SHADOW HEALTH - TINA JONES, HEALTH
HISTORY LATEST UPDATE
Medications -Albuterol MDI, 2 puffs every 4 hours as needed for wheezing
Acetaminophen 325 mg tabs by mouth, 2 tabs every 4 hours as needed for fever greater than 38.6C
/101.5F
Clindamycin 600mg/50ml every 6 hours intravenously
0.9 NaCl intravenously 100 ml/hr continuously x2 Liters
Lortab 5mg 1-2 tabs by mouth as needed for pain
Oxycodone 5mg 1 tab by mouth as needed
Insulin glargine 10 units at bedtime
Health History Tips & Tricks: -
Student: Hello! -Diana Shadow: Hi. I'm Preceptor Diana. I will explain the details of this assignment and
your objectives, just as a preceptor would in real life. Pay close attention to this information as it will
help guide your exam. At the end of this prebrief, you will answer a short question about the upcoming
assignment. During the simulation, you may return to these instructions at any time by scrolling to the
top of your transcript.
Student: What is the situation? -Diana Shadow: Your patient is Tina Jones:, a 28-year-old African
American woman who has just been admitted to Shadow General Hospital for a painful foot wound.
Your role in this simulation is that of a healthcare provider who will take Ms. Jones' health history, a key
component of her admission process.
Student: What are my objectives in this assessment? -Diana Shadow: A health history requires you to
ask questions related to Ms. Jones' past and present health, from her current foot wound to her pre-
existing conditions. You will also want to review Ms. Jones' systems, psychosocial history, and family
medical history. These assessments together will give you a comprehensive picture of Ms. Jones' overall
health. If you discover any disease states, ask about symptoms and the patient's experiences of them.
Your questioning should cover a broad array of the symptoms' characteristics. Throughout the
conversation, you should educate and empathize with Ms. Jones when appropriate to increase her
health literacy and sense of well-being. Regardless of whether you have assessed Ms. Jones previously,
ask all questions that are necessary for obtaining a complete health history. While you should
communicate with patients using accessible, everyday language, it is standard practice to use
professional medical terminology everywhere else, such as in documenting physical findings and nursing
notes. You may complete the exam activities in any order and move between them as needed. After
,obtaining Ms. Jones' health history, you will complete an information processing activity. You will
identify and prioritize diagnoses, then create a plan to address the identified diagnoses.
Student: What else will this exam involve? -Diana Shadow: You will complete nursing tasks to protect
the patients safety, privacy, and health. You can document your findings, including vital signs, in the
Electronic Health Record. This record provides necessary information for healthcare professionals who
will continue patient care. Besides Subjective Data Collection, and Education and Empathy, there are
activities within the simulation that provide valuable practice for their real-world counterparts, but they
are not automatically graded by the simulation.
Student: How will I be evaluated? -Diana Shadow: In this assignment, you will be evaluated on your
Subjective Data Collection, as well as your Education and Empathy. Your success in Education and
Empathy is based on whether you promptly respond after identifying a moment worthy of therapeutic
communication. The evaluation of your interview is dependent on how you word your questions
therapeutically and precisely and explore all relevant topics with comprehensive breadth and depth. You
will also be evaluated on your ability to collect data and form nursing diagnoses in the information
processing activity. This assignment takes on average between 90 and 110 minutes. This exam may take
longer than in real life, because in this safe simulation, students of all experience levels can take time to
hone and review their skills. You can pause and resume the assignment at any time; your work is always
saved automatically.
Student: How does this assignment prepare me for the real world? -Diana Shadow: In this assessment,
you will become familiarized with the structure and content of a health history exam so that with real-
life patients, you can: º ask effective and comprehensive questions º obtain a thorough health history º
evaluate the patient's risk of disease, infection, injury, and complications º educate and empathize º
reflect on your experience and identify areas to improve º identify and prioritize nursing diagnoses º and
develop a plan to address nursing diagnoses.
Diana Shadow: In 1 or 2 sentences, answer this question to help prepare for the upcoming exam: Why is
it important to obtain a patient's complete health history? -Student: Getting a complete health history
enables the nurse to make informed judgments about the client including formulating nursing diagnoses
requiring nursing care, identifying collaborative problems requiring interdisciplinary care, medical issues
requiring immediate referral, and the need for client teaching.
Diana Shadow: Time to begin. -
Patient Exam - Vital Signs: -Height: 170 cm, Weight: 90 kg, BMI: 31, Random blood glucose: 238,
Temperature: 102.4° F, Blood pressure: 138/90 mmHg, Heart rate: 90, Respiratory rate: 18, O2 sat: 98%
Patient Exam - Interview: -
Student: Hello, my name is Rachel and I am your nurse today. -Tina Jones: Hey.
Student: Can you confirm your name? -Tina Jones: Tina Jones:.
,Student: What brings you in today? -Tina Jones: I got this scrape on my foot a while ago, and it got really
infected. It's killing me.
Student: Where is your wound located? -Tina Jones: It's on the ball of my foot.
Student: Which foot is injured? -Tina Jones: My right foot.
Student: I'm sorry to hear that. I'm glad you came in to get your foot evaluated. -Tina Jones: Thanks a
lot.
Student: Can you tell me how you scraped your foot? -I was changing a light bulb, and I had to use our
little stepstool to reach it. My foot slid off the bottom step and it got all scraped up. I didn't realize how
sharp the edge was!
Student: Can you rate your current pain level on a scale of 0 to 10? -Tina Jones: ...Like a 7. It hurts a lot,
but whatever pain med the ER gave me is helping a little bit.
Student: Can you describe the pain? -Tina Jones: It's throbbing and like, sharp if I try to put weight on it.
Student: Have you had any other symptoms? -Tina Jones: I mean, it's all red and swollen, and there's
pus, it feels hot, it hurts like hell... It's got all that going on.
Student: When did you first notice the pus? -Tina Jones: I noticed it about 2 days ago.
Student: What color was the pus? -Tina Jones: It's... white or maybe off-white.
Student: Did your foot bleed? -Tina Jones: It bled a little after I injured it.
Student: How have you been treating your foot? -Tina Jones: I made sure to clean it and keep it
bandaged. And I put Neosporin on it.
Student: How have you treated the wound? -Tina Jones: I've been taking Advil for my foot for a few
days.
Student: Was the Neosporin effective? -Tina Jones: Well, I'm here, so I guess it didn't do its job.
Student: Can you walk on your injured foot? -Tina Jones: No, I can't. I can't put any weight on it without
like, shooting pain.
Student: How effective was your pain medication at home? -Tina Jones: Whatever pain medication the
ER gave me is helping. Before I came in, I was just taking Advil. For the past few days, the Advil wasn't
doing much for me -- it would only last a couple of hours.
Student: Have you had any fever at home? -Tina Jones: Yeah, I started to have one yesterday, and then
it was a little better this morning. It kinda crept up all day.
Student: Do you have any preexisting medical conditions? -Tina Jones: I mean, I have asthma and
diabetes, but right I now I just care about my foot!
, Student: I understand your foot hurts. We have to ask a lot of questions, but it's to ensure we treat your
injury and anything else that could contribute to the problem. -Tina Jones: That's kind of you.
Student: When were you diagnosed with diabetes? -Tina Jones: I was diagnosed when I was 24.
Student: How do you manage your asthma? -Tina Jones: I try to avoid things that give me breathing
problems, but when my asthma starts to act up, I just use my inhaler.
Student: What medications did you take for your diabetes? -Tina Jones: It was metformin.
Student: Do you currently take medicine for your diabetes? -Tina Jones: No, I don't take anything for my
diabetes anymore.
Student: What made you stop taking medication for your diabetes? -Tina Jones: I guess I just got sick of
feeling sick and gassy all the time, and it was overwhelming, remembering to take pills and check my
sugar. I feel a lot better now that I'm just eating healthier than I did when I was taking the pills.
Student: Do you monitor your blood glucose? -Tina Jones: I have a monitor at home, but to be honest I
don't really use it that often.
Student: Do you get thirsty often? -Tina Jones: You know, I did notice lately that I've been really thirsty.
Student: How frequently do you urinate? -Tina Jones: I don't know. Every hour or two when I'm awake?
Student: What is your current diet? -Tina Jones: It's pretty good, I think. I'm not a huge health nut or
anything.
Student: Have you had a change in appetite? -Tina Jones: Yeah, lately I've definitely been much hungrier
than usual.
Student: Have you had any changes in your weight? -Tina Jones: Yeah, I've lost some weight recently.
Student: Do you know what caused your weight loss? -Tina Jones: I don't know what caused it, I just lost
weight.
Student: How often do you have asthma exacerbations? -Tina Jones: I haven't had a full attack in years.
But my breathing definitely acts up. . .not always. Max twice a week.
Student: What asthma symptoms have you experienced? -Tina Jones: My chest and throat get tight, and
I start to wheeze. It feels like I can't take in air, like I can't get enough air into my lungs.
Student: Does anything else worsen your asthma? -Tina Jones: Cats are the worst for my asthma--no
matter what, if I'm around cats, my breathing gets bad. But sometimes it gets bad from being around
dust or having to run upstairs, too.
Student: Do you have a rescue inhaler? -Tina Jones: Yeah, I use it when my asthma acts up.
HISTORY LATEST UPDATE
Medications -Albuterol MDI, 2 puffs every 4 hours as needed for wheezing
Acetaminophen 325 mg tabs by mouth, 2 tabs every 4 hours as needed for fever greater than 38.6C
/101.5F
Clindamycin 600mg/50ml every 6 hours intravenously
0.9 NaCl intravenously 100 ml/hr continuously x2 Liters
Lortab 5mg 1-2 tabs by mouth as needed for pain
Oxycodone 5mg 1 tab by mouth as needed
Insulin glargine 10 units at bedtime
Health History Tips & Tricks: -
Student: Hello! -Diana Shadow: Hi. I'm Preceptor Diana. I will explain the details of this assignment and
your objectives, just as a preceptor would in real life. Pay close attention to this information as it will
help guide your exam. At the end of this prebrief, you will answer a short question about the upcoming
assignment. During the simulation, you may return to these instructions at any time by scrolling to the
top of your transcript.
Student: What is the situation? -Diana Shadow: Your patient is Tina Jones:, a 28-year-old African
American woman who has just been admitted to Shadow General Hospital for a painful foot wound.
Your role in this simulation is that of a healthcare provider who will take Ms. Jones' health history, a key
component of her admission process.
Student: What are my objectives in this assessment? -Diana Shadow: A health history requires you to
ask questions related to Ms. Jones' past and present health, from her current foot wound to her pre-
existing conditions. You will also want to review Ms. Jones' systems, psychosocial history, and family
medical history. These assessments together will give you a comprehensive picture of Ms. Jones' overall
health. If you discover any disease states, ask about symptoms and the patient's experiences of them.
Your questioning should cover a broad array of the symptoms' characteristics. Throughout the
conversation, you should educate and empathize with Ms. Jones when appropriate to increase her
health literacy and sense of well-being. Regardless of whether you have assessed Ms. Jones previously,
ask all questions that are necessary for obtaining a complete health history. While you should
communicate with patients using accessible, everyday language, it is standard practice to use
professional medical terminology everywhere else, such as in documenting physical findings and nursing
notes. You may complete the exam activities in any order and move between them as needed. After
,obtaining Ms. Jones' health history, you will complete an information processing activity. You will
identify and prioritize diagnoses, then create a plan to address the identified diagnoses.
Student: What else will this exam involve? -Diana Shadow: You will complete nursing tasks to protect
the patients safety, privacy, and health. You can document your findings, including vital signs, in the
Electronic Health Record. This record provides necessary information for healthcare professionals who
will continue patient care. Besides Subjective Data Collection, and Education and Empathy, there are
activities within the simulation that provide valuable practice for their real-world counterparts, but they
are not automatically graded by the simulation.
Student: How will I be evaluated? -Diana Shadow: In this assignment, you will be evaluated on your
Subjective Data Collection, as well as your Education and Empathy. Your success in Education and
Empathy is based on whether you promptly respond after identifying a moment worthy of therapeutic
communication. The evaluation of your interview is dependent on how you word your questions
therapeutically and precisely and explore all relevant topics with comprehensive breadth and depth. You
will also be evaluated on your ability to collect data and form nursing diagnoses in the information
processing activity. This assignment takes on average between 90 and 110 minutes. This exam may take
longer than in real life, because in this safe simulation, students of all experience levels can take time to
hone and review their skills. You can pause and resume the assignment at any time; your work is always
saved automatically.
Student: How does this assignment prepare me for the real world? -Diana Shadow: In this assessment,
you will become familiarized with the structure and content of a health history exam so that with real-
life patients, you can: º ask effective and comprehensive questions º obtain a thorough health history º
evaluate the patient's risk of disease, infection, injury, and complications º educate and empathize º
reflect on your experience and identify areas to improve º identify and prioritize nursing diagnoses º and
develop a plan to address nursing diagnoses.
Diana Shadow: In 1 or 2 sentences, answer this question to help prepare for the upcoming exam: Why is
it important to obtain a patient's complete health history? -Student: Getting a complete health history
enables the nurse to make informed judgments about the client including formulating nursing diagnoses
requiring nursing care, identifying collaborative problems requiring interdisciplinary care, medical issues
requiring immediate referral, and the need for client teaching.
Diana Shadow: Time to begin. -
Patient Exam - Vital Signs: -Height: 170 cm, Weight: 90 kg, BMI: 31, Random blood glucose: 238,
Temperature: 102.4° F, Blood pressure: 138/90 mmHg, Heart rate: 90, Respiratory rate: 18, O2 sat: 98%
Patient Exam - Interview: -
Student: Hello, my name is Rachel and I am your nurse today. -Tina Jones: Hey.
Student: Can you confirm your name? -Tina Jones: Tina Jones:.
,Student: What brings you in today? -Tina Jones: I got this scrape on my foot a while ago, and it got really
infected. It's killing me.
Student: Where is your wound located? -Tina Jones: It's on the ball of my foot.
Student: Which foot is injured? -Tina Jones: My right foot.
Student: I'm sorry to hear that. I'm glad you came in to get your foot evaluated. -Tina Jones: Thanks a
lot.
Student: Can you tell me how you scraped your foot? -I was changing a light bulb, and I had to use our
little stepstool to reach it. My foot slid off the bottom step and it got all scraped up. I didn't realize how
sharp the edge was!
Student: Can you rate your current pain level on a scale of 0 to 10? -Tina Jones: ...Like a 7. It hurts a lot,
but whatever pain med the ER gave me is helping a little bit.
Student: Can you describe the pain? -Tina Jones: It's throbbing and like, sharp if I try to put weight on it.
Student: Have you had any other symptoms? -Tina Jones: I mean, it's all red and swollen, and there's
pus, it feels hot, it hurts like hell... It's got all that going on.
Student: When did you first notice the pus? -Tina Jones: I noticed it about 2 days ago.
Student: What color was the pus? -Tina Jones: It's... white or maybe off-white.
Student: Did your foot bleed? -Tina Jones: It bled a little after I injured it.
Student: How have you been treating your foot? -Tina Jones: I made sure to clean it and keep it
bandaged. And I put Neosporin on it.
Student: How have you treated the wound? -Tina Jones: I've been taking Advil for my foot for a few
days.
Student: Was the Neosporin effective? -Tina Jones: Well, I'm here, so I guess it didn't do its job.
Student: Can you walk on your injured foot? -Tina Jones: No, I can't. I can't put any weight on it without
like, shooting pain.
Student: How effective was your pain medication at home? -Tina Jones: Whatever pain medication the
ER gave me is helping. Before I came in, I was just taking Advil. For the past few days, the Advil wasn't
doing much for me -- it would only last a couple of hours.
Student: Have you had any fever at home? -Tina Jones: Yeah, I started to have one yesterday, and then
it was a little better this morning. It kinda crept up all day.
Student: Do you have any preexisting medical conditions? -Tina Jones: I mean, I have asthma and
diabetes, but right I now I just care about my foot!
, Student: I understand your foot hurts. We have to ask a lot of questions, but it's to ensure we treat your
injury and anything else that could contribute to the problem. -Tina Jones: That's kind of you.
Student: When were you diagnosed with diabetes? -Tina Jones: I was diagnosed when I was 24.
Student: How do you manage your asthma? -Tina Jones: I try to avoid things that give me breathing
problems, but when my asthma starts to act up, I just use my inhaler.
Student: What medications did you take for your diabetes? -Tina Jones: It was metformin.
Student: Do you currently take medicine for your diabetes? -Tina Jones: No, I don't take anything for my
diabetes anymore.
Student: What made you stop taking medication for your diabetes? -Tina Jones: I guess I just got sick of
feeling sick and gassy all the time, and it was overwhelming, remembering to take pills and check my
sugar. I feel a lot better now that I'm just eating healthier than I did when I was taking the pills.
Student: Do you monitor your blood glucose? -Tina Jones: I have a monitor at home, but to be honest I
don't really use it that often.
Student: Do you get thirsty often? -Tina Jones: You know, I did notice lately that I've been really thirsty.
Student: How frequently do you urinate? -Tina Jones: I don't know. Every hour or two when I'm awake?
Student: What is your current diet? -Tina Jones: It's pretty good, I think. I'm not a huge health nut or
anything.
Student: Have you had a change in appetite? -Tina Jones: Yeah, lately I've definitely been much hungrier
than usual.
Student: Have you had any changes in your weight? -Tina Jones: Yeah, I've lost some weight recently.
Student: Do you know what caused your weight loss? -Tina Jones: I don't know what caused it, I just lost
weight.
Student: How often do you have asthma exacerbations? -Tina Jones: I haven't had a full attack in years.
But my breathing definitely acts up. . .not always. Max twice a week.
Student: What asthma symptoms have you experienced? -Tina Jones: My chest and throat get tight, and
I start to wheeze. It feels like I can't take in air, like I can't get enough air into my lungs.
Student: Does anything else worsen your asthma? -Tina Jones: Cats are the worst for my asthma--no
matter what, if I'm around cats, my breathing gets bad. But sometimes it gets bad from being around
dust or having to run upstairs, too.
Student: Do you have a rescue inhaler? -Tina Jones: Yeah, I use it when my asthma acts up.
