health assessment student handbookthis assignment occurs at 8 a.m. on ms. jones’ second day in the...

Your guide to the Shadow Health® Digital Clinical Experience™ UGV.1

Health Assessment Student Handbook

Health Assessment Student Handbook | | Copyright© 2017 Shadow Health® | | ShadowHealth.com2

Table of ContentsWelcome! ............................................................................................ 3

HealtH HistoryInstructions .........................................................................................4-5Self Reflection.........................................................................................6

HeeNtInstructions ........................................................................................... 7

respiratoryInstructions ........................................................................................... 8

cardiovascularInstructions ........................................................................................... 9

abdomiNalInstructions ..........................................................................................10

musculoskeletalInstructions ..........................................................................................11

NeurologicalInstructions ..........................................................................................12

skiN, Hair, & NailsInstructions ..........................................................................................13

Focused exam: cougHInstructions ..........................................................................................14

Focused exam: cHest paiNInstructions ..........................................................................................15

Focused exam: abdomiNal paiNInstructions ..........................................................................................16

compreHeNsive assessmeNtInstructions ..........................................................................................17

Health Assessment Student Handbook | | Copyright© 2017 Shadow Health® | | ShadowHealth.com3

Shadow Health® understands that you want to learn your core nursing competencies in the most engaging and effective way possible. The Shadow Health Digital Clinical Experience™ (DCE) provides you with a dynamic, immersive experience designed to enrich classroom instruction through the clinical examination of our Digital Standard-ized Patients.™ We are committed to providing you with an innovative, intuitive virtual clinical experience that offers comprehensive participation in a safe learning environ-ment.

Welcome!

4Undergraduate Student Handbook Spring 2017 | | Copyright© 2017 Shadow Health® | | ShadowHealth.com

Health HistoryAs healthcare professionals, the health history helps us compile important information to better care for our patients. You should conduct a thorough patient interview to collect all the necessary information to treat your patient.

Patient Narrative: In this assignment, your patient, Tina Jones, has been admitted to the hospital for a painful foot wound, and you will conduct a health history as part of her admittal process. This assignment occurs at midnight on Tina Jones’ first day in the hospital. You will interact with Ms. Jones throughout the course of her hospital stay, so this assignment is especially important to establish baseline information about your patient.

Planning your time:

• Review the assignment settings your instructor selected on the assignment overview page.

• Every assignment setting allows you to stop and resume an assignment until you leave

Assignment Setting First Turn-in Allow Reopening Flexible Turn In

Time Estimate 90 minutes 120 minutes 150 minutes

Getting Started:View this tutorial for guidance on getting started with the Health History Assignment.

Tips for success:Unlike the Conversation Concept Lab, there are no prompts during your interview, so you should prepare prior to entering Ms. Jones’ room. We suggest taking out your textbook to remind your-self of what taking a health history entails. There are essential sections of patient information that your interview will need to uncover. As you learned in the Conversation Concept Lab, there are multiple essential questions for each of these topics: q Chief Complaint q History of Present Illness q Pain Assessment q Allergies q Immunizations q Medications q Medical History q Surgical History q Previous Hospitalizations q Gynecological History q Family History (3 Generations) q Social History q Full Review of Systems

https://vimeo.com/197330284/8a7841ef42


Health HistoryKnow all of your qualifying questions for any symptom that may be reported: q Onset q Location q Duration q Characteristics q Aggravating/alleviating factors q Related symptoms q Treatments tried

Remember when you are doing these exams that this simulation is designed to help you improve your health assessment skills. Preparing ahead of time will help to set you up for success.

Technical Support: Contact Shadow Health with any questions or technical issues before contacting your instructor. Support is available at http://support.shadowhealth.com.

In all assignments, remember to complete your Self Reflection: What is Self Reflection?Self reflection enables us to look at our performance - be it on the job, in the classroom, or out on the field - and critique our practice in a systematic and rigorous way. This process enables us to develop a greater sense of self awareness and to create a plan to improve on areas of weakness in our performance. We gain critical insights from this reflection that help us move from novices to experts in our fields. Self-reflection is proven1 to improve our skills as providers, which leads to better patient outcomes.How do I begin?As you reflect on your practice, thinking about things that have gone well will help you to understand how you can make this happen more often. Conversely, thinking about things that haven’t gone so well helps you to think about how things could be different in the future. Here are some questions to ask yourself:1. What are you reflecting on? a. What assignment did you complete? b. How did you do on the assignment? c. Did you meet your goal and achieve a score you were happy with?2. How were you thinking and feeling a. What were you feeling while completing the assignment? b. How do you feel about your score?3. Evaluate a. What are the highs and lows of your experience? b. Were there any factors that influenced the outcome?4. Analyze a. What could I have done differently? b. What did I do that was successful that I will continue to do? c. What did I do that was unsuccessful that I will discontinue?5. Conclusion a. How do I feel about the overall experience? b. What have I learned about my practice? c. How will this experience change my nursing practice? d. Are there any factors in a real life scenario that may be different than this virtual environment that may prevent me from reaching my goal that I can anticipate?_________1Gustafsson, C., and Fagerberg, I. (2004), Reflection, the way to professional development? Journal of Clinical Nursing, 13: 271–280.

https://support.shadowhealth.com


Health HistoryExcerpt from an Excellent Self

ReflectionExcerpt from a Satisfactory

Self ReflectionExcerpt from an Unsat-isfactory Self Reflection

I asked Mrs. Smith about her health history and tried to find more in-formation about her low back pain, cough, and frequent urinary tract infections. OLDCARTS helped guide me through the 7 dimensions of her complaints. I assumed that if I went through OLDCARTS I would capture all of the information, and it seems that it really helped me get a very clear picture of the problem. I asked about her self-care related to her frequent urinary tract infections to get a good idea of what education and care she would need to prevent them. I should have addressed Mrs. Smith’s nutrition plan. This would help her manage her obesity, which is probably contributing to her low back pain. I should have asked Mrs. Smith about the possibility of quitting smoking and about whether she had ever tried to quit (Stead et al., 2008).

When I reviewed my transcript, it became apparent that I kept it purely medical and rarely asked any social or cultural questions. I used Jarvis to ask the subjective questions but didn’t think much about finding much else out. This has been really good for me to remember to think of my patients as people with families and lives as well as medical problems. Citation: Stead, L. F., Bergson, G., & Lancaster, T. (2008). Physician advice for smoking cessation. Co-chrane Database Syst Rev, 2 (2).

This reflection describes the ex-perience. It also describes clinical reasoning and supporting citation. It demonstrates analysis of missed items. It recognizes assumptions and failings, and it addresses how these may be addressed in the future.

Mrs. Smith was a very easy patient to interview. I used OLDCARTS to interview her, and it worked well. I think I really did well. I missed a few things about her diet and personal hygiene, but I won’t forget about these things in the future.

While the student identified areas that should improve, he or she does not make a specific and measurable improvement plan or challenge any of his or her assumptions or practices. The re-flection is incomplete with limited introspection.

I loved this experience!

This is an incomplete re-flection. A deep reflection should explain what about the experience was found to be meaningful and how it can help one become a better nurse. Deep reflec-tions involve practitioners examining and questioning their practices and as-sumptions.


HEENTThe HEENT exam is an interview and physical exam that is concerned with the head, eyes, ears, nose and throat. It is performed when a patient presents with a problem with the HEENT system.

Patient Narrative: In this assignment, your patient, Tina Jones, said that she felt congested. This is an opportunity for you to practice a full HEENT exam on Ms. Jones. This assignment occurs at 8 a.m. on Ms. Jones’ second day in the hospital.

Planning your time:





Getting Started:View this tutorial for guidance on getting started with the HEENT Assignment.

Tips for success:You should prepare prior to entering Ms. Jones’ room. We suggest taking out your textbook to remind yourself of what doing an HEENT assessment entails. There are essential sections of pa-tient information that your interview will need to uncover. There are multiple essential questions for each of these topics: q Medical History pertaining to the HEENT system q Targeted Review of Systems related to the HEENT system q Family History related to the HEENT systemKnow all of your qualifying questions for any symptom that may be reported: q Onset q Location q Duration q Characteristics q Aggravating/alleviating factors q Related symptoms q Treatments tried



https://youtu.be/j7eJ3NJP0kY


RespiratoryThe respiratory exam is an interview and physical assessment that is performed when a patient presents with a respiratory problem or a history that is suggestive of a pathology of the lungs.

Patient Narrative: Because Tina Jones has a history of asthma, you will perform a full respiratory exam on her. This assignment occurs at noon on Ms. Jones’ second day in the hospital.

Planning your time:


• Every assignment setting allows you to stop and resume an assignment until you leave the patient’s room. Your progress is automatically saved every 30 seconds.



Getting Started:View this tutorial for guidance on getting started with the Respiratory Assignment.

Tips for success:You should prepare prior to entering Ms. Jones’ room. We suggest taking out your textbook to remind yourself of what doing a respiratory assessment entails. There are essential sections of patient information that your interview will need to uncover. There are multiple essential ques-tions for each of these topics: q Medical History pertaining to the respiratory system q Targeted Review of Systems related to the respiratory system q Risk factors associated with respiratory disease q Family History related to the respiratory systemKnow all of your qualifying questions for any symptom that may be reported: q Onset q Location q Duration q Characteristics q Aggravating/alleviating factors q Related symptoms q Treatments tried



https://youtu.be/TL94zmuC_qI

http://support.shadowhealth.com.


CardiovascularThe cardiovascular exam is an interview and physical assessment that is performed when a patient presents with symptoms suggestive of a pathology such as chest pain or high blood pressure.

Patient Narrative: Ms. Jones’ attending physician is considering putting her on a medication for her blood pressure. Before the doctor prescribes the medication, you’ll need to conduct a cardiovascular exam. This assignment occurs at 4 p.m. on Ms. Jones’ second day in the hospital.

Planning your time:





Getting Started:View this tutorial for guidance on getting started with the Cardiovascular Assignment.

Tips for success:You should prepare prior to entering Ms. Jones’ room. We suggest taking out your textbook to remind yourself of what doing a cardiovascular assessment entails. There are essential sections of patient information that your interview will need to uncover. There are multiple essential questions for each of these topics: q Medical History pertaining to the cardiovascular system q Targeted Review of Systems related to the cardiovascular system q Risk factors associated with cardiovascular disease q Family History related to the cardiovascular systemKnow all of your qualifying questions for any symptom that may be reported: q Onset q Location q Duration q Characteristics q Aggravating/alleviating factors q Related symptoms q Treatments tried



https://youtu.be/6njGPv7VRWg



AbdominalThe abdominal exam is an interview and physical assessment to pick up on any gastrointestinal pathology that may be causing symptoms such as abdominal pain, distention, or altered bowel habits.

Patient Narrative: Because Ms. Jones has been admitted to Shadow General for almost 24 hours, you will conduct a full gastrointestinal exam and check her intake and output. This assignment occurs at 8 p.m. on Ms. Jones’ second day in the hospital.

Planning your time:





Getting Started:View this tutorial for guidance on getting started with the Abdominal Assignment.

Tips for success:You should prepare prior to entering Ms. Jones’ room. We suggest taking out your textbook to remind yourself of what doing a abdominal assessment entails. There are essential sections of patient information that your interview will need to uncover. There are multiple essential ques-tions for each of these topics: q Medical History pertaining to the abdominal system q Targeted Review of Systems related to the abdominal system q Risk factors associated with abdominal disease q Family History related to the abdominal systemKnow all of your qualifying questions for any symptom that may be reported: q Onset q Location q Duration q Characteristics q Aggravating/alleviating factors q Related symptoms q Treatments tried



https://youtu.be/pSys_sVuCqY



MusculoskeletalThe musculoskeletal exam is an interview and physical assessment that assesses the overall functionality of the muscles and bones.

Patient Narrative: Ms. Jones will be receiving a physical therapy consultation later today. Before the physical therapist arrives, you will conduct a full musculoskeletal system to collect subjective and objective data. This assignment occurs at 8 a.m. on Ms. Jones’ third day in the hospital.

Planning your time:





Getting Started:View this tutorial for guidance on getting started with the Musculoskeletal Assignment.

Tips for success:You should prepare prior to entering Ms. Jones’ room. We suggest taking out your textbook to remind yourself of what doing a musculoskeletal assessment entails. There are essential sec-tions of patient information that your interview will need to uncover. There are multiple essential questions for each of these topics: q Medical History pertaining to the musculoskeletal system q Targeted Review of Systems related to the musculoskeletal system q Risk factors associated with musculoskeletal disease q Family History related to the musculoskeletal systemKnow all of your qualifying questions for any symptom that may be reported: q Onset q Location q Duration q Characteristics q Aggravating/alleviating factors q Related symptoms q Treatments tried



https://youtu.be/It3JMHMMpqA



NeurologicalThe neurologic exam is an interview and physical assessment that assesses the nervous system, which includes the brain and spinal cord.

Patient Narrative: Because Ms. Jones has a history diabetes, you will conduct a complete neurologic exam to collect subjective and objective data to assess her risk for neuropathy. This assignment occurs at noon on Ms. Jones’ third day in the hospital.

Planning your time:





Getting Started:View this tutorial for guidance on getting started with the Neurological Assignment.

Tips for success:You should prepare prior to entering Ms. Jones’ room. We suggest taking out your textbook to remind yourself of what doing a neurologic assessment entails. There are essential sections of patient information that your interview will need to uncover. There are multiple essential ques-tions for each of these topics: q Medical History pertaining to the neurological system q Targeted Review of Systems related to the neurological system q Risk factors associated with neurological disease q Family History related to the neurological systemKnow all of your qualifying questions for any symptom that may be reported: q Onset q Location q Duration q Characteristics q Aggravating/alleviating factors q Related symptoms q Treatments tried



https://youtu.be/MBT9-f3otTs



Skin, Hair, and NailsThe skin, hair, and nails exam is an interview and physical exam that assesses the integumentary system. It is performed when a patient presents with a wound or hair loss, among many other clinical reasons.

Patient Narrative: In preparation for Tina Jones’ discharge from Shadow General, you willassess Ms. Jones’ skin, hair and nails for any additional wounds or signs of impaired healing. This assignment occurs at 4 p.m. on Ms. Jones third day in the hospital.

Planning your time:





Getting Started:View this tutorial for guidance on getting started with the Skin, Hair, and Nails Assignment.

Tips for success:You should prepare prior to entering Ms. Jones’ room. We suggest taking out your textbook to remind yourself of what doing a skin, hair, and nails assessment entails. There are essential sec-tions of patient information that your interview will need to uncover. There are multiple essential questions for each of these topics: q Medical History pertaining to skin, hair, and nails q Targeted Review of Systems related to skin, hair, and nails q Family History related to skin, hair, and nailsKnow all of your qualifying questions for any symptom that may be reported: q Onset q Location q Duration q Characteristics q Aggravating/alleviating factors q Related symptoms q Treatments tried



https://youtu.be/VN0Eza8Zhh4



Focused Exam: CoughPatient Narrative: Daniel “Danny” Rivera is an 8-year-old boy who is sent to the school nurse’s office because he has been coughing. You will act as a school nurse to gather data and decide if Danny is in respiratory distress, and he should be sent home.

Planning your time:





Getting Started:View this tutorial for guidance on getting started with the Focused Exam: Cough Assignment.

Tips for success:You should prepare prior to meeting Danny Rivera in the nurse’s office. We suggest taking out your textbook to remind yourself of what doing a focused, complaint oriented respiratory exam assessment entails. There are essential sections of patient information that your interview will need to uncover. There are multiple essential questions for each of these topics: q History of Present Illness (HPI) q Targeted review of systems related to the HPI Know all of your qualifying questions for any symptom that may be reported: q Onset q Location q Duration q Characteristics q Aggravating/alleviating factors q Related symptoms q Treatments tried


https://youtu.be/XwC8y35SyqI



Focused Exam: Chest PainPatient Narrative: The simulation takes place in a hospital, where Mr. Foster, 58, is on his third day of recovery after a simple open prostatectomy. He has had an uneventful postoperative course so far. When the simulation begins, Mr. Foster has started complaining of chest pain.

Planning your time:





Getting Started:View this tutorial for guidance on getting started with the Focused Exam: Cough Assignment.

Tips for success:You should prepare prior to meeting Brian Foster in his hospital room. We suggest taking out your textbook to remind yourself of what doing a focused, complaint oriented cardiovascular exam assessment entails. There are essential sections of patient information that your interview will need to uncover. There are multiple essential questions for each of these topics: q History of Present Illness (HPI) q Family history related to the cardiovascular system q Targeted review of systems related to the HPI Know all of your qualifying questions for any symptom that may be reported: q Onset q Location q Duration q Characteristics q Aggravating/alleviating factors q Related symptoms q Treatments tried


https://youtu.be/4C2_pZEIAoM



Focused Exam: Abdominal Pain

Patient Narrative: Mrs. Esther Park is a 78-year-old woman who comes to the emergency department complaining of abdominal pain. She reports that the pain isn’t severe, but that her daughter was concerned and brought her in. You will have to decide whether or not the situation an emergency and try to determine the underlying cause of Mrs. Park’s discomfort.

Planning your time:





Getting Started:View this tutorial for guidance on getting started with the Focused Exam: Abdominal Pain.

Tips for success:You should prepare prior to meeting Esther Park in her room in the emergency department. We suggest taking out your textbook to remind yourself of what doing a focused, complaint orient-ed abdominal exam assessment entails. There are essential sections of patient information that your interview will need to uncover. There are multiple essential questions for each of these topics: q History of Present Illness (HPI) q Targeted review of systems related to the HPI Know all of your qualifying questions for any symptom that may be reported: q Onset q Location q Duration q Characteristics q Aggravating/alleviating factors q Related symptoms q Treatments tried


https://youtu.be/DYlUkSqrWjI



Comprehensive AssessmentPatient Narrative: In this assignment, your patient, Tina Jones presents in your outpatient clinic for a pre-employment physical. This visit takes place 6 months after her hospitalization and is a well visit.

Planning your time:





Tips for success:You should prepare prior to entering Ms. Jones’ room. We suggest taking out your textbook to remind yourself of what taking a health history entails. There are essential sections of patient information that your interview will need to uncover. There are multiple essential questions for each of these topics: q Reason for Visit q History of Present Illness q Allergies q Medications q Medical History q Surgical History q Health Maintenance q Family History (3 Generations) q Social History q Mental Health History q General Review of Systems

Know all of your qualifying questions for any symptom that may be reported: q Onset q Location q Duration q Characteristics q Aggravating/alleviating factors q Related symptoms q Treatments tried



health assessment student handbookthis assignment occurs at 8 a.m. on ms. jones’ second day in the...

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