Exam (elaborations) NR 509 Asthma Respiratory Completed Shadow Health

Exam (elaborations) NR 509 Asthma Respiratory Completed Shadow Health All Lines (297) Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM Question 07/21/18 11:19 PM CDT Empathize 07/21/18 11:20 PM CDT Educate 07/21/18 11:22 PM CDT Question 07/21/18 11:22 PM CDT Question 07/21/18 11:22 PM CDT Question 07/21/18 11:22 PM CDT Question 07/21/18 11:23 PM CDT Question 07/21/18 11:23 PM CDT You can't get enough air in to your lungs? (No matching questions found.) I'm sorry, thats a terrible feeling. Thanks for saying that. I know that we have been through these same set of questions, so I'm sorry I'm going to ask them again. I'm not really insulting your intelligence, although it may seem like I am. Alright, thanks for letting me know. When did your breathing issues begin? All of these breathing problems started two days ago, at my cousin's house. Were you around cats? Two days ago, at my cousin's house. She has three of them, and my asthma always goes crazy when I'm there. Because your allergic to cats, right? Definitely. Cats make my asthma go crazy. How long were you exposed to these cats? (No matching questions found.) Has your asthma gotten worse since you were exposed to the cats? Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM Question 07/21/18 11:24 PM CDT Question 07/21/18 11:24 PM CDT Question 07/21/18 11:25 PM CDT Question 07/21/18 11:25 PM CDT Question 07/21/18 11:26 PM CDT Question 07/21/18 11:26 PM CDT Question 07/21/18 11:27 PM CDT No, my asthma has definitely got better since I was little. It used to be really bad--I would get asthma attacks all the time. Just lately, though, it's been worse than usual. Did anything make you asthma feel better? (No matching questions found.) Your inhaler didn't help your asthma? (Clarified to what do you do if your inhaler doesn't work.) I guess I don't really have a backup plan; it's always worked in the past, though lately I've needed more puffs than usual. How many puffs do you need? Sometimes I have to take three puffs instead of two, and the past couple days, always three. [Nurse confirmed with Pharmacy: albuterol 90mcg/spray MDI] How many times did you use your inhaler the past two days? (Clarified to how many times have you used your inhaler in the past two days.) I've been needing my inhaler about every four hours, I'd say. What have you done to treat your asthma? (Clarified to how do you manage your asthma.) I try to avoid things that give me breathing problems, but when my asthma starts to act up, I just use my inhaler. Why didn't you avoid the cats this time? I haven't been sleeping as well because my asthma has been getting a little worse at night, and it's been waking me up, too. How many times to you wake up with asthma? Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM Question 07/21/18 11:27 PM CDT Question 07/21/18 11:28 PM CDT Question 07/21/18 11:28 PM CDT Question 07/24/18 11:37 AM CDT Question 07/24/18 11:39 AM CDT Question 07/24/18 11:41 AM CDT Empathize 07/24/18 11:42 AM CDT I feel like I've woken up at least twice each night with breathing problems the past two nights. Are you able to fall back asleep? (No matching questions found.) Have you been sick lately? No, I'm usually healthy. Have you been exposed to any dust lately? No. . . I'm not around dust much. It mostly happens if I'm at someone's house and they don't keep it very clean, and that hasn't happened in a while. How often have you been having trouble breathing? Maybe as much as every four hours? It's a lot. When is the last time you were hospitalized because of an asthma attack? I used to go to the hospital a lot for asthma attacks, but not since I was sixteen. What have you done to avoid hospitalizations due to asthma? (No matching questions found.) That's awesome - to be able to avoid going to the hospital since 16 years old. I appreciate you saying that. Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM Question 07/24/18 11:42 AM CDT Question 07/24/18 11:42 AM CDT Question 07/24/18 11:43 AM CDT Question 07/24/18 11:44 AM CDT Question 07/24/18 11:44 AM CDT Question 07/24/18 11:45 AM CDT Question 07/24/18 11:46 AM CDT How have you been treating your asthma? I try to avoid things that give me breathing problems, but when my asthma starts to act up, I just use my inhaler. How often have you been using your inhaler lately? I don't usually use it every day, but I've used it a bunch the past couple days. How many times a day do you sue your inhaler? I don't usually use it every day, but I've used it a bunch the past couple days. How many puffs do you need to help you breath better? (Clarified to How many inhaler puffs do you need.) Sometimes I have to take three puffs instead of two, and the past couple days, always three. [Nurse confirmed with Pharmacy: albuterol 90mcg/spray MDI] How many inhaler puffs are you prescribed? I'm supposed to just do two puffs. [Nurse confirmed with Pharmacy: albuterol 90mcg/spray MDI] How effective has your inhaler been? (No matching questions found.) Is your inhaler been functioning abnormally lately? I don't usually use it every day, but I've used it a bunch the past couple days. Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM Question 07/24/18 11:46 AM CDT Question 07/24/18 11:47 AM CDT Question 07/24/18 11:48 AM CDT Question 07/24/18 11:48 AM CDT Question 07/24/18 11:49 AM CDT Question 07/24/18 11:50 AM CDT Question 07/24/18 11:51 AM CDT Do you use any other medications for your asthma? My inhaler is the only prescription I always have, but I usually don't need it everyday, except for recently. . . Do you take any other medications? (Clarified to are you taking other medications.) No, all I really use is my inhaler. Have you ever been prescribed with a corticosteroid? Yeah, when I was diagnosed they gave me a medicine to try. What medication did they give you when you were first diagnosed with asthma? (Clarified to how old were you when you were diagnosed with asthma.) My doctor told me when I was pretty little... I think I was about two and a half? I used to have a lot of trouble with asthma attacks back then. Which medication did your doctor first diagnosed with asthma? (No matching questions found.) Which medications have you tried for asthma in the past? It's just a regular Proventil inhaler. Do you get asthma symptoms when you exercise? (Clarified to Do you have asthma when you exercise.) Well, I don't exercise, really. I mean, I'm active -- I'm on my feet all day -- but I don't go running or stuff like that. I bet I'd get winded pretty fast, and I'd probably need my inhaler. Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM Question 07/24/18 11:51 AM CDT Question 07/24/18 11:53 AM CDT Question 07/24/18 11:54 AM CDT Empathize 07/24/18 12:00 PM CDT Question 07/24/18 12:00 PM CDT Question 07/24/18 12:01 PM CDT Question 07/24/18 12:01 PM CDT Question 07/24/18 12:02 PM CDT Do you get winded while going up a flight of stairs? (Clarified to Do you get short of breath when you go up a flight of stairs?.) Only when I'm in a rush and have to hurry up them. Do you have shortness of breath while doing normal activities around the house? It's definitely been harder to move around without worrying my asthma was going to act up again. Have you ever had an asthma attack that was so severe that you nearly died? (Clarified to How many asthma attacks have you had.) I haven't had a full attack, but I've had a lot of breathing problems-- probably. . . ten times since I was at my cousin's house two days ago. I'm sorry, that's rough and a but scary. Thanks for saying that. Are you experiencing any chest pain? My chest has been feeling tight, but it doesn't hurt or anything. Do you feel increased tightness when you take a slow deep breath? (No matching questions found.) Do you have an increase in chest tightness when you take a deep breath? (Clarified to do you have pain when you breathe.) No, my chest feels tight when I have breathing problems, but it doesn't hurt. On a scale from 0 to 10, ten being the worst chest tightness you've ever felt, how would you rate your chest tightness right now? Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM Question 07/24/18 12:04 PM CDT Question 07/24/18 12:04 PM CDT Question 07/24/18 12:11 PM CDT Question 07/24/18 12:41 PM CDT Question 07/24/18 12:43 PM CDT Question 07/24/18 12:43 PM CDT It doesn't hurt. . . it's just hard to breathe, but there's no pain. Have you had any coughing fits lately? I've been coughing a lot, yeah. When do you usually cough the most? I've been coughing all day, but. . . I guess it gets a little worse at night. Does your coughing get worse any time you lay down? Yeah, it's like, as soon as I lie down in bed the cough gets worse. It's making it harder to sleep. When did your asthma symptoms start? I think I was about two and a half? I used to have a lot of trouble with asthma attacks back then. How many times have you had breathing problems in the past two days? Well. . . it's kind of hard to count because my breathing's been at least a little bad most of the past two days, but it's really acted up, like with wheezing and everything, probably every four hours or so--like five times each day. Is you asthma keeping you up at night? My asthma doesn't usually wake me up, but it has the past couple nights. Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM Question 07/24/18 12:44 PM CDT Question 07/24/18 12:44 PM CDT Question 07/24/18 12:45 PM CDT Question 07/24/18 12:45 PM CDT Question 07/24/18 12:46 PM CDT Question 07/24/18 12:47 PM CDT How many times do you wake up during the night? I feel like I've woken up at least twice each night with breathing problems the past two nights. How severe is your asthma? My asthma used to be really scary. I haven't had a full attack in years, and if you had asked me before this I would have said my asthma wasn't that bad anymore, but the last couple days I've had a lot of trouble breathing. Is there anything you can't do because of your asthma? There usually isn't anything I can't do because of my asthma. . . I guess I try to avoid things that make my breathing worse, but that's about it. The past couple days, though, it's been hard to do anything. Have you missed work because of your asthma? (Clarified to Have you had to miss work because of your asthma?.) Luckily I haven't been expected in at work the past two days, or else I probably would have had to call in sick. . . my asthma's never kept me home from work before this, though. Have you had to miss school because of your asthma? (Clarified to Have you had to miss work because of your asthma?.) Luckily I haven't been expected in at work the past two days, or else I probably would have had to call in sick. . . my asthma's never kept me home from work before this, though. Has your chest been tight these past two days? (Clarified to how many days has your chest felt tight in the past week.) Just the past two days, since I was around those cats. Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM Question 07/24/18 12:47 PM CDT Question 07/24/18 12:48 PM CDT Question 07/24/18 12:48 PM CDT Question 07/24/18 12:50 PM CDT Question 07/24/18 12:51 PM CDT Question 07/24/18 12:51 PM CDT Question 07/24/18 12:52 PM CDT How bad is your chest tightness right now? It's not so bad right this second, but it's been pretty tight lately, like I can't take in air. Why is your chest tightness feeling a little better right this second? It's not so bad right this second, but it's been pretty tight lately, like I can't take in air. Did you do anything to help relieve your chest tightness? (No matching questions found.) How do you relieve your chest tightness? Once my asthma starts to act up, I just use my inhaler, and then I feel better within a minute or two. How would you describe your cough? Um. . . I guess I'd describe it as a small, dry cough. Have you tried anything to treat your cough? I haven't taken medicine for it or anything. Does laying down on your back make your cough worse? Yeah, it's like, as soon as I lie down in bed the cough gets worse. It's making it harder to sleep. Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM Educate 07/24/18 12:58 PM CDT Question 07/24/18 12:58 PM CDT Empathize 07/24/18 12:59 PM CDT Question 07/24/18 12:59 PM CDT Question 07/24/18 12:59 PM CDT Question 07/24/18 12:59 PM CDT Question 07/24/18 1:00 PM CDT Try to make sure that when you lay down, you elevate your shoulders, neck and head at a slight angle. Use two pillows or you can buy a wedge on Amazon that will sit you up ever so slightly - like 20 degrees to 30 degrees. This will help your cough calm down at night, allow you to get a better nights sleep. It even helps with those who have heart failure, congestion sometimes, and obstructive sleep apnea. That makes sense. It sounds like you need more rest. I'm sorry you've struggled sleeping ad breathing at night. I hope this helps. (No matching questions found.) It sounds like you need more rest. I'm sorry you've struggled sleeping ad breathing at night. I hope this helps. Thanks for understanding. Have you had any congestions lately? No, congestion isn't the problem. Any sinus pain? Nope. Any headaches lately? Yeah, I get them a lot when I'm studying. Are your headaches related to your asthma? (Clarified to is your asthma related to your allergies.) I guess so. . . it's worst around cats, and sometimes I also get breathing problems when I'm around a lot of dust. Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM Question 07/24/18 1:00 PM CDT Question 07/24/18 1:01 PM CDT Question 07/24/18 1:02 PM CDT Question 07/24/18 1:03 PM CDT Exam Action 07/24/18 1:05 PM CDT Exam Action 07/24/18 1:05 PM CDT Exam Action 07/24/18 1:05 PM CDT Exam Action 07/24/18 1:06 PM CDT Do you have seasonal allergies? A little while ago, I had some seasonal allergies, but it didn't really bother my asthma, and it's better now. What makes your asthma worse? For the last two days, it seems worse at night when I'm lying down, or when I'm moving around too much. Typically it's stuff like cats or dust that gets to me. What is the most severe cause of your allergies? No, never anything severe, unless my asthma acting up around cats counts. Ok, I'm going to do a physical examination, if that's all right with you? Sure. Inspected anterior chest wall Inspected right side chest wall Inspected posterior chest wall Inspected left side chest wall Respiratory | Completed | Shadow Health 7/26/18, 2)22 PM Exam Action 07/24/18 1:06 PM CDT Exam Action 07/24/18 1:06 PM CDT Exam Action 07/24/18 1:06 PM CDT Exam Action 07/24/18 1:06 PM CDT Exam Action 07/24/18 2:36 PM CDT Exam Action 07/24/18 2:54 PM CDT Exam Action 07/24/18 2:54 PM CDT Exam Action 07/24/18 2:54 PM CDT Exam Action 07/24/18 2:54 PM CDT Exam Action 07/24/18 2:54 PM CDT Exam Action 07/24/18 2:54 PM CDT Inspected posterior chest wall Inspected left side chest wall Inspected anterior chest wall Palpated chest expansion: Both sides rise symmetrically Palpated fremitus in anterior upper chest wall: Equal bilaterally, exp