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Health and Illness Across the Lifespan...

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Unguided Intermediate Patient Case Results | Turned In Pharmacology - Remediation/Refresher - January 2021, CCE 705 and 701 Return to Assignment (/assignments/432434/)

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Lab Pass (/assignment_attempts/9682253/lab_pass.pdf)

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Transcript Started: Apr 19, 2021 | Total Time: 100 min Subjective Data Collection All Lines (82)

Interview Questions (59)

Statements (9)

Exam Actions (14)

Objective Data Collection Education & Empathy

Hello!

Question 04/19/21 12:21 AM EDT

QSEN Competencies Documentation Care Plan Reflections

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.

Student Survey

What is the situation?

Question 04/19/21 12:25 AM EDT

Your patient is Edward Carter, a 65-year-old African American man who has been admitted to Shadow General Hospital for back pain, blood in his urine, and increased urinary frequency. In this unguided assignment, your role is that of a practicing nurse. You must decide what data is necessary to gather during the assessment so that you may determine the safety and efficacy of his current and pending medications.

What are my objectives in this assessment?

Question 04/19/21 12:26 AM EDT

In your interview with Edward Carter, you will ask about his past and present medical issues, including general symptoms and any adverse reactions to medications, so that you may better understand his pharmacological needs. You will also inquire into his current status with regards to inputs and outputs (Is and Os) which will help you determine the safety and efficacy of his medications. 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 touch on the health history of Mr. Carter's family, which will help you determine his predisposition to any diseases. Throughout the conversation, you should educate and empathize with Mr. Carter when appropriate to increase his health literacy and sense of well-being. In addition to collecting subjective data during the patient interview, you will perform a physical exam on Mr. Carter to gather objective data about his 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. Subjective Data findings should be listed in the Nursing Admitting Note. You may complete the exam activities in any order and move between them as needed.

What else will this exam involve?

Question 04/19/21 12:32 AM EDT

You will complete nursing tasks to protect the patient's safety, privacy, and health. You will assess the Orders, MAR, and labs in the Electronic Health Record to determine which medications are due. 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. After the exam, you will continue the patient's care using a Care Plan, in which you will select an appropriate diagnosis, plan a healthcare goal and interventions to achieve it, and evaluate your success.

How will I be evaluated?

Question 04/19/21 12:32 AM EDT

In this assignment, you will be evaluated on your Subjective and Objective Data Collection, Education and Empathy, and your Care Plan. Your success in Education and Empathy is based on whether you promptly respond after identifying a moment worthy of therapeutic communication. 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. The evaluation of your Care Plan is based on how successfully you identify the most appropriate diagnosis, select a meaningful healthcare goal, interventions, and data collections, and evaluate the results of your nursing actions. Other activities, such as Documentation, provide valuable practice for their real-world counterparts, but are not automatically evaluated by the simulation. This assignment takes on average 75 to 85 minutes. You can pause and resume the assignment at any time; your work is always saved automatically. Once you've finished your assignment, you will receive feedback developed by the QSEN Institute on how your performance demonstrated your clinical competency in patient safety and quality care. This information is meant to help you improve the quality and safety of your work as a nurse but does not affect your evaluation.

How does this assignment prepare me for the real world?

Question 04/19/21 12:35 AM EDT

In this assignment, you will become familiarized with an assessment of pharmacological needs so that in real-life practice, you can: º Discriminate information from evidence-based medication resources to guide practice and understand implementation of drug therapy º Utilize the nursing process in planning the care of patients/clients receiving various pharmacologic agents to promote, maintain or restore health º Utilize communication principles in the development of patient/client education related to pharmacotherapeutics to promote adherence and safety º Utilize therapeutic communication skills in interaction with patients, colleagues and members of the health care team º Demonstrate the principles of safe medication administration º Reflect on experiences to gain insight on your patient interactions and identify areas for improvement º Demonstrate an understanding of the patient's condition by identifying a diagnosis º Address the patient's diagnosis by planning interventions and data collections, and evaluating your results In 1 or 2 sentences, answer this question to help prepare for the upcoming exam: What factors should you consider when determining the success or failure of a recently taken medication?

Route of the medication used, type of medication

Statement 04/19/21 12:38 AM EDT

Time to begin.

Hello Mr Carter. My name is Emily and i'll be your nurse today.

Greet 04/19/21 12:39 AM EDT

Hello.

How are you doing?

Question 04/19/21 12:39 AM EDT

Right now, the pain has gone down a lot from whatever pain medication they're giving me. I'm pretty worried about how much pain I'll be in passing this stone.

What is your current pain level on a scale of 1 to 10?

Question 04/19/21 12:40 AM EDT

Right now, it's... a 2. Thank God for the medication.

Thats good, hopefully we can get everything figured out and get you feeling better.

Empathize 04/19/21 12:40 AM EDT

I appreciate that. Thanks.

Do you know where we are today?

Question 04/19/21 12:40 AM EDT

I'm at Shadow General Hospital.

Okay perfect. Can you tell me your name and date of birth?

Question 04/19/21 12:41 AM EDT

Edward Carter. January 1 . . . [Mr. Carter reports the correct birth year.]

Okay Mr Carter, so what brings you to the hospital today?

Question 04/19/21 12:41 AM EDT

I had this terrible pain in my back. And this morning I think there was blood in my urine -- it was a pink color. I could tell something serious was going on.

How long have you had these symptoms?

Question 04/19/21 12:42 AM EDT

The pain started three days ago. It was more subtle then, and built up over the past few days.

What does this pain feel like? (Clarified to Can you describe your pain?.)

Question 04/19/21 12:42 AM EDT

Just terrible. Sharp, almost like a shooting pain. Very intense. (Clarified to what the pain is like.)

Where is this pain located?

Question 04/19/21 12:42 AM EDT

In my lower back -- on the left side.

Are you able to go to the restroom? (Clarified to How often do you use the bathroom?.)

Question 04/19/21 12:43 AM EDT

Typically, not that often. But lately I've been urinating what seems like too often -- once an hour? (Clarified to how often I use the bathroom.)

When your back starts hurting, what do you do to relieve this pain?

The pain started three days ago. It was more subtle then, and built up over the past few days.

Question 04/19/21 12:44 AM EDT

How do you treat the back pain? (Clarified to How do you treat your symptoms?.)

Question 04/19/21 12:44 AM EDT

I didn't take anything for the pain at home -- I thought it would pass. Until this morning, that is, when it got unbearable. The pain medication I got in the ER has helped. (Clarified to how I treat my symptoms.)

Are there any aggravating factors of the pain?

Question 04/19/21 12:44 AM EDT

The only pattern I noticed with this pain is that it started out as a slight backache, and gradually got worse until I had to come to the ER. I'm not sure what made it worse -- seems like the kidney stone determined that.

Is it still uncomfortable when you go to the restroom? (No matching questions found.)

Is there anything that makes the pain worse?

Question 04/19/21 12:45 AM EDT

Question 04/19/21 12:46 AM EDT

The only pattern I noticed with this pain is that it started out as a slight backache, and gradually got worse until I had to come to the ER. I'm not sure what made it worse -- seems like the kidney stone determined that.

Urinary comfort?

Question 04/19/21 12:47 AM EDT

The same as usual -- no pain or anything.

What was the last meal you ate?

Question 04/19/21 12:47 AM EDT

It was quiche -- for dinner last night.

How are your normal eating habits?

Question 04/19/21 12:47 AM EDT

I try to eat three square meals a day. I usually have eggs and toast in the morning, a sandwich with cold cuts for lunch, some fruit . . . Dinner is usually baked chicken or fish, though sometimes we have a casserole. I guess the casserole can be a bit rich . . . Over the last 24 hours, how much water have you drank? (Clarified to How much have you drunk in the past 24 hours?.)

Question 04/19/21 12:48 AM EDT

It seems like I've been drinking a lot more water ever since last night, but typically I try to drink at least a few glasses a day. (Clarified to how much I have drunk in the past twentyfour hours.)

Its very important to stay hydrated, especially with these stones.

Educate 04/19/21 12:48 AM EDT

Thanks for letting me know.

Do you have any existing health conditions?

Educate 04/19/21 12:49 AM EDT

I understand that.

Do you have any existing health conditions?

Question 04/19/21 12:49 AM EDT

Yes, I've got a few. I'm diagnosed with chronic kidney disease, and I have some typical old man stuff: high blood pressure, and atrial fib. I notice a little heartburn here and there, too. It's getting to be quite a list.

When were you diagnosed with the chronic kidney disease?

Question 04/19/21 12:49 AM EDT

I was 62 -- I've known about my kidneys for 3 years.

When were you diagnosed with high blood pressure?

Question 04/19/21 12:50 AM EDT

I was 55 -- that was ten years ago.

Tell me about your atrial fibrillation

Question 04/19/21 12:50 AM EDT

Back when I was first experiencing atrial fibrillation, I saw my doctor about it. She diagnosed me and set up my treatment plan.

Do you have any allergies?

Question 04/19/21 12:51 AM EDT

No, I don't have any allergies.

Any medication allergies?

Question 04/19/21 12:51 AM EDT

No.

What medications do you take at home?

Question 04/19/21 12:51 AM EDT

I take several. I have two medications to treat my atrial fib, and I take another for blood pressure. And for over the counter stuff, just the occasional antacid. What are the two medications you take for your Atrial fib? (Clarified to What atrial fibrillation medication do you take?.)

Question 04/19/21 12:52 AM EDT

I take warfarin, and verapamil. (Clarified to what medications I take for my atrial fibrillation.)

With these blood thinners its very important to take them at the same time everyday.

Educate 04/19/21 12:56 AM EDT

OK, I understand. Thank you.

What medication do you take for high blood pressure

Question 04/19/21 12:56 AM EDT

It's called Hyzaar.

When was the last time you took your home medications?

The last time I took any of my regular medications was last night. I usually take most of them in the morning, but I didn't get a chance to yet today.

Question 04/19/21 12:57 AM EDT

Do you take any antacids?

Question 04/19/21 12:57 AM EDT

Yes, I do take antacids when I need them.

What antacids do you take?

Question 04/19/21 12:57 AM EDT

I usually take Tums.

What is your daily fluid intake?

Question 04/19/21 12:58 AM EDT

It seems like I've been drinking a lot more water ever since last night, but typically I try to drink at least a few glasses a day.

Do you stay hydrated?

Question 04/19/21 12:58 AM EDT

I have been drinking a lot more water ever since last night. I've definitely been thirstier.

What is your typical fluid intake and hydration?

Question 04/19/21 12:58 AM EDT

I probably don't drink enough of it to be honest. Maybe a few glasses a day. I just drink if I feel thirsty, which doesn't seem to be that often.

Do you take any recreational drugs?

Question 04/19/21 12:59 AM EDT

No. I never once tried drugs.

What are your usual activities of daily living? (Clarified to Are you able to perform all of your usual daily activities?.)

Question 04/19/21 12:59 AM EDT

I can still do everything I need to do, but I've been just taking it easy, going as slow as possible. (Clarified to if I am able to perform daily activities.)

Have you noticed any elder abuse? (No matching questions found.)

Question 04/19/21 12:59 AM EDT

Have you ever dealt with any elder abuse?

Question 04/19/21 1:00 AM EDT

No; I really don't drink.

Elder abuse?

Question 04/19/21 1:00 AM EDT

I've never been abused in any way.

Can you tell me about your family history?

Oh, I guess a few folks had some problems . . I'm not sure what you're looking for exactly though.

Question 04/19/21 1:01 AM EDT

Family issues with kidney issues?

Question 04/19/21 1:01 AM EDT

Yes - this kidney stone is awful!

Do you have any family members with high blood pressure?

Question 04/19/21 1:01 AM EDT

Now that's something I know my mother and father both had.

Any constitutional health history? (Clarified to Do you have constitutional health?.)

Question 04/19/21 1:04 AM EDT

I'm not quite sure what you're getting at. [AUDIO COMING SOON] (Clarified to if I have constitutional health.)

How is your constitutional health?

Question 04/19/21 1:04 AM EDT

Oh, I think my health is pretty good for a guy my age. I have some diagnosed problems, but I follow the doctor's orders and live a healthy life.

Have you ever had any neurological side effects from your hydromorphone?

Question 04/19/21 1:05 AM EDT

Neurological problems? No, I don't think so.

Have you had any EENT problems from your hydromorphone? (No matching questions found.)

Have you had any EENT problems ? (No matching questions found.)

Question 04/19/21 1:05 AM EDT

Question 04/19/21 1:05 AM EDT

Have you had any ears, nose or throat side effects from your hydromorphone ? (No matching questions found.)

04/19/21 1:06 AM EDT

Have you had any nose or throat side effects from your hydromorphone ? (No matching questions found.)

04/19/21 1:06 AM EDT

Have you had any respiratory side effects from your hydromorphone ? (Clarified to Are you experiencing any side effects with the dilaudid?.)

Question 04/19/21 1:07 AM EDT

Question

Question

I'm not sure what I should be looking for, but I don't think I've had any side effects. (Clarified to if I am experiencing side effects from the hydromorphone.)

How have you noticed any side effects with your Tamsulosin? (No matching questions found.)

Are you experiencing any side effects with your Tamsulosin? (No matching questions found.)

Have you ever taken the drug Tamsulosin before?

Question 04/19/21 1:08 AM EDT

Question 04/19/21 1:09 AM EDT

Question 04/19/21 1:10 AM EDT

No, to my knowledge I've never taken that.

Okay i am going to take your vitals now.

Question 04/19/21 1:10 AM EDT

Do whatever you need to do.

Assessed vitals

Assessed IV bag

Assessed IV pump

Assessed IV site: Dressing dry and intact

Exam Action 04/19/21 1:10 AM EDT

Exam Action 04/19/21 1:13 AM EDT

Exam Action 04/19/21 1:14 AM EDT

Exam Action 04/19/21 1:39 AM EDT

Inspected mouth: Gums moist and pink

Exam Action 04/19/21 1:40 AM EDT

Inspected skin turgor

Exam Action 04/19/21 1:40 AM EDT

Inspected front of legs for edema

Inspected left leg for edema

Inspected right leg for edema

Exam Action 04/19/21 1:40 AM EDT

Exam Action 04/19/21 1:40 AM EDT

Exam Action 04/19/21 1:40 AM EDT

Auscultated breath sounds

Exam Action 04/19/21 1:40 AM EDT

Auscultated heart sounds

Exam Action 04/19/21 1:40 AM EDT

Assessed urine quality: Clear, pink or amber in color

Checked hat

Strained urine for passed kidney stones

Hello Mr Carter, with you having increased urination, blood in your urine, and impaired urinary elimination, this could be due to your kidney stones. Normally with kidney stones they can effect the color of your urine and also the frequency of how often you go.

Exam Action 04/19/21 1:40 AM EDT

Exam Action 04/19/21 1:40 AM EDT

Exam Action 04/19/21 1:40 AM EDT

Educate 04/19/21 2:01 AM EDT

That makes sense.

So what we plan to do is administer a medication called Tamsulosin every morning. While taking thi...