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Exam (elaborations)

HEENT Physical Assessment Assignment Results

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Asked about character of nasal symptoms Denies itchy nose Denies sinus pain Denies sinus pressure Denies sneezing Followed up about character of nasal discharge Reports clear discharge Reports thin discharge Denies purulent discharge

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Uploaded on
September 8, 2023
Number of pages
6
Written in
2023/2024
Type
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HEENT Physical Assessment Assignment Results | Completed
Advanced Health Assessment - Chamberlain, NR509
Return to Assignment




Your Results Turn In Lab Pass




Overview
Subjective Data Collection: 25 of 28 (89.3%)
Transcript

Subjective Data Collection Hover To Reveal...
Indicates an item that you found.
Hover over the Patient Data items
Objective Data Collection Indicates an item that is available to be
below to reveal important information,
found.
including Pro Tips and Example
Education & Empathy
Questions.
Documentation

Lifespan Category Scored Items Patient Data
Review Questions Not Scored
Experts selected these topics as essential
Self-Reflection A combination of open and closed questions
components of a strong, thorough interview
will yield better patient data. The following
with this patient.
details are facts of the patient's case.



Chief Complaint


Established chief complaint Reports sore throat
Reports itchy throat
Reports itchy eyes
Reports runny nose




History of Present Illness


Asked about onset of symptoms Reports sore throat began "about a week
ago"
Reports runny nose began "about a week
ago"
Reports itchy eyes began "about a week
ago"

, Asked about aggravating factors for Reports throat pain is constant
throat symptoms
Reports throat pain is worse in the
morning
Reports some soreness with swallowing




Asked severity of throat discomfort Describes sore throat as mild to moderate




Asked about frequency and duration of Reports nose is runny "pretty much all
runny nose day"




Asked about character of nasal Denies itchy nose
symptoms
Denies sinus pain
Denies sinus pressure
Denies sneezing




Followed up about character of nasal Reports clear discharge
discharge
Reports thin discharge
Denies purulent discharge




Asked about eye symptoms Reports eye itching is constant
Reports eye redness




Asked related respiratory symptoms Reports breathing isn't affected
Denies cough
Denies chest tightness




Asked about related asthma symptoms Denies recent wheezing
Denies increase in recent asthma
symptoms




Asked about exposure to allergens Reports no exposure to cats
Reports no exposure to mold or mildew
Reports no exposure to dust
Reports no known exposure to irritants in
work environment
Reports changing bedding "once a week"




Asked about perceived cause of Describes symptoms as similar to
symptoms allergies
Reports that the symptoms don't seem
like a common cold
Describes similarity to her sister's hay
fever symptoms
Reports no history of cigarette smoking
Reports no recent exposure to
secondhand smoke
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