Shadow Health Focused Exam Abdominal Pain Esther Park
Shadow Health Focused Exam Abdominal Pain Esther Park
Shadow Health Focused Exam Abdominal Pain Esther Park
Within the Shadow Health platform, complete the Focused Exam: Abdominal Pain. The estimated average time to complete this assignment is 1 hour and 25 minutes. Please note, this is an average time. Some students may need longer.
This clinical experience is a focused exam. Students have one opportunity to complete this assignment and score at the Proficiency level. Upon completion, submit the lab pass through the assignment dropbox.
Students successfully scoring within the Proficiency level in the Digital Clinical Experience will earn a grade of 100 points. Students who do not pass the performance-based assessment and scoring within the Proficiency level will receive a failing grade (68 points).
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Your avatar: Hello! Question
01/18/20 11:03 AM MST
Diana Shadow: 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.
Your avatar: What is the situation? Question
01/18/20 11:04 AM MST
Diana Shadow: Your patient is Esther Park, a 78-year-old Korean woman presenting with abdominal pain in Shadow General Hospital’s Emergency Department. Your role in this simulation is that of a healthcare provider who will conduct a focused history and physical examination of Mrs. Park in order to assess her condition and transfer her care.
Your avatar: What are my objectives in this assessment? Question
01/18/20 11:04 AM MST
Diana Shadow: In your interview with Mrs. Park, you will ask about the history of her presenting illness and the functioning of relevant systems in order to obtain subjective data related to her abdominal pain. 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. In addition to collecting subjective data, you will perform a physical exam on Mrs. Park to gather objective data about her 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. Shadow Health Focused Exam Abdominal Pain Esther Park
Your avatar: How does this assignment prepare me for the real world? Question
01/18/20 11:06 AM MST
Diana Shadow: In this assessment, you will become familiarized with the structure and content of a abdominal 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.
Diana Shadow: In 1 or 2 sentences, answer this question to help prepare for the upcoming exam: In a geriatric patient, what are some common considerations regarding abdominal pain?
Your avatar: Bowel obstruction is a common cause of abdominal pain in geriatric patients. Statement
01/18/20 11:09 AM MST
Your avatar: Hello Greet
01/18/20 11:09 AM MST
Esther Park: Hello.
Your avatar: My name is Chinwe and I will be conducting the abnormal physical assessment on you. (No matching questions found.) Question
01/18/20 11:10 AM MST
Your avatar: My name is Chinwe and I will be conducting the abnormal physical assessment on you. Educate
01/18/20 11:10 AM MST
Esther Park: Thank you for explaining that.
Your avatar: Do you have any abdominal pain? Question
01/18/20 11:13 AM MST
Esther Park: Yes . . . it isn’t terrible at the moment, thank goodness, but there has certainly been pain.
Your avatar: Sorry to hear that Empathize
01/18/20 11:13 AM MST
Esther Park: Thank you.
Your avatar: Are you able to have a bowel movement? Shadow Health Focused Exam Abdominal Pain Esther Park Question
01/18/20 11:14 AM MST
Esther Park: I haven’t gone to the bathroom in almost a week.
Your avatar: Can you tell me who you are? Question
01/18/20 11:15 AM MST
Esther Park: I’m Esther Park.
Your avatar: Do you know where you are right now? Question
01/18/20 11:15 AM MST
Esther Park: Yes. I am at Shadowville General Clinic.
Your avatar: Do you know why you are here today? Question
01/18/20 11:15 AM MST
Esther Park: I have pain in my belly. . . and I’m having some difficulty with going to the bathroom. My daughter was concerned.
Your avatar: What is the date and year? Question
01/18/20 11:16 AM MST
Esther Park: It must be… [says correct date and year].
Your avatar: How long have you had stomach pain? Question
01/18/20 11:16 AM MST
Esther Park: The pain started as a general discomfort, about five days ago, when I started having the. . . difficulties going to the bathroom.
Your avatar: Has the stomach pain changed? Question
01/18/20 11:17 AM MST
Esther Park: Well, the type of pain never changes, nor does the location. But the pain sort of fluctuates in intensity.
Your avatar: Where is your discomfort located? Question
01/18/20 11:31 AM MST
Esther Park: The pain and discomfort is down low in my belly.
Your avatar: Is the pain in a specific spot? Question
01/18/20 11:32 AM MST
Esther Park: It’s mostly in the lower part. Down in my lower belly.
Your avatar: Do you have pain on your sides? Question
01/18/20 11:32 AM MST
Esther Park: No, no. The pain is more towards the front, down low.
Your avatar: How would you rate your pain on a scale of one to ten? Question
01/18/20 11:33 AM MST
Esther Park: It has its ups and downs. At the moment, I’d say it’s a 2.
Your avatar: How would you rate your pain at its lowest? Question
01/18/20 11:34 AM MST
Esther Park: Probably a 2. Luckily, that’s what it is at the moment.
Your avatar: How would you rate your pain at its worst? Shadow Health Focused Exam Abdominal Pain Esther Park Question
01/18/20 11:35 AM MST
Esther Park: I’d say at its worst. . .maybe an 8.
Your avatar: Can you describe the pain? Question
01/18/20 11:35 AM MST
Esther Park: I’d say it’s cramping and. . . a dull, cramping feeling, yes.
Your avatar: Is your pain constant? Question
01/18/20 11:36 AM MST
Esther Park: The pain has its ups and downs, but it’s always there. It fluctuates in how severe it is.
Your avatar: Does your pain fluctuate? Question
01/18/20 11:36 AM MST
Esther Park: Well, the type of pain never changes, nor does the location. But the pain sort of fluctuates in intensity.
Your avatar: What relieves your pain besides medication? Question
01/18/20 11:37 AM MST
Esther Park: I’ve just been resting, but it barely helps. I did try drinking warm water slowly. . .I think that’s a myth, that that works.
Your avatar: Have you taken medication for the stomach pain? Question
01/18/20 11:39 AM MST
Esther Park: I’m not taking anything for it.
Your avatar: Have you taken laxatives? Question
01/18/20 11:39 AM MST
Esther Park: No. I can’t imagine they are very good for you.
Your avatar: Does eating aggravate the pain? Question
01/18/20 11:40 AM MST
Esther Park: Yes. The pain is there all the time, but eating can make it worse.
Your avatar: Does physical activity aggravate the pain? Question
01/18/20 11:40 AM MST
Esther Park: Yes. When I move around the house or try to garden, I feel more pain. And I did not go to my exercise classes. I was sure that would be too much. I prefer to be active, but my daughter wants me to rest.
Your avatar: How has your illness affected your daily life? Question
01/18/20 11:41 AM MST
Esther Park: Well, I have been slowed down lately. This week I missed both of my fitness classes. I never miss a class. . . and I like to help with the cleaning at home, but I’m just too weak. It’s very discouraging.
Your avatar: Have you had low energy? Question
01/18/20 11:42 AM MST
Esther Park: Yes, it seems like my energy got low when I did simple things around the house, like tidying up. I had to miss my exercise classes this week — I didn’t have the energy for them. That’s unusual for me.
Your avatar: Are you constipated right now? Question
01/18/20 11:42 AM MST
Esther Park: Yes, right now, and for the past five or so days.
Your avatar: For how long have you been constipated? Question
01/18/20 11:43 AM MST
Esther Park: It has been five whole days now.
Your avatar: Have you had diarrhea recently? Question
01/18/20 11:43 AM MST
Esther Park: No. The last time I had anything of that nature was . . . maybe six months ago.
Your avatar: How long ago did you have diarrhea? Question
01/18/20 11:44 AM MST
Esther Park: Well, that must have been six months ago. Luckily, the ordeal only lasted a day.
Your avatar: Did the diarrhea happen suddenly? Question
01/18/20 11:45 AM MST
Esther Park: It came on all of a sudden and only lasted a day–a few bouts of it over the course of a day.
Your avatar: How long did your diarrhea last? Question
01/18/20 11:46 AM MST
Esther Park: It came on all of a sudden and only lasted a day–a few bouts of it over the course of a day.
Your avatar: Has there been mucus in your stool? Shadow Health Focused Exam Abdominal Pain Esther Park Question
01/18/20 11:47 AM MST
Esther Park: No, I haven’t noticed anything like that.
Your avatar: Has there been blood in your stool? Question
01/18/20 11:47 AM MST
Esther Park: No. I’ve never experienced that.
Your avatar: Have you had any changes in the frequency of your urination? Question
01/18/20 11:48 AM MST
Esther Park: I’ve been going slightly less often because. . . well, I’ve been little less thirsty than usual.
Your avatar: Has your urine been darker recently? Question
01/18/20 11:49 AM MST
Esther Park: Yes, it has been a little darker than usual lately.
Your avatar: Have you had blood in your urine? Question
01/18/20 11:49 AM MST
Esther Park: No, it seems normal enough to me. Maybe a little darker than usual.
Your avatar: Have you been thirstier recently? (No matching questions found.) Question
01/18/20 11:49 AM MST
Your avatar: Have you been thirstier lately? Question
01/18/20 11:50 AM MST
Esther Park: I haven’t been as thirsty. I suppose I’ve been drinking a little less water than usual, just in these last few days.
Your avatar: Have you had changes in your fluid intake? Question
01/18/20 11:51 AM MST
Esther Park: I haven’t been as thirsty. I suppose I’ve been drinking a little less water than usual, just in these last few days.
Your avatar: How many glasses of water do you drink daily? Question
01/18/20 11:51 AM MST
Esther Park: A glass or two a day, I’d say. It’s been too difficult to drink even that since all this started.
Your avatar: Do you drink caffeinated beverages? Question
01/18/20 11:52 AM MST
Esther Park: No. I avoid caffeinated drinks altogether.
Your avatar: Are you typically constipated? Question
01/18/20 11:53 AM MST
Esther Park: I don’t usually have problems going to the bathroom, but this has been going on for . . . about five days now. It’s taken quite a toll.
Your avatar: How many bowel movements do you typically have per week? Question
01/18/20 11:54 AM MST
Esther Park: Before this? Every day. Well, I miss a day now and then, but usually every day.
Your avatar: Are your stools typically brown? Question
01/18/20 11:54 AM MST
Esther Park: Brown. A normal shade of brown. Like. . . oh, I don’t know. Cardboard.
Your avatar: Are your stools typically formed? Question
01/18/20 11:55 AM MST
Esther Park: Yes, they’re in the formed shape I think they should be.
Your avatar: Are your stools typically soft? Question
01/18/20 11:55 AM MST
Esther Park: They’re normally soft.
Your avatar: Do you have a latex allergy? Question
01/18/20 11:56 AM MST
Esther Park: Yes. Latex gives me an itchy rash.
Your avatar: Are you allergic to any medications? Question
01/18/20 11:56 AM MST
Esther Park: No, not that I’m aware of.
Your avatar: Do you have any food allergies? Question
01/18/20 11:56 AM MST
Esther Park: No.
Your avatar: Do you have a primary care doctor? Question
01/18/20 11:57 AM MST
Esther Park: Yes. I see Dr. Keller, at my clinic–Shadowville Primary Care.
Your avatar: When was your last pap smear? Question
01/18/20 11:58 AM MST
Esther Park: A pap smear? I haven’t had one in years. Ten years, at least.
Your avatar: Do you feel you are healthy? Question
01/18/20 11:58 AM MST
Esther Park: I suppose so, yes. I don’t put an inordinate amount of thought into it — I just do what comes naturally. Shadow Health Focused Exam Abdominal Pain Rachel Adler
Your avatar: Have you had a colonoscopy? Question
01/18/20 11:59 AM MST
Esther Park: I’ve had two colonoscopies. The last one was ten years ago.
Your avatar: Have you ever been tasted for STIs? (Clarified to Have you been tested for STDs?.) Question
01/18/20 11:59 AM MST
Esther Park: No, that hasn’t been necessary. I haven’t had any symptoms. (Clarified to if I have ever been tested for STDs.)
Your avatar: Have you ever been tested for STIs? Question
01/18/20 12:00 PM MST
Esther Park: No, that hasn’t been necessary. I haven’t had any symptoms.
Your avatar: Have you had STI symptoms? Question
01/18/20 12:01 PM MST
Esther Park: No, I’ve never had anything. . .like that. I don’t have any symptoms.
Your avatar: Are you sexually active? Question
01/18/20 12:01 PM MST
Esther Park: I have a gentleman friend and, yes. . .We are intimate.
Your avatar: Do you have high blood pressure? Question
01/18/20 12:01 PM MST
Esther Park: Yes, I have been diagnosed with high blood pressure. But I take very good care of that.
Your avatar: Did you have any complications during pregnancy? Question
01/18/20 12:02 PM MST
Esther Park: Near the end of my pregnancy, I felt her stop moving. The doctors did the C-section, but it was too late. She’d been caught up in the cord, around her neck.
Your avatar: At what age did you have a C-section? Question
01/18/20 12:02 PM MST
Esther Park: Forty.
Your avatar: Have you had a gallbladder removed? Question
01/18/20 12:03 PM MST
Esther Park: I had gallstones–many, many years ago. I had my gallbladder removed.
Your avatar: At what age did you have your gallbladder removed? Question
01/18/20 12:04 PM MST
Esther Park: I was. . . 42.
Your avatar: Did you have any complications after your surgery? Question
01/18/20 12:05 PM MST
Esther Park: No, no complications.
Your avatar: Do you take high blood pressure medication? Question
01/18/20 12:05 PM MST
Esther Park: Yes.
Your avatar: What medication do you take for your high blood pressure? Question
01/18/20 12:06 PM MST
Esther Park: It’s called Accupril.
Your avatar: What dose is your high blood pressure medication? Question
01/18/20 12:06 PM MST
Esther Park: 10 milligrams.
Your avatar: When do you take your high blood pressure medication? Question
01/18/20 12:07 PM MST
Esther Park: I take it every morning at about 8 a.m., after breakfast.
Your avatar: Do you have any over-the-counter medication? (Clarified to Do you take over the counter medications a lot?.) Question
01/18/20 12:08 PM MST
Esther Park: No. Those over-the-counter medicines. . . Tylenol–they say it’s very bad for the stomach. (Clarified to if I take over the counter medication a lot.)
Your avatar: Do you take any over-the-counter medications? Question
01/18/20 12:08 PM MST
Esther Park: No. Those over-the-counter medicines. . . Tylenol–they say it’s very bad for the stomach.
Your avatar: Do you have any difficulty getting on and off the toilet? Question
01/18/20 12:09 PM MST
Esther Park: No. I have no trouble doing that.
Your avatar: Do you have difficulty dressing yourself? Question
01/18/20 12:10 PM MST
Esther Park: I can dress myself, thank you.
Your avatar: Do you have difficulty feeding yourself? Question
01/18/20 12:11 PM MST
Esther Park: I can feed myself, but I just haven’t been hungry. It hurts to eat.
Your avatar do you have difficulty walking? Question
01/18/20 12:11 PM MST
Esther Park: I can walk just fine. I just have been resting as much as possible. Moving too much hurts.
Your avatar: Do you have difficulty bathing yourself? Question
01/18/20 12:12 PM MST
Esther Park: I can do that just fine.
Your avatar: Do you have difficulty getting in and out of chairs? Question
01/18/20 12:13 PM MST
Esther Park: I can do that–I’ve been doing what I need to do. I just have so little energy, and moving too much hurts.
Your avatar: When was your last meal? Question
01/18/20 12:13 PM MST
Esther Park: I haven’t been eating much at all lately. . . the last time I ate was this morning, a little toast.
Your avatar: How many meals do you typically eat per day? Question
01/18/20 12:14 PM MST
Esther Park: Usually three, but sometimes I skip breakfast. I don’t eat snacks.
Your avatar: What do you typically eat for a snack? Question
01/18/20 12:15 PM MST
Esther Park: I don’t usually have snacks.
Your avatar: What do you usually eat for breakfast? Question
01/18/20 12:15 PM MST
Esther Park: Toast, usually. Fruit, maybe once or twice a week.
Your avatar: What do you usually eat for lunch? Question
01/18/20 12:16 PM MST
Esther Park: Sometimes I skip lunch if I’m not feeling hungry, but usually I eat something light, like soup.
Your avatar: What do you usually eat for dinner? Question
01/18/20 12:20 PM MST
Esther Park: Chicken or fish, with some rice.
Your avatar: Do you take fiber supplements? Question
01/18/20 12:20 PM MST
Esther Park: No, I don’t take any extra fiber. I hadn’t quite considered it . . .
Your avatar: Do you think you get enough fiber? Question
01/18/20 12:20 PM MST
Esther Park: I don’t know how much fiber is in what . . . I don’t think about it, even. I have a vegetable every day or two, which I’d guess has fiber.
Your avatar: What sources of fiber do you eat? Question
01/18/20 12:21 PM MST
Esther Park: I’m not sure–I’m not positive what fiber is in what. I don’t consciously eat foods with fiber, I mean. I have a vegetable every day or two, and a fruit once or twice a week . . . those probably have a good amount of fiber.
Your avatar: Do you eat fruit? Question
01/18/20 12:21 PM MST
Esther Park: No . . . once every three of four days or so. I’ll have it instead of my breakfast toast.
Your avatar: Do you stay active? Question
01/18/20 12:21 PM MST
Esther Park: Yes, I garden, take walks. I take exercise classes at the community center — water aerobics, and I started enjoying Pilates as well.
Your avatar: What is your typical activity level? Question
01/18/20 12:22 PM MST
Esther Park: Normally, I garden, take walks, I even do exercise classes at the center. But since getting sick. . .it’s not that I have difficulty taking care of myself; I just don’t have as much energy to do so. Shadow Health Focused Exam Abdominal Pain Rachel Adler
Your avatar: Do you use illicit drugs? Question
01/18/20 12:22 PM MST
Esther Park: I have never used drugs of any kind.
Your avatar: Do you smoke cigarettes? Question
01/18/20 12:23 PM MST
Esther Park: I’ve never smoked a cigarette in my life. What a sad habit.
Your avatar: Do you consume alcohol? Question
01/18/20 12:23 PM MST
Esther Park: Yes, but very little.
Your avatar: How many nights a week do you drink alcohol? Question
01/18/20 12:23 PM MST
Esther Park: On Sundays, I have my only drink for the week.
Your avatar: How many alcoholic drinks do you have in a month? Shadow Health Focused Exam Abdominal Pain Esther Park Question
01/18/20 12:24 PM MST
Esther Park: I only have a drink on Sundays, and then only one glass of white wine — four drinks each month. That seems very moderate to me.
Your avatar: When you have alcohol, what do you typically drink? Question
01/18/20 12:25 PM MST
Esther Park: I always have one glass of wine. A dry white wine.
Your avatar: Do you live with anyone? Question
01/18/20 12:25 PM MST
Esther Park: I live with my daughter, Jennifer. It’s very nice living with her.
Your avatar: Who can you go to for support? Question
01/18/20 12:26 PM MST
Esther Park: Usually I don’t need much help. But since I’ve been sick, my daughter has been helping me, doing things around the house–gardening, cleaning, making sure I eat a little something. She’s very busy with her job, and it’s very sweet of her to help me.
Your avatar: Have you travelled anywhere recently? Question
01/18/20 12:26 PM MST
Esther Park: No, I haven’t gone on any trips in several years.
Your avatar: Have you experienced any physical abuse? Question
01/18/20 12:26 PM MST
Esther Park: Goodness. . .I’ve never been abused in any sense of the word.
Your avatar: Have you experienced any sexual abuse? Question
01/18/20 12:27 PM MST
Esther Park: Goodness. . .I’ve never been abused in any sense of the word.
Your avatar: Have you experienced any emotional abuse? Question
01/18/20 12:28 PM MST
Esther Park: No, the people in my life–they treat me very well.
Your avatar: Have you experienced any financial abuse? Question
01/18/20 12:28 PM MST
Esther Park: Goodness. . .I’ve never been abused in any sense of the word.
Your avatar: Have you experienced any verbal abuse? Question
01/18/20 12:29 PM MST
Esther Park: No, the people in my life–they treat me very well.
Your avatar: Have you had any recent weight changes? Question
01/18/20 12:29 PM MST
Esther Park: No, not that I’ve noticed.
Your avatar: Have you had a fever recently? Question
01/18/20 12:30 PM MST
Esther Park: No, I don’t believe so.
Your avatar: Have you had chills? Question
01/18/20 12:30 PM MST
Esther Park: No chills.
Your avatar: Do you have night sweats? Question
01/18/20 12:30 PM MST
Esther Park: No. That is not a problem for me.
Your avatar: Have you had any swelling? Question
01/18/20 12:31 PM MST
Esther Park: I haven’t seen anything swelling.
Your avatar: Do you have fatigue? Question
01/18/20 12:31 PM MST
Esther Park: Well, I have experienced low energy, like I need to rest more often. It’s quite frustrating not being my normal self.
Your avatar: Have you had difficulty sleeping? Question
01/18/20 12:31 PM MST
Esther Park: No, usually I sleep right through the night.
Your avatar: Do you have a history of heartburn? Question
01/18/20 12:32 PM MST
Esther Park: No. I don’t get indigestion, heartburn, nothing like that.
Your avatar: Have you ever had appendicitis? Question
01/18/20 12:33 PM MST
Esther Park: No.
Your avatar: Do you have a history of stomach cancer? Question
01/18/20 12:33 PM MST
Esther Park: No.
Your avatar: Do you have a history of stomach cancer? Question
01/18/20 12:34 PM MST
Esther Park: No.
Your avatar: Do you have a history of liver disease? Question
01/18/20 12:35 PM MST
Esther Park: I’ve never had any problems with my liver.
Your avatar: Do you have palpitations? Question
01/18/20 12:35 PM MST
Esther Park: No. My heart rate has always been normal.
Your avatar: Do you have chest pain? Question
01/18/20 12:35 PM MST
Esther Park: No, I don’t ever experience chest pain.
Your avatar: Do you have heart race? Question
01/18/20 12:36 PM MST
Esther Park: No. My heart rate has always been normal.
Your avatar: Do you have a sore throat? Question
01/18/20 12:36 PM MST
Esther Park: No. My throat is fine.
Your avatar: Have you been coughing? Question
01/18/20 12:36 PM MST
Esther Park: No, I haven’t been coughing at all.
Your avatar: Do you have difficulty swallowing? Question
01/18/20 12:37 PM MST
Esther Park: No. I am able to swallow without any problems.
Your avatar: Have you had difficulty breathing? Question
01/18/20 12:37 PM MST
Esther Park: No. I can breathe well. My lungs feel very healthy.
Your avatar: Do you feel bloated? Question
01/18/20 12:37 PM MST
Esther Park: Yes. Quite a bit.
Your avatar: Do you have more gas than usual? Question
01/18/20 12:38 PM MST
Esther Park: I have been slightly more . . . gassy. [AUDIO COMING SOON]
Shadow Health Focused Exam Abdominal Pain Rachel Adler
Your avatar: How is your appetite? Question
01/18/20 12:38 PM MST
Esther Park: I haven’t been hungry. Eating only makes me feel worse.
Your avatar: Do you have nausea? Question
01/18/20 12:39 PM MST
Esther Park: No. I haven’t vomited or had any nausea. It’s more of a problem with pain. . . and difficulty going to the bathroom.
Your avatar: Have you been vomiting? Question
01/18/20 12:39 PM MST
Esther Park: Very rarely. The last time I vomited. . . I had a stomach virus a few years ago. One of those nasty, 24-hour bugs.
Your avatar: Do you have food poisoning? Question
01/18/20 12:39 PM MST
Esther Park: No, I didn’t eat anything unusual.
Your avatar: Do you have a history of bladder disease? Question
01/18/20 12:40 PM MST
Esther Park: No.
Your avatar: Do you have any pain when you urinate? Question
01/18/20 12:40 PM MST
Esther Park: No. It feels just the same as always.
Your avatar: Do you have burning with urination? Question
01/18/20 12:41 PM MST
Esther Park: No, my urination has felt normal.
Your avatar: Do you have problems holding your urine? Question
01/18/20 12:42 PM MST
Esther Park: I’ve never had problems with. . . controlling myself.
Your avatar: Have you had past urinary tract infections? Question
01/18/20 12:42 PM MST
Esther Park: I don’t remember ever having one, no.
Your avatar: Do you hold your urine in unnecessarily? Question
01/18/20 12:43 PM MST
Esther Park: I wouldn’t say I hold it in, no.
Your avatar: Do you have any gynecological problems? Question
01/18/20 12:49 PM MST
Esther Park: No. I don’t have problems with that area.
Your avatar: Do you have vaginal bleeding? Question
01/18/20 12:49 PM MST
Esther Park: No.
Your avatar: Do you have vaginal discharge? Question
01/18/20 12:50 PM MST
Esther Park: I think I have the normal amount of vaginal discharge. . . it all seems fine.
Your avatar: When did you start menopause? Question
01/18/20 12:50 PM MST
Esther Park: Oh my. . . it was twenty years or more ago. . . I think I was 54.
Your avatar: Do you have a history of kidney disease? Question
01/18/20 12:51 PM MST
Esther Park: No, I’ve never had any kidney trouble.
Your avatar: Measured vitals Exam Action
01/18/20 12:56 PM MST
Your avatar: Inspected general face: Slight flushing of cheeks Exam Action
01/18/20 12:57 PM MST
Your avatar: Inspected forehead and scalp Exam Action
01/18/20 12:57 PM MST
Your avatar: Inspected nose and mouth Exam Action
01/18/20 12:57 PM MST
Your avatar: Inspected right side of face Exam Action
01/18/20 12:58 PM MST
Your avatar: Inspected back of head Exam Action
01/18/20 12:58 PM MST
Your avatar: Inspected left side of face Exam Action
01/18/20 12:58 PM MST
Your avatar: Inspected general face: Slight flushing of cheeks Exam Action
01/18/20 12:58 PM MST
Your avatar: Performed otoscopic examination of right naris Exam Action
01/18/20 12:58 PM MST
Your avatar: Performed otoscopic examination of left naris Exam Action
01/18/20 12:58 PM MST
Your avatar: Inspected mouth and throat Exam Action
01/18/20 12:59 PM MST
Your avatar: Inspected right side of abdomen Exam Action
01/18/20 12:59 PM MST
Your avatar: Inspected front of abdomen Exam Action
01/18/20 12:59 PM MST
Your avatar: Inspected right side of abdomen Exam Action
01/18/20 1:00 PM MST
Your avatar: Inspected front of abdomen Exam Action
01/18/20 1:00 PM MST
Your avatar: Inspected left side of abdomen Exam Action
01/18/20 1:00 PM MST
Your avatar: Inspected right leg for edema: No edema Exam Action
01/18/20 1:01 PM MST
Your avatar: Inspected front of legs for edema: No edema Exam Action
01/18/20 1:01 PM MST
Your avatar: Inspected left leg for edema: No edema Exam Action
01/18/20 1:01 PM MST
Your avatar: Inspected front of legs for edema: No edema Exam Action
01/18/20 1:01 PM MST
Your avatar: Auscultated aortic area with the bell Exam Action
01/18/20 1:02 PM MST
Your avatar: Auscultated aortic area with the diaphragm Exam Action
01/18/20 1:02 PM MST
Your avatar: Auscultated pulmonic area with the diaphragm Exam Action
01/18/20 1:02 PM MST
Your avatar: Auscultated pulmonic area with the bell Exam Action
01/18/20 1:02 PM MST
Your avatar: Auscultated Erb’s point with the bell Exam Action
01/18/20 1:02 PM MST
Your avatar: Auscultated Erb’s point with the diaphragm Exam Action
01/18/20 1:02 PM MST
Your avatar: Auscultated tricuspid area with the diaphragm Exam Action
01/18/20 1:02 PM MST
Your avatar: Auscultated tricuspid area with the bell Exam Action
01/18/20 1:02 PM MST
Your avatar: Auscultated mitral area with the bell Exam Action
01/18/20 1:02 PM MST
Your avatar: Auscultated mitral area with the diaphragm Exam Action
01/18/20 1:02 PM MST
Your avatar: Auscultated breath sounds in anterior right upper lobe Exam Action
01/18/20 1:04 PM MST
Your avatar: Auscultated breath sounds in anterior left upper lobe Exam Action
01/18/20 1:04 PM MST
Your avatar: Auscultated breath sounds in anterior right middle lobe Exam Action
01/18/20 1:04 PM MST
Your avatar: Auscultated breath sounds in anterior left mid-chest (upper lobe) Exam Action
01/18/20 1:04 PM MST
Your avatar: Auscultated breath sounds in anterior right lower lobe Exam Action
01/18/20 1:04 PM MST
Your avatar: Auscultated breath sounds in anterior left lower lobe Exam Action
01/18/20 1:04 PM MST
Your avatar: Auscultated breath sounds in posterior left upper lobe Exam Action
01/18/20 1:04 PM MST
Your avatar: Auscultated breath sounds in posterior right upper lobe Shadow Health Focused Exam
Abdominal Pain Rachel Adler Exam Action
01/18/20 1:04 PM MST
Your avatar: Auscultated breath sounds in posterior left mid-back (lower lobe) Exam Action
01/18/20 1:04 PM MST
Your avatar: Auscultated breath sounds in posterior right mid-back (lower lobe) Exam Action
01/18/20 1:04 PM MST
Your avatar: Auscultated breath sounds in posterior left lower lobe Exam Action
01/18/20 1:04 PM MST
Your avatar: Auscultated breath sounds in posterior left lower lobe on side Exam Action
01/18/20 1:04 PM MST
Your avatar: Auscultated breath sounds in posterior left lower lobe near spine Exam Action
01/18/20 1:05 PM MST
Your avatar: Auscultated breath sounds in posterior right lower lobe Exam Action
01/18/20 1:05 PM MST
Your avatar: Auscultated breath sounds in posterior right lower lobe near spine Exam Action
01/18/20 1:05 PM MST
Your avatar: Auscultated breath sounds in posterior right lower lobe on side Exam Action
01/18/20 1:05 PM MST
Your avatar: Auscultated aorta in abdomen Exam Action
01/18/20 1:06 PM MST
Your avatar: Auscultated right upper quadrant Exam Action
01/18/20 1:06 PM MST
Your avatar: Auscultated left upper quadrant Exam Action
01/18/20 1:06 PM MST
Your avatar: Auscultated right lower quadrant Exam Action
01/18/20 1:06 PM MST
Your avatar: Auscultated left lower quadrant Exam Action
01/18/20 1:06 PM MST
Your avatar: Auscultated right renal artery Exam Action
01/18/20 1:07 PM MST
Your avatar: Auscultated left renal artery Exam Action
01/18/20 1:07 PM MST
Your avatar: Auscultated right iliac artery Exam Action
01/18/20 1:07 PM MST
Your avatar: Auscultated left iliac artery Exam Action
01/18/20 1:07 PM MST
Your avatar: Auscultated right femoral artery Exam Action
01/18/20 1:07 PM MST
Your avatar: Auscultated left femoral artery Exam Action
01/18/20 1:07 PM MST
Your avatar: Percussed right upper quadrant Exam Action
01/18/20 1:08 PM MST
Your avatar: Percussed left upper quadrant Exam Action
01/18/20 1:08 PM MST
Your avatar: Percussed right lower quadrant Exam Action
01/18/20 1:08 PM MST
Your avatar: Percussed left lower quadrant Exam Action
01/18/20 1:08 PM MST
Your avatar: Percussed left flank for CVA tenderness Exam Action
01/18/20 1:09 PM MST
Your avatar: Percussed right flank for CVA tenderness Exam Action
01/18/20 1:09 PM MST
Your avatar: Percussed for spleen Exam Action
01/18/20 1:10 PM MST
Your avatar: Percussed for liver span: 7 cm in the mid-clavicular line Exam Action
01/18/20 1:12 PM MST
Your avatar: Palpated right upper quadrant with light pressure: No tenderness reported; no masses, guarding, or distension Exam Action
01/18/20 1:14 PM MST
Your avatar: Palpated left upper quadrant with light pressure: No tenderness reported; no masses, guarding, or distension Exam Action
01/18/20 1:14 PM MST
Your avatar: Palpated right lower quadrant with light pressure: No tenderness reported; no masses, guarding, or distension Exam Action
01/18/20 1:14 PM MST
Your avatar: Palpated left lower quadrant with light pressure: Tenderness reported; palpable guarding and distension, no masses Exam Action
01/18/20 1:14 PM MST
Your avatar Palpated right upper quadrant with light pressure: No tenderness reported; no masses, guarding, or distension Exam Action
01/18/20 1:15 PM MST
Esther Park: That feels alright.
Your avatar: Palpated left upper quadrant with light pressure: No tenderness reported; no masses, guarding, or distension Exam Action
01/18/20 1:15 PM MST
Esther Park: That feels alright.
Your avatar: Palpated right lower quadrant with light pressure: No tenderness reported; no masses, guarding, or distension Exam Action
01/18/20 1:15 PM MST
Esther Park: That feels alright.
Your avatar: Palpated left lower quadrant with light pressure: Tenderness reported; palpable guarding and distension, no masses Exam Action
01/18/20 1:15 PM MST
Esther Park: Mmm, it feels sore there.
Your avatar: Palpated right upper quadrant with deep pressure: No masses Exam Action
01/18/20 1:16 PM MST
Esther Park: That feels alright.
Your avatar: Palpated left upper quadrant with deep pressure: No masses Exam Action
01/18/20 1:16 PM MST
Esther Park: That feels alright.
Your avatar Palpated right lower quadrant: with deep pressure: No masses Exam Action
01/18/20 1:16 PM MST
Esther Park: That feels alright.
Your avatar: Palpated left lower quadrant with deep pressure: Firm, oblong mass (2x4cm) Exam Action
01/18/20 1:16 PM MST
Esther Park: Ooo, that–that’s sore right there.
Your avatar: Palpated for liver: Palpable 1 cm below right costal margin Exam Action
01/18/20 1:17 PM MST
Your avatar: Palpated for spleen: Not palpable Exam Action
01/18/20 1:18 PM MST
Your avatar: Palpated bladder: Not palpable; no distention or tenderness Exam Action
01/18/20 1:18 PM MST
Your avatar: Palpated for right kidney: Not palpable Exam Action
01/18/20 1:18 PM MST
Your avatar: Palpated for left kidney: Not palpable Exam Action
01/18/20 1:19 PM MST
Your avatar: Tested skin turgor Exam Action
01/18/20 1:19 PM MST
Diana Shadow: In 1 or 2 sentences, answer this question to help prepare for the upcoming exam: In a geriatric patient, what are some common considerations regarding abdominal pain?
Your avatar: Already answered Statement
01/19/20 11:35 AM MST
Diana Shadow: Time to begin.
Diana Shadow: In 1 or 2 sentences, answer this question to help prepare for the upcoming exam: In a geriatric patient, what are some common considerations regarding abdominal pain?
Your avatar: What is the situation? Question
01/19/20 11:54 AM MST
Diana Shadow: Your patient is Esther Park, a 78-year-old Korean woman presenting with abdominal pain in Shadow General Hospital’s Emergency Department. Your role in this simulation is that of a healthcare provider who will conduct a focused history and physical examination of Mrs. Park in order to assess her condition and transfer her care.
Diana Shadow: In 1 or 2 sentences, answer this question to help prepare for the upcoming exam: In a geriatric patient, what are some common considerations regarding abdominal pain?
Your avatar: They are at risk for both small and large bowel obstructions. Statement
01/19/20 8:50 PM MST
Diana Shadow: Time to begin.
Your avatar: Esther park is a 78-year-old woman who is presenting with persistent, generalized abdominal pain. She rated the pain at 6/10 and said that it is dull and crampy. She has had vague abdominal discomfort discomfort for almost a week, and her pain has gotten worse. (No matching questions found.) Question
01/19/20 8:57 PM MST
End-of-life care becomes an issue at some point for elderly clients. Even with the emergence of palliative care programs and hospice programs, most elderly people do not die in their own home as is their preference. What are the reasons for this trend? Discuss what you can do as a nurse to support your clients regarding end-of-life care in accordance with their wishes. Support your response with evidence-based literature.
ETHEL
According to Green (2018), end-of-life care is the support and medical care given during the time surrounding death. The older population live with one or more long term ailments, care is needed significantly for the time before their death which can go for days or even months. This may appear different due to one`s preference ,needs or choices. While some may want to be in a facility, others may wish to be in their homes till the very of it.
Many people expire in facilities like nursing homes or hospitals receiving care that is not in line with their wishes. This is because they do not plan ahead and make their preferences made known to their caregivers and providers or members of the family. If people are not clear about their end of life care wishes, they are likely to be swayed by the providers` recommendation. One other reason is that the patient`s condition may be volatile and may require stringent supervision around the clock, the loved ones may be intensely strained by this leaving the hospital as the best route for all people involved.
Nurses have an important role to play to ensure clients` end-of-life-care is according to their wishes. Most people prefer to die at home but only a third of the adults have an advance directive expressing their wishes for end of life care( Pew 2006, AARP 2008). Information should be given to clients on advance care planning to make sure the treatment they get is in line with their preferences. As a nurse, I would develop and initiate care plan so as to address patient and family needs, offering emotional support that is caring and compassionate.
References
- Green S.Z (2018). Grand Canyon University. Health Assessment: Foundations for Effective Practice https://lc.gcumedia.com/nrs434vn/health-assessment-foundations-for-effective-practice/v1.1/#/chapter/5
- Providing Care and Comfort at the end of Life https//:www.nia.nih.gov/health/providing-comfort-end-life
- Advance Care Planning https://www.cdc.gov/aging/pdf/advance-care-planning-critical-issue-brief-pdf
ADDITIONAL INSTRUCTIONS FOR THE CLASS
Discussion Questions (DQ)
- Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
- Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
- One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
- I encourage you to incorporate the readings from the week (as applicable) into your responses.
Weekly Participation
- Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
- In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
- Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
- Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality
- Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
- Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
- I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes
- I discourage the overutilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly.
- As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
- It is best to paraphrase content and cite your source.
LopesWrite Policy
- For assignments that need to be submitted to LopesWrite, please be sure you have received your report, and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
- Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
- Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
- Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy
- The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
- Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
- If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
- I do not accept assignments that are two or more weeks late unless we have worked out an extension.
- As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication
Communication is so very important. There are multiple ways to communicate with me:
- Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
- Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.
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