Focused exam: Cough shadow health answers

Transcript

Started: February 04, 2023 | Total Time: 170 min focused exam: cough shadow health answers
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Hello!

Question
04/02/23 2:08 PM MDT
Diana Shadow.
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.
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What is the situation?

Question
04/02/23 2:10 PM MDT
Diana Shadow.
Your patient is Danny Rivera, an 8-year-old Puerto Rican boy presenting with a cough in the Shadowville Elementary nurse’s office. Your role in this simulation is that of a healthcare provider who will perform a focused history and physical examination in order to collect data, assess Danny’s condition, and transfer care. In this simulation, you will be able to perform procedures not always typical to a school setting so you can gather as much data as possible.
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What are my objectives in this assessment?

ORDER SHADOW HEALTH HELP HERE

Question
04/02/23 2:11 PM MDT
Diana Shadow.
Danny is very health literate and a good historian of his own health history; he can answer questions that not every child may be able to. In your interview with Danny, you will ask about the history of his presenting illness and the functioning of relevant systems in order to obtain subjective data related to his cough. 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 inquire into the health history of Danny’s family so you can determine his genetic predisposition to any diseases. In addition to collecting subjective data, you will perform a physical exam on Danny to gather objective data about his health and physiology. Throughout the conversation, you should educate and empathize with Danny when appropriate to increase his health literacy and sense of well-being. 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. You may complete the exam activities in any order and move between them as needed.
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What else will this exam involve?

Question
04/02/23 2:12 PM MDT
Diana Shadow.
Because Danny is a pediatric patient, you will also be required to make a phone call to his guardian’s home to gather additional information. 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. You will then move onto the Care Plan activity, in which you will synthesize your subjective and objective data to complete the nursing process. You will develop a nursing diagnosis for Mr. Rivera’s condition, identify a treatment goal, plan your interventions and evaluations, and finally assess if your goal was achieved. You may also need to call Danny’s guardian again to involve them in his treatments. The Care Plan is just as important as your assessment, and the patient’s well-being will be greatly affected by your diagnosis and interventions.
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How will I be evaluated?

Question
04/02/23 2:12 PM MDT
Diana Shadow.
The activities evaluated by the simulation are Subjective and Objective Data Collection, Education and Empathy, and the Care Plan activity. Nursing tasks and Documentation, while they provide valuable practice for their real-world counterparts, are not automatically evaluated by the simulation. 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. Your success in Education and Empathy is based on whether you promptly respond after identifying a moment worthy of therapeutic communication. Your success in the Care Plan activity is based on whether you accurately identify Mr. Rivera’s nursing diagnosis, select a goal most immediately beneficial to him, select and prioritize the most effective treatments, and accurately evaluate your results. The Care Plan will make up a signficant part of your grade, so be sure to carefully choose your answers based on evidence. This assignment takes on average between 80 and 100 minutes. You can pause and resume the assignment at any time; your work is always saved automatically.
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How does this assignment prepare me for the real world?

Question
04/02/23 2:13 PM MDT
Diana Shadow.
In this assessment, you will familiarize yourself with the structure and content of a cough focused exam so that with real-life patients, you can: º ask effective and comprehensive questions º obtain and assess objective data º educate and empathize with the patient º develop a nursing diagnosis º create an effective and expedient care plan º and evaluate your results to determine your goal’s achievement.
Diana Shadow.
In 1 or 2 sentences, answer this question to help prepare for the upcoming exam: What strategies can you use to develop rapport with a pediatric patient?
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Being friendly with the patient

Statement
04/02/23 2:15 PM MDT
Diana Shadow.
Time to begin.
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Hello. xxx  interview and examine you.

Greet
04/02/23 2:18 PM MDT
Danny Rivera.
Hi.
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What is your name? (Clarified to What is your name?.)

Question
04/02/23 2:24 PM MDT
Danny Rivera.
My name is Daniel Rivera, but I just go by Danny. (Clarified to what is my name.)
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What brings you to the clinic today?

Question
04/02/23 2:24 PM MDT
Danny Rivera.
My music teacher Mr. Hillman sent me here because he said I look sick. I have been coughing a lot. . . and I feel kinda tired.
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Am sorry to hear that you are sick.

Empathize
04/02/23 2:25 PM MDT
Danny Rivera.
That is nice of you.
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Do you have a cough?

Question
04/02/23 2:26 PM MDT
Danny Rivera.
I guess I’m kind of sick. . . I’ve been coughing a lot.
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How long have you had a cough?

Question
04/02/23 2:27 PM MDT
Danny Rivera.
I think the cough started two . . . No, it started three days ago.
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Is your cough a wet or a dry one?

Question
04/02/23 2:27 PM MDT
Danny Rivera.
My cough seems kind of gurgly and watery.
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That sounds like a wet cough.

Empathize
04/02/23 2:28 PM MDT
Danny Rivera.
Thanks for saying that.
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Are you ever around cigarette smoke?

Question
04/02/23 2:28 PM MDT
Danny Rivera.
Well . . . sometimes Papi smokes cigars in the house and my mom has to tell him to go outside. I breathe it a little bit then, but it’s not all the time or anything. I don’t like how it smells, and I don’t like that he is hurting himself. He could get sick.
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Am sorry about that, I understand your concerns

Empathize
04/02/23 2:29 PM MDT
Danny Rivera.
Thank you.
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What makes your cough worse?

Question
04/02/23 2:29 PM MDT
Danny Rivera.
I don’t think anything makes my cough be worse.
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Have you tried to treat your cough?

Question
04/02/23 2:31 PM MDT
Danny Rivera.
My mom gave me some medicine this morning. . . that helped my cough a little. I don’t remember what it was called though, sorry.
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What is the name of the medicine?

Question
04/02/23 2:32 PM MDT
Danny Rivera.
I don’t know. It was the purple one.
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Who gave you the medicine?

Question
04/02/23 2:32 PM MDT
Danny Rivera.
My mom gave it to me.
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How much medicine do you take?

Question
04/02/23 2:32 PM MDT
Danny Rivera.
It was just a spoonful.
Thanks for saying that.
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 Washed hands.

Exam Action
04/02/23 3:08 PM MDT
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 Measured blood pressure

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04/02/23 3:09 PM MDT
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 Measured heart rate

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04/02/23 3:09 PM MDT
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 Measured pulse oximetry

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04/02/23 3:09 PM MDT
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 Measured respiratory rate

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04/02/23 3:09 PM MDT
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 Measured temperature

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04/02/23 3:09 PM MDT
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 Tested lung capacity with spirometer: FEV1: 1.549 L, FVC 1.78 L (FEV1/FVC: 87%)

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04/02/23 3:10 PM MDT
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 Inspected upper conjunctiva

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04/02/23 3:10 PM MDT
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 Inspected right orbital area and sclera

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04/02/23 3:10 PM MDT
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 Inspected left orbital area and sclera

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04/02/23 3:10 PM MDT
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 Inspected lower conjunctiva

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04/02/23 3:10 PM MDT
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 Performed otoscopic examination of right ear

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04/02/23 3:11 PM MDT
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 Performed otoscopic examination of left ear

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04/02/23 3:11 PM MDT
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 Performed otoscopic examination of right naris

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04/02/23 3:11 PM MDT
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 Performed otoscopic examination of left naris

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04/02/23 3:11 PM MDT
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 Inspected mouth

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04/02/23 3:11 PM MDT
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 Inspected front of neck

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04/02/23 3:11 PM MDT
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 Inspected right side of neck

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04/02/23 3:11 PM MDT
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 Inspected back of neck

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04/02/23 3:11 PM MDT
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 Inspected left side of neck

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04/02/23 3:11 PM MDT
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 Inspected anterior chest wall

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04/02/23 3:12 PM MDT
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 Inspected posterior chest wall

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04/02/23 3:12 PM MDT
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 Palpated frontal sinuses: No tenderness reported

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04/02/23 3:12 PM MDT
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 Palpated maxillary sinuses: No tenderness reported

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04/02/23 3:12 PM MDT
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 Palpated lymph nodes of head and neck: Enlarged and reported tenderness on the right side

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04/02/23 3:13 PM MDT
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 Palpated supraclavicular lymph nodes: Not palpable

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04/02/23 3:13 PM MDT
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 Palpated axillary lymph nodes: Not palpable

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04/02/23 3:13 PM MDT
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 Palpated fremitus in anterior upper chest wall: Present and equal bilaterally

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04/02/23 3:14 PM MDT
Danny Rivera.
Ninety-nine.
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 Palpated fremitus in anterior lower chest wall: Present and equal bilaterally

Exam Action
04/02/23 3:14 PM MDT
Danny Rivera.
Ninety-nine.
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 Palpated fremitus in posterior upper chest wall: Present and equal bilaterally

Exam Action
04/02/23 3:14 PM MDT
Danny Rivera.
Ninety-nine.
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 Palpated fremitus in posterior middle chest wall: Present and equal bilaterally

Exam Action
04/02/23 3:14 PM MDT
Danny Rivera.
Ninety-nine.
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 Palpated fremitus in posterior lower chest wall: Present and equal bilaterally

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04/02/23 3:14 PM MDT
Danny Rivera.
Ninety-nine.
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 Palpated chest expansion: Both sides rise symmetrically

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04/02/23 3:14 PM MDT
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 Auscultated breath sounds in anterior right upper lobe

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04/02/23 3:15 PM MDT
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 Auscultated breath sounds in anterior left upper lobe

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04/02/23 3:15 PM MDT
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 Auscultated breath sounds in anterior right upper lobe

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04/02/23 3:15 PM MDT
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 Auscultated breath sounds in anterior left middle lobe

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04/02/23 3:15 PM MDT
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 Auscultated breath sounds in anterior right middle lobe focused exam: cough shadow health answers

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04/02/23 3:15 PM MDT
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 Auscultated breath sounds in anterior left middle lobe

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04/02/23 3:15 PM MDT
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 Auscultated breath sounds in anterior right lower lobe

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04/02/23 3:15 PM MDT
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 Auscultated breath sounds in anterior left lower lobe

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04/02/23 3:15 PM MDT
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 Auscultated breath sounds in posterior left upper lobe

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04/02/23 3:16 PM MDT
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 Auscultated breath sounds in posterior right upper lobe focused exam: cough shadow health answers

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04/02/23 3:16 PM MDT
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 Auscultated breath sounds in posterior left mid-back (lower lobe)

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04/02/23 3:16 PM MDT
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 Auscultated breath sounds in posterior right mid-back (lower lobe)

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04/02/23 3:16 PM MDT
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 Auscultated breath sounds in posterior left lower lobe near spine

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04/02/23 3:16 PM MDT
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 Auscultated breath sounds in posterior right lower lobe near spine

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04/02/23 3:16 PM MDT
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 Auscultated breath sounds in posterior left lower lobe on side

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04/02/23 3:16 PM MDT
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 Auscultated breath sounds in posterior left lower lobe

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04/02/23 3:16 PM MDT
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 Auscultated breath sounds in posterior right lower lobe

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04/02/23 3:16 PM MDT
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 Auscultated breath sounds in posterior right lower lobe on side

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04/02/23 3:16 PM MDT
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 Auscultated voice sounds in anterior right upper lobe

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04/02/23 3:16 PM MDT
Danny Rivera.
Ninety-nine.
Danny Rivera.
Ninety-nine.
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 Auscultated voice sounds in anterior left upper lobe

Exam Action
04/02/23 3:16 PM MDT
Danny Rivera.
Ninety-nine.
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 Auscultated voice sounds in anterior right upper lobe

Exam Action
04/02/23 3:16 PM MDT
Danny Rivera.
Ninety-nine.
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 Auscultated voice sounds in anterior left mid-chest (upper lobe)

Exam Action
04/02/23 3:16 PM MDT
Danny Rivera.
Ninety-nine.
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 Auscultated voice sounds in anterior right middle lobe

Exam Action
04/02/23 3:17 PM MDT
Danny Rivera.
Ninety-nine.
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 Auscultated voice sounds in anterior left mid-chest (upper lobe)

Exam Action
04/02/23 3:17 PM MDT
Danny Rivera.
Ninety-nine.
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 Auscultated voice sounds in anterior right lower lobe

Exam Action
04/02/23 3:17 PM MDT
Danny Rivera.
Ninety-nine.
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 Auscultated voice sounds in anterior left lower lobe

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04/02/23 3:17 PM MDT
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 Auscultated voice sounds in posterior left upper lobe

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04/02/23 3:17 PM MDT
Danny Rivera.
Ninety-nine.
Danny Rivera.
Ninety-nine.
Danny Rivera.
Ninety-nine.
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 Auscultated voice sounds in posterior right upper lobe

Exam Action
04/02/23 3:17 PM MDT
Danny Rivera.
Ninety-nine.
Danny Rivera.
Ninety-nine.
Danny Rivera.
Ninety-nine.
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 Auscultated voice sounds in posterior left mid-back (lower lobe)

Exam Action
04/02/23 3:17 PM MDT
Danny Rivera.
Ninety-nine.
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 Auscultated voice sounds in posterior right mid-back (lower lobe)

Exam Action
04/02/23 3:17 PM MDT
Danny Rivera.
Ninety-nine.
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 Auscultated voice sounds in posterior left lower lobe near spine

Exam Action
04/02/23 3:17 PM MDT
Danny Rivera.
Ninety-nine.
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 Auscultated voice sounds in posterior right lower lobe near spine

Exam Action
04/02/23 3:17 PM MDT
Danny Rivera.
Ninety-nine.
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 Auscultated voice sounds in posterior left lower lobe on side

Exam Action
04/02/23 3:17 PM MDT
Danny Rivera.
Ninety-nine.
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 Auscultated voice sounds in posterior left lower lobe

Exam Action
04/02/23 3:17 PM MDT
Danny Rivera.
Ninety-nine.
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 Auscultated voice sounds in posterior right lower lobe

Exam Action
04/02/23 3:17 PM MDT
Danny Rivera.
Ninety-nine.
Danny Rivera.
Ninety-nine.
Danny Rivera.
Ninety-nine.
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 Auscultated aortic area with the bell

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04/02/23 3:18 PM MDT
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 Auscultated pulmonic area with the bell

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04/02/23 3:18 PM MDT
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 Auscultated Erb’s point with the bell

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04/02/23 3:18 PM MDT
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 Auscultated tricuspid area with the bell

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04/02/23 3:18 PM MDT
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 Auscultated mitral area with the bell

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04/02/23 3:18 PM MDT
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 Auscultated mitral area with the diaphragm focused exam: cough shadow health answers

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04/02/23 3:18 PM MDT
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 Auscultated aortic area with the diaphragm

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04/02/23 3:18 PM MDT
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 Auscultated pulmonic area with the diaphragm

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04/02/23 3:18 PM MDT
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 Auscultated Erb’s point with the diaphragm

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04/02/23 3:18 PM MDT
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 Auscultated tricuspid area with the diaphragm

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04/02/23 3:18 PM MDT
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 Auscultated mitral area with the diaphragm

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04/02/23 3:18 PM MDT
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 Percussed anterior right upper lobe

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04/02/23 3:23 PM MDT
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 Percussed anterior left upper lobe

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04/02/23 3:23 PM MDT
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 Percussed anterior right middle lobe

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04/02/23 3:23 PM MDT
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 Percussed anterior left mid-chest (upper lobe)

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04/02/23 3:23 PM MDT
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 Percussed anterior right lower lobe

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04/02/23 3:23 PM MDT
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 Percussed anterior left lower lobe

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04/02/23 3:23 PM MDT
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 Percussed posterior left upper lobe

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04/02/23 3:23 PM MDT
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 Percussed posterior right upper lobe

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04/02/23 3:23 PM MDT
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 Percussed posterior left mid-back (lower lobe)

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04/02/23 3:23 PM MDT
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 Percussed posterior right mid-back (lower lobe)

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04/02/23 3:23 PM MDT
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 Percussed posterior left lower lobe

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04/02/23 3:23 PM MDT
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 Percussed posterior right lower lobe

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04/02/23 3:23 PM MDT
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 Percussed posterior left lower lobe on side

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04/02/23 3:23 PM MDT
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 Percussed posterior left lower lobe near spine

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04/02/23 3:23 PM MDT
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 Percussed posterior right lower lobe near spine

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04/02/23 3:23 PM MDT
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 Percussed posterior left right lobe on side

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04/02/23 3:23 PM MDT
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 Measured diaphragmatic excursion: 3 cm

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04/02/23 3:24 PM MDT
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Danny, we want to make sure you dont develop an infection and become more sick by taking you through the different that can prevent that and the focus will be on your risk factors. Some of your risk factors include you being close to a sick friend, exposure to cigar smoke, having touches your face with uncleaned fingers. They may sound a lot but by working together and mitigating your risk factors can be easy and effective

Educate
04/02/23 4:43 PM MDT
Danny Rivera.
OK. I get it!
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To make sure you dont become sicker, I will talk to you and your father and what must e done. The three of us will collaborate and agree to your health goals. Then both of you will repeat what you have learnt to be sure you have understood all which should be done.

Educate
04/02/23 4:48 PM MDT
Danny Rivera.
Alright.
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Does the plan sound good to you?

Educate
04/02/23 4:49 PM MDT
Danny Rivera.
We can do it! I love learning and I’m really a good learner.
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If you don’t have any other question, we can start our discussion.

Educate
04/02/23 4:49 PM MDT
Danny Rivera.
Okie dokie artichokey.