Experience Overview
Patient: Tina Jones
Digital Clinical Experience Score
100%
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 80.0%. This score may not be your final grade if your instructor chooses to include additional components, such as documentation or time spent.
Student Performance Index
|
31
out of 31
|
Proficiency Level:
Proficient
Students rated as “proficient” demonstrate an entry-level 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.
Subjective Data Collection
21
out of
21
Objective Data Collection
6
out of
6
Education and Empathy
4
out of
4
Transcript
Started: May 14, 2020 | Total Time: 138 min
| Hello! | Question 0x/x4/2x 8:xx PM MDT |
|
| Hi. I’m Preceptor Diana. I will explain the details of this assignment and your objectives, just as a preceptor would in real life. Pay close attention to this information as it will help guide your exam. At the end of this prebrief, you will answer a short question about the upcoming assignment. During the simulation, you may return to these instructions at any time by scrolling to the top of your transcript. | ||
| What is the situation? | Question 0x/x4/2x 8:xx PM MDT |
|
| It’s noon on Tina Jones’ first day as a patient here at Shadow General Hospital. Your role in this simulation is that of a healthcare provider who will perform a full respiratory exam on Ms. Jones given her history of asthma. | ||
| What else will this exam involve? | Question 0x/14/2x 8:xx PM MDT |
|
| You will complete nursing tasks to protect the patients safety, privacy, and health. You can document your findings, including vital signs, in the Electronic Health Record. This record provides necessary information for healthcare professionals who will continue patient care. Activities other than Subjective and Objective Data Collection, such as Documentation and Education and Empathy, provide valuable practice for their real-world counterparts. However, they are not automatically graded by the simulation. | ||
| How will I be evaluated? | Question xxx |
|
| In this assignment, you will be evaluated on your Subjective and Objective Data Collection. The evaluation of your interview is dependent on how you word your questions therapeutically and precisely and explore all relevant topics with comprehensive breadth and depth. The evaluation of your physical exam is based on how successfully you report on your physical findings by selecting among clinical terms in the Electronic Health Record. This assignment takes on average between 40 and 50 minutes. You can pause and resume the assignment at any time; your work is always saved automatically. | ||
| How does this assignment prepare me for the real world? | Question xxx |
|
| In this assessment, you will become familiarized with the structure and content of respiratory exams so that with real-life patients, you can: º ask effective and comprehensive questions º use therapeutic language º evaluate the patient’s risk of disease, infection, injury, and complications º and obtain and assess objective data. | ||
| What are my objectives in this assessment? | Question 0xx |
|
| In your interview with Ms. Jones, you will ask about her respiratory system and identify any risk factors so that you can determine any current and potential issues. 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. You will also inquire into the health history of Ms. Jones’ family with regards to the respiratory system so you can determine her genetic predisposition to any diseases. Regardless of whether you have assessed Tina previously, ask all questions that are medically relevant to her respiratory system. In addition to collecting subjective data, you will perform a physical exam on Ms. Jones’ respiratory system to gather objective data about the system’s health and physiology. 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. | ||
| What is the situation? | Question 0x/14/2x xxx PM MDT |
|
| It’s noon on Tina Jones’ first day as a patient here at Shadow General Hospital. Your role in this simulation is that of a healthcare provider who will perform a full respiratory exam on Ms. Jones given her history of asthma. | ||
| What is the situation? | Question xxx PM MDT |
|
| It’s noon on Tina Jones’ first day as a patient here at Shadow General Hospital. Your role in this simulation is that of a healthcare provider who will perform a full respiratory exam on Ms. Jones given her history of asthma. | ||
| In 1 or 2 sentences, answer this question to help prepare for the upcoming exam: Based on your current knowledge, explain the pathophysiology of asthma. | ||
| Hello. Asthma is a pulmonary condition defined by chronic inflammation of respiratory tubes, tightening of smooth muscle and bronchoconstriction | Statement 05/14/20 8:35 PM MDT |
|
| Time to begin. | ||
| Hello. My name is xxxx and I will be interviewing you today and later do a physical exam. | Greet | |
| Hey. | ||
| Please tell me what is your name | Q | |
| Tina Jones. | ||
| Your date of birth? | Question 0x/14/ |
|
| February 17th. | ||
| How old are you? | Question 0xx/14/2xxx |
|
| I’m 28. | ||
| What brought you to the clinic today? | Question xx/14/xxPM MDT |
|
Hi. My name is xxx . I will be interviewing you today and later examine you.
|
Greet |
|
 |
Hey.
|
|
 |
What is your name?
|
Question |
|
Tina Jones.
|
|
|
What is your date of birth?
|
Question |
|
February 17th.
|
|
|
How a old are you?
|
Question |
|
I’m 28.
|
|
|
What brings you to the clinic today?
|
Question |
|
I came in because I’ve been having breathing problems, and my inhaler just isn’t working the way it normally does.
|
|
|
Am sorry to hear that.
|
Empathize |
|
I appreciate you saying that.
|
|
|
What medical problems do you have?
|
Question |
|
Well. . . I’ve had asthma since I was really little, though for a while there it wasn’t really much of a problem. And I have sugar diabetes, too.
|
|
|
What do you use for your asthma?
|
Question |
|
It’s just a regular Proventil inhaler.
|
|
|
How often do you use your inhaler?
|
Question |
|
I’ve been using it probably every. . . four hours or so, I’d say.
|
|
|
When did your symptoms start?
|
Question |
|
I don’t know if I’d call it an asthma attack, but my asthma started acting up two days ago at my cousin’s house. She has cats, and I’m allergic, so I’m used to it being a problem there, but usually the inhaler fixes it. . . it doesn’t feel totally under control, though.
|
|
|
Am sorry to hear that
|
Empathize |
|
Thanks for understanding.
|
|
|
How long have you had breathing problems?
|
Question |
|
My breathing’s been acting up off and on for the past two days.
|
|
|
How frequent are your shortness of breath episodes?
|
Question |
|
Sometimes it can take a few minutes for me to realize I need my inhaler, then once I use it the wheezing usually gets better. . . I’d say it takes about a minute to work at most after that. So five minutes total, at the longest?
|
|
|
How long does one episode last?
|
Question |
|
I haven’t had a full attack in years, but usually once I use my inhaler it only takes a minute or two for my breathing to go back to normal. . . that’s not what’s been happening recently, though.
|
|
|
How many times have you had breathing problems in the past 2 days?
|
Question |
|
Well. . . it’s kind of hard to count because my breathing’s been at least a little bad most of the past two days, but it’s really acted up, like with wheezing and everything, probably every four hours or so–like five times each day.
|
|
|
Is your asthma keeping you up at night?
|
Question |
|
My asthma doesn’t usually wake me up, but it has the past couple nights.
|
|
|
How bad was your asthma attack?
|
Question |
|
My asthma used to be really scary. I haven’t had a full attack in years, and if you had asked me before this I would have said my asthma wasn’t that bad anymore, but the last couple days I’ve had a lot of trouble breathing.
|
|
|
Is there anything you can’t do because of your asthma?
|
Question |
|
There usually isn’t anything I can’t do because of my asthma. . . I guess I try to avoid things that make my breathing worse, but that’s about it. The past couple days, though, it’s been hard to do anything.
|
|
|
Do you wheeze during an asthma exacerbation?
|
Question |
|
During a full attack, I would wheeze a lot, like I couldn’t breathe at all, but until the past couple days, I would usually just wheeze a little when I had breathing problems.
|
|
|
Any chest tightness? (Clarified to Have you had chest tightness?.)
|
Question |
|
Yeah, when my asthma gets bad my chest feels pretty tight, like I can’t take in air. It’s felt that way a lot the past two days. (Clarified to if I have had chest tightness.)
|
|
|
Are you having any chest tightness?
|
Question |
|
It just feels like I can’t really take in air when I breathe, sort of like breathing makes my chest tighter. . . it doesn’t hurt or anything, though.
|
|
|
Any cough?
|
Question |
|
I’ve been coughing a lot, yeah.
|
|
|
How long have you had the cough?
|
Question |
|
Since my asthma acted up two days ago.
|
|
|
How would you describe the cough?
|
Question |
|
Um. . . I guess I’d describe it as a small, dry cough.
|
|
|
How would you describe the cough?
|
Question |
|
Um. . . I guess I’d describe it as a small, dry cough.
|
|
|
What makes your cough better?
|
Question |
|
Drinking some water helps a little, as long as the water isn’t too cold.
|
|
|
Have you tried to treat your cough?
|
Question |
|
I haven’t taken medicine for it or anything.
|
|
|
Is your asthma worse at night?
|
Question |
|
It has been the past couple nights, yeah.
|
|
|
Does lying on your back make your asthma worse?
|
Question |
|
Just recently lying on my back has definitely made my breathing worse.
|
|
|
To help your breathing, you may want to elevate your head with two pillows
|
Educate |
|
Alright, thanks for letting me know.
|
|
|
Any allergies?
|
Question |
|
Yeah, I’m allergic to cats.
|
|
|
Any medication allergies?
|
Question |
|
Yeah, I’m allergic to penicillin.
|
|
|
Any family history breathing problems?
|
Question |
|
My baby sister has asthma, too, but no one else in the family has lung problems, I don’t think.
|
|
|
Inspected anterior chest wall
|
Exam Action |
|
Inspected right side chest wall
|
Exam Action |
|
Inspected posterior chest wall
|
Exam Action |
|
Inspected left side chest wall
|
Exam Action |
|
Inspected anterior chest wall
|
Exam Action |
|
Palpated chest expansion: Both sides rise symmetrically
|
Exam Action |
|
Percussed anterior right upper lobe
|
Exam Action |
|
Percussed anterior left upper lobe
|
Exam Action |
|
Percussed anterior right middle lobe
|
Exam Action |
|
Percussed anterior left mid-chest (upper lobe)
|
Exam Action |
|
Percussed anterior right lower lobe
|
Exam Action |
|
Percussed anterior left lower lobe
|
Exam Action |
|
Percussed posterior left upper lobe
|
Exam Action |
|
Percussed posterior right upper lobe
|
Exam Action |
|
Percussed posterior left mid-back (lower lobe)
|
Exam Action |
|
Percussed posterior right mid-back (lower lobe)
|
Exam Action |
|
Percussed posterior left lower lobe
|
Exam Action |
|
Percussed posterior right lower lobe
|
Exam Action |
|
Percussed posterior right lower lobe
|
Exam Action |
|
Percussed posterior left lower lobe on side
|
Exam Action |
|
Percussed posterior left lower lobe near spine
|
Exam Action |
|
Percussed posterior right lower lobe near spine
|
Exam Action |
|
Percussed posterior right lower lobe on side
|
Exam Action |
|
Auscultated breath sounds in anterior right upper lobe
|
Exam Action |
|
Auscultated breath sounds in anterior left upper lobe
|
Exam Action |
|
Auscultated breath sounds in anterior right middle lobe
|
Exam Action |
|
Auscultated breath sounds in anterior left mid-chest (upper lobe)
|
Exam Action |
|
Auscultated breath sounds in anterior right lower lobe
|
Exam Action |
|
Auscultated breath sounds in anterior left lower lobe
|
Exam Action |
|
Auscultated breath sounds in posterior left upper lobe
|
Exam Action |
|
Auscultated breath sounds in posterior right upper lobe
|
Exam Action |
|
Auscultated breath sounds in posterior left mid-back (lower lobe)
|
Exam Action |
|
Auscultated breath sounds in posterior right mid-back (lower lobe)
|
Exam Action |
|
Auscultated breath sounds in posterior left lower lobe
|
Exam Action |
|
Auscultated breath sounds in posterior right lower lobe
|
Exam Action |
|
Auscultated breath sounds in posterior left lower lobe on side
|
Exam Action |
|
Auscultated breath sounds in posterior left lower lobe near spine
|
Exam Action |
|
Auscultated breath sounds in posterior right lower lobe near spine
|
Exam Action |
|
Auscultated breath sounds in posterior right lower lobe on side
|
Exam Action |
|
Auscultated voice sounds in anterior right upper lobe
|
Exam Action |
|
Ninety-nine.
|
|
|
Auscultated voice sounds in anterior left upper lobe
|
Exam Action |
|
Auscultated voice sounds in anterior right middle lobe
|
Exam Action |
|
Ninety-nine.
|
|
|
Auscultated voice sounds in anterior left mid-chest (upper lobe)
|
Exam Action |
|
Ninety-nine.
|
|
|
Ninety-nine.
|
|
|
Auscultated voice sounds in anterior right lower lobe
|
Exam Action |
|
Ninety-nine.
|
|
|
Ninety-nine.
|
|
|
Auscultated voice sounds in anterior left lower lobe
|
Exam Action |
|
Ninety-nine.
|
|
|
Ninety-nine.
|
|
|
Auscultated voice sounds in posterior left upper lobe
|
Exam Action |
|
Ninety-nine.
|
|
|
Auscultated voice sounds in posterior right upper lobe
|
Exam Action |
|
Ninety-nine.
|
|
|
Auscultated voice sounds in posterior left mid-back (lower lobe)
|
Exam Action |
|
Ninety-nine.
|
|
|
Ninety-nine.
|
|
|
Auscultated voice sounds in posterior right mid-back (lower lobe)
|
Exam Action |
|
Ninety-nine.
|
|
|
Auscultated voice sounds in posterior left lower lobe
|
Exam Action |
|
Ninety-nine.
|
|
|
Ninety-nine.
|
|
|
Auscultated voice sounds in posterior right lower lobe
|
Exam Action |
|
Ninety-nine.
|
|
|
Auscultated voice sounds in posterior left lower lobe on side
|
Exam Action |
|
Ninety-nine.
|
|
|
Ninety-nine.
|
|
|
Auscultated voice sounds in posterior left lower lobe near spine
|
Exam Action |
|
Ninety-nine.
|
|
|
Auscultated voice sounds in posterior right lower lobe near spine
|
Exam Action |
|
Ninety-nine.
|
|
|
Auscultated voice sounds in posterior right lower lobe on side
|
Exam Action |
|
Ninety-nine.
|
|
|
Ninety-nine.
|
|
|
Check pulse oximetry using right hand
|
Exam Action |
|
Checked pulse oximetry using left hand
|
Exam Action |
|
Checked spirometer
|
Exam Action |
|
Checked patient’s inhaler
|
Exam Action |
|
Always make sure your inhaler is up to date.
|
Educate |
|
Sure, I think I understand what you mean.
|
|
|
What medications do you take?
|
Question |
|
My inhaler is the only prescription I always have, but I usually don’t need it everyday, except for recently. . .
|
|
|
When did you last use your inhaler?
|
Question |
|
I had to use it early this morning.
|
|
|
How many puffs of your inhaler are you prescribed?
|
Question |
|
I’m supposed to just do two puffs of the albuterol inhaler. It’s 90 micrograms a spray. [AUDIO COMING SOON]
|
|
|
Make sure to follow the Proventil instructions as prescribed.
|
Educate |
|
Thanks for telling me.
|
|
|
Are you taking any other medications?
|
Question |
|
No, all I really use is my inhaler.
|
|
|
Do you take any over-the-counter medications?
|
Question |
|
I take Tylenol for a headache sometimes, or Advil for cramps, but not often.
|
|
|
How much Tylenol do you take? (Clarified to How much Tylenol do you take?.)
|
Question |
|
I just take one or two of the 500 mg acetaminophen. I usually get the headaches at night from reading — squinting I guess — and so I take one or two and go to bed. [AUDIO COMING SOON] (Clarified to how much Tylenol I take.)
|
|
|
How much advil do you take for cramps?
|
Question |
|
I take three 200 mg pills at a time. And I’d bet I take it up to three times a day. [AUDIO COMING SOON]
|
|
|
Any new allergies?
|
Question |
|
No, not that I know of.
|
|
|
What started your recent asthma problems?
|
Question |
|
This all started at my cousin’s house. She has cats, and I’m allergic, so my asthma always goes crazy when I’m there.
|
|
|
Does being around dust trigger your asthma?
|
Question |
|
Yeah, being around a lot of dust, especially hanging out in a really dusty house, can make my asthma act up.
|
|
|
Am sorry to hear that
|
Empathize |
|
I appreciate you saying that.
|
|
|
Does climbing stairs trigger asthma?
|
Question |
|
Only when I’m in a rush and have to hurry up them.
|
|
|
Any seasonal allergies?
|
Question |
|
A little while ago, I had some seasonal allergies, but it didn’t really bother my asthma, and it’s better now.
|
|
|
Does anything at work make your asthma worse?
|
Question |
|
Well. . . sometimes when there’s dust at work it can make my asthma act up, but that doesn’t happen very often.
|
|
|
Do you see an asthma specialist?
|
Question |
|
I used to go to Dr. Dewitt, but she moved her practice recently. Luckily she’s still been able to call in refills of my inhaler, but I haven’t actually been in to see her in about two years.
|
|
|
It is important to follow up regularly with your asthma specialist.
|
Educate |
|
OK, I understand.
|
|
|
How long have you had asthma?
|
Question |
|
I’ve had asthma a long time. . . since I was really little.
|
|
|
How old were you when you were diagnosed with asthma?
|
Question |
|
My doctor told me when I was pretty little… I think I was about two and a half? I used to have a lot of trouble with asthma attacks back then.
|
|
|
Have you ever been hospitalized for asthma?
|