tina jones comprehensive assessment quizlet
37 C. Patient is in no apparent distress. mucosa moist and pink, septum midline. occasional shortness of breath, wheezing, and chest Tina Jones comes into the clinic for a general physical exam. Poppa died of a heart attack when he was 80. . NRS Week 4: Comprehensive Assessment Tina Jones NRS 434 Shadow Health: Comprehensive Assessment ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT NRS 434 Shadow Health: Comprehensive Assessment Complete the Comprehensive Assessment on the Shadow Health platform. Diagnosed with asthma at 2 1/2 years DIagnosed with diabetes at age 24 years Last asthma exacerbation 3 months ago Diagnosed with PCOS four months ago and take Yaz Has a history of hypertension Comprehensive Assessment Tina Jones Shadow Health Transcript, Subjective, Objective & Documentation. About Press Copyright Contact us Creators Advertise Developers Terms Privacy Policy & Safety How YouTube works Test new features Press Copyright Contact us Creators . She drinks four caffeinated drinks/day (diet soda). What is your relationship like with your family? Scrape on foot. appropriately for the weather with good hygiene. The following actions reveal the objective data of the patients case. Askedaboutcurrentnon-prescriptionmedications. Able to perform repetitive alternating movements, finger to nose smooth, able to run heel down shin with no deviation. prescribed oral contraceptives at that visit, which she Ms. Jones appears alert and oritented She is appropriately dressed She appears to be in good health. Genitourinary: Denies flank pain, dysuria, urgency, and cloudy urine. American woman who presents for pre-employment Patient states there is relief when foot is elevated, not walking on it. A comprehensive assessment of Ms. Jones will be performed, and key findings will be determined. app.shadowhealth/assignment_attempts/4562098 7/. Advanced health assessment and clinical diagnosis in primary care (4th ed.). She is a good historian. About healthy people. Pro Tip: Tinas response to a question about managing her diabetes will reveal the severity of her symptoms, her health literacy, and the way shes complied with previous treatment plans. Offers information without hesitation. Patient does have slight anxiety, congruent with sticks or an apple. That is great. At that time, she was diagnosed with polycystic ovarian syndrome (PCOS) for which she was prescribed the oral contraceptive Yaz. "I came in because I'm required to have a recent Eyes are placed Case - Tina jones subjective heent | completed | shadow health 2 4. Shadow Health Comprehensive Assessment Tina Jones -Documentation /Electronic Health Record. Flashcards. She has glasses following a vision exam. 1. Indicatesanitemthatisavailabletobefound. Patient denies any Vision change, good start I havent smoked pot since I was twenty or twenty-one. healthliteracy,andcurrenttreatmentplans. ), No, I dont think so. Retinopathy is caused by her diabetes as well and mild symptoms indicate the early stage of the disease. Shadow Health - Comprehensive Assessment: Tina Jones Flashcards | Quizlet Shadow Health - Comprehensive Assessment: Tina Jones Term 1 / 7 Current Health Status Click the card to flip Definition 1 / 7 Click the card to flip Flashcards Learn Test Match Created by Cate_Howe Terms in this set (7) Current Health Status . What is your new job? No recent foreign Palpated fremitus equal bilaterally. She states that family and church help her cope with frequencyanddurationofherpalpitationsrecentlywillallowyoutoassesstherecent treatmentplans. She seems to be doing okay though. Reports recommended dose is 1-3 puffs as needed. She has no medication side effects at this time. She has no Metformin: Started five months ago. Im sleeping a lot better now, which is a relief. This strong support system helps to ease her stress and anxiety by providing a sounding board. no other hair or nail changes. She is well-nourished, well-developed, and dressed . Gag reflex present, swallows without difficulty. Grand Canyon University (75) What is the name of your diabetes medication? she'sseenhervisionassomethingthathasneededmedicalattention. appropriately with good hygiene. Reportsthateatingprobioticyogurthelpswithsideeffectsandtheyhaveabatedover Neurological. I havent had a full asthma attack in years, though. Buy best Assignments with zero plagiarism. on face and facial hair on upper lip. Lived independently Never married, no children. (Clarified to Does your younger sister have health problems?. Ear canal pink, tympanic membrane pearly gray, no drainage. AskingTinaifshe'shada ProTip:Themedicationapatienttakesindicatestheirhealthliteracy,treatmentplan, problems, changes in taste, dry mouth, pain, sores, Denies adverse effects of asthma medication. Reports no dizziness, light-headedness, tingling, Her last asthma exacerbation was three months ago, which she resolved with her inhaler. No current complaints or recent illness. Typical AskingTinawhenshelastusedherinhalerwillindicatewhenher Asking Tina why she started taking birth control will allow Tina to express any concerns or problems in her own words. No, Im actually feeling really good these days. NY Times Paywall - Case Analysis with questions and their answers. Tina jones comprehensive questions to ask, Copyright 2023 StudeerSnel B.V., Keizersgracht 424, 1016 GC Amsterdam, KVK: 56829787, BTW: NL852321363B01, Psychology (David G. Myers; C. Nathan DeWall), Principles of Environmental Science (William P. Cunningham; Mary Ann Cunningham), Brunner and Suddarth's Textbook of Medical-Surgical Nursing (Janice L. Hinkle; Kerry H. Cheever), Business Law: Text and Cases (Kenneth W. Clarkson; Roger LeRoy Miller; Frank B. ProTip:Themedicationapatienttakesindicatestheirhealthliteracy,treatmentplan, Occasional cannabis use from age 15 to age 21. Ms. Jones reports no muscle pain or weakness. Asking if Tinas been using her inhaler more frequently since exacerbation can indicate how shes been treating her symptoms since exacerbation. andaccesstohealthcare. Her last general physical exam was five months ago when she was prescribed metformin for her diabetes and a daily inhaler for her asthma. . Ive maybe used it twice since I came in with those asthma problems. Pro Tip: Follow up questions about Tinas medication history will help you to understand her treatment plan and recent health history. reports no change in sense of smell sneezing for Reports no general mouth Skin on neck has stopped darkening She states that she feels healthy, is taking better care of herself than in the past, and is looking forward to beginning the new job. No ptosis or edema noted. roasted vegetables and a protein, snack is carrot Thorough examinations will yield better patient data. 2 hours ago Study with Quizlet and memorize flashcards containing terms like Current Health Status, , and more. The last visit to the clinic was four months ago for an annual gynecological exam. the examination table, and is in no apparent distress. factsofthepatient'scase. changes, or swollen nodes. By visualizing the fundus, you can look for any retinopathic changes. Reports decreased stress and improved coping Ms. Jones is alert and oriented, seated upright on the examination table, and is in no apparent distress. Asthma is a lung condition that affects people of all ages. Acanthosis nigricans. new job. Tina reports she has improved her diet by limiting carbohydrates, staying away from sweets and increasing vegetable consumption. She is now on metformin, Proventil, and Flovent. Comprehensive Physical Assessment of Tina Jones in Shadow Health Decreased sensation to Pro Tip: Healthy kidneys are not usually palpable. Comprehensive Assessment Tina Jones Shadow Health Transcript, Subjective, Objective & Documentation. (2018). No tobacco. Haveyoumissedanydaysofyourbirthcontrolpill? Diabetes increases the risk of cardiovascular disease and doubles the risk of dying from it. Snellen: 20/20 right Distal symmetric sensorimotor polyneuropathy is the most common type and due to Ms. Jones being asymptomatic, is most likely (Bickley & Szilagyi, 2013). Allergic to penicillin, and also allergic to cats. I will be conducting an interview and later perform a physical exam. . Ms. Jones has already begun treating her diabetes, but early treatment has not been established to improve cardiovascular outcomes (Bickley & Szilagyi, 2013). Cannabis use from age 15 to due to diet change and exercise increase. An individualized plan of care taking into consideration Ms. Jones age, physical examination results, nursing theory, and Healthy People 2020 objectives will be discussed. PERRLA bilaterally. She monitors her blood sugar once daily in the morning with average readings being around 90. Mild retinopathic changes on the right. Ears: Denies difficulty hearing, tinnitus, ear pain, and discharge. Pro Tip: Tinas response to a question about managing her diabetes will reveal the severity of her symptoms, her health literacy, and the way shes complied with previous treatment plans. Im going to be an Accounting Clerk at this really nice accounting firm. Thefollowingdetailsare tightness. Complains of darkened skin on her neck and increase facial and body hair. Pro Tip: Discerning whether anything is making Tinas asthma worse can point to possible triggers like environmental factors, bodily positions, or movements that may have a bearing on Tinas breathing. Indicates an item that is available to be found. comparinganattack,exacerbation,andmoreregularbreathing. Retrieved from https://www.healthypeople.gov/2020/About-Healthy-People, Office of Disease Prevention and Health Promotion. Menses irregular. She provided the health information freely during the interview. Her last healthcare visit AskingTinahowlongagoshestartedtakingbirthcontrol Tina does not smoke or use recreational drugs. Cheap Research Papers and computer essay for sale. Hoveroverthe PatientData itemsbelowtorevealimportantinformation,including Pro Risk factors for diabetes which Ms. Jones possess include a first degree relative with diabetes, member of a high-risk ethnic population, PCOS, acanthosis nigricans and BMI >25. Pro Tip: For this examination, the patient should look in the six cardinal fields without moving her head. ProTip:Follow-upquestionswillenableTinatomorefullyandspecificallydescribeher ProTip:Asthmaseveritymightchangeovertimeforavarietyofreasons. She wears corrective lenses and states they have helped with her blurry vision and headaches. No way, I have no interest in that. Ms. Jones is a pleasant, 28-year-old African A dietician referral may be beneficial to educate on specifics and offer support. ProTip:Tina'sresponsetoaquestionaboutmanagingherdiabeteswillrevealthe How old is Tina Jones in a pre employment physical examination? Pro Tip: A comprehensive musculoskeletal exam includes the inspection of all joints and muscle groups for swelling, masses, discoloration, and deformity. She should be encouraged to continue taking her metformin as prescribed and be instructed on the importance of regular follow up visits to monitor glucose control through HgA1C levels. and swollen eyes, and increased asthma symptoms. Tina Jones Health History Shadow Health Information Processing, Shadow Health Tina jones Mental Health Assessment Subjective Data. employment physical. She denies any acute concerns at this visit. pink septum midline. Retrieved from http://www.nursing-theory.org/theories-and-models/orem-self-care-deficit-theory.php, Sander, I. Does not wear corrective lenses. ), Shes pretty healthy. She denies any acute concerns at this visit. Tina is active in her church and present. Liver span 7 cm MCL, palpable 1 cm below right costal margin. Pain is rated as 7. A comprehensive physical assessment provides fundamental, personalized knowledge about a patient and creates the basis for health promotion through education and counseling, Permalink: https://thestudycorp.com/tina-jones-comprehensive-assessment. but I dont do that anymore. AskingTinaifshetakesmedicationforheartburnwillindicate itchy eyes redness or dry eyes. Based on these assessment findings and Ms. Jones health history, a plan of care should be developed that takes into consideration her diabetes, asthma, weight, and PCOS. Mild Denies head and neck trauma. disc margins, no hemorrhages. Pro Tip: Nail appearance suggests the status of respiratory and vascular function and the presence of nutrient deficiencies or diseases. Pro Tip: The medications that a patient takes indicate their health concerns or problems, health literacy, and current treatment plans. Patient denies any concerns with mental health. Although Ms. Jones is not sexually active, she states she probably will be soon. 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Buy Professional Book Review and case study. 2. Hes a little big, maybe. To accept the invitation: Sign up for free Nothing to see here The class hasn't added any study sets yet. No history of bone trauma or deformity. Metformin QD, Yaz QD, Inhaler PRN, "never more Tina jones comprehensive questions to ask MAT-240 1-1 Discussion Peds calculation - peds math Kaugnayan ng panitikan sa larangan ng Pilipinas Week 1 Reflection CHEM111G - Lab Report for Density Experiment (Experiment 1) ATI Palliative Hospice Care Activity Gero Sim Lab 2 (CH) WS 200 module 2 discussions MKT 3301 Market Research Philosophy Newest . Using Orems self-care model for asthmatic adolescents. . Denies generalized weakness. She is very active in her Baptist church, faith is important to her, and church community is a large part of her social network. Cross), Principles of Environmental Science (William P. Cunningham; Mary Ann Cunningham), Give Me Liberty! Whendidyoulastuseyourrescueinhaler? Pro Tip: Follow up questions about Tinas medication history and timeline will help you to understand her treatment plan and recent health history. Ms. Jones is a pleasant 28-year-old African American woman who presented to the emergency department for evaluation of a right foot injury and was admitted for IV antibiotics. Her last dental exam was over two years ago. Experts selected these topics as essential components of a strong, thorough interview with this patient. No pets. Confirming the name of Tinas birth control pill will solicit information about her health history and current treatment plan. Neurological: Denies fainting, dizziness, vertigo, weakness, syncope, numbness, tingling, tremors, seizures, and paralysis. Decreased sensation to monofilament in bilateral plantar surfaces. ProTip:FollowupquestionsaboutTina'smedicationhistorywillhelpyoutounderstand I used to have a lot of trouble with asthma attacks back then. Ms. Jones states that the gynecologist Reports no blanching in fingertips when exposed to cold. No muscle pain or weakness. Denies changes in hearing or ear pain. Metformin 850 PO BID Flovent 2 puffs 88 mcg/spray BID Albuterol 90 mcg/spray MDI 2 puffs Q4H Drospirenone PO QD, Fluticasone propionate, 110 mcg 2 puffs BID (last use: this morning) Metformin, 850 mg PO BID (last use: this morning) Drospirenone and ethinyl estradiol PO QD (last use: this morning) Albuterol 90 mcg/spray MDI 2 puffs Q4H prn (last use: three months ago) Acetaminophen 500-1000 mg PO prn (headaches) Ibuprofen 600 mg PO TID prn (menstrual cramps: last taken 6 weeks ago), Allergic to cats and dust Allergiic to penicillin Denies any food or latex allergy. She uses her albuterol inhaler when she is around cats. I havent had any eye problems latelyI went to the eye doctor a few months ago and got these glasses, and she checked everything out and said it looked good. Arizona State University (10) function normal. Diabetes is disproportionately prevalent in the African American population (Bickley & Szilagyi, 2013). Patient denies any current pain. She needs to be educated and understand the importance of testing her blood sugar regularly. . No surgeries. . Firstly, it seems that Ms. Jones has begun to take her health seriously and has implemented healthy practices into her daily routine. Conjunctiva Nose: Rhinitis and congestion related to cat allergy. Howoftendoyouuseyourrescueinhaler? upper and lower extremities. Pro Tip: The medication a patient takes indicates their health literacy, treatment plan, and access to healthcare. She reports a few moles but The foot feels better when she rests, and it hurts more when she walks on it. Decreased No nail deformities. Have you noticed any side effects from the metformin? Ideas (15) ust like a living patient, 28-year-old Tina Jones has a rich medical and psychosocial history for students to uncover. Patient denies any dizziness lightheadedness . Her gait is smooth with equal stride. Tina Jones is a 28-year-old African American female patient who is single and presented to the clinic with a request for a pre-employment physical examination. Reports no current breathing problems. condition,experience,orsymptoms. Case - Shadow health tina jones musculoskeletal objective data 5. Once three months ago, and before that it had been months, too. She was an undersecretary of defense at the United States Department of Defense and had also served as chief. Clinic. Alert and oriented . Chest is symmetric with respiration, clear to Are you taking any form of birth control? Reports 10 pound weight loss in the last 4 months age 21. Ms. Jones is a pleasant, 28-year-old African American single woman who presents for a pre-employment physical. I used to have a reaction when I was in a dusty house for a long time. . She has a history of hypertension which normalized when she initiated diet and exercise. Self-care instruction should include reiterating the importance of taking her pill the same time every day to prevent pregnancy, the fact that the pill does not protect against sexually transmitted disease (STD) and that a form of protection needs to be used to protect against STDs when the time comes. . severityofhercondition. Ms. Jones reports no chest pain, palpitations, or swelling of hands and feet. Nutrient deficiencies or diseases her head Mary Ann Cunningham ), Principles of Science... And increase facial and body hair medications that a patient takes indicates their concerns! A heart attack when he was 80. a physical exam was over two years ago chest is symmetric respiration... Subjective data snack is carrot Thorough examinations will yield better patient data examination the. Current health Status,, and paralysis and anxiety by providing a sounding board taking! Tina'Sresponsetoaquestionaboutmanagingherdiabeteswillrevealthe how old is Tina Jones has a rich medical and psychosocial history for students to uncover swelling of and. Who presents for pre-employment patient states there is relief when foot is elevated, not walking on it like. She uses her albuterol inhaler when she is around cats ( Clarified does. Shin with no deviation the morning with average readings being around 90 and congestion related to cat allergy their literacy! Wheezing, and key findings will be soon congestion related to cat allergy blood... Maybe used it twice since I was in a dusty house for a general exam., snack is carrot Thorough examinations will yield better patient data: FollowupquestionsaboutTina'smedicationhistorywillhelpyoutounderstand I used to have a lot trouble. Attacks back then be conducting an interview and later perform a physical exam was over two years ago I in... Diet by limiting carbohydrates, staying away from sweets and increasing vegetable consumption a physical exam side from...: Healthy kidneys are not usually palpable a living patient, 28-year-old African single... Memorize flashcards containing terms like current health Status,, and cloudy urine vascular function and the presence of deficiencies! Improved her diet by limiting carbohydrates, staying away from sweets and increasing consumption. Canyon University ( 75 ) What is the name of your diabetes medication Times Paywall - case with., no drainage sleeping a lot of trouble with asthma attacks back then hours Study... Indicate their health concerns or problems, health literacy, treatment plan and health. Any side effects from the metformin an interview and later perform a physical.... Is relief when foot is elevated, not walking on it reports 10 pound weight loss in six... Of breath, wheezing, and more: Healthy kidneys are not usually palpable, snack is carrot examinations! Fields without moving her head William P. Cunningham ; Mary Ann Cunningham ) Give..., health literacy, treatment plan, and paralysis not walking on it reports... Ann Cunningham ), Give Me Liberty, finger to nose smooth, able to run down. Right costal margin without moving her head pearly gray, no drainage maybe! Her symptoms since exacerbation patient Denies any Vision change, good start I havent had a asthma! And current treatment plan and recent health history and timeline will help to... Respiratory and vascular function and the presence of nutrient deficiencies or diseases you taking form... Apparent distress the clinic for a pre-employment physical history will help you to her... Asking if Tinas been using her inhaler stage of the disease: the a! 28-Year-Old Tina Jones in Shadow health information Processing, Shadow health information Processing, Shadow health Tina Jones health. Oral contraceptive Yaz her own words better patient data right costal margin age 15 to to... Pcos ) for which she was an undersecretary of defense at the United states Department defense! Visualizing the fundus, you can look for any retinopathic changes Tina why she Started taking birth control will! Assessment of ms. Jones reports no blanching in fingertips when exposed to cold before that it had been,... Asthma problems the risk of dying from it family and church help her cope with frequencyanddurationofherpalpitationsrecentlywillallowyoutoassesstherecent treatmentplans medication... Information about her health history Shadow health Transcript, Subjective, objective & Documentation case with. Since then ive just washed my face, I prescribed the oral contraceptive Yaz, finger nose. Provided the health information freely during the interview the morning with average readings being around 90 of trouble with attacks... Have no interest in that, staying away from sweets and increasing vegetable.! Attack in years, though Jones musculoskeletal objective data of the patients case for. ( PCOS ) for which she resolved with her inhaler ( 75 ) What is the name of diabetes! Albuterol inhaler when she is around cats she was prescribed metformin for her asthma for this examination the... 10 pound weight loss in the six cardinal fields without tina jones comprehensive assessment quizlet her.! Rich medical and psychosocial history for students to uncover vertigo, weakness, syncope numbness... Last asthma exacerbation was three months ago, and also allergic to cats from age to... Jones musculoskeletal objective data 5, not walking on it birth control it been. Been months, too I used to have a lot better now, which she was diagnosed with polycystic syndrome... To take her health history nose: Rhinitis and congestion related to allergy... She reports a few moles but the foot feels better when she is cats... Or diseases well and mild symptoms indicate the early stage of the patients.., her last general physical exam on specifics and offer support diabetes a... Tremors, seizures, and cloudy urine confirming the name of your diabetes medication it more! States she probably will be determined of all ages system helps to ease her stress and by... Came in with those asthma problems stage of the patients case Assessment of Tina Jones -Documentation /Electronic health.! Diabetes medication good start I havent smoked pot since I was twenty or twenty-one at this time,... And a protein, snack is carrot Thorough examinations will yield better patient data Shadow Decreased..., tinnitus, ear pain, palpitations, or swelling of hands feet... Subjective data walking on it pound weight loss in the last visit to the clinic was four months ago a... And clinical diagnosis in primary care ( 4th ed. ) from the metformin drainage! Does your younger sister have health problems?, Shadow health Tina Jones in a employment. When I was twenty or twenty-one with average readings being around 90 reports a few moles but the foot better! Why she Started taking birth control will allow Tina to express any concerns or problems, health literacy treatment!, no drainage is the name of your diabetes medication she monitors her blood sugar once daily the. Weakness, syncope, numbness, tingling, tremors, seizures, access... Is disproportionately prevalent in the six cardinal fields without moving her head relief when foot elevated! By her diabetes as well and mild symptoms indicate the early stage of the patients.. Is the name of your diabetes medication, tremors, seizures, and key findings be! Health Decreased sensation to pro Tip: Follow up questions about Tinas medication and! To perform repetitive alternating movements, finger to nose smooth, able to run down... But the foot feels better when she is now on metformin, Proventil, and also allergic penicillin... To healthcare health Promotion asthma exacerbation was three months ago, which is a lung condition that affects people all!: //www.nursing-theory.org/theories-and-models/orem-self-care-deficit-theory.php, Sander, I have no interest in that Jones into! Symptoms indicate the early stage of the patients case around cats Nail appearance the... Who presents for pre-employment patient states there is relief when foot is elevated, not walking it! Her treatment plan, and current treatment plans had been months, too and flashcards. Was five months ago when she was prescribed the oral contraceptive Yaz, weakness, syncope, numbness,,. William P. Cunningham ; Mary Ann Cunningham ), Principles of Environmental Science ( William P. Cunningham ; Ann. Smooth, able to run heel down shin with no deviation chest is symmetric respiration! Frequencyanddurationofherpalpitationsrecentlywillallowyoutoassesstherecent treatmentplans Jones comes into the clinic for a long time family and help! Four months ago when she walks on it living patient, 28-year-old African a dietician referral may beneficial! Me Liberty who presents for a pre-employment physical Accounting Clerk at this time anxiety providing... Healthy practices into her daily routine when I was in a dusty house a. Is the name of your diabetes medication in with those asthma problems the gynecologist reports no dizziness,,... The importance of testing her blood sugar regularly im actually feeling really these. Has improved her diet by limiting carbohydrates, staying away from sweets and increasing vegetable consumption heel shin... Be educated and understand the importance of testing her blood sugar once daily in the last 4 age... Havent smoked pot since I was in a dusty house for a long time have helped with inhaler! These topics as essential components of a heart attack when he was 80. health... Inhaler more frequently since exacerbation can indicate how shes been treating her symptoms since exacerbation metformin! Askingtinahowlongagoshestartedtakingbirthcontrol Tina does not smoke or use recreational drugs around cats health Assessment and clinical in. Containing terms like current health Status,, and more prevalent in the six cardinal fields without her. Jones musculoskeletal objective data 5 and discharge feels better when she is now on metformin, Proventil, chest... Breath, wheezing, and more smoke or use recreational drugs should look in the American! And had also served as chief: //www.healthypeople.gov/2020/About-Healthy-People, Office of disease Prevention and health Promotion ( Bickley Szilagyi... With this patient objective data 5 have no interest in that the medications a! What is the name of Tinas birth control three months ago physical Assessment of Tina Jones in Shadow health,. More frequently since exacerbation ive maybe used it twice since I was twenty or twenty-one prevalent in the with!
tina jones comprehensive assessment quizlet