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Head and neck (25)
Inspect head
Inspect eyes
Inspect mouth and throat
Inspect eyelids
Inspect ears
Palpate scalp
xxx
Palpate axillary lymph nodes
Use penlight
Use ophthalmoscope
Perform whisper test
Assess eye movements
Use otoscope
xxx
Anterior chest (7)
Inspect anterior chest, cardiac
Palpate PMI
xxx
Ausculate cardiac points
Posterior chest (5)
Inspect posterior chest
xx
Auscultate posterior chest
Abdomen (9)
Inspect abdomen
Palpate abdomen, light
xx
Auscultate abdominal arteries
Upper extremities (16)
Palpate peripheral pulses, upper
Assess capillary refill, fingers
xx
Test stereognosis
Assess bicep strength
Assess hand strength
xx
Inspect fingernails
Lower extremities (15)
Inspect legs for edema
Palpate peripheral pulses, lower
Assess capillary refill, toes
xx
Assess ROM knees
Inspect toenails
Full body (4)
Vitals
xx
Inspect skin, general
Unused Exam Actions (0)
Transcript
Started: May 22, 2025 | Total Time:
All Lines () Interview Questions () Statements () Exam Actions ()
Hello!
Question
05/22/25 7:42 AM EDT
Hi. Im Preceptor Diana. I will explain the details of this assignment and your objectives, just as a preceptor would in real life. Pay close attention to this information as it will help guide your exam. At the end of this prebrief, you will answer a short question about the upcoming assignment. During the simulation, you may return to these instructions at any time by scrolling to the top of your transcript.
What is the situation? Tina jones comprehensive assessment shadow health exam plan
Question
05/22/25 7:43 AM EDT
Six months have passed since Tina Jones was admitted to Shadow General Hospital, and her foot wound has healed. Your role in this simulation is that of a healthcare provider who will perform a comprehensive assessment on Ms. Jones to demonstrate your clinical competency.
What are my objectives in this assessment?
Question
05/22/25 7:44 AM EDT
You will collect subjective data from Ms. Jones: inquire into her current health status, body systems, mental health, and psychosocial history. Regardless of whether you have assessed Tina previously, ask all questions that are medically relevant to understanding her current health status. In addition to collecting subjective data, you will perform a physical exam on Ms. Jones systems to gather objective data about her overall health. Ms. Jones has no new abnormal findings, so after you complete an exam task, you do not need to make selections in the Electronic Health Record, though you may document your findings if you like. While you should communicate with patients using accessible, everyday language, it is standard practice to use professional medical terminology everywhere else, such as in documenting physical findings and nursing notes. Tina jones comprehensive assessment shadow health exam plan You may complete the exam activities in any order and move between them as needed.
What else will this exam involve?
Question
05/22/25 7:45 AM EDT
You will complete nursing tasks to protect the patients safety, privacy, and health. While it is not required for this assignment, you can document your findings, including vital signs, in the Electronic Health Record. This record provides necessary information for healthcare professionals who will continue patient care. Activities other than Subjective and Objective Data Collection, such as Documentation and Education and Empathy, provide valuable practice for their real-world counterparts. However, they are not automatically graded by the simulation.
How will I be evaluated?
Question
05/22/25 7:46 AM EDT
In this assignment, you will be evaluated on your Subjective and Objective Data Collection. The evaluation of your interview is dependent on how you word your questions therapeutically and precisely and explore all relevant topics with comprehensive breadth and depth. The evaluation of your physical exam requires you only to complete all exam actions. Documentation of the exam is encouraged, as it can provide you valuable real-world experience, but they are not automatically graded by the simulation. This assignment takes on average between 140 and 170 minutes. You can pause and resume the assignment at any time; your work is always saved automatically.
How does this assignment prepare me for the real world?
Question
05/22/25 7:48 AM EDT
In this assessment, you will become familiarized with the structure and content of comprehensive assessments so that with real-life patients, you can: º develop a mental model for sequencing a comprehensive exam º ask effective and comprehensive questions º evaluate the patients risk of disease, infection, injury, and complications º and document data with professional terminology.
In 1 or 2 sentences, answer this question to help prepare for the upcoming exam: How does interviewing a healthy patient differ from interviewing a patient with a known health condition ?
Interviewing a healthy patient focuses on general health conditions lifestyle and preventive care while for a sick patient and concentrates on specific symptoms, history and potential complications
Statement
05/22/25 7:57 AM EDT
Time to begin Tina jones comprehensive assessment shadow health exam plan.
Hello, I a Kerine, I will interview and examine you today
Greet
05/22/25 7:52 AM EDT
Hey.
What is your name
Question
05/22/25 7:53 AM EDT
Tina Jones.
Your date of birth
Question
05/22/25 7:53 AM EDT
February 17th.
Objective Data Collection: 70 of 73 (95.9%)
Hover To Reveal…
Hover over the Patient Data items below to reveal important information, including Pro Tips .
Found:
Indicates an item that you found.
Available:
Indicates an item that is available to be found.
Category
Scored Items
Experts selected these examinations as essential components of objective data collection for this patient.
Patient Data
Not Scored
Thorough examinations will yield better patient data. The following actions reveal the objective data of the patient’s case.
HEENT
Finding:
Inspected head and neck
Tina jones comprehensive assessment shadow health exam plan
Finding:
Scattered pustules on face and facial hair on upper lip
(Found)
Pro Tip: Inspecting the facial skin for the presence of discoloration, lesions, or abnormal hair growth assesses for underlying medical problems.
Example Question:
Finding:
Head is normocephalic, atraumatic
(Found)
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 patient’s head can identify any indications of trauma.
Example Question:
Finding:
Normal scalp hair distribution
(Found)
Pro Tip: It’s important to inspect your patient’s hair for distribution, color, and texture because abnormal hair growth or characteristics can indicate underlying health problems.
Example Question:
Finding:
Acanthosis nigricans noted on neck
(Found)
Pro Tip: Skin changes are common in patients with uncontrolled diabetes. A thorough inspection should be conducted of your patient’s skin, especially in folds around the neck, axilla, and groin.
Example Question:
Finding:
Inspected eyebrows and orbital area
Finding:
Right eye: equal hair distribution on lashes and eyebrows, lids without lesions, no ptosis or edema
(Found)
Pro Tip: Examining the external eye for hair distribution, coloration, edema, lesions, and ptosis identifies abnormalities that can indicate infection or underlying conditions.
Example Question:
Finding:
Left eye: equal hair distribution on lashes and eyebrows, lids without lesions, no ptosis or edema
(Found)
Pro Tip: Examining the external eye for hair distribution, coloration, edema, lesions, and ptosis identifies abnormalities that can indicate infection or underlying conditions.
Example Question:
Finding:
Palpated scalp
Finding:
No masses
(Found)
Pro Tip: Female hair loss can indicate an underlying health problem or skin infection. Inspecting the scalp and hair for texture, distribution, and quantity helps to identify lesions or masses.
Example Question:
Finding:
Palpated sinuses
Tina jones comprehensive assessment shadow health exam plan
Finding:
No frontal sinus tenderness
(Found)
Pro Tip: Palpating the frontal sinuses checks for sinusitis.
Example Question:
Finding:
No maxillary sinus tenderne
