Shadow Health - Tina Jones, Health History
with correct answers
1. Acute pain - CORRECT ANSWER -Priority: High Priority Pro Tip: Managing
acute pain is an immediate high priority, because other health concerns cannot
be effectively addressed while a patient experiences severe pain. Evidence -
Relevant: "...Like a 7. It hurts a lot, but whatever pain med the ER gave me is
helping a little bit." "It's throbbing and like, sharp if I try to put weight on it."
Evidence Pro Tip: Tina expresses pain, which is the strongest evidence for this
problem. She reports intense pain on a numerical scale and describes pain
characteristics. The presence of a physical injury supports her susceptibility to
acute pain. Planning - Relevant: Assess - Pain: Assess the patient's pain at
regular intervals and with each assessment of vital signs. Assess - Pain: Assess
the patient's response to pain medication. Educate - Medication: Educate the
patient on medications used for pain relief. Educate - Pain: Educate the patient
on non-pharmaceutical methods to reduce pain intensity. Intervene - Pain:
Administer non-pharmacologic interventions to reduce pain. Intervene - Pain:
Administer prescribed analgesics to provide optimal pain relief. Planning Pro
Tip: To reduce the patient's pain, assess her current rating. Provide an
appropriate intervention (pharmaceutical or otherwise) and educate the
patient. After an appropriate time interval, assess pain levels again to see how
the intervention affected the pain.
1. 1.Expression of pain Followed Up - CORRECT ANSWER -Description: Tina
expresses frustration about her level of pain. Student: How effective was the
Neosporin? Tina Jones: Well, I'm here, so I guess it didn't do its job. Student:
, Can you walk with your foot being injured? Tina Jones: No, I can't. I can't put
any weight on it without like, shooting pain. Student: What preexisting
medical conditions do you have? Tina Jones: I mean, I have asthma and
diabetes, but right I now I just care about my foot! Student: I understand your
foot hurts, but I need to know this information to make sure I take care of the
problem correctly. Tina Jones: Thanks. Model Statement: "I'm sorry to hear
that your pain is returning. We want you to be in as little pain as possible. I
can give you some Advil at this time, and in a few hours, you can have more
tramadol. I can also walk through some pain management exercises with you
that don't involve medication, if you are interested."
2. Impaired skin integrity - CORRECT ANSWER -Priority: High Priority Pro Tip:
This is a high priority. The infection is the most immediate threat to the
patient's health, and the wound is at risk for delayed healing because of the
patient's uncontrolled blood glucose. Evidence - Relevant: Evidence Pro Tip: As
Tina discusses symptoms of her wound, including symptoms such as discharge,
redness, warmth, and swelling, she reports strong evidence of impaired skin
integrity. Planning - Relevant: Planning Pro Tip: Because wound infections
impact the patient's overall health, it's important to assess perfusion, hydration,
and swelling. Assess the status of the wound itself and ensure proper cleaning
and dressing per the physician's order. Prevent worsening infection by
educating the patient about wound care and self-monitoring.
3. 2.Impact of injury on daily life Followed Up - CORRECT ANSWER -
Description: Tina brings up her pain and frustration at how being unable to
bear weight on her foot impacts her life. Student: What are stressors? Tina
Jones: I feel really stressed out right now! Honestly, I didn't realize that I'd be
admitted to the hospital for my foot. I don't want to miss work or school but
now it looks like I'll have to. And I want my foot to stop hurting. I know I
need sleep, too. Student: We are going to take care of everything as quickly as
possible. Tina Jones: Thanks. Model Statement: "This sounds like a challenging
, time for you. I understand your frustration at having your life interrupted by
foot pain. Please let me know if there is anything I can help you with, such as
contacting your employer or asking a family member to bring your
schoolwork. We'll do our best to get you feeling better and, on your way,
home as soon as possible."
4. Impaired walking - CORRECT ANSWER -Priority - High Priority Pro Tip: This is
a high priority. The patient is unable to bear weight on her affected leg, which
prevents walking. This impacts her daily life and increases her risk for falls and
deep-vein thrombosis. Evidence - Relevant: "I mean, it's all red and swollen,
and there's pus, it feels hot, it hurts like hell... It's got all that going on." "I got
this scrape on my foot a while ago, and it got really infected. It's killing me."
"No, I can't. I can't put any weight on it without like, shooting pain." Evidence
Pro Tip: The strongest evidence of impaired walking is that Tina directly
reports she can't bear weight or walk on her affected foot. Other supporting
data points are the presence of her foot wound and her general reports of
pain. Planning - Relevant: Assess - Musculoskeletal: Assess the patient's ability
to bear weight and gait. Assess - Musculoskeletal: Assess the patient's mobility.
Consult / Refer: Consult with physical therapist to develop a plan to improve
the patient's mobility. Intervene - Mobility: Assist the patient as needed with
mobility. Intervene - Mobility: Provide assistive devices to facilitate mobility
(crutches, therapeutic boot to minimize pressure on plantar surface,
wheelchair). Planning Pro Tip: Assess how well the patient can bear weight and
walk. While the patient is in your care, work with other healthcare
professionals to keep the pain managed and improve the patient's mobility.
Provide assistance with activities such as toileting and ensure that the patient
can access and use assistive devices.
5. 3.Gaps in health literacy around diabetic diet Not Encountered - CORRECT
ANSWER -Description: Tina describes controlling her diabetes by avoiding
"sweets." Model Statement: "Staying away from sugar is a great start. I can give
, you some more information on what a balanced diet looks like for someone
with diabetes. For example, many starchy foods break down into glucose in
the body, like pasta, and so you can eat those in moderation, too. Most
people with diabetes feel better when they limit all starches, eat protein, and
take regular medication."
6. 4. Ineffective diabetes management - CORRECT ANSWER -Priority - High
Priority Pro Tip: Poorly managed diabetes and uncontrolled blood glucose
complicate wound healing. As the underlying cause for delayed healing and
infection, they must be addressed. Evidence - Relevant: "No, I don't take
anything for my diabetes anymore." "I guess I just got sick of feeling sick and
gassy all the time, and it was overwhelming, remembering to take pills and
check my sugar. I feel a lot better now that I'm just eating healthier than I did
when I was taking the pills." "I have a monitor at home, but to be honest I
don't really use it that often." Evidence Pro Tip: Tina directly reports ineffective
diabetes management when discussing her lack of treatment. She expresses gaps
in health literacy about the risk of ceasing prescribed medication and blood
glucose monitoring. Supporting evidence comes from her inability to
incorporate meaningful dietary changes or increase her exercise. Planning -
Relevant: Assess - Health Literacy and Patterns: Assess the patient's knowledge
related to diabetic disease process, assess personal/social supports. Assess -
Health Literacy and Patterns: Assess the patient's perceived barriers to
adherence to the prescribed regimen (cost, adverse effects, lack of knowledge).
Assess - Health Literacy and Patterns: Assess the patient's readiness for
change/education. Educate - Disease Process: Educate the patient on diabetes
pathophysiology, risks of morbidity and mortality, importance of self-care.
Planning Pro Tip: To gain a deep understanding of your patient's situation,
determine her level of health literacy, her feelings and beliefs about the disease,
and the motivation behind her choices. Educate the patient about what risks
are, and what good diabetes care looks like. Most importantly, ask about her
goals and changes she may be willing to make.
