May 30, | nursing, med, NURS, Paper
Gabriel Martinez Asthma Exacerbation Shadow health Transcript
Gabriel Martinez Asthma Exacerbation Shadow health Transcript
Transcript
Started: Jan 23, 2021 | Total Time: 185 min
All Lines (135)Interview Questions (76)Statements (29)Exam Actions (30)
Begin by confirming the patient’s name and date of birth. Which of the following is the most appropriate way to do so?
Hello. I’ll be taking care of you tonight. Can you tell me your name and when you were born?
Question
01/23/21 6:33 PM PST
Hey . . . Gabriel . . . I’m 8 . . .”
His name is Gabriel Martinez. Gabriel is 8. Gabriel Martinez Asthma Exacerbation Shadow health Transcript
You should also confirm Ms. Martinez’s relationship with Gabriel. Which of the following questions is the most appropriate way to do so?
Hello. Are you Gabriel’s guardian?
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Question
01/23/21 6:34 PM PST
Yes. I’m his mother.
Which of the following actions should you perform first?
I want to interview the patient and guardian to establish Chief Complaint.
Question
01/23/21 6:37 PM PST
What brings you in today?
Question
01/23/21 6:38 PM PST
It’s really hard to breathe . . . I have asthma . . .
Yes, my son started having difficulty breathing after school today. It’s been about 4 hours or so.
What should you do next?
Now that I have established Gabriel’s chief complaint, I need to take his vitals and conduct a pediatric asthma severity (PAS) score to better understand the severity of the patient’s condition.
Question
01/23/21 6:39 PM PST
Perform all of the following assesments and record the vitals in your EHR. Use the PAS Score tab in the EHR to calculate Gabriel’s total score and choose the appropriate exacerbation severity for Assessed PAS – PreIntervention in the Objective Data tab. Gabriel Martinez Asthma Exacerbation Shadow health Transcript
Auscultated breath sounds: expiratory and inspiratory wheezing
Exam Action
01/23/21 6:40 PM PST
Select your next course of action.
Inpected chest: Mild intercostal retractions visible
Exam Action
01/23/21 6:43 PM PST
Select your next course of action.
You observe so far during the assessment that Gabriel is speaking in partial sentences before having to take a breath.
Exam Action
01/23/21 6:44 PM PST
Select your next course of action.
Assessed vitals
Exam Action
01/23/21 6:45 PM PST
Select your next course of action.
Now choose the corresponding severity description under Assessed PAS-PreIntervention in the Objective Data tab.
You now know the patient’s chief complaint, and you have collected his vitals and determined a PAS score. What should you do next?
Now that I have determined Gabriel’s chief complaint, vitals, and PAS score, I have enough information to initiate the Asthma Exacerbation Protocol and finally relieve Gabriel’s respiratory distress.
Question
01/23/21 7:14 PM PST
Unfortunately, you have not collected enough information about Gabriel’s condition to initiate a protocol at this time.
You have not selected the most critical and necessary action. The incorrect response you selected has been removed. Try again with the remaining responses.
You now know the patient’s chief complaint, and you have collected his vitals and determined a PAS score. What should you do next?
I want to get a spirometer reading to confirm my findings so far. Gabriel Martinez Asthma Exacerbation Shadow health Transcript
Question
01/23/21 7:14 PM PST
I did one before we came in.
Your second choice is not the most critical and necessary action, either. The incorrect responses you have selected have been removed. Select the correct response, and you will move on to the next question.
You now know the patient’s chief complaint, and you have collected his vitals and determined a PAS score. What should you do next?
I want to ask about allergies to medication.
Question
01/23/21 7:15 PM PST
No, he doesn’t have medicine allergies.
You’ve determined the patient’s chief complaint, collected vitals and a PAS score, and inquired about medicine allergies. What should you do next?
In order to rule out additional respiratory complications, I need to ask a handful of key history of present illness questions.
Question
01/23/21 7:15 PM PST
At this stage you have collected the necessary and critical information to safely initiate the asthma exacerbation protocol. Any other assessments or tests are unnecessary at this time.
You have not selected the most critical and necessary action. The incorrect response you selected has been removed. Try again with the remaining responses.
You’ve determined the patient’s chief complaint, collected vitals and a PAS score, and inquired about medicine allergies. What should you do next?
I want to inform the patient and his guardian that I have determined that Gabriel is experiencing a moderate asthma exacerbation and am ready to begin treatment. I will ask them if they have any questions or anything else they’d like to tell me before I order the initiation of the Shadowville General Hospital Asthma Exacerbation Protocol. Gabriel Martinez Asthma Exacerbation Shadow health Transcript
Question
01/23/21 7:16 PM PST
No. No questions, thank you.
Your assessment of Gabriel has determined he is currently experiencing a moderate asthma exacerbation. Your protocol order is approved and you administer albuterol via nebulizer and prednisone orally.
Hello Gabriel, I am Nurse xxxx and I will be interviewing you and later perform a physical assessment
Greet
01/23/21 7:23 PM PST
Hey.
How are you feeling?
Question
01/23/21 7:24 PM PST
I feel better now . . . I can definitely breathe better, but my chest is kinda sore.
Sorry about your chest being sore
Empathize
01/23/21 7:25 PM PST
Everyone is really nice here. Thank you very very very much!
How does your chest feel?
Question
01/23/21 7:26 PM PST
My chest doesn’t feel as tight now. It’s still a little sore though. Gabriel Martinez Asthma Exacerbation Shadow health Transcript
Do you feel any wheezing?
Question
01/23/21 7:26 PM PST
My breath was squeaky earlier, but I can’t hear it anymore.
Okay, got it
Empathize
01/23/21 7:26 PM PST
Thanks, that makes me feel better.
When did the breathing problem start?
Question
01/23/21 7:27 PM PST
My attack started after kickball . . . and it got worse and worse when we got home.
Sorry about that Gabriel
Empathize
01/23/21 7:27 PM PST
Oh wow, thanks.
What worsens the breathing problem?
Question
01/23/21 7:27 PM PST
Ummmm smokers. Smoke makes my breathing a lot worse.
Sorry about that
Empathize
01/23/21 7:28 PM PST
Ok, thanks.
Are you normally around smoke?
Question
01/23/21 7:28 PM PST
I try to stay away from it. But these new kids were smoking by the kickball field after school today.
It is good to stay away from anyone smoking
Educate
01/23/21 7:29 PM PST
I guess that makes sense.
What triggers your asthma?
Question
01/23/21 7:29 PM PST
Smoke bothers me a lot. I try to stay away from it. But today some kids I’ve never seen before were smoking at my afterschool program.
What action did you take after the asthma attacK
Question
01/23/21 7:30 PM PST
Well I . . . I guess I’m supposed to take my emergency inhaler, but . . . I threw it away. So we don’t have it anymore.
Ooh, you should always ensure you have the inhaler at a safe and accessible place
Educate
01/23/21 7:31 PM PST
Ohhh, yeah. Good . . . to . . . know.
What is the name of the inhaler you were using?
Question
01/23/21 7:31 PM PST
I dunno. I think my mom does.
Why did you throw away the inhaler?
Question
01/23/21 7:32 PM PST
I hate the way that inhaler makes me all . . . shaky. It makes my heart beat too fast. That’s why, when my mom told me to clean out my backpack, I threw it in the trash.
Sometimes I give him an over the counter antihistamine, when his allergies are bad or the pollen count is high.
What are some of your son’s allergies? (No matching questions found.)
Question
01/23/21 8:09 PM PST
alleges? (No matching questions found.) Gabriel Martinez Asthma Exacerbation Shadow health Transcript
Question
01/23/21 8:09 PM PST
Any allergies?
Question
01/23/21 8:09 PM PST
I don’t, no. Just my son does. [AUDIO COMING SOON]
What allergies does your son have?
Question
01/23/21 8:10 PM PST
Pets, dust, pollen. He’s not allergic to any of the other obvious stuff. No food or medicine or latex or anything.
How does your son’s environmental allergies impact his asthma?
Question
01/23/21 8:11 PM PST
Gabriel’s allergies always make his asthma worse. I can and do keep dust and dander out of the house, but pollen is a different story. The last time he had trouble with his asthma like this was during pollen season.
It is always good to keep the allergy triggers away
Educate
01/23/21 8:12 PM PST
Yeah . . . Yeah, I get it. We’ll work on that.
Has your son been hospitalized before?
Question
01/23/21 8:13 PM PST
Yes, he went to the hospital a year ago, because of his asthma.
Sorry about that. Being hospitalized can really take a toll on any parent Gabriel Martinez Asthma Exacerbation Shadow health Transcript
Empathize
01/23/21 8:14 PM PST
Thank you for saying that.
Why was your son last hospitalized?
Question
01/23/21 8:14 PM PST
He was hospitalized last year because of his asthma. The night before, he was around some smoke — cigarette smoke, and maybe smoke from fireworks . . . We tried his rescue inhaler at home, but it wasn’t working, so I brought him to the ER. Kind of similar to this time, actually.
Sorry about that ordeal.
Empathize
01/23/21 8:15 PM PST
Thank you. I’m . . . I’m just doing the best I can.
Please let him always keep away from triggers such as smoke
Educate
01/23/21 8:16 PM PST
Alright, I understand.
How does exercise impact your son’s asthma?
Question
01/23/21 8:16 PM PST
Too much exercise could trigger an asthma attack. He knows the rules. He can walk, but he isn’t supposed to run.
Does anyone in your family use tobacco?
Question
01/23/21 8:17 PM PST
No, none of us do.
That is great. Smoking is really bad for health, especially in people with respiratory problems such as asthma
Educate
01/23/21 8:18 PM PST
That makes a lot of sense, thank you.
What is your childcare situation?
Question
01/23/21 8:18 PM PST
I work 55 hours a week. Gabriel goes to after-school clubs, so I pick him up around 5:30. He’s really close to my parents, so sometimes on the weekends he spends the night with his Lito and Lita. Gabriel Martinez Asthma Exacerbation Shadow health Transcript
Raising a child alone is really challenging. I know you are a great parent. Even Gabriel really appreciates you. But I am aware being a single parent can be difficult. You are really doing a great job by taking care of your son alone
Empathize
01/23/21 8:22 PM PST
Thank you for saying that.
What is your childcare situation?
Question
01/23/21 8:23 PM PST
I work 55 hours a week. Gabriel goes to after-school clubs, so I pick him up around 5:30. He’s really close to my parents, so sometimes on the weekends he spends the night with his Lito and Lita.
What health problems run in your family?
Question
01/23/21 8:23 PM PST
There’s nothing like asthma in the family. But my father has heart disease and my brother has diabetes.
Sorry about your father and brother’s conditions.
Empathize
01/23/21 8:24 PM PST
Thank you. I’m . . . I’m just doing the best I can.
Also sorry about your son’s asthma. He will get better.
Empathize
01/23/21 8:24 PM PST
Thanks, I appreciate that.
Checked ID band
Exam Action
01/23/21 8:27 PM PST
Assessed vitals
Exam Action
01/23/21 8:27 PM PST
Auscultated top right chest breath sounds: normal breathing
Exam Action
01/23/21 11:10 PM PST
Auscultated top left chest breath sounds: normal breathing
Exam Action
01/23/21 11:10 PM PST
Auscultated upper right chest breath sounds: normal breathing
Exam Action
01/23/21 11:10 PM PST
Auscultated upper left chest breath sounds: normal breathing
Exam Action
01/23/21 11:10 PM PST
Auscultated lower right chest breath sounds: normal breathing
Exam Action
01/23/21 11:10 PM PST
Auscultated lower left chest breath sounds: normal breathing
Exam Action
01/23/21 11:10 PM PST
Auscultated top left back breath sounds: normal breathing
Exam Action
01/23/21 11:10 PM PST
Auscultated top right back breath sounds: normal breathing
Exam Action
01/23/21 11:10 PM PST
Auscultated upper left back breath sounds: normal breathing
Exam Action
01/23/21 11:11 PM PST
Auscultated upper right back breath sounds: normal breathing
Exam Action
01/23/21 11:11 PM PST
Auscultated lower left back breath sounds: normal breathing
Exam Action
01/23/21 11:11 PM PST
Auscultated lower right back breath sounds: normal breathing
Gabriel Martinez Asthma Exacerbation Shadow health Transcript
Exam Action
01/23/21 11:11 PM PST
Auscultated lower left chest breath sounds: normal breathing
Exam Action
01/23/21 11:11 PM PST
Auscultated lower right chest breath sounds: normal breathing
Exam Action
01/23/21 11:11 PM PST
Auscultated upper right chest breath sounds: normal breathing
Exam Action
01/23/21 11:11 PM PST
Auscultated upper left chest breath sounds: normal breathing
Exam Action
01/23/21 11:11 PM PST
Auscultated top left chest breath sounds: normal breathing
Exam Action
01/23/21 11:11 PM PST
Auscultated top right chest breath sounds: normal breathing
Exam Action
01/23/21 11:11 PM PST
No abnormal findings
Exam Action
01/23/21 11:11 PM PST
Assessed dyspnea
Exam Action
01/23/21 11:13 PM PST
PAS Score: determine the PAS Score using the EHR tab
Exam Action
01/23/21 11:19 PM PST
Assessed growth
Exam Action
01/23/21 11:21 PM PST
Assessed vitals Gabriel Martinez Asthma Exacerbation Shadow health Transcript
Exam Action
01/23/21 11:23 PM PST
May 30, | nursing, med, NURS, Paper
Evidence Based Practice Paper – Cardiovascular Diseases Essay
Evidence Based Practice Paper – Cardiovascular Diseases Essay
Introduction
The primary assessment of patients is an essential part of clinical care. It is advised that interventions options are discussed with the patient to reduce the risk incidences of the cardiovascular diseases and probable risk of other illnesses (diabetes). With knowledge of the combined risk factors, both the nurse and patient work to effective prevention and care of the cardiovascular disease. Upon concurrence, choices about lifestyle, diet and exercises can be initiated.Family history is an important aspect when evaluating early risk for cardiovascular disease. The danger of early onset is common among persons whose relatives are affected (Alberti, &Zimmet, 2006).
Plan of the Study
David’s age of 56 years is a concern because research shows that individuals whose families develop cardiovascular conditions before attaining 60 of age years are at more risk of early onset of heart-related conditions(Alberti, &Zimmet, 2006). The early start is worsened by David’s social behavior associated with alcohol intake.
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The clinical assessment approach is recommendable for individuals with the higher risk factor as this will help David in preventing further risks exposures. An apt lifestyle adjustments like the diet, body exercise and diabetic control is extensively discussed with the patient. Though David’s history indicates earlier family exposure to the heart condition, it is prudent to share that information as it will form guidance in knowing the level of exposure and age risk factors. Family risk factors identifiable are diabetes and coronary heart diseases for years below 65years among others. Besides other posing risk factors, the individual’s personal history is necessary to establish precipitants to cardiovascular-related conditions.
The assessment is varied and includes evaluation of factors such as smoking habits and alcohol use, gestational diabetes, blood pressure levels and the heart beat (Szabov, 2012). Combined personal questions, laboratory examinations and physical assessments help in the diagnosis and critical care in David’s case. It is practical to correlate readings for blood pressure and non-fasting or fasting glucose logged during the previous years so as to compare with the ones during a visit. Evidence Based Practice Paper – Cardiovascular Diseases Essay.
Absolute risk defines the individual chance of acquiring cardiovascular disease (diabetes, stroke and arterial diseases). In most cases, the symptoms are not very definite hence it is advisable to perform a routine test to ascertain the risk level and appreciate the available preventive measures that can improve individual’s body health. David’s case seems to present early symptoms, and initiation of a screening test and practical precautions is highly preferred.
A higher variance depicts greater risk level and should be taken seriously with respect to the presenting symptoms. Frequent tests can be advised for David so as to check severity and progress, however, those who present higher risks need to be reassessed soon and as often as it is practicable (Braun, 2006). The care clinical nurse may have an interactive talk about his/her risk evaluations with the patient and discuss the risk level as this will help David benefit from an improved change in lifestyle.
Considering the condition of David’s wife and the underlying responsibility he is likely to develop elevated pressure due to stress. Counseling is critical to bringing back hope and understanding of the situation at hand. The recommendations to avoid strenuous activities and to quit alcohol permanently are practices that will help David in managing both the pressure levels and diabetes.
Case StudyAnalysis
The chest tightness with sweating in David’s case is an indication of the advancement of a heart condition. Occasionally the heart attacks appear to be impulse and severe, but in a majority of instances, it starts out to be slow with moderate discomfort especially during strenuous exercise as in David’s case. The chest pain is related to coronary heart attack. The symptoms normally presented take the distinct form of uncomfortable pressure, ‘jamming’ and pain of the muscles (Braun, 2006).
Regarding David’s case as narrated and observed during a face to face encounter with a clinician, it is advisable to undertake the following medical tests into consideration. Laboratory tests of the lipids and cholesterol (both HDL and LDL). These are used when calculating the ratios in cardiovascular risk assessment (CVDRA). The aggregate cholesterol and high-density lipoprotein (HDL) ratio measured is usually more sensitive to cardiovascular disease when compared to the total cholesterol (TC). During calculations, the total HDL and low-density lipid (LDL) in the blood are summed together to aggregate the overall quantity of cholesterol in the body.
It is therefore, signifies that low levels of HDL accounts for higher levels of LDL. While ratios above 10 are considered to be precipitants of risk factors, the levels of HDL should be maintained to 2.5 and below (Hoffmann, 2003). Though other complications may be necessitous to manage, David’s condition requires screening of the arterial vessels because he probably may have developed a coronary heart disease. David’s pain while exercising can be a potential sign of coronary heart disease in the absence of initial tests as his family history also indicate that the father was a victim of the cardiovascular ailment.
Interestingly not all chest pains can lead to coronary heart disease (CHD). Other conditions that can cause pain may be due to blocking of the arterial vessels in the lung, panic attack, infections of the arteries and inflammations in the vessels and the surrounding tissues of the heart.
The anatomy of the heart comprises of arteries that handle the supply of oxygenated blood to the heart. When plaque in the form of a blockade builds up along the arteries, it compromises the flow of the blood. A medical condition called atherosclerosis ensues over time leading to narrowing of the arteries and thus reducing the flow of oxygenated blood into the vessels.
A heart attack is experienced when the flow of oxygenated blood to a section of heart muscle is not sufficient for the body’s use. This leads to serious health issues that can result in early death (Couzin, 2007). Heart failure and arrhythmias are health problems that are frequently associated with heart failure. In David’s case, it is important to record the rate and rhythm of the heartbeat. Abnormal rates and rhythm signify failure in the arterial vessels.
When the arterial endothelium comes into contact with bacterial infections and other risk substances (alcohol) as in David’s case, they increase the adhesion of molecules promoting the flow of blood to the inner arterial walls. Such an interaction triggers the chemoattractants cytokines and leads to clumping of these substances within the endothelium, thereby causing atherosclerosis. Protein mediators also cause inflammation of the endothelium.
Due to a higher prevalence of coronary artery disease (CAD), it presents mixed onset in both young and old populations, therefore, the need to screen those who are at increased risk. Technological advances in the use of the noninvasive imaging techniques of CT and MRI, however, make it possible to view the heart while in both static and motion (Hoffmann, 2003). An evaluation can be done without the need of using invasive methods. This helps in identifying the exact region of the artery that is blocked. Early diagnosis and medical care of coronary artery disease contribute to limit its effect on other tissue parts.
The risk of contracting cardiovascular medical conditions depends on many risk factors including the family history and precipitants (use of alcohol) that may aggravate the condition (Szabov, 2012). For example individuals with family history of cardiac conditions and are habitual abusers of drugs (cigarettes and alcohol) are more prone to higher chances of cardiac arrests. These individuals are advised to undergo noninvasive calcium screening so as to assist in preventive care (Hoffmann, 2003).
David’s case is of interest and calcium screening (CT scan) is relevant in preventing further escalation. It is advisable for him to stop the use of alcohol. This high-risk profile can be managed by the early start of preventive therapy.However, it is necessary to test so as to reduce the customary risk factors through improved diet, body exercise, and alcohol intake cessation. All these should be aimed at improving cardiovascular health.
David’s case requires early determination of what characterizes the endothelium lesions of his coronary artery. Noninvasive CT scan technique is used to obtain information such as the presence of a disease within the arterial vessels. In as much as it is advisable to go for a CT scan to determine the level of coronary artery calcification, its significance still lies on the blocking of the arterial endothelium (Couzin, 2007). Features such as the structure (size shape and configuration) with absolutely no motion of the arteries can be visualized and quantified. The CT scan technique serves ideally for David because it’s relatively simple and suitable for administering. The whole process takes about thirty minutes with minimal preparation and limited restrictions to medications before or after a test.
Determination of calcification in the endothelium is essentially used to interpret presence and absence of calcium in the coronary arteries. Traces of calcium follows its presence in the coronary artery thereby destructive as it results in heart diseases. The Subclinical Coronary Artery Disease occurs when calcification is detected when no apparent symptoms are evident. A test is considered to be positive if calcification is detected within the coronary arteries.
The scores obtained are used to categorize the extent of calcification as minimal, moderate or extensive in individuals. These scores usually numbered 10, 11 to 99, and 100 to above 400 indicate the amount of atherosclerosis. A positive test is considered when calcification is identified within the coronary arteries and negative when there is an absence of calcification. Evidence Based Practice Paper – Cardiovascular Diseases Essay.
Though this result might not project the early onset of the disease it guides a clinical care for heart condition patients (Hoffmann, 2003). A positive test commonly indicated in men of 55 years and above is detectable within the score ranges and indicates risk of myocardial infarction even when there are little or no symptoms. David’s condition is probably of a myocardial infarction in the early stages. A negative test, however, does not signify an absence of atherosclerosis in the coronary arteries.
Management of David’s (case study) Condition.
Although there is no known cure for coronary heart disease, (CHD) various interventions are used to help in the management of symptoms so as to reduce the associated risks. The known combined approach to coronary heart disease includes surgery medicine and modification of various lifestyle habits. All these combinations are integral for reducing the symptoms while improving the functioning of the heart; however, some treatments have their disadvantages. The lifestyle habits that can help David manage his cardiovascular condition hence reduce future risk include quitting alcohol use, eating healthy diets and performing regular exercises (Usherwood, 2013).
Foods that are likely to increase the level of cholesterol in the blood should be avoided. Foods that have high amounts of saturated fat (cholesterol) include meat pies, sausages, and cheese. Diets that trigger diabetes are also advisable to be avoided as this may lead to alteration of the levels of sugar in the body (Duprez, 2011). Counseling of the individual on how to live a healthy lifestyle is an equally important element in managing cardiovascular disease. A lot of stress is also associated with elevated blood pressure that might cause cardiac arrest.
Conclusion.
In summation, early diagnosis is very crucial in the management of cardiovascular diseases. Risk factors such as substance abuse and family history are crucial information needed while assessing an individual. While pharmacological therapy is not yet clear, other methods of intervention are proving to be more reliable forms of improving health in such cardiovascular conditions.
The overall responsibility lies with an individual right from the point of seeking medical help to the available options for managing the disease and reducing its associated risk factors. It is, therefore, advisable to visit a medical doctor to help in checking the early indicators of the illness and practice on how to reduce and manage cardiovascular heart conditions.
References:
Alberti, K., &Zimmet, P. (2006).Metabolic Syndrome.Metabolic Syndrome and Cardiovascular Disease Epidemiology, Assessment, and Management, 1-15
Braun, L. (2006). Cardiovascular Disease.The Journal of Cardiovascular Nursing, S20-S42
Couzin, J. (2007). DRUG SAFETY: Heart Attack Risk Overshadows a Popular Diabetes Therapy. Science, 1550-1551.
Duprez, D. (2011). Prevention of Coronary Artery Disease.Coronary Heart Disease, 497-508.
Hoffmann, U. (2003). Use of New Imaging Techniques to Screen for Coronary Artery Disease.Circulation. Evidence Based Practice Paper – Cardiovascular Diseases Essay.
Szabov, E. (2012). Individualized Cardiovascular Risk Assessment.Coronary Artery Disease – New Insights and Novel Approaches.
Usherwood, T. (2013). National guidelines for the management of absolute cardiovascular disease risk. Med J AustThe Medical Journal of Australia, 243-244.
Evidence Based Practice Paper – Cardiovascular Diseases Essay
