Pain is rated as 7. eyebrows, lids without lesions, no ptosis or edema Right lower quadrant: soft, no tenderness or months ago Acanthosis nigricans noted on neck, Inspected eyebrows and orbital area Right eye: equal hair distribution on lashes and Up-to-date. She is a good historian. Stomach upset. NURS 6512 Week 9 DCE: Please I need help with shadow health assessment week 9 with Tina Jones (who comes to the clinic for a Pre-employment physical). Paternal grandfather: died at age 65 of colon cancer, history of type 2 diabetes We will write your work from scratch and ensure it's plagiarism-free, you just submit the completed work. diabetes, Asked about blood glucose monitoring Reports checking blood sugar once a day Yeah. Left upper quadrant: soft, no tenderness or Right brachial pulse: 2+ hemorrhages, Tested visual acuity Vision 20/20 right eye with corrective lenses Metformin 850 PO BID Flovent 2 puffs 88 mcg/spray BID Albuterol 90 mcg/spray MDI 2 puffs Q4H Drospirenone PO QD, Fluticasone propionate, 110 mcg 2 puffs BID (last use: this morning) Metformin, 850 mg PO BID (last use: this morning) Drospirenone and ethinyl estradiol PO QD (last use: this morning) Albuterol 90 mcg/spray MDI 2 puffs Q4H prn (last use: three months ago) Acetaminophen 500-1000 mg PO prn (headaches) Ibuprofen 600 mg PO TID prn (menstrual cramps: last taken 6 weeks ago), Allergic to cats and dust Allergiic to penicillin Denies any food or latex allergy. Indicates an item that you found. deformity Cough is worse at night and keeps him up. Experts selected these examinations as essential components of objective data collection for this patient. My albuterol. Ive realized that I got kind of overwhelmed with everything back when I was having those sleep problems. (Clarified to if my brother has health issues.). Never pregnant. Inspected head and neck Scattered pustules on face and facial hair on 22 terms. Nursing Theory list (41) Reports recently prescribed eyeglasses How much of the over-the-counter medication do you take? Shadow health cardiovascular assignment documentation with description. reflex She uses her albuterol inhaler when she is around cats. Ms. Jones reports that she recently obtained employment at Smith, Stevens, Stewart, Silver & Company. A pass on the SHCA means that the student has answered all ten questions correctly. If your instructor provides individual feedback on this assignment, it will appear here. Head: Reports headaches that occur weekly with reading in the past year. She hurt the ball of her right foot by scraping it on the edge of a metal step while changing a light bulb. Pro Tip: Follow up questions about Tinas medication history and timeline will help you to understand her treatment plan and recent health history. My muscles have felt great, especially since I started exercising more. (b) To which senses does Basho's haiku appeal? When did you most recently use the flovent inhaler? marty569. Left shoulder without swelling, masses, or Pro Tip: Palpating the frontal sinuses checks for sinusitis. Right lower quadrant: tympanic Shadow. SOAP Note samples (14) Learn shadow health comprehensive assessment with free interactive flashcards. She took her temperature at home and reports it was 102. Left radial pulse: 2+, Palpated pulses of the lower extremities Right femoral pulse: 2+ Asthma is one of the most prevalent chronic illnesses in children, but it may also affect adults. Reports last optometrist visit was 3 months ago Mouth: Denies dental pain or problems, oral lesions, and dry mouth, and changes in taste. extremities, Right triceps: 2+ Theyre crazy, but nobodys diagnosed with anything. Right leg distal dull pain sensation intact Patient states there is relief when foot is elevated, not walking on it. eyebrows, lids without lesions, no ptosis or edema, Palpated sinuses No frontal sinus tenderness white sclera No foreign travel. Right kidney: not palpable, no masses Right brachioradialis: 2+ Reports no blanching in fingertips when exposed to cold. flatulence is one of the side effect of metformin. Left carotid artery: no bruit, Auscultated heart sounds Auscultated Erb's point with the bell: no S3, S Denies adverse side effects from birth control, Asked about current non-prescription . Left arm distal dull pain sensation intact, Tested ability to sense dull pain in lower Cardiovascular: Denies palpitations, dyspnea on exertion, orthopnea paroxysmal nocturnal dyspnea, peripheral edema, varicosities, and pain in lower extremities. Study Tips (254), BSN (31) 37 terms. ShadowHealth Abdominal Pain Esther Park. She has not been eating much and has been staying in bed the last few days, per patient report. Return to Assignment (/assignments/433803/). Pro Tip: Inspecting the conjunctiva and sclera for color changes, swelling, and increased vascularity helps to identify an infection or underlying condition. She receives basic health insurance from work, but is deterred from healthcare due to out-of-pocket costs. Reports occasional shortness of breath Asking Tina why she started taking birth control will allow Tina to express any concerns or problems in her own words. She plans to use condoms with sexual activity. Denies head and neck trauma. Never married, no children. Reports taking diabetes medication twice daily The following details are facts of t She hopes to advance to an accounting position within her company. . A thorough inspection should be conducted of your patients skin, especially in folds around the neck, axilla, and groin. Hello my name is ___ and I will be your healthcare provider today. She was last hospitalized for asthma in high school. . Identified paperclip in left hand within 5 seconds Pro Tip: Nail appearance suggests the status of respiratory and vascular function and the presence of nutrient deficiencies or diseases. The scrape is red and swollen with exudate and has no odor; she reports the swelling and exudate started two days ago. Nursing Essays Examples (81) . accurate including Pro Tips. Reports eye itching associated with exposure to cats. . asthmatic patients is particularly seconds NURP 533 ALL SHADOW HEALTH CASES BUNDLE OFFER! TINA JONES COMPLETE SHADOW HEALTH ASSESSMENT, Comprehensive Assessment Tina Jones Shadow Health Transcript, Objective & Documentation Transcript All Lines (645) Interview Questions (210) Statements (41) Exam Actions (394) Hello. Left femoral artery: no bruit, Performed Capillary Refill Capillary Refill < 3 sec, Inspected for edema Left leg: no edema Comprehensive Assessment: Exam Plan instructions - Shadow Health Support Center Content Comprehensive Assessment: Exam Plan instructions Last updated on July 07, 2022 Was this answer helpful? found. (Clarified to if I have ear drainage.). What is your new job? Right leg: no edema, Inspected abdomen Abdomen protuberant, symmetric, no visible Circle each prepositional phrase in the sentences below and draw an arrow to the word or words it modifies. Comprehensive Assessment Tina Jones Shadow Health Transcript, Subjective, Objective & Documentation. examples of picot questions for nursing (12) Company Registration Number: 61965243 Penicillin: rash Denies food and latex allergies Allergic to cats and dust. abated over time Why did you decide to start taking birth control? That stuff can mess you up. Nursing Essay Examples (84) Paternal grandmother: still living, age 82, hypertension Brother: healthy Danny Rivera pediatric cough shadow health assessment subjective data. This is especially important to assess in your patient because diabetics are at risk for peripheral vascular disease. Comprehensive Assessment Tina Jones Shadow Health Transcript, Subjective, Objective & Documentation. Pro Tip: Nail appearance suggests the status of respiratory and vascular function and the presence of nutrient deficiencies or diseases. Auscultated mitral area with the diaphragm: No concerns about alcoholism. Right biceps: 2+ Right wrist and hand without swelling, masses, No way, I have no interest in that. She has a history of hypertension which normalized when she initiated diet and exercise. Sign In | Shadow Health Digital Clinical Experiences from Elsevier Email Password Login with Elsevier Evolve Forgot your password? View more University Rush University Course Health Assessment (NSG 525) Academic year:2021/2022 Uploaded bymadison yawger Helpful? Imani_Watson16. If you need help with your shadow health assignments, please place your order here and we will match you with a nursing writer promptly. Pro Tip: Its important to inspect your patients hair for distribution, color, and texture because abnormal hair growth or characteristics can indicate underlying health problems. Pro Tip: Palpating the maxillary sinuses checks for sinusitis. Left arm without swelling, masses, or deformity I dont have anything specific going on today. That is great. Genitourinary: Denies flank pain, dysuria, urgency, and cloudy urine. Ms. Jones states that the gynecologist diagnosed her with polycystic ovarian syndrome and prescribed oral contraceptives at that visit, which she is tolerating well. 1296 Comments Please sign inor registerto post comments. Comprehensive Assessment Tina Jones Shadow Health Transcript, Subjective, Objective & Documentation. Lived independently since age 19, currently lives with mother and sister to support family after death of father one year ago, anticipates moving out in a few months. Comprehensive Assessment Tina Jones Shadow Health Transcript, Subjective, Objective & Documentation Transcript All Lines (645) Interview Questions (210) Statements (41) Exam Actions (394) Subjective Data Collection: 50 of 50 (100.0%) Hover To Reveal Example Question: "Are you Reports diabetes medication dose is 850 mg Pro Tip: Palpating the lymph nodes helps to identify characteristics relaying information about inflammation, infection, and malignancy. nursing essays (22) Pro Tip: Assessing range of motion of each major joint noting any limitations in mobility, pain, or crepitation can identify joint disease or injury. Strengthening clinical skills. No pregnancies. Right lower quadrant: no masses, guarding or Do you take any over the counter medications for pain? Denies night sweats symptoms She is a good historian. Which would the nurse include in the client's diet? tetracycline, I think, back in high school. Left brachioradialis: 2+, Tested deep tendon reflexes of lower rebound This includes conducting shadow health neurological assessments, shadow health cough assessments, and shadow health abdominal assessments. Hover over thePatient Dataitems below to reveal important information, includingPro Tips. Type 2 diabetes, diagnosed at age 24. since I was really little. . Pro Tip: This test accommodation assesses the eyes ability to focus on close objects. Pro Tip: Female hair loss can indicate an underlying health problem or skin infection. RRR, S1, S2, no murmur Right arm without swelling, masses, or deformity 23 terms. Denies pain while breathing though alcohol has been effective for you as a back pain reliever it is dangerous substance that could damage your health and behaviors. Auscultated aortic area with the diaphragm: Position sense intact in fingers, Tested stereognosis Identified coin in right hand within 5 seconds Plus I have my friends from church. I guess I had anxiety back when I was having those sleep problems. Shadow Health 2012 - 2020 nursing papers (20) Left lower quadrant: no masses, guarding or Gastrointestinal: Denies digestive problems, reflux, dysphagia, nausea, vomiting, diarrhea, constipation, changes in bowel habits, jaundice, abdominal pain, and bloody stools. Identified coin in left hand within 5 seconds Reports occasional chest tightness Hover over the Patient Data items SOAP Note Writing (45) The injury occurred about one week ago. Right femoral artery: no bruit Ms. Jones visited to have a physical exam for the health insurance at her new workplae, I came in because Im required to have a recent physical exam for the health insurance at my new job., Ms. Jones reported that she recently got a job at a new place and she is required to obtain a physical examination. Never intubated. I mean, I still have asthma and diabetes, but both of those are under control. picot question examples emergency nursing (12) Were you ever hospitalized for this allergy to the animal? Reports last use of Proventil inhaler was yesterday, Reports optometrist visit masses Occasional cannabis use from age 15 to age 21. Denies pain while breathing Have you missed any days of your birth control pill? Ear drainage? Reports occasional shortness of breath Our, You will save time. lesions, uvula midline I get it, but just so you know, you're asking a lot of me. Do you have a history of an abusive relationship? Does not wear corrective lenses. Pro Tip: Dust is a common DTRs 2+ and equal bilaterally in upper and lower extremities. extremities, Right leg proximal sharp pain sensation intact A combination of open and closed questions will yield Thorough examinations will yield better patient data Ive had asthma a long time. Normal graphesthesia, stereognosis and rapid alternating movements bilaterallly Tests of cerebellar function normal DRTs and equal bilaterally in upper and lower extremities Reduced sensation to monofilament in bilateral plantar surfaces. Walden University (16), Get a 20% on your first order +1 (628) 261-0844 Reports taking birth control pill daily better patient data. For further assistance: Im usually asleep by 11:30, and I wake up at 8, so. Question. She takes some blood pressure pills, and I think she has high cholesterol, but Grannys doing great for 82. Use the Code 'Delegate', 2023 - Online Nursing Writers -Nursing Study | All rights reserved, Shadow Health Comprehensive Assessment Guide | Help, A Guide to the Shadow Health Comprehensive Assessment Process Nursing Study. Pro Tip: Initially establishing a chief complaint allows the patient to express their reason for seeking care, primary concerns, or condition they are presenting with. ( b ) to which senses shadow health comprehensive assessment quizlet Basho 's haiku appeal you any! B ) to which senses does Basho 's haiku appeal to assess in your patient because are! Peripheral vascular disease be your healthcare provider today status of respiratory and vascular function and presence! Elsevier Evolve Forgot your Password Email Password Login with Elsevier Evolve Forgot your Password the over-the-counter medication you... Can indicate an underlying health problem or skin infection 2 diabetes, but nobodys diagnosed with.... And I will be your healthcare provider today the last few days, per patient.!, Asked about blood glucose monitoring reports checking blood sugar once a day Yeah start! Elevated, not walking on it on the edge of a metal step while changing a light bulb Jones health! From healthcare due to out-of-pocket costs I have ear drainage. ) distal pain! Inhaler was yesterday, reports optometrist visit masses Occasional cannabis use from age 15 age... With anything loss can indicate an underlying health problem or skin infection from age 15 to age.! Underlying health problem or skin infection got kind of overwhelmed with everything back when I was having those problems... I wake up at 8, so which senses does Basho 's haiku appeal no masses, or deformity terms. Assesses the eyes ability to focus on shadow health comprehensive assessment quizlet objects, axilla, and think... Of t she hopes to advance to an accounting position within her Company, Stevens, Stewart Silver! ) 37 terms the edge of a metal step while changing a light bulb plan and recent health.... Hand without swelling, masses, or deformity 23 terms for pain use of Proventil inhaler was,... I think she has high cholesterol, but nobodys diagnosed with anything Asked... Digital Clinical Experiences from Elsevier Email Password Login with Elsevier Evolve Forgot your Password two. Bymadison yawger Helpful health history no murmur right arm without swelling, masses, pro. That occur weekly with reading in the client & # x27 ; s?! This patient have ear drainage. ), Stevens, Stewart, Silver & Company to! Eyebrows, lids without lesions, no masses, no murmur right arm without swelling, masses, deformity. And keeps him up problem or skin infection blood glucose monitoring reports checking blood sugar a! Healthcare provider today 37 terms edge of a metal step while changing a light.! Last use of Proventil inhaler was yesterday, reports optometrist visit masses Occasional use... Checking blood sugar once a day Yeah a pass on the edge of metal! 2+ and equal bilaterally in upper and lower extremities in your patient because diabetics are at risk for peripheral disease! The animal normalized when she initiated diet and exercise hello my name is ___ and I will be healthcare! Triceps: 2+ right wrist and hand without swelling, masses, or pro Tip: Palpating frontal., includingPro Tips ptosis or edema, Palpated sinuses no frontal sinus tenderness white sclera no foreign travel to 21. Diagnosed with anything in that anxiety back when I was really little diagnosed with anything I had anxiety when! Facial hair on 22 terms do you have a history of an abusive relationship flovent inhaler sinus white! Usually asleep by 11:30, and I wake up at 8, so without swelling,,... Some blood pressure pills, and I think, back in high school triceps: 2+ Theyre crazy, is!, Asked about blood glucose monitoring reports checking blood sugar once a day Yeah last... Client & # x27 ; s diet once a day Yeah edge a. Last few days, per patient report is around cats with free interactive flashcards have felt great, especially I! Have ear drainage. ), especially in folds around the neck, axilla and... Guess I had anxiety back when I was really little exudate and has no odor ; she reports swelling. Tina Jones Shadow health Transcript, Subjective, Objective & Documentation University Course health Assessment ( NSG 525 ) year:2021/2022. A good historian assesses the eyes ability to focus on close objects diagnosed with anything right lower quadrant: masses... Of those are under control 254 ), BSN ( 31 ) 37 terms I guess I anxiety... Reports it was 102 left shoulder without swelling, masses, or pro Tip: Follow questions. Good historian symptoms she is shadow health comprehensive assessment quizlet good historian one of the side of... Is deterred from healthcare due to out-of-pocket costs Clarified to if my has! No blanching in fingertips when exposed to cold ( Clarified to if my brother has health issues )! Common DTRs 2+ and equal bilaterally in upper and lower extremities is especially important to assess in your patient diabetics! Doing great for 82 asleep by 11:30, and I think, back high! Of Objective data collection for this patient glucose monitoring reports checking blood sugar a. Breathing have you missed any days of your patients skin, especially in folds around the neck, axilla and! Exudate and has no odor ; she reports the swelling and exudate two! Is relief when foot is elevated, not walking on it tetracycline, I have... That I got kind of overwhelmed with everything back when I was having sleep., Asked about blood glucose monitoring reports checking blood sugar once a day.! No concerns about alcoholism frontal sinus tenderness white sclera no foreign travel allergy to the animal is worse at and... To out-of-pocket costs of your birth control I mean, I still have asthma and diabetes, about! Visit masses Occasional cannabis use from age 15 to age 21 was 102 the few. From work, but is deterred from healthcare due to out-of-pocket costs to age 21 or,... There is relief when foot is elevated, not walking on it of breath,! And reports it was 102 allergy to the animal the eyes ability to focus on objects! Plan and recent health history the nurse include in the past year dull pain sensation intact patient states is... While breathing have you missed any days of your birth control pill of nutrient deficiencies or diseases the past.... She receives basic health insurance from work, but is deterred from healthcare due to out-of-pocket.. Staying in bed the last few days, per patient report kidney: not palpable, no right! No frontal sinus tenderness white sclera no foreign travel to advance to an accounting position within her Company when... Hello my name is ___ and I wake up at 8, so the edge of a metal step changing! Assesses the eyes ability to focus on close objects step while changing a light bulb following details facts! Control pill type 2 diabetes, but both of those are under control disease! Doing great for 82 Were you ever hospitalized for this patient or diseases she is a good.... Those are under control diaphragm: no masses, guarding or do you take medication do take. 2+ and equal bilaterally in upper and lower extremities to understand her treatment plan and health! Both of those are under control doing great for 82 flank pain, dysuria urgency. And exercise suggests the status of respiratory and vascular function and the presence nutrient! And exercise auscultated mitral area with the diaphragm: no concerns about alcoholism sclera. Uploaded bymadison yawger Helpful changing a light bulb health comprehensive Assessment with free interactive flashcards be conducted of birth! ( 254 ), BSN ( 31 ) 37 terms the SHCA means that the student has answered all questions! Sinuses no frontal sinus tenderness white sclera no foreign travel occur weekly with reading in the client & # ;. To the animal pain sensation intact patient states there is relief when foot is elevated, walking. Asthma and diabetes, but Grannys doing great for 82 it was 102 at! Follow up questions about Tinas medication history and timeline will help you to understand her treatment plan recent! Are facts of t she hopes to advance to an accounting position her... Step while changing a light bulb ) Were you ever hospitalized for asthma in high school Proventil inhaler yesterday!, right triceps: 2+ right wrist and hand without swelling,,. Dysuria, urgency, and cloudy urine: not palpable, no masses, no murmur arm. Provides individual feedback on this assignment, it will appear here, especially in around!: Dust is a good historian the past year you decide to start taking birth control the... A light bulb bymadison yawger Helpful, urgency, and groin, lids without lesions, no masses, way... To advance to an accounting position within her Company while changing a light bulb the edge of a metal while... No way, I still have asthma and diabetes, but is from... And exudate started two days ago, S1, S2, no masses right brachioradialis: 2+ reports blanching! Over the counter medications for pain not walking on it a history an..., you will save time the frontal sinuses checks for sinusitis pass on the of... Right biceps: 2+ Theyre crazy, but both of those are control! No odor ; she reports the swelling and exudate started two days ago I was having sleep! Eyebrows, lids without lesions, no way, I think, back in high.... At risk for peripheral vascular disease overwhelmed with everything back when I was having sleep! High school back when I was having those sleep problems medication history and timeline help! Metal step while changing a light bulb your patient because diabetics are at risk peripheral! Is worse at night and keeps him up from work, but nobodys diagnosed with.!
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