NR 509 Shadow Health Focused Exam Abdominal Education & Empathy: 6 of 7 (85.7%)

Document Content and Description Below

Chamberlain College of Nursing NR 509 Shadow Health Focused Exam Abdominal Education Empathy Education & Empathy: 6 of 7 (85.7%) 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 1 Symptoms Followed Up Description: Ms. Park describes the symptoms that have been bothering her. what bring you in today? Question 07:54 PM CDTI have pain in my belly. . . and I'm having some difficulty with going to the bathroom. My daughter was concerned. when did your pain start? Question 07:55 PM CDT The pain started as a general discomfort, about five days ago, when I started having the. . . difficulties going to the bathroom. I'm sorry to hear you are having pain and discomfort Empathize 07:56 PM CDT Thank you.where is your pain? Question 07:58 PM CDT The pain and discomfort is down low in my belly. can you point the location? Question 07:58 PM CDT Well my whole belly is uncomfortable to some degree, but it's mostly in the lower part, that's where the pain is. Down in my lower belly. are you in pain right now? Question 07:59 PM CDTYes. . . it hurts now, like it has been. can you describe your pain? Question 07:59 PM CDT I'd say it's crampy and. . . a dull, crampy feeling. what is your pain level 0-10, 10 being worst? Question 08:00 PM CDT Right now. . . 6 out of 10.sorry to hear that you are in pain, Empathize 08:01 PM CDT Thank you. what make your pain relieve? (Clarified to: what relieves your pain) Question 08:01 PM CDT When I rest and try not to move much, I feel better. But the pain is still there. (Clarified to: what relieves the pain) what makes your pain worse? Question 08:02 PM CDTMoving around certainly doesn't help. Neither does eating. how often are your having pain? Question 08:03 PM CDT Oh, it's with me all the time. The bloating, too. But certain things do make it worse. what make your pain worse? Question 08:04 PM CDT Moving around certainly doesn't help. Neither does eating.how long have you had this problem? (Clarified to: how long have you been in pain) Question 08:05 PM CDT The pain started as a general discomfort, about five days ago, when I started having the. . . difficulties going to the bathroom. (Clarified to: how long I have been in pain) what were you doing 5 days ago? (Clarified to: What were you doing prior to the start of the pain?) Question 08:06 PM CDT I don't know what caused it. . . about five days ago, I started having difficult going to the bathroom. It came with a general uneasiness and a small amount of discomfort. Then the pain got much worse two-- maybe three--days ago. (Clarified to: what I was doing when the pain started) was the pain started sudden? Question 08:07 PM CDTNo, it was gradual. I had some pain and discomfort about. . . five days ago. Then in the past few days it got much worse. how long does your pain last? Question 08:07 PM CDT The pain is there all the time, but it gets much worse at certain points--when I move around a lot or eat something, especially. I'm sorry to hear that, in order to figure out what cause your pain, I need to gather information and examining you Educate 08:09 PM CDT Thank you for explaining that.can you describe the diarrhea? Question 08:39 PM CDT It was very loose. Watery. what color was the diarrhea? Question 08:40 PM CDT It was brown, but thinned out. It was liquidy. Oof! I do not enjoy discussing this. sorry about you might not comfortable taking about this, but in order to figure something out, your information is very important Educate 08:42 PM CDTThank you for explaining that. how are your bowel movement? Question 08:45 PM CDT My bowel movements are usually. . . what I assume one would call normal. Not too soft, a normal brown color. Fairly regular. how often are your bowel movement? Question 08:45 PM CDT Before this? Every day. Well, I miss a day now and then, but usually every day.although sounds little gross, your bowel can tell your health, so it's important to look shape, color, Educate 08:49 PM CDT Thank you for explaining that. when was last your bowel movement? Question 08:49 PM CDT That was a few days ago. When I had a digestive upset. Diarrhea. any discomfort with your last bowel movement? Question 08:50 PM CDTYes, I have been very uncomfortable in my belly--my lower belly. It's been going on for almost a week. any changes the frequency of your urination? Question 08:51 PM CDT I've been going slightly less often because. . . well, I've been little less thirsty than usual. sorry to hear that Empathize 08:52 PM CDT Thank you.have you lost of appetite? Question 09:21 PM CDT I haven't been hungry. Eating only makes me feel worse. how long have you had decrease in appetite? Question 09:23 PM CDT It's been hard to eat since the belly pain got much worse, about two or three days ago. When I do eat-- my daughter Jennifer makes sure I have a little something--it only makes me feel worse. sorry to hear that Question 09:23 PM CDTWell, my hearing is not as good as a younger person's. But I hear well enough that I don't notice problems. sorry to hear that Empathize 09:23 PM CDT 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." 2 Medications Followed Up Description: Ms. Park describes her medication use and attitudes toward taking medication. Have you take any medication to relieve the pain? Question 08:18 PM CDTI'm not taking anything for it. what have you done to relieve the pain? Question 08:18 PM CDT I've tried taking small sips of warm water, resting. The warm water does nothing. A friend suggested it, but it's nonsense. I'm sorry to hear that it sounds nothing help your pain Empathize 08:26 PM CDT Thank you.do you take any medication? Question 10:04 PM CDT Just the medication for my blood pressure. what's the name of it? (Clarified to: What are the names of your medications?) Question 10:04 PM CDT It's called Accupril. (Clarified to: what the names of my medications are) how much accupril do you take? Question 10:05 PM CDT10 milligrams. how often do you take accupril? Question 10:05 PM CDT 10 milligrams. are you take a medication everyday? Question 10:06 PM CDT I take pills for my blood pressure.do you take accupril everyday? (Clarified to: How long have you been taking Accupril?) Question 10:06 PM CDT I've been taking it since I was diagnosed. I was. . . 54. (Clarified to: how long I have been taking Accupril) it's good you take as prescribed Educate 10:07 PM CDT Thank you for explaining that. when do you take your medication? Question 10:08 PM CDTI take it every morning at about 8 a.m., after breakfast. when was last time you took your medication? Question 10:08 PM CDT I took my Accupril this morning, at around 8. it's very important to take your medication as prescribed Educate 10:09 PM CDT Thank you for explaining that. Model Statement: "I understand not wanting to take many medications. However, some medications can help reduce pain, relieve symptoms, and keep youhealthy in the long-run." 3 Diet Followed Up Description: Ms. Park describes her dietary habits. how's your eating habit? Question 08:13 PM CDT I eat a heart-healthy diet. Low fat, lean meats, low sugar. . . I eat light. very good Ms Park, you are on healthy diet Educate 08:14 PM CDT Thank you for explaining that. what do you typically eat a day? Question 09:07 PM CDTHm. Fruit for breakfast. For lunch. . . usually soup, maybe a salad. But I don't always have lunch. And for dinner I eat fish, or sometimes chicken, and a vegetable. skipping a meal is not ideal Educate 09:08 PM CDT Thank you for explaining that. do you eat fruit for breakfast only? (Clarified to: What's your usual breakfast?) Question 09:09 PM CDT For breakfast? I eat fruit, usually a banana. (Clarified to: what I usually eat for breakfast)it's important to have balance meal Educate 09:11 PM CDT Thank you for explaining that. how do you managed to avoid diabetes? (Clarified to: how do you manage your diet) Question 10:19 PM CDT I eat a heart-healthy diet. Low fat, lean meats, low sugar. . . I eat light. (Clarified to: how I manage my diet) do you eat fiber? Question 10:19 PM CDTI think I get enough fiber. I try to eat at least one vegetable every day. have you noticed thirsty? Question 10:20 PM CDT I haven't felt noticeably thirsty. I suppose I've been drinking a little less water than usual, just in these last few days. drinking 6-8 glass of water a day is one of way to maintain healthy way of living Educate 10:21 PM CDT Thank you for explaining that. Model Statement: "Keeping an eye on your fiber intake is a great start. The USDA recommends that adults eat around 28 grams of fiber per day, which isseveral servings of fruits, vegetables, and whole grains. Let’s talk about ways for you to get a little more fiber in your diet." 4 Activity Level Followed Up Description: Ms. Park describes staying socially active and exercising. what's your usual activities? Question 08:30 PM CDT I enjoy staying busy -- but not too busy. I take classes at the community center--water aerobics, and now Pilates. And I love to walk. My friend and I walk to the botanical gardens, once a week. I garden as well. Those are all nice ways to spend my time. any change of usual activities? Question 08:32 PM CDT Yes, it seems like my energy got low when I did simple things around the house, like tidying up. I had to miss my exercise classes this week -- I didn't have the energy for them. That's unusual for me. what have you done last couple days? Question 08:32 PM CDTI've tried taking small sips of warm water, resting. The warm water does nothing. A friend suggested it, but it's nonsense. you seems enjoy your usual activities, we will work together so you can go back to your usual activities as soon as possible Educate 08:34 PM CDT Thank you for explaining that. do you exercise? Question 10:42 PM CDT Yes, I usually love exercise--water aerobics, Pilates . . . I take classes at the community center. But with this pain and feeling so uncomfortable this week, I've skipped my classes.very good that you are exercise and keep busy Educate 10:43 PM CDT Thank you for explaining that. Model Statement: "It sounds like you stay physically and socially active. That’s great!" 5 Medical History Not Followed Up Description: Ms. Park describes her past c-section and losing a child at birth. what were two operations ? (Clarified to: what surgeries have you had) Question 09:06 PM CDT I've had two. I had my gallbladder out, and I had a Csection. Both in my early 40s. (Clarified to: what surgeries I have had) what do you typically eat a day? Question 09:07 PM CDTModel Statement: "I’m so sorry to hear about this. It must have been a painful situation for you. Thank you for sharing." 6 Sexual Activity Followed Up Description: Ms. Park describes being sexually active. do you have sexual activity? (Clarified to: are you sexually active) Question 10:22 PM CDT I have a gentleman friend and, yes... We are intimate. (Clarified to: if I am sexually active) do you use any protection? Question 10:23 PM CDT No. That isn't necessary. have you had test for STI? Question 10:23 PM CDTNo, that hasn't been necessary. have your gentleman friend had test for STI? Question 10:24 PM CDT I don't know, but I have no reason to think that is something we should be concerned about. do you have intercourse? Question 10:25 PM CDT I have a gentleman friend and, yes... We are intimate.it's important to have a protection to prevent STI Educate 10:25 PM CDT Thank you for explaining that. how often do you have intercourse? Question 10:26 PM CDT Well, I don't have intercourse. But I have... My gentleman friend and I do other things. Thank you for explaining Empathize 10:27 PM CDTThank you. what kind of intercourse do you have? Question 10:29 PM CDT Max and I. . . this is not what I'd expected to be discussing here. We kiss, touch, you know. . . we don't have intercourse, but there is oral sex. I hope that answers your question. it's very important part of relationship thank your for answering Educate 10:31 PM CDT Thank you for explaining that. Model Statement: "Thank you for sharing this personal information. It will help me determine if any part of your abdominal pain is caused by sexualactivity." 7 Family and Support Followed Up Description: Ms. Park describes being widowed and living with her daughter. how many children you have? Question 10:38 PM CDT Two wonderful grown-up children. Jennifer and Timothy. that sounds blessing Empathize 10:40 PM CDT Thank you. do you live alone? Question 10:40 PM CDTNo. I live with my daughter, Jennifer. do you have family support? Question 10:41 PM CDT I am fortunate that I have a daughter who takes care of me the way she does. And my gentleman friend Max is also very supportive. it's good to hear that you have strong family and friend support Empathize 10:42 PM CDT Thank you. 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 tohear that you have a strong support system in your children." [Show More]

Last updated: 2 years ago

Preview 1 out of 33 pages