Tina Jones Neurological Completed Shadow Health 1 | Completed A

Neurological Results | Turned In Advanced Health Assessment - Spring 2019, NSG516 Online Return to Assignment Your Results Reopen Reopen Lab Pass Lab Pass This score measures your performance on the Student Performance Index in relation to other students in comparable academic programs. Your instructor has chosen to scale your Student Performance Index score so that the average score on the index is a 87.0%. This score may not be your final grade if your instructor chooses to include additional components, such as documentation or time spent. Patient: Tina Jones Digital Clinical Experience Score 100% Beginning Developing Proficient Subjective Data Collection 20 out of 20 Objective Data Collection 37 out of 37 Education and Empathy 2 out of 4 Interaction with patient 56 minutes Post-exam activities 11 minutes Time 67 minutes total spent in assignment Student Performance Index 59 out of 61 Proficiency Level: Proficient Students rated as “proficient” demonstrate an entrylevel expertise in advanced practice competencies and clinical reasoning skills. In comparable programs, the top 25% of students perform at the level of a proficient practitioner. Started: Feb 14, 2019 | Patient Exam Time: 56 min Transcript Overview Transcript Subjective Data Collection Objective Data Collection Education & Empathy Documentation Self-Reflection Experience Overview All Lines (187) All Lines (187) Interview Questions (81) Interview Questions (81) Statements (7) Statements (7) Exam Actions (99) Exam Actions (99)Greet 02/14/19 9:20 AM EST Question 02/14/19 9:20 AM EST Question 02/14/19 9:21 AM EST Empathize 02/14/19 9:21 AM EST Question 02/14/19 9:21 AM EST Question 02/14/19 9:21 AM EST Empathize 02/14/19 9:22 AM EST Question 02/14/19 9:22 AM EST Hello Tina. I am Juliana, the nurse practitioner student. I am here to day to interview and examine you. Hey. What brings you in today? Well, I got into a little fender bender a week ago and I've been getting these headaches ever since. And my neck is sore too. Oh Tina, I am sorry to hear you got into an accident. Its so scary. I hope it was not too serious! (No matching questions found.) Oh Tina, I am sorry to hear you got into an accident. Its so scary. I hope it was not too serious! I appreciate you saying that. When did the headaches start? Five days ago... The headaches started two days after the accident. How often do you get the headaches? It's been every day for like, the last five days. Oh, that must make it tough to get things done! Lets see if we can make these headaches go away. I appreciate you telling me that. How long do the headaches last? About an hour or two.Question 02/14/19 9:22 AM EST Question 02/14/19 9:22 AM EST Question 02/14/19 9:22 AM EST Empathize 02/14/19 9:23 AM EST Question 02/14/19 9:23 AM EST Question 02/14/19 9:23 AM EST Question 02/14/19 9:23 AM EST Empathize 02/14/19 9:24 AM EST Where do you get the headaches? The headaches are in the crown of my head, and kind of the back of my head. How severe is the headache? The headaches I've been getting aren't horrible, I'm just getting them much more often than I usually do. How do you rate the headaches from 0 to 10? It's not horrible or anything, but it's no fun. Maybe a 3. I bet you its no fun! Thanks. Can you explain the car accident? (No matching questions found.) How did the car accident happen? We were in my friend's car during the accident. It wasn't serious at all-- we were going pretty slowly--but it was still scary. Were you wearing seat belts? Yes, I always do. Excellent! Its very important to wear seat beltsQuestion 02/14/19 9:24 AM EST Question 02/14/19 9:24 AM EST Question 02/14/19 9:24 AM EST Question 02/14/19 9:24 AM EST Question 02/14/19 9:25 AM EST Question 02/14/19 9:25 AM EST Question 02/14/19 9:25 AM EST Thanks for saying that. Did your head get hit? No, I didn't hit my head in the accident or anything. Can you describe the headaches? The headaches feel like a dull ache, kind of in the crown of my head, and the back of my head. Does anything make the headache worse? Nothing really makes them worse. . . they just sort of start, and eventually they go away. Does anything make the headaches better? Yeah, the Tylenol helps a little. How often do you take Tylenol? I've been taking it every day since I started getting these headaches. How many Tylenol have you been taking every day? I take two of the regular strength kind when I feel a headache coming on, but it's only been once a day. Are you taking other medications? No -- Tylenol is all I've taken recently.Question 02/14/19 9:25 AM EST Question 02/14/19 9:26 AM EST Question 02/14/19 9:26 AM EST Question 02/14/19 9:26 AM EST Question 02/14/19 9:26 AM EST Question 02/14/19 9:26 AM EST Empathize 02/14/19 9:26 AM EST Do you take prescription medications? I have a Flovent inhaler and a Proventil inhaler. Do you have any allergies? Yeah, I'm allergic to cats. How do you react to cats? Whenever I'm around cats, I start sneezing, my eyes get itchy. . . and my asthma starts to act up. Do you have any allergy to medications? Yeah, I'm allergic to penicillin. How do you react to penicillin? I don't remember that well because the last time I had penicillin I was pretty little. . . I think I got a rash, like, hives. The doctor told me not to take it again after that. Do you smoke? No. I think it's gross. Good for you! Smoking can cause so many health problems! Thanks for understanding.Question 02/14/19 9:27 AM EST Question 02/14/19 9:27 AM EST Question 02/14/19 9:27 AM EST Question 02/14/19 9:27 AM EST Question 02/14/19 9:27 AM EST Question 02/14/19 9:28 AM EST Question 02/14/19 9:28 AM EST Do you drink alcohol? I do sometimes, yeah, when I go out with my friends. How many drinks do you have per month? Oh, I don't know. Let's see... I might go out every few weeks, so twice a month... and I maybe have 2 or 3 drinks at a time, so maybe 6 drinks a month. Even if I go out more than usual, no more than ten. Do you use recreational drugs? No. Does anything relieve the neck pain? I haven't been doing anything in particular for my neck. . . just resting and trying not to move it too much. How is your sleep? I think I usually get enough sleep. I don't think I have any sleeping problems or anything. [AUDIO COMING SOON] Do you have fever? No. Do you have chills? No.Question 02/14/19 9:28 AM EST Question 02/14/19 9:28 AM EST Question 02/14/19 9:28 AM EST Question 02/14/19 9:28 AM EST Question 02/14/19 9:28 AM EST Question 02/14/19 9:29 AM EST Question 02/14/19 9:29 AM EST Have you lost weight? I think I've gained a pound or two recently, but I don't weigh myself that often. Do you have fatigue? No, not really. Do you have dizziness? No, I haven't been feeling dizzy. Do you have changes in sensation? No, I don't think so. Do you have numbness? Nope. Do you have tingling? No, I haven't been tingling at all. Do you have vision problems? Well, no, my vision hasn't changed recently -- not since the accident. But sometimes my vision gets blurry when I do a lot of reading... that's been going on for awhile. Since when you have the vision problems? (Clarified to When did you first notice blurry vision?.)Question 02/14/19 9:29 AM EST Question 02/14/19 9:29 AM EST Question 02/14/19 9:30 AM EST Question 02/14/19 9:30 AM EST Question 02/14/19 9:30 AM EST Question 02/14/19 9:31 AM EST Question 02/14/19 9:31 AM EST Hm, I haven't really paid close attention. Maybe over the past few months or so. (Clarified to when the blurry vision began.) Since when do you have these vision problems? Well -- first off, my vision's been fine since the car accident. But in general, my vision isn't that great. Sometimes it gets blurry when I read for a long time. How often you have headaches? It's been every day for like, the last five days. Do you have problems with hearing? No. Did you get headaches before the car accident? The only time I got headaches before the accident was when I would read or study for a long time. Do you have a headache right now? No, I'm fine right now. Do you have trouble swallowing? Nope.Question 02/14/19 9:31 AM EST Question 02/14/19 9:31 AM EST Question 02/14/19 9:31 AM EST Question 02/14/19 9:32 AM EST Question 02/14/19 9:32 AM EST Empathize 02/14/19 9:32 AM EST Question 02/14/19 9:32 AM EST Question 02/14/19 9:33 AM EST Do you have muscle weakness? No, I wouldn't say I feel weak. Do you have memory loss? Nope. How is your mood? I haven't noticed any changes with my mood since the accident. . . I've been about as even-keeled as always. Do you have a family history of headaches? No, not that I know of. Do you have a history of seizures? No. I've seen somebody have one, though. It's scary. It understand. It can be scary to witness a person having a seizure. Thanks. May I examine you? Sure. What is your name and date of birth?Exam Action 02/14/19 9:33 AM EST Question 02/14/19 9:33 AM EST Exam Action 02/14/19 9:33 AM EST Question 02/14/19 9:33 AM EST Exam Action 02/14/19 9:33 AM EST Question 02/14/19 9:33 AM EST Exam Action 02/14/19 9:34 AM EST Question 02/14/19 9:34 AM EST Exam Action 02/14/19 9:34 AM EST My name is Tina Jones, and I was born on February 17th. Evaluated orientation to person What building are you in now? I'm at the doctor's office. . . it's Shadow Health General Clinic. Evaluated orientation to place What is the date and year? Um, today's date is [Tina says correct date and year]. Evaluated orientation to time How are apples and oranges alike? How are they alike? Um.... they're both kinds of fruit. Evaluated abstract thinking: similarities among fruit How are a lake and an ocean alike? Uh.... they're both bodies of water. Evaluated abstract thinking: similarities among bodies of waterQuestion 02/14/19 9:34 AM EST Exam Action 02/14/19 9:34 AM EST Empathize 02/14/19 9:34 AM EST Question 02/14/19 9:34 AM EST Exam Action 02/14/19 9:35 AM EST Exam Action 02/14/19 9:35 AM EST Question 02/14/19 9:35 AM EST Exam Action 02/14/19 9:35 AM EST Question 02/14/19 9:35 AM EST How are a trumpet and a flute alike? They...... they're both musical instruments. Evaluated abstract thinking: similarities among instruments Excellent! Thanks for understanding. Count backwards by 7s from 100 Okay. . . 100, 93. . . 86, 79, 72. . . 65. . . 58, 51. . . 44. . . 37, 30, 23, 16. . . 9, and 2. Evaluated attention with serial sevens Established one-stage comprehension Who was the first president of the United States? That's George Washington. Evaluated knowledge of first president Who are the last four presidents of the United States? Well, right now it's Donald Trump. Before him it was Obama. Before *him* we had Bill Clinton and George W. Bush.Exam Action 02/14/19 9:35 AM EST Question 02/14/19 9:36 AM EST Exam Action 02/14/19 9:36 AM EST Question 02/14/19 9:36 AM EST Exam Action 02/14/19 9:36 AM EST Question 02/14/19 9:37 AM EST Exam Action 02/14/19 9:37 AM EST Question 02/14/19 9:37 AM EST Evaluated knowledge of last four presidents Name five large cities in the United States Let's see. . . New York City. . . and Chicago. . . Detroit. . . Los Angeles. . . and Houston. That's five. Evaluated knowledge of five large cities What would you do if you found a stamped addressed envelope on the sidewalk? What would I do.... Hmm.. Well, I'd try to figure out who dropped the envelope, but if not... Well, I'd probably just drop it in the first mailbox I saw, if there was one nearby. Evaluated judgment Repeat and remember burger, tulip, nose and tea. Burger, tulip, nose, and tea. Evaluated immediate memory How did you celebrate your last birthday? Wow. . . it's weird, birthdays were huge for us before Dad died because he would always make a really big deal out of them, like he loved planning these huge celebrations. But the past two birthdays, he hasn't been there, so it's been kind of sad, thinking about what he's missing, and we haven't done huge parties or anything. Last birthday. . . Michael and his fiance came over, and we all had dinner at the house, and I opened presents, and we had a really good cake from this bakery I love. It was nice.Exam Action 02/14/19 9:38 AM EST Question 02/14/19 9:38 AM EST Exam Action 02/14/19 9:38 AM EST Exam Action 02/14/19 9:38 AM EST Question 02/14/19 9:38 AM EST Exam Action 02/14/19 9:38 AM EST Question 02/14/19 9:38 AM EST Exam Action 02/14/19 9:39 AM EST Exam Action 02/14/19 9:39 AM EST Evaluated remote memory Repeat the four words from before Burger. . . tulip. . .nose. . . and tea. Evaluated immediate learning Observed patient's general vocabulary What classes are you taking? I'm taking two classes right now, one on auditing and one on managerial accounting Observed patient's general ability to articulate Can you tell me more about school? School's good, although it's a little stressful because I keep thinking about everything I have to do to graduate, and then after that, too. I'm about two months from being done with my last semester. Tested CN I (olfactory nerve) with smell test D E F P O T E C Tested visual acuity of both eyesExam Action 02/14/19 9:39 AM EST Exam Action 02/14/19 9:40 AM EST Exam Action 02/14/19 9:40 AM EST Exam Action 02/14/19 9:40 AM EST Exam Action 02/14/19 9:41 AM EST Exam Action 02/14/19 9:41 AM EST Question 02/14/19 9:41 AM EST Exam Action 02/14/19 9:41 AM EST D E F P O T E C Tested visual acuity of left eye That's... I can't really tell. Um, that one's kind of blurry. E D E O X F P E C F D Tested visual acuity of right eye Inspected fundus of right eye Inspected fundus of left eye Inspected right pupil and tested pupillary light reflex Inspected left pupil and tested left pupillary light reflex Follow my finger with just your eyes Ok. Tested EOM to the upper rightExam Action 02/14/19 9:41 AM EST Exam Action 02/14/19 9:41 AM EST Exam Action 02/14/19 9:41 AM EST Exam Action 02/14/19 9:41 AM EST Exam Action 02/14/19 9:41 AM EST Exam Action 02/14/19 9:41 AM EST Question 02/14/19 9:42 AM EST Exam Action 02/14/19 9:42 AM EST Exam Action 02/14/19 9:42 AM EST Exam Action 02/14/19 9:42 AM EST Tested EOM to the upper center Tested EOM to the upper left Tested EOM to the lower left Tested EOM to the lower center Tested EOM to the lower right Tested convergence Close your eyes and tell me if the touch is sharp, dull or soft. Ok. Tested facial sensation: dull stimulus Dull. Tested facial sensation: dull stimulus Dull. Tested facial sensation: soft stimulusExam Action 02/14/19 9:42 AM EST Exam Action 02/14/19 9:42 AM EST Exam Action 02/14/19 9:42 AM EST Exam Action 02/14/19 9:42 AM EST Exam Action 02/14/19 9:42 AM EST Exam Action 02/14/19 9:42 AM EST Exam Action 02/14/19 9:43 AM EST Exam Action 02/14/19 9:43 AM EST Soft. Tested facial sensation: soft stimulus Soft. Tested facial sensation: soft stimulus Soft. Tested facial sensation: sharp stimulus Sharp. Tested facial sensation: sharp stimulus Sharp. Tested facial sensation: sharp stimulus Sharp. Tested facial sensation: sharp stimulus Sharp. Inspected front of face for asymmetry and facial droop Inspected left side of face for asymmetry and facial droopExam Action 02/14/19 9:43 AM EST Exam Action 02/14/19 9:43 AM EST Exam Action 02/14/19 9:43 AM EST Question 02/14/19 9:43 AM EST Question 02/14/19 9:44 AM EST Exam Action 02/14/19 9:44 AM EST Exam Action 02/14/19 9:45 AM EST Exam Action 02/14/19 9:45 AM EST Inspected back of head for asymmetry Inspected right side of face for asymmetry and facial droop Inspected front of face for asymmetry and facial droop Is the volume the same in both ears or louder in one ear? Ok. Same in both ears. Tell me when you no longer hear the ringing Ok, I will. Now. Performed Rinne test on right side with tuning fork Now. Now. Now. Tested gag reflex Tested trapezius muscle strength against resistance: 5 strength against resistanceExam Action 02/14/19 9:46 AM EST Exam Action 02/14/19 9:46 AM EST Exam Action 02/14/19 9:46 AM EST Exam Action 02/14/19 9:46 AM EST Exam Action 02/14/19 9:46 AM EST Exam Action 02/14/19 9:46 AM EST Exam Action 02/14/19 9:46 AM EST Exam Action 02/14/19 9:47 AM EST Exam Action 02/14/19 9:47 AM EST Exam Action 02/14/19 9:47 AM EST Exam Action 02/14/19 9:47 AM EST Exam Action 02/14/19 9:48 AM EST Exam Action 02/14/19 9:48 AM EST Tested sternocleidomastoid muscle strength against resistance - head turned to the right: 5 strength against resistance Tested sternocleidomastoid muscle strength against resistance - head turned to the left: 5 strength against resistance Inspected mouth Inspected mouth: pushed tongue left with tongue blade Inspect mouth: pushed tongue right with tongue blade Inspect mouth: lifted tongue with tongue blade Inspected mouth: depressed tongue with tongue blade Tested reflexes of right triceps: 2+ Tested reflexes of left triceps: 2+ Tested reflexes of right biceps: 2+ Tested reflexes of left biceps: 2+ Tested reflexes of right brachioradialis: 2+ Tested reflexes of left brachioradialis: 2+Exam Action 02/14/19 9:48 AM EST Exam Action 02/14/19 9:48 AM EST Exam Action 02/14/19 9:49 AM EST Question 02/14/19 9:49 AM EST Question 02/14/19 9:49 AM EST Exam Action 02/14/19 9:49 AM EST Question 02/14/19 9:50 AM EST Exam Action 02/14/19 9:50 AM EST Question 02/14/19 9:50 AM EST Exam Action 02/14/19 9:50 AM EST Tested reflexes of right patellar tendon: 2+ Tested reflexes of right achilles tendon: 2+ Tested reflexes of left achilles tendon: 2+ Close your eyes and touch your fingers to your nose I can do that. Run your right foot down your shin Sure. Observed right heel moving to shin Run your left foot down your right shin Ok. Observed left heel moving to shin Place your hands on your knees and turn them over Ok, like this? Observed rapid alternating hand movements: Movement is smooth, performed without difficultyExam Action 02/14/19 9:50 AM EST Question 02/14/19 9:50 AM EST Exam Action 02/14/19 9:51 AM EST Exam Action 02/14/19 9:51 AM EST Question 02/14/19 9:51 AM EST Exam Action 02/14/19 9:51 AM EST Exam Action 02/14/19 9:51 AM EST Exam Action 02/14/19 9:51 AM EST Observed patient's gait Close your eyes and tell me what I trace on your palm Ok. That's an "A." Tested left-hand graphesthesia by letter identification A figure "8." Tested right-hand graphesthesia by number identification Close your eyes and tell me if the touch is sharp, dull, or soft. Ok. Tested right arm proximal dull sensation Dull. Tested left arm proximal dull sensation Dull. Tested right arm distal sharp sensationExam Action 02/14/19 9:51 AM EST Exam Action 02/14/19 9:51 AM EST Question 02/14/19 9:52 AM EST Exam Action 02/14/19 9:52 AM EST Exam Action 02/14/19 9:52 AM EST Exam Action 02/14/19 9:52 AM EST Exam Action 02/14/19 9:52 AM EST Sharp. Tested left arm distal sharp sensation Sharp. Test sensory light chest Soft. Close your eyes and tell me if the touch is sharp, dull or soft. Ok. Tested right leg proximal dull sensation Dull. Tested left leg proximal dull sensation Dull. Tested left leg distal light sensation Soft. Tested right leg distal light sensation Soft.Exam Action 02/14/19 9:52 AM EST Exam Action 02/14/19 9:52 AM EST Question 02/14/19 9:53 AM EST Exam Action 02/14/19 9:53 AM EST Exam Action 02/14/19 9:53 AM EST Exam Action 02/14/19 9:53 AM EST Exam Action 02/14/19 9:53 AM EST Exam Action 02/14/19 9:53 AM EST Tested left leg proximal sharp sensation Sharp. Tested right leg distal sharp sensation Sharp. Close your eyes and tell me when you feel the touch Ok, I will. Tested sensation of right heel with monofilament Yes. Tested sensation of left ball of foot under small toe with monofilament Tested sensation of right big toe with monofilament Yes. Tested sensation of right big toe with monofilament Tested sensation of left heel with monofilament Yes. Tested sensation of left ball of foot under small toe with monofilamentExam Action 02/14/19 9:53 AM EST Exam Action 02/14/19 9:53 AM EST Exam Action 02/14/19 9:53 AM EST Question 02/14/19 9:54 AM EST Exam Action 02/14/19 9:54 AM EST Exam Action 02/14/19 9:54 AM EST Exam Action 02/14/19 9:54 AM EST Question 02/14/19 9:54 AM EST Tested sensation of left ball of foot under big toe with monofilament Tested sensation of left big toe with monofilament Close your eyes and tell me if your finger or toe moves up or down Ok, I will. Down. Tested position sense of finger on right hand Up. Tested position sense of finger on left hand ...I think that was up. Tested position sense of toe on right foot Down. Close your eyes and tell me what I put in your hand Ok, sure.Exam Action 02/14/19 9:55 AM EST Exam Action 02/14/19 9:55 AM EST Exam Action 02/14/19 9:55 AM EST Exam Action 02/14/19 9:55 AM EST Exam Action 02/14/19 9:55 AM EST Exam Action 02/14/19 9:55 AM EST ...Some kind of coin. Tested right-hand stereognosis with coin This is... some wire thing... paperclip? Tested right-hand stereognosis with paper clip Um... that feels like a key. Tested right-hand stereognosis with key ...Some kind of coin. Tested left-hand stereognosis with coin The paperclip again. Tested left-hand stereognosis with paper clip Um... that feels like a key. Tested left-hand stereognosis with key Comments If your instructor provides individual feedback on this assignment, it will appear here. © Shadow Health® 2018