Chamberlain College of Nursing - NR 509W2_SH_[Transcript}]-Asthma-Respiratory | Completed. 100%. Complete.

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Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM https://chamberlain.shadowhealth.com/assignment_attempts/3664486 Page 1 of 39 Respiratory Results | Turned In Advanced Health Assessment - C... hamberlain, NR509-June-2018 Return to Assignment Your Results Lab Pass Lab Pass Started: Jul 21, 2018 | Patient Exam Time: 738 min Transcript Subjective Data Collection Objective Data Collection Education & Empathy Documentation Student Pre-Survey Lifespan Review Questions Self-Reflection Interview Questions (216) Interview Questions (216) Statements (23) Statements (23) Exam Actions (58) Exam Actions (58) Tina, it's good to see you again. If you don't remember me, I'm Scott, your nurse practitioner. I'll be doing your examination today. Hey. 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. Tell me about the breathing issues your experiencing? It feels like it's been hard to take in air. My chest feels all tight and I've been wheezing... I've had to use my inhaler a lot, and it doesn't feel like it's totally working. To make sure I understand, you feel like you can't get enough air? (No matching questions found.) All Lines (297) All Lines (297)Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM https://chamberlain.shadowhealth.com/assignment_attempts/3664486 Page 2 of 39 I'm sorry, thats a terrible feeling. Thanks for saying that. I know that we have been through these same set of questions, so I'm sorry I'm going to ask them again. I'm not really insulting your intelligence, although it may seem like I am. Alright, thanks for letting me know. When did your breathing issues begin? All of these breathing problems started two days ago, at my cousin's house. Were you around cats? Two days ago, at my cousin's house. She has three of them, and my asthma always goes crazy when I'm there. Because your allergic to cats, right? Definitely. Cats make my asthma go crazy. How long were you exposed to these cats? (No matching questions found.) Has your asthma gotten worse since you were exposed to the cats?Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM https://chamberlain.shadowhealth.com/assignment_attempts/3664486 Page 3 of 39 Question Did anything make you asthma feel better? (No matching questions found.) Your inhaler didn't help your asthma? (Clarified to what do you do if your inhaler doesn't work.) I guess I don't really have a backup plan; it's always worked in the past, though lately I've needed more puffs than usual. How many puffs do you need? Sometimes I have to take three puffs instead of two, and the past couple days, always three. [Nurse confirmed with Pharmacy: albuterol 90mcg/spray MDI] How many times did you use your inhaler the past two days? (Clarified to how many times have you used your inhaler in the past two days.) I've been needing my inhaler about every four hours, I'd say. What have you done to treat your asthma? (Clarified to how do you manage your asthma.) I try to avoid things that give me breathing problems, but when my asthma starts to act up, I just use my inhaler. Why didn't you avoid the cats this time? I haven't been sleeping as well because my asthma has been getting a little worse at night, and it's been waking me up, too. How many times to you wake up with asthma?Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM I feel like I've woken up at least twice each night with breathing problems the past two nights. Are you able to fall back asleep? (No matching questions found.) Have you been sick lately? No, I'm usually healthy. Have you been exposed to any dust lately? No. . . I'm not around dust much. It mostly happens if I'm at someone's house and they don't keep it very clean, and that hasn't happened in a while. How often have you been having trouble breathing? Maybe as much as every four hours? It's a lot. When is the last time you were hospitalized because of an asthma attack? I used to go to the hospital a lot for asthma attacks, but not since I was sixteen. What have you done to avoid hospitalizations due to asthma? (No matching questions found.) That's awesome - to be able to avoid going to the hospital since 16 years old. I appreciate you saying that.Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM https://chamberlain.shadowhealth.com/assignment_attempts/3664486 Page 5 of 39 Question reating your asthma? I try to avoid things that give me breathing problems, but when my asthma starts to act up, I just use my inhaler. How often have you been using your inhaler lately? I don't usually use it every day, but I've used it a bunch the past couple ple days.Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM https://chamberlain.shadowhealth.com/assignment_attempts/3664486 Page 6 of 39 ications for your asthma? My inhaler is the only prescription I always have, but I usually don't need it everyday, except for recently. . . Do you take any other medications? (Clarified to are you taking other medications.) No, all I really use is my inhaler. Have you ever been prescribed with a corticosteroid? Yeah, when I was diagnosed they gave me a medicine to try. What medication did they give you when you were first diagnosed with asthma? (Clarified to 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. Which medication did your doctor first diagnosed with asthma? (No matching questions found.) Which medications have you tried for asthma in the past? It's just a regular Proventil inhaler. Do you get asthma symptoms when you exercise? (Clarified to Do you have asthma when you 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.Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM https://chamberlain.shadowhealth.com/assignment_attempts/3664486 Page 7 of 39 Do you get winded while going up a flight of stairs? (Clarified to Do you get short of breath when you go up a flight of stairs?.) Only when I'm in a rush and have to hurry up them. Do you have shortness of breath while doing normal activities around the house? It's definitely been harder to move around without worrying my asthma was going to act up again. Have you ever had an asthma attack that was so severe that you nearly died? (Clarified to How many asthma attacks have you had.) I haven't had a full attack, but I've had a lot of breathing problems-- probably. . . ten times since I was at my cousin's house two days ago. I'm sorry, that's rough and a but scary. Thanks for saying that. Are you experiencing any chest pain? My chest has been feeling tight, but it doesn't hurt or anything. Do you feel increased tightness when you take a slow deep breath? (No matching questions found.) Do you have an increase in chest tightness when you take a deep breath? (Clarified to do you have pain when you breathe.) No, my chest feels tight when I have breathing problems, but it doesn't hurt. On a scale from 0 to 10, ten being the worst chest tightness you've ever felt, how would you rate your chest tightness right now?Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM https://chamberlain.shadowhealth.com/assignment_attempts/3664486 Page 8 of 39 It doesn't hurt. . . it's just hard to breathe, but there's no pain. Have you had any coughing fits lately? I've been coughing a lot, yeah. When do you usually cough the most? I've been coughing all day, but. . . I guess it gets a little worse at night. Does your coughing get worse any time you lay down? Yeah, it's like, as soon as I lie down in bed the cough gets worse. It's making it harder to sleep. When did your asthma symptoms start? I think I was about two and a half? I used to have a lot of trouble with asthma attacks back then. How many times have you had breathing problems in the past two days? 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 you asthma keeping you up at night? My asthma doesn't usually wake me up, but it has the past couple nights.Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM https://chamberlain.shadowhealth.com/assignment_attempts/3664486 Page 9 of 39 Qu How many times do you wake up during the night? I feel like I've woken up at least twice each night with breathing problems the past two nights. 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. Have you missed work because of your asthma? (Clarified to Have you had to miss work because of your asthma?.) Luckily I haven't been expected in at work the past two days, or else I probably would have had to call in sick. . . my asthma's never kept me home from work before this, though. Have you had to miss school because of your asthma? (Clarified to Have you had to miss work because of your asthma?.) Luckily I haven't been expected in at work the past two days, or else I probably would have had to call in sick. . . my asthma's never kept me home from work before this, though. Has your chest been tight these past two days? (Clarified to how many days has your chest felt tight in the past week.) Just the past two days, since I was around those cats.Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM https://chamberlain.shadowhealth.com/assignment_attempts/3664486 Page 10 of 39 How bad is your chest tightness right now? It's not so bad right this second, but it's been pretty tight lately, like I can't take in air. Why is your chest tightness feeling a little better right this second? It's not so bad right this second, but it's been pretty tight lately, like I can't take in air. Did you do anything to help relieve your chest tightness? (No matching questions found.) How do you relieve your chest tightness? Once my asthma starts to act up, I just use my inhaler, and then I feel better within a minute or two. How would you describe your cough? Um. . . I guess I'd describe it as a small, dry cough. Have you tried anything to treat your cough? I haven't taken medicine for it or anything. Does laying down on your back make your cough worse? Yeah, it's like, as soon as I lie down in bed the cough gets worse. It's making it harder to sleep.Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM https://chamberlain.shadowhealth.com/assignment_attempts/3664486 Page 11 of 39 Try to make sure that when you lay down, you elevate your shoulders, 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. What makes your asthma worse? For the last two days, it seems worse at night when I'm lying down, or when I'm moving around too much. Typically it's stuff like cats or dust that gets to me. What is the most severe cause of your allergies? No, never anything severe, unless my asthma acting up around cats Inspected left side chest wallRespiratory | Completed | Shadow Health 7/26/18, 2)22 PM https://chamberlain.shadowhealth.com/assignment_attempts/3664486 Page 13 of 39 Percussed anterior right lower lobeRespiratory | Completed | Shadow Health 7/26/18, 2)22 PM https://chamberlain.shadowhealth.com/assignment_attempts/3664486 Page 14 of 39 Exam Action Auscultated breath sounds in anterior right upper lobeRespiratory | Completed | Shadow Health 7/26/18, 2)22 PM https://chamberlain.shadowhealth.com/assignment_attempts/3664486 Page 15 of 39 Auscultated breath sounds in anterior left mid-chest (upper lobe) Ninety-nine.Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM https://chamberlain.shadowhealth.com/assignment_attempts/3664486 Page 16 of 39 piratory | Completed | Shadow Health 7/26/18, 2)22 PM https://chamberlain.shadowhealth.com/assignment_attempts/3664486 Page 17 of 39 Exam Action Auscultated voice sounds in anterior left lower lobeRespiratory | Completed | Shadow Health 7/26/18, 2)22 PM https://chamberlain.shadowhealth.com/assignment_attempts/3664486 Page 18 of 39 Exam Action N oice sounds in posterior right lower lobeRespiratory | Completed | Shadow Health 7/26/18, 2)22 PM https://chamberlain.shadowhealth.com/assignment_attempts/3664486 Page 20 of 39 Exam Action | Completed | Shadow Health 7/26/18, 2)22 PM https://chamberlain.shadowhealth.com/assignment_attempts/3664486 Page 21 of 39 Ninety-nine.Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM https://chamberlain.shadowhealth.com/assignment_attempts/3664486 Page 22 of 39 Ninety-nine. Ninety-nine.Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM https://chamberlain.shadowhealth.com/assignment_attempts/3664486 Page 23 of 39 piratory | Completed | Shadow Health 7/26/18, 2)22 PM https://chamberlain.shadowhealth.com/assignment_attempts/3664486 Page 24 of 39 Ninety-nine. Ninety-nine.Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM 9 Ninety-nine.Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM https://chamberlain.shadowhealth.com/assignment_attempts/3664486 Page 27 of 39 Ninety-nine. Ninety-nine.Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM https://chamberlain.shadowhealth.com/assignment_attempts/3664486 Page 28 of 39 Alright, exam is over, you may put your shirt back on. Thanks. (No matching questions found.) Alright, exam is over, you may put your shirt back on. Thanks. Alright, thanks for letting me know. I have some more questions for you, if that's ok? (Clarified to i would like to ask questions about your medical history.) Ok. What about? Have you ever had any traumatic accidents? (Clarified to have you had trauma.)Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM https://chamberlain.shadowhealth.com/assignment_attempts/3664486 Page 29 of 39 ry a few months ago, but that's all I can think of. Have you had any surgeries? Nope. No surgeries... I've been lucky. Have you had any mental illness? Nope. Have you ever been depressed? The closest I ever came to depression was after Dad died...I just felt sad all the time. I'm sorry to hear about that. It's tough to lose someone so close to you, especially a parent. (No matching questions found.) I'm sorry to hear about that. It's tough to lose someone so close to you, especially a parent. Thanks. Are you current on your immunizations? Yeah, I'm pretty sure. Did you receive a flu shot this year? No.Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM https://chamberlain.shadowhealth.com/assignment_attempts/3664486 Page 30 of 39 Question If you don't mind me asking, Why not? (No matching questions found.) Why not? (No matching questions found.) What kept you from getting getting a flu shot? I just don't see a need for it. Why do you feel there's no need for a flu shot? (No matching questions found.) Is the reason why you didn't get a flu shot this year a matter of money? (Clarified to why didn't you get a flu shot.) I've had a couple in the past, but it never seemed like they were that effective so I just kind of stopped getting them. If I can avoid getting a shot, I will! whealth.com/assignment_attempts/3664486 Page 31 of 39 Educate 07/24/18 10:30 PM CDT The flu-shot while it is not perfect shield of protection from the flu, it does substantially increase two things: First, if you do get the flu, it substantially decreases the chance that it will become infected with the worse types of flu strands that are out there. Over my years in a respiratory ICU, those who were otherwise healthy individuals that become infected with the flu (the worst kinds of flu) that led to hospitalization in the ICU were those who failed to get their flu-shot that year. Second is that it actually does help us avoid contracting the flu - the same influenza that was a world-wide epidemic and wiped millions around the world. Such a dramatic decrease in world-wide flu r vaccine for that matter)? No, it doesn't. Like any other medications, it does have it's associated risks, can cause complications or is ineffective, as you mentioned. However, unlike most if not all medications, it does have perhaps the best track-records of any medication ever. More successful than any other medication with perhaps one of the lowest risks for bad outcomes than any other medication ever. Before the vaccine we lost millions and millions of people world-wide to the flu; immediately after the vaccine was introduced, produced, disseminated and used by a large part if the population, we immediately had the most dramatic increases in mortality than any other medication in human history, that we know of. That's why I advocate for it and even offer $10 flu vaccine shots, and free shots to those who cannot afford the $10 option. From what I've seen over history and in the ICU, its that important to help people get a flu shot. I'm not forcing you at all. I just feel driven to help dismiss any misunderstanding or misinformation that is out there.Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM https://chamberlain.shadowhealth.com/assignment_attempts/3664486 Page 32 of 39 Exam Action me know. Check pulse oximetry using right hand Checked pulse oximetry using left hand Checked spirometer Checked patient's inhaler Ok, in a bit I will have you show me how you use the inhaler. Is that ok with you? (No matching questions found.) Ok, in a bit I will have you show me how you use the inhaler. Is that ok with you? Sure, I think I understand what you mean. Ok, Have you had any weight changes lately? My weight hasn't changed, no. Have you had any changes in appetite? I wouldn't say it's changed recently, but I do feel hungry a lot.Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM https://chamberlain.shadowhealth.com/assignment_attempts/3664486 Page 33 of 39 Question CDT Do you urinate more often now? eating? (No matching questions found.) What are your blood sugars lately? Honestly, I can't really say. I haven't been checking my blood sugar. How often do you check your blood sugars? I don't really check my blood sugar much. I had it checked here when I came in a couple months ago, and they said it was a little high, but I feel fine--I'm much more worried about my breathing right now. Ok, now worries. We can talk about it a little later, although I am concerned about your diabetes.Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM https://chamberlain.shadowhealth.com/assignment_attempts/3664486 Page 34 of 39 Empathize OK, I understand. I'm sorry if I struck a bad chord asking you about your diabetes. Thanks for saying that. Have you feverish? No, I haven't had a fever. Have you felt achy? (No matching questions found.) Have you had any aching? No, my muscles are fine. Have you had any fatigue? Yeah, my energy's been pretty low because I haven't been sleeping as well as usual. Have you been sweating excessively lately? (Clarified to Have you been having night sweats?.) I don't get sweaty, but sometimes I wake up hot and have to kick off my sheets. Have you had any changes in strength? (No matching questions found.)Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM https://chamberlain.shadowhealth.com/assignment_attempts/3664486 Page 35 of 39 CDT Have you been feeling weak? No, I wouldn't say I feel weak. Have you had any skin color changes? Well...I guess I was noticing the other day that the skin around my neck is looking weird. Like the skin is getting darker. And my skin's breaking out, but that's how it is. When did you skin changes start? I've been getting break-outs since I was in middle school, I think. Like around the time I started my period, my skin started to break out. It went away for a few years in my twenties, but now I'm getting zits again. Has your skin changed anywhere else? (Clarified to how long have you been noticing the skin changes.) Well...I guess I was noticing the other day that the skin around my neck is looking weird. The skin is getting darker. And my skin's breaking out, but that's how it is. Does you skin usually break out like this? (Clarified to does your skin break out often.) I've been getting break-outs since I was in middle school, I think. Like around the time I started my period, my skin started to break out. It went away for a few years in my twenties, but now I'm getting zits again. Is your skin usually dry? It seems like it's dry most of the time. I put a lot of lotion on, but it never totally goes away.Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM https://chamberlain.shadowhealth.com/assignment_attempts/3664486 Page 36 of 39 Question How much water do you drink a day? I don't really keep track of how much, but I've been drinking a lot of water lately. Way more than usual. Have you been peeing more than usual? Yeah, but I've been drinking more water. has your skin around your neck fluctuated in color? No, it doesn't hurt at all. Does the skin around your neck feel warmer? No, it doesn't hurt at all. Do you have any sores on your skin? (Clarified to do you have a rash or sores anywhere on your skin.) I don't have any rashes. Do you have any moles? I have some, but not too many. Where are your moles?Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM https://chamberlain.shadowhealth.com/assignment_attempts/3664486 Page 37 of 39 Question es with your moles? I don't think so. How do you feel about your health in general? (Clarified to how would you describe your general health.) Overall, my health is pretty good. I have a couple of problems, I guess, but they don't bother me too much. Have you ever had headaches? Yeah, I get them a lot when I'm studying. How often do you get these headaches? Just sometimes...maybe once a week? Whenever I read for a long time. How would you describe your headache pain? (Clarified to how severe are your headaches.) I don't think they're that bad--it's just when I read too much. Usually some Tylenol will make them a little better at least. How much Tylenol do you take each time? 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]Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM https://chamberlain.shadowhealth.com/assignment_attempts/3664486 Page 38 of 39 CDT Show more How much Tylenol do you take in a day? 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 long after reading do your headaches start? Comments If your instructor provides individual feedback on this assignment, it will appear here.Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM https://chamberlain.shadowhealth.com/assignment_attempts/3664486 Page 39 of 39 © Shadow Health® 2018 [Show More]

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