Shadow Health - Tina Jones, Health
History with complete solution 2022
1. Acute pain - ANSWER Priority: High Priority Pro Tip: Managing acute pain is an
immediate high priority, because other health concerns cannot be effectively addressed
while a patient experiences severe pain. Evidence - Relevant: "...Like a 7. It hurts a lot,
but whatever pain med the ER gave me is helping a little bit." "It's throbbing and like,
sharp if I try to put weight on it." Evidence Pro Tip: Tina expresses pain, which is the
strongest evidence for this problem. She reports intense pain on a numerical scale and
describes pain characteristics. The presence of a physical injury supports her
susceptibility to acute pain. Planning - Relevant: Assess - Pain: Assess the patient's
pain at regular intervals and with each assessment of vital signs. Assess - Pain: Assess
the patient's response to pain medication. Educate - Medication: Educate the patient on
medications used for pain relief. Educate - Pain: Educate the patient on non-
pharmaceutical methods to reduce pain intensity. Intervene - Pain: Administer non-
pharmacologic interventions to reduce pain. Intervene - Pain: Administer prescribed
analgesics to provide optimal pain relief. Planning Pro Tip: To reduce the patient's pain,
assess her current rating. Provide an appropriate intervention (pharmaceutical or
otherwise) and educate the patient. After an appropriate time interval, assess pain
levels again to see how the intervention affected the pain.
1.Expression of pain Followed Up - ANSWER Description: Tina expresses frustration
about her level of pain. Student: How effective was the Neosporin? Tina Jones: Well,
I'm here, so I guess it didn't do its job. Student: Can you walk with your foot being
injured? Tina Jones: No, I can't. I can't put any weight on it without like, shooting pain.
Student: What preexisting medical conditions do you have? 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, but I need to know this information to make sure I take care of the
problem correctly. Tina Jones: Thanks. Model Statement: "I'm sorry to hear that your
pain is returning. We want you to be in as little pain as possible. I can give you some
Advil at this time, and in a few hours, you can have more tramadol. I can also walk
through some pain management exercises with you that don't involve medication, if you
are interested."
2. Impaired skin integrity - ANSWER Priority: High Priority Pro Tip: This is a high
priority. The infection is the most immediate threat to the patient's health, and the wound
is at risk for delayed healing because of the patient's uncontrolled blood glucose.
Evidence - Relevant: Evidence Pro Tip: As Tina discusses symptoms of her wound,
including symptoms such as discharge, redness, warmth, and swelling, she reports
strong evidence of impaired skin integrity. Planning - Relevant: Planning Pro Tip:
Because wound infections impact the patient's overall health, it's important to assess
perfusion, hydration, and swelling. Assess the status of the wound itself and ensure
proper cleaning and dressing per the physician's order. Prevent worsening infection by
educating the patient about wound care and self-monitoring.
2.Impact of injury on daily life Followed Up - ANSWER Description: Tina brings up her
pain and frustration at how being unable to bear weight on her foot impacts her life.
,Shadow Health - Tina Jones, Health
History with complete solution 2022
Student: What are stressors? Tina Jones: I feel really stressed out right now! Honestly, I
didn't realize that I'd be admitted to the hospital for my foot. I don't want to miss work or
school but now it looks like I'll have to. And I want my foot to stop hurting. I know I need
sleep, too. Student: We are going to take care of everything as quickly as possible. Tina
Jones: Thanks. Model Statement: "This sounds like a challenging time for you. I
understand your frustration at having your life interrupted by foot pain. Please let me
know if there is anything I can help you with, such as contacting your employer or
asking a family member to bring your schoolwork. We'll do our best to get you feeling
better and, on your way, home as soon as possible."
3. Impaired walking - ANSWER Priority - High Priority Pro Tip: This is a high priority.
The patient is unable to bear weight on her affected leg, which prevents walking. This
impacts her daily life and increases her risk for falls and deep-vein thrombosis.
Evidence - Relevant: "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." "I got this scrape on my foot a while ago, and it
got really infected. It's killing me." "No, I can't. I can't put any weight on it without like,
shooting pain." Evidence Pro Tip: The strongest evidence of impaired walking is that
Tina directly reports she can't bear weight or walk on her affected foot. Other supporting
data points are the presence of her foot wound and her general reports of pain.
Planning - Relevant: Assess - Musculoskeletal: Assess the patient's ability to bear
weight and gait. Assess - Musculoskeletal: Assess the patient's mobility. Consult /
Refer: Consult with physical therapist to develop a plan to improve the patient's mobility.
Intervene - Mobility: Assist the patient as needed with mobility. Intervene - Mobility:
Provide assistive devices to facilitate mobility (crutches, therapeutic boot to minimize
pressure on plantar surface, wheelchair). Planning Pro Tip: Assess how well the patient
can bear weight and walk. While the patient is in your care, work with other healthcare
professionals to keep the pain managed and improve the patient's mobility. Provide
assistance with activities such as toileting and ensure that the patient can access and
use assistive devices.
3.Gaps in health literacy around diabetic diet Not Encountered - ANSWER Description:
Tina describes controlling her diabetes by avoiding "sweets." Model Statement: "Staying
away from sugar is a great start. I can give you some more information on what a
balanced diet looks like for someone with diabetes. For example, many starchy foods
break down into glucose in the body, like pasta, and so you can eat those in
moderation, too. Most people with diabetes feel better when they limit all starches, eat
protein, and take regular medication."
4. Ineffective diabetes management - ANSWER Priority - High Priority Pro Tip: Poorly
managed diabetes and uncontrolled blood glucose complicate wound healing. As the
underlying cause for delayed healing and infection, they must be addressed. Evidence -
Relevant: "No, I don't take anything for my diabetes anymore." "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
,Shadow Health - Tina Jones, Health
History with complete solution 2022
was taking the pills." "I have a monitor at home, but to be honest I don't really use it that
often." Evidence Pro Tip: Tina directly reports ineffective diabetes management when
discussing her lack of treatment. She expresses gaps in health literacy about the risk of
ceasing prescribed medication and blood glucose monitoring. Supporting evidence
comes from her inability to incorporate meaningful dietary changes or increase her
exercise. Planning - Relevant: Assess - Health Literacy and Patterns: Assess the
patient's knowledge related to diabetic disease process, assess personal/social
supports. Assess - Health Literacy and Patterns: Assess the patient's perceived barriers
to adherence to the prescribed regimen (cost, adverse effects, lack of knowledge).
Assess - Health Literacy and Patterns: Assess the patient's readiness for
change/education. Educate - Disease Process: Educate the patient on diabetes
pathophysiology, risks of morbidity and mortality, importance of self-care. Planning Pro
Tip: To gain a deep understanding of your patient's situation, determine her level of
health literacy, her feelings and beliefs about the disease, and the motivation behind her
choices. Educate the patient about what risks are, and what good diabetes care looks
like. Most importantly, ask about her goals and changes she may be willing to make.
4.Lack of treatment with diabetes medication Not Followed Up - ANSWER Description:
Tina reveals that she does not treat her diabetes with medication. 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. Model Statement: "I
understand that it can be challenging to keep up with daily medication. But it's important
to keep your blood sugar under control to prevent long-term damage to your health, and
medication can really help. I'd like to talk with you more about getting back onto a
prescription. We could start you at a low dose, which reduces the side effects."
5. Lack of blood glucose monitoring Not Followed Up - ANSWER Description: Tina
reveals that she does not check her blood sugar. 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. Model Statement: "I understand how it can feel like a frustrating chore to check
your sugar every day. But it is important to keeping your diabetes under control. When
you monitor your sugar, it helps you understand what foods, activities, and times of day
contribute to you feeling your best. And keeping your sugar down will help your foot
wound heal quickly, too. If you would like, I can help you find a monitor that is as
painless as possible. I can also teach you more about what the numbers mean."
5. Risk for falls - ANSWER Priority - High Priority Pro Tip: The patient's foot wound
impairs her walking, which in turn increases her risk for falls while she is an admitted
patient. Her past history of injury also adds to this risk. Evidence - Relevant: Evidence
Pro Tip: The strongest evidence of Tina's fall risk is reports of being unable to bear
weight or walk on her foot. Other supporting evidence is her recent injury caused by
, Shadow Health - Tina Jones, Health
History with complete solution 2022
falling. Planning - Relevant: Planning Pro Tip: Protect your patient by taking all fall
precautions, and educate your patient about how to be safe as she goes through her
daily activities at the hospital. Make sure that the patient feels comfortable asking for
your assistance.
6. Gaps in health literacy around asthma control Not Followed Up - ANSWER
Description: Tina describes increased inhaler use and decreased effectiveness,
indicating that her asthma is uncontrolled. Student: How many puffs do you take when
using your asthma inhaler? Tina Jones: I usually use two puffs from my inhaler, but
sometimes I need three. [Nurse confirmed with Pharmacy: albuterol 90mcg/spray MDI]
Student: What are some things that trigger your asthma? Tina Jones: Being around cats
is the worst, but dust and running up stairs can make my breathing bad, too. Student:
What allergies do you have? Tina Jones: I'm allergic to cats. Model Statement: "It
sounds like your asthma is giving you some problems, and you're not getting full relief
from your inhaler. I would like to talk with you about changing your medication and your
regimen, to reduce your frequent breathing problems, so that you feel better day-to-day.
Most patients find that using a daily inhaler is an easy way to reduce your asthma
symptoms even more."
6. Risk for unstable blood glucose level - ANSWER Priority - High Priority Pro Tip:
Uncontrolled blood glucose levels delay or prevent wound healing, and must be
addressed to resolve the infection. Unstable blood glucose levels could increase the
patient's risk for falls. Evidence - Relevant: "Random blood glucose: 238" Evidence Pro
Tip: Tina reports infrequent blood glucose monitoring and a general lack of diabetes
management, which increases her risk for fluctuating blood glucose levels. Infection can
contribute to poorer glycemic control, and so Tina is likely to experience blood glucose
levels that are significantly higher than her baseline. Planning - Relevant: Assess -
Vitals: Assess the patient's blood glucose levels according to orders. Educate - Disease
Process: Educate the patient on the signs and symptoms of hyper- and hypoglycemia.
Intervene - Diet: Provide the patient a diet without concentrated sweets. Intervene -
Hypoglycemia: Administer insulin and/or oral hypoglycemics, per physician orders.
Planning Pro Tip: First, gauge your patient's current status by checking hydration, vital
signs, and perfusion. Measure the patient's blood glucose and provide medication as
per the physician's orders. While the patient is in your care, ensure that their meals align
with a low glycemic diet, and educate the patient on monitoring her own health status.
7. Loss of a family member Not Followed Up - ANSWER Description: Tina shares
information about her father dying. Student: Why don't you have your dad's income?
Tina Jones: Um...well, my dad died in a car accident, about a year ago. Model
Statement: "I'm sorry to hear about your father's passing. That sounds like a difficult
situation."
7. Obesity - ANSWER Priority - Low Priority Pro Tip: A BMI greater than 30 indicates
obesity, but this diagnosis is a low priority at present. Obesity is a long-term health
History with complete solution 2022
1. Acute pain - ANSWER Priority: High Priority Pro Tip: Managing acute pain is an
immediate high priority, because other health concerns cannot be effectively addressed
while a patient experiences severe pain. Evidence - Relevant: "...Like a 7. It hurts a lot,
but whatever pain med the ER gave me is helping a little bit." "It's throbbing and like,
sharp if I try to put weight on it." Evidence Pro Tip: Tina expresses pain, which is the
strongest evidence for this problem. She reports intense pain on a numerical scale and
describes pain characteristics. The presence of a physical injury supports her
susceptibility to acute pain. Planning - Relevant: Assess - Pain: Assess the patient's
pain at regular intervals and with each assessment of vital signs. Assess - Pain: Assess
the patient's response to pain medication. Educate - Medication: Educate the patient on
medications used for pain relief. Educate - Pain: Educate the patient on non-
pharmaceutical methods to reduce pain intensity. Intervene - Pain: Administer non-
pharmacologic interventions to reduce pain. Intervene - Pain: Administer prescribed
analgesics to provide optimal pain relief. Planning Pro Tip: To reduce the patient's pain,
assess her current rating. Provide an appropriate intervention (pharmaceutical or
otherwise) and educate the patient. After an appropriate time interval, assess pain
levels again to see how the intervention affected the pain.
1.Expression of pain Followed Up - ANSWER Description: Tina expresses frustration
about her level of pain. Student: How effective was the Neosporin? Tina Jones: Well,
I'm here, so I guess it didn't do its job. Student: Can you walk with your foot being
injured? Tina Jones: No, I can't. I can't put any weight on it without like, shooting pain.
Student: What preexisting medical conditions do you have? 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, but I need to know this information to make sure I take care of the
problem correctly. Tina Jones: Thanks. Model Statement: "I'm sorry to hear that your
pain is returning. We want you to be in as little pain as possible. I can give you some
Advil at this time, and in a few hours, you can have more tramadol. I can also walk
through some pain management exercises with you that don't involve medication, if you
are interested."
2. Impaired skin integrity - ANSWER Priority: High Priority Pro Tip: This is a high
priority. The infection is the most immediate threat to the patient's health, and the wound
is at risk for delayed healing because of the patient's uncontrolled blood glucose.
Evidence - Relevant: Evidence Pro Tip: As Tina discusses symptoms of her wound,
including symptoms such as discharge, redness, warmth, and swelling, she reports
strong evidence of impaired skin integrity. Planning - Relevant: Planning Pro Tip:
Because wound infections impact the patient's overall health, it's important to assess
perfusion, hydration, and swelling. Assess the status of the wound itself and ensure
proper cleaning and dressing per the physician's order. Prevent worsening infection by
educating the patient about wound care and self-monitoring.
2.Impact of injury on daily life Followed Up - ANSWER Description: Tina brings up her
pain and frustration at how being unable to bear weight on her foot impacts her life.
,Shadow Health - Tina Jones, Health
History with complete solution 2022
Student: What are stressors? Tina Jones: I feel really stressed out right now! Honestly, I
didn't realize that I'd be admitted to the hospital for my foot. I don't want to miss work or
school but now it looks like I'll have to. And I want my foot to stop hurting. I know I need
sleep, too. Student: We are going to take care of everything as quickly as possible. Tina
Jones: Thanks. Model Statement: "This sounds like a challenging time for you. I
understand your frustration at having your life interrupted by foot pain. Please let me
know if there is anything I can help you with, such as contacting your employer or
asking a family member to bring your schoolwork. We'll do our best to get you feeling
better and, on your way, home as soon as possible."
3. Impaired walking - ANSWER Priority - High Priority Pro Tip: This is a high priority.
The patient is unable to bear weight on her affected leg, which prevents walking. This
impacts her daily life and increases her risk for falls and deep-vein thrombosis.
Evidence - Relevant: "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." "I got this scrape on my foot a while ago, and it
got really infected. It's killing me." "No, I can't. I can't put any weight on it without like,
shooting pain." Evidence Pro Tip: The strongest evidence of impaired walking is that
Tina directly reports she can't bear weight or walk on her affected foot. Other supporting
data points are the presence of her foot wound and her general reports of pain.
Planning - Relevant: Assess - Musculoskeletal: Assess the patient's ability to bear
weight and gait. Assess - Musculoskeletal: Assess the patient's mobility. Consult /
Refer: Consult with physical therapist to develop a plan to improve the patient's mobility.
Intervene - Mobility: Assist the patient as needed with mobility. Intervene - Mobility:
Provide assistive devices to facilitate mobility (crutches, therapeutic boot to minimize
pressure on plantar surface, wheelchair). Planning Pro Tip: Assess how well the patient
can bear weight and walk. While the patient is in your care, work with other healthcare
professionals to keep the pain managed and improve the patient's mobility. Provide
assistance with activities such as toileting and ensure that the patient can access and
use assistive devices.
3.Gaps in health literacy around diabetic diet Not Encountered - ANSWER Description:
Tina describes controlling her diabetes by avoiding "sweets." Model Statement: "Staying
away from sugar is a great start. I can give you some more information on what a
balanced diet looks like for someone with diabetes. For example, many starchy foods
break down into glucose in the body, like pasta, and so you can eat those in
moderation, too. Most people with diabetes feel better when they limit all starches, eat
protein, and take regular medication."
4. Ineffective diabetes management - ANSWER Priority - High Priority Pro Tip: Poorly
managed diabetes and uncontrolled blood glucose complicate wound healing. As the
underlying cause for delayed healing and infection, they must be addressed. Evidence -
Relevant: "No, I don't take anything for my diabetes anymore." "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
,Shadow Health - Tina Jones, Health
History with complete solution 2022
was taking the pills." "I have a monitor at home, but to be honest I don't really use it that
often." Evidence Pro Tip: Tina directly reports ineffective diabetes management when
discussing her lack of treatment. She expresses gaps in health literacy about the risk of
ceasing prescribed medication and blood glucose monitoring. Supporting evidence
comes from her inability to incorporate meaningful dietary changes or increase her
exercise. Planning - Relevant: Assess - Health Literacy and Patterns: Assess the
patient's knowledge related to diabetic disease process, assess personal/social
supports. Assess - Health Literacy and Patterns: Assess the patient's perceived barriers
to adherence to the prescribed regimen (cost, adverse effects, lack of knowledge).
Assess - Health Literacy and Patterns: Assess the patient's readiness for
change/education. Educate - Disease Process: Educate the patient on diabetes
pathophysiology, risks of morbidity and mortality, importance of self-care. Planning Pro
Tip: To gain a deep understanding of your patient's situation, determine her level of
health literacy, her feelings and beliefs about the disease, and the motivation behind her
choices. Educate the patient about what risks are, and what good diabetes care looks
like. Most importantly, ask about her goals and changes she may be willing to make.
4.Lack of treatment with diabetes medication Not Followed Up - ANSWER Description:
Tina reveals that she does not treat her diabetes with medication. 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. Model Statement: "I
understand that it can be challenging to keep up with daily medication. But it's important
to keep your blood sugar under control to prevent long-term damage to your health, and
medication can really help. I'd like to talk with you more about getting back onto a
prescription. We could start you at a low dose, which reduces the side effects."
5. Lack of blood glucose monitoring Not Followed Up - ANSWER Description: Tina
reveals that she does not check her blood sugar. 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. Model Statement: "I understand how it can feel like a frustrating chore to check
your sugar every day. But it is important to keeping your diabetes under control. When
you monitor your sugar, it helps you understand what foods, activities, and times of day
contribute to you feeling your best. And keeping your sugar down will help your foot
wound heal quickly, too. If you would like, I can help you find a monitor that is as
painless as possible. I can also teach you more about what the numbers mean."
5. Risk for falls - ANSWER Priority - High Priority Pro Tip: The patient's foot wound
impairs her walking, which in turn increases her risk for falls while she is an admitted
patient. Her past history of injury also adds to this risk. Evidence - Relevant: Evidence
Pro Tip: The strongest evidence of Tina's fall risk is reports of being unable to bear
weight or walk on her foot. Other supporting evidence is her recent injury caused by
, Shadow Health - Tina Jones, Health
History with complete solution 2022
falling. Planning - Relevant: Planning Pro Tip: Protect your patient by taking all fall
precautions, and educate your patient about how to be safe as she goes through her
daily activities at the hospital. Make sure that the patient feels comfortable asking for
your assistance.
6. Gaps in health literacy around asthma control Not Followed Up - ANSWER
Description: Tina describes increased inhaler use and decreased effectiveness,
indicating that her asthma is uncontrolled. Student: How many puffs do you take when
using your asthma inhaler? Tina Jones: I usually use two puffs from my inhaler, but
sometimes I need three. [Nurse confirmed with Pharmacy: albuterol 90mcg/spray MDI]
Student: What are some things that trigger your asthma? Tina Jones: Being around cats
is the worst, but dust and running up stairs can make my breathing bad, too. Student:
What allergies do you have? Tina Jones: I'm allergic to cats. Model Statement: "It
sounds like your asthma is giving you some problems, and you're not getting full relief
from your inhaler. I would like to talk with you about changing your medication and your
regimen, to reduce your frequent breathing problems, so that you feel better day-to-day.
Most patients find that using a daily inhaler is an easy way to reduce your asthma
symptoms even more."
6. Risk for unstable blood glucose level - ANSWER Priority - High Priority Pro Tip:
Uncontrolled blood glucose levels delay or prevent wound healing, and must be
addressed to resolve the infection. Unstable blood glucose levels could increase the
patient's risk for falls. Evidence - Relevant: "Random blood glucose: 238" Evidence Pro
Tip: Tina reports infrequent blood glucose monitoring and a general lack of diabetes
management, which increases her risk for fluctuating blood glucose levels. Infection can
contribute to poorer glycemic control, and so Tina is likely to experience blood glucose
levels that are significantly higher than her baseline. Planning - Relevant: Assess -
Vitals: Assess the patient's blood glucose levels according to orders. Educate - Disease
Process: Educate the patient on the signs and symptoms of hyper- and hypoglycemia.
Intervene - Diet: Provide the patient a diet without concentrated sweets. Intervene -
Hypoglycemia: Administer insulin and/or oral hypoglycemics, per physician orders.
Planning Pro Tip: First, gauge your patient's current status by checking hydration, vital
signs, and perfusion. Measure the patient's blood glucose and provide medication as
per the physician's orders. While the patient is in your care, ensure that their meals align
with a low glycemic diet, and educate the patient on monitoring her own health status.
7. Loss of a family member Not Followed Up - ANSWER Description: Tina shares
information about her father dying. Student: Why don't you have your dad's income?
Tina Jones: Um...well, my dad died in a car accident, about a year ago. Model
Statement: "I'm sorry to hear about your father's passing. That sounds like a difficult
situation."
7. Obesity - ANSWER Priority - Low Priority Pro Tip: A BMI greater than 30 indicates
obesity, but this diagnosis is a low priority at present. Obesity is a long-term health
