Danny Rivera Pediatric Cough Shadow Health Assessment Subjective Data

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Shadow Health Assessments – Danny Rivera Pediatric Cough Shadow Health Assessment Subjective Data

Shadow Health is a simulation used in modern healthcare education as a learning platform. Students are presented with a safe and interactive environment to improve their clinical reasoning, communication, and diagnostic skills. The platform simulates real-world patient scenarios, whereby learners can conduct virtual assessments, hence minimizing the harm that could be caused while using real-life patient scenarios for similar learning. Additionally, the virtual assessments allow learners to develop and refine their patient interviewing and care planning skills. This essay explores shadow health assessment characteristics, how to approach them, and essential things to note about the platform.

Overall, the platform features digitally standardized patients in a simulated environment, used by learners to improve their patient assessment skills. The assessments include subjective and objective data collection, critical thinking exercises, and feedback and scoring. Learners gather subjective data on the patient’s health history and symptoms in a virtual interview, followed by objective data collection, whereby the student conducts a physical assessment of the patient using virtual tools. Thereafter, the learners use the critical thinking exercises to analyze the data, identify problems, and develop treatment plans accordingly. The system then provides feedback based on the learner’s work on the above areas, highlighting areas of strengths and opportunities for improvement.

Adequate preparation and understanding of the platform are essential for a learner to know how to approach and navigate shadow health assessments. One of the crucial factors is familiarizing themselves with the platform and ensuring they have the necessary equipment, including a functional speaker, microphone, and internet connection. The other issue is ensuring the learner has understood the care scenario, including the objectives and what is being assessed.

Additionally, the learner should follow the structured format, starting with subjective data collection, followed by virtual physical assessment and documenting findings. More so, it is crucial to apply clinical reasoning in analyzing the collected data, identifying patterns and potential diagnoses, and relating findings to the patient’s chief complaint and overall health context. Learners should also use the feedback to assess performance and improve on the recommended areas of improvement.

Furthermore, it is essential to note the key considerations and things to avoid for shadow health assessments. The considerations include being thorough while interacting with the virtual patient and using the structured framework to avoid missing out on essential parts, using patient-centered language, and prioritizing relevant patient information based on the chief complaint. Documenting accurately and consulting clinical guidelines on potential conditions in the case scenario is also crucial. On the other hand, the learner should avoid overwhelming the virtual patient by asking unrelated and clinically irrelevant questions, asking biased questions, and ignoring symptoms/minor complaints.

However, it is worth noting that shadow health assessments have some limitations. These include technical difficulties, such as software glitches or connectivity issues that can disrupt the learning experience and the inability to fully replicate actual patients’ variability and unpredictability, but these are very rare. Shadow health assessments offer students a unique opportunity to practice and refine critical skills in a safe, virtual environment. They combine patient interaction, clinical reasoning, and feedback to prepare students for the challenges of real-world patient care.

Danny Rivera Pediatric Cough Shadow Health Assessment Subjective Data

Danny Rivera Pediatric Cough Shadow Health Assessment Subjective Data

Subjective Data Collection: 20 of 20 (100.0%)

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DANNY RIVERA OBJECTIVE DATA JAN 2024

Danny Rivera Focused Exam: Cough

Patient details: Daniel Raviera, eight years, Male, Hispanic

Subjective

Chief Complaint (CC): “I’ve been feeling sick. I have been coughing a lot. . . and I feel kinda tired.”

History of Present Illness (HPI): The 8-year-old boy of Hispanic ethnicity was brought to the facility by his grandmother, complaining of a persistent cough for five days. The patient describes coughing every few minutes and producing clear sputum occasionally. His symptoms worsen at night. It is worth noting that the patient’s father is a heavy smoker who sometimes smokes indoors. Despite resting or drinking water, the patient finds no relief from his cough. Additionally, he experiences a runny nose without sneezing; the discharge is clear and thin, with no improvement after using over-the-counter medications. D.R. denies shortness of breath, exposure to animals, or conjunctival discharge while reporting mild right ear pain (rated three out of ten) starting yesterday alongside a sore throat accompanied by mild pain during swallowing.

Home medications: Daily multivitamin

Cough medicine, purple and provided temporary relief

Allergies: none

Immunizations History:

  • No influenza vaccine in the last 12 months.
  • Completed Hep B 3-dose series at six months
  • Finished Hep A 2-dose series at 15 months
  • Completed Pneumococcal 4-dose series at 15 months
  • Completed DTaP 5-dose series at six years
  • Completed MMR 2-dose series at six years
  • Finished Varicella 2-dose series at six years
  • Complete Polio 4-D dose system completed after completing the sixth year

Medical History:

  • No history of surgical procedures
  • No prior hospitalizations
  • Treated for pneumonia last year in an urgent care clinic

Family History:

  • Mother: has Type II diabetes, HTN (hypertension), hypercholesterolemia, spinal stenosis, and obesity.
  • Father: smoker with HTN (hypertension), hypercholesterolemia, had childhood asthma.
  • Maternal grandmother: has Type II diabetes and hypertension
  • Maternal grandfather: is a smoker and has eczema
  • Paternal grandmother died in a car accident when she was only fifty-two
  • Paternal grandfather: No known history

Social Background

An 8-year-old boy attending 3rd grade. Absent from school for two weeks the previous year due to pneumonia. He resides with both parents; his grandmother cares for him while his parents work. English is the main language spoken at home, although there is some usage of Spanish.

Review of Systems (ROS):

GENERAL: D.R. is experiencing a cough and has noted increased weakness. This has led to difficulties sleeping at night, which is believed to be directly related to the presence of the cough. Additionally, the patient presents with a fever, and their vital signs appear normal without any indications of shortness of breath or respiratory distress. He complained of sore throat and earache but denied any additional problems. Denies experiencing weight loss, fever, chills, weakness, or weariness.

HEENT:

Eyes: Patient denies having an eye problem or hazy visions and mentions having a test but not needing spectacles.

Ears, Nose, Throat (ENT): no hearing loss, denies nose discomfort other than a runny nose that worsens with coughing, claims earache that started days ago.

SKIN: States that have never had a rash, allergic reaction, or trauma.

CARDIOVASCULAR: No palpitation or chest discomfort. There were no problems during the subjective evaluation.

RESPIRATORY: The patient does not experience any difficulty or shortness of breath. There is no persistent cough, congestion, or pain while breathing.

GASTROINTESTINAL: Although the patient reports frequent bathroom visits, they deny experiencing nausea, vomiting, or stomach pain.

GENITOURINARY: No problems such as burning during urination or decreased urine flow.

NEUROLOGICAL: The patient states feeling weak but can still walk normally. They do not have a headache, and there are no dizziness or vision problems symptoms. MUSCULOSKELETAL: There is no discomfort or complaints in any muscular area. The patient denies having back pain, stiffness, or joint pain.

HEMATOLOGIC: While the patient mentions bruising, no other blood-related problems are reported, and no active bleeding is observed.

LYMPHATICS: There is no history of swollen lymph nodes nor neck tissue inflammation seen in this case; edema is not present either

PSYCHIATRIC: The patient denies feeling stressed or anxious and claims to live with their parents and grandparents without facing mental difficulties themselves

ENDOCRINE SYSTEM: No family history related to diabetes exists here, with the absence of urinary concerns noted.

Physical examination

GENERAL: An 8-year-old Hispanic boy, in satisfactory overall health condition, was overweight at the time of evaluation.

HEENT: Eyes: No blurry vision observed. The sclera is white, and the pupillary response to light and accommodation is normal.

Ears, Nose, Throat: Inflammation is present in the auditory canal and tympanic membrane on the right side: erythemic auditory canal and tympanic membrane in the right ear. No discharge or perforation was noted. Nasal passages are usually pink, with clear discharge—Erythema and cobblestones appearance on the posterior oropharynx. Soreness reported. Erythema was noted on the tonsils, but no exudates.

Lymph Nodes: Cervical palpable nodes on the right side.

SKIN: no skin problems, undamaged, no bruises, no sores, no scrapes

CARDIOVASCULAR: no chest pain, no palpitation, S1 and S2 present during auscultation, no extra sounds.

RESPIRATORY: There is no shortness of breath, a persistent cough, symmetry, and no peculiar sound during auscultation, and there is no respiratory distress.

GASTROINTESTINAL: no abdominal pain.

NEUROLOGICAL: the patient is attentive and oriented; there is no confusion; he follows orders and denies headaches or eyesight problems.

MUSCULOSKELETAL: the patient is mobile, has no pain, no previous trauma, and does not require help while ambulating.

HEMATOLOGIC/LYMPHATIC: Cervical lymph nodes palpable.

Vitals

  • BP 120/76 mmHg, O2 Sat 96% Pulse 100 bpm, R.R. 28/min Temp: 37.2 C
  • Weight 90 lbs
  • Height 4’22”

Diagnostic Findings

By completing influenza, A and b, and streptococcal throat swab tests, the infection can be ruled out due to the painful throat and earache. Since the patient described the bruises, hemoglobin levels should be checked through a CBC to rule out any signs of infection or blood problems. Despite the apparent health of the patient’s lungs and previous observations, it would be beneficial to consider a chest X-ray to ascertain if bronchitis or pneumonia is present.

Nevertheless, if there is no improvement in the cough, it becomes imperative for the patient to seek consultation with a pulmonologist. At this stage, an expert recommendation from the pulmonologist may include additional diagnostic procedures such as X-rays or C.T. scans for further evaluation (Mukerji et al., 2022). These advanced imaging techniques could provide valuable insights into any underlying respiratory conditions. An advanced healthcare professional can effectively address cases with minor symptoms, such as cough.

DIFFERENTIAL DIAGNOSIS:

Acute Upper Respiratory Tract Infection

Based on the patient’s symptoms, a viral common cold is the primary and most frequent cause of coughing. The most frequently diagnosed sickness in children is an upper respiratory tract infection (URI), ranging from a mild cough to a severe or even life-threatening condition (Susaman et al., 2021). The primary symptom of a typical viral cold is a cough; there are no fevers or shortness of breath. A viral or bacterial infection of the upper respiratory tract may cause the patient’s painful throat, nasal congestion, clear nasal discharge, erythema, and erythemic tympanic membranes.

Allergic Rhinitis

Sneezing, nasal congestion, itching, and rhinorrhea are all symptoms of allergic rhinitis, the most common type (Jean, 2022). Except in extreme cases of asthma or anaphylaxis, allergic rhinitis is not fatal. However, it can significantly impact one’s health. An individual may experience symptoms such as nasal congestion with clear discharge and erythema in the nasal cavities due to allergens like pollen, dust mites, or pet dander that trigger this inflammatory disorder known as allergic rhinitis. Additionally, cobblestoning in the posterior oropharynx was observed.

Sinusitis

Leung et al. (2020) state that sinusitis is an inflammation of the sinuses’ mucosal lining. It can be acute, subacute, or chronic. In some situations, a viral, bacterial, or fungal infection might lead to a common cold complication; for instance, in the patient, a complication of the pneumonia they previously experienced. According to Battisti and Pangia (2020), bacterial sinusitis typically develops after a viral upper respiratory infection, manifesting as chronic symptoms after ten days or worsening symptoms after five days. Sinusitis, an inflammation or infection of the sinuses, may be indicated by tenderness in the frontal and maxillary sinuses and symptoms of nasal congestion, clear discharge, and erythema in the nasal cavities.

Pharyngitis: Pharyngitis is a condition characterized by the inflammation of the mucus membranes in the oropharynx. Common causes include bacterial or viral infections, although allergies, trauma, cancer, acid reflux, and some toxins all play a role (Wolford et al., 2022).  The patient may have pharyngitis, which can be brought on by viral or bacterial infections based on their sore throat, throat erythema, and tonsillar erythema.

References

Battisti, A. S., & Pangia, J. (2020). Sinusitis. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470383/

Jean, T. (2023). Allergic rhinitis: Practice essentials, background, pathophysiology. Medscape.com. https://emedicine.medscape.com/article/134825-overview

Leung, A. K., Hon, K. L., & Chu, W. C. (2020). Acute bacterial sinusitis in children: An updated review. Drugs in Context, 9. https://doi.org/10.7573/dic.2020-9-3

Mukerji, S. S., Yenduri, N. J. S., Chiou, E., Moonnumakal, S. P., & Bedwell, J. R. (2022). A multi‐disciplinary approach to chronic cough in children. Laryngoscope Investigative Otolaryngology, 7(2), 409–416. https://doi.org/10.1002/lio2.778

Susaman, N., Bayar Muluk, N., & Sallavaci, S. (2021). Common cold in children. Pediatric ENT Infections, 417–425. https://doi.org/10.1007/978-3-030-80691-0_36

Wolford, R. W., Goyal, A., Belgam Syed, S. Y., & Schaefer, T. J. (2022). Pharyngitis. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK519550/#:~:text=Pharyngitis%20is%20the%20inflammation%20o