Gabriel Martinez Asthma Exacerbation Shadow health Transcript
Transcript
Started: Jan 23, 2021 | Total Time: 185 min
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Begin by confirming the patient’s name and date of birth. Which of the following is the most appropriate way to do so?
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Hello. I’ll be taking care of you tonight. Can you tell me your name and when you were born?
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Hey . . . Gabriel . . . I’m 8 . . .”
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His name is Gabriel Martinez. Gabriel is 8. Gabriel Martinez Asthma Exacerbation Shadow health Transcript
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You should also confirm Ms. Martinez’s relationship with Gabriel. Which of the following questions is the most appropriate way to do so?
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Hello. Are you Gabriel’s guardian?
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Yes. I’m his mother.
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Which of the following actions should you perform first?
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I want to interview the patient and guardian to establish Chief Complaint.
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What brings you in today?
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It’s really hard to breathe . . . I have asthma . . .
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Yes, my son started having difficulty breathing after school today. It’s been about 4 hours or so.
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What should you do next?
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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.
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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
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Auscultated breath sounds: expiratory and inspiratory wheezing
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Select your next course of action.
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Inpected chest: Mild intercostal retractions visible
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Select your next course of action.
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You observe so far during the assessment that Gabriel is speaking in partial sentences before having to take a breath.
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Select your next course of action.
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Assessed vitals
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Select your next course of action.
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Now choose the corresponding severity description under Assessed PAS-PreIntervention in the Objective Data tab.
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You now know the patient’s chief complaint, and you have collected his vitals and determined a PAS score. What should you do next?
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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.
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Unfortunately, you have not collected enough information about Gabriel’s condition to initiate a protocol at this time.
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You have not selected the most critical and necessary action. The incorrect response you selected has been removed. Try again with the remaining responses.
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You now know the patient’s chief complaint, and you have collected his vitals and determined a PAS score. What should you do next?
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I want to get a spirometer reading to confirm my findings so far. Gabriel Martinez Asthma Exacerbation Shadow health Transcript
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I did one before we came in.
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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.
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You now know the patient’s chief complaint, and you have collected his vitals and determined a PAS score. What should you do next?
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I want to ask about allergies to medication.
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No, he doesn’t have medicine allergies.
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You’ve determined the patient’s chief complaint, collected vitals and a PAS score, and inquired about medicine allergies. What should you do next?
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In order to rule out additional respiratory complications, I need to ask a handful of key history of present illness questions.
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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.
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You have not selected the most critical and necessary action. The incorrect response you selected has been removed. Try again with the remaining responses.
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You’ve determined the patient’s chief complaint, collected vitals and a PAS score, and inquired about medicine allergies. What should you do next?
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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
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No. No questions, thank you.
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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.
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Hello Gabriel, I am Nurse xxxx and I will be interviewing you and later perform a physical assessment
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Hey.
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How are you feeling?
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I feel better now . . . I can definitely breathe better, but my chest is kinda sore.
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Sorry about your chest being sore
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Everyone is really nice here. Thank you very very very much!
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How does your chest feel?
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My chest doesn’t feel as tight now. It’s still a little sore though. Gabriel Martinez Asthma Exacerbation Shadow health Transcript
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Do you feel any wheezing?
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My breath was squeaky earlier, but I can’t hear it anymore.
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Okay, got it
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Thanks, that makes me feel better.
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When did the breathing problem start?
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My attack started after kickball . . . and it got worse and worse when we got home.
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Sorry about that Gabriel
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Oh wow, thanks.
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What worsens the breathing problem?
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Ummmm smokers. Smoke makes my breathing a lot worse.
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Sorry about that
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Ok, thanks.
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Are you normally around smoke?
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I try to stay away from it. But these new kids were smoking by the kickball field after school today.
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It is good to stay away from anyone smoking
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I guess that makes sense.
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What triggers your asthma?
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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.
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What action did you take after the asthma attacK
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Well I . . . I guess I’m supposed to take my emergency inhaler, but . . . I threw it away. So we don’t have it anymore.
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Ooh, you should always ensure you have the inhaler at a safe and accessible place
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Ohhh, yeah. Good . . . to . . . know.
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What is the name of the inhaler you were using?
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I dunno. I think my mom does.
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Why did you throw away the inhaler?
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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.
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Sometimes I give him an over the counter antihistamine, when his allergies are bad or the pollen count is high.
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What are some of your son’s allergies? (No matching questions found.)
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alleges? (No matching questions found.) Gabriel Martinez Asthma Exacerbation Shadow health Transcript
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Any allergies?
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I don’t, no. Just my son does. [AUDIO COMING SOON]
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What allergies does your son have?
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Pets, dust, pollen. He’s not allergic to any of the other obvious stuff. No food or medicine or latex or anything.
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How does your son’s environmental allergies impact his asthma?
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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.
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It is always good to keep the allergy triggers away
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Yeah . . . Yeah, I get it. We’ll work on that.
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Has your son been hospitalized before?
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Yes, he went to the hospital a year ago, because of his asthma.
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Sorry about that. Being hospitalized can really take a toll on any parent Gabriel Martinez Asthma Exacerbation Shadow health Transcript
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Thank you for saying that.
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Why was your son last hospitalized?
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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.
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Sorry about that ordeal.
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Thank you. I’m . . . I’m just doing the best I can.
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Please let him always keep away from triggers such as smoke
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Alright, I understand.
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How does exercise impact your son’s asthma?
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Too much exercise could trigger an asthma attack. He knows the rules. He can walk, but he isn’t supposed to run.
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Does anyone in your family use tobacco?
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No, none of us do.
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That is great. Smoking is really bad for health, especially in people with respiratory problems such as asthma
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That makes a lot of sense, thank you.
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What is your childcare situation?
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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
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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
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Thank you for saying that.
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What is your childcare situation?
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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.
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What health problems run in your family?
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There’s nothing like asthma in the family. But my father has heart disease and my brother has diabetes.
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Sorry about your father and brother’s conditions.
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Thank you. I’m . . . I’m just doing the best I can.
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Also sorry about your son’s asthma. He will get better.
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Thanks, I appreciate that.
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Checked ID band
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Assessed vitals
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Auscultated top right chest breath sounds: normal breathing
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Auscultated top left chest breath sounds: normal breathing
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Auscultated upper right chest breath sounds: normal breathing
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Auscultated upper left chest breath sounds: normal breathing
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Auscultated lower right chest breath sounds: normal breathing
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Auscultated lower left chest breath sounds: normal breathing
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Auscultated top left back breath sounds: normal breathing
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Auscultated top right back breath sounds: normal breathing
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Auscultated upper left back breath sounds: normal breathing
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Auscultated upper right back breath sounds: normal breathing
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Auscultated lower left back breath sounds: normal breathing
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Auscultated lower right back breath sounds: normal breathing
Gabriel Martinez Asthma Exacerbation Shadow health Transcript
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Auscultated lower left chest breath sounds: normal breathing
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Auscultated lower right chest breath sounds: normal breathing
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Auscultated upper right chest breath sounds: normal breathing
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Auscultated upper left chest breath sounds: normal breathing
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Auscultated top left chest breath sounds: normal breathing
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Auscultated top right chest breath sounds: normal breathing
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No abnormal findings
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Assessed dyspnea
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PAS Score: determine the PAS Score using the EHR tab
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Assessed growth
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Assessed vitals Gabriel Martinez Asthma Exacerbation Shadow health Transcript
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