Shadow Health - Tina Jones, Health History (2025)
ACTUAL EXAM (detailed & elaborated) comprehensive
QUESTIONS AND CORRECT ANSWERS| EXAM TEST!!
1. Acute pain - 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 - 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 - 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 - Description: Tina brings up her
pain and frustration at how being unable to bear weight on her foot impacts
her life. 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 - 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 - 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 - 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 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 - 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
ACTUAL EXAM (detailed & elaborated) comprehensive
QUESTIONS AND CORRECT ANSWERS| EXAM TEST!!
1. Acute pain - 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 - 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 - 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 - Description: Tina brings up her
pain and frustration at how being unable to bear weight on her foot impacts
her life. 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 - 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 - 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 - 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 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 - 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
