by pointing] [AUDIO COMING SOON] How did you get hurt? Question 09/17/20 9:05 AM CDT I fell. Did you break your arm? (No matching questions found.) Question 09/17/20 9:05 AM CDT How much does it hurt? Question 09/17/20 9:05 AM CDT Really bad. [AUDIO COMING SOON] Do you fall a lot? (Clarified to Can you tell me how you fell?.) Question 09/17/20 9:06 AM CDT I was showing Donnie a basketball trick. I couldn't do it so I fell. It was my fault. (Clarified to how I fell.) Did you fall on your arm? Question 09/17/20 9:06 AM CDT No, on the floor. [AUDIO COMING SOON] how long has your arm been hurting? Question 09/17/20 9:06 AM CDT Since when I fell. [AUDIO COMING SOON] Is there anything else that makes your pain better? (Clarified to Does anything help the pain?.) Question 09/17/20 9:08 AM CDT Keeping still. (Clarified to if anything helps the pain.) Is this woman your mom? (No matching questions found.) Question 09/17/20 9:08 AM CDT What is your relationship to Landon? Question 09/17/20 9:08 AM CDT Mommy's friend. We were playing when I fell . . . Do you feel dizzy? Question 09/17/20 9:09 AM CDT Yeah . . . [AUDIO COMING SOON] Do you have trouble seeing? (No matching questions found.) Question 09/17/20 9:09 AM CDT Do you have trouble remembering what happened? (No matching questions found.) Question 09/17/20 9:10 AM CDT Do you have trouble moving? (No matching questions found.) Question 09/17/20 9:10 AM CDT Is it hard to move? (Clarified to Do you have difficulty moving your fingers?.) Question 09/17/20 9:10 AM CDT No, they're OK. [AUDIO COMING SOON] (Clarified to if I have difficulty moving my fingers.) Do your muscles feel weak? (No matching questions found.) Question 09/17/20 9:11 AM CDT Is it hard to move? (Clarified to Does the pain limit your movement?.) Question 09/17/20 9:11 AM CDT I don't wanna move my arm. It really hurts to move. (Clarified to if the pain is limiting my movement.) I'm sorry it hurts to move your arm. Empathize 09/17/20 9:11 AM CDT Thank you. Keeping your arm still can help relieve the pain too. Educate 09/17/20 9:12 AM CDT Mhm, yeah. Do you have muscle pain? (No matching questions found.) Question 09/17/20 9:12 AM CDT Does it feel warm where you hurt your arm? (No matching questions found.) Question 09/17/20 9:13 AM CDT Do you play a lot? (No matching questions found.) Question 09/17/20 9:14 AM CDT Do you play a lot of basketball? (No matching questions found.) Question 09/17/20 9:14 AM CDT Do you run around a lot? (No matching questions found.) Question 09/17/20 9:14 AM CDT Does it hurt to move? (No matching questions found.) Question 09/17/20 9:14 AM CDT Do you have trouble moving? (No matching questions found.) Question 09/17/20 9:14 AM CDT is there any bone pain? (No matching questions found.) Question 09/17/20 9:14 AM CDT Do you have pain in more than one joint? (No matching questions found.) Question 09/17/20 9:17 AM CDT Do you have pain elsewhere? Question 09/17/20 9:17 AM CDT It's only my arm. How is this woman related to you? (No matching questions found.) Question 09/17/20 9:18 AM CDT How is she related to you? (No matching questions found.) Question 09/17/20 9:18 AM CDT Is this your mom here? (No matching questions found.) Question 09/17/20 9:18 AM CDT Is she your arm? (No matching questions found.) Question 09/17/20 9:18 AM CDT Who is this adult next to you? (No matching questions found.) Question 09/17/20 9:18 AM CDT who brought you in today? (Clarified to Do you know what brings you in today?.) Question 09/17/20 9:18 AM CDT . . . my arm. (Clarified to if I know why I came in.) Who brought you in? (No matching questions found.) Question 09/17/20 9:18 AM CDT Is this woman your mom? (No matching questions found.) Question 09/17/20 9:19 AM CDT Who is with you? Question 09/17/20 9:19 AM CDT Mommy's friend. We were playing when I fell . . . Did you mom bring you here? (No matching questions found.) Question 09/17/20 9:19 AM CDT Your hurt your arm? (Clarified to Did Donnie hurt your arm?.) Question 09/17/20 9:19 AM CDT Um, no. [AUDIO COMING SOON] (Clarified to if Donnie hurt my arm.) who brought you here? (Clarified to Who are you?.) Question 09/17/20 9:20 AM CDT I'm Landon. (Clarified to who am I.) and who is the other person? (No matching questions found.) Question 09/17/20 9:20 AM CDT who is the other person? (No matching questions found.) Question 09/17/20 9:20 AM CDT Do you have any allergies? Question 09/17/20 9:21 AM CDT Um... [AUDIO COMING SOON] It's good to come to the hospital right away after getting hurt. Educate 09/17/20 9:21 AM CDT Umm, ok. How long has it been since you hurt your arm? (Clarified to How long have you been in pain?.) Question 09/17/20 9:21 AM CDT Since when I fell. [AUDIO COMING SOON] (Clarified to how long I have been in pain.) When did you fall? Question 09/17/20 9:21 AM CDT After naptime. Mommy wasn't home yet. When was nap time? (No matching questions found.) Question 09/17/20 9:22 AM CDT Did you come here right away? Question 09/17/20 9:22 AM CDT My arm is hurting bad. Guardian, what is your relationship? (No matching questions found.) Question 09/17/20 9:22 AM CDT What is your relationship to Landon? Question 09/17/20 9:23 AM CDT Mommy's friend. We were playing when I fell . . . Who was babysitting you? (No matching questions found.) Question 09/17/20 9:23 AM CDT Who babysits you? (No matching questions found.) Question 09/17/20 9:23 AM CDT Where is your mom? (No matching questions found.) Question 09/17/20 9:23 AM CDT How long has your arm been hurting? Question 09/17/20 9:24 AM CDT Since when I fell. [AUDIO COMING SOON] Is this your parent? (No matching questions found.) Question 09/17/20 9:26 AM CDT Who is this person that is with you? (No matching questions found.) Question 09/17/20 9:30 AM CDT Guardian (No matching questions found.) Question 09/17/20 9:39 AM CDT What is your relationship to Landon? (Clarified to What is your relationship to the patient?.) Question 09/17/20 9:40 AM CDT I'm Landon's mother. [AUDIO COMING SOON] (Clarified to what my relationship is to the patient.) How did Landon get hurt? Question 09/17/20 9:43 AM CDT Well, I was at the office, but my boyfriend was at home watching Landon. He said Landon was off playing in his room when he heard a thud and crying. When he went into Landon's room, Landon was on the floor and cradling his arm. [AUDIO COMING SOON] Did Landon break his arm? (No matching questions found.) Question 09/17/20 9:45 AM CDT Is his arm broken? (No matching questions found.) Question 09/17/20 9:45 AM CDT Landon hurt his arm? (Clarified to How did your son get hurt?.) Question 09/17/20 9:46 AM CDT Well, I was at the office, but my boyfriend was at home watching Landon. He said Landon was off playing in his room when he heard a thud and crying. When he went into Landon's room, Landon was on the floor and cradling his arm. [AUDIO COMING SOON] (Clarified to how my son injured himself.) What brings Landon in today? Question 09/17/20 9:46 AM CDT Landon fell while I was at work . . . l think his arm broke the fall. He seems pretty hurt. [AUDIO COMING SOON] It's best to keep the bone still to prevent further injury. Educate 09/17/20 9:47 AM CDT OK. Thank you. Icing his arm will help to relieve his pain too. (No matching questions found.) Question 09/17/20 9:48 AM CDT It will help to take some pain medication too. Educate 09/17/20 9:48 AM CDT taking some pain medication will help. (No matching questions found.) Question 09/17/20 9:48 AM CDT Gotcha. How long has it been since Landon got hurt? (Clarified to How long has it been since your son hurt himself?.) Question 09/17/20 9:48 AM CDT It's been about two hours since he fell and hurt his arm. [AUDIO COMING SOON] (Clarified to how long it has been since my son hurt himself.) What helps the pain? (No matching questions found.) Question 09/17/20 9:49 AM CDT What are some relieving factors? (No matching questions found.) Question 09/17/20 9:49 AM CDT What makes the pain feel better? (Clarified to What helps your son feel better?.) Question 09/17/20 9:49 AM CDT I wasn't there when he fell, but when I got home I realized right away we needed to come to the hospital. Mothers just know when something is wrong with their baby. [AUDIO COMING SOON] (Clarified to what helps my son feel better.) Does Landon take any other medication? Question 09/17/20 9:51 AM CDT No, we're very lucky he doesn't need any. [AUDIO COMING SOON] What's Landon's medical history? (No matching questions found.) Question 09/17/20 9:52 AM CDT Has Landon been to the hospital before? (Clarified to Has your son ever been to the hospital before?.) Question 09/17/20 9:52 AM CDT No, no hospitalizations at all. [AUDIO COMING SOON] (Clarified to if my son has been hospitalized before.) Does Landon have any allergies? Question 09/17/20 9:54 AM CDT No, he's allergy free. [AUDIO COMING SOON] Does he take any supplements? (No matching questions found.) Question 09/17/20 9:54 AM CDT Does Landon live with you? (No matching questions found.) Question 09/17/20 9:58 AM CDT Does anybody else live at home? (No matching questions found.) Question 09/17/20 9:58 AM CDT What is your living situation? Question 09/17/20 9:58 AM CDT My living situation is great. It's just me and Landon right now and I love our little home. My parents used to watch Landon a lot more, but we live further away now so that's not really an option anymore. But I like Landon in daycare, he gets to play and be around kids his own age. [AUDIO COMING SOON] How do you like daycare? (No matching questions found.) Question 09/17/20 10:08 AM CDT Do you like daycare? (No matching questions found.) Question 09/17/20 10:09 AM CDT Is there any emotional and physical abuse at home? (No matching questions found.) Question 09/17/20 10:09 AM CDT Does Landon get hurt often? (No matching questions found.) Question 09/17/20 10:09 AM CDT I'm sorry you live farther away from your parents now. Empathize 09/17/20 10:09 AM CDT Thanks, I . . . I needed to hear that I think. It's hard when you don't have many family members around. (No matching questions found.) Question 09/17/20 10:10 AM CDT Daycare is a great option otherwise. (No matching questions found.) Question 09/17/20 10:10 AM CDT Daycare does help with a lot of learning. Educate 09/17/20 10:10 AM CDT That makes sense, thanks. Is your home safe? Question 09/17/20 10:10 AM CDT Yeah, of course I do. I'm going to get rid of Landon's bunk bed now though, so he doesn't fall again and hurt himself. [AUDIO COMING SOON] Does Landon feel any pain? (No matching questions found.) Question 09/17/20 10:12 AM CDT Does Landon have trouble seeing? (Clarified to Is your son having difficulty moving?.) Question 09/17/20 10:12 AM CDT His movements seem normal. I mean, he definitely doesn't want to move his arm around. But he got in and out of the car OK once I got him out of his car seat. [AUDIO COMING SOON] (Clarified to if my son is having difficulty moving.) Are there any neurological issues? (No matching questions found.) Question 09/17/20 10:13 AM CDT Was Landon conscious? (No matching questions found.) Question 09/17/20 10:14 AM CDT Does Landon have trouble remembering anything? Question 09/17/20 10:14 AM CDT His movements seem normal. I mean, he definitely doesn't want to move his arm around. But he got in and out of the car OK once I got him out of his car seat. [AUDIO COMING SOON] Can Landon remember what he had for breakfast? (No matching questions found.) Question 09/17/20 10:14 AM CDT Does Landon have memory problems? (No matching questions found.) Question 09/17/20 10:15 AM CDT Can Landon move his fingers? Question 09/17/20 10:15 AM CDT Yeah, I asked him to wiggle his fingers for me earlier and he could without issue. [AUDIO COMING SOON] Did he scrape himself? (No matching questions found.) Question 09/17/20 10:15 AM CDT Did Landon get any cut? (No matching questions found.) Question 09/17/20 10:15 AM CDT Checked ID band Exam Action 09/17/20 10:36 AM CDT Assessed vitals Exam Action 09/17/20 10:36 AM CDT is he bleeding? (No matching questions found.) Question 09/17/20 10:16 AM CDT Is he bleeding? (No matching questions found.) Question 09/17/20 10:16 AM CDT Assessed vitals Exam Action 09/17/20 10:37 AM CDT Is he bleeding? (No matching questions found.) Question 09/17/20 10:37 AM CDT Is he bleeding? (No matching questions found.) Question 09/17/20 10:37 AM CDT Inspected shoulders from the front Exam Action 09/17/20 10:38 AM CDT Inspected left shoulder Exam Action 09/17/20 10:38 AM CDT Inspected upper back Exam Action 09/17/20 10:38 AM CDT Inspected left arm Exam Action 09/17/20 10:39 AM CDT Inspected front of left arm: swelling and discoloration Exam Action 09/17/20 10:39 AM CDT Inspected side of left arm: swelling and discoloration Exam Action 09/17/20 10:40 AM CDT Inspected back of left arm: swelling and discoloration Exam Action 09/17/20 10:40 AM CDT Inspected side of left arm: swelling and discoloration Exam Action 09/17/20 10:40 AM CDT Inspected front of left arm: swelling and discoloration Exam Action 09/17/20 10:40 AM CDT How did Landon fall? Question 09/17/20 10:40 AM CDT I wasn't home at the time, but Donnie said he heard a thump from upstairs where Landon was playing. He ran upstairs and found him crying on the floor, holding his arm. His bed is about four feet tall-- it's one of those bunks for little kids that Landon insisted I get for him. It must have been a pretty nasty fall. [AUDIO COMING SOON] Was the bruise this big? (No matching questions found.) Question 09/17/20 10:41 AM CDT Did he have a bruise? (No matching questions found.) Question 09/17/20 10:41 AM CDT Was he bruised? (No matching questions found.) Question 09/17/20 10:41 AM CDT Inspected left elbow Exam Action 09/17/20 10:41 AM CDT Inspected right elbow Exam Action 09/17/20 10:41 AM CDT Inspected both wrists Exam Action 09/17/20 10:42 AM CDT Inspected both hands: No visible abnormal findings Exam Action 09/17/20 10:42 AM CDT Inspected front of hips Exam Action 09/17/20 10:42 AM CDT Inspected front of hips Exam Action 09/17/20 10:42 AM CDT Inspected front of thighs Exam Action 09/17/20 10:42 AM CDT Inspected front of knees Exam Action 09/17/20 10:42 AM CDT Inspected front of thighs Exam Action 09/17/20 10:42 AM CDT Inspected front of knees Exam Action 09/17/20 10:42 AM CDT Inspected front of legs Exam Action 09/17/20 10:42 AM CDT Inspected right ankle Exam Action 09/17/20 10:43 AM CDT Inspected top of feet Exam Action 09/17/20 10:43 AM CDT Inspected top of feet Exam Action 09/17/20 10:43 AM CDT Tested capillary refill Exam Action 09/17/20 10:43 AM CDT Tested ROM of shoulders - flexion Exam Action 09/17/20 10:44 AM CDT Tested ROM of elbows - flexion and extension Exam Action 09/17/20 10:48 AM CDT Tested ROM of wrists - flexion Exam Action 09/17/20 10:49 AM CDT Tested left arm sensation Exam Action 09/17/20 10:49 AM CDT Tested right arm sensation Exam Action 09/17/20 10:49 AM CDT Inspected left torso: No abnormal findings Exam Action 09/17/20 10:51 AM CDT Inspected back torso: There is a fading bruise. No other abnormal findings. Exam Action 09/17/20 10:51 AM CDT Inspected right torso: No abnormal findings Exam Action 09/17/20 10:52 AM CDT Inspect skin Exam Action 09/17/20 10:52 AM CDT How did you get that bruise on your back? Question 09/17/20 10:52 AM CDT I . . . I dunno . . . I fell. Do you fall often? Question 09/17/20 10:52 AM CDT I just fall sometimes . . . Donnie says Im clumsy. Do you get hurt a lot? Question 09/17/20 10:53 AM CDT I mean I think so. Now you have me a little paranoid with these questions. Landon is an active kid. I thought falling around, bumps, and bruises were normal for a 4-year-old. He said the bruise on his back was from falling on a toy and I believed him. How long has that bruise been there? Question 09/17/20 10:53 AM CDT Probably because hes so slow on the uptake. Donnies really sweet, but hes no genius, trust me. When did you get that bruise on your back? (Clarified to How did you get the bruise?.) Question 09/17/20 10:54 AM CDT I fell down. (Clarified to how I got the bruise.) Does Landon bruise easily? (Clarified to Does your son have any bruises?.) Question 09/17/20 10:54 AM CDT He's got a bruise on his back from a tumble a few days ago, but it's healing up. Other than that, there's just the bruising and swelling from his arm. [AUDIO COMING SOON] (Clarified to if my son has any bruises.) Are there any other safety concerns? Question 09/17/20 10:55 AM CDT Not really. I mean, I'm a little freaked out about all of this. But I'll answer anything you ask me. I just want Landon to be taken care of. He's my number one priority. The most common injuries for children his age are head injuries and broken bones. Educate 09/17/20 10:55 AM CDT I appreciate you telling us, now we know. I'm sorry Landon got hurt. Empathize 09/17/20 10:55 AM CDT I'm glad to hear that, thank you. How long have you been with Donnie? Question 09/17/20 10:57 AM CDT I've known Donnie for about 7 months. We met at a restaurant. I introduced him to Landon a few weeks ago, and he's been visiting the house lately. [AUDIO COMING SOON] Has Landon gotten any bruises before you met Donnie? (No matching questions found.) Question 09/17/20 10:58 AM CDT Did these injuries start when you met Donnie? (No matching questions found.) Question 09/17/20 10:58 AM CDT Do you feel safe around Donnie? Question 09/17/20 10:58 AM CDT I don't wanna be at home. Is this when your mom isn't home? (No matching questions found.) Question 09/17/20 10:59 AM CDT Do you feel safe with Donnie? Question 09/17/20 10:59 AM CDT I don't wanna be at home. Has Donnie hurt you? (No matching questions found.) Question 09/17/20 10:59 AM CDT Does Donnie hurt you? (No matching questions found.) Question 09/17/20 10:59 AM CDT Where do you feel safe? Question 09/17/20 10:59 AM CDT I don't wanna be at home. I'm sorry you don't want to be at home. Empathize 09/17/20 10:59 AM CDT Thanks. When children don't feel safe, they don't want be near people who hurt them. Educate 09/17/20 11:01 AM CDT Gotcha. I'm sorry your son doesn't want to be at home. Empathize 09/17/20 11:01 AM CDT Thats kind of you to say, thank you. Does Landon play basketball? (No matching questions found.) Question 09/17/20 11:02 AM CDT Did you like being at home before? (No matching questions found.) Question 09/17/20 11:03 AM CDT Inspected shoulders from the front Exam Action 09/17/20 11:04 AM CDT Inspected both wrists Exam Action 09/17/20 11:04 AM CDT Inspected both hands: No visible abnormal findings Exam Action 09/17/20 11:04 AM CDT Inspected both hands: No visible abnormal findings Exam Action 09/17/20 11:04 AM CDT Inspected front of hips Exam Action 09/17/20 11:04 AM CDT Tested ROM of shoulders - flexion Exam Action 09/17/20 11:05 AM CDT Tested ROM of shoulders - flexion Exam Action 09/17/20 11:06 AM CDT Tested ROM of elbows - flexion and extension Exam Action 09/17/20 11:06 AM CDT You will now report your concerns about abuse. Talk to Preceptor Diana like you would your charge nurse. You will not be automatically scored on your choices or responses in this activity, but your instructor may choose to review your responses. Exam Action 09/17/20 11:06 AM CDT Proceed. Question 09/17/20 11:06 AM CDT Let's walk through your concerns together. We will begin by talking about the subjective data you collected that raised concerns about abuse. Then, we will address objective data that may indicate abuse. Finally, we will discuss why you think this data is a sign of risk of abuse. Remember that you do not need to speculate about what specifically happened to Landon or who is responsible. You only need to identify data that indicates that there is an elevated risk of abuse in this situation. Can you tell me what subjective data you collected that increased your index of suspicion for abuse? Landon has no previous history of hospitalizations. His mother introduced him to her boyfriend of 7 months, just a few weeks ago and he's been visiting every day since then. Landon says, "I don't want to be home." Question 09/17/20 11:08 AM CDT I understand. You did the right thing escalating your concerns. Let's continue to look at the data you collected Can you tell me the objective data you collected that increased your index of suspicion for abuse? Landon has a dark bruise on his back from one side to the other. Question 09/17/20 11:09 AM CDT I see why you approached me to escalate your concerns about abuse. Let's review all the data we've discussed before we report this case to Child Protective Services. Look over the subjective and objective data that elevated your index of suspicion for abuse. Why did you include each of these items? Objective: Landon's arm is hurt and the bruise on his upper left arm does not look natural as the bruise is wrapped around his arm. There is also a dark bruise across on his lower back. Subjective data: Landon reports he "does not want to be at home." Question 09/17/20 11:12 AM CDT Good. It looks like we're ready to report. You and Diana contact Child Protective Services with the apppropriate information. They will promptly conduct an investigation. Exam Action 09/17/20 11:12 AM CDT I know it's not easy to raise concerns about abuse, but you did the right thing for Landon. The next step is to talk to Heather about what will happen next. Now you will have a conversation with Heather about the decision to escalate your concerns of physical abuse. This will be a stressful conversation for Heather, so utilize your therapeutic communication skills and choose your words carefully. You will not be automatically scored on your choices or responses in this activity, but your instructor may choose to review your responses. Exam Action 09/17/20 11:13 AM CDT I am ready to begin the conversation with Heather. Question 09/17/20 11:13 AM CDT Hey, um, what's going on here? Some of the questions you've been asking are starting to make me nervous. You can't just keep me in the dark here . . . if something is going on, I need to know about it. Explain to Heather that you are a mandatory reporter, and as such you have reported Landon's case for potential physical abuse. Be sure to stick to factual information and avoid speculation or opinion. Exam Action 09/17/20 11:13 AM CDT I am mandated to report suspicions of child abuse. Children often bruse around bony prominences such as knees and elbows. The bruising on his back isn't naturally where children get bruised. The bruise around his upper left arm does not look like an accident. Landon's report of "not wanting to be home" is another red flag. Question 09/17/20 11:15 AM CDT What?! That's absolutely ridiculous, I would never let anything like that happen to my son. Landon's afraid. He's in a lot of pain. And now we're going to have to stay here for this? I can't believe this . . . Respond to Heather, communicating that care of Landon's physical injury will definitely continue and that you and the hospital are still there for the both of them. Exam Action 09/17/20 11:15 AM CDT Landon's injury still needs to be observed and we're going to continue to take care of him, including you. If you have any other quesitons, you're welcome to ask. Question 09/17/20 11:16 AM CDT I appreciate that, I do, but I just . . . you don't seriously think I would let that happen, do you? Or that I could do it myself? That Donnie could? God, I know he's not great with kids but I'm having a hard time believing that he's capable of something like this. Let Heather know that you cannot speculate on what happened or did not happen, but that it is simply your due diligence to report your findings, as your only priority is the safety of Landon. Exam Action 09/17/20 11:16 AM CDT I cannot speculate what happened but if there is a suspicion of abuse, I have to report it. Question 09/17/20 11:16 AM CDT No, I . . . I get that. Obviously Landon is my only priority . . . things have just been so busy at work lately and . . . God . . . Look, if anyone is hurting Landon, I need to know who it is for certain so I can press charges or do whatever I need to do to make sure that this never happens again. Ask Heather about home safety and if she may be at risk for abuse herself. Exam Action 09/17/20 11:17 AM CDT Is your home childproofed? Are there safety locks and cords are put away? Do you feel safe at home as well? Question 09/17/20 11:17 AM CDT I haven't known Donnie for very long but if I had even an inkling that he was getting violent with me or with Landon, I would have either left or called the police or . . . something. I'm sorry, my mind is just racing right now, trying to think what I missed or how I didn't see this . . . what, um . . . what happens now? Explain the next steps of the process to Heather empathetically and accurately. Exam Action 09/17/20 11:18 AM CDT We're going to continue to take care of you. Social services is going to be involved and law enforcement will be contacted. We're going to be here for you so if you have any questions, you're welcome to ask. Question 09/17/20 11:18 AM CDT OK. I'm just . . . this is not OK. Not you, you're just doing your job, I know that. I just feel horrible . . . but we need to get to the bottom of this, for his sake. So I'll do whatever it takes to make sure if something is going on, that it'll never happen again. Reassure Heather that the hospital is going to do everything possible to keep Landon safe through the process and say goodbye. Exam Action 09/17/20 11:19 AM CDT When these kinds of occurences happen, and at all times, we do our best to keep our patients safe. That also includes you. If Landon continues to be in pain, we can give him pain medication. We can give him ice to help with the pain as well. If you need anything else, just ask. Question 09/17/20 11:20 AM CDT OK, we'll wait for the next steps then . . . and thank you. Really, nurse. You have successfully communicated the child safety protocol to Heather and informed her of the situation at hand. Scenarios like these can be difficult to think about and will be even more difficult in actual practice to walk through. It is important to remember that your role is not to figure out the explicit details of what has occurred or "solve" the situation, but rather to uphold and protect the patient's safety and provide them with the treatment that they need. Exam Action 09/17/20 11:20 AM CDT You have completed this situation and performed all your duties appropriately while staying empathetic to the patient's needs. Exam Action 09/17/20 11:20 AM CDT I have created a care plan that will focus on decreasing his pain to 2/10 or less in the next 2 hours. I will continue to assess for presence of pain by asking if on a scale of 0-10, with 0 being no pain and 10 being the worst, or, I will base it on how he is expressing it by face. Upon the provider's order, I will be able to give Landon some pain medication. We also have some activities for Landon to help forget the pain. In the meantime, again, we will continue to assess his pain. Educate 09/17/20 11:29 AM CDT Alright. That makes sense. I want to be kept in the loop with all of Landon's treatment. Parents are always part of the care team. Educate 09/17/20 11:29 AM CDT Alright. I just want what's best for Landon. Would you like to proceed with the care plan? Educate 09/17/20 11:30 AM CDT You have my permission. Upon the doctor's order, I will be able to give him some pain medication. In the meantime, we can ice it if he'd like? Educate 09/17/20 11:30 AM CDT Ok. Landon, we're going to focus on bringing your pain down in the next 2 hours. When I get the doctor's order, we'll give you some medicine and continue to see if your pain gets better. We'll have some activities for you to do if you'd like? Educate 09/17/20 11:31 AM CDT Umm, ok. Our goal with you is to bring your pain down to a 2/10 and we will continue to assess for that after we get the doctor's order to give you some pain medication. In the meantime we can do some activities of your choice? Educate 09/17/20 11:32 AM CDT Umm, I'm not sure. If Mommy says ok. May we continue with this care plan? Educate 09/17/20 11:33 AM CDT Um. I don't want my arm to hurt. Subjective Data Collection: 26 of 26 (100.0%) Hover To Reveal... Hover over the Patient Data items below to reveal important 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 Patient • Finding: Established chief complaint • Finding: Reports arm pain (Found) Pro Tip: A pediatric patient's chief complaint establishes any illnesses or concerns they are presenting. Asking about the chief complaint will allow the patient to voice any concerns or symptoms the patient may have. Example Question: May I ask what has brought you in? Patient Comfort • Finding: Asked about patient comfort and needs • Finding: Reports no additional discomfort (Found) Pro Tip: Assessing a pediatric patient's status involves asking about their current comfort, needs, and chief complaint. It's important to check in with a patient's status, because it may reveal insight into their current condition. Example Question: Is there anything I can do to make you more comfortable? • Finding: Denies needing to use the bathroom (Found) Pro Tip: Assessing a pediatric patient's status involves asking about their current comfort, needs, and chief complaint. It's important to check in with a patient's status, because it may reveal insight into their current condition. Example Question: Would you like help to get to the restroom? History of Present Illness Patient • Finding: Asked about onset • Finding: Reports falling after naptime but before his mom came home (Found) Pro Tip: Asking a pediatric patient about the duration and onset of their current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing. Example Question: When did the injury occur? • Finding: Asked about pain location • Finding: Reports pain in upper arm (by his shoulder) (Found) Pro Tip: Asking a pediatric patient about the duration and onset of their current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing. Example Question: Where does the pain come from? • Finding: Asked about duration • Finding: Reports the pain ongoing since the fall (Found) Pro Tip: Asking a pediatric patient about the duration and onset of their current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing. Example Question: Does your pain get worse and then get better? • Finding: Asked about aggravating factors • Finding: Reports pain is worse upon movement (Found) Pro Tip: Asking a pediatric patient about the duration and onset of their current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing. Example Question: Does anything make the pain worse? • Finding: Reports pain when touching arm (Found) Pro Tip: Asking a pediatric patient about the duration and onset of their current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing. Example Question: Does your arm hurt to touch? • Finding: Asked about relieving factors • Finding: Reports Donnie putting peas on his arm, and it not working (Available) Pro Tip: Asking a pediatric patient about the duration and onset of their current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing. Example Question: Did Donnie do anything to help you feel better? • Finding: Reports not moving arm helps pain (Found) Pro Tip: Asking a pediatric patient about the duration and onset of their current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing. Example Question: What helps the pain go away? • Finding: Asked about severity • Finding: Reports arm pain 4 out of 10 pain on a scale (Available) Pro Tip: Asking a pediatric patient about the duration and onset of their current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing. Example Question: Can you rate your current pain level on a scale of 0 to 10? • Finding: Reports pain has lessened somewhat since fall (Available) Pro Tip: Asking a pediatric patient about the duration and onset of their current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing. Example Question: Do you feel better now? • Finding: Asked about mechanism of injury • Finding: Reports falling (Found) Pro Tip: Asking a pediatric patient about the duration and onset of their current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing. Example Question: What happened to your arm? • Finding: Denies landing on anything (Found) Pro Tip: Asking a pediatric patient about the duration and onset of their current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing. Example Question: Did you fall on your hands? • Finding: Followed up about mechanism of injury • Finding: Reports falling off of bed (Available) Pro Tip: Asking a pediatric patient about the duration and onset of their current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing. Example Question: What did you fall off of? • Finding: Refuses to explain how he fell (Found) Pro Tip: Asking a pediatric patient about the duration and onset of their current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing. Example Question: How did the fall happen? • Finding: Reports Donnie was with him when he fell (Found) Pro Tip: Asking a pediatric patient about the duration and onset of their current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing. Example Question: Did anyone see you fall? • Finding: Reports falling was his own fault (Found) Pro Tip: Asking a pediatric patient about the duration and onset of their current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing. Example Question: What were you doing when you fell off your bunk bed? Review of Relevant Systems Patient • Finding: Asked about neurological system • Finding: Denies tingling or pins and needles (Available) Pro Tip: Understanding a pediatric patient's health involves a comprehensive overview of their physiological systems. This is necessary to understand what symptoms may indicate larger issues, and what treatments the patient may require. Example Question: Have you felt tingling anywhere? • Finding: Denies problems moving digits (Found) Pro Tip: Understanding a pediatric patient's health involves a comprehensive overview of their physiological systems. This is necessary to understand what symptoms may indicate larger issues, and what treatments the patient may require. Example Question: Do you have difficulty moving your fingers? • Finding: Denies numbness (Available) Pro Tip: Understanding a pediatric patient's health involves a comprehensive overview of their physiological systems. This is necessary to understand what symptoms may indicate larger issues, and what treatments the patient may require. Example Question: Do you feel numb right now? • Finding: Asked about musculoskeletal system • Finding: Denies injury elsewhere (Found) Pro Tip: Understanding a pediatric patient's health involves a comprehensive overview of their physiological systems. This is necessary to understand what symptoms may indicate larger issues, and what treatments the patient may require. Example Question: Do you have any other injuries? Confirmed Guardian's Relationship • Finding: Confirmed guardian's relationship to patient • Finding: Reports being patient's mother (Found) Pro Tip: Determining the guardian's relationship to a pediatric patient confirms the appropriate family members are present. Knowing who is with the pediatric patient will help you to develop the best approach to gathering information on the patient's condition. Example Question: What is your relationship to the patient? • Finding: Reports patient's correct name and date of birth (Available) Pro Tip: Determining the guardian's relationship to a pediatric patient confirms the appropriate family members are present. Knowing who is with the pediatric patient will help you to develop the best approach to gathering information on the patient's condition. Example Question: How old is your son? Chief Complaint Guardian • Finding: Confirmed chief complaint • Finding: Reports being told that patient fell and hurt his arm (Found) Pro Tip: A pediatric patient's chief complaint establishes any illnesses or concerns they are presenting. Asking a pediatric patient's guardian about the chief complaint will allow them to voice any concerns or symptoms they may have. Example Question: May I ask the reason for your visit? • Finding: Reports bruising and swelling (Found) Pro Tip: A pediatric patient's chief complaint establishes any illnesses or concerns they are presenting. Asking a pediatric patient's guardian about the chief complaint will allow them to voice any concerns or symptoms they may have. Example Question: What are your son's symptoms History of Present Illness Guardian • Finding: Asked about onset and duration of symptoms • Finding: Reports being told that patient fell approximately two hours ago (Found) Pro Tip: Asking a pediatric patient's guardian about the duration and onset of the patient's current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing. Example Question: When did your son fall? • Finding: Asked guardian about relieving factors • Finding: Denies giving patient medication (Found) Pro Tip: Asking a pediatric patient's guardian about the duration and onset of the patient's current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing. Example Question: Did you give any medication to your son? • Finding: Reports Donnie putting a bag of frozen peas on patient's arm, which did not help (Available) Pro Tip: Asking a pediatric patient's guardian about the duration and onset of the patient's current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing. Example Question: When you were at home, what did you do for your son? • Finding: Asked guardian about mechanism of injury • Finding: Reports patient fell about four feet (Found) Pro Tip: Asking a pediatric patient's guardian about the duration and onset of the patient's current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing. Example Question: How far did your son fall? • Finding: Reports not being present when patient was injured (Found) Pro Tip: Asking a pediatric patient's guardian about the duration and onset of the patient's current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing. Example Question: Who was with your son when he fell? • Finding: Reports being filled in on the fall by boyfriend, Donnie (Found) Pro Tip: Asking a pediatric patient's guardian about the duration and onset of the patient's current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing. Example Question: Do you know if someone else was involved in your sons fall? • Finding: Reports being told that patient hurt arm by falling off of bed (Found) Pro Tip: Asking a pediatric patient's guardian about the duration and onset of the patient's current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing. Example Question: How did your son get hurt? • Finding: Asked about timeline of events • Finding: Reports being told that Donnie heard the patient fall and ran up to find him on the floor (Found) Pro Tip: Asking a pediatric patient's guardian about the duration and onset of the patient's current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing. Example Question: How did your son fall? • Finding: Reports rushing home after being called, and coming to the hospital very soon after (Found) Pro Tip: Asking a pediatric patient's guardian about the duration and onset of the patient's current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing. Example Question: Were you nearby your son at the time of his fall? • Finding: Reports Donnie did not call immediately after the fall (Available) Pro Tip: Asking a pediatric patient's guardian about the duration and onset of the patient's current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing. Example Question: Were you with your son when he fell? Past Medical History Guardian • Finding: Asked about past medical history • Finding: Denies past medical conditions (Available) Pro Tip: Asking a guardian about the pediatric patient's relevant medical history can reveal past diagnoses and previous conditions or concerns. Information about the patient's existing health conditions, a timeline of the diagnosis, symptoms, and allergies can indicate where you should follow-up for further care and treatment. Example Question: Does your son have a history of health concerns? • Finding: [Show More]

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