(Answered) NURS-6512N-48 Week 5: Assignment 2 DIGITAL CLINICAL EXPERIENCE: FOCUSED EXAM: COUGH

COURSE  

NURS-6512N-48 Advanced Health Assessment

In this DCE Assignment, you will conduct a focused exam related to cough in your DCE using the simulation tool, Shadow Health. You will determine what history should be collected from the patient, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions.

TO PREPARE

  • Review this week’s Learning Resources and consider the insights they provide related to ears, nose, and throat.
  • Review the Shadow Health Resources provided in this week’s Learning Resources specifically the tutorial to guide you through the documentation and interpretation within the Shadow Health platform. Review the examples also provided.
  • Review the DCE (Shadow Health) Documentation Template for Focused Exam: Cough found in this week’s Learning Resources and use this template to complete your Documentation Notes for this DCE Assignment.
  • Access and login to Shadow Health using the link in the left-hand navigation of the Blackboard classroom.
  • Review the Week 5 Focused Exam: Cough Rubric provided in the Assignment submission area for details on completing the Assignment in Shadow Health.
  • Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?

FOCUSED EXAM: COUGH ASSIGNMENT:

Complete the following in Shadow Health:

  • Respiratory Concept Lab (Required)
  • Episodic/Focused Note for Focused Exam: Cough
  • HEENT (Recommended but not required)

ANSWER  

Episodic/Focused SOAP Note Template

Patient Information:

Initials D. R, Age, Sex M  Race Caucasian

S.

Chief Complaint (CC): Reports cough, runny nose, sore throat, and right ear pain. History of Present Illness

(HPI):

Reports cough started five days ago with coughing every few minutes. Reports cough is wet and clear sputum and worse at night. A runny nose is frequent with thin clear discharge. Pain in the right ear is a 3/10 that started after the cough with nasal discharge from the ear. Throat has now become sore with mild pain when swallowing. Medications: Pt. denies daily prescriptions. He takes a daily OTC multivitamin. Today his mother gave him a cough medication that temporarily relieved the symptoms he was experiencing.

Allergies: No known allergies to food, medication, or latex.…….please click the icon below to access entire answer at $15