ShadowHealthFocusedExams
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Doris Untalan
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ShadowHealthFocusedExams (2).docx
ORIGINALITY REPORT
PRIMARY SOURCES
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Student Paper
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ShadowHealthFocusedExams (2).docx
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ShadowHealthFocusedExams (2).docxby Doris
UntalanShadowHealthFocusedExams (2).docxORIGINALITY
REPORTPRIMARY SOURCESShadowHealthFocusedExams
(2).docx
Social class affects families in every conceivable way. Family
form, marriage, divorce, and childrearing are all related to
class. Social class is a complex concept that centers on the
distribution of economic resources. That is, when a number of
people occupy the same relative economic rank in the
stratification system, they form a social class. There are no
clear-cut boundaries, except perhaps those delineating the
highest and lowest classes. A social class is not a homogeneous
group, given the diversity within it, yet there is some degree of
identification with other people in similar economic situations.
Also, people have a sense of who is superior, inferior, or equal
to them (Eitzen et al., 2013).
The class system in the United States is marked by striking
differences in income. Income is the amount of money brought
into a household in 1 year (Andersen and Collins, 2010b:71).
Table 6.2 shows the average household income for each fifth of
the population from 1970 to 2011. This illustrates the growing
income gap between the bottom fifth and the top fifth of the
population. However, it is open to different interpretations of
how income inequality is maintained.
Table 6.2 Share of Aggregate Income by Each Fifth of
Households, 1970, 1980, 1990, 2000, 2004, 2007, 2010, 2011

Sociologists agree that there are social classes and that income
or money is the basis for classification. However, they disagree
on the meaning of class for family life. Although this
oversimplifies the debate, there are two different ways to think
about class. The cultural approach argues that family patterns
are responsible for inequality. The structural approach argues
that class inequalities themselves produce different family
patterns. Each approach gives us a distinctive view of family.
Objective: Explain the impact of race on family life
Like the class and gender systems, racial stratification has
structural foundations. The meaning and significance of race
was fundamentally changed in the beginning of the twenty-first
century. The blatant forms of racism that existed in the past
have given way to new, more subtle practices (Lewis et al.,
2004:4). Furthermore, the United States is moving from being
predominantly White to being a global society of diverse racial
and ethnic peoples. Does this mean that the United States is
becoming integrated and moving beyond racial disparities?
Many people think that multicultural attitudes and a “color-
blind” climate have replaced old-fashioned racism. After all,
President Barack Obama, a Black man, holds the nation’s
highest office. This makes his family the nation’s official “first
family.” Today, people of color are visible in public positions.
While these changes are important, they do not signal a post-
racial society. This section of the chapter shows how racial
inequality is a powerful force in shaping family life in the
twenty-first century. The theme of this chapter is that the
inequalities of class, race, and gender have structural
foundations. Although important changes are occurring, our

society remains structured along the lines of class, race, and
gender.
Impact of Racism on Family Life
As we saw in Chapter 5, the growing presence of racial-ethnic
groups is changing U.S. society. At the beginning of the twenty-
first century, the United States was 70 percent White, 12
percent African American, 12 percent Hispanic, 4 percent Asian
American, and 1 percent Native American. Figure 6.1 shows
how the racial composition of the United States is expected to
change through the year 2050. Terms of reference are also
changing, and the changes are contested within groups as well
as between them. For example, Blacks continue to debate the
merits of the term African American, while Latinos disagree on
the label Hispanic. In this book, we use such terms
interchangeably because they are currently used in popular and
scholarly discourse.
Figure 6.1 Projected Population of the United States by Race
and Hispanic Origin, 2000–2050
Select or deselect the different years to compare the projected
populations of the US by race and Hispanic origin. Roll over
each column for specific data.
Gender, like race and class, is a way of organizing social life.
Gender inequality is built into the larger world we inhabit. From
the macro level of the global economy, through the institutions
of society, to interpersonal relations, gender is the basis for
dividing labor, assigning roles, and allocating social
opportunities. Until recently, gender differences seemed natural.
Today, we know that gender is not natural at all. Instead,
“women” and “men” are social creations. To emphasize this
point, sociologists distinguish between sex and gender. Sex
refers to the biological differences between females and males.

Gender refers to the social and cultural meanings attached to
women and men.
Gender is not only about women. Men often think of themselves
as “genderless,” as if gender did not matter in the daily
experiences of their lives. Yet, from birth to old age, men’s
family lives are deeply gendered (Kimmel and Messner, 2007).
In the big picture, gender divisions make women and men
unequal. Still, we cannot understand the gender system by
looking at gender alone. Gender is linked with other
characteristics such as class, race, and sexual orientation. These
overlapping inequalities produce different gender experiences
for women and men of different races and classes. Nevertheless,
the gender system ranks women and men differently, and it
denies both women and men the full range of human and social
possibilities. The social inequalities created by gender influence
family life in profound ways. In fact, “gender relations and
family are so intertwined, it is impossible to pay attention to
one, without paying attention to the other” (Coltrane, 1998:1).
Like class and race, there are two main ways to think about
gender and family. The first, a gender roles approach, treats
gender differences as roles learned by individuals. The second
approach, a structural or gendered institutions approach (Acker,
1992), emphasizes factors that are external to individuals, such
as the social structure and social institutions that treat women
and men differently. These approaches differ in how they view
women and men, in how they explain inequality, and in the
solutions they suggest for change. The main difference between
the two approaches lies in whether the individual or society is
the primary unit of analysis.

Focused Exam: Chest Pain Results | Turned In
Advanced Physical Assessment - March 2020,
advanced_physical_assessment__td8__031720__sect1
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Started: Apr 21, 2020 | Total Time: 113 min
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Your Results Lab Pass
(/assignment_attempts/6701636/lab_pass.pd
Overview
Transcript
Subjective Data Collection
Objective Data Collection
Education & Empathy
Documentation
All Lines (238) Interview Questions (87) Statements (30) Exam
Actions (121)
Good morning.
What brings you into the clinic today
I have been having some troubling chest pain in my chest now
and then for the past month.
Thanks. I appreciate that.
When did this chest pain start
I first noticed it earlier this month. I thought it might just be
heartburn and it passed after a
couple of minutes.
Can you tell me the location of your pain
When the pain happens, I feel it mostly in the middle of my

chest, over my heart.
Desert pain radiate to your arm (Clarified to Is your pain
radiating?.)
The pain doesn't radiate anywhere. It's mostly just right in the
middle of my chest. (Clarified to
if the pain is radiating.)
Does it radiate to your arm (Clarified to Does the pain travel
down your arm?.)
No, my pain doesn't seem to travel. (Clarified to if the pain
travels down my arm.)
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04/21/20 7:00 PM MD
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Do you have shoulder pain with it (No matching questions
found.)
Do you have shoulder pain
No, the pain hasn't been in my shoulder.
Good to know. Thank you.
Do you have any back pain
I haven't had back pain, no.
Do you have any neck pain

My neck's been fine.
How long does it pain happen
When I feel it, it seems to get better over the course of a couple
of minutes or so.
Does anything happen that causes it to happen (Clarified to
Does anything trigger the pain?.)
Well, the pain seems to start when I'm doing something physical
. . . the first time it happened
while I was doing yard work, and the second time . . . I had to
take the stairs at work because
the elevator broke. Both times it got better if I took a break or
sat down to rest. (Clarified to if
anything triggers the pain.)
Is there anything that makes it better
Well . . . it seemed to subside a little bit when I sat down to rest
for a few minutes.
How frequent is your pain
Well, it has happened three times the past month. It usually
goes away after about a couple
minutes.
Have you tried any treatment (No matching questions found.)
Have you tried anything to help your pain
This is the first I'm seeing anyone about the pain, so not much
has been done yet.

Describe from 0 to 10 Pain Scale (Clarified to How would you
rate your chest pain on a
scale?.)
I'd say maybe a . . . 5? It's just really uncomfortable . . . like
there's nothing I can do about it.
Right now it's like a zero though. (Clarified to how I would rate
my chest pain on a scale.)
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04/21/20 7:03 PM MD
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Can you describe the characteristic of your pain
Light yellow? Yellowish clear? The normal color, I guess.
Can you describe your pain
Well, it mostly feels tight and uncomfortable right in the middle
of my chest.
Does it feel like someone standing on your chest
It's more tight and uncomfortable than anything. I've had the
feeling . . . maybe three times
this month?
Is it a crushing pain
No, it's more tight and uncomfortable.
Is it a burning pain
Not really.
Is the pain worse when you eat spicy food
I don't think spicy foods have anything to do with it.

Is the pain worse when you're eating (Clarified to Does the pain
get worse after you eat?.)
I don't think eating has anything to do with it. One episode did
happen when my wife and I
were out for dinner, but it seemed to happen before we even
settled. The episodes don't
seem all that related, to be honest. (Clarified to if the pain is
worse after I eat.)
Are you taking any medication for your pain
I take Ibuprofen for various aches and pains every now and
then. That's about it.
What aches and pains are you having (No matching questions
found.)
How often do you get aches and pain
I usually drink water all day at work. At least four glasses,
probably more. [AUDIO COMING
SOON]
Do you get a chest pain
Well, it doesn't hurt right now, but I have been having chest
pain now and then for the past
month.
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04/21/20 7:07 PM MD
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Do you have breathing problems
My breathing's fine.
What is your medical history
The doctors told me I have a little bit of high blood pressure

and cholesterol, but that's it.
Have you had any surgeries
I've never had any surgeries.
Are you allergic to any medication
I think I'm allergic to codeine. It makes me toss my cookies.
What happens with codeine (Clarified to What is your reaction
to codeine?.)
It makes me nauseous and I vomit. (Clarified to what my
reaction to codeine is.)
Have you ever been diagnosed with angina
I've never been diagnosed with angina. [AUDIO COMING
SOON]
Do you have any coronary heart disease
My grandfather on my mom's side died of a heart attack. He was
in his mid-fifties.
Do you have diabetes
No, I've avoided it but my mother and sister both have it.
High blood pressure
Yes, I supposedly have moderately high blood pressure.

What medication are you taking
Yeah, let's see, I take atorvastatin for cholesterol, metoprolol
for blood pressure. . . Oh yeah,
and I take fish oil too. I hear that's good for your cholesterol.
[AUDIO COMING SOON]
Have you ever been admitted for your high blood pressure
(Clarified to How do you control
your blood pressure?.)
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04/21/20 7:11 PM MD
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Well, my healthcare provider started me on metoprolol a year
ago to get my blood pressure
under control. [AUDIO COMING SOON] (Clarified to how I
control my blood pressure.)
Have you been hospitalized for high blood pressure
Yes, I supposedly have moderately high blood pressure.
Do you check your blood pressure daily
I usually only get it checked when I visit the doctor.
What you normal readings are for your BP
Um, let's see . . . For breakfast I usually eat a granola bar and
drink an instant breakfast
shake. I've been doing that a while since it saves time in the
morning. Most days for lunch I
get a sandwich from the sub shop near work. That's usually a
turkey sub, but sometimes I get
a spicy Italian sub. My wife and I grill a lot, and usually have
some grilled meat with veggies
for dinner.
Do you exercise
Well I used to ride my bike a lot but it got stolen a couple years
ago. I guess I haven't had
much regular exercise since then. I want to get a new bike if the
doctor says it is OK to

exercise with this chest pain I've been having.
Have you had any cardiac testing like an EKG
I've had . . . well, I guess I've had the EKG a few times and they
give me an annual stress test.
How are your results (Clarified to What were the results of your
heart tests?.)
I'm not sure, all the doctor ever tells me is, "everything looks
good." (Clarified to what the
results of my heart tests were.)
Are you taking any medication for your cholesterol
I take atorvastatin. [AUDIO COMING SOON]
What is your dosage of all your medications let's review your
medications
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04/21/20 7:14 PM MD
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04/21/20 7:15 PM MD

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The atorvastatin's 20 mg a day, and the other one, metoprolol, is
100 mg daily. [AUDIO
COMING SOON]
Are you taking any over-the-counter medication
Oh, just ibuprofen or Tylenol occasionally for pain.
Does it help you with your pain
I haven't taken anything for the chest pain yet.

How much fluid are you drinking a day
I usually drink water all day at work. At least four glasses,
probably more. [AUDIO COMING
SOON]
Do you drink any caffeine
I drink a cup or two of coffee almost every day. Not much else.
This is make your heart beat fast
No, I haven't noticed anything like that.
Do you drink any soda
Once in a blue moon maybe. I avoid it 99% of the time.
do you Drink alcohol
Sure, but never more than two or three beers on a weekend.
Do you take illicit drugs
Nope.
Do you smoke cigarettes
Nope, I had a lot of friends who did but I never started.
Do you smoke e-cigarettes
Nope, I had a lot of friends who did but I never started.
Do you have any fever

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04/21/20 7:17 PM MD
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I haven't had a fever, no.

Do you have any chills
I haven't had chills, no.
Have you had any blood clots or bleeding problems
Not that I know of.
Do you bruise easy
I don't bruise easily, no.
Do you have circular problems (No matching questions found.)
Deer swimming on your feet (No matching questions found.)
Do you have swelling in your feet
I haven't noticed any swelling.
Have you had any night sweats
Nope, no night sweats.
Any recent weight loss
Not exactly . . . I've gained about fifteen to twenty pounds in
the last couple years.
Does your heart ever beat fast

Do you get dizzy or lightheadedness
I haven't felt faint or even lightheaded really.
Do you have difficulty breathing
My breathing's fine.
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04/21/20 7:20 PM MD
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04/21/20 7:21 PM MD
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04/21/20 7:22 PM MD
Have you had a cough
I don't have a cough.
Do you get any shortness of breath
No, I can usually breathe just fine. Unless I have a cold or
something, but that's rare.
Do you have a change in taste
I can still taste things fine.
Do you have difficulty swallowing
I haven't had any trouble swallowing.
Germany sore throat
I haven't had a sore throat in a long time.
Do you have any nausea or vomiting
No, I haven't felt nauseous. I just had pain in my chest.
Any diarrhea or constipation
I'm not having either of those problems.

Do you get gassy or bloated
No, I wish this was only gas but it feels different.
Do you have any heartburn or GERD
No, I've never had problems with heartburn. I sure hope that's
all this is, but it's pretty intense
if it's heartburn.
Do you have any family history of a heart attack
Well, my mom's dad died of a heart attack. He was pretty young
too.
How old was your grandfather (Clarified to How old was your
maternal grandfather when he
passed?.)
It's not a great time to realize this, but he died of a heart attack
in his fifties. I think he was 54.
(Clarified to how old my maternal grandfather lived to be.)
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04/21/20 7:22 PM MD
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04/21/20 7:27 PM MD
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Any family history of stroke
No, none that I know of.
Anybody with respiratory problems (Clarified to Do you have a
family history of lung
problems?.)
Nobody has had anything wrong with their lungs. (Clarified to
if I have a family history of lung
problems.)
Is there anything that you haven't told me that I should know
Thankfully, no.
Do you have any headaches right now
No, my head feels okay.

Do you feel like your pail (No matching questions found.)
Im going to look at your abdomen (No matching questions
found.)
Having trouble breathing (Clarified to Are you having difficulty
breathing right now?.)
My breathing's fine. (Clarified to if I am having difficulty
breathing now.)
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04/21/20 7:49 PM MD

I am checking your femoral pulses (No matching questions
found.)
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Focused Exam: Abdominal Pain Results | Turned In
Transcript
Started: Apr 22, 2020 | Total Time: 115 min
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04/22/20 3:02 PM MD
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Overview

Transcript
Education & Empathy
Documentation
Student Survey
All Lines (271) Interview Questions (135) Statements (42)
Exam Actions (94)
Hello.
Thank you for explaining that.
What brings you into the office today
I have some pain in my belly. . . and I'm having difficulty going
to the bathroom. My daughter
was worried about me.
Thank you.
What do you mean by difficult going to the bathroom (Clarified
to What do you mean by
difficulty going to the bathroom?.)
Well, for several days I've had to strain to even have a bowel
movement, and I can't make it
happen. And the pain is there in my stomach. [AUDIO COMING
SOON] (Clarified to what I
mean by difficulty going to the bathroom.)

What is your name and date of birth
My name is Esther Park, and I was born on January 7th . . . [Ms.
Park reports correct birth
year.]
Do you know where you're at today
Yes. I am at Shadowville General Clinic.
Do you know what time it is (Clarified to What is todays date?.)
ab_pass.pdf
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04/22/20 3:05 PM MD
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04/22/20 3:15 PM MD
Today must be . . . [Ms. Park reports the correct date].
(Clarified to what today's date is.)
What time is it (No matching questions found.)
When did the pain start
The pain started as a general discomfort, about five days ago,
when I started having the. . .
difficulties going to the bathroom.
Where is the pain at
The pain and discomfort is down low in my belly.
How long is this been happening
I have not felt as energetic as usual for -- I believe for the past
week.
Describe your pain

I'd say it's crampy and. . . a dull, crampy feeling.
Thank you.
Thank you.
Is there anything that makes it worse
Yes. When I move around the house or try to garden, I feel
more pain. And I did not go to my
exercise classes. I was sure that would be too much. I prefer to
be active, but my daughter
wants me to rest.
Does the pain radiate anywhere in your body
I wouldn't say that, no. It's more of a general pain that stays in
one place.
Does anything make the pain better
When I rest and try not to move much, I feel better. But the pain
is still there.
can you Point to your pain (Clarified to Can you point to the
location of your abdominal pain?.)
Well my whole belly is uncomfortable to some degree, but it's
mostly in the lower part, that's
where the pain is. Down in my lower belly. (Clarified to if I can
point to where my abdominal
pain is.)
Does your back hurt

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04/22/20 3:16 PM MD
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No. I think my exercising helps me avoid that.
What is your pain scale from 1 to 10
Right now. . . 6 out of 10.

What is the pain at its worst (Clarified to What would you rate
your pain at its worst?.)
I'd say it's as bad as it gets right now. . . about a 6 out of 10.
(Clarified to how I would rate my
pain at its worst.)
Is this all the time (No matching questions found.)
Is this constant pain (Clarified to Is your pain constant?.)
Yes. Certain things can make it a tiny bit better or a tiny bit
worse, I suppose. But it's always
there. (Clarified to if the pain is constant.)
What makes it better
When I rest and try not to move much, I feel better. But the pain
is still there.
Have you tried anything to help it
I've tried taking small sips of warm water, resting. The warm
water does nothing. A friend
suggested it, but it's nonsense.
Are you taking any pain medication
I'm not taking anything for it.
Are you taking any laxatives (Clarified to Have you tried taking
laxatives?.)
I haven't tried laxatives. I don't think they're very good for you.
[AUDIO COMING SOON]

(Clarified to if I have tried taking laxatives.)
Does eating make it worse (Clarified to Does eating anything
make your pain worse?.)
Yes. The pain is there all the time, but eating can make it
worse. (Clarified to if eating makes
the pain worse.)
Is it worse when you're walking around (Clarified to How are
you getting around?.)
When I have to go somewhere that's too far for me to walk, my
daughter drives me. But
usually, I get most places by walking. I usually like to do that
whenever I can. (Clarified to how
I am getting around.)
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Does this interfere with your daily activities (Clarified to Has
the pain affected your usual
activities?.)
Well, I don't feel unnaturally tired or weak. But I have
experienced low energy, like I need to
rest more often. (Clarified to if my pain has affected my
activities.)
Thank you.
Do you take naps (Clarified to Do you take vitamins or
supplements?.)
No, I don't take anything like that. (Clarified to if I take

vitamins or supplements.)
Have you had any diarrhea
Yes, I did have a bout of diarrhea pretty recently. [AUDIO
COMING SOON]
How often do you get diarrhea
I don't have diarrhea often at all. . . the bout six months ago was
the first time in a long while.
[AUDIO COMING SOON]
When was your last diarrhea episode
That must have been six months ago. It lasted for a day.
[AUDIO COMING SOON]
Do you have anything on your stool like mucus (No matching
questions found.)
Do you have anything on your stool like blood or mucus (No
matching questions found.)
Do you have bloody stools
No. I've never experienced that.
do you have mucus in your stool
Are you avoiding okay
No.

Do you have trouble peeing
No, no trouble.
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04/22/20 3:30 PM MD
What color is your urine
Yellow and. . . maybe a bit darker than usual.
Do you have blood in your urine
No, it seems normal enough to me. Maybe a little darker than
usual.
How much fluids are you taking Daily
Usually I drink, oh, two glasses of water a day. But it's been
difficult to drink much in the last
few days. [AUDIO COMING SOON]
Do you drink caffeinated drinks
No. I avoid caffeinated drinks altogether.
Do you drink soda
No, I never do.
What is your typical bowel movement routine
What has been happening with my. . . digestion. . . is new. I'm
usually fairly regular, but I
haven't moved my bowels in about five days. [AUDIO COMING
SOON]
What color is your stool

Brown. A normal shade of brown. Like. . . oh, I don't know.
Cardboard.
Is it soft or hard (No matching questions found.)
is your stool soft or hard
My stool? Usually it's brown, not too hard. Solid. Not watery.
No, not that I'm aware of.
Do you have any food allergies
No.
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Are you allergic to anything
I have an allergy to latex.
What happens with latex
I get an itchy skin rash.
Do you see the doctor regularly
Yes. I usually see Dr. Keller, here--at Shadowville Primary
Care. But I was told she's out today.
When was your last pap smear
A pap smear? I haven't had one in years. Ten years, at least.
define your health today

I haven't been feeling well lately.
Have you ever had a colonoscopy
I've had two colonoscopies. The last one was ten years ago.
What was your results (Clarified to What was the result of your
colonoscopy?.)
They had nothing to report. [AUDIO COMING SOON]
(Clarified to what the result of my
colonoscopy was.)
What was your result for your last pap smear
A pap smear? I haven't had one in years. Ten years, at least.
what is your result for your pap smear (Clarified to What was
the result of your last smear
test?.)
It was years ago, so I don't remember anything about it. I'm sure
it was fine. (Clarified to what
the result of my last pap smear was.)
Have you ever had any sexual transmitted infections (Clarified
to Do you have a history of
STD?.)
No, I've never had anything... like that. (Clarified to if I have
had an STD.)
Are you still sexually active
I have a gentleman friend and, yes... We are intimate.

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04/22/20 3:33 PM MD
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Does it burn or hurt with urination (Clarified to Do you feel
burning when you urinate?.)
No, my urination has felt normal. (Clarified to if it burns when I

urinate.)
do you take any blood pressure medications
Yes.
Have you had trouble with your blood pressure lately
Yes, I have been diagnosed with high blood pressure. But I take
very good care of that.
I've had two operations, both many years ago.
What was the reason for your surgery (Clarified to What type of
surgery did you have?.)
I've had two. I had my gallbladder out, and I had a C-section.
Both in my early 40s. (Clarified
to what surgery I had.)
Have you been hospitalized before
Yes. I had a couple surgeries years ago. And of course I stayed
in the hospital briefly when
Jennifer and Timothy were born.
Are you taking any over-the-counter medication
No. Those over-the-counter medicines. . . Tylenol--they say it's
very bad for the stomach.

Difficult with daily activities (Clarified to Have you required
assistance in performing daily
activities?.)
Usually I don't need much help. But since I've been sick, my
daughter has been helping me,
doing things around the house--gardening, cleaning, making
sure I eat a little something.
She's very busy with her job, and it's very sweet of her to help
me. (Clarified to if I have
needed help with daily activities.)
Are you able to dress yourself
No -- I had to miss my exercise classes this week -- I didn't
have the energy for them. That's
unusual for me.
Do you need help eating
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I don't need any help right now. Thank you.
Do you have difficult walking (Clarified to Is it hard for me to
walk?.)
I can walk just fine. (Clarified to if it is hard for me to walk.)
Do you need help bathing
No, I can do that myself.
Are you able to get in and out of a chair
Any kind of movement makes my abdominal discomfort worse,
but I don't usually have
problems with that.
Tell me about your diet (Clarified to What is your diet like?.)

I usually eat low fat foods, healthy proteins. . . on holidays our
family gets together, so I make
traditional dishes then. Korean dishes. But usually I eat very
light. (Clarified to what my diet is
like.)
Do you eat three meals a day
Usually three, but sometimes I skip breakfast. I don't eat
snacks.
What are you eating habits (Clarified to What are your eating
habits?.)
Hm. Toast for breakfast. For lunch. . . usually soup. But I don't
always have lunch. And for
dinner I eat fish, or sometimes chicken, and rice. [AUDIO
COMING SOON] (Clarified to what
my eating habits are.)
Have you had any change in weight
No, not that I've noticed.
Have you had any fever or chills
No, I haven't been feverish or chilly. [AUDIO COMING SOON]
Have you had night sweats
No. That is not a problem for me.
so you see swelling in your extremities or face

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04/22/20 3:40 PM MD
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Nothing is swelling that I know of.
Do you smoke

I've never smoked a cigarette in my life. What a sad habit.
Do you drink alcohol
Yes, but very little.
How often and what type of alcohol
Very little.
How often do you drink alcohol
Very little.
Do you take illicit drugs
I have never used drugs of any kind.
How much alcohol do you drink
Very little.
How often do you drink in a week
On Sundays, I have my only drink for the week.
What kind of alcohol do you drink
I always have one glass of wine. A dry white wine.
Do you live alone
No. I live with my daughter, Jennifer.

Do you have family around besides Jennifer
Two wonderful grown-up children. Jennifer and Timothy.
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Do you have grandchildren
Oh, I would have loved to have had grandchildren. Both of my
children... Everything is about
their careers. But I supposed--some of my friends, their children
are grown--in their 40s, 50s--
and they never found their way. So I'm very lucky.
Thank you.
Do you travel
My late husband Shin and I went on a few vacations with the
kids--Florida, once to St.
Thomas in the Caribbean. And once I went to Munich, Germany
where Shin was doing a
lecture. But since he died, I've only gone on one trip--to
Houston, to see my son.
Thank you.
Have you had been physically abused
No, never.
Have you ever been sexually abused (No matching questions
found.)
Have you ever been sexually abused (No matching questions
found.)
have you been abused sexually

No.
Have you been emotionally abused
No, the people in my life--they treat me very well.
Are you okay with your finances
No. My daughter handles the bills.
Is that going well for you (No matching questions found.)
Thank you.
Do you have trouble sleeping
No, usually I sleep right through the night.
Have you ever had a history of appendicitis (No matching
questions found.)
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04/22/20 3:46 PM MD
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Have you ever had appendicitis
No.
Have you had any stomach cancer (Clarified to Have you had
stomach cancer?.)
No. (Clarified to if I have had stomach cancer.)
Is there a family history of stomach cancer
No.
Do you or your family have liver disease
No, not that I know of.
Have you ever had GERD

No. I don't get indigestion, heartburn, nothing like that.
Do you have a family history of ulcer (Clarified to Do your
family members have health
problems?.)
Let's see. . . high cholesterol and diabetes. My father was an
overweight man. My two older
brothers, they live in California. One of them has high
cholesterol and now prostate cancer,
but he's not having the surgery. His doctor says his cancer is
very slow growing. Both. . . Yes,
both have high blood pressure. Both my parents had high blood
pressure, and so do I, so you
might say that runs in my family. (Clarified to if my family
members have health problems.)
Have you ever had any palpitation
No. My heart rate has always been normal.
Have you ever had chest discomfort (Clarified to Have you ever
had chest pain?.)
No, I don't ever experience chest pain. (Clarified to if I have
ever had chest pain.)
Have you ever felt your heart rate was going fast
No. My heart rate has always been normal.
Do you have any sore throat
No. My throat is fine.

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Do you have any cough
No, I haven't been coughing at all.
Do you have difficulty swallowing
No. I am able to swallow without any problems.
Do you have difficulty breathing (Clarified to Do you have
breathing problems?.)
No. I can breathe well. My lungs feel very healthy. (Clarified to
if I have breathing problems.)
Do you have any bloating
Yes. Quite a bit.
Are you gassy
Hm. I have been experiencing some of that.
Do you feel nauseous
No. I haven't vomited or had any nausea. It's more of a problem
with pain. . . and difficulty
going to the bathroom.
Have you had food poisoning
Years ago I eat some bad shellfish. . . this doesn't feel like that.
Do you have vomiting
Very rarely. The last time I vomited. . . I had a stomach virus a
few years ago. One of those

nasty, 24-hour bugs.
Do you have bladder problems
No.
You have any history of bladder cancer (Clarified to Have you
had a bladder infection?.)
No, never. (Clarified to if I have had a bladder infection.)
Have you ever had problem gynecological
I haven't had any.
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Do you have vaginal bleeding
No.
Do you have menopause (Clarified to How long ago did you
have menopause?.)
Oh my. . . it was twenty years or more ago. . . I think I was 54.
(Clarified to how long ago I
underwent menopause.)
Do you have any kidney problems
No, I've never had any kidney trouble.
Thank you.
the stethoscope may be cold (No matching questions found.)

Is that tender (No matching questions found.)
Is that tender to touch (No matching questions found.)
did that hurt (No matching questions found.)
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That feels alright.
That feels alright.
That feels alright.
Mmm, it feels sore there.

Thank you.
That feels alright.
That feels alright.
That feels alright.
Ooo, that--that's sore right there.
Bart would you like a flu injection (No matching questions
found.)
Miss Park would you like to have a flu injection
Not today. Maybe I'll get one at my next check-up, if my doctor
recommends it.
How many pregnancies have you had

I've had three pregnancies... I have two wonderful grown
children.
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Did you have a miscarriage
No, not a miscarriage. When I was forty I had a baby, delivered
by C-section. It was what they
called an umbilical cord accident--where the cord wraps around
the baby's neck. It was a
stillbirth.
Thank you.
Do you have any depression
I don't struggle with depression, thankfully. I feel positive
about my life.
Did you have resources for the loss of your child (No matching

questions found.)
Did you need therapy for the loss of your child (No matching
questions found.)
Are you coping with the loss of your child
I like to think so. I think I'm good at letting things go--not
holding onto resentments, things
that make me sad. Between my friends, my daughter, and. . .
and also my gentleman friend, I
have good people around me.
Comments
®

information
Education & Empathy : 5 of 6 (83.3%)
During the patient interview, there are a number of
opportunities to provide patient education and empathy. The
opportunities listed below ar
those identified by nursing experts to be of particular
importance to this patient. A Model Statement is provided as an
example of an
appropriate response to each opportunity.
Opportunities marked as Not Encountered are opportunities that
were not elicited in the interview
Opportunities marked as Not Followed Up are missed
opportunities that were present in the interview, but where no
statements were
made
Opportunities marked as Followed Up were followed up by
students, and include the dialogue between student and patient

Description: Mr. Foster describes his past medical history of
hypertension and high cholesterol.
What is your medical history
Questio
07:07 PM MD
The doctors told me I have a little bit of high blood pressure
and cholesterol, but that's it.
Questio
07:07 PM MD
I've never had any surgeries.
Questio
07:07 PM MD
I think I'm allergic to codeine. It makes me toss my cookies.
Model Statement: "It’s good that I know you have been
diagnosed with hypertension and high
cholesterol, because those conditions can cause additional heart
problems. I would like to find out more
about your diagnosis and treatment of those conditions."
Overview

Transcript
Education & Empathy
Documentation
1 Symptoms Followed Up
2 Hypertension and High Cholesterol Not Followed Up
ab_pass.pdf
3 Exercise Followed Up
4 Diet Followed Up
5 Weight Gain Followed Up
6 Family History Followed Up
Comments

®
Education & Empathy : 6 of 7 (85.7%)
During the patient interview, there are a number of
opportunities to provide patient education and empathy. The
opportunities listed below ar
those identified by nursing experts to be of particular
importance to this patient. A Model Statement is provided as an
example of an
appropriate response to each opportunity.
Opportunities marked as Not Encountered are opportunities that
were not elicited in the interview
Opportunities marked as Not Followed Up are missed

opportunities that were present in the interview, but where no
statements were
made
Opportunities marked as Followed Up were followed up by
students, and include the dialogue between student and patient
Description: Ms. Park describes staying socially active and
exercising.
Is there anything that makes it worse
Questio
03:07 PM MD
Yes. When I move around the house or try to garden, I feel
more pain. And I did not go to my exercise
classes. I was sure that would be too much. I prefer to be active,
but my daughter wants me to rest.
Does the pain radiate anywhere in your body
Questio
03:14 PM MD
Model Statement: "It sounds like you stay physically and
socially active. That’s great!"
Overview
Transcript

Education & Empathy
Documentation
Student Survey
1 Symptoms Followed Up
2 Medications Followed Up
3 Diet Followed Up
4 Activity Level Not Followed Up
5 Medical History Followed Up
6 Sexual Activity Followed Up
7 Family and Support Followed Up
Comments
ab_pass.pdf

®
Focused Exam: Cough Results | Turned In
Documentation / Electronic Health Record
Document: Provider Notes
Student Documentation Model Documentation
Subjective
Dany is a 8 year old hispanic boy, brought into clinic by his
grandmother. He is able to answer the questions independently
and
maintains eye contact. He reports a gurgly watery cough for the
last
4-5 days. His throat is hurting with the cough, and is feeling
tired.
Difficult sleeping due to the cough. His mother gave him a
"purple
medicine" this morning, for the cough, although he doesn't

know the
name of it. It has helped, but then his cough presents itself
again. He
has c/o right ear pain, that started yesterday. He has had hx of
ear
infections when he was 2 yo.
He denies fever or chills, or watery eyes but states he gets the
"cold"
frequently. Denies chest pain or difficult breathing
No allergies to meds or pollen
Immunizations: updated
PMHx; ear infections at childhood
Surgical hx: none
Social hx: Lives with parents, grandmother assists with care,
when
parents are at work. does not smoke, exposed to 2nd hand
smoke
from his Papi. Washes hands before eating or after restroom.
No family history of asthma or allergies.
Danny reports a cough lasting four to five days. He describes
the
cough as “watery and gurgly.” He reports the cough is worse at
n
and keeps him up. He reports general fatigue due to lack of slee
He reports pain in his right ear. He is experiencing mild
soreness
his throat. He reports his mother treated his cough symptoms wi
over-the-counter medicine, but it was only temporarily
effective.
reports frequent cold and runny nose, and he states that he had
frequent ear infections as a child. He reports a history of
pneumo
in the past year. He reports normal bowel movements. He denies
fever, headache, dizziness, trouble swallowing, nosebleed,
phleg

or sputum, chest pain, trouble breathing and abdominal pain. He
denies cough aggravation with activity.
Objective
Daniel appears slightly tired, and has been coughing throughout
the
exam
Vital signs stable
Spirometer: FEV1: 3.15L FVC 3.91L/ 80.5%
Head: Cervical lymph nodes enlarged and tender on right side;
Sinus: no tenderness on frontal or maxillary
eyes: pink in color, no discharge
Ears: right ear redness and inflammed: no d/c
nose: clear watery phlem, no odor
Throat: oropharynix: cobberstone, redness with postnasal drip
Lungs: CTA bilaterally:
Breath sounds: clear bilaterally anterior and posterior.
bronchophony: negative
Chest: S1 and S2 audible, no murmurs or abnormal heart sounds
• General Survey: Fatigued appearing young boy seated on nurs
station bench. Appears stable.
• HEENT: Mucus membranes are moist, clear nasal discharge.
Redness, cobblestoning in the back of throat. Eyes are dull in
appearance, pink conjunctiva. Right Tympanic membrane is red
inflamed. Right cervical lymph node enlarged with reported
tenderness.
• Cardiovascular: S1, S2, no murmurs, gallops or rubs.
• Respiratory: Respiratory rate increased, but no acute distress.
A
to speak in full sentences. Breath sounds clear to auscultation.
Negative bronchophony. Chest wall resonant to percussion.

Expected fremitus, equal bilaterally. Spirometry: FEV1: 3.15 L,
FV
3.91L (FEV1/FVC: 80.5%)
Overview
Transcript
Education & Empathy
Documentation
Document: Vitals Document: Provider Notes
ab_pass.pdf
Assessment
Differential diagnosis:
1. flu-like syndrome or cold
2. strep throat
3. Allergies
4. Allergic rhinitis

My differentials include cold, strep throat, rhinitis, allergies
and
asthma based on abnormal findings affecting the ears, upper
respiratory tract and lymphatic region.
Plan
Discuss hand hygiene and hygiene ettiquitte when coughing:
cough
in elbows, and hand hygiene.
Strep culture
Cough medication to help sleep at night and suppress cough
Antihistamine to dry up secretions
Encourage fluid intake, avoid dairy products that can make
cough
worse: phlem may get thicker
Refer for allergy testing if antihistamine did not work
Educate warning signs for immediate attention like difficult
breathing,
fever, chills, or cough worsening.
Follow up in a week or telephone appt in 3 days to follwo up on
progress
Educate the family the importance of hand hygiene
Danny should be referred for an allergy test to rule out allergies
a
well as a lung function test to rule out asthma. He should
receive
strep culture to rule out strep throat. I recommend antitussive
treatment at night to help with his sleep in addition to bed rest.
Comments

®
Subjective
Miss Park is a pleasant Korean 78 year old woman who presents
to
the clinic with complaints of abdominal pain for the past 5 days.
She
is oriented to person place and time. She answers the questions
appropriately and maintains eye contact during the interview

and
exam. This with her daughter who assist with her Care at home.
Pains are described as crampy, dull at her lower abdomen, with
a
pain scale of 6/10, mostly constant. Has had difficulty using the
bathroom this past 5 days, which has affected her daily
activites.
She has been feeling more tired than usual, denies feeling fever
chills
or rectal pain. She drinks two glasses of water a day and eats
well,
although has had a decrease in appetite since her abdominal
pain
started. Her abominal pain Is aggravated with food and activity,
pain
is relieved with rest. Her stool is soft and brown, no current
diarrhea.
She has history of colonoscopy that was negative. She denies
any
vaginal bleeding or urinary difficulty. She denies any GERD,
colon
cancer or stomach issues.
PMHx: HTN on accupril 10 mg daily
Immunizations: updated: declines flu vaccination today.
Surgical hx:
choleystectomy at 42yo
Cesarean delivery at 40yo:
OB/GYN: G3P3L2: one stillbirth for cord accident. No hx of
STI. Pap
WNL 2010
Social hx: has a friend who she is intimate with, no tobacco use,
no
illicit drugs. Drinks once a week with white wine. Has stong
family
support. Visits her Son in Houston occasionally.
Family Hx:

Mother: DM and HTN: Deceased @ 88yo
Father: HTN and hypercholestremia: deceased at 82yo
MGP: HTN
PGM: HTN/ CVA/obesity
Brothers: HTN
SOn: healthy
daughter: Healthy
Ms. Park reports that she is “having pain in her belly.” She
experienced mild diarrhea three days ago and has not had a bow
movement since. She reports that she has been feeling some
abdominal discomfort for close to a week, but the pain has
increased in the past 2-3 days. She now rates her pain at 6 out o
10, and describes it as dull and crampy. She reports her pain lev
the onset at 3 out of 10. She is also experiencing bloating. She d
not feel her symptoms warranted a trip to the clinic but her daug
insisted she come. She describes her symptoms primarily as
generalized discomfort in the abdomen, and states that her lowe
abdomen is the location of the pain. She denies nausea and
vomiting, blood or mucus in stool, rectal pain or bleeding, or
rece
fever. She denies vaginal bleeding or discharge. Reports no
histo
of inflammatory bowel disease or GERD. Denies family history
of
disorders. Her appetite has decreased over the last few days and
she is taking small amounts of water and fluids. Previously she
reports regular brown soft stools every day to every other day.
Overview

Transcript
Education & Empathy
Documentation
Student Survey
ab_pass.pdf
Objective
Alert and oriented x3: Some discomfort due to abdominal pain
HEENT: moist mucus mambrane, normal skin turgor, no tenting
Heart: S1 and S2 with no abnormal heart sounds
Lungs; CTA
Liver: 1cm below Rt costal margin: nontender
Abdomen: BS present at all quads, normoactive, No bruits or
friction
sounds. Dullness on LLQ, Tender to touch, with guarding and
distension. 2x4cm oblong mass palpated on LLQ.
RUQ : with scar s/p choleystectomy, and al lower transverse
abdominal scar from s/p cs
no CVA tenderness
Pelvic: neg

Rectal: no hemorrhoids, strong spincter reflex, fecal mass
detected
in rectal vault
Extremties: no edema: normal reflexes
UA: clear but dark urine, neg for nitrites, wbc or ketones.
• General Survey: Uncomfortable and flushed appearing elderly
woman seated on exam table grimacing at times. Appears stable
mildly distressed.
• HEENT: Mucus membranes are moist. Normal skin turgor; no
tenting.
• Cardiovascular: S1, S2, no murmurs, gallops or rubs; no S3,
S4
rubs. No lower extremity edema.
• Respiratory: Respirations quiet and unlabored, able to speak in
sentences. Breath sounds clear to auscultation.
• Abdominal: 6 cm scar in RUQ and 10 cm scar at midline in
suprapubic region. An abdominal exam reveals no discoloration;
normoactive bowel sounds in all quadrants; no bruits; no
friction
sounds over spleen or liver; tympany presides with scattered
dullness over LLQ; abdomen soft in all quadrants; an oblong ma
noted in the LLQ with mild guarding, distension; no
organomega
no CVA tenderness; liver span 7 cm @ MCL; no hernias.
• Rectal: No hemorrhoids, no fissures or ulceration; strong
sphinc
tone, fecal mass in rectal vault.
• Pelvic: No inflammation or irritation of vulva, abnormal
discharg

or bleeding; no masses, growths, or tenderness upon palpation.
• Urinalysis: Urine clear, dark yellow, normal odor. No nitrites,
WB
RBCs, or ketones detected; pH 6.5, SG 1.017.
Assessment
Constipation causing abdominal mass
Intestinal obstruction
Diverticulitis
Irritable bowel syndrome
Mrs. Park’s bowel sounds are normoactive in all quadrants, with
bruits or friction sounds. Scattered dullness in LLQ during
percussion is suggestive of feces in the colon; otherwise, her
abdomen is tympanic. Her abdomen is soft to palpation; mild
guarding and oblong mass suggesting feces were discovered in
LLQ. No CVA tenderness; liver span 7 cm @ MCL; no splenic
dullness. Digital rectal exam revealed a fecal mass in the rectal
v
No abnormalities were noted during the pelvic exam, so pelvic
inflammatory disease is not suspected. Ms. Park’s urinalysis
was
normal, which rules out a urinary tract infection. No signs of
dehydration or cardiovascular abnormalities. Mrs. Park’s
sympto
and health history suggest she has constipation. Differential
diagnoses are constipation, diverticulitis, and intestinal
obstructi
Plan
stool for occult blood
CBC/ ESR with CRP
Metabolic panel

serum amylase
abdominal sonogram or abdominal x-ray for to locate mass;
Bowel rest if diverticulitis : if neg: increase po fluids, increase
fiber,
increase activity as tolerated.
Creating a bowel regimen is encouraged.
Mrs. Park should receive diagnostic tests to rule out
differentials
CBC to assess for elevated WBCs associated with diverticulitis,
electrolyte profile to evaluate electrolyte and fluid status, and a
C
scan to assess for obstruction. If Mrs. Park has diverticulitis I
recommend IV fluids and bowel rest. If she has bowel
obstructio
recommend NPO, IV fluids, and general surgical consult. If she
h
constipation, I recommend that she increase fluids, increase fibe
and increase activity as tolerated.
Comments
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information
Subjective
Brain is a 58 you caucasian Male who presents with C/o chest
pain
in the middle of his chest over his heart, 3 times this month. His
pain

is 5/10 when the pain arises, no chest pain currently. Chest pain
does not radiate to his arm, shoulder or neck. Aggravated chest
pain
when walking up the steps, and is relieved when he rests.
Denies
any heartburn, difficult breathing. No change in appetite but
mentioned he gained some weight when his bike was stolen.
Rare
exercise at this moment, desires clearance for exercise since the
onset of his chest pain. Never been seen for chest pain, and has
not
taken anything for chest pain.
Medical history:
HTN on Lopressor 100 mg/daily x1 year
Hyperlipedmia on lipitor 20 mg daily x1 year
Omega 3 daily
No surgical history
Family Medical hx:
Father: htn/hyperlipdemia, obesity, died of colon cancer @ 75yo
MGF: heart attack died @ 54 yo
Sister: HTN and Diabetes type 2
Social hx: beer 3 drinks in a weekend
denies tobacco or drug use
Pt. reports "I have been having some troubling chest pain in my
chest now and then for the past month." Experiencing periodic c
pain with exertion such as yard work as well as with overeating.
Points to midsternum as location. Describes pain as “tight and
uncomfortable.” Denies radiation. Pain lasts for “a few”
minutes
goes away when he rests. Most recent episode was three days a
after eating a large restaurant dinner. States “It has never gotten
‘really bad’” so didn’t think it was an emergency, but is
concerne
after three episodes in one month and wants his heart checked o

Reports mild cramping in legs with activity. Denies shortness of
breath, indigestion, heartburn. Denies chest pain at this time.
Overview
Transcript
Education & Empathy
Documentation
ab_pass.pdf
Objective
Brian is a 58 year old Caucasian male appears to be well-
groomed,

is pleasant and answers questions clearly and appropriately. He
maintains eye contact throughout the exam. He appears in no
distress
VSS: Bp 146/90
Skin warm to touch, dry, pink and intact. no tenting
Heart: S1, s2, s3 and S4 with murmur
Carotid pulse: positive Thrill, +3 on right:
PMI: displaced laterally, briks and tapping, <3cm
Breath sounds: clear in upper lobes, posterior lower lobes with
crackles bilaterally.
GI: no tenderness, no masses, guarding or distension. BS
present at
all quads, WNL
Liver is palpable and nontender: spleen and kidneys are not
palpable
Extremties: No edema, Brachial and radial pulse neg for thrill at
2+
popliteal, tibal and dorsalis pedis pulse diminised at 1+.
capillary
refill less than 3 seconds on extremiteis.
EKG: Regular sinus rhythm. No ST changes
• General Survey: 58 year old male is alert and oriented, with
clea
speech and in no acute distress.
• Cardiac: S1, S2, without murmurs or rubs. PMI displaced
latera
S3 noted at mitral area.
• Peripheral Vascular: Right side carotid bruit. JVP 3cm above
ste
angle. Right carotid pulse with thrill, 3+. Left carotid pulse
withou
thrill, 2+. Brachial, radial, femoral pulses without thrill, 2+.

Poplite
tibial, and dorsalis pedis pulses without thrill, 1+. Cap refill
less t
3
seconds - 4 extremities.
• Respiratory: Breathing is quiet and unlabored. Breath sounds a
clear to auscultation in upper lobes and RML. Fine
crackles/rales
posterior bases of L/R lungs.
• Gastrointestinal: Round, soft, non-tender with normoactive
bow
sounds in 4 quadrants; no abdominal bruits. No tenderness to lig
or deep palpation. Tympanic throughout. Liver is 7 cm at the
MC
and 1 cm below the right costal margin. Spleen and bilateral
kidn
are not palpable.
• Neuro: Alert and oriented x 3, follows commands, moves all
extremities.
• Skin: Warm, dry, pink, and intact. No tenting.
• EKG (interpretation): Regular sinus rhythm. No ST changes.
Assessment
Coronary Artery disease
Stable angina
Carotid disease
pericarditis
Aortic aneurysm
r/o GERD
R/O Sarcodosis

Based on the abnormal findings during cardiovascular and
respiratory auscultation, my differentials include coronary
artery
disease with stable angina; congestive heart failure; carotid
disea
aortic aneurysm; pericarditis; or GERD.
Plan
Blood work for cardiac enzyme, electrolytes, CBC, Lipid
profile, liver
function test, cxr, 12 lead EKG
Consult with cardiologist
Echocardiogram
Exercise stress test
Dopplers for carotid
Patient should be tested with results on labs at the least, and not
discharged home.
Baby Asa upon arrival
Ntiroglycerin if chest pain is present again
Warning signs of when to seek medical help like another onset
of
chest pain, SOB, shoulder or arm pain
Mr. Foster should receive a 12-lead ECG, chest x-ray, and lab
workup (cardiac enzymes, electrolytes, CBC, BNP, CMP, Hgb
A1
lipid profile, and liver function tests) to confirm a diagnosis. He
should be referred for an echocardiogram, exercise stress test, a
carotid dopplers as well as a consult with a vascular surgeon for
carotid evaluation. Mr. Foster should be prescribed diltiazem
and
diuretic in addition to his daily Lopressor and Lipitor. If
needed, a
an ACE inhibitor to manage his hypertension and PRN

nitroglyce
for chest pain that does not subside with rest.
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