93.62% HEENT Results Turned In Health Assessment - August 2016, NUR 101. Experience Overview. Results for Sarah Smith

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1 HEENT Results Turned In Health Assessment - August 2016, NUR 101 Results for Sarah Smith Overview Experience Overview Transcript Subjective Data Collection Objective Data Collection Patient: Tina Jones Student Performance Index 34.6 out of 51 Documentation Hallway Lifespan Review s Self-Reflection Digital Clinical Experience Score 93.62% This score measures your performance on the Student Performance Index in relation to other students in comparable academic programs. Your instructor has chosen to scale your Student Performance Index score so that the average score on the index is a 80.0%. This score may not be your final grade if your instructor chooses to include additional components, such as documentation or time spent. Subjective Data Collection 18 out of 32 Proficiency Level: Proficient Beginning Developing Proficient Students rated as proficient demonstrate entry-level expertise in nursing competencies and clinical reasoning skills. In comparable nursing programs, the top 25% of students perform at the level of a proficient nurse. Interaction with patient 73 minutes Objective Data Collection 16.6 out of 19 Time 101 minutes total spent in assignment Post-exam activities 28 minutes Shadow Health 2016

2 HEENT Results Turned In Health Assessment - August 2016, NUR 101 Results for Sarah Smith Overview Transcript Subjective Data Collection: 18 of 32 (56.3%) Subjective Data Collection Objective Data Collection Documentation Hallway Lifespan Review s Self-Reflection Hover To Reveal... Hover over the Patient Data items below to reveal important information, including Pro Tips and Example s. Category Scored Items Experts selected these topics as essential components of a strong, thorough interview with this patient. Indicates an item that you found. Indicates an item that is available to be found. Patient Data Not Scored A combination of open and closed questions will yield better patient data. The following details are facts of the patient's case. Relevant Medical History Asked about history of headache Reports occasional headaches Asked about frequency and/or duration of headaches Headaches occur once a week Headaches last "a few hours" Asked about character and location of headaches Describes headaches as tight and throbbing Describes headache location as behind her eyes Asked to rate headache pain on a scale Rates headaches as a 2 or 3 Asked about headache treatment Reports treating headaches with Tylenol

3 Reports Tylenol and rest usually resolve symptoms Asked about headache triggers Reports headaches only happen when reading or studying Reports that blurry vision and headaches often coincide Asked about vision problems Reports occasional blurry vision Asked about character of blurry vision Describes blurry vision as "fuzzy letters" Asked about onset and frequency of blurry vision Reports worsening vision began within the past year Blurry vision only occurs when reading for long periods Reports noticing it increasing in the past few months Asked about relieving factors for blurry vision Reports that resting eyes seems to help Asked about vision care Reports last vision exam was in childhood Reports no corrective lens use Asked about current nasal problems Reports no current nasal problems Review of Systems Asked about eye problems Reports occasional itchy eyes Reports no general eye problems other than blurry vision Reports no eye pain Reports no eye dryness Reports no eye redness Asked about triggers for itchy eyes Reports cat allergy is trigger for itchy eyes Asked about treatment of itchy eyes Reports not taking medication for itchy eyes Asked about head problems Reports no problems other than occasional headaches Reports no current headache

4 Asked about ear problems Reports no general ear problems Reports no ear pain Reports no ear discharge Asked about changes in hearing Reports no hearing changes Reports no difficulty hearing Asked about nasal and sinus problems Reports occasional runny nose Reports no frequent sinus problems Reports no nosebleeds Asked about triggers of runny nose Reports cat allergy is trigger for runny nose Asked about treatment of runny nose Reports not taking medication for runny nose Reports only treatment is avoiding trigger and showering Asked about mouth problems Reports no general mouth problems Reports no bleeding gums Reports no mouth pain Reports no mouth sores Reports no tongue problems Reports no dry mouth Asked about dentition Reports no current dental problems Reports visit within the last 2 years Reports regular visits in childhood Reports a few cavities in childhood Asked about throat problems Reports no general throat problems Reports no sore throat Reports no voice changes Asked about lymph node problems Reports no general lymph node problems Reports no painful lymph nodes Reports no swollen lymph nodes Asked about thyroid problems Reports no known thyroid problems Relevant Family History

5 Asked family history of head problems Reports no family history of head problems Reports no family history of migraines Asked family history of eye problems Reports no family history of eye problems Reports no family history of glaucoma Asked family history of ear problems Reports no family history of ear problems Reports no family history of hearing loss Asked family history of nasal problems Reports sister has regular hay fever Asked family history of mouth problems Reports no family history of mouth problems Reports no family history of dental problems Reports no family history of mouth cancer Asked family history of throat and gland problems Reports no family history of thyroid problems Reports no family history of lymph node cancers Reports no family history of throat cancer Shadow Health 2016

6 HEENT Results Turned In Health Assessment - August 2016, NUR 101 Results for Sarah Smith Overview Transcript Objective Data Collection: 16.6 of 19 (87.37%) Subjective Data Collection Objective Data Collection Correct Partially correct Incorrect Missed Documentation Inspected head and face 1.0 of 1 point Hallway Lifespan Review s Self-Reflection Skull Symmetry (1/3 point) Symmetric Asymmetric Appearance (1/3 point) No visible abnormal findings Rash Papules, pustules, or comedones Freckles, moles, or birth mark Excessive hair growth Evidence of skin trauma (scar, laceration, or bruising) Facial Feature Symmetry (1/3 point) Symmetric Asymmetric Inspected eyes and orbital area 1.0 of 1 point Orbital Area (1/4 point) No visible abnormal findings Ptosis Swelling Lesion Conjunctiva (1/4 point) Moist and pink Dry appearance Redness Swelling Sclera (1/4 point) White Yellow tint Redness Conjunctival Discharge (1/4 point) No discharge Clear, watery discharge Purulent discharge

7 Inspected nasal cavities 0.5 of 1 point Color (1/4 point) Pink Red Bluish Turbinate Patency (No point) Patent Decreased patency Not patent Discharge (1/4 point) No discharge Clear discharge Bloody discharge Purulent discharge Observations (No point) No additional visible abnormal findings Foreign body present Polyp Septum perforated Septum deviated Lesion Inspected ears 1.0 of 1 point Right: Auditory Canal Color (1/10 point) Pink Red Pallor Right: Tympanic Membrane Appearance (1/10 point) No visible abnormal findings Fluid observed Visible scars Bulging Perforation Retraction Right: Discharge (1/10 point) No discharge Cerumen Clear discharge Bloody discharge Purulent discharge Left: Tympanic Membrane Color (1/10 point) Pearly gray Red Opaque Yellow Not visible because of cerumen Left: Cone Of Light (1/10 point) 7:00 Cone of light distorted Right: Tympanic Membrane Color (1/10 point) Pearly gray Red Opaque Yellow Not visible because of cerumen Right: Cone Of Light (1/10 point) 5:00 Cone of light distorted Left: Auditory Canal Color (1/10 point) Pink Red Pallor Left: Tympanic Membrane Appearance (1/10 point) No visible abnormal findings Fluid observed Visible scars Bulging Perforation Retraction Left: Discharge (1/10 point) No discharge Cerumen Clear discharge

8 Bloody discharge Purulent discharge Inspected mouth and throat 0.6 of 1 point Oral Mucosa (1/5 point) Moist and pink Dry appearance Redness Throat Texture (No point) No abnormal findings Cobblestoning Exudate Throat Color (1/5 point) Pink Red Tonsils (1/5 point) No visible abnormal findings Swelling Redness Post Nasal Drip (No point) No discharge Clear discharge Purulent discharge Inspected neck 1.0 of 1 point Symmetry (1/2 point) Symmetric Asymmetric Appearance (1/2 point) No visible abnormal findings Swelling Visible pulsation Visible mass Discoloration Palpated scalp 1.0 of 1 point Observations (1/2 point) No additional abnormal findings Balding or thinning areas in hair distribution Palpable masses Tenderness (1/2 point) None reported Tenderness reported Palpated sinuses 1.0 of 1 point Frontal (1/2 point) None reported Tenderness reported Maxillary (1/2 point) None reported Tenderness reported Palpated carotid arteries 1.0 of 1 point Right: Vibration (1/4 point) No thrill Thrill Right: Intensity (1/4 point) 0 Absent 1+ Diminished or barely palpable 2+ Expected 3+ Increased

9 4+ Bounding pulse Left: Vibration (1/4 point) No thrill Thrill Left: Intensity (1/4 point) 0 Absent 1+ Diminished or barely palpable 2+ Expected 3+ Increased 4+ Bounding pulse Palpated jaw 1.0 of 1 point Observations (1/1 point) No palpable abnormal findings Limited range of motion Popping or clicking Palpated lymph nodes 1.0 of 1 point Head And Neck (1/3 point) No palpable nodes Palpable nodes on right side Palpable nodes on left side Supraclavicular (1/3 point) No palpable nodes Palpable nodes on right side Palpable nodes on left side Axillary (1/3 point) No palpable nodes Palpable nodes on right side Palpable nodes on left side Palpated thyroid gland 1.0 of 1 point Observations (1/2 point) No palpable abnormal findings Nodules Enlarged Irregular Tenderness (1/2 point) None reported Tenderness reported Auscultated carotid arteries 1.0 of 1 point Right (1/2 point) No bruit Bruit Left (1/2 point) No bruit Bruit Tested pupillary reaction 1.0 of 1 point Observations With Penlight (1/1 point) No visible abnormal findings (PERRL) Unequal Irregular Miosis

10 Mydriasis Non-reactive to light Tested extraocular eye movements 1.0 of 1 point Cardinal Fields (1/2 point) No abnormal findings Nystagmus Fixed pupil Convergence (1/2 point) No abnormal findings Unequal bilaterally Fixed pupil Tested peripheral vision 0.0 of 1 point Observations (No point) No abnormal findings Reduced right visual field Reduced left visual field Examined fundus with ophthalmoscope 0.5 of 1 point Right: Retina (No point) No visible abnormal findings Myelinated nerve fibers Papilledema Glaucomatous cupping Drusen bodies Cotton wool bodies Hemorrhage Left: Retina (1/4 point) No visible abnormal findings Myelinated nerve fibers Papilledema Glaucomatous cupping Drusen bodies Cotton wool bodies Hemorrhage Right: Disc Margin (No point) Sharp Blurred Left: Disc Margin (1/4 point) Sharp Blurred Tested visual acuity 1.0 of 1 point Right (1/2 point) 20/100 20/70 20/50 20/40 20/30 20/25 20/20 20/15 20/13 20/10 Left (1/2 point) 20/100 20/70 20/50 20/40 20/30 20/25 20/20 20/15 20/13 20/10

11 Performed whisper test 1.0 of 1 point Right (1/2 point) Normal Unable to hear whispered words Left (1/2 point) Normal Unable to hear whispered words Shadow Health 2016

12 HEENT Results Turned In Health Assessment - August 2016, NUR 101 Results for Sarah Smith Overview Transcript Documentation / Electronic Health Record Subjective Data Collection Flowsheets Nursing Progress Notes Objective Data Collection Documentation Notes Hallway Lifespan Review s Self-Reflection Student Documentation Patients Head is symmetrical, Acne to bilateral cheeks which she reports has been happening for awhile. Patients eyes have no discharge, denies any pain or itchiness besides when she is around cats. Patients vision in left eye is 20/20 and in right eye is 20/40. Patient reports not being to the eye doctor since she was 10. She reports "blurriness when I read too much", and does not have glasses or contacts. Patients nose looks like there is something obstructing the pathway on both, but denies any problems breathing out of her nose. Patient denies any hearing loss, tympanic membrane intact for bilateral ears. Ear and mouth membranes pink. Patients conjunctiva are pink with white sclera. Patient has no palpable lymph nodes. Patients thyroid unpalpable. Patient denies any sore throat, itchy throat or nose, denies a runny nose, denies having a cold, denies any sinus tenderness, denies having any hair thinning or hair loss. Patient has decreased peripheral vision. Denies any dizzinness with her headaches or any blood noses. Patient reports headaches are only when I've been reading too much". Model Documentation (No Model Documentation Provided) Shadow Health 2016

13 HEENT Results Turned In Health Assessment - August 2016, NUR 101 Results for Sarah Smith Overview Transcript Hallway Activity Time: 8 min Subjective Data Collection Objective Data Collection Documentation Hallway Ron Registered Nurse Hey, you just finished Ms. Jones HEENT exam, right? I m headed to her room now; what do I need to know? Lifespan Review s Self-Reflection Hi Ron! Tina's HEENT exam was negative for the most part, she does have decreased peripheral vision bilaterally and her right eye vision is 20/40, her left eye vision is 20/20. She denies being to the eye doctor since she was 10 years old, so I educated her on the importance of going and getting some glasses. She reports getting headaches every once in awhile, but only when she has been reading for awhile, so this could be due to her needing glasses. This is you. Stephanie Charge Nurse Hello, I m Stephanie, the charge nurse. I m going in to welcome Ms. Jones to our floor, ask her about her satisfaction so far, and to check her safety interventions. How satisfied do you think Tina is with her care here? In general, what do you think helps to promote patient satisfaction and safety? This is you.

14 Hi Stephanie, I asked Tina if she needed anything before I left and she said she didn't have any complaints so far, other than the fact that she has to be in the hospital. I think that she is pretty satisfied with her stay so far. I think that to promote patient satisfaction and safety, it is extremely important to be washing our hands to keep them and ourselves safe, as well as educating them on the call light and ways to keep themselves safe while here in the hospital. To keep our patients satisfied, I think it is important to explain to them what we are doing, and ask them frequently if they need anything so that they feel we really care about their needs. Diana Your Preceptor Given that Tina Jones has 20/40 vision in her right eye, what safety goals would you set for Tina's decreased vision? Which evidence-based practices would you implement to help her achieve those goals? How will you know if your intervention worked? I think it will be important to make sure that we keep everything she might need within her reach on the bedside table close to her so that she is able to reach them. I would want to educate Tina on going to the eye doctor for regular screenings so that she can get glasses and be able to see and read without getting headaches. I did notice while looking at her eyes that the right looked different than the left, I am not sure what was wrong with it so I would have called someone in for help to see what the difference is and what it means. Since she is diabetic and has slight hypertension, I feel as though she is a risk for glaucoma, so it would be even more important to educate her on regular screenings, and ways to prevent this such as health habits, controlling her diabetes and preventing hypertension since glaucoma can cause blindness. I would educate her on the importance of using her call light, and perhaps reading bigger print so that she can see without squinting. I would know if we achieved her goals if she reported that these things are helping and if we kept her safe from falls or injury. This is you. Shadow Health 2016

15 HEENT Results Turned In Health Assessment - August 2016, NUR 101 Results for Sarah Smith Overview Review s Activity Time: 11 min Transcript Subjective Data Collection Objective Data Collection Documentation Hallway Lifespan Review s Self-Reflection It is important to inspect Tina s mouth thoroughly because oral cancers are most commonly found: Correct: The majority of oral cancers are squamous cell carcinomas that occur on the side of the tongue. Other common locations include the tonsils, oropharynx, gums, and the floor of the mouth. On the uvula Near the posterior pillars Roof of the mouth Side of the tongue (Correct Response) Which of the following best describes the tympanic membrane? Correct: The translucent properties of the tympanic membrane allow the malleus and incus bones to be visualized behind the membrane in healthy ears. The membrane that connects the middle ear with the nasopharynx A translucent oval membrane that separates the middle and outer ear (Correct Response) An outer fibrous rim encircling the eardrum The inner ear structure that contains the hearing apparatus Suppose Tina mentioned that she gets styes (also called hordeolums) in her eyes. What is a stye or hordeolum? Correct: You can reduce your risk for styes by practicing good eye hygiene: wash your hands before touching your eyes or changing your contact lenses, thoroughly disinfect contact lenses before use, wash off eye makeup before going to bed, and avoid using old or expired eye cosmetics. Benign deposits on the ocular fundus Involuntary movement of the eyeball Localized dilated blood vessels Infected hair follicle at the eyelid margin (Correct Response)

16 Describe the technique you would use to examine Tina s cervical lymph nodes. Student Response: First I would inspect bilaterally, looking for any visible masses or lumps. Next, I would use the pads of my second and third fingers and palpate and gently move my fingers with a small, circular motion down the sides of the neck. Model Note: To examine the cervical lymph nodes, gently palpate the lymph node groups in a circular motion with pads of your fingers, using both hands to palpate and compare bilateral nodes. It s important to palpate all ten groups--preauricular, posterior auricular, occipital, tonsillar, submandibular, submental, superficial cervical, posterior cervical, deep cervical, and supraclavicular. To reach the deep cervical nodes, assess one side at a time and ask the patient to lean towards the side being palpated to relax the sternocleidomastoid muscle. To reach the supraclavicular nodes, ask the patient to shrug his shoulders. Tina has 20/40 vision in her right eye, and 20/20 vision in her left eye. What does each of these measurements mean? Student Response: 20/40 vision means that what a person with perfect vision can see at 40 feet, she can only see that at 20 feet. Having 20/20 vision in her left eye is normal, so this means that her right eye has decreased vision. Model Note: The finding of 20/40 vision in the right eye means that when Tina is standing 20 feet away from an eye chart, she can read with her right eye what a person with normal vision can read from 40 feet away with the right eye. Tina has 20/20 vision in the left eye. This means that when Tina stands 20 feet away from the eye chart, she can read with her left eye what a person with normal vision can read from 20 feet away with the left eye. In summary, Tina has normal vision in her left eye and decreased vision in her right. Imagine you found that Tina had ptosis of the left eye. Describe how you would identify this condition. Student Response: Ptosis is a condition that you can see by looking at someone, it is when the eye lid droops down. Model Note: Ptosis is characterized by the drooping of the upper eyelid. Ptosis can be caused by neuromuscular weakness, cranial nerve III damage, sympathetic nerve damage, or congenital abnormality. Shadow Health 2016

17 HEENT Results Turned In Health Assessment - August 2016, NUR 101 Results for Sarah Smith Overview Lifespan Activity Time: 1 min Transcript Subjective Data Collection Objective Data Collection Documentation Hallway Lifespan Review s Self-Reflection A 13-month-old girl presents to the Shadow General Hospital Emergency Department with fussiness and pulling at her left ear. She has also had a fever. What is the primary expected finding on the HEENT exam? Correct: This patient presents with signs and symptoms of an ear infection. She may have nasal discharge that contributed to the infected fluid behind her tympanic membrane, but that is not the direct cause of her pulling at her ear. The provider should order antibiotics. White patches on her tongue and gums Green eye discharge Bulging, red left tympanic membrane (Correct Response) Nasal discharge A 78-year-old man comes to the surgical floor of Shadow General Hospital after knee surgery. When examining his eyes you notice lens opacity. What is this finding a sign of? Correct: This patient likely has cataracts which are the leading cause of blindness in older adults. He will need a referral to an ophthalmologist. Arcus senilis Glaucoma Macular degeneration Cataracts (Correct Response) Shadow Health 2016

18 HEENT Results Turned In Health Assessment - August 2016, NUR 101 Results for Sarah Smith Overview Transcript Subjective Data Collection Self-Reflection Explicitly describe the tasks you undertook to complete this exam. Activity Time: 8 min Objective Data Collection Documentation Hallway Student Response: To do the HEENT exam, I first started off inspected and asking questions, starting at the head then going through the eyes, ears, mouth/throat, neck. I used an otoscope and opthalmoscope to look inside the patients eyes, ears and mouth, looking for any deviations from defined limits. I asked subjective data to see if the patient had any concerns. Next, I palpated anything that could be palpated such as the thyroid gland, head etc. I auscultated and listened for a bruit over her carotid arteries. Lifespan Review s Self-Reflection Explain the clinical reasoning behind your decisions and tasks. Student Response: We are always taught to look (inspect) before you jump right in. This way, you can stop and see if you notice anything out of the ordinary. I like to ask subjective data before and as I am inspecting to see if I can gather anything from the patient that will be pertinent to anything I might find. Tina's assessment was fairly normal, she reports getting headaches when she reads and blurry vision, which I then found out that she has decreased peripheral vision and only 20/40 vision in her left eye, which could be the source behind her headaches. I educated Tina on the importance of getting her eyes screened regularly, especially because the patient is diabetic and has a high risk for hypertension. Next I palpated and auscultated things that were applicable, and if I found something or saw something that I thought was out of the ordinary, I would ask Tina more questions about it to see if she knew or had a history of this. Identify how your performance could be improved and how you can apply lessons learned within the assignment to your professional nursing practice. Student Response: My performance could be improved by getting a better flow to my questions and assessments. I kind of jumped a little bit all over, I would ask something and then do something else and then go back to it later to ask her another similar question. I also think my charting could be better, but this could be easier if you didn't have to switch from page to page to write all of your assessment down. I think that it is good to know some of these extra in depth assessment strategies for my nursing profession so that I can be more educated in it and be able to teach my patients and be a better advocate for them.

19 HEENT Results Turned In Health Assessment - August 2016, NUR 101 Results for Sarah Smith Overview Transcript Subjective Data Collection Objective Data Collection Documentation Transcript All Lines (177) Started: Aug 25, 2016 Patient Exam Time: 74 min Interview s (80) Statements (4) s (93) Hello Tina, nice to meet you. My name is Sarah I will be you nurse today Greet 06:39 PM CDT Hallway Lifespan Hey. Review s Self-Reflection Checked patient's identity with ID band before interacting with patient 06:39 PM CDT Can you tell me your name and date of birth? 06:39 PM CDT My name's Tina Jones, and my birthday's February 17th. Closed curtain upon entering 06:39 PM CDT Washed hands before beginning examination 06:40 PM CDT Checked vitals 06:42 PM CDT Are you having any pain right now? 06:43 PM CDT My foot still hurts, but it feels a little better since the nurse gave me pain pills this morning.

20 what would you rate it on a scale of 1-10? (Clarified to How would you rate your current pain on a scale of 1 to 10?.) 06:43 PM CDT I'd say it's down to around a 6 out of 10 now. Inspected general face 06:44 PM CDT Inspected right side of face 06:44 PM CDT Inspected general face 06:45 PM CDT Inspected left side of face 06:45 PM CDT Inspected general face 06:45 PM CDT Inspected forehead and scalp 06:45 PM CDT Inspected nose and mouth 06:45 PM CDT Inspected forehead and scalp 06:45 PM CDT Inspected nose and mouth 06:45 PM CDT I am inspecting your face and head (No matching questions found.) 06:46 PM CDT I am inspecting your face and head right now, just looking at your general appearance Educate 06:46 PM CDT Thanks for telling me. Inspected forehead and scalp 06:47 PM CDT Inspected right side of face 06:47 PM CDT Inspected general face 06:47 PM CDT Inspected nose and mouth 06:47 PM CDT

21 Could you open your mouth? (No matching questions found.) 06:47 PM CDT How long have you had acne? 06:48 PM CDT I've been getting break-outs since I was in middle school, I think. Like around the time I started my period, my skin started to break out. It went away for a few years in my twenties, but now I'm getting zits again. Do you get headaches? 06:48 PM CDT Yeah, I get them when I'm studying. Where do you feel your headaches? 06:49 PM CDT It's kind of behind my forehead. How long do they last? (No matching questions found.) 06:49 PM CDT How long do your headaches last? 06:49 PM CDT A few hours, I guess. Do you take anything for your headaches? 06:49 PM CDT Yeah. Usually I'll take a Tylenol and go to bed, and that'll get rid of it. Is the headache severe? 06:50 PM CDT No, the headaches I get aren't that bad. Do your headaches intensify? (Clarified to Do your headaches crescendo?.) 06:50 PM CDT No, the headaches I get aren't that bad. Do you get the headaches at the same time of the day? (Clarified to do you get headaches at any other time.) 06:50 PM CDT

22 No. It's really only when I read for too long. Do you get blurry vision or dizziness with your headaches? 06:50 PM CDT Yeah, it seems like usually my eyes start to blur, and then my headaches start. Do you get nausea or vomiting with your headaches? 06:51 PM CDT Nope, I just get plain ol' headaches. Do you ever get bloody noses 06:51 PM CDT No. Do you have a family history of headaches 06:51 PM CDT No, not really. Inspected right orbital area and sclera 06:52 PM CDT Inspected upper conjunctiva 06:52 PM CDT Inspected lower conjunctiva 06:52 PM CDT Inspected left orbital area and sclera 06:52 PM CDT Inspected upper conjunctiva 06:52 PM CDT Inspected left orbital area and sclera 06:52 PM CDT Inspected upper conjunctiva 06:52 PM CDT Inspected lower conjunctiva 06:52 PM CDT Do your eyes ever get itchy 06:52 PM CDT

23 Not right now, but they get itchy around cats. Have you had any drainage our of your eyes? 06:53 PM CDT Sometimes, if I'm having allergies. Is the drainage clear 06:53 PM CDT No, my nose isn't running. Do your eyes ever get dry? (Clarified to Have your eyes been dry.) 06:53 PM CDT No. Do you get eye pain? 06:53 PM CDT No. How is your vision? 06:53 PM CDT It's okay, I guess? Sometimes my vision gets a little blurry. When does it get blurry? 06:53 PM CDT Usually when I'm reading. Do you have glasses? 06:54 PM CDT No, I don't wear glasses -- or contacts. When was the last time you got your eyes checked? 06:54 PM CDT I must've been... maybe ten? The last time the school nurse checked my vision. You know how the school nurses do those little checks every year. Do you ever have eye pain?

24 06:54 PM CDT No. Do you get specks in your eyes 06:54 PM CDT No, I don't ever see anything like that. Have you seen any flashing light (Clarified to Have you seen flashes of light in your vision.) 06:54 PM CDT No, I never see anything weird like that. Is your vision worse with distance or working close? 06:55 PM CDT I think I see far and close things pretty much the same... Although I guess when I'm reading I have blurriness. So I don't know what that means exactly. Once you leave us here, you should go and get your eyes checked at the eye doctor. It's important to get this done yearly or every two years. The eye doctor can check not only your vision, but they can detect changes in your eyes Educate 06:56 PM CDT Thanks for telling me. Do you ever have double vision 06:56 PM CDT No, I don't ever see anything like that. Performed otoscopic examination of right naris 06:57 PM CDT Performed otoscopic examination of left naris 06:57 PM CDT Do you have nasal polyps? 06:58 PM CDT No. Performed otoscopic examination of right naris 06:58 PM CDT

25 Performed otoscopic examination of left naris 06:58 PM CDT Do you get frequent colds? 07:00 PM CDT No, I don't get sick very often. Are you having any stuffiness? (Clarified to are you congested.) 07:00 PM CDT No, my nose isn't stuffed up this morning. Does your nose ever itch? 07:00 PM CDT Not usually. Do you get bloody noses? 07:00 PM CDT No. Does it ever feel hard to breath through your nose (Clarified to have you had difficulty breathing through your nose.) 07:01 PM CDT No, my nose feels fine this morning. Performed otoscopic examination of left naris 07:01 PM CDT Performed otoscopic examination of right naris 07:01 PM CDT Do you have any discharge from your nose 07:01 PM CDT Just when I'm around a cat. Is that discharge clear 07:02 PM CDT No, my nose isn't running. Performed otoscopic examination of right ear 07:02 PM CDT

26 Performed otoscopic examination of left ear 07:02 PM CDT Performed otoscopic examination of right ear 07:02 PM CDT Performed otoscopic examination of left ear 07:03 PM CDT Performed otoscopic examination of right ear 07:04 PM CDT Performed otoscopic examination of left ear 07:04 PM CDT Performed otoscopic examination of right ear 07:05 PM CDT Performed otoscopic examination of left ear 07:05 PM CDT How is your hearing 07:06 PM CDT I think it's good. Have you noticed any hearing loss? 07:06 PM CDT No. Do you ever have difficulty understanding people when they talk 07:07 PM CDT No. Do you ever have a hard time hearing in a noisy environment 07:07 PM CDT No. Do you ever get earaches or pain in your ears? 07:07 PM CDT No. Do you notice any discharge from your ears 07:08 PM CDT

27 Not that I've noticed. Do you get a lot of wax in your ears? 07:08 PM CDT Not too much. Do you ever have ringing in your ears 07:08 PM CDT No, I don't hear any extra sounds. Does it ever feel like your environment is spinning? 07:08 PM CDT No, I can't remember the last time I got dizzy. Do you ever have light headedness> (Clarified to any dizziness or light headedness.) 07:08 PM CDT No, I'm not dizzy. Inspected mouth 07:09 PM CDT Have you had a sore throat? 07:10 PM CDT No, my throat has been fine. Have you noticed your gums bleeding 07:11 PM CDT No. Have you had any sores in your mouth 07:11 PM CDT No. Have you had any hoarseness 07:11 PM CDT No.

28 Does your mouth ever feel dry 07:11 PM CDT No. Do your tonsils ever swell up 07:12 PM CDT No, I've never had problems with my tonsils. Does your tongue ever hurt 07:12 PM CDT No, my tongue's fine. Have you always had those bumps on your tongue? 07:12 PM CDT I've been getting break-outs since I was in middle school, I think. Like around the time I started my period, my skin started to break out. It went away for a few years in my twenties, but now I'm getting zits again. Do you have any pain in your throat or mouth? (Clarified to do you have mouth or throat problems.) 07:13 PM CDT My mouth's fine. Inspected front of neck 07:13 PM CDT Inspected right side of neck 07:13 PM CDT Inspected front of neck 07:13 PM CDT Inspected left side of neck 07:13 PM CDT Inspected front of neck 07:14 PM CDT Inspected left side of neck 07:14 PM CDT Inspected front of neck 07:14 PM CDT

29 Inspected right side of neck 07:14 PM CDT Have you noticed any lumps or bumps in your neck? 07:14 PM CDT I don't think so. Do you prefer hot or cold weather (No matching questions found.) 07:14 PM CDT Palpated scalp: No balding or thinning hair distribution, no masses, no tenderness reported 07:16 PM CDT Do you have any head tenderness? (Clarified to is your scalp tender.) 07:16 PM CDT No, I keep my scalp healthy. Have you noticed any hair loss? 07:16 PM CDT Nope. Palpated frontal sinuses: No tenderness reported 07:17 PM CDT Palpated maxillary sinuses: No tenderness reported 07:17 PM CDT Have you ever had a sinus infection? 07:17 PM CDT No. Is there any tenderness where I just palpated? 07:17 PM CDT Yeah, my foot's definitely still tender. The pain pills have helped, though. Palpated right carotid artery: No thrill, 2+ 07:19 PM CDT Palpated left carotid artery: No thrill, 2+ 07:19 PM CDT Palpated jaw: Full range of motion, no popping or clicking 07:20 PM CDT

30 Palpated axillary lymph nodes: Not palpable 07:20 PM CDT Palpated supraclavicular lymph nodes: Not palpable 07:20 PM CDT Palpated lymph nodes of head and neck: Not palpable 07:21 PM CDT Palpated thyroid gland: No nodules, not enlarged, no irregularities, no tenderness reported 07:21 PM CDT Auscultated right carotid artery 07:22 PM CDT Auscultated left carotid artery 07:22 PM CDT Tested right pupillary reaction with penlight 07:22 PM CDT Tested left pupillary reaction with penlight 07:22 PM CDT Tina can you follow my finger with just your eyes 07:23 PM CDT Ok. Tested convergence to the center 07:23 PM CDT Tested EOM to the upper left 07:24 PM CDT Tested EOM to the upper center 07:24 PM CDT Tested EOM to the lower left 07:24 PM CDT Tested EOM to the lower right 07:24 PM CDT Tested EOM to the upper right 07:24 PM CDT Tested EOM to the lower center 07:24 PM CDT Tested convergence to the center 07:24 PM CDT

31 Tested EOM to the upper left 07:24 PM CDT Tested EOM to the upper right 07:24 PM CDT Tested EOM to the lower right 07:24 PM CDT Tested EOM to the lower left 07:24 PM CDT Tested EOM to the lower center 07:24 PM CDT Tested EOM to the upper center 07:24 PM CDT Tested convergence to the center 07:24 PM CDT Tell me when you can no longer see my fingers 07:25 PM CDT Ok, I will. Tested peripheral vision 07:25 PM CDT Now. Could you see my finger on one side of your head and not the other? 07:25 PM CDT Um, during a headache, both sides hurt the same. Tell me when you can no longer see my fingers 07:26 PM CDT Ok, I will. Tested peripheral vision 07:26 PM CDT Now. Examined fundus of right eye 07:26 PM CDT

32 Examined fundus of left eye 07:29 PM CDT Examined fundus of right eye 07:34 PM CDT Have you noticed any halos in your eyesight? (Clarified to Do you see halos around objects.) 07:36 PM CDT No, I never see anything weird like that. F P F P F P T O Z L P E D P E C F D E D F C Z P F E L O P Z D D E F P O T E C Tested visual acuity with both eyes 07:38 PM CDT I can't read that line. It's too little. T O Z L P E D P E C F D

33 Tested visual acuity of right eye (left eye covered) 07:38 PM CDT E D E O X F T O Z L P E D P E C F D E D F C Z P F E L O P Z D D E F P O T E C Tested visual acuity of left eye (right eye covered) 07:39 PM CDT I can't read that line. It's too little. F. 07:40 PM CDT F. Eight. W. Performed whisper test in right ear 07:40 PM CDT Four 07:40 PM CDT Four. R. 07:40 PM CDT

34 R. Nine 07:40 PM CDT Nine. Performed whisper test in left ear 07:40 PM CDT Have you noticed any stiffness in your neck? 07:42 PM CDT My neck isn't stiff at all. Do you notice you can see better with one eye than the other? 07:42 PM CDT I've never noticed if one eye is worse than the other. They both seem blurry when I read too much. Do you have a history of glaucoma? 07:42 PM CDT No. Inspected general face 07:43 PM CDT Everything looked pretty good in your head eyes ears nose and throat exam Tina. You do have decreased vision in your right eye, you have 20/40 in your right eye and 20/20 in your left eye. It would be good for you to go to the eye doctor and look into getting glasses, because this could be causing your headaches when you read. Educate 07:48 PM CDT Thanks for telling me. Alright Tina, that is all for today. Is there anything you need before I leave? 07:50 PM CDT I don't think so. Not right now. Are you comfortable? 07:50 PM CDT

35 I mean, I'd rather not be in the hospital at all, but I don't have any complaints with my stay. Ok, thank you! (No matching questions found.) 07:50 PM CDT Alright, if you need anything call us with your call light Educate 07:51 PM CDT Thanks for telling me. Applied non-skid socks 07:52 PM CDT Bedside table within reach 07:52 PM CDT Placed call button within patient's reach 07:52 PM CDT Raised upper set of bed rails 07:52 PM CDT Washed hands after examination 07:52 PM CDT Shadow Health 2016