Gabriel Martinez Asthma Exacerbation Shadow health Transcript

Transcript

Started: Jan 23, 2021 | Total Time: 185 min
Diana Shadow
Begin by confirming the patient’s name and date of birth. Which of the following is the most appropriate way to do so?
Your avatar
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

Gabriel Martinez
Hey . . . Gabriel . . . I’m 8 . . .”
Yvonne Martinez
His name is Gabriel Martinez. Gabriel is 8.
Diana Shadow
You should also confirm Ms. Martinez’s relationship with Gabriel. Which of the following questions is the most appropriate way to do so?
Your avatar
Hello. Are you Gabriel’s guardian?

Question
01/23/21 6:34 PM PST

Yvonne Martinez
Yes. I’m his mother.
Diana Shadow
Which of the following actions should you perform first?
Your avatar
I want to interview the patient and guardian to establish Chief Complaint.

Question
01/23/21 6:37 PM PST

Your avatar
What brings you in today?

Question
01/23/21 6:38 PM PST

Gabriel Martinez
It’s really hard to breathe . . . I have asthma . . .
Yvonne Martinez
Yes, my son started having difficulty breathing after school today. It’s been about 4 hours or so.
Diana Shadow
What should you do next?
Your avatar
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

Diana Shadow
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.
Your avatar
 Auscultated breath sounds: expiratory and inspiratory wheezing

Exam Action
01/23/21 6:40 PM PST

Diana Shadow
Select your next course of action.
Your avatar
 Inpected chest: Mild intercostal retractions visible

Exam Action
01/23/21 6:43 PM PST

Diana Shadow
Select your next course of action.
Your avatar
 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

Diana Shadow
Select your next course of action.
Your avatar
 Assessed vitals

Exam Action
01/23/21 6:45 PM PST

Diana Shadow
Select your next course of action.
Diana Shadow
Now choose the corresponding severity description under Assessed PAS-PreIntervention in the Objective Data tab.
Diana Shadow
You now know the patient’s chief complaint, and you have collected his vitals and determined a PAS score. What should you do next?
Your avatar
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

Diana Shadow
Unfortunately, you have not collected enough information about Gabriel’s condition to initiate a protocol at this time.
Diana Shadow
You have not selected the most critical and necessary action. The incorrect response you selected has been removed. Try again with the remaining responses.
Diana Shadow
You now know the patient’s chief complaint, and you have collected his vitals and determined a PAS score. What should you do next?
Your avatar
I want to get a spirometer reading to confirm my findings so far.

Question
01/23/21 7:14 PM PST

Yvonne Martinez
I did one before we came in.
Diana Shadow
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.
Diana Shadow
You now know the patient’s chief complaint, and you have collected his vitals and determined a PAS score. What should you do next?
Your avatar
I want to ask about allergies to medication.

Question
01/23/21 7:15 PM PST

Yvonne Martinez
No, he doesn’t have medicine allergies.
Diana Shadow
You’ve determined the patient’s chief complaint, collected vitals and a PAS score, and inquired about medicine allergies. What should you do next?
Your avatar
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

Diana Shadow
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.
Diana Shadow
You have not selected the most critical and necessary action. The incorrect response you selected has been removed. Try again with the remaining responses.
Diana Shadow
You’ve determined the patient’s chief complaint, collected vitals and a PAS score, and inquired about medicine allergies. What should you do next?
Your avatar
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.

Question
01/23/21 7:16 PM PST

Yvonne Martinez
No. No questions, thank you.
Diana Shadow
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.
Your avatar
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

Gabriel Martinez
Hey.
Your avatar
How are you feeling?

Question
01/23/21 7:24 PM PST

Gabriel Martinez
I feel better now . . . I can definitely breathe better, but my chest is kinda sore.
Your avatar
Sorry about your chest being sore

Empathize
01/23/21 7:25 PM PST

Gabriel Martinez
Everyone is really nice here. Thank you very very very much!
Your avatar
How does your chest feel?

Question
01/23/21 7:26 PM PST

Gabriel Martinez
My chest doesn’t feel as tight now. It’s still a little sore though.
Your avatar
Do you feel any wheezing?

Question
01/23/21 7:26 PM PST

Gabriel Martinez
My breath was squeaky earlier, but I can’t hear it anymore.
Your avatar
Okay, got it

Empathize
01/23/21 7:26 PM PST

Gabriel Martinez
Thanks, that makes me feel better.
Your avatar
When did the breathing problem start?

Question
01/23/21 7:27 PM PST

Gabriel Martinez
My attack started after kickball . . . and it got worse and worse when we got home.
Your avatar
Sorry about that Gabriel

Empathize
01/23/21 7:27 PM PST

Gabriel Martinez
Oh wow, thanks.
Your avatar
What worsens the breathing problem?

Question
01/23/21 7:27 PM PST

Gabriel Martinez
Ummmm smokers. Smoke makes my breathing a lot worse.
Your avatar
Sorry about that

Empathize
01/23/21 7:28 PM PST

Gabriel Martinez
Ok, thanks.
Your avatar
Are you normally around smoke?

Question
01/23/21 7:28 PM PST

Gabriel Martinez
I try to stay away from it. But these new kids were smoking by the kickball field after school today.
Your avatar
It is good to stay away from anyone smoking

Educate
01/23/21 7:29 PM PST

Gabriel Martinez
I guess that makes sense.
Your avatar
What triggers your asthma?

Question
01/23/21 7:29 PM PST

Gabriel Martinez
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.
Your avatar
What action did you take after the asthma attacK

Question
01/23/21 7:30 PM PST

Gabriel Martinez
Well I . . . I guess I’m supposed to take my emergency inhaler, but . . . I threw it away. So we don’t have it anymore.
Your avatar
Ooh, you should always ensure you have the inhaler at a safe and accessible place

Educate
01/23/21 7:31 PM PST

Gabriel Martinez
Ohhh, yeah. Good . . . to . . . know.
Your avatar
What is the name of the inhaler you were using?

Question
01/23/21 7:31 PM PST

Gabriel Martinez
I dunno. I think my mom does.
Your avatar
Why did you throw away the inhaler?

Question
01/23/21 7:32 PM PST

Gabriel Martinez
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.
Your avatar
What are some of your son’s allergies? (No matching questions found.)

Question
01/23/21 8:09 PM PST

Your avatar
alleges? (No matching questions found.)

Question
01/23/21 8:09 PM PST

Your avatar
Any allergies?

Question
01/23/21 8:09 PM PST

Yvonne Martinez
I don’t, no. Just my son does. [AUDIO COMING SOON]
Your avatar
What allergies does your son have?

Question
01/23/21 8:10 PM PST

Yvonne Martinez
Pets, dust, pollen. He’s not allergic to any of the other obvious stuff. No food or medicine or latex or anything.
Your avatar
How does your son’s environmental allergies impact his asthma?

Question
01/23/21 8:11 PM PST

Yvonne Martinez
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.
Your avatar
It is always good to keep the allergy triggers away

Educate
01/23/21 8:12 PM PST

Yvonne Martinez
Yeah . . . Yeah, I get it. We’ll work on that.
Your avatar
Has your son been hospitalized before?

Question
01/23/21 8:13 PM PST

Yvonne Martinez
Yes, he went to the hospital a year ago, because of his asthma.
Your avatar
Sorry about that. Being hospitalized can really take a toll on any parent

Empathize
01/23/21 8:14 PM PST

Yvonne Martinez
Thank you for saying that.
Your avatar
Why was your son last hospitalized?

Question
01/23/21 8:14 PM PST

Yvonne Martinez
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.
Your avatar
Sorry about that ordeal.

Empathize
01/23/21 8:15 PM PST

Yvonne Martinez
Thank you. I’m . . . I’m just doing the best I can.
Your avatar
Please let him always keep away from triggers such as smoke

Educate
01/23/21 8:16 PM PST

Yvonne Martinez
Alright, I understand.
Your avatar
How does exercise impact your son’s asthma?

Question
01/23/21 8:16 PM PST

Yvonne Martinez
Too much exercise could trigger an asthma attack. He knows the rules. He can walk, but he isn’t supposed to run.
Your avatar
Does anyone in your family use tobacco?

Question
01/23/21 8:17 PM PST

Yvonne Martinez
No, none of us do.
Your avatar
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

Yvonne Martinez
That makes a lot of sense, thank you.
Your avatar
What is your childcare situation?

Question
01/23/21 8:18 PM PST

Yvonne Martinez
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.
Your avatar
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

Yvonne Martinez
Thank you for saying that.
Your avatar
What is your childcare situation?

Question
01/23/21 8:23 PM PST

Yvonne Martinez
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.
Your avatar
What health problems run in your family?

Question
01/23/21 8:23 PM PST

Yvonne Martinez
There’s nothing like asthma in the family. But my father has heart disease and my brother has diabetes.
Your avatar
Sorry about your father and brother’s conditions.

Empathize
01/23/21 8:24 PM PST

Yvonne Martinez
Thank you. I’m . . . I’m just doing the best I can.
Your avatar
Also sorry about your son’s asthma. He will get better.

Empathize
01/23/21 8:24 PM PST

Yvonne Martinez
Thanks, I appreciate that.
Your avatar
 Checked ID band

Exam Action
01/23/21 8:27 PM PST

Your avatar
 Assessed vitals

Exam Action
01/23/21 8:27 PM PST

Your avatar
 Auscultated top right chest breath sounds: normal breathing

Exam Action
01/23/21 11:10 PM PST

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 Auscultated top left chest breath sounds: normal breathing

Exam Action
01/23/21 11:10 PM PST

Your avatar
 Auscultated upper right chest breath sounds: normal breathing

Exam Action
01/23/21 11:10 PM PST

Your avatar
 Auscultated upper left chest breath sounds: normal breathing

Exam Action
01/23/21 11:10 PM PST

Your avatar
 Auscultated lower right chest breath sounds: normal breathing

Exam Action
01/23/21 11:10 PM PST

Your avatar
 Auscultated lower left chest breath sounds: normal breathing

Exam Action
01/23/21 11:10 PM PST

Your avatar
 Auscultated top left back breath sounds: normal breathing

Exam Action
01/23/21 11:10 PM PST

Your avatar
 Auscultated top right back breath sounds: normal breathing

Exam Action
01/23/21 11:10 PM PST

Your avatar
 Auscultated upper left back breath sounds: normal breathing

Exam Action
01/23/21 11:11 PM PST

Your avatar
 Auscultated upper right back breath sounds: normal breathing

Exam Action
01/23/21 11:11 PM PST

Your avatar
 Auscultated lower left back breath sounds: normal breathing

Exam Action
01/23/21 11:11 PM PST

Your avatar
 Auscultated lower right back breath sounds: normal breathing

Exam Action
01/23/21 11:11 PM PST

Your avatar
 Auscultated lower left chest breath sounds: normal breathing

Exam Action
01/23/21 11:11 PM PST

Your avatar
 Auscultated lower right chest breath sounds: normal breathing

Exam Action
01/23/21 11:11 PM PST

Your avatar
 Auscultated upper right chest breath sounds: normal breathing

Exam Action
01/23/21 11:11 PM PST

Your avatar
 Auscultated upper left chest breath sounds: normal breathing

Exam Action
01/23/21 11:11 PM PST

Your avatar
 Auscultated top left chest breath sounds: normal breathing

Exam Action
01/23/21 11:11 PM PST

Your avatar
 Auscultated top right chest breath sounds: normal breathing

Exam Action
01/23/21 11:11 PM PST

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 No abnormal findings

Exam Action
01/23/21 11:11 PM PST

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 Assessed dyspnea

Exam Action
01/23/21 11:13 PM PST

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 PAS Score: determine the PAS Score using the EHR tab

Exam Action
01/23/21 11:19 PM PST

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 Assessed growth

Exam Action
01/23/21 11:21 PM PST

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 Assessed vitals

Exam Action
01/23/21 11:23 PM PST

 

 

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