Debbie O’Connor COPD shadow health

During the patient interview, there are a number of opportunities to provide patient education and empathy. The opportunities listed below are those identified by nursing experts to be of particular importance to this patient. A Model Statement is provided as an example of an appropriate response to each opportunity.

Opportunities marked as Not Encountered are opportunities that were not elicited in the interview
Opportunities marked as Not Followed Up are missed opportunities that were present in the interview, but where no statements were made
Opportunities marked as Followed Up were followed up by students, and include the dialogue between student and patient

1 Anxiety Over Worsening Symptoms

Followed Up

	Description: Ms. O’Connor reports anxiety and distress over her worsening health.
	What brings you in today?	Question 03:44 PM CDT
	I’m having so much trouble just trying to breathe. And I’ve had these terrible coughing fits. A few days ago, a bronchospasm. My health is going downhill fast . . . I know it has to do with my smoking habit. It’s so hard to kick. I was hoping I could get something to help me.
	I’m sorry to hear that you are experiencing anxiety over your current health conditions. Not being able to breathe is a scary condition. With the right therapy, and if you quit smoking, you’ll begin to feel better.	Empathize 03:47 PM CDT
	That’s very kind.
	Model Statement: “I’m sorry to hear that you are experiencing anxiety over your current health conditions. Not being able to breathe is a scary condition. With the right therapy, and if you quit smoking, you’ll begin to feel better soon.”

2 Life Tragedy

Not Followed Up

	Description: Ms. O’Connor reports details of her difficult life, including the loss of her husband.
	Any family history of illness?	Question 04:24 PM CDT
	My parents died from smoking their whole lives. It was a different time . . . my father had a heart attack at 42. My mother edged him out, but she eventually got pneumonia.
	Changes in your weight? (Clarified to: Has your weight changed recently?)	Question 04:24 PM CDT
	Model Statement: “I’m sorry that you lost your husband and your other family members. That sounds like it must have been very difficult for you.”

3 Pneumonia and Flu Vaccines

Followed Up

	Description: Ms. O’Connor reports that she has not had a recent flu or pneumococcal vaccine.
	Have you had any vaccines?	Question 04:05 PM CDT
	I’ve had vaccines before, but . . . it’s been a long time.
	At your age, and with your health conditions, it’s vital that you get an annual flu shot, and that you receive a pneumococcal vaccine every ten years. These two infections could have terrible effects on your health because your respiratory system is already compromised.	Educate 04:08 PM CDT
	That’s good to know.
	Model Statement: “At your age, and with your health conditions, it’s vital that you get an annual flu shot, and that you receive a pneumococcal vaccine every ten years. These two infections could have terrible effects on your health because your respiratory system is already compromised.”

4 Smoking Cessation

Followed Up

	Description: Ms. O’Connor reports that she has relapsed into smoking and would like assistance quitting.
	What brings you in today?	Question 03:44 PM CDT
	I’m having so much trouble just trying to breathe. And I’ve had these terrible coughing fits. A few days ago, a bronchospasm. My health is going downhill fast . . . I know it has to do with my smoking habit. It’s so hard to kick. I was hoping I could get something to help me.
	I’m sorry to hear that you are experiencing anxiety over your current health conditions. Not being able to breathe is a scary condition. With the right therapy, and if you quit smoking, you’ll begin to feel better.	Empathize 03:47 PM CDT
	That’s very kind.
	Do you use home oxygen?	Question 04:01 PM CDT
	I don’t use oxygen . . . it could probably help me. But I’d blow myself up, smoking near it.
	Oxygen therapy could help alleviate some of your symptoms of breathlessness and fatigue. Unfortunately, you cannot use oxygen therapy if you smoke. It’s too dangerous. Once you quit smoking, you can seek this treatment.	Educate 04:04 PM CDT
	You certainly know your stuff.
	how long have you been a smoker	Question 04:12 PM CDT
	I started smoking when I was 15. I’ve smoked for a long time. Had a little success quitting. I stopped for ten years when my daughter was born. But, I picked up the habit again. I’ve tried quitting since my husband died, but . . . it’s hard.
	I’m sorry that you lost your husband. That sounds like it must have been very difficult for you.	Empathize 04:15 PM CDT
	Thanks.
	how many cigarettes do you smoke per day	Question 04:15 PM CDT
	Typically I smoke between three and five cigarettes a day. It’s been that way for the last four months. Ever since I relapsed. Smoking makes my breathing worse, so . . . I try to hold off as long as I can between cigarettes.
	It’s vital that you quit smoking as soon as possible in order to get some relief from you COPD symptoms. Smoking is putting your life in danger and making your symptoms worse. I can point you towards community or national smoking cessation programs that can help support you while you are quiting	Educate 04:20 PM CDT
	I’ll be sure to keep that in mind.
	Model Statement: “It is vital that you quit smoking as soon as possible in order to get some relief from your COPD symptoms. Smoking is putting your life in danger and making your symptoms much worse. I can point you towards community or national smoking cessation programs that can help support you while you are quitting.”

5 Diet and Exercise

Followed Up

	Description: Ms. O’Connor reports she mainly eats frozen food, and that she is not capable of exercise.
	Do you exercise?	Question 04:20 PM CDT
	I can’t exercise. I can’t even move around the house without feeling fatigued and out of breath. Exerting myself in any way makes me feel worse.
	Tell me about your diet?	Question 04:21 PM CDT
	Well, I’m too weak to cook. I eat microwavable meals if I’m alone. Pasta, pizza, rice, all that. My daughter cooks nice food . . . quinoa, salads, salmon.
	When you COPD symptoms have been alleviated it is important that you try to eat well and get some light exercise. Not exercising can exacerbate your symptoms, and some exercise will help you breathe easier and build lung capacity	Educate 04:23 PM CDT
	Oh! That makes sense.
	Model Statement: “When your COPD symptoms have been alleviated it is important that you try to eat well and get some light exercise. Not exercising can exacerbate your symptoms, and some exercise will help you breathe easier and build lung capacity.”

6 Oxygen Therapy

Followed Up

	Description: Ms. O’Connor expresses that she would like oxygen therapy but is unable to use it while smoking.
	Do you use home oxygen?	Question 04:01 PM CDT
	I don’t use oxygen . . . it could probably help me. But I’d blow myself up, smoking near it.
	Oxygen therapy could help alleviate some of your symptoms of breathlessness and fatigue. Unfortunately, you cannot use oxygen therapy if you smoke. It’s too dangerous. Once you quit smoking, you can seek this treatment.	Educate 04:04 PM CDT
	You certainly know your stuff.
	Model Statement: “Oxygen therapy could help alleviate some of your symptoms of breathlessness and fatigue. Unfortunately, you cannot use oxygen therapy if you smoke. It’s too dangerous. Once you quit smoking, you can seek this treatment.”

Debbie O’Connor COPD shadow health

Education & Empathy: 5 of 6 (83.3%)

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