NRS 434 Shadow Health: Conversation Concept Lab
NRS 434 Shadow Health Conversation Concept Lab
Within the Shadow Health platform, complete the Conversation Concept Lab. The estimated average time to complete this assignment is 40 minutes. Please note, this is an average time. Some students may need longer.
This clinical experience is a conversation concept lab. Students have one opportunity to complete this graded assignment. Upon completion, submit the lab pass through the assignment dropbox. Students will receive full points for successful completion of this assignment. A proficiency score is not provided.
Please review the assignment in the Health Assessment Student Handbook in Shadow Health prior to beginning the assignment to become familiar with the expectations for successful completion.
You are not required to submit this assignment to LopesWrite.
Attachments
NRS-434VN-R-HealthScreeningandHisto
Shadow Health is an educational software developer of learning environments termed Digital Clinical Experiences™ (DCEs).
Founded in Gainesville, Florida in 2011, Shadow Health offers web-based clinical learning environments for masters, bachelors, and associate degree students and faculty in the fields of nursing and healthcare. The Shadow Health DCE is used in universities across the United States and Canada. As a learning management system, each DCE provides educators with administration, documentation and tracking functions to measure student clinical competence and clinical reasoning. Students navigate the digital clinical experience gaining confidence, developing clinical skills and learning how to effectively interact with patients within a safe environment.
Through the Shadow Health DCE, students engage with Digital Standardized Patients™ to perform patient exams, practice documentation and develop clinical reasoning skills. Upon completion of each virtual patient examination, students are prompted to reflect on their experiences and compare them against an expert’s notes. Shadow Health’s premier DSP is Tina Jones. According to a health educator at Drexel University, “what truly makes Shadow Health unique, however, is that Tina acts like a real patient by responding to how she is treated, approached or the type of questions she is asked by the student practitioner” [1]
The Shadow Health work environment includes cross-functional teams using agile management. Shadow Health is a graduate of The Innovation Hub, a local incubator hub opened in 2011. “Hub tenants have created more than 760 jobs and drawn more than $50 million in private investment funds” [2] Having been named as one of the 2014 Florida Companies to watch,[3] Shadow Health continues to expand with moves to larger office spaces in both 2012[4] and again December 2015.
Transcript
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What brings you in today?
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I’m here for my physical.
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What health problems do you have?
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I’ve never had any health problems. I almost never get like, a cold, and I’ve never been in the hospital. I’ve never even broken a bone.
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What medications do you take?
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I don’t take any medications. I mean, unless you count ibuprofen every so often.
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Do you use supplements?
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I don’t take any vitamins, supplements, anything like that.
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Do you use prescription drugs?
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No, I don’t have any prescriptions.
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Why do you use ibuprofen?
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For cramps — when I get my period.
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How often do you use ibuprofen?
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I only take Advil once a month.
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What dosage of ibuprofen do you use?
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Um, I don’t know how many milligrams… It’s not extra-strength or anything. I think it’s just kind of regular Advil.
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Do you take OTC medications? (Clarified to Do you take any OTC medication beside ibuprofen?.)
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The only thing I ever take is Advil. (Clarified to if I take any OTC medication beside ibuprofen.)
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Are you allergic to drugs? (Clarified to Do you have medication allergies?.)
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No, I’m not allergic to any medications that I know of. (Clarified to if I have medication allergies.)
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What environmental and seasonal allergies do you have?
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No, I don’t get hay fever, or sneezy around flowers or anything. Lucky for my mom, since she makes me help her in the garden all the time.
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Do you have food allergies?
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Yeah, I’ve been allergic to peanuts since I was little.
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What reaction do you have to peanuts?
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Well, when I’ve eaten peanuts the inside of my mouth and inside my throat gets pretty itchy. It’s weird. But I don’t think I’ve ever had hives or anything like that.
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How do you treat your peanut allergy?
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The last time I had a reaction, the doctor told me it was pretty mild and to just take some Benadryl. Other than that, I just avoid them.
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How do you prevent your peanut allergy?
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Well… I ask what’s in things, especially if something’s fried, because it could be fried in peanut oil. And I read ingredients before I buy something if I’m not sure.
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Are you allergic to latex?
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Latex allergy? No, I’ve never had that.
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Is your allergy severe?
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No, I wouldn’t say they are severe.
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how severe is your allergy?
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Not really. Just the itching in my mouth and stuff when I’ve eaten peanuts, or food made with peanut oil or whatever.
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when was your allergy discovered? (Clarified to How old were you when you discovered your peanut allergy?.)
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I first found out I couldn’t eat peanuts when I was 4. (Clarified to how old I was when I discovered my allergy to peanuts.)
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Do you take alcohol? (No matching questions found.)
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Do you use alcohol?
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Nah, I’m not really interested in that.
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what tobacco products have you used?
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Just cigarettes, honestly.
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what do you smoke?
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Just cigarettes, honestly.
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do you smoke cigars?
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No, last I checked I wasn’t an old dude.
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have you ever tried chewing tobacco?
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Ew! Like chewing tobacco. No.
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have you ever tried an electronic cigarette?
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No, I haven’t tried that.
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how much do you smoke?
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Really . . . not very many.
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how many times have you smoked?
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I’ve had, like, three cigarettes ever. It wasn’t a big deal.
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can you tell me what you know about the impact of cigarette smoking?
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I know people die from smoking all the time, like millions of people. It causes lung cancer, emphysema… A whole bunch of other stuff. I mean, by this point everyone must know that.
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Yes, smoking is dangerous for you.
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Oh . . . Good to know.
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how do you feel about smoking?
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Yeah, I know. Thanks.
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how do you feel about smoking?
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I guess I feel kinda embarrassed that I smoked, because I know all the bad stuff it does. Cancer, emphysema, all of that. It wasn’t even enjoyable really.
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sorry to hear that
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Thanks.
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do your friends encourage you to smoke?
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Empathize |
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Thanks.
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what will you say if your friends asked you to smoke again?
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Empathize |
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Thank you.
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what will you say if your friends asked you to smoke again?
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I’ll tell them no thanks, and that it’s not for me. I’m sure they’ll be cool with that.
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have you ever tried alcohol?
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Nah, I’m not really interested in that.
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do your friends ever drink alcohol?
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No, none of my “friends” drink.
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does anyone at home ever drink alcohol? (Clarified to Does anyone in your family drink alcohol?.)
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Yeah, both my parents drink sometimes. (Clarified to if anyone in my family drinks alcohol.)
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how much alcohol do your parents drink at home?
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Not much at all really. They’ll have, like, a glass of wine at dinner.
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have you ever experimented with alcohol?
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Nah, I’m not really interested in that.
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have you ever experimented with drugs?
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No. I’ve never done any drugs, ever.
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Has peer pressure made you drink alcohol? (No matching questions found.)
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do your friends ever drink alcohol?
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No, none of my “friends” drink.
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do your friends ever use drugs?
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No. I don’t do drugs, and neither do my friends.
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do your friends ever smoke? \
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No, none of my “friends” drink.
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did peer pressure cause your smoking? (Clarified to Did your friends pressure you to smoke?.)
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When I smoked, I wasn’t trying to impress anyone. I mean, maybe I did want to fit in, but mostly I was just curious. My friends didn’t, like, make me do it–I definitely don’t want you to think that. (Clarified to if my friends pressured me to smoke.)
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Advanced Heath Assessment Documentation Tutorial
In each of the Shadow Health (SH) Assignments, you will be asked to complete a narrative note as part of the grading criteria. Narrative or progress notes are often a new skill. This document is provided to assist students in understanding how to write a narrative note. Shadow Health refers to these notes as Provider Notes.
Documentation of patient care is essential to quality and safety of care. Much of the clinical documentation is completed electronically using point and click tools to describe the patient condition (Lindo, et al., 2016). Often computer prompts fall short of fully describing the patient condition. Other situations such as lack of technology, electrical outages, system hacking, failure of equipment, and any number of situations which may interfere with normal electronic documentation may require a narrative nurses/progress note. Nurses must be able to clearly communicate patient information with everyone on the health care team to ensure quality and safety of care (Lindo, et al., 2016).
Documentation must be clear, paint a picture of the patient, and provide measurable concise information in a timely manner. The information communicated must be able to be understood by others and provide enough information to understand if a change has occurred in the patient condition and to clearly communicate all treatments, interventions, and therapies received by the patient and/or planned for the patient. Documentation also serves as a legal record of care (Lippincott Williams and Wilkins, 2007).
Documentation begins with subjective data/information. This is information the patient, family member, or caregiver may provide if the patient is unable to communicate which includes such data as the history of present illness (HPI), the past history- allergies, medications, medical surgical & social and the review of systems (ROS). Objective data/information includes the physical exam, observations and measurements obtained during the examination of the patient. Objective data also includes vital signs, laboratory and diagnostic results (Bates, 2017, pg.7)
Subjective vs. Objective Data-As you begin to acquire data from the patient interview and physical exam, it is important to remember the difference between subjective and objective information. Symptoms are the subjective concerns of what the patient tells you of their experience. Signs are the objective findings from your observations. (Bates, 2017, pg.6). Sequence of data is documented in the manner it is collected from the sequence of the examination. Physical examination follows a cephalocaudal sequence with the cardinal techniques of inspection, palpation percussion and auscultation (Bates, 2018)
Subjective information assists in understanding the patient condition and provides a basis upon which the nurse decides which body systems need to be assessed and which assessments need to be completed. Many of the assessments to be performed in the class are focused or problem based and focus on the assessment of a specific body system. The Comprehensive assessment is a complete health history and physical exam of most all body systems (Bates, 2017. Pg.5)
Once subjective and objective information are obtained and have been thoroughly considered an assessment/nursing diagnosis or medical diagnosis (physicians and advanced practice only) is identified. A plan of care will then be developed based on the nursing diagnoses. In the health assessment competencies, the primary focus is on gathering accurate subjective and objective data (Bates, 2017, pg.24)
Subjective data should be recorded using the patient’s own words and describing his/her feelings and experiences related to health. When interviewing the patient about a current issue or illness the seven attributes of a symptom need to be included in the documentation (Bates, 2017, pg.79)). The seven attributes of a symptom would be asked for any positive response during the health history (HH) and review of systems (ROS). Here is a list of the attirbutes and a few sample questions for a patient with complains of abdominal pain (Bates, 2017, pg.79)
- Location: “Where does it hurt?” “Please point to the area of pain.”
- Quality: “How would you describe the pain?” “Is it sharp pain?” “Dull pain?”
- Quantity or Severity: “On a scale of 0-10, 0 being no pain and 10 being the worst pain ever, what is your level of pain?” “How has the pain impacted your daily routine?”
- Timing: “When does the pain occur?” “How long does it last?” “Approximately how long after you have eaten does the pain begin?” ”Does the pain radiate?” “If yes, where does it radiate?”
- Onset or Setting in which it occurs: “What were you doing when the pain began?”
- Aggravating or Relieving Factors: “Is the pain worse after eating certain foods?” “What makes the pain better?”
- Associated Factors: “Do you have any nausea or vomiting?” “Any diarrhea?” “Any constipation?”
Another way to remember what to ask the patient is to use the mnemonic OLDCARTS or OPQRST (Bates, 2017. p.79)
O: Onset
L: Location
D: Duration of symptoms
C: Character
A: Aggravating/Alleviating Factors
R: Radiation
T: Timing
S: Severity
OR
O: Onset
P: Provocative or Palliative
Q: Quality or Quantity
R: Region or Radiation
S: Site
T: Timing
When documenting the ROS it is necessary to document each condition or item asked about because others will be reading the notes and relying on the information provided. If information is incomplete or inaccurate patient safety and quality of care may be affected. Documentation of pertinent negatives should be specifically described. Do not overgeneralize by using terms such as “WNL”, or neurologic exam negative” as this does not convey what exactly was assessed subjectively and/or objectively (Bates, 2018, p. 38)
ROS (Subjective) Documentation Example:
Review the following ROS areas and the associated documentation and note the quality of the information provided for each system.
- Skin: Denies any rashes or changes to skin
- Head: No problems with head or headaches.
- Ears: Positive for fullness feeling in bilateral ears for past 2 days, denies changes in hearing, pain in ears or any drainage.
- Eyes: No problems, says they are normal.
Skin and ears are documented correctly. The skin description relays what items were subjectively asked of the patient. The ears ROS also includes pertinent positive with further information and pertinent negatives.
Head and eyes are not documented correctly. There is not a description of the items subjectively asked and is an incomplete picture.
(Bates, 2017, pg. 32)
Assessment (Objective) Documentation Example:
Skin: Uniform in color, tan, warm, dry, intact. Turgor good, skin returns immediately when released. Scattered flat small macules on face around nose. On back of left shoulder 4mm, symmetrical, smooth borders, dark brown, evenly colored, slightly raised nevus, without tenderness or discharge. Well healed pale scar 3 cm right forearm. Left wrist approximately 1 cm area around the circumference of the wrist pruritic papules and vesicles with an erythematous base. Silver colored striae around lower outer quadrants of abdomen and hips.
- Head: Shape okay.
- Eyes: Eye color brown. brows, lids, and lashes symmetric, right brow ridge piercing with intact silver hoop, no redness, tenderness, or discharge; lacrimal ducts pink and open without discharge. Conjunctiva clear, sclera white, moist, and clear, no lesions or redness, no ptosis, lid lag, discharge or crusting. Snellen vision assessment 20/20 in each eye with corrective lenses. EOMs intact, no nystagmus, PERRLA
- Ears: TM with good cone of light, pearly gray appearance, canal clear of wax bilaterally, no edema or drainage present. Auditory acuity present bilaterally to whispered voice.
Skin is documented very complete and concise a picture of the patient is evolving and measurable assessment data is provided. Complete description of the rash on the left wrist provides a measurable concise picture. A mole was noted and documentation included the ABCDE of the mole. It is important to describe both normal and abnormal findings in a measurable manner. The text offers examples of how to provide measurable information for many assessment findings such as tonsils, pulses, reflexes, and strength (Bates, 2017, pg. 33)
The documentation for head is less measurable. How is one to know what “shape okay” is for this patient?
The documentation for the eyes is very thorough and concise. Measurable terms are used and a description of the patient’s eyes is provided.
The documentation for the ears is also very concise and thorough. Measurable terminology is used and a description is provided.
Some of the Shadow Health (SH) exams focus on one body system such as Cardiac. In this situation focus on pertinent questions related to the ROS and physical assessment for cardiac and any associated body systems. In the case of cardiac, peripheral vascular and respiratory would be additional systems to assess.
When completing the assessments in SH use the textbook as a guide. Open to the appropriate chapter and follow along to ensure all aspects of the assessment are covered for both subjective and objective assessment areas. Document carefully for each assessment area keeping in mind the differences between subjective and objective information and ensuring measurable concise information is recorded.
Subjective and objective information is separated and each body system is used as a heading for easier retrieval of information. When information is disorganized it is difficult to know which is the information provided by the patient and which is the objective clinical assessment data. In an emergency retrieval of information must be done quickly. Well organized and written notes allow for timely retrieval (Lindo et al., 2016).
References
Bickley, L. S. (2017). Bates Guide to Physical Examination and History Taking (12th ed.). Wolters Kluwer Health/Lippincott Williams & Wilkins: Philadelphia, PA.
Lindo, J., Stennett, R., Stephenson-Wilson, K., Barrett, K.A., Bunnaman, D., Anderson-Johnson, P., Waugh-Brown, V., and Wint, Y. (2016). An audit of nursing documentation at three public hospitals in Jamaica. Journal of Nursing Scholarship, 48(5), 508-516.
Lippincott Williams & Wilkins (2007). Charting: An incredibly easy pocket guide. Ambler, PA: Author.