Science Medicine Nursing
Shadow Health - Tina Jones, Health History
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Unit 1 Vital Signs Week 2 Med Abbrev
52 terms 24 terms 20 terms
skyler_farrar Preview malaeam Preview kjcarwise49
Terms in this set (469)
Diana Shadow: Your patient is Tina Jones:, a 28-year-old African
American woman who has just been admitted to Shadow
Student: What is the situation? General Hospital for a painful foot wound. Your role in this
simulation is that of a healthcare provider who will take Ms. Jones'
health history, a key component of her admission process.
Diana Shadow: A health history requires you to ask questions
related to Ms. Jones' past and present health, from her current
foot wound to her pre-existing conditions. You will also want to
review Ms. Jones' systems, psychosocial history, and family
medical history. These assessments together will give you a
comprehensive picture of Ms. Jones' overall health. If you
discover any disease states, ask about symptoms and the
patient's experiences of them. Your questioning should cover a
broad array of the symptoms' characteristics. Throughout the
conversation, you should educate and empathize with Ms. Jones
Student: What are my objectives when appropriate to increase her health literacy and sense of
in this assessment? well-being. Regardless of whether you have assessed Ms. Jones
previously, ask all questions that are necessary for obtaining a
complete health history. While you should communicate with
patients using accessible, everyday language, it is standard
practice to use professional medical terminology everywhere
else, such as in documenting physical findings and nursing notes.
You may complete the exam activities in any order and move
between them as needed. After obtaining Ms. Jones' health
history, you will complete an information processing activity. You
will identify and prioritize diagnoses, then create a plan to
address the identified diagnoses.
, Diana Shadow: In this assessment, you will become familiarized
with the structure and content of a health history exam so that
with real-life patients, you can: º ask effective and
Student: How does this comprehensive questions º obtain a thorough health history º
assignment prepare me for the evaluate the patient's risk of disease, infection, injury, and
real world? complications º educate and empathize º reflect on your
experience and identify areas to improve º identify and prioritize
nursing diagnoses º and develop a plan to address nursing
diagnoses.
Diana Shadow: In 1 or 2 Student: So that you understand if there are any problems
sentences, answer this question related to their chief complaint. Also, to help treat their current
to help prepare for the condition.
upcoming exam: Why is it
important to obtain a patient's
complete health history?
Height: 170 cm, Weight: 90 kg, BMI: 31, Random blood glucose:
Patient Exam - Vital Signs: 238, Temperature: 102.4° F, Blood pressure: 138/90 mmHg, Heart
rate: 90, Respiratory rate: 18, O2 sat: 98%
Patient Exam - Interview:
Student: Hello, my name is Tina Jones: Hey.
Catlain, I am your nurse today.
Student: Can you confirm your Tina Jones: Tina Jones:.
name?
Student: Why did you come in Tina Jones: I got this scrape on my foot a while ago, and it got
today? really infected. It's killing me.
Student: What additional Tina Jones: I mean, it's all red and swollen, and there's pus, it feels
symptoms have you hot, it hurts like hell... It's got all that going on.
experienced?
Student: Can you rate your Tina Jones: ...Like a 7. It hurts a lot, but whatever pain med the ER
current pain level on a scale of 0 gave me is helping a little bit.
to 10?
Student: Please describe the Tina Jones: It's throbbing and like, sharp if I try to put weight on it.
pain.
Tina Jones: I was changing a light bulb, and I had to use our little
Student: How did you hurt your
stepstool to reach it. My foot slid off the bottom step and it got
foot?
all scraped up. I didn't realize how sharp the edge was!
Student: Has your foot been Tina Jones: Yeah, there's definitely pus.
draining any liquids?
Student: What color was the Tina Jones: It's... white or maybe off-white.
pus?
Student: How have you treated Tina Jones: I've been taking Advil for my foot for a few days.
the wound?
Student: What did you do to Tina Jones: I made sure to clean it and keep it bandaged. And I
treat your foot after your put Neosporin on it.
accident?
Student: How effective was the Tina Jones: Well, I'm here, so I guess it didn't do its job.
Neosporin?
,Student: Can you walk with your Tina Jones: No, I can't. I can't put any weight on it without like,
foot being injured? shooting pain.
Student: What preexisting Tina Jones: I mean, I have asthma and diabetes, but right I now I
medical conditions do you just care about my foot!
have?
Student: I understand your foot Tina Jones: Thanks.
hurts, but I need to know this
information to make sure I take
care of the problem correctly.
Student: When were you Tina Jones: I was diagnosed when I was 24.
diagnosed with diabetes?
Student: What do you do to Tina Jones: I try to avoid things that give me breathing problems,
manage your asthma? but when my asthma starts to act up, I just use my inhaler.
Student: What medications did Tina Jones: It was metformin.
you take for your diabetes?
Student: Do you currently take Tina Jones: No, I don't take anything for my diabetes anymore.
medicine for your diabetes?
Tina Jones: I guess I just got sick of feeling sick and gassy all the
Student: What made you stop
time, and it was overwhelming, remembering to take pills and
taking medication for your
check my sugar. I feel a lot better now that I'm just eating
diabetes?
healthier than I did when I was taking the pills.
Student: Do you monitor your Tina Jones: I have a monitor at home, but to be honest I don't
blood glucose? really use it that often.
Student: How frequently do you Tina Jones: I don't know. Every hour or two when I'm awake?
urinate?
Student: What is your current Tina Jones: It's pretty good, I think. I'm not a huge health nut or
diet? anything.
Student: Have you had any Tina Jones: Yeah, lately I've definitely been much hungrier than
change in appetite? usual.
Student: Has your weight Tina Jones: Yeah, I've lost some weight recently.
changed?
Student: Do you know why you Tina Jones: I don't know what caused it, I just lost weight.
lost weight?
Student: How often do you have Tina Jones: I haven't had a full attack in years. But my breathing
asthma exacerbations? definitely acts up. . .not always. Max twice a week.
Tina Jones: My chest and throat get tight, and I start to wheeze. It
Student: What asthma symptoms
feels like I can't take in air, like I can't get enough air into my
have you experienced?
lungs.
Student: How many puffs do Tina Jones: I usually use two puffs from my inhaler, but sometimes
you take when using your I need three. [Nurse confirmed with Pharmacy: albuterol
asthma inhaler? 90mcg/spray MDI]
Student: What are some things Tina Jones: Being around cats is the worst, but dust and running
that trigger your asthma? up stairs can make my breathing bad, too.
Student: What allergies do you Tina Jones: I'm allergic to cats.
have?
Student: When did you realize Tina Jones: For as long as I've been around.
you were allergic to cats?
, Tina Jones: Whatever pain medication the ER gave me is helping.
Student: How effective was your Before I came in, I was just taking Advil. For the past few days,
pain medication at home? the Advil wasn't doing much for me -- it would only last a couple
of hours.
Student: What medication Tina Jones: I'm allergic to penicillin.
allergies do you have?
Student: What food allergies do Tina Jones: I don't have any food allergies that I know of.
you have?
Student: Are you allergic to dust, Tina Jones: Well. . . I don't know if it's allergies, but sometimes my
mold, or pollen? asthma acts up around dust.
Tina Jones: I got a tetanus booster for work about a year ago. For
Student: What immunizations
the other kinds, I got all the required ones when I was a kid, and
have you received?
for college...I'm sure I have a record somewhere at home.
Student: Have you received a flu Tina Jones: No.
vaccine?
Tina Jones: Well, before this I went a bunch of times when I was
Student: Have you had any prior
little, for asthma attacks. This is the first time I've been in the
hospitalizations?
hospital since I was probably sixteen, though.
Student: Have you had any Tina Jones: No. I've never really had stomach or bowel problems.
gastrointestinal problems?
Student: Do you have a family Tina Jones: No. They're crazy, but nobody's diagnosed with
history of psychiatric illness? anything.
Student: Do you have any neck, Tina Jones: No, not that I noticed.
throat or gland problems?
Student: Do you have any Tina Jones: I don't think I have any problems. I get headaches
problems with your head? sometimes, but that's all.
Student: Any problems with your Tina Jones: No.
ears?
Tina Jones: I've actually been noticing problems lately. When I'm
Student: Any problems with your
reading or studying I'll notice that things start to get kind of
eyes and vision?
blurry.
Student: Any problems with your Tina Jones: My nose is fine right now. Sometimes it runs, but not
nose? very often.
Student: Do you have problems Tina Jones: No.
with your mouth?
Student: Do you have a history Tina Jones: My heart's fine, thank God!
of cardiovascular problems?
Student: Any problems with your Tina Jones: No, my heart's always been fine.
heart?
Student: Have you had any Tina Jones: I haven't noticed any pain there.
problems with your breasts?
Student: Have you had any Tina Jones: I don't think I have problems in that area. I just get
reproductive problems? really bad periods, that's all.
Student: Have you had any Tina Jones: No, I haven't.
neurological problems?
Shadow Health - Tina Jones, Health History
22 studiers today 5.0 (1 review)
Save
Students also studied
Flashcard sets Study guides
Unit 1 Vital Signs Week 2 Med Abbrev
52 terms 24 terms 20 terms
skyler_farrar Preview malaeam Preview kjcarwise49
Terms in this set (469)
Diana Shadow: Your patient is Tina Jones:, a 28-year-old African
American woman who has just been admitted to Shadow
Student: What is the situation? General Hospital for a painful foot wound. Your role in this
simulation is that of a healthcare provider who will take Ms. Jones'
health history, a key component of her admission process.
Diana Shadow: A health history requires you to ask questions
related to Ms. Jones' past and present health, from her current
foot wound to her pre-existing conditions. You will also want to
review Ms. Jones' systems, psychosocial history, and family
medical history. These assessments together will give you a
comprehensive picture of Ms. Jones' overall health. If you
discover any disease states, ask about symptoms and the
patient's experiences of them. Your questioning should cover a
broad array of the symptoms' characteristics. Throughout the
conversation, you should educate and empathize with Ms. Jones
Student: What are my objectives when appropriate to increase her health literacy and sense of
in this assessment? well-being. Regardless of whether you have assessed Ms. Jones
previously, ask all questions that are necessary for obtaining a
complete health history. While you should communicate with
patients using accessible, everyday language, it is standard
practice to use professional medical terminology everywhere
else, such as in documenting physical findings and nursing notes.
You may complete the exam activities in any order and move
between them as needed. After obtaining Ms. Jones' health
history, you will complete an information processing activity. You
will identify and prioritize diagnoses, then create a plan to
address the identified diagnoses.
, Diana Shadow: In this assessment, you will become familiarized
with the structure and content of a health history exam so that
with real-life patients, you can: º ask effective and
Student: How does this comprehensive questions º obtain a thorough health history º
assignment prepare me for the evaluate the patient's risk of disease, infection, injury, and
real world? complications º educate and empathize º reflect on your
experience and identify areas to improve º identify and prioritize
nursing diagnoses º and develop a plan to address nursing
diagnoses.
Diana Shadow: In 1 or 2 Student: So that you understand if there are any problems
sentences, answer this question related to their chief complaint. Also, to help treat their current
to help prepare for the condition.
upcoming exam: Why is it
important to obtain a patient's
complete health history?
Height: 170 cm, Weight: 90 kg, BMI: 31, Random blood glucose:
Patient Exam - Vital Signs: 238, Temperature: 102.4° F, Blood pressure: 138/90 mmHg, Heart
rate: 90, Respiratory rate: 18, O2 sat: 98%
Patient Exam - Interview:
Student: Hello, my name is Tina Jones: Hey.
Catlain, I am your nurse today.
Student: Can you confirm your Tina Jones: Tina Jones:.
name?
Student: Why did you come in Tina Jones: I got this scrape on my foot a while ago, and it got
today? really infected. It's killing me.
Student: What additional Tina Jones: I mean, it's all red and swollen, and there's pus, it feels
symptoms have you hot, it hurts like hell... It's got all that going on.
experienced?
Student: Can you rate your Tina Jones: ...Like a 7. It hurts a lot, but whatever pain med the ER
current pain level on a scale of 0 gave me is helping a little bit.
to 10?
Student: Please describe the Tina Jones: It's throbbing and like, sharp if I try to put weight on it.
pain.
Tina Jones: I was changing a light bulb, and I had to use our little
Student: How did you hurt your
stepstool to reach it. My foot slid off the bottom step and it got
foot?
all scraped up. I didn't realize how sharp the edge was!
Student: Has your foot been Tina Jones: Yeah, there's definitely pus.
draining any liquids?
Student: What color was the Tina Jones: It's... white or maybe off-white.
pus?
Student: How have you treated Tina Jones: I've been taking Advil for my foot for a few days.
the wound?
Student: What did you do to Tina Jones: I made sure to clean it and keep it bandaged. And I
treat your foot after your put Neosporin on it.
accident?
Student: How effective was the Tina Jones: Well, I'm here, so I guess it didn't do its job.
Neosporin?
,Student: Can you walk with your Tina Jones: No, I can't. I can't put any weight on it without like,
foot being injured? shooting pain.
Student: What preexisting Tina Jones: I mean, I have asthma and diabetes, but right I now I
medical conditions do you just care about my foot!
have?
Student: I understand your foot Tina Jones: Thanks.
hurts, but I need to know this
information to make sure I take
care of the problem correctly.
Student: When were you Tina Jones: I was diagnosed when I was 24.
diagnosed with diabetes?
Student: What do you do to Tina Jones: I try to avoid things that give me breathing problems,
manage your asthma? but when my asthma starts to act up, I just use my inhaler.
Student: What medications did Tina Jones: It was metformin.
you take for your diabetes?
Student: Do you currently take Tina Jones: No, I don't take anything for my diabetes anymore.
medicine for your diabetes?
Tina Jones: I guess I just got sick of feeling sick and gassy all the
Student: What made you stop
time, and it was overwhelming, remembering to take pills and
taking medication for your
check my sugar. I feel a lot better now that I'm just eating
diabetes?
healthier than I did when I was taking the pills.
Student: Do you monitor your Tina Jones: I have a monitor at home, but to be honest I don't
blood glucose? really use it that often.
Student: How frequently do you Tina Jones: I don't know. Every hour or two when I'm awake?
urinate?
Student: What is your current Tina Jones: It's pretty good, I think. I'm not a huge health nut or
diet? anything.
Student: Have you had any Tina Jones: Yeah, lately I've definitely been much hungrier than
change in appetite? usual.
Student: Has your weight Tina Jones: Yeah, I've lost some weight recently.
changed?
Student: Do you know why you Tina Jones: I don't know what caused it, I just lost weight.
lost weight?
Student: How often do you have Tina Jones: I haven't had a full attack in years. But my breathing
asthma exacerbations? definitely acts up. . .not always. Max twice a week.
Tina Jones: My chest and throat get tight, and I start to wheeze. It
Student: What asthma symptoms
feels like I can't take in air, like I can't get enough air into my
have you experienced?
lungs.
Student: How many puffs do Tina Jones: I usually use two puffs from my inhaler, but sometimes
you take when using your I need three. [Nurse confirmed with Pharmacy: albuterol
asthma inhaler? 90mcg/spray MDI]
Student: What are some things Tina Jones: Being around cats is the worst, but dust and running
that trigger your asthma? up stairs can make my breathing bad, too.
Student: What allergies do you Tina Jones: I'm allergic to cats.
have?
Student: When did you realize Tina Jones: For as long as I've been around.
you were allergic to cats?
, Tina Jones: Whatever pain medication the ER gave me is helping.
Student: How effective was your Before I came in, I was just taking Advil. For the past few days,
pain medication at home? the Advil wasn't doing much for me -- it would only last a couple
of hours.
Student: What medication Tina Jones: I'm allergic to penicillin.
allergies do you have?
Student: What food allergies do Tina Jones: I don't have any food allergies that I know of.
you have?
Student: Are you allergic to dust, Tina Jones: Well. . . I don't know if it's allergies, but sometimes my
mold, or pollen? asthma acts up around dust.
Tina Jones: I got a tetanus booster for work about a year ago. For
Student: What immunizations
the other kinds, I got all the required ones when I was a kid, and
have you received?
for college...I'm sure I have a record somewhere at home.
Student: Have you received a flu Tina Jones: No.
vaccine?
Tina Jones: Well, before this I went a bunch of times when I was
Student: Have you had any prior
little, for asthma attacks. This is the first time I've been in the
hospitalizations?
hospital since I was probably sixteen, though.
Student: Have you had any Tina Jones: No. I've never really had stomach or bowel problems.
gastrointestinal problems?
Student: Do you have a family Tina Jones: No. They're crazy, but nobody's diagnosed with
history of psychiatric illness? anything.
Student: Do you have any neck, Tina Jones: No, not that I noticed.
throat or gland problems?
Student: Do you have any Tina Jones: I don't think I have any problems. I get headaches
problems with your head? sometimes, but that's all.
Student: Any problems with your Tina Jones: No.
ears?
Tina Jones: I've actually been noticing problems lately. When I'm
Student: Any problems with your
reading or studying I'll notice that things start to get kind of
eyes and vision?
blurry.
Student: Any problems with your Tina Jones: My nose is fine right now. Sometimes it runs, but not
nose? very often.
Student: Do you have problems Tina Jones: No.
with your mouth?
Student: Do you have a history Tina Jones: My heart's fine, thank God!
of cardiovascular problems?
Student: Any problems with your Tina Jones: No, my heart's always been fine.
heart?
Student: Have you had any Tina Jones: I haven't noticed any pain there.
problems with your breasts?
Student: Have you had any Tina Jones: I don't think I have problems in that area. I just get
reproductive problems? really bad periods, that's all.
Student: Have you had any Tina Jones: No, I haven't.
neurological problems?
