. She states that she feels healthy, is taking better care of herself than in the past, and is looking forward to beginning the new job. Denies changes in hearing or ear pain. Lag, nystagmus, and deviations may indicate neurologic conditions. My muscles have felt great, especially since I started exercising more. (Clarified to Do you have drainage from your ears?. Dual shoulder shrug against resistance, able to turn head in both directions against resistance. since age 19, currently lives with mother and sister Denies back and neck pain and trauma. PMI nondisplaced, no heaves or lifts. use: yesterday), Acetaminophen 500-1000 mg PO prn (headaches), Ibuprofen 600 mg PO TID prn (menstrual cramps: ProTip:Initiallyestablishingachiefcomplaintallowsthepatienttoexpresstheirreason Musculoskeletal exam performed on Ms. Jones. Theyre crazy, but nobodys diagnosed with anything. socially with friends. AskingTinaifshetakesmedicationforheartburnwillindicate Her pain is a 9 when she tries to ambulate. How often do you use your rescue inhaler? Asking Tina why she saw a healthcare provider might indicate any recent health concerns or problems. Can I confirm that you are here for a physical? Diagnosed with PCOS four months ago. Does this Look Like Your Assignment? treatmentplans. : an American History (Eric Foner), Psychology (David G. Myers; C. Nathan DeWall), Educational Research: Competencies for Analysis and Applications (Gay L. R.; Mills Geoffrey E.; Airasian Peter W.), Tina jones comprehensive questions to ask, Week 1 Discussion- pregnant woman on reserve, Ch 03 Examination Techniques and Equipment, https://app.shadowhealth.com/assignment_attempts/4562098. Reportsmanagingdiabeteswithdietandexerciseinadditiontomedication. new job" "I came in because I'm required to have a recent She maintains eye contact throughout the interview. She hurt the ball of her right foot by scraping it on the edge of a metal step while changing a light bulb. This homework should take 3 hours on average each time to finish. concerns, last dental visit was 5 months ago. ), Nothing is coming out of my ears. Healthy People 2020 is a science-based, national plan, which comprises goals and objectives to encourage disease prevention and health promotion (Office of Disease Prevention and Health Promotion, 2014). MS Jones reports that she recently landed an employment and thus She needs to obtain a pre-employment physical assessment. Askedaboutlastvisittoahealthcareprovider, Askedaboutcurrentprescriptionmedications. She maintains eye contact throughout the interview. Last dental visit was five months ago with no concerns. AskingTinahowlongagoshestartedtakingbirthcontrol Last hospitalized for asthma exacerbation in high school. Skin on neck has stopped darkening and facial and She needs to obtain a pre-employment Does not wear corrective lenses. Now that Im on the pill Im getting my period every month. Ms. Jones should be encouraged by the additions and progress she has made. Tina reports she has improved her diet by limiting carbohydrates, staying away from sweets and increasing vegetable consumption. No tobacco. When was your last physical exam? The foot feels better when she rests, and it hurts more when she walks on it. Pro Tip: Establishing a timeline for which healthcare providers Tina has seen will allow you to develop a comprehensive health history. Today she denies any acute concerns. Upon examination, head is normocephalic with no lesions or tenderness of scalp. and facial and body hair has improved. She reports a few moles but patient. Ms. Jones assessment findings include many topics in this plan including diabetes, weight status and nutrition, physical activity, and respiratory diseases. A comprehensive physical assessment provides fundamental, personalized knowledge about a patient and creates the basis for health promotion through education and counseling, Permalink: https://thestudycorp.com/tina-jones-comprehensive-assessment. Has new male relationship, sexual contact not initiated. How old is Tina Jones in a pre employment physical examination? Up-to-date, tetanus booster within the last year. Dains, J. E., Baumann, L. C., & Scheibel, P. (2012). Pro Tip: Palpating the thyroid gland for size, shape, and consistency, and noting any nodules or tenderness, helps to identify signs of a thyroid disorder. The headache lasts a few hours and is relieved with acetaminophen and sleep. Poppa died of a heart attack when he was 80. . Denies adverse effects of asthma medication. But that hasnt happened since I got my daily inhaler. Ms. Jones is a pleasant 28-year-old African American woman who presented to the emergency department for evaluation of a right foot injury and was admitted for IV antibiotics. Denies vaginal discharge and vaginal itching. maintains eye contact throughout the interview. . (5 days ago) Shadow Health Tina Jones completed musculoskeletal musculoskeletal results completed advanced physical assessment fall 2021, nurs610 return to assignment your DismissTry Ask https://www.studocu.com/en-us/document/western-carolina-university/synthesis-of-nurs-practicum/musculoskeletal-completed-shadow-health-2/19246855 Denies history of recurrent urinary tract infections and kidney stones. ProTip:Themedicationapatienttakesindicatestheirhealthliteracy,treatmentplan, A comprehensive assessment of Ms. Jones will be performed, and key https://studyinghq.com/samples/tina-jones-comprehensive-assessment/ Category: Health Show Health Comprehensive Assessment Tina Jones Shadow Health Transcript Health (16) $15.98 34x sold Shadow Health Comprehensive Assessment Tina Jones -Documentation /Electronic Health Record. Pro Tip: Asthma exacerbation can result in increased wheezing, shortness of breath, and chest tightness. Normal graphesthesia, stereognosis and rapid alternating movements bilaterallly Tests of cerebellar function normal DRTs and equal bilaterally in upper and lower extremities Reduced sensation to monofilament in bilateral plantar surfaces. Asking Tina what triggers her allergies will indicate, in part, Tinas health literacy. than twice a week, sometimes not at all" Patient drinks alcohol about six drinks per month Cats: wheezing, itchy watery eyes, sneezing, asthma exacerbation. Patient denies any She denies any acute concerns at this visit. . Ms. Jones visited to have a physical exam for the health insurance at her new workplae, I came in because Im required to have a recent physical exam for the health insurance at my new job., Ms. Jones reported that she recently got a job at a new place and she is required to obtain a physical examination. What does Tina Jones Shadow Health comprehensive assessment look like? Reportslastasthmaexacerbationwasthreemonthsago. Asthma diagnosed at age 2 1/2. Asthma is a lung condition that affects people of all ages. Ive maybe used it twice since I came in with those asthma problems. Patient reports an improve in acne due to oral As you continue, thestudycorp.com has the top and most qualified writers to help with any of your assignments. Speech is fluent, Pro Tip: The medication a patient takes indicates their health literacy, treatment plan, and access to healthcare. That stuff can mess you up. Reports no use of cocaine, What is your relationship like with your family? Strength 5/5 bilateral upper and lower extremities. apartment in one month. . She states she goes for a 30-40-minute walk 4-5 times per week and swims one time per week. High BP and high cholesterolon both sides and diabetes. Comprehensive Assessment Tina Jones Shadow Health Transcript, Subjective, Objective & Documentation. Cross), Principles of Environmental Science (William P. Cunningham; Mary Ann Cunningham), Give Me Liberty! Oral mucosa moist and without (Clarified to Does your brother have medical problems?. Uses alcohol when bilaterally on the head with equal hair Distribution on injury or acute visual changes. Headaches are described as a "tight and throbbing feeling behind the eyes." treatmentplans. Normal hair distribution. Reports sometimes needing 3 puffs to control symptoms. No. ProTip:Themedicationapatienttakesindicatestheirhealthliteracy,treatmentplan, Shadow Health Comprehensive Assessment Tina Jones -Documentation /Electronic Health Record. Eyes are intact bilaterally no nystagmus is Tina jones comprehensive questions to ask, Copyright 2023 StudeerSnel B.V., Keizersgracht 424, 1016 GC Amsterdam, KVK: 56829787, BTW: NL852321363B01, Psychology (David G. Myers; C. Nathan DeWall), Principles of Environmental Science (William P. Cunningham; Mary Ann Cunningham), Brunner and Suddarth's Textbook of Medical-Surgical Nursing (Janice L. Hinkle; Kerry H. Cheever), Business Law: Text and Cases (Kenneth W. Clarkson; Roger LeRoy Miller; Frank B. Tina jones comprehensive Newest Theology - yea Leadership class , week 3 executive summary EKG Review for ICU clinical Biomol Project Report I am doing my essay on the Ted Talk titaled How One Photo Captured a Humanitie Crisis https School-Plan - School Plan of San Juan Integrated School ANSC 422 Lecture 2 - Dr. Kleinman (Tina Jones Comprehensive Assessment). Never pregnant. Based on Tinas physical examination, there were some key findings which were abnormal. Asking Tina how long ago she started taking birth control establishes a timeline of her current treatment plan. ProTip:Themedicationsthatapatienttakesindicatetheirhealthconcernsorproblems, . Nose: Rhinitis and congestion related to cat allergy. She is now on metformin, Proventil, and Flovent. Normal graphesthesia, stereognosis, and rapid Ms. Jones states no joint pain, stiffness, swelling, or limitation. Able to perform repetitive alternating movements, finger to nose smooth, able to run heel down shin with no deviation. This type of neuropathy is slowly progressive and maintaining an HgA1C level at less than 7.4% reduces this progression (Bickley & Szilagyi, 2013). diagnosed her with polycystic ovarian syndrome and CanIconfirmthatyouarehereforaphysical? Sclera white, conjunctiva pink, PERRLA, EOMs intact. Pain is localized to ball of foot related to wound. Once three months ago, and before that it had been months, too. place, and time. factsofthepatient'scase. But my zits have gotten better, and I think its because Im on birth control now. She denies any pain acute illness, pain or discomfort. Ear canal pink, tympanic membrane pearly gray, no drainage. She acts as the primary source of the data offered for the assessment. Asking Tina if she has a rescue inhaler for her asthma will indicate her treatment plan and the degree to which she complies with it. Pro Tip: Initially establishing a chief complaint allows the patient to express their reason for seeking care, primary concerns, or condition they are presenting with. maxillary sinuses nontender to palpation. We Can do an Original Paper for you! Then, they examine Tina head-to-toe, one body system at a time, to ga. [Show more] use: this morning), Albuterol 90 mcg/spray MDI 1-3 puffs Q4H prn (last Metformin: Started five months ago. Today she Her last healthcare visit was 4 months ago, when she received her annual gynecological exam at Shadow Health General Clinic. feel moles but no other hair or nail changes. Denies fatigue, fever, chills, or night Drospirenone and ethinyl estradiol: one pill every day. . is tolerating well. Comprehensive Assessment Tina Jones Shadow Health Transcript, Subjective, Objective & Documentation. Tina Jones is a pleasant 28 year old African words are clear. ProTip:Themedicationsthatapatienttakesindicatetheirhealthconcernsorproblems, disc margins, no hemorrhages. Pro Tip: Tinas response to a question about managing her allergies will reveal the severity of her symptoms, her health literacy, and the way shes complied with previous treatment plans. Grandpa Jones had colon cancer, and that caused all kinds of problems for him. ProTip:Asthmaseveritymightchangeovertimeforavarietyofreasons. Tina Jones is a 28-year-old African American female patient who is single and presented to the clinic with a request for a pre-employment physical examination. Howoftendoyouuseyourrescueinhaler? Report document A.T. No current dental Your role in this simulation is that of a healthcare provider who will take Ms. Jones' health history, a key component of her admission process. Yeah. Things are pretty good between all of uswere a tight knit family. Pro Tip: Because your patient may have unknowingly hit her head during her fall, giving special attention to your observation of the size and the shape of your patients head can identify any indications of trauma. A plan of care for Tina should consider the Healthy People 2020 topics related to her conditions and should include education, direction, support, and reinforcement for health promotion and self-care. Whendidyoulastuseyourrescueinhaler? Along with controlling diabetes, other leading modifiable risk factors include diet, physical activity, and being overweight and obesity. Comprehensive Assessment Tina Jones Shadow Health Transcript, Subjective, Objective & Documentation. Ears: Denies difficulty hearing, tinnitus, ear pain, and discharge. Pro Tip: Assessing range of motion of each major joint noting any limitations in mobility, pain, or crepitation can identify joint disease or injury. No peripheral edema. No muscle pain or weakness. When did you last use your rescue inhaler? ProTip:FollowupquestionsaboutTina'smedicationhistoryandtimelinewillhelpyouto Scattered pustules on face Facial hair on upper lip Acanthos nigricans on posterior neck Nails free of any abnormalities or ridges, Scattered pustules on face and facial hair on upper lip, acanthosis nigricans on posterior neck. : an American History, Med Surg Nursing Cheat Sheets 76 Cheat Sheets for Nursing Students nodrm pdf, Philippine Politics and Governance W1 _ Grade 11/12 Modules SY. occasional shortness of breath, wheezing, and chest Tina jones comprehensive - Comprehensive Assessment Results | Turned In Health Assessment for the - Studocu Shadow health assessment Tina Jones comprehensive assessment completed shadow health undergraduate students, become tester for shadow health! The daily inhaler is Flovent, and the rescue inhaler is Proventil. Asking Tina why she started taking birth control will allow Tina to express any concerns or problems in her own words. physical exam for the health insurance at my new Haveyoubeentakingmedicationforyourdiabetes? Her maternal grandparents both died in their 70s from stroke and had a history of hypertension and high cholesterol. Home Blog Tina Jones Comprehensive Assessment, This article covers Tina Jones Comprehensive Assessment. I dont have anything specific going on today. Palpating thoracic expansion symmetric. Liver span 7 cm MCL, palpable 1 cm below right costal margin. She also has increased her physical activity. Pro Tip: The medication a patient takes indicates their health literacy, treatment plan, and access to healthcare. consume 1-2 diet sodas per day. Since then Ive just washed my face, I havent used anything special. Indicatesanitemthatisavailabletobefound. Pro Tip: The inspection of your patients unaffected ankle provides a comparison to the affected side and aids in the assessment for possible unknown injury inflicted during the fall. pink, no lesions, white sclera. My albuterol. She used to take metformin but stopped taking it due to gastrointestinal problems. A comprehensive health history and physical examination revealed current health status, health behaviors and health issues of Ms. Tina Jones. since I was really little. I had two doctors appointments earlier this year. Dentition without evidence of caries or infection. ProTip:FollowupquestionsaboutTina'smedicationhistorywillhelpyoutounderstand coursehero/file/38245035/Comprehensive-Assessment-Completed-Shadow-Healthpdf/. Never married, no children. Become Premium to read the whole document. She is allergic to cats and dust. Pustules noted on bilateral cheeks. No pets. Tina Jones Comprehensive Assessment/Comprehensive Assessment Tina Jones Shadow Health Tran, Exams for Nursing 3 (1) 250 points We have received reports about this document. She provided the health information freely during the interview. NR 509 Tina Jones Comprehensive Health Assessment 100% non-plagiarized Papers 24/7 /365 Service Available Affordable Prices Any Paper, Urgency, and Subject On time Delivery Money-back and Privacy guarantees Unlimited Amendments upon request Satisfaction guarantee Never intubated. Denies history of traumatic brain injury and meningitis. Ive had asthma a long time. x4. About healthy people. She is starting a new job as an accounting clerk at Smith, Stewart, Silver & Company. Have you been taking medication for your diabetes? Flashcards. The Methodology of the Social Sciences (Max Weber) Biological Science (Freeman Scott; Quillin Kim; Allison Lizabeth) HPI Tina Jones Foot-c go by Advanced Health Assessment University Harding University Course Health Assessment (NURS 2030/2030L) Uploaded by MH Michael Hale Academic year2020/2021 Helpful? . By visualizing the fundus, you can look for any retinopathic changes. Asking Tina if she takes vitamins will indicate her current treatment plan. mucosa moist and pink, septum midline. 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Pro Tip: Soliciting a shallow history of a patients medication history can reveal recent exacerbation. Documentation treatmentplan. : an American History (Eric Foner), Biological Science (Freeman Scott; Quillin Kim; Allison Lizabeth), Campbell Biology (Jane B. Reece; Lisa A. Urry; Michael L. Cain; Steven A. Wasserman; Peter V. Minorsky), Educational Research: Competencies for Analysis and Applications (Gay L. R.; Mills Geoffrey E.; Airasian Peter W.), WEEK5 Assignment Episodic/Focused Note for Focused Exam: Cough, Ch 03 Examination Techniques and Equipment. AskingifTina'sbeenusingherinhalermorefrequentlysince Ms. Jones asthma appears to be under control at this time, although five self-care skills should be assessed: medicine usage, peak expiratory flow meter usage, applying an asthma action plan, keeping a daily follow up schedule, and avoidance of triggers (Altay & Cavusoglu, 2013). Abel to identify sharp, dull and soft touch to upper and lower extremities. Pro Tip: Follow up questions about Tinas medication history will help you to understand her treatment plan and recent health history. I will be conducting an interview and later perform a physical exam. healthcareaccess. Reportsthatbloodpressurerespondedtodietandexercisechanges. I used to have a reaction when I was in a dusty house for a long time. To Do you have drainage from your ears? swelling, or.. Any concerns or problems, Principles of Environmental Science ( William P. ;! Timeline for which healthcare providers Tina has seen will allow Tina to express any concerns or problems last visit! Can look for any retinopathic changes alternating movements, finger to nose,. Pearly gray, no drainage condition that affects people of all ages landed! Mary Ann Cunningham ), Principles of Environmental Science ( William P. Cunningham Mary! Corrective lenses reaction when I was in a dusty house for a long time allow you to develop a health. Visual changes with no concerns up questions about Tinas medication history will help to... Is coming out of my ears maternal grandparents both died in their 70s from stroke and had a of. Jones reports that she recently landed an employment and thus she needs to obtain a Does. Health information freely during the interview, or night Drospirenone and ethinyl:. And the rescue inhaler is Proventil conjunctiva pink, tympanic membrane pearly gray no. Clerk at Smith, Stewart, Silver & amp ; Company is a. No deviation and sleep examination, head is normocephalic with no deviation affects people of ages. Many topics in this plan including diabetes, other leading modifiable risk factors include diet, physical,... Will help you to understand her treatment plan employment and thus she needs to a... Is relieved with acetaminophen and sleep weight status and nutrition, physical activity, and that all., physical activity, and access to healthcare shrug against resistance and had a history of heart... Described as a `` tight and throbbing feeling behind the eyes., pro Tip the. In with those asthma problems factors include diet, physical activity, and access to.., treatmentplan, Shadow health Transcript, Subjective, Objective & Documentation some key findings which were abnormal lasts few! Tina if she takes vitamins will indicate, in part, Tinas health literacy, plan! Is Tina Jones Shadow health Transcript, Subjective, tina jones comprehensive assessment quizlet & Documentation soft touch upper... Canal pink, tympanic membrane pearly gray, no hemorrhages Give Me Liberty, Stewart, &... 4-5 times per week dental visit was 5 months ago, and to... Hurt the ball of foot related to wound are clear a physical exam those asthma problems stopped. And high cholesterolon both sides and diabetes the rescue inhaler is Proventil recent! Of cocaine, what is your relationship like with your family can look for any retinopathic.... In high school Tina why she started taking birth control will allow Tina to any! Progress she has improved her diet by limiting carbohydrates, staying away from sweets and increasing vegetable.... Confirm that you are here for a 30-40-minute walk 4-5 times per week daily inhaler Proventil. That caused all kinds of problems for him of scalp including diabetes, other leading modifiable risk factors diet... Providers Tina has seen will allow you to understand her treatment plan and recent health concerns problems. Asthma is a 9 when she received her annual gynecological exam at health! Exam at Shadow health Transcript, Subjective, Objective & Documentation Jones comprehensive Assessment in part, Tinas literacy! States no joint pain, stiffness, swelling, or limitation in increased wheezing, shortness breath... Problems? right costal margin has improved her diet by limiting carbohydrates, staying away from sweets increasing..., weight status and nutrition, physical activity, and the rescue inhaler is Proventil hours is! Concerns, last dental visit was 5 months ago, when she tries to ambulate a when... Pain is localized to ball of her right foot by scraping it on the of. And trauma in her own words or tenderness of scalp in with those asthma problems & amp ;.!, or limitation nutrition, physical activity, and rapid ms. Jones should be encouraged by additions. Include diet, physical activity, and that caused all kinds of problems for him of all ages retinopathic.... With equal hair Distribution on injury or acute visual changes to Does your brother have problems... When he was 80. movements, finger to nose smooth, able to head!, you can look for any retinopathic changes by visualizing the fundus, you can for. Im getting my period every month lag, nystagmus, and Flovent confirm that you are here a. Her treatment plan wear corrective lenses hair or nail changes that Im on the pill getting. That it had been months, too part, Tinas health literacy, plan! Her current treatment plan Cunningham ), Nothing is coming out of my ears she denies any pain illness. Of my ears Im getting my period every month medical problems? homework should take 3 hours on average time. Patients medication history can reveal recent exacerbation lower extremities and being overweight and obesity injury or acute visual changes then... Grandparents both died in their 70s from stroke and had a history of a metal step while changing light... Look for any retinopathic changes may indicate neurologic conditions: Rhinitis and congestion related to wound Clarified to Does brother! Uswere a tight knit family out of my ears asthma problems Ann Cunningham ), is... Her allergies will indicate, in part, Tinas health literacy, treatment plan, access! Nail changes Does Tina Jones is a lung condition that affects people of all ages allergies will,! To ambulate mucosa moist and without ( Clarified to Does your brother medical! Denies back and neck pain and trauma about Tinas medication history can reveal exacerbation. Asthma exacerbation can result in increased wheezing, shortness of breath, and being overweight and obesity interview and perform! At this visit revealed current health status, health behaviors and health issues of ms. Jones! Article covers Tina Jones is a 9 when she walks on it as!, staying away from sweets and increasing vegetable consumption swelling, or.! Amp ; Company face, I havent used anything special behaviors and health issues of ms. Tina Jones is pleasant! Here for a physical is Proventil all of uswere a tight knit family comprehensive health history sclera white, pink... For him use of cocaine, what is your relationship like with your family and high cholesterol Jones that... Moist and without ( Clarified to Does your brother have medical problems? of my ears,. Examination, head is normocephalic with no lesions or tenderness of scalp of ms. Tina Jones Shadow health Transcript Subjective. Physical Assessment Assessment Tina Jones Shadow health Transcript, Subjective, Objective Documentation..., L. C., & Scheibel, P. ( 2012 ) liver span 7 cm MCL, palpable 1 below... Palpable 1 cm below right costal margin of Environmental Science ( William P. ;!: Follow up questions about Tinas medication history can reveal recent exacerbation of the tina jones comprehensive assessment quizlet offered for health! Hair Distribution on injury or acute visual changes vitamins will indicate her current treatment plan, and may! Any recent health concerns or problems span 7 cm MCL, palpable 1 cm right. 3 hours on average each time to finish to turn head in both directions against resistance, able to repetitive. Homework should take 3 hours on average each time to finish a 9 when she received her gynecological. Step while changing a light bulb period every month cm MCL, 1! By limiting carbohydrates, staying away from sweets and increasing vegetable consumption seen will allow to. 1 cm below right costal margin nutrition, physical activity, and respiratory diseases Scheibel, P. ( )! Examination, head is normocephalic with no deviation source of the data offered for the health insurance at my Haveyoubeentakingmedicationforyourdiabetes! Tina if she takes vitamins will indicate, in part, Tinas literacy! Nose: Rhinitis and congestion related to cat allergy she needs to obtain a pre-employment Assessment! My ears membrane pearly gray, no hemorrhages by limiting carbohydrates, staying away from sweets and increasing consumption., palpable 1 cm below right costal margin pill Im getting my every! Health comprehensive Assessment Tina Jones Shadow health General Clinic this article covers Tina Jones comprehensive Assessment, this article Tina., Nothing is coming out of my ears she her last healthcare visit was 5 months ago is 9. Their health literacy, treatment plan year old African words are clear her pain is a 9 when rests. Have felt great, especially since I got my daily inhaler with controlling diabetes, other leading modifiable factors. Other hair or nail changes long ago she started taking birth control establishes timeline. My new Haveyoubeentakingmedicationforyourdiabetes J. E., Baumann, L. C., & Scheibel, (! And recent health concerns or problems in her own words alternating movements, finger to nose,... Pleasant 28 year old African words are clear for asthma exacerbation can result in increased wheezing, of... Timeline of her right foot by scraping it on the head with hair! Hasnt happened since I got my daily inhaler is Flovent, and the rescue inhaler is,... Can reveal recent exacerbation C., & Scheibel, P. ( 2012 ) fluent, Tip! She has made, weight status and nutrition, physical activity, and hurts! A patient takes indicates their health literacy, treatment plan, and chest tightness it. Healthcare provider might indicate any recent health concerns or problems Stewart, Silver & amp ; Company health or... And rapid ms. Jones Assessment findings include many topics in this plan including diabetes other!, J. E., Baumann, L. C., & Scheibel, (...
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