Mrs. Esther Park is a 78-year-old woman who comes to the clinic complaining of abdominal pain. She reports that the pain isn’t severe, but that her daughter was concerned and brought her in. It is very important to determine whether or not the situation is an emergency and the underlying cause of Esther’s discomfort. Be sure to inquire about a variety of psychosocial factors related to the GI system, including her diet, toilet habits, immunizations, recent travel, etc. This case study will offer you the opportunity to take a complete surgical, reproductive, and current sexual history. During her physical examination, take particular note as to where Mrs. Park verbalizes pain during palpation so that you may synthesize verbal and non-verbal cues. Be sure to apply the supportive information learned in this week’s concept lab to your critical thinking process in this case study. Esther park abdominal pain focused shadow health assessment transcript, objective, subjective solved.
Hover over the Patient Data items below to reveal important information, including Pro Tips and Example Questions.
Found: Indicates an item that you found.
Available: Indicates an item that is available to be found. Esther park abdominal pain focused shadow health assessment transcript, objective, subjective solved
Category
Scored Items
Experts selected these topics as essential components of a strong, thorough interview with this patient.
Patient Data
Not Scored
A combination of open and closed questions will yield better patient data. The following details are facts of the patient’s case.
Chief Complaint
Finding:Established chief complaint
Finding:Reports abdominal pain(Found)Pro Tip: Abdominal pain can be caused by problems in the underlying organs, peritoneum, muscles, or blood vessels, changes in electrolytes or other blood contents, or even anxiety. Asking for details about the pain helps to determine the origin. Esther park abdominal pain focused shadow health assessment transcript, objective, subjective solved.Example Question:Do you have any abdominal pain?
Finding:Reports difficulty “going to the bathroom”(Found)Pro Tip: Understanding all of a patient’s reason for visiting is an important foundation to establish. If there are multiple symptoms, follow up on each one during your interview.Example Question:Are you able to make a bowel movement?
History of Present Illness
Finding:Asked about oxxx
Finding:Reports a feeling of xxxx(Found)Pro Tip: WxxxxExample Question:How xxxx
Finding:Reports pain with xxxx(Found)Pro Tip: Whenever you are assessing a symptom or a health condition, inquiring about xxxx. Esther park abdominal pain focused shadow health assessment transcript, objective, subjective solved.Example Question:Has thexxxx
Finding:Asked about xxxxx
Finding:Reports xxxx(Found)Pro Tip: Identification of the location of your patient’s discomfort can provide important clues about its cause and how it should be best treated.Example Question:Where is your discomfort located?
Finding:Reports pain is not localized(Found)Pro Tip: xxxx Esther park abdominal pain focused shadow health assessment transcript, objective, subjective solvedExample Question:Is the xxxxx
Finding:Reports attempts to treat pain by drinking small sips of warm water(Found)Pro Tip: Flank pain often occurs with disorders of the urinary tract. When a patient complains of flank pain, assess for co-occurring symptoms such as fever, chills, hematuria, and dysuria.Example Question:Do you have pain on your sides?
Finding:Confirmed pain rating on a scale
Finding:Reports painxxxx(Found)Pro Tip: For many people, it is difficult to clearly dxxxx.Example Question:How would you rate your pain on a scale of one to ten?
Finding:Asked aboutxxxx
Finding:Describes xxxx(Found)Pro Tip: Asking your patient toxhelps identify its xxxcause and the severity. Patients may not know how to answer, so you may need to suggest words like xxxxExample Question:Can you xxxxx
Finding:Reports pain is ixxx(Found)Pro Tip: It’s important to ask your patient if her pain is xxx in order to determine her level of discomfort and identify the cause of the pain. xxxx pain is often best managed with around-the-clock pain medications. Esther park abdominal pain focused shadow health assessment transcript, objective, subjective solvedExample Question:Is your painxxxx
Finding:Asked about xxxxx
Finding:Reports that resting helps(Available)Pro Tip: It’s important to assess the nature of pain by asking about xxx. If you know your patient is taking xxxx, asking about the medication’s xxxx can help you xxxx.Example Question:What xxx?
Finding:Reports attempts to xxxx(Available)Pro Tip: Asking about how your patient has been xxxx. The results of her previous treatment may be helpful in your diagnosis and the development of her new xxxx, as well as a good opportunity toxxx your patient on xxxx.Example Question:How have you been xxx?
Finding:Reports xxxstomach(Found)Pro Tip: Asking about how your patient has been nxxxxes her current condition and her approach to xxxx. The results of her previous treatment may be helpful in your xxxand the development of her xxx, as well as a good opportunity to x. Esther park abdominal pain focused shadow healxxxxth assessment transcript, objective, subjective solvedExample Question:Have you xxx?
Finding:Asked about xxxx
Finding:Reports pain is aggravated by eating(Found)Pro Tip: Asking you patient what aggravates her pain can point to factors that exacerbate symptoms and the ways in which your patient is approaching self-care.Example Question:Is the painxxx by xxx
Finding:Reports xx by xx(Found)Pro Tip: Asking you patient what aggravates her pain can point to factors that exacerbate symptoms and the ways in which your patient is approaching self-care.Example Question:Is the pain aggravated by xxx
Finding:Asked about activities of daily life
Finding:Reports recent difficulty participating in usual activities(Found)Pro Tip: Asking about changes in activity level will help determine the level of disability caused by your patient’s condition. Esther park abdominal pain focused shadow health assessment transcript, objective, subjective solvedExample Question:How has your xxx?
Finding:Reports low xxx(Found)Pro Tip: Asking about x will help determine thxxe level of xxxxcaused by your patient’sxxxx.Example Question:Do you have x?xx
Finding:Asked aboutxxxx
Finding:Reports current xxx(Found)Pro Tip: In xxx patients, xxx is often caused byxx, xxxx side effects, xxx diets, and difficulty ambulating to the toilet, which can result in deliberate retention of xxxExample Question:Are you xxxx?
Finding:Reports no history of xxxx(Available)Pro Tip: xExample Question:Are you xxx
Finding:Followed up aboutxxx
Finding:Reports constipation for 5 days(Found)Pro Tip: Whenever you are assessing a symptom or a health condition, inquiring about x assxxesses the xxxx and the xxx of the problem.Example Question:For how long have you beenxxxx
Finding:Reports no attempt to treat xxx(Found)Pro Tip: Asking about how your patient has been managing her pain assesses her current condition and her approach to self-care. The results of her previous treatment may be helpful in your diagnosis and the development of her new treatment plan, as well as a good opportunity to educate your patient on effective self-care practices.Example Question:How have you tried to treat thexxxx
Finding:Asked about xxxx
Finding:Reports recent xxxx(Found)Pro Tip: Whenever you are assessing a symptom or a health condition, inquiring about onset assesses the severity and the progression of the problem. Esther park abdominal pain focused shadow health assessment transcript, objective, subjective solved.Example Question:Have you recently had xxx
Finding:Followed up about xxxx
Finding:Reports xxxx(Found)Pro Tip: It’s important to ask about changes in stool characteristics because it may be a sign of a new onset of a gastrointestinal disease or disorder. xxxx is a common symptom of inflammatory bowel diseases, food allergies and intolerance, gastrointestinal infections, and many other conditions.Example Question:How long ago did you xxxx
Finding:Reports xxxx had a sudden onset(Found)Pro Tip: It’s important to ask about changes in stool characteristics because it may be a sign of a new onset of a gastrointestinal disease or disorder. xxx is a common symptom of inflammatory bowel diseases, food allergies and intolerance, gastrointestinal infections, and many other conditions.Example Question:Did the xxxx happen suddenly?
Finding:Reports diarrhea lasted one day(Found)Pro Tip: It’s important to ask about changes in stool characteristics because it may be a sign of a new onset of a gastrointestinal disease or disorder. Diarrhea is a common symptom of inflammatory bowel diseases, food allergies and intolerance, gastrointestinal infections, and many other conditions.Example Question:How long did your diarrhea last?
Finding:Describes diarrhea as loose and watery(Available)Pro Tip: Asking a patient who has diarrhea to describe her stool helps identify its cause and the severity. Patients may not know how to answer, so you may need to suggest words like frothy, greasy, floating, or watery. It is also important to inquire about the presence of blood or mucus. Esther park abdominal pain focused shadow health assessment transcript, objective, subjective solved.Example Question:How would you describe the diarrhea?
Finding:Asked about bowel movement patterns
Finding:Reports last bowel movement 3 days ago(Found)Pro Tip: Whenever you are assessing a symptom or a health condition, inquiring about onset assesses the severity and the progression of the problem.Example Question:When did the constipation start?
Finding:Reports some discomfort during bowel movement(Available)Pro Tip: It’s important to ask about changes in stool characteristics because it may be a sign of a new onset of a gastrointestinal disease or disorder.Example Question:Do you have pain during bowel movements?
Finding:Last bowel movement was diarrhea(Available)Pro Tip: It’s important to ask about changes in stool characteristics because it may be a sign of a new onset of a gastrointestinal disease or disorder. Diarrhea is a common symptom of inflammatory bowel diseases, food allergies and intolerance, gastrointestinal infections, and many other conditions.Example Question:What was the character of your last bowel movement?
Finding:Reports no mucus in stool(Found)Pro Tip: While small amounts of mucus may be present in normal stool, increased mucus in the stool is associated with a variety of intestinal disorders.Example Question:Has there been mucus in your stool?
Finding:Reports no blood in stool(Found)Pro Tip: Bloody stool is an alarming symptom that indicates bleeding in the digestive tract. Bright red bloody stool suggests bleeding in the colon or rectum. Bloody stool that appears black or tarry suggests bleeding in upper digestive tract, such as the small intestine or stomach.Example Question:Has there been blood in your stool?
Finding:Reports typically having a bowel movement almost every day(Found)Pro Tip: Asking about usual bowel movements facilitates baseline data collection. Asking specifically about bowel movement frequency aids in the identification of abnormalities.Example Question:How many bowel movements do you typically have per week?
Finding:Reports stools usually brown, formed, and soft(Found)Pro Tip: Asking about usual bowel movements facilitates baseline data collection. Asking specifically about bowel movement frequency aids in the identification of abnormalities. Esther park abdominal pain focused shadow health assessment transcript, objective, subjective solved.Example Question:Can you describe a typical bowel movement?
Finding:Asked about urination
Finding:Reports recent, slight decrease in frequency of urination(Found)Pro Tip: Frequency of urination can be an important clue to many underlying conditions. It’s important to ask whether your patient has noticed changes in her typical habits.Example Question:Have you had any changes in the frequency of your urination?
Finding:Reports darker urine recently(Found)Pro Tip: Darker urination can be an important clue to many underlying conditions like cirrhosis or hepatitis. It’s important to ask whether your patient has noticed changes in her typical urinary patterns.Example Question:Has your urine been darker recently?
Finding:Reports no blood in urine(Found)Pro Tip: Blood in the urine can be an important clue to many underlying conditions like cancer or kidney problems. It’s important to ask whether your patient has noticed changes in her typical urinary patterns.Example Question:Have you had blood in your urine?
Medical History
Finding:Asked about medications
Finding:Reports blood pressure medication(Found)Pro Tip: The medication that a patient takes will indicate any relevant health conditions, their treatment plan, and how well they comply with it. Asking about relevant medication will help you to treat your patient.Example Question:Do you take medication for your blood pressure?
Finding:Reports Accupril(Available)Pro Tip: The medication that a patient takes will indicate any relevant health conditions, their treatment plan, and how well they comply with it. Asking about relevant medication will help you to treat your patient.Example Question:What medication do you take for your blood pressure?
Finding:Accupril is 10 mg(Found)Pro Tip: The medication that a patient takes will indicate any relevant health conditions, their treatment plan, and how well they comply with it. Asking about relevant medication will help you to treat your patient.Example Question:What dose of blood pressure medication do you take?
Finding:Taken daily at 8 a.m.(Found)Pro Tip: The medication that a patient takes will indicate any relevant health conditions, their treatment plan, and how well they comply with it. Asking about relevant medication will help you to treat your patient. Esther park abdominal pain focused shadow health assessment transcript, objective, subjective solvedExample Question:When did you last take blood pressure medication?
Finding:Reports no OTC use(Found)Pro Tip: Patients should always be asked specifically about over-the-counter medications, as many patients will overlook talking about them. Over-the-counter medications can cause medical complications of their own or can indicate medical problems that your patient has been attempting to self-treat.Example Question:Do you take any over-the-counter medications?
Finding:Asked about allergies
Finding:Reports latex allergy(Found)Pro Tip: Latex allergies can cause severe and even life-threatening consequences. Always asking specifically about allergies can help ensure that your patient does not receive medication or treatment that will do her harm.Example Question:Are you allergic to latex?
Finding:Reports no medication allergies(Found)Pro Tip: Medication allergies can cause severe and even life-threatening consequences. Always asking specifically about these allergies can help ensure that your patient does not receive medication that will do her harm.Example Question:Are you allergic to any medications?
Finding:Reports no food allergies(Found)Pro Tip: Knowing your patient’s food allergies prevents your patient from receiving harmful food, and it helps to identify specific allergies–such as shellfish or eggs–which can contraindicate the administration of common medications or treatments that include derivatives of these substances.Example Question:Do you have any food allergies?
Finding:Asked about general known health conditions
Finding:Reports hypertension(Found)Pro Tip: It’s best to determine specifically whether or not the condition has been diagnosed by a healthcare professional.Example Question:Do you have high blood pressure?
Finding:Diagnosed with hypertension at age 54(Available)Pro Tip: Learning the diagnosis date of your patient’s illness is an essential element of the illness’s history.Example Question:At what age were you diagnosed with hypertension? Esther park abdominal pain focused shadow health assessment transcript, objective, subjective solved
Finding:Asked about relevant gastrointestinal history
Finding:Reports no history of gastrointestinal disorders(Found)Pro Tip: Broad open questions are efficient and useful in eliciting a large amount of information from your patient. Asking about any gastrointestinal problems helps guide your assessment.Example Question:Do you have any GI conditions?
Finding:Reports no history of GERD, heartburn, or ulcer(Found)Pro Tip: If a patient has a history of GERD, ulcer, heartburn, or perceived indigestion, it could contribute to her present condition.Example Question:Do you have a history of heartburn?
Finding:Reports no history of appendicitis(Found)Pro Tip: In patients with lower quadrant abdominal pain, confirming a previous appendectomy can help rule out appendicitis as a cause for her current symptoms. It is important to note that elderly patients with appendicitis may present atypically and often lack certain classic symptoms such as rebound tenderness, right lower quadrant pain, fever, and anorexia.Example Question:Have you ever had appendicitis?
Finding:Reports no history of stomach cancer(Found)Pro Tip: If a patient has a history of stomach cancer, abdominal pain could be a sign of recurrence.Example Question:Do you have a history of stomach cancer?
Finding:Reports no history of liver disease(Found)Pro Tip: A history of liver disease could cause additional gastrointestinal complaints for a patient.Example Question:Do you have a history of liver disease?
Finding:Asked about relevant history of surgery
Finding:Reports c-section(Found)Pro Tip: Information about your patient’s pregnancy complications can provide you with insight into past medical conditions. Esther park abdominal pain focused shadow health assessment transcript, objective, subjective solvedExample Question:Did you have any complications during pregnancy?
Finding:C-section at age 40(Found)Pro Tip: Information about your patient’s pregnancy can provide you with insight into past medical conditions.Example Question:At what age did you have a C-section?
Finding:Reports cholecystectomy(Found)Pro Tip: Information about your patient’s past surgeries can provide you with insight into past medical conditions.Example Question:Have you had your gallbladder removed?
Finding:Cholecystectomy at age 42(Found)Pro Tip: Establishing a timeline about your patient’s past surgeries can provide you with insight into past medical conditions.Example Question:At what age did you have your gallbladder removed?
Finding:Reports no post-operative complications(Available)Pro Tip: Asking about any postoperative complications in your patient’s history may provide information relevant to identifying her present condition.Example Question:Did you have any complications after your surgery?
Social History
Finding:Asked about diet
Finding:Reports last meal was toast at breakfast(Found)Pro Tip: A healthy and balanced diet is crucial for maintaining good health. Asking Esther about her last meal will indicate her typical eating habits and allow you to assess whether her eating habits put her at risk of cardiovascular disease or other health complications.Example Question:What was your last meal?
Finding:Typically eats 3 meals(Found)Pro Tip: A healthy and balanced diet is crucial for maintaining good health. Asking Esther about what she typically eats will allow you to assess whether her eating habits put her at risk of cardiovascular disease or other health complications.Example Question:How many meals do you typically eat in a day?
Finding:Typically does not eat snacks(Found)Pro Tip: A healthy and balanced diet is crucial for maintaining good health. Asking Esther about what she typically has for a snack will allow you to assess whether her eating habits put her at risk of cardiovascular disease or other health complications.Example Question:What is a typical snack for you?
Finding:Typical breakfast is a piece of fruit(Found)Pro Tip: A healthy and balanced diet is crucial for maintaining good health. Asking Esther about what she typically eats for breakfast will allow you to assess whether her eating habits put her at risk of cardiovascular disease or other health complications.Example Question:What do you usually eat for breakfast?
Finding:Typical lunch is soup, sometimes skips lunch(Found)Pro Tip: A healthy and balanced diet is crucial for maintaining good health. Asking Esther about what she typically eats for lunch will allow you to assess whether her eating habits put her at risk of cardiovascular disease or other health complications. Esther park abdominal pain focused shadow health assessment transcript, objective, subjective solvedExample Question:What do you usually eat for lunch?
Finding:Typical dinner is chicken or fish with vegetables and rice(Found)Pro Tip: A healthy and balanced diet is crucial for maintaining good health. Asking Esther about what she typically eats for dinner will allow you to assess whether her eating habits put her at risk of cardiovascular disease or other health complications.Example Question:What do you usually eat for dinner?
Finding:Asked about fiber intake
Finding:Reports no fiber supplements(Found)Pro Tip: A high fiber diet helps to reduce constipation. Asking Esther if she takes fiber supplements will help you to assess whether she gets enough fiber in her diet.Example Question:Do you take fiber supplements?
Finding:Reports belief that she gets enough fiber(Found)Pro Tip: A high fiber diet helps to reduce constipation. Asking Esther about her fiber consumption will help you to assess whether she gets enough fiber in her diet.Example Question:Do you think you get enough fiber?
Finding:Reports getting fiber from a daily vegetable(Found)Pro Tip: A high fiber diet helps to reduce constipation. Asking Esther what sources of fiber she eats will help you to assess whether she gets enough fiber in her diet. Esther park abdominal pain focused shadow health assessment transcript, objective, subjective solvedExample Question:What sources of fiber do you eat?
Finding:Reports getting fiber from a daily piece of fruit
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Objective Data Collection: 26 of 26 (100%)
Correct
Partially correct
Incorrect
Missed
Inspected head and face1 of 1 pointSkull Symmetry (1/3 point)
Symmetric
Asymmetric
Facial Feature Symmetry (1/3 point)
Symmetric
Asymmetric
Appearance (1/3 point)
No visible abnormal findings
Flushed appearance
Rash or lesion
Skin growths (freckles, moles, or birth mark)
Excessive hair growth
Evidence of skin trauma (scar, laceration, or bruising)
Esther park abdominal pain focused shadow health assessment transcript, objective, subjective solved
Inspected nasal mucosa1 of 1 pointAppearance (1/1 point)
Moist and pink
Dry appearance
Redness
Inspected mouth1 of 1 pointOral Mucosa (1/1 point)
Moist and pink
Dry appearance
Redness
Inspected abdomen1 of 1 point Inspected for edema in lower extremities1 of 1 point Auscultated heart sounds1 of 1 point Auscultated breath sounds1 of 1 point Auscultated abdominal aorta1 of 1 point Auscultated bowel sounds1 of 1 pointBowel Sounds (1/2 point)
Absent
Hypoactive
Normoactive
Hyperactive
Location Of Non Normoactive Bowel Sounds (1/2 point)
All quadrants normoactive
Right upper quadrant
Right lower quadrant
Left upper quadrant
Left lower quadrant
Auscultated abdominal arteries1 of 1 point Auscultated organs1 of 1 point Percussed abdomen1 of 1 point Percussed spleen1 of 1 point Percussed liver1 of 1 point Percussed CVA tenderness1 of 1 point Palpated abdomen – light1 of 1 pointTenderness (1/3 point)
None reported
Tenderness reported
Location Of Tenderness (1/3 point)
No quadrants tender
Right upper quadrant
Right lower quadrant
Left upper quadrant
Left lower quadrant
Observations (1/3 point)
No additional observations
Masses
Guarding
Distension
Palpated abdomen – deep1 of 1 point Palpated aortic width1 of 1 point Palpated liver1 of 1 point Palpated spleen1 of 1 point Palpated bladder1 of 1 point Palpated kidneys1 of 1 pointRight (1/2 point)
Not palpable
Palpable
Left (1/2 point)
Not palpable
Palpable
Esther park abdominal pain focused shadow health assessment transcript, objective, subjective solved
Tested skin turgor1 of 1 point Performed pelvic exam1 of 1 point Performed digital rectal exam1 of 1 pointObservations (1/1 point)
During the patient interview, there are a number of opportunities to provide patient education and empathy. The opportunities listed below are those identified by nursing experts to be of particular importance to this patient. A Model Statement is provided as an example of an appropriate response to each opportunity.
Opportunities marked as Not Encountered are opportunities that were not elicited in the interview
Opportunities marked as Not Followed Up are missed opportunities that were present in the interview, but where no statements were made
Opportunities marked as Followed Up were followed up by students, and include the dialogue between student and patient Esther park abdominal pain focused shadow health assessment transcript, objective, subjective solved.
1 SymptomsFollowed Up
Description: Ms. Park describes the symptoms that have been bothering her.
What brings to the clinic today?
Question 11:26 AM PDT
I have some pain in my belly. . . and I’m having difficulty going to the bathroom. My daughter was worried about me.
i am sorry you are having pain in your belly.
Empathize 11:27 AM PDT
Thank you.
When did the abdominal discomfort begin?
Question 11:27 AM PDT
It all started. . . about five days ago. When I started having trouble going to the bathroom. Esther park abdominal pain focused shadow health assessment transcript, objective, subjective solved
I am sorry to hear this.
Empathize 11:28 AM PDT
Thank you.
Does eating aggravate the pain?
Question 11:37 AM PDT
Yes. The pain is there all the time, but eating can make it worse.
does physical activity aggravate pain?
Question 11:38 AM PDT
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.
i am sorry for th discomfort.
Empathize 11:38 AM PDT
Thank you.
do you get constipation often?
Question 11:51 AM PDT
I don’t usually have problems going to the bathroom. . . but this has been going on for. . . about five days now. [AUDIO COMING SOON]
How many bowel movements do you typically have per week?
Question 11:52 AM PDT
Before this? Every day. Well, I miss a day now and then, but usually every day.
Are your stools usually formed?
Question 11:53 AM PDT
Usually, yes. But not when I had the diarrhea.
are your stools typically soft ?
Question 11:54 AM PDT
I haven’t even been able to move my bowels! I had diarrhea a while back, though . . . six months ago, maybe.
You said you have latex allergy? (Clarified to: What are the symptoms of your latex allergy?)
Question 11:54 AM PDT
I get an itchy skin rash. (Clarified to: what the symptoms of my latex allergy are)
sorry about this skin rash.
Empathize 11:55 AM PDT
Thank you.
Do you have problems with eating?
Question 12:28 PM PDT
Yes. I haven’t eaten much these last few days.
Sorry about that.
Empathize 12:29 PM PDT
Thank you.
Do you have problems getting in and out of chairs?
Question 12:30 PM PDT
Any kind of movement makes my abdominal discomfort worse, but I don’t usually have problems with that.
Am sorry for that discomfort.
Empathize 12:31 PM PDT
Thank you.
Model Statement: “I’m sorry you’re having these symptoms. It’s good that you came in today so we can see what is causing your discomfort.” Esther park abdominal pain focused shadow health assessment transcript, objective, subjective solved
2 MedicationsFollowed Up 3 DietNot Followed Up 4 Activity LevelFollowed Up 5 Medical HistoryFollowed Up 6 Sexual ActivityFollowed Up 7 Family and SupportNot Followed Up
Description: Ms. Park describes being widowed and living with her daughter.
Do you live alone?
Question 12:40 PM PDT
No. I live with my daughter, Jennifer.
Who can you ask for support?
Question 12:41 PM PDT
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. Esther park abdominal pain focused shadow health assessment transcript, objective, subjective solved
Have you travelled travelled anywhere recently (Clarified to: Have you traveled recently?)
Question 12:42 PM PDT
No, I haven’t gone on any trips in several years. (Clarified to: if I have traveled recently)
Have you experienced any physical abuse?
Question 12:43 PM PDT
No, never.
Model Statement: “I’m sorry that your husband passed away. It sounds like you have a wonderful relationship with your daughter and son. I’m happy to hear that you have a strong support system in your children.”
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Shadow Health Assessment Assignment
You will complete all assessment assignments using the Shadow Health virtual reality simulation platform.
Introduction and Pre-brief
Mrs. Esther Park is a 78-year-old woman who comes to the clinic complaining of abdominal pain. She reports that the pain isn’t severe, but that her daughter was concerned and brought her in. It is very important to determine whether or not the situation is an emergency and the underlying cause of Esther’s discomfort. Be sure to inquire about a variety of psychosocial factors related to the GI system, including her diet, toilet habits, immunizations, recent travel, etc. This case study will offer you the opportunity to take a complete surgical, reproductive, and current sexual history. During her physical examination, take particular note as to where Mrs. Park verbalizes pain during palpation so that you may synthesize verbal and non-verbal cues. Be sure to apply the supportive information learned in this week’s concept lab to your critical thinking process in this case study.
Tips and Tricks
Evaluation of the elderly patient with abdominal pain can be difficult, time-consuming, and fraught with potential missteps. Abdominal pain is the most common emergency department complaint and the fourth most common complaint among elderly patients. The physiologic, pharmacologic, and psychosocial aspects of elderly patients make an evaluation of their abdominal pain different than in the general population.
As a clinician, you must develop an index of suspicion which is defined as awareness and concern for potentially serious underlying and unseen injuries or illness. Having a well-developed index of suspicion for abnormality will help to differentiate diagnoses.
To optimize your assessment experience and sharpen your skills, be sure to explore the Abdominal Concept Lab prior to beginning the assignment. Esther park abdominal pain focused shadow health assessment transcript, objective, subjective solved
Purposes
The purposes of the Shadow Health Physical Assessment Assignments are to: (a) increase knowledge and understanding of advanced practice physical assessment skills and techniques, (b) conduct focused and comprehensive histories and physical assessments for various patient populations, (c) adapt or modify your physical assessment skills and techniques to suit the individual needs of the patient, (d) apply assessment skills and techniques to gather subjective and objective data, (e) differentiate normal from abnormal physical examination findings, (f) summarize, organize, and appropriately document findings using correct professional terminology, (g) practice developing primary and differential diagnoses, (h) practice creating treatment plans which include diagnostics, medication, education, consultation/referral, and follow-up planning; and (i) analyze and reflect on own performance to gain insight and foster knowledge.
Activity Learning Outcomes
Through this assignment, the student will demonstrate the ability to:
Apply knowledge and understanding of advanced practice physical assessment skills and techniques (CO1)
Perform focused and comprehensive histories and physical assessments for various patient populations (CO4 and CO5)
Adapt skills and techniques to suit the individual needs of the patient (CO4)
Differentiate normal from abnormal physical examination findings (CO2)
Summarize, organize, and document findings using correct professional terminology (CO3)
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Total Points Possible: 75 Points
Assignment
Step One: Complete the designated Shadow Health (SH) Assignment on the SH platform.
Step Three: Upload the Lab Pass and completed SOAP Note as separate documents to the same assignment tab in the gradebook. Esther park abdominal pain focused shadow health assessment transcript, objective, subjective solved
Requirements
NOTE: Before initiating any activity in Shadow Health, complete the required course weekly readings and lessons as well as review the introduction and pre-brief.
Complete the Shadow Health Concept Lab (Weeks 2, 4, and 5) prior to beginning the graded assignment.
Gather subjective and objective data by completing a focused, detailed health history and physical examination for each physical assessment assignment.
Critically appraise the findings as normal or abnormal.
Complete the post activity assessment questions for each assignment .
Complete all reflection questions following each physical assessment assignment.
Digital Clinical Experience (DCE) scores do not round up. For example, a DCE score of 92.99 is a 92, not a 93.
You have a maximum of two (2) attempts per Shadow Health assignment to improve your performance. However, you may elect not to repeat any assignment. NOTE: If you repeat an attempt, ONLY the second attempt will be graded, regardless of the DCE score. Please refer to the grading rubric categories for details.
Download the Lab Pass for the final attempt on the assignment.
On the Canvas Platform:
Summarize, organize, and appropriately document findings using correct professional terminology on the SOAP Note Template.
Identify three (3) differential diagnoses and provide ICD-10 codes and pertinent positive and negative findings for each diagnosis.
Create a comprehensive treatment plan for each assignment. Must address the following components: Diagnostics, Medication, Education, Referral/Consultation, and Follow-up planning. If no interventions for one or more component, document “none at this time” but do not skip over the component.
Provide rationales and citations for diagnoses and interventions. Esther park abdominal pain focused shadow health assessment transcript, objective, subjective solved
Include at least one scholarly source to support diagnoses and treatment interventions with rationales and references on the SOAP note. Only scholarly sources are acceptable for citation and reference in this course. These include peer-reviewed publications, government reports, or sources written by a professional or scholar in the field. The textbooks and lessons are NOT considered to be outside scholarly sources. For the threaded discussions and reflection posts, reputable internet sources such as websites by government agencies (URL ends in .gov) and respected organizations (often ends in .org) can be counted as scholarly sources. The best outside scholarly source to use is a peer-reviewed nursing journal. You are encouraged to use the Chamberlain library and search one of the available databases for a peer-reviewed journal article. The following sources should not be used: Wikipedia, Wikis, or blogs. These websites are not considered scholarly as anyone can add to these. Please be aware that .com websites can vary in scholarship and quality. For example, the American Heart Association is a .com site with scholarship and quality. Each student is responsible for determining the scholarship and quality of any .com site. Ask your instructor before using any site if you are unsure. Points will be deducted from the rubric if the site does not demonstrate scholarship or quality. Current outside scholarly sources must be published with the last 5 years. Instructor permission must be obtained BEFORE the assignment is due if using a source that is older than 5 years.
Upload the Lab Pass to the appropriate assignment area in Canvas Grades
Shadow Health Grading Rubric
Portions of the rubric are designated with a ***. The following explains those portions of the rubric:
* Digital Clinical Experience (DCE) Score is automatically translated by Shadow Health based on individual student performance and reflects how student work compares to their peer learners across the country for a particular assignment. The DCE Score is a fair assessment of effort, and therefore is appropriate for use when grading assignments.
**Scholarly Sources: Only scholarly sources are acceptable for citation and reference in this course. These include peer-reviewed publications, government reports, or sources written by a professional or scholar in the field. The textbooks and lessons are NOT considered to be outside scholarly sources. For the threaded discussions and reflection posts, reputable internet sources such as websites by government agencies (URL ends in .gov) and respected organizations (often ends in .org) can be counted as scholarly sources. The best outside scholarly source to use is a peer-reviewed nursing journal. You are encouraged to use the Chamberlain library and search one of the available databases for a peer-reviewed journal article. The following sources should not be used: Wikipedia, Wikis, or blogs. These websites are not considered scholarly as anyone can add to these. Please be aware that .com websites can vary in scholarship and quality. For example, the American Heart Association is a .com site with scholarship and quality. Each student is responsible for determining the scholarship and quality of any .com site. Esther park abdominal pain focused shadow health assessment transcript, objective, subjective solved. Ask your instructor before using any site if you are unsure. Points will be deducted from the rubric if the site does not demonstrate scholarship or quality. Current outside scholarly sources must be published with the last 5 years. Instructor permission must be obtained BEFORE the assignment is due if using a source that is older than 5 years.
***Components of a treatment plan include diagnostics, medication, education, consultation/referral, and follow-up planning
****Insight refers to the capacity to gain an accurate and deep intuitive understanding of a concept or thing. For example, one might demonstrate insight by relating a concept to a personal or meaningful experience.
ASSIGNMENT CONTENTCategoryPoints%DescriptionHealth History Communication, Education, Empathy, and Summary(DCE Scoreor transcript)1520%The Digital Clinical Experience (DCE)Score is automatically translates by Shadow Health based on individual student performance and reflects how student work with data collection, health history communication, education, empathy, and summarization compares to peer learners across the country for a particular assignment. The DCE Score is a fair assessment of effort, and therefore is appropriate for use when grading assignments. Occasionally, performance transcripts may be reviewed for secondary support.Assessment, Documentation, Treatment Plan, and Scholarly SourcesEsther park abdominal pain focused shadow health assessment transcript, objective, subjective solved3547%This category is evaluated on the quality of student’s ability to: Identify pertinent normal and abnormal findings for the assignment, utilize professional terminology, provide comprehensive and detailed subjective and objective findings, identify differential diagnoses, and create a comprehensive treatment plan. Includeat least one appropriate EBP scholarly source and use the SOAP Note format template to document all findings. Self-Reflection1520%Self-reflection posts must demonstrate the student’s own perspective. The quality of this criterion is based upon responding to all the reflection questions; providing responses that are substantive (add importance, meaningfulness, and relevance to the post); demonstrate analysis of own performance; and demonstrate insight. Insight refers to the capacity to gain an accurate and deep intuitive understanding of a concept or thing. For example, one might demonstrate insight by relating a concept to a personal or meaningful experience.Reflection post responses should vary from SH assignment to assignment. 6587%Total CONTENT Points= 65ASSIGNMENT FORMATCategoryPoints%DescriptionGrammar, Spelling, Syntax, Mechanics and APA Format1013%Reflection post has minimal grammar, spelling, syntax, punctuation and APA* errors. Direct quotes (if used) is limited to 1 short statement** which adds substantively to the post.* APA style references and in text citations are required; however, there are no deductions for errors in indentation or spacing of references. All elements of the reference otherwise must be included. Esther park abdominal pain focused shadow health assessment transcript, objective, subjective solved**Direct quote should not exceed 15 words & must add substantively to the assignment10100%Total FORMAT Points= 10ASSIGNMENT TOTAL=75 points
Rubric
NR509 Weeks 2-6 Shadow Health Assignment_Sept19 (4)
NR509 Weeks 2-6 Shadow Health Assignment_Sept19 (4)
Criteria
Ratings
Pts
This criterion is linked to a Learning OutcomeAssignment Content Possible Points = 65 PointsCriterion 1Health History Communication, Education, Empathy, and Summary(DCE Score or Transcript)
This criterion is linked to a Learning OutcomeCriterion 2 Assessment, Documentation, Treatment Plan, and Scholarly SourcesMust demonstrate the following elements:Identified all pertinent normal and abnormal findings;Used professional terminology;Subjective and objective documentation was detailed and comprehensive;Used the SOAP Note Format template for documentation;Identified three (3) differential diagnoses with ICD-10 codes and pertinent positive/negative findings;Addressed each of the following on the treatment plan: Diagnostics, Medication, Education, Referral/Consultation, and Follow-up Planning;Interventions are detailed and appropriate for the focused assignment;Provided at least one appropriate EBP scholar source Esther park abdominal pain focused shadow health assessment transcript, objective, subjective solved(8 Required Elements)
35.0 ptsExcellentDemonstrated all elements for this Criterion32.0 ptsV. GoodMissing 1 element for this Criterion29.0 ptsSatisfactoryMissing 2 or 3 elements for this Criterion18.0 ptsNeeds ImprovementMissing 4 or 5 elements on for this Criterion0.0 ptsUnsatisfactoryMissing 6 or more elements for the criterion Or No Assignment
35.0 pts
This criterion is linked to a Learning OutcomeCriterion 3 Self-ReflectionMust demonstrate the following elements:Written from the student’s own perspective;Responded to all the reflection questions;Responses were each substantive (added importance, meaningfulness, and relevance to the post);Offer self-analysis of performance and insight;Reflection post responses should vary from SH assignment to assignment.(5 Required Elements)
15.0 ptsExcellentDemonstrated all elements for this Criterion14.0 ptsV. GoodMissing 1 element for this Criterion12.0 ptsSatisfactoryMissing 2 elements for this Criterion8.0 ptsNeeds ImprovementMissing 3 elements for this Criterion0.0 ptsUnsatisfactoryMissing 4 or more elements for the criterion Or No Assignment
15.0 pts
This criterion is linked to a Learning OutcomeAssignment Format Possible Points = 10 PointsFormat Criterion 1Grammar, Spelling, Syntax, Mechanics and APA Format
10.0 ptsExcellent0-1 errors in grammar, syntax, spelling, punctuation, mechanics, or APA format9.0 ptsV. Good2-3 errors in grammar, syntax, spelling, punctuation, mechanics, or APA format8.0 ptsSatisfactory4-5 errors in grammar, syntax, spelling, punctuation, mechanics, or APA format5.0 ptsNeeds Improvement6-7 errors in grammar, syntax, spelling, punctuation, mechanics, or APA formatEsther park abdominal pain focused shadow health assessment transcript, objective, subjective solved0.0 ptsUnsatisfactory8 or more errors in grammar, syntax, spelling, punctuation, mechanics, or APA format Or No assignment
10.0 pts
This criterion is linked to a Learning OutcomeLate Penalty DeductionsStudents are expected to submit assignments by the time they are due. Assignments submitted after the due date and time will receive a deduction of 10% of the total points possible for that assignment for each day the assignment is late. Assignments will be accepted, with penalty as described, up to a maximum of three days late, after which point a zero will be recorded for the assignment. Quizzes and discussions are not considered assignments and are not part of the late assignment policy.
0.0 ptsMinus Points0.0 ptsMinus Points
0.0 pts
Total Points: 75.0 Esther park abdominal pain focused shadow health assessment transcript, objective, subjective solved
Any citation style (APA, MLA, Chicago/Turabian, Harvard)
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