1
Shadow Health - Tina Jones, Health
History
1. Acute pain - ANSWER Priority: High Priority Pro Tip: Managing acute pain is an
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immediate high priority, because other health concerns cannot be effectively addressed
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while a patient experiences severe pain. Evidence - Relevant: "...Like a 7. It hurts a lot,
ail
but whatever pain med the ER gave me is helping a little bit." "It's throbbing and like,
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sharp if I try to put weight on it." Evidence Pro Tip: Tina expresses pain, which is the
strongest evidence for this problem. She reports intense pain on a numerical scale and
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describes pain characteristics. The presence of a physical injury supports her
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susceptibility to acute pain. Planning - Relevant: Assess - Pain: Assess the patient's pain
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at regular intervals and with each assessment of vital signs. Assess - Pain: Assess the
patient's response to pain medication. Educate - Medication: Educate the patient on
ing
medications used for pain relief. Educate - Pain: Educate the patient on
fly
non-pharmaceutical methods to reduce pain intensity. Intervene - Pain: Administer
non-pharmacologic interventions to reduce pain. Intervene - Pain: Administer prescribed
analgesics to provide optimal pain relief. Planning Pro Tip: To reduce the patient's pain,
assess her current rating. Provide an appropriate intervention (pharmaceutical or
, 2
otherwise) and educate the patient. After an appropriate time interval, assess pain levels
again to see how the intervention affected the pain.
1.Expression of pain Followed Up - ANSWER Description: Tina expresses frustration
about her level of pain. Student: How effective was the Neosporin? Tina Jones: Well, I'm
m
here, so I guess it didn't do its job. Student: Can you walk with your foot being injured?
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Tina Jones: No, I can't. I can't put any weight on it without like, shooting pain. Student:
ail
What preexisting medical conditions do you have? Tina Jones: I mean, I have asthma and
gm
diabetes, but right I now I just care about my foot! Student: I understand your foot
hurts, but I need to know this information to make sure I take care of the problem
r@
correctly. Tina Jones: Thanks. Model Statement: "I'm sorry to hear that your pain is
he
returning. We want you to be in as little pain as possible. I can give you some Advil at
hig
this time, and in a few hours, you can have more tramadol. I can also walk through some
pain management exercises with you that don't involve medication, if you are interested."
ing
fly
2. Impaired skin integrity - ANSWER Priority: High Priority Pro Tip: This is a high
priority. The infection is the most immediate threat to the patient's health, and the
wound is at risk for delayed healing because of the patient's uncontrolled blood glucose.
Evidence - Relevant: Evidence Pro Tip: As Tina discusses symptoms of her wound,
, 3
including symptoms such as discharge, redness, warmth, and swelling, she reports strong
evidence of impaired skin integrity. Planning - Relevant: Planning Pro Tip: Because
wound infections impact the patient's overall health, it's important to assess perfusion,
hydration, and swelling. Assess the status of the wound itself and ensure proper cleaning
and dressing per the physician's order. Prevent worsening infection by educating the
m
patient about wound care and self-monitoring.
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ail
2.Impact of injury on daily life Followed Up - ANSWER Description: Tina brings up
gm
her pain and frustration at how being unable to bear weight on her foot impacts her life.
Student: What are stressors? Tina Jones: I feel really stressed out right now! Honestly, I
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didn't realize that I'd be admitted to the hospital for my foot. I don't want to miss work
he
or school but now it looks like I'll have to. And I want my foot to stop hurting. I know I
hig
need sleep, too. Student: We are going to take care of everything as quickly as possible.
Tina Jones: Thanks. Model Statement: "This sounds like a challenging time for you. I
ing
understand your frustration at having your life interrupted by foot pain. Please let me
fly
know if there is anything I can help you with, such as contacting your employer or asking
a family member to bring your schoolwork. We'll do our best to get you feeling better
and, on your way, home as soon as possible."
, 4
3. Impaired walking - ANSWER Priority - High Priority Pro Tip: This is a high
priority. The patient is unable to bear weight on her affected leg, which prevents
walking. This impacts her daily life and increases her risk for falls and deep-vein
thrombosis. Evidence - Relevant: "I mean, it's all red and swollen, and there's pus, it feels
hot, it hurts like hell... It's got all that going on." "I got this scrape on my foot a while
m
ago, and it got really infected. It's killing me." "No, I can't. I can't put any weight on it
.co
without like, shooting pain." Evidence Pro Tip: The strongest evidence of impaired
ail
walking is that Tina directly reports she can't bear weight or walk on her affected foot.
gm
Other supporting data points are the presence of her foot wound and her general reports
of pain. Planning - Relevant: Assess - Musculoskeletal: Assess the patient's ability to bear
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weight and gait. Assess - Musculoskeletal: Assess the patient's mobility. Consult / Refer:
he
Consult with physical therapist to develop a plan to improve the patient's mobility.
hig
Intervene - Mobility: Assist the patient as needed with mobility. Intervene - Mobility:
Provide assistive devices to facilitate mobility (crutches, therapeutic boot to minimize
ing
pressure on plantar surface, wheelchair). Planning Pro Tip: Assess how well the patient
fly
can bear weight and walk. While the patient is in your care, work with other healthcare
professionals to keep the pain managed and improve the patient's mobility. Provide
assistance with activities such as toileting and ensure that the patient can access and use
assistive devices.
Shadow Health - Tina Jones, Health
History
1. Acute pain - ANSWER Priority: High Priority Pro Tip: Managing acute pain is an
m
immediate high priority, because other health concerns cannot be effectively addressed
.co
while a patient experiences severe pain. Evidence - Relevant: "...Like a 7. It hurts a lot,
ail
but whatever pain med the ER gave me is helping a little bit." "It's throbbing and like,
gm
sharp if I try to put weight on it." Evidence Pro Tip: Tina expresses pain, which is the
strongest evidence for this problem. She reports intense pain on a numerical scale and
r@
describes pain characteristics. The presence of a physical injury supports her
he
susceptibility to acute pain. Planning - Relevant: Assess - Pain: Assess the patient's pain
hig
at regular intervals and with each assessment of vital signs. Assess - Pain: Assess the
patient's response to pain medication. Educate - Medication: Educate the patient on
ing
medications used for pain relief. Educate - Pain: Educate the patient on
fly
non-pharmaceutical methods to reduce pain intensity. Intervene - Pain: Administer
non-pharmacologic interventions to reduce pain. Intervene - Pain: Administer prescribed
analgesics to provide optimal pain relief. Planning Pro Tip: To reduce the patient's pain,
assess her current rating. Provide an appropriate intervention (pharmaceutical or
, 2
otherwise) and educate the patient. After an appropriate time interval, assess pain levels
again to see how the intervention affected the pain.
1.Expression of pain Followed Up - ANSWER Description: Tina expresses frustration
about her level of pain. Student: How effective was the Neosporin? Tina Jones: Well, I'm
m
here, so I guess it didn't do its job. Student: Can you walk with your foot being injured?
.co
Tina Jones: No, I can't. I can't put any weight on it without like, shooting pain. Student:
ail
What preexisting medical conditions do you have? Tina Jones: I mean, I have asthma and
gm
diabetes, but right I now I just care about my foot! Student: I understand your foot
hurts, but I need to know this information to make sure I take care of the problem
r@
correctly. Tina Jones: Thanks. Model Statement: "I'm sorry to hear that your pain is
he
returning. We want you to be in as little pain as possible. I can give you some Advil at
hig
this time, and in a few hours, you can have more tramadol. I can also walk through some
pain management exercises with you that don't involve medication, if you are interested."
ing
fly
2. Impaired skin integrity - ANSWER Priority: High Priority Pro Tip: This is a high
priority. The infection is the most immediate threat to the patient's health, and the
wound is at risk for delayed healing because of the patient's uncontrolled blood glucose.
Evidence - Relevant: Evidence Pro Tip: As Tina discusses symptoms of her wound,
, 3
including symptoms such as discharge, redness, warmth, and swelling, she reports strong
evidence of impaired skin integrity. Planning - Relevant: Planning Pro Tip: Because
wound infections impact the patient's overall health, it's important to assess perfusion,
hydration, and swelling. Assess the status of the wound itself and ensure proper cleaning
and dressing per the physician's order. Prevent worsening infection by educating the
m
patient about wound care and self-monitoring.
.co
ail
2.Impact of injury on daily life Followed Up - ANSWER Description: Tina brings up
gm
her pain and frustration at how being unable to bear weight on her foot impacts her life.
Student: What are stressors? Tina Jones: I feel really stressed out right now! Honestly, I
r@
didn't realize that I'd be admitted to the hospital for my foot. I don't want to miss work
he
or school but now it looks like I'll have to. And I want my foot to stop hurting. I know I
hig
need sleep, too. Student: We are going to take care of everything as quickly as possible.
Tina Jones: Thanks. Model Statement: "This sounds like a challenging time for you. I
ing
understand your frustration at having your life interrupted by foot pain. Please let me
fly
know if there is anything I can help you with, such as contacting your employer or asking
a family member to bring your schoolwork. We'll do our best to get you feeling better
and, on your way, home as soon as possible."
, 4
3. Impaired walking - ANSWER Priority - High Priority Pro Tip: This is a high
priority. The patient is unable to bear weight on her affected leg, which prevents
walking. This impacts her daily life and increases her risk for falls and deep-vein
thrombosis. Evidence - Relevant: "I mean, it's all red and swollen, and there's pus, it feels
hot, it hurts like hell... It's got all that going on." "I got this scrape on my foot a while
m
ago, and it got really infected. It's killing me." "No, I can't. I can't put any weight on it
.co
without like, shooting pain." Evidence Pro Tip: The strongest evidence of impaired
ail
walking is that Tina directly reports she can't bear weight or walk on her affected foot.
gm
Other supporting data points are the presence of her foot wound and her general reports
of pain. Planning - Relevant: Assess - Musculoskeletal: Assess the patient's ability to bear
r@
weight and gait. Assess - Musculoskeletal: Assess the patient's mobility. Consult / Refer:
he
Consult with physical therapist to develop a plan to improve the patient's mobility.
hig
Intervene - Mobility: Assist the patient as needed with mobility. Intervene - Mobility:
Provide assistive devices to facilitate mobility (crutches, therapeutic boot to minimize
ing
pressure on plantar surface, wheelchair). Planning Pro Tip: Assess how well the patient
fly
can bear weight and walk. While the patient is in your care, work with other healthcare
professionals to keep the pain managed and improve the patient's mobility. Provide
assistance with activities such as toileting and ensure that the patient can access and use
assistive devices.
