gastrointestinal

Digital Clinical Experience Score 99.3% Beginning Developing Proficient Subjective Data Collection 30 out of 30 Objective Data Collection 17 out of 18 Education and Empathy 2 out of 4 Interaction with patient 59 minutes Post-exam activities 8 minutes Time 67 minutes total spent in assignment Student Performance Index 49 out of 52 Proficiency Level: Proficient Students rated as “proficient” demonstrate an entrylevel expertise in advanced practice competencies and clinical reasoning skills. In comparable programs, the top 25% of students perform at the level of a proficient practitioner. Started: Mar 09, 2019 | Patient Exam Time: 59 min Transcript Overview Transcript Subjective Data Collection Objective Data Collection Education & Empathy Documentation Self-Reflection Student Survey Experience Overview All Lines (145) Interview Questions (73) Statements (13) Exam Actions (59) Greet 03/09/19 9:51 AM EST Question 03/09/19 9:51 AM EST Empathize 03/09/19 9:52 AM EST Question 03/09/19 9:52 AM EST Question 03/09/19 9:52 AM EST Question 03/09/19 9:52 AM EST Empathize 03/09/19 9:53 AM EST Question 03/09/19 9:53 AM EST Hi Tina, I am Juliana, the nurse practitioner student. I will interview and examine you today. Nice seeing you again. Hey. What brings you in? I've been having this stomach pain for awhile. It keeps coming back, and it really is starting to bother me. Sorry to hear you are having trouble with stomach pain. Let;s see if we can figure out what the problem is. Thanks for saying that. When did the stomach pain start? Probably at least a month ago. Maybe longer. It started out really minor so it took me awhile to realize it was getting bad. Can you describe the stomach pain? Um, it feels like heartburn. But sometimes, if it's bad, it's sharper than that. Does anything make the pain worse? Eating seems to cause it. Oh, what a burden! Hopefully you are not experiencing it all the time! I appreciate you telling me that. Do greasy foods make the pain worse? Question 03/09/19 9:53 AM EST Question 03/09/19 9:53 AM EST Question 03/09/19 9:54 AM EST Question 03/09/19 9:54 AM EST Empathize 03/09/19 9:54 AM EST Question 03/09/19 9:55 AM EST Question 03/09/19 9:55 AM EST I don't think so. What makes the pain worse? Eating seems to cause it. What makes the stomach pain better? I feel the best in-between meals. And sitting up on the couch seems to help. And sometimes I take an antacid. How often do you take antacids? I take them every few days. Just if the heartburn gets bad. How much do antacids help? Yeah, they help. I try to only take them when the pain seems worse than usual. I am glad to hear you are able to get some relief from the antacids Thanks. Does the stomach pain radiate? No, it's right in the center of my stomach, like between my belly button and my ribs. How often do you get stomach pain? It started really gradually, so I didn't notice for awhile that it was happening more and more often. Now it's like, every day. Empathize 03/09/19 9:55 AM EST Question 03/09/19 9:55 AM EST Question 03/09/19 9:56 AM EST Question 03/09/19 9:56 AM EST Empathize 03/09/19 9:56 AM EST Question 03/09/19 9:57 AM EST Question 03/09/19 9:59 AM EST It must be hard to have to deal with stomach pains daily. I appreciate you saying that. How long does the pain last? For a few hours after I eat. How would you rate the stomach pain from 0-10? Right now, it's like a 1 or 2. But after I eat, it's like a. . . 5? How long does the stomach pain last? For a few hours after I eat. A daily pain of 5/10 is a lot to deal with. Thanks for understanding. Does the pain interfere with your life? (Clarified to Has the pain affected your usual activities?.) Not too much. I'm still able to do everything with work and school. But it affects the way I eat -- I haven't wanted to eat much, because I feel like it's gonna hurt if I eat the wrong thing, or if I eat too much at one time. (Clarified to if my pain has affected my activities.) What foods make it worse? Question 03/09/19 9:59 AM EST Empathize 03/09/19 10:00 AM EST Question 03/09/19 10:00 AM EST Empathize 03/09/19 10:01 AM EST Educate 03/09/19 10:01 AM EST Question 03/09/19 10:01 AM EST Question 03/09/19 10:02 AM EST Definitely spicy food. I stopped eating anything spicy. And any really big meal makes it hurt worse. How does the stomach pain affect your appetite? Yes. Every time I eat it hurts. I've been eating less because I don't like being in pain. I am surprised you havent lost more weight. Lets come up with a plan to address it Thanks for saying that. Has the stomach pain caused weight loss? Yeah, I've been trying to eat really little meals. I haven't been that hungry, and I don't want to have the pain of eating a big meal. I completely understand. Thanks for understanding. Eating smaller meals and making some diet modifications can help with these symptoms. That makes sense. Have you lost weight? No, I don't think so. Have you been burping lately? Yeah, that's been happening after I eat. Question 03/09/19 10:02 AM EST Question 03/09/19 10:02 AM EST Question 03/09/19 10:02 AM EST Question 03/09/19 10:02 AM EST Question 03/09/19 10:02 AM EST Question 03/09/19 10:03 AM EST Question 03/09/19 10:03 AM EST DO you have any allergies? Yeah, I'm allergic to cats. What is your reaction to cat allergies? Whenever I'm around cats, I start sneezing, my eyes get itchy. . . and my asthma starts to act up. Do you have medication allergies? Yeah, I'm allergic to penicillin. What is your reaction to penicillin? I don't remember that well because the last time I had penicillin I was pretty little. . . I think I got a rash, like, hives. The doctor told me not to take it again after that. Do you have any trouble breathing? Well, I have asthma, but I haven't had much trouble with it. With my inhaler, it's under control. What medications do you currently take? I have a daily inhaler. And I've been taking antacid chews sometimes for my stomach, too. Do you take any other over the counter medications? No, the only thing lately has been those antacid chews. How often do you use the antacid chews Question 03/09/19 10:03 AM EST Question 03/09/19 10:04 AM EST Question 03/09/19 10:04 AM EST Question 03/09/19 10:04 AM EST Question 03/09/19 10:05 AM EST Empathize 03/09/19 10:05 AM EST Question 03/09/19 10:05 AM EST I take them every few days. Just if the heartburn gets bad. Do you drink alcohol? Not lately, but I do every so often. How much alcohol do you drink per month? I only go out 2 or 3 times a month at the most. I haven't been out in a couple weeks. How many drinks do you have per month? We're talking, like... maybe twice a month, I meet up with friends and have 2 to 3 drinks. That's like, 6 a month. And I haven't had a drink in at least 2 weeks. DO you smoke? No, I've never smoked a cigarette in my life. Good for you! Thanks. Do you use recreational drugs? Yeah, in high school and a little after that I smoked pot sometimes. But I haven't done anything like that in a long time. Question 03/09/19 10:05 AM EST Question 03/09/19 10:06 AM EST Question 03/09/19 10:06 AM EST Question 03/09/19 10:06 AM EST Question 03/09/19 10:06 AM EST Question 03/09/19 10:07 AM EST Question 03/09/19 10:07 AM EST Do you have a history of gastrointestinal problems? I don't have a history of gastrointestinal problems. I've never experienced this before. [AUDIO COMING SOON] Are you constipated? I don't have that problem. Do you have regular bowel movements? Um, I don't go every day... I probably go every two days. That's normal for me. Do you have regular urination? Well. . . I would say I've been peeing a lot more lately. When did you start peeing a lot more? I guess it started. . . maybe a few months? But I've been drinking a lot more water, too. Have you been more thirsty? You know, I did notice lately that I've been really thirsty. When did you last have a bowel movement? I haven't gone yet today, but I did last night. Question 03/09/19 10:07 AM EST Question 03/09/19 10:08 AM EST Question 03/09/19 10:08 AM EST Question 03/09/19 10:08 AM EST Question 03/09/19 10:08 AM EST Question 03/09/19 10:08 AM EST Empathize 03/09/19 10:09 AM EST Question 03/09/19 10:09 AM EST Do you have loose stools? No. Do you have blood in the stools? Um, no. Have you had diarrhea? No. Have you had a lot of gas? (Clarified to Do you feel gassy?.) No. (Clarified to if I am gassy.) Do you feel nauseous? No, I'm fine. Do you feel dizzy? No, I'm not dizzy but I feel pretty crappy. I am sorry to hear you feel this way! I appreciate you saying that. Do you have regular periods? Question 03/09/19 10:09 AM EST Question 03/09/19 10:09 AM EST Question 03/09/19 10:09 AM EST Question 03/09/19 10:10 AM EST Question 03/09/19 10:10 AM EST Question 03/09/19 10:10 AM EST Question 03/09/19 10:11 AM EST It's not regular. Sometimes it's every month, but sometimes it's more like every two months. I don't write it down or anything. I probably get...six periods a year. Are you sexually active? Um, not right now. When was your last meal? This morning, I had breakfast at home. What did you eat for breakfast? This morning, I had toast with butter and honey, and some orange juice. Did your breakfast cause pain? (No matching questions found.) What did you eat in the last 24 hours? Um ...Yesterday, I had ... Let me start at breakfast. I had a bowl of cereal. For lunch ... I had a piece of pizza. For dinner, I made baked potatoes with broccoli and cheese soup. This morning I had toast with butter and honey, and some orange juice, and that's the last thing I've had. What is your typical diet like? It's pretty good, I think. I'm not a huge health nut or anything. What do you usually eat for breakfast? Question 03/09/19 10:11 AM EST Question 03/09/19 10:11 AM EST Question 03/09/19 10:11 AM EST Question 03/09/19 10:11 AM EST Question 03/09/19 10:11 AM EST Question 03/09/19 10:12 AM EST I usually have either cereal or toast, or if I pick something up on my way to work, I'll get a muffin or some pumpkin bread. What do you usually eat for lunch? I usually either make a sandwich and bring it with me, or I get a sandwich somewhere. And I have chips or pretzels with it. Or *maybe* French fries, but I try not to get them too often. WHat do you usually eat for dinner? Oh, we try to make something easy. We eat a lot of frozen chicken breasts. We do hamburgers that we make at home every so often. We make sure we have a vegetable, and we eat a lot of potatoes. And we usually have rolls or something. What do you usually eat for snacks? Well, if I'm at home, I would have pretzels or chips. Or crackers, whatever we had around. If I'm on my way to work or campus... sometimes I stop and get a small thing of French fries at Sonic. What do you like to drink? Most of t