NR 509 Shadow Health Focused Exam Abdominal Education Empathy (NR509)

Exam (elaborations) NR 509 Shadow Health Focused Exam Abdominal Education Empathy (NR509) Education & Empathy : 6 of 7 (85.7%) 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 Symptoms Followed Up Description: Ms. Park describes the symptoms that have been bothering her. what bring you in today? Question 07:54 PM CDT I have pain in my belly. . . and I'm having some difficulty with going to the bathroom. My daughter was concerned. when did your pain start? Question 07:55 PM CDT NR 509 Shadow Health Focused Exam Abdominal Education Empathy The pain started as a general discomfort, about five days ago, when I started having the. . . difficulties going to the bathroom. I'm sorry to hear you are having pain and discomfort Empathize 07:56 PM CDT Thank you. where is your pain? Question 07:58 PM CDT The pain and discomfort is down low in my belly. can you point the location? Question 07:58 PM CDT Well my whole belly is uncomfortable to some degree, but it's mostly in the lower part, that's where the pain is. Down in my lower belly. are you in pain right now? Question 07:59 PM CDT Yes. . . it hurts now, like it has been. can you describe your pain? Question 07:59 PM CDT I'd say it's crampy and. . . a dull, crampy feeling. what is your pain level 0-10, 10 being worst? Question 08:00 PM CDT Right now. . . 6 out of 10. sorry to hear that you are in pain, Empathize 08:01 PM CDT Thank you. what make your pain relieve? (Clarified to: what relieves your pain) Question 08:01 PM CDT When I rest and try not to move much, I feel better. But the pain is still there. (Clarified to: what relieves the pain) what makes your pain worse? Question 08:02 PM CDT Moving around certainly doesn't help. Neither does eating. how often are your having pain? Question 08:03 PM CDT Oh, it's with me all the time. The bloating, too. But certain things do make it worse. what make your pain worse? Question 08:04 PM CDT Moving around certainly doesn't help. Neither does eating. how long have you had this problem? (Clarified to: how long have you been in pain) Question 08:05 PM CDT The pain started as a general discomfort, about five days ago, when I started having the. . . difficulties going to the bathroom. (Clarified to: how long I have been in pain) what were you doing 5 days ago? (Clarified to: What were you doing prior to the start of the pain?) Question 08:06 PM CDT I don't know what caused it. . . about five days ago, I started having difficult going to the bathroom. It came with a general uneasiness and a small amount of discomfort. Then the pain got much worse two-- maybe three--days ago. (Clarified to: what I was doing when the pain started) was the pain started sudden? Question 08:07 PM CDT No, it was gradual. I had some pain and discomfort about. . . five days ago. Then in the past few days it got much worse. how long does your pain last? Question 08:07 PM CDT The pain is there all the time, but it gets much worse at certain points--when I move around a lot or eat something, especially. I'm sorry to hear that, in order to figure out what cause your pain, I need to gather information and examining you Educate 08:09 PM CDT Thank you for explaining that. can you describe the diarrhea? Question 08:39 PM CDT It was very loose. Watery. what color was the diarrhea? Question 08:40 PM CDT It was brown, but thinned out. It was liquidy. Oof! I do not enjoy discussing this. sorry about you might not comfortable taking about this, but in order to figure something out, your information is very important Educate 08:42 PM CDT Thank you for explaining that. how are your bowel movement? Question 08:45 PM CDT My bowel movements are usually. . . what I assume one would call normal. Not too soft, a normal brown color. Fairly regular. how often are your bowel movement? Question 08:45 PM CDT Before this? Every day. Well, I miss a day now and then, but usually every day. although sounds little gross, your bowel can tell your health, so it's important to look shape, color, Educate 08:49 PM CDT Thank you for explaining that. when was last your bowel movement? Question 08:49 PM CDT That was a few days ago. When I had a digestive upset. Diarrhea. any discomfort with your last bowel movement? Question 08:50 PM CDT Yes, I have been very uncomfortable in my belly--my lower belly. It's been going on for almost a week. any changes the frequency of your urination? Question 08:51 PM CDT I've been going slightly less often because. . . well, I've been little less thirsty than usual. sorry to hear that Empathize 08:52 PM CDT Thank you. have you lost of appetite? Question 09:21 PM CDT I haven't been hungry. Eating only makes me feel worse. how long have you had decrease in appetite? Question 09:23 PM CDT It's been hard to eat since the belly pain got much worse, about two or three days ago. When I do eat-- my daughter Jennifer makes sure I have a little something--it only makes me feel worse. sorry to hear that Question 09:23 PM CDT Well, my hearing is not as good as a younger person's. But I hear well enough that I don't notice problems. sorry to hear that Empathize 09:23 PM CDT Thank you. Model Statement: "I’m sorry you’re having these symptoms. It’s good that you came in today so we can see what is causing your discomfort." 2 Medications Followed Up Description: Ms. Park describes her medication use and attitudes toward taking medication. Have you take any medication to relieve the pain? Question 08:18 PM CDT I'm not taking anything for it. what have you done to relieve the pain? Question 08:18 PM CDT I've tried taking small sips of warm water, resting. The warm water does nothing. A friend suggested it, but it's nonsense. I'm sorry to hear that it sounds nothing help your pain Empathize 08:26 PM CDT Thank you. do you take any medication? Question 10:04 PM CDT Just the medication for my blood pressure.