Education & Empathy Maya Parker Preschooler Sick Visit Ear Pain Health

During the patient interview, there are a number of opportunities to provide patient education and empathy. The opportunities listed below are those identified by nursing experts to be of particular importance to this patient. A Model Statement is provided as an example of an appropriate response to each opportunity.

  • Opportunities marked as Not Encountered are opportunities that were not elicited in the interview
  • Opportunities marked as Not Followed Up are missed opportunities that were present in the interview, but where no statements were made
  • Opportunities marked as Followed Up were followed up by students, and include the dialogue between student and patient Education & Empathy Maya parker preschooler sick visit ear pain health

 1 Fitting inFollowed Up

 Description: Samantha feels like she doesn’t fit in with her peers.
This is your avatar.Do you want to lose weight? (Clarified to: Why do you think you need to lose weight?)Question
06:29 AM EST
Samantha MonroeJust . . . to look more athletic, you know. Like I fit in with everybody. (Clarified to: why I think I need to lose weight)
This is your avatar.You should not try to fit in. Everyone is unique.Educate
06:30 AM EST
Samantha MonroeUm, that makes sense.
 Model Statement: “At age 13, there are a lot of social pressures, coming from your friends at school, teammates at soccer, and influencers on social media. It’s important to be a part of a community that accepts and supports you. If you don’t feel accepted or supported, then you should feel comfortable discussing these issues with people you do trust, because that environment might not be healthy for you. Education & Empathy Maya parker preschooler sick visit ear pain health It’s also possible that you’re being hard on yourself. I know it’s tempting to compare yourself to others, but don’t let that damage your self-worth.”

ORDER SHADOW HEALTH, EXAM OR WRITEN PAPER HERE

 2 Body ImageFollowed Up

 Description: Samantha has insecurities about her body image.
This is your avatar.Do you feel your weight is okay? (Clarified to: How do you feel about your weight?)Question
06:27 AM EST
Samantha MonroeUm, I mean, I wish I could lose this baby fat. All my friends wear one size smaller than me, so it’s super awkward when they’re swapping clothes . . . and talking about their periods . . . just hard not to compare. (Clarified to: how I feel about my weight)
This is your avatar.I understand your concerns but you should not try to fit in or compare yourself to others.Educate
06:29 AM EST
Samantha MonroeGotcha.
 Model Statement: “Samantha, you’ve mentioned wanting to lose baby fat and look athletic. I’m really sorry you’re having a hard time with the way people see you and the way you see yourself, but there’s nothing wrong with how you look, and you’re in good health. I know it’s easy for me to say this here in the clinic and hard for you when you’re getting compared to other people, but there’s nothing you need to change about yourself.”

 3 MenstruationFollowed Up

 Description: Samantha has concerns that she should have had her first period already.
This is your avatar.Have you started your periods?Question
06:17 AM EST
Samantha MonroeNo, I haven’t started my period yet. It’s kind of weird because all my friends have? Whenever they talk about it, like the cramps or whatever, I just pretend like I’ve had mine, too.  Education & Empathy Maya parker preschooler sick visit ear pain health Just to fit in.
This is your avatar.I understand your concerns, but it’s normal for a person of your age to not have started their periods yet.Educate
06:20 AM EST
Samantha MonroeCool. Good to know.
 Model Statement: “Knowing that your classmates are having their periods when you haven’t had one yet can be frustrating, but you don’t have anything to worry about. It’s typical for someone your age to not have started menstruating yet, and we can expect it to happen before you are 15. Everyone’s experience is a little bit different—sometimes I have patients who are concerned at how early they started. You’re prepared for your first period when it happens, and you’re comfortable talking about it here. That’s the maturity that matters, so do your best not to worry about where your peers are.” Education & Empathy Maya parker preschooler sick visit ear pain health

 4 Skipping MealsFollowed Up

 Description: Samantha says that she skips lunch once or twice a week to reduce her caloric intake.
This is your avatar.Do you skip any meals?Question
06:32 AM EST
Samantha MonroeYeah, I skip lunch once or twice each week.
This is your avatar.It is not advisable to skip any meal at your age because you are still growingEducate
06:33 AM EST
Samantha MonroeFor sure. OK.
 Model Statement: “It’s very important to eat lunch, along with the rest of your regular meals. You’re still growing, and that takes a lot of food and energy. You’re also a soccer player, and athletes need plenty of calories and nutrients to play well and stay healthy. You definitely don’t need to feel bad about eating lunch Education & Empathy Maya parker preschooler sick visit ear pain health. On top of that, skipping meals can feel pretty bad. When I miss lunch, I get a headache and feel cranky. Please go easy on yourself and your body and try not to skip lunch anymore.” Education & Empathy Maya parker preschooler sick visit ear pain health

Adolescent Sports Evaluation Samantha Monroe Shadow Health

Transcript

Started: Mar 05, 2022 | Total Time: 306 minALL LINES (91)INTERVIEW QUESTIONS (54)STATEMENTS (9)EXAM ACTIONS (28)

Your Avatar.Hello. My name is xxxx, I will interview you and later conduct a physical exam.\Greet
03/05/22 5:41 AM EST
Samantha Monroe.Hello.
Your Avatar.What is your relationship with the patient?Question
03/05/22 5:42 AM EST
Samantha Monroe.Oh, this is my mom.
Jackie Monroe.Hey, I’m Jackie Monroe. This is my daughter, Samantha.
Your Avatar.Why are you here today?Question
03/05/22 5:42 AM EST
Samantha Monroe.I’m here for a sports physical. I’m gonna play on my school soccer team. We’re called the Nightingales, which is pretty cool. Adolescent Sports Evaluation Samantha Monroe shadow health
Your Avatar.Any medical issue?ORDER SHADOW HEALTH, EXAM OR WRITEN PAPER HEREQuestion
03/05/22 5:43 AM EST
Samantha Monroe.Uh, nope. No health issues.
Your Avatar.Any history of surgery?Question
03/05/22 5:43 AM EST
Samantha Monroe.I had my tonsils removed when I was like 9, but that’s it.
Jackie Monroe.Yeah, that was Samantha’s only surgery.
Your Avatar.Any missing organ? (No matching questions found.)Question
03/05/22 5:45 AM EST
Your Avatar.Does your daughter have any missing organ? (No matching questions found.)Question
03/05/22 5:46 AM EST
Your Avatar.Have you had any of your organs removed?Question
03/05/22 5:46 AM EST
Samantha Monroe.Uh . . . no. All my organs are 100% present.
Your Avatar.Any allergies?Question
03/05/22 5:49 AM EST
Samantha Monroe.No, I’ve never had any allergies before.
Your Avatar.Are your vaccinations current?Question
03/05/22 5:50 AM EST
Samantha Monroe.Yeah, I’ve had all my vaccines.
Jackie Monroe.I always made sure she was up to date on her vaccinations.
Your Avatar.Are you using any medications?Question
03/05/22 5:50 AM EST
Samantha Monroe.No, I don’t take anything.
Education & Empathy : 4 Of 4 (100.0%)During the patient interview, there are a number of opportunities to provide patient education and empathy. The opportunities listed below are those identified by nursing experts to be of particular importance to this patient. A Model Statement is provided as an example of an appropriate response to each opportunity. Adolescent Sports Evaluation Samantha Monroe shadow healthOpportunities marked as Not Encountered are opportunities that were not elicited in the interviewOpportunities marked as Not Followed Up are missed opportunities that were present in the interview, but where no statements were madeOpportunities marked as Followed Up were followed up by students, and include the dialogue between student and patient 1 Fitting inFollowed Up Description: Samantha feels like she doesn’t fit in with her peers.This is your avatar.Do you want to lose weight? (Clarified to: Why do you think you need to lose weight?)Question
06:29 AM ESTSamantha MonroeJust . . . to look more athletic, you know. Like I fit in with everybody. (Clarified to: why I think I need to lose weight)This is your avatar.You should not try to fit in. Everyone is unique Adolescent Sports Evaluation Samantha Monroe shadow health.Educate
06:30 AM ESTSamantha MonroeUm, that makes sense. Model Statement: “At age 13, there are a lot of social pressures, coming from your friends at school, teammates at soccer, and influencers on social media. It’s important to be a part of a community that accepts and supports you. If you don’t feel accepted or supported, then you should feel comfortable discussing these issues with people you do trust, because that environment might not be healthy for you. It’s also possible that you’re being hard on yourself. I know it’s tempting to compare yourself to others, but don’t let that damage your self-worth.” 2 Body ImageFollowed Up Description: Samantha has insecurities about her body image.This is your avatar.Do you feel your weight is okay? (Clarified to: How do you feel about your weight?)Question
06:27 AM ESTSamantha MonroeUm, I mean, I wish I could lose this baby fat. All my friends wear one size smaller than me, so it’s super awkward when they’re swapping clothes . . . and talking about their periods . . . just hard not to compare. (Clarified to: how I feel about my weight)This is your avatar.I understand your concerns but you should not try to fit in or compare yourself to others.Educate
06:29 AM ESTSamantha MonroeGotcha. Model Statement: “Samantha, you’ve mentioned wanting to lose baby fat and look athletic. I’m really sorry you’re having a hard time with the way people see you and the way you see yourself, but there’s nothing wrong with how you look, and you’re in good health. I know it’s easy for me to say this here in the clinic and hard for you when you’re getting compared to other people, but there’s nothing you need to change about yourself.” 3 MenstruationFollowed Up Description: Samantha has concerns that she should have had her first period already.This is your avatar.Have you started your periods?Question
06:17 AM ESTSamantha MonroeNo, I haven’t started my period yet. It’s kind of weird because all my friends have? Whenever they talk about it, like the cramps or whatever, I just pretend like I’ve had mine, too. Just to fit in.This is your avatar.I understand your concerns, but it’s normal for a person of your age to not have started their periods yet.Educate
06:20 AM ESTSamantha MonroeCool. Good to know. Model Statement: “Knowing that your classmates are having their periods when you haven’t had one yet can be frustrating, but you don’t have anything to worry about. It’s typical for someone your age to not have started menstruating yet, and we can expect it to happen before you are 15 Adolescent Sports Evaluation Samantha Monroe shadow health. Everyone’s experience is a little bit different—sometimes I have patients who are concerned at how early they started. You’re prepared for your first period when it happens, and you’re comfortable talking about it here. That’s the maturity that matters, so do your best not to worry about where your peers are.” 4 Skipping MealsFollowed Up Description: Samantha says that she skips lunch once or twice a week to reduce her caloric intake.This is your avatar.Do you skip any meals?Question
06:32 AM ESTSamantha MonroeYeah, I skip lunch once or twice each week.This is your avatar.It is not advisable to skip any meal at your age because you are still growingEducate
06:33 AM ESTSamantha MonroeFor sure. OK. Model Statement: “It’s very important to eat lunch, along with the rest of your regular meals. You’re still growing, and that takes a lot of food and energy. You’re also a soccer player, and athletes need plenty of calories and nutrients to play well and stay healthy. You definitely don’t need to feel bad about eating lunch. On top of that, skipping meals can feel pretty bad. When I miss lunch, I get a headache and feel cranky. Please go easy on yourself and your body and try not to skip lunch anymore.”
Objective Data Collection: 23 Of 23 (100%) Correct Partially correct Incorrect Missed Growth Chart: Height & Weight1 of 1 pointWeight Percentile (1/4 point) Below 5th percentile Between 5th and 95th percentile Above 95th percentileWeight Growth Curve (1/4 point) Growth curve maintained Growth curve declineHeight Percentile (1/4 point) Below 5th percentile Between 5th and 95th percentile Above 95th percentileHeight Growth Curve (1/4 point) Growth curve maintained Growth curve declined Inspected Skin1 of 1 pointLesions (1/5 point) No visible lesions
Documentation / Electronic Health RecordMy Provider NotesStudent DocumentationModel DocumentationSubjectiveMs. Monroe is a 13 year old female presenting for a preparticipation evaluation so she can play soccer this year. Past Medical History: No current medical problems. Tonsillectomy as a child. Medications: No prescription medications. Takes multivitamin Adolescent Sports Evaluation Samantha Monroe shadow health
Treatment Plan: 21 Of 21 (100.00%)Problem Selection8 out of 8Primary DiagnosisReview Your Answers For The Problem Selection Activities Adolescent Sports Evaluation Samantha Monroe Shadow Health. You Receive One Point For Each Correct Diagnosis, And One Point For Each Correct Evidence Linked To A Correct Diagnosis. If There Are Multiple Correct Diagnoses, You Will Also Receive A Point For Correctly Selecting Which Diagnosis Is The Primary Diagnosis.Learner SelectionModel Documentation Diagnosis: Pre-Participation Sports Physical Identified as primaryEvidences: Samantha reports the reason for her visit is a sports physicalLearner Rationale:The patient indicates that she came for a sports physical.Score: out of 3 Diagnosis: Pre-Participation Sports PhysicalPrimary: YesEvidences:Samantha reports the reason for her visit is a sports physicalModel Rationale:The primary diagnosis is the reason for the patient’s visit. Because Samantha has indicated she is in the office for her sports physical, the correct primary diagnosis is Pre-Participation Sports Physical. As a primary care provider, it is critical to properly code the reason for Samantha’s visit so it can be covered by insurance.
Subjective Data Collection: 26 Of 27 (96.3%)Hover To Reveal…Hover over the Patient Data items below to reveal important information, including Pro Tips and Example Questions.Found: Indicates an item that you found.Available: Indicates an item that is available to be found.CategoryScored ItemsExperts selected these topics as essential components of a strong, thorough interview with this patient.Patient DataNot ScoredA combination of open and closed questions will yield better patient data. The following details are facts of the patient’s case.
Samantha Monroe.Nope. My head’s fine.
Your Avatar.Have you had a concussion?Question
03/05/22 6:03 AM EST
Samantha Monroe.I’ve never had a concussion, but I did see my friend wipeout at the skatepark once. It was crazy. He was skating, then boom. I was filming, so it was, you know, pretty scarring.
Your Avatar.Any numbness or tingling? Adolescent Sports Evaluation Samantha Monroe shadow healthQuestion
03/05/22 6:04 AM EST
Samantha Monroe.No numbness or tingling. That sounds weird.
Your Avatar.Any weakness in your limbs?Question
03/05/22 6:09 AM EST
Samantha Monroe.Nope, no weakness.
Your Avatar.Do you exercise in the heat?Question
03/05/22 6:14 AM EST
Samantha Monroe.Sure. We do gym outside sometimes. When soccer season starts, practice and games are outside.
Your Avatar.Any eye problems?Question
03/05/22 6:16 AM EST
Samantha Monroe.My eyes are fine.
Your Avatar.Have you started your periods?Question
03/05/22 6:17 AM EST
Samantha Monroe.No, I haven’t started my period yet. It’s kind of weird because all my friends have? Whenever they talk about it, like the cramps or whatever, I just pretend like I’ve had mine, too. Just to fit in.
Jackie Monroe.She asked how old I was when I got my first period. I told her I was about 12.
Your Avatar.I understand your concerns, but it’s normal for a person of your age to not have started their periods yet.Educate
03/05/22 6:20 AM EST
Samantha Monroe.Cool. Good to know.
Your Avatar.Tell me about your family medical history.Question
03/05/22 6:21 AM EST
Samantha Monroe.Wait, like the entire family medical history or do you mean something more specific?
Your Avatar.Any genetic conditions in your family? (Clarified to Does anyone in your family have a genetic heart condition?.)Question
03/05/22 6:22 AM EST
Samantha Monroe.I don’t know. Mom? (Clarified to if anyone in my family has a genetic heart condition.)
Jackie Monroe.No, no one in the family has any genetic heart conditions.
Your Avatar.Any heart problems in your family?Question
03/05/22 6:22 AM EST
Samantha Monroe.I don’t think anyone has heart problems, but I’m not totally sure.
Jackie Monroe.You know, I can’t think of anybody in the family who’s had heart problems.
Your Avatar.Any history of unexpected deaths in your family? (No matching questions found.)Question
03/05/22 6:23 AM EST
Your Avatar.Any family history of unexpected deaths before the age of 35? (No matching questions found.)Question
03/05/22 6:24 AM EST
Your Avatar.Has any of your family members had a pacemaker before age 35? (Clarified to Has anyone in your family had a pacemaker before 35?.) Adolescent Sports Evaluation Samantha Monroe shadow healthQuestion
03/05/22 6:25 AM EST
Samantha Monroe.I’m not sure about the pacemaker thing. (Clarified to if anyone in my family had a pacemaker before thirty five.)
Jackie Monroe.To my knowledge, there isn’t anyone in the family who’s ever had a pacemaker.
Your Avatar.Do you feel your weight is okay? (Clarified to How do you feel about your weight?.)Question
03/05/22 6:27 AM EST
Samantha Monroe.Um, I mean, I wish I could lose this baby fat. All my friends wear one size smaller than me, so it’s super awkward when they’re swapping clothes . . . and talking about their periods . . . just hard not to compare. (Clarified to how I feel about my weight.)
Jackie Monroe.I told her . . . middle school is tough, especially with all the social media they’re dealing with now. But luckily time goes by faster the older you get and one day you’re my age and it’s all in the rearview.
Your Avatar.I understand your concerns but you should not try to fit in or compare yourself to others.Educate
03/05/22 6:29 AM EST
Samantha Monroe.Gotcha.
Your Avatar.Do you want to lose weight? (Clarified to Why do you think you need to lose weight?.)Question
03/05/22 6:29 AM EST
Samantha Monroe.Just . . . to look more athletic, you know. Like I fit in with everybody. (Clarified to why I think I need to lose weight.)
Your Avatar.You should not try to fit in. Everyone is unique.Educate
03/05/22 6:30 AM EST
Samantha Monroe.Um, that makes sense.
Your Avatar.Tell me about your diet.Question
03/05/22 6:31 AM EST
Samantha Monroe.I do the Mediterranean diet. It’s healthy. I try not to eat bad stuff. No candy, white carbs, processed food.
Your Avatar.Do you skip any meals?Question
03/05/22 6:32 AM EST
Samantha Monroe.Yeah, I skip lunch once or twice each week.
Your Avatar.It is not advisable to skip any meal at your age because you are still growingEducate
03/05/22 6:33 AM EST
Samantha Monroe.For sure. OK.
Your Avatar.How long have you been skipping your lunch? (Clarified to How long have you been skipping lunch?.)Question
03/05/22 6:34 AM EST
Samantha Monroe.I started skipping lunch maybe a month ago? (Clarified to how long I have been skipping lunch.)
Your Avatar. Inspected weight and height growth chartExam Action
03/05/22 6:35 AM EST
Your Avatar. Inspected SkinExam Action
03/05/22 6:48 AM EST
Your Avatar. Assessed appearanceExam Action
03/05/22 6:49 AM EST
Your Avatar. Assessed Cervical Spine Range of MotionExam Action
03/05/22 6:52 AM EST
Your Avatar. Assessed Spine Range of Motion: Full range of motion performed without discomfortExam Action
03/05/22 6:53 AM EST
Your Avatar. Assessed wrist range of motionExam Action
03/05/22 7:01 AM EST
Your Avatar. Assessed Elbow Range of MotionExam Action
03/05/22 7:03 AM EST
Your Avatar. Assessed range of motion of shoulders – adduction and abduction: Strength equal bilaterally against full resistanceExam Action
03/05/22 7:06 AM EST
Your Avatar. Assessed Trapezius Strength: Strength equal bilaterally against full resistanceExam Action
03/05/22 7:06 AM EST
Your Avatar. Assessed deltoid strength and shoulder rotationExam Action
03/05/22 7:07 AM EST
Your Avatar. Assessed Hand and Finger Range of Motion and Strength: Right and left hand strength equal bilaterally against resistanceExam Action
03/05/22 7:08 AM EST
Your Avatar. Assessed Symmetry of ExtremitiesExam Action
03/05/22 7:09 AM EST
Your Avatar. Assessed leg symmetry, knee and ankle effusionExam Action
03/05/22 7:09 AM EST
Your Avatar. Assessed Calf Symmetry and Leg StrengthExam Action
03/05/22 7:10 AM EST
Your Avatar. Tested Hip, Knee, and Ankle ROMExam Action
03/05/22 7:11 AM EST
Your Avatar. Tested Cardinal Fields of VisionExam Action
03/05/22 7:14 AM EST
Your Avatar. Tested peripheral visionExam Action
03/05/22 7:15 AM EST
Your Avatar. Tested visual acuityExam Action
03/05/22 7:15 AM EST
Your Avatar. Tested balance: ExpectedExam Action
03/05/22 7:16 AM EST
Your Avatar. Auscultated lungsExam Action
03/05/22 7:17 AM EST
Your Avatar. Auscultated abdomenExam Action
03/05/22 7:18 AM EST
Your Avatar. Auscultated heartExam Action
03/05/22 7:18 AM EST
Your Avatar. Screened Adam’s Forward BendExam Action
03/05/22 7:20 AM EST
Your Avatar.Mrs. Monroe please step out so I can have a private conversation with your daughter.Educate
03/05/22 7:34 AM EST
Jackie Monroe.Sure, no problem.
Your Avatar.I will be asking you some personal questions and I need you to know that you are in a safe and a nonjudgmental environment.Educate
03/05/22 7:36 AM EST
Samantha Monroe.OK. That sounds alright.
Your Avatar.Tell me about your school life, friends and hobbies. Adolescent Sports Evaluation Samantha Monroe shadow healthQuestion
03/05/22 7:38 AM EST
Samantha Monroe.Everything’s fine. I mean . . . My grades are average. I get a lot of Bs. I feel like my friends used to be really chill but I don’t know what happened this year. It’s like everybody got super skinny and so many more followers on their social accounts. Soccer is gonna be fun, for sure, but . . . everything was easier before I turned 13.
Your Avatar.Am sorry about that. Everything will be fine.Empathize
03/05/22 7:39 AM EST
Samantha Monroe.Thanks. I’m glad you understand.
Your Avatar.Tell me about your support system.ORDER SHADOW HEALTH, EXAM OR WRITEN PAPER HEREQuestion
03/05/22 7:41 AM EST
Samantha Monroe.Yeah, me and my mom are pretty close, and I have some friends who get it. We talk and stuff.
Your Avatar.Have you ever used tobacco?Question
03/05/22 7:42 AM EST
Samantha Monroe.Definitely not. I feel like I’ve heard smoking can help you lose weight, but I’m not ever gonna do it because it’s so bad for your lungs. That would ruin my soccer game.
Your Avatar.Have you used any drugs?Question
03/05/22 7:43 AM EST
Samantha Monroe.No. I wouldn’t ever do drugs.
Your Avatar.Have you used alcohol?Question
03/05/22 7:44 AM EST
Samantha Monroe.I don’t drink. No way.
Your Avatar.Are you interested in relationships and dating?Question
03/05/22 7:45 AM EST
Samantha Monroe.I’m not really interested in that yet.
Your Avatar.Are you sexually active?Question
03/05/22 7:45 AM EST
Samantha Monroe.No.
Your Avatar.I would like to know more about your feeling of nervousness or anxiety.Question
03/05/22 7:54 AM EST
Samantha Monroe.I mean . . . school’s a lot. Projects and tests and stuff. And I want to do really well in soccer. But I guess it’s mostly the whole “keeping up with appearances” thing. It’s like a full-time job.
Your Avatar.Am sorry about that.Empathize
03/05/22 7:55 AM EST
Samantha Monroe.Thanks.
Your Avatar.I noticed that you are concerned about your body image, weight, and diet.Question
03/05/22 7:57 AM EST
Samantha Monroe.Well, I’ve definitely started paying more attention to health stuff, but I thought that was a good thing. I just want to post a selfie and not have a double-chin, you know?
Your Avatar.Have you ever considered doing anything more extreme to manage your weight?Question
03/05/22 7:58 AM EST
Samantha Monroe.No, I wouldn’t do anything dangerous. I promise.
Your Avatar.Do you have any questions for me?Question
03/05/22 7:59 AM EST
Samantha Monroe.No, I don’t think so.
Your Avatar. You will now discuss the appropriate non-pharmacological interventions with Samantha and her mother, Ms. Monroe. You will not be automatically scored on your choices or responses in this activity, but your instructor may choose to review your responses.Exam Action
03/06/22 8:19 AM EST
Your Avatar.I am ready to begin the conversation with Samantha.Question
03/06/22 8:20 AM EST
Your Avatar. In your own words, discuss life-threatening health problems related to disordered eating with Samantha and Ms. Monroe.Exam Action
03/06/22 8:20 AM EST
Your Avatar.Forcing yourself to diet or skip meals can make you very sick because strong bones teeth, and hair require adequate nutrition.Question
03/06/22 8:23 AM EST
Samantha Monroe.Oh, um yeah. That makes sense. I don’t want any of that to happen.
Jackie Monroe.Thank you. This is pretty concerning so we’ll take this very seriously.
Your Avatar. In your own words, discuss limiting media intake with Samantha and Jackie.Exam Action
03/06/22 8:24 AM EST
Your Avatar.You should limit media exposure and remember that your body deserves to be fed, cared or, regardless of the size.Question
03/06/22 8:30 AM EST
Samantha Monroe.Yeah, I mean I don’t want an eating disorder or anything like that. I just thought thinking like that was pretty normal, but I guess not.
Jackie Monroe.We’re just both going to have to rethink how we see our bodies and talk about nutrition. I don’t want to see my daughter struggle with her self-esteem.
Your Avatar. In your own words, discuss increasing knowledge of coping mechanisms with Samantha and Jackie.Exam Action
03/06/22 8:33 AM EST
Your Avatar.You can try journalling, relaxation and stress management techniques, and affirmationsQuestion
03/06/22 8:58 AM EST
Samantha Monroe.Yeah, that make sense. It’s not like I want to feel this way, you know?
Jackie Monroe.I’m just glad we figured out that this was an issue. I had no idea.
Your Avatar. You have provided Samantha and her mother education on all appropriate non-pharmacological interventions. Adolescent Sports Evaluation Samantha Monroe shadow health
  • Reports being Samantha’s mother(Found)Pro Tip: Confirming the patient’s relationship with their guardian ensures that you are observing legal and ethical protections for patient privacy, and that you are speaking with someone who has access to the patient’s information.Example Question:What is your relationship to the patient?

Chief Complaint


  • Finding:Asked about reason for visit

  • Finding:Reports needing sports physical for soccer(Found)Pro Tip: Confirming the purpose of a patient’s visit is important for determining the scope of the exam. Knowing that a patient is seeking a pre-participation evaluation will guide your conversation and inform the physical exam actions that you take, all with the goal of determining if a patient is healthy enough to participate in sports. It is also important to know which sport(s) the patient plays. Some sports have a higher risk of concussions, while other may require participants to maintain a certain weight. Individual considerations must be made for each type of activity.Example Question:What brings you into the clinic?

Past Medical History


  • Finding:Asked about medical conditions

  • Finding:Denies having any medical conditions(Found)Pro Tip: Discussing the patient’s past medical history will alert you to any past or present medical conditions that may restrict a patient from participating in sports. Keep in mind the particular sport the patient wishes to participate in, as a contact sport like football has different risks than a sport like golf.Example Question:Do you have any medical conditions?

  • Finding:Asked about history of surgery

  • Finding:Reports only having a tonsillectomy(Found)Pro Tip: Discussing the patient’s past medical history will alert you to any past or present medical conditions that may restrict a patient from participating in sports. Keep in mind the particular sport the patient wishes to participate in, as a contact sport like football has different risks than a sport like golf.Example Question:Have you ever had surgery?

  • Finding:Asked about missing organs

  • Finding:Denies missing organs(Found)Pro Tip: Discussing the patient’s past medical history will alert you to any past or present medical conditions that may restrict a patient from participating in sports. Keep in mind the particular sport the patient wishes to participate in, as a contact sport like football has different risks than a sport like golf.Example Question:Are you missing any organs?

  • Finding:Asked about allergies

  • Finding:Denies being allergic to insects(Available)Pro Tip: Discussing the patient’s past medical history will alert you to any past or present medical conditions that may restrict a patient from participating in sports. Keep in mind the particular sport the patient wishes to participate in, as a contact sport like football has different risks than a sport like golf.Example Question:Are you allergic to insects?

  • Finding:Denies environmental allergies(Available)Pro Tip: Discussing the patient’s past medical history will alert you to any past or present medical conditions that may restrict a patient from participating in sports. Keep in mind the particular sport the patient wishes to participate in, as a contact sport like football has different risks than a sport like golf.Example Question:Are you allergic to pollen?

  • Finding:Denies food allergies(Available)Pro Tip: Discussing the patient’s past medical history will alert you to any past or present medical conditions that may restrict a patient from participating in sports. Keep in mind the particular sport the patient wishes to participate in, as a contact sport like football has different risks than a sport like golf.Example Question:Do you have food allergies?

  • Finding:Denies medication allergies(Available)Pro Tip: Discussing the patient’s past medical history will alert you to any past or present medical conditions that may restrict a patient from participating in sports. Keep in mind the particular sport the patient wishes to participate in, as a contact sport like football has different risks than a sport like golf.Example Question:Do you have medication allergies?

  • Finding:Asked about immunizations

  • Finding:Reports being up to date on all immunizations(Found)Pro Tip: Discussing the patient’s past medical history will alert you to any past or present medical conditions that may restrict a patient from participating in sports. Keep in mind the particular sport the patient wishes to participate in, as a contact sport like football has different risks than a sport like golf.Example Question:Are your vaccinations up to date?

Home Medications


  • Finding:Asked about medications

  • Finding:Denies taking medications(Found)Pro Tip: Learning what medication the patient takes is important for understanding any conditions they may be suffering from, how those conditions are managed, and if those medications pose any risks for sports participation. Pay careful attention to any vitamins or supplements, as this is an important aspect of health for many athletes, and although they are meant to maintain and improve health, improper use of vitamins and supplements can be dangerous.Example Question:Do you take any medications?

  • Finding:Asked about vitamins and supplements

  • Finding:Reports taking a multivitamin(Found)Pro Tip: Learning what medication the patient takes is important for understanding any conditions they may be suffering from, how those conditions are managed, and if those medications pose any risks for sports participation. Pay careful attention to any vitamins or supplements, as this is an important aspect of health for many athletes, and although they are meant to maintain and improve health, improper use of vitamins and supplements can be dangerous.Example Question:Do you take vitamins?

  • Finding:Reports drinking apple cider vinegar(Found)Pro Tip: Learning what medication the patient takes is important for understanding any conditions they may be suffering from, how those conditions are managed, and if those medications pose any risks for sports participation. Pay careful attention to any vitamins or supplements, as this is an important aspect of health for many athletes, and although they are meant to maintain and improve health, improper use of vitamins and supplements can be dangerous.Example Question:Do you take supplements?

  • Finding:Reports belief that apple cider vinegar gives her energy(Available)Pro Tip: Learning what medication the patient takes is important for understanding any conditions they may be suffering from, how those conditions are managed, and if those medications pose any risks for sports participation. Pay careful attention to any vitamins or supplements, as this is an important aspect of health for many athletes, and although they are meant to maintain and improve health, improper use of vitamins and supplements can be dangerous.Example Question:How do supplements help you?

Review Of Systems


  • Finding:Asked about passing out during or after exercise

  • Finding:Denies passing out during exercise(Found)Pro Tip: For a pre-participation evaluation, it is important to tailor your questions to the individual patient and to their identified sport(s). For many sports, it is important to hit on several key systems: respiratory, musculoskeletal, and neurological. Uncovering any issues in these areas will help you determine if a patient is healthy enough to participate in sports or if their participation should be restricted due to health risks.Example Question:Have you passed out during soccer?

  • Finding:Denies passing out after exercise(Found)Pro Tip: For a pre-participation evaluation, it is important to tailor your questions to the individual patient and to their identified sport(s). For many sports, it is important to hit on several key systems: respiratory, musculoskeletal, and neurological. Uncovering any issues in these areas will help you determine if a patient is healthy enough to participate in sports or if their participation should be restricted due to health risks.Example Question:Have you passed out after soccer?

  • Finding:Reports that she has felt dizzy during gym class(Found)Pro Tip: For a pre-participation evaluation, it is important to tailor your questions to the individual patient and to their identified sport(s). For many sports, it is important to hit on several key systems: respiratory, musculoskeletal, and neurological. Uncovering any issues in these areas will help you determine if a patient is healthy enough to participate in sports or if their participation should be restricted due to health risks.Example Question:Have you passed out during or after exercise?

  • Finding:Asked about dizziness

  • Finding:Reports dizziness was due to skipping lunch(Found)Pro Tip: For a pre-participation evaluation, it is important to tailor your questions to the individual patient and to their identified sport(s). For many sports, it is important to hit on several key systems: respiratory, musculoskeletal, and neurological. Uncovering any issues in these areas will help you determine if a patient is healthy enough to participate in sports or if their participation should be restricted due to health risks.Example Question:Can you tell me more about feeling dizzy?

  • Finding:Reports she only felt dizzy once or twice(Found)Pro Tip: For a pre-participation evaluation, it is important to tailor your questions to the individual patient and to their identified sport(s). For many sports, it is important to hit on several key systems: respiratory, musculoskeletal, and neurological. Uncovering any issues in these areas will help you determine if a patient is healthy enough to participate in sports or if their participation should be restricted due to health risks.Example Question:How often are you dizzy?

  • Finding:Reports the last time she felt dizzy was last week(Available)Pro Tip: For a pre-participation evaluation, it is important to tailor your questions to the individual patient and to their identified sport(s). For many sports, it is important to hit on several key systems: respiratory, musculoskeletal, and neurological. Uncovering any issues in these areas will help you determine if a patient is healthy enough to participate in sports or if their participation should be restricted due to health risks.Example Question:When did you last feel dizzy?

  • Finding:Asked about heart problems during and after exercise

  • Finding:Denies heart problems during exercise(Found)Pro Tip: For a pre-participation evaluation, it is important to tailor your questions to the individual patient and to their identified sport(s). For many sports, it is important to hit on several key systems: respiratory, musculoskeletal, and neurological. Uncovering any issues in these areas will help you determine if a patient is healthy enough to participate in sports or if their participation should be restricted due to health risks.Example Question:Have you had heart problems during exercise?

  • Finding:Denies heart problems after exercise(Found)Pro Tip: For a pre-participation evaluation, it is important to tailor your questions to the individual patient and to their identified sport(s). For many sports, it is important to hit on several key systems: respiratory, musculoskeletal, and neurological. Uncovering any issues in these areas will help you determine if a patient is healthy enough to participate in sports or if their participation should be restricted due to health risks.Example Question:Have you had heart problems after exercise?

  • Finding:Asked about diagnosed heart problems

  • Finding:Denies ever being told she has a heart problem(Found)Pro Tip: For a pre-participation evaluation, it is important to tailor your questions to the individual patient and to their identified sport(s). For many sports, it is important to hit on several key systems: respiratory, musculoskeletal, and neurological. Uncovering any issues in these areas will help you determine if a patient is healthy enough to participate in sports or if their participation should be restricted due to health risks.Example Question:Do you have known heart problems?

  • Finding:Asked about heart tests

  • Finding:Denies having any heart tests(Available)Pro Tip: For a pre-participation evaluation, it is important to tailor your questions to the individual patient and to their identified sport(s). For many sports, it is important to hit on several key systems: respiratory, musculoskeletal, and neurological. Uncovering any issues in these areas will help you determine if a patient is healthy enough to participate in sports or if their participation should be restricted due to health risks.Example Question:Have you ever had any heart tests?

  • Finding:Asked about breathing during and after exercise

  • Finding:Denies breathing problems during exercise(Found)Pro Tip: For a pre-participation evaluation, it is important to tailor your questions to the individual patient and to their identified sport(s). For many sports, it is important to hit on several key systems: respiratory, musculoskeletal, and neurological. Uncovering any issues in these areas will help you determine if a patient is healthy enough to participate in sports or if their participation should be restricted due to health risks.Example Question:How is your breathing during exercise?

  • Finding:Denies breathing problems after exercise(Found)Pro Tip: For a pre-participation evaluation, it is important to tailor your questions to the individual patient and to their identified sport(s). For many sports, it is important to hit on several key systems: respiratory, musculoskeletal, and neurological. Uncovering any issues in these areas will help you determine if a patient is healthy enough to participate in sports or if their participation should be restricted due to health risks.Example Question:How is your breathing after exercise?

  • Finding:Asked about history of seizures

  • Finding:Denies ever having a seizure(Found)Pro Tip: For a pre-participation evaluation, it is important to tailor your questions to the individual patient and to their identified sport(s). For many sports, it is important to hit on several key systems: respiratory, musculoskeletal, and neurological. Uncovering any issues in these areas will help you determine if a patient is healthy enough to participate in sports or if their participation should be restricted due to health risks.Example Question:Have you ever had a seizure?

  • Finding:Asked about musculoskeletal injuries

  • Finding:Reports spraining her ankle when she was ten(Found)Pro Tip: For a pre-participation evaluation, it is important to tailor your questions to the individual patient and to their identified sport(s). For many sports, it is important to hit on several key systems: respiratory, musculoskeletal, and neurological. Uncovering any issues in these areas will help you determine if a patient is healthy enough to participate in sports or if their participation should be restricted due to health risks.Example Question:Have you had a stress fracture?

  • Finding:Denies current musculoskeletal injuries(Found)Pro Tip: For a pre-participation evaluation, it is important to tailor your questions to the individual patient and to their identified sport(s). For many sports, it is important to hit on several key systems: respiratory, musculoskeletal, and neurological. Uncovering any issues in these areas will help you determine if a patient is healthy enough to participate in sports or if their participation should be restricted due to health risks.Example Question:Do you have any current musculoskeletal problems?

  • Finding:Asked about rashes

  • Finding:Denies rashes(Found)Pro Tip: For a pre-participation evaluation, it is important to tailor your questions to the individual patient and to their identified sport(s). For many sports, it is important to hit on several key systems: respiratory, musculoskeletal, and neurological. Uncovering any issues in these areas will help you determine if a patient is healthy enough to participate in sports or if their participation should be restricted due to health risks.Example Question:Do you have any rashes?

  • Finding:Asked about history of head injuries

  • Finding:Denies ever having a head injury(Found)Pro Tip: For a pre-participation evaluation, it is important to tailor your questions to the individual patient and to their identified sport(s). For many sports, it is important to hit on several key systems: respiratory, musculoskeletal, and neurological. Uncovering any issues in these areas will help you determine if a patient is healthy enough to participate in sports or if their participation should be restricted due to health risks.Example Question:Have you had a head injury?

  • Finding:Denies concussions(Found)Pro Tip: For a pre-participation evaluation, it is important to tailor your questions to the individual patient and to their identified sport(s). For many sports, it is important to hit on several key systems: respiratory, musculoskeletal, and neurological. Uncovering any issues in these areas will help you determine if a patient is healthy enough to participate in sports or if their participation should be restricted due to health risks.Example Question:Have you had a concussion?

  • Finding:Asked about numbness, tingling, and weakness in limbs

  • Finding:Denies numbness in limbs(Found)Pro Tip: For a pre-participation evaluation, it is important to tailor your questions to the individual patient and to their identified sport(s). For many sports, it is important to hit on several key systems: respiratory, musculoskeletal, and neurological. Uncovering any issues in these areas will help you determine if a patient is healthy enough to participate in sports or if their participation should be restricted due to health risks.Example Question:Do you ever have numbness in your limbs?

  • Finding:Denies tingling in limbs(Found)Pro Tip: For a pre-participation evaluation, it is important to tailor your questions to the individual patient and to their identified sport(s). For many sports, it is important to hit on several key systems: respiratory, musculoskeletal, and neurological. Uncovering any issues in these areas will help you determine if a patient is healthy enough to participate in sports or if their participation should be restricted due to health risks.Example Question:Do you feel tingling in your limbs?

  • Finding:Denies weakness in limbs(Found)Pro Tip: For a pre-participation evaluation, it is important to tailor your questions to the individual patient and to their identified sport(s). For many sports, it is important to hit on several key systems: respiratory, musculoskeletal, and neurological. Uncovering any issues in these areas will help you determine if a patient is healthy enough to participate in sports or if their participation should be restricted due to health risks.Example Question:Do you have weakness in your limbs?

  • Finding:Asked about exercising in the heat

  • Finding:Reports becoming ill in the heat once in the 5th grade(Available)Pro Tip: For a pre-participation evaluation, it is important to tailor your questions to the individual patient and to their identified sport(s). For many sports, it is important to hit on several key systems: respiratory, musculoskeletal, and neurological. Uncovering any issues in these areas will help you determine if a patient is healthy enough to participate in sports or if their participation should be restricted due to health risks.Example Question:Have you ever become sick exercising in the heat?

  • Finding:Asked about HEENT

  • Finding:Denies eye problems(Found)Pro Tip: For a pre-participation evaluation, it is important to tailor your questions to the individual patient and to their identified sport(s). For many sports, it is important to hit on several key systems: respiratory, musculoskeletal, and neurological. Uncovering any issues in these areas will help you determine if a patient is healthy enough to participate in sports or if their participation should be restricted due to health risks.Example Question:Do you have any eye problems?

  • Finding:Denies vision problems(Available)Pro Tip: For a pre-participation evaluation, it is important to tailor your questions to the individual patient and to their identified sport(s). For many sports, it is important to hit on several key systems: respiratory, musculoskeletal, and neurological. Uncovering any issues in these areas will help you determine if a patient is healthy enough to participate in sports or if their participation should be restricted due to health risks.Example Question:How is your vision?

  • Finding:Denies hearing problems(Available)Pro Tip: For a pre-participation evaluation, it is important to tailor your questions to the individual patient and to their identified sport(s). For many sports, it is important to hit on several key systems: respiratory, musculoskeletal, and neurological. Uncovering any issues in these areas will help you determine if a patient is healthy enough to participate in sports or if their participation should be restricted due to health risks.Example Question:How is your hearing?

  • Finding:Asked about menstrual period

  • Finding:Reports she hasn’t started her menstrual period(Found)Pro Tip: For a pre-participation evaluation, it is important to tailor your questions to the individual patient and to their identified sport(s). For many sports, it is important to hit on several key systems: respiratory, musculoskeletal, and neurological. Uncovering any issues in these areas will help you determine if a patient is healthy enough to participate in sports or if their participation should be restricted due to health risks.Example Question:Have you started menstruating?

Family Medical History


  • Finding:Asked about relevant family medical history

  • Finding:Denies any family members having a genetic heart condition(Found)Pro Tip: Discussing family medical history can allow you to uncover any genetic risks to the patient. For pre-participation evaluations, it is important to focus on a family history of cardiac issues, as this could yield important information relating to the patient’s cardiac health.Example Question:Does anyone in your family have a genetic heart condition?

  • Finding:Denies family members dying of cardiac problems(Available)Pro Tip: Discussing family medical history can allow you to uncover any genetic risks to the patient. For pre-participation evaluations, it is important to focus on a family history of cardiac issues, as this could yield important information relating to the patient’s cardiac health.Example Question:Has anyone in your family died of heart problems?

  • Finding:Denies any unexpected deaths before the age of 35(Available)Pro Tip: Discussing family medical history can allow you to uncover any genetic risks to the patient. For pre-participation evaluations, it is important to focus on a family history of cardiac issues, as this could yield important information relating to the patient’s cardiac health.Example Question:Has anyone in your family died unexpectedly at a young age?

  • Finding:Denies any family members having a pacemaker before age 35(Found)Pro Tip: Discussing family medical history can allow you to uncover any genetic risks to the patient. For pre-participation evaluations, it is important to focus on a family history of cardiac issues, as this could yield important information relating to the patient’s cardiac health.Example Question:Does anyone in your family have a pacemaker?

Social History


  • Finding:Asked about perception of weight

  • Finding:Reports feeling like she needs to lose baby fat(Found)Pro Tip: Discussing a patient’s social history is important for building rapport, understanding relevant aspects of daily living, and discovering risk factors that may have an impact on their ability to participate in sports. With athletes, it is important to focus on areas such as diet, while other areas such as substance use, alcohol use, and sexual activity may be discussed after asking a guardian to briefly step outside the room.Example Question:How do you feel about your overall health?

  • Finding:Reports comparing herself to friends(Found)Pro Tip: Discussing a patient’s social history is important for building rapport, understanding relevant aspects of daily living, and discovering risk factors that may have an impact on their ability to participate in sports. With athletes, it is important to focus on areas such as diet, while other areas such as substance use, alcohol use, and sexual activity may be discussed after asking a guardian to briefly step outside the room.Example Question:How do you feel about your weight?

  • Finding:Followed up on perception of weight

  • Finding:Reports wanting to look athletic(Found)Pro Tip: Discussing a patient’s social history is important for building rapport, understanding relevant aspects of daily living, and discovering risk factors that may have an impact on their ability to participate in sports. With athletes, it is important to focus on areas such as diet, while other areas such as substance use, alcohol use, and sexual activity may be discussed after asking a guardian to briefly step outside the room.Example Question:What makes you want to lose weight?

  • Finding:Reports feeling like she doesn’t fit in(Found)Pro Tip: Discussing a patient’s social history is important for building rapport, understanding relevant aspects of daily living, and discovering risk factors that may have an impact on their ability to participate in sports. With athletes, it is important to focus on areas such as diet, while other areas such as substance use, alcohol use, and sexual activity may be discussed after asking a guardian to briefly step outside the room.Example Question:Can you tell me more about feeling different than your friends?

  • Finding:Asked about diet

  • Finding:Reports being on the Mediterranean diet(Found)Pro Tip: Discussing a patient’s social history is important for building rapport, understanding relevant aspects of daily living, and discovering risk factors that may have an impact on their ability to participate in sports. With athletes, it is important to focus on areas such as diet, while other areas such as substance use, alcohol use, and sexual activity may be discussed after asking a guardian to briefly step outside the room.Example Question:What is your diet like?

  • Finding:Reports avoiding sweets, “white carbs,” and processed foods(Found)Pro Tip: Discussing a patient’s social history is important for building rapport, understanding relevant aspects of daily living, and discovering risk factors that may have an impact on their ability to participate in sports. With athletes, it is important to focus on areas such as diet, while other areas such as substance use, alcohol use, and sexual activity may be discussed after asking a guardian to briefly step outside the room.Example Question:Do you avoid any foods?

  • Finding:Reports skipping lunch once or twice each week(Found)Pro Tip: Discussing a patient’s social history is important for building rapport, understanding relevant aspects of daily living, and discovering risk factors that may have an impact on their ability to participate in sports. With athletes, it is important to focus on areas such as diet, while other areas such as substance use, alcohol use, and sexual activity may be discussed after asking a guardian to briefly step outside the room.Example Question:What are your eating habits?

  • Finding:Reports skipping meals for the past month(Found)Pro Tip: Discussing a patient’s social history is important for building rapport, understanding relevant aspects of daily living, and discovering risk factors that may have an impact on their ability to participate in sports. With athletes, it is important to focus on areas such as diet, while other areas such as substance use, alcohol use, and sexual activity may be discussed after asking a guardian to briefly step outside the room.Example Question:How long have you been skipping meals?

Comments

If your instructor provides individual feedback on this assignment, it will appear here.

Primary Diagnosis

Review Your Answers For The Problem Selection Activities. You Receive One Point For Each Correct Diagnosis, And One Point For Each Correct Evidence Linked To A Correct Diagnosis. If There Are Multiple Correct Diagnoses, You Will Also Receive A Point For Correctly Selecting Which Diagnosis Is The Primary Diagnosis.

Learner SelectionModel Documentation
 Diagnosis: Pre-Participation Sports Physical Identified as primaryEvidences: Samantha reports the reason for her visit is a sports physicalLearner Rationale:The patient indicates that she came for a sports physical.Score: out of 3 Diagnosis: Pre-Participation Sports PhysicalPrimary: YesEvidences:Samantha reports the reason for her visit is a sports physicalModel Rationale:The primary diagnosis is the reason for the patient’s visit. Because Samantha has indicated she is in the office for her sports physical, the correct primary diagnosis is Pre-Participation Sports Physical. As a primary care provider, it is critical to properly code the reason for Samantha’s visit so it can be covered by insurance.

Additional Diagnosis

Learner SelectionModel Documentation
 Diagnosis: Inappropriate Diet and Eating HabitsEvidences: Samantha reports a desire to lose baby fat Samantha reports dizziness Samantha reports wanting to look more athletic Samantha reports skipping lunch once or twice each weekScore: out of 5 Diagnosis: Inappropriate Diet and Eating HabitsEvidences:Samantha reports a desire to lose baby fatSamantha reports dizzinessSamantha reports wanting to look more athleticSamantha reports skipping lunch once or twice each weekModel Rationale:Samantha’s desire to lose baby fat and appear more athletic, as well as her diet modifications, are clear indications that Samantha’s diagnosis pertains to Inappropriate Diet and Eating Habits. This subjective data, along with Samantha’s normal weight range and healthy BMI collected during physical examination, indicate that Samantha’s problematic behavior is not severe enough to meet the criteria of other eating-related diagnosis or disorders. Therefore, Inappropriate Diet and Eating Habits is the correct additional diagnosis at this time. American Psychiatric Association. (2017). Feeding and Eating Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596.dsm10

ORDER SHADOW HEALTH, EXAM OR WRITEN PAPER HERE

Plan of Care7 out of 7

Review Your Answers For The Plan Of Care Activity. You Must Select “Yes” Or “No” For Each Of The Seven Care Actions. You Will Receive One Point For Determining The Correct Answer For Each Care Action.

Learner SelectionModel Documentation
Pharmacological InterventionSelected: NoLearner Rationale:No disease or problem was indicated by the patientScore: out of 1Recommended: NoThis selection is not appropriate. Samantha did not indicate any illness or problem during her sports physical that would require Pharmacological Intervention.
Non-Pharmacological InterventionSelected: YesLearner Rationale:You should discuss with the patient about her food and dieting habits.Score: out of 1Recommended: YesBecause you’ve uncovered some eating and body issues during Samantha’s visit, it is appropriate to perform Non-Pharmacological Interventions. You will talk to Samantha and Jackie about their attitudes and habits around food, dieting, and body image in order to interrupt Samantha’s disordered habits before they become more problematic. A more intuitive, holistic approach to healthy living will allow Samantha to shift her focus away from restrictive eating and weight loss towards a lifestyle that supports her well being.
Educate PatientSelected: YesLearner Rationale:Patient should be taught to take care of her own health.Score: out of 1Recommended: YesWhen a pediatric patient is old enough to take responsibility for their own care, you must educate them as well as their guardian. Clearly communicating to a patient and their guardian what care they need and why improves adherence and outcomes.
Preventive Screening and InterventionSelected: NoLearner Rationale:Samantha already got preventive screening during her 134-year old well visit.Score: out of 1Recommended: NoThis selection is not appropriate. Samantha already had her 13-year-old well visit where she was vaccinated and screened for preventative care.
Diagnostic Testing: Labs and ImagingSelected: NoLearner Rationale:No conditions were indicated that would require testing.Score: out of 1Recommended: NoThis selection is not appropriate. Samantha did not indicate any conditions or issues that would require labs or testing.
Referral of CareSelected: NoLearner Rationale:This selection is not appropriate.Score: out of 1Recommended: NoThis selection is not appropriate. It’s important to follow-up with Samantha about your initial intervention strategies before referring the patient out for specialized care.
Continued Care and Follow-upSelected: YesLearner Rationale:A follow-up appointment is essential to see how the patient is complying with non-pharmacological interventionsScore: out of 1Recommended: YesGiven Samantha’s inappropriate eating habits and body image concerns, a follow-up appointment to see how well she is adhering to the non-pharmacological interventions is an appropriate selection.

Non-Pharmacological Intervention6 out of 6

Learner SelectionModel Documentation
Discuss life-threatening health problems caused by eating disorders, such as heart failure, bone loss, hair and tooth loss, and loss of menses.Selected: YesLearner Rationale: Score: out of 1Recommended: YesGiven Samantha’s lack of knowledge around the consequences of eating disorders, it is critical she understand the long-term consequences of poor nutrition. Samantha’s diagnosis of Inappropriate Diet and Eating Habits requires that Samantha understand the potential risks she is taking with her behavior. Therefore, Discuss Life-threatening Health Problems is an appropriate selection at this time.
Discuss limiting Samantha’s media intake, including unfollowing fitness accounts on social media and refraining from watching shows about weight loss or dieting.Selected: YesLearner Rationale: Score: out of 1Recommended: YesGiven that Samantha mentioned social media and peer pressure as influencing her body image and self-esteem, it is critical she limits her exposure to media that promotes dieting, weight loss, fitness, and idealized or unrealistic bodies. Samantha’s diagnosis of Inappropriate Diet and Eating Habits requires a holistic approach that considers the cultural factors that may influence her. Therefore, Limiting Media Intake is the appropriate selection at this time.
Discuss with Samantha various ways to track her calorie intake, including apps and food diaries, to ensure she meets her recommended caloric intake.Selected: NoLearner Rationale: Score: out of 1Recommended: NoGiven best practices and the details of Samantha’s case, this is an inappropriate intervention. Taking into account all of Samantha’s signs and symptoms, it is not appropriate to encourage Samantha to fixate further on calories or food intake. Eating Disorder Foundation. (n.d.). About eating disorders. https://eatingdisorderfoundation.org/learn-more/about-eating-disorders
Educate Samantha on identifying problematic eating behaviors, including skipping meals on purpose, misusing laxatives, counting calories, or purging via exercise or vomiting.Selected: NoLearner Rationale: Score: out of 1Recommended: NoGiven best practices and the details of Samantha’s case, this is an inappropriate intervention; however, Samantha could be educated on problematic eating behaviors, including in-depth examples like misusing laxatives or purging via exercise or vomiting may unintentionally give the patient more strategies to continue covert disordered eating. Eating Disorder Foundation. (n.d.). About eating disorders. https://eatingdisorderfoundation.org/learn-more/about-eating-disorders
Increase knowledge of coping mechanisms for low self-esteem and poor body image, including journaling, support groups, relaxation and stress management, positive self-talk, and affirmations.Selected: YesLearner Rationale: Score: out of 1Recommended: YesGiven Samantha’s poor body image, desire to lose weight, and her tendency to compare herself to her peers, it is critical she develop positive coping mechanisms to build a more neutral, if not positive, approach to her body. Coping mechanisms may include journaling, support group, relaxation and stress management, positive self-talk, and affirmations. Samantha’s diagnosis of Inappropriate Diet and Eating Habits requires a patient-centered empathetic approach. Therefore, Increase Knowledge of Coping Mechanisms is the appropriate selection at this time.
Inform Samantha that if she sets her mind to it, she can overcome her body issues and low-self esteem through proper diet and exercise.Selected: NoLearner Rationale: Score: out of 1Recommended: NoGiven best practices and the details of Samantha’s case, this is an inappropriate intervention. Disordered eating arises from complex, overlapping factors such as culture, fatphobia, peer pressure, and anxiety. Informing Samantha that she can simply choose to overcome her low self-esteem is not a patient-centered intervention. Eating Disorder Foundation. (n.d.). About eating disorders. https://eatingdisorderfoundation.org/learn-more/about-eating-disorders

Education

In your own words, discuss life-threatening health problems related to disordered eating with Samantha and Ms. Monroe.

Learner ResponseModel Response
Forcing yourself to diet or skip meals can make you very sick because strong bones teeth, and hair require adequate nutrition.Eating as much as you should is a very important part of staying healthy. Forcing yourself to diet or skip meals can make you very sick. Strong bones, hair, and teeth all require sufficient nutrition and calories. Eating well is important for development. You mentioned feeling self-conscious about not having your period yet, but you’re developing at a normal rate. Eating regularly will help you stay on track to develop properly, which includes getting your period. Also, you’re a soccer player — that requires a lot of energy and stamina. Eating plenty of food allows you to perform on the field and helps protect you from injury and overexertion. As an athlete, a student, and a young woman, having three meals of balanced food a day will help you achieve your goals.
Samantha Monroe

Oh, um yeah. That makes sense. I don’t want any of that to happen.

Jackie Monroe

Thank you. This is pretty concerning so we’ll take this very seriously.In your own words, discuss limiting media intake with Samantha and Jackie.

Learner ResponseModel Response
You should limit media exposure and remember that your body deserves to be fed, cared or, regardless of the size.Samantha, you mentioned social media and your friends’ follower count as influencing your body-image. We’re going to talk about social media and strategies you can use to protect your mental health and body-image. It’s critical you limit your exposure to media sources that promote diet culture, fad diets, weight loss, fitness goals, and idealized, unrealistic bodies. Instead of focusing on how you look in comparison to others, try to reframe those thoughts and remind yourself that your body isn’t a problem to be solved or punished. When you see images, articles, or TV shows that make you feel bad, turn them off and remember your body deserves to be fed, cared for, and appreciated, regardless of its size.
Samantha Monroe

Yeah, I mean I don’t want an eating disorder or anything like that. I just thought thinking like that was pretty normal, but I guess not.

Jackie Monroe

We’re just both going to have to rethink how we see our bodies and talk about nutrition. I don’t want to see my daughter struggle with her self-esteem.In your own words, discuss increasing knowledge of coping mechanisms with Samantha and Jackie.

Learner ResponseModel Response
You can try journalling, relaxation and stress management techniques, and affirmationsNow we’re going to talk about some specific coping strategies you can use to interrupt negative thoughts about yourself and work towards a more neutral, if not positive, approach to your body. You can try journaling, relaxation and stress management techniques, replacing negative self-talk with positive things you like and appreciate about yourself, and affirmations. A good affirmation for you might be, “All bodies deserve to be fed and watered,” or “All bodies deserve care and praise.” You can also consider going to a support group for teens looking to build-up their self-esteem. Body image and disordered eating can significantly impact a person’s anxiety levels and sense of control over their lives. Try using these coping strategies the next time you have anxious, controlling, or restrictive thoughts about your body or food.
Samantha Monroe

Yeah, that make sense. It’s not like I want to feel this way, you know?

Jackie Monroe

I’m just glad we figured out that this was an issue. I had no idea.

Objective Data Shadow Health – Samantha Monroe

Objective Data Collection: 23 Of 23 (100%)

  •  Correct
  •  Partially correct
  •  Incorrect
  •  Missed

 Growth Chart: Height & Weight1 of 1 pointWeight Percentile (1/4 point)

  •  Below 5th percentile
  •  Between 5th and 95th percentile
  •  Above 95th percentile

Weight Growth Curve (1/4 point)

  •  Growth curve maintained
  •  Growth curve decline

Height Percentile (1/4 point)

  •  Below 5th percentile
  •  Between 5th and 95th percentile
  •  Above 95th percentile

Height Growth Curve (1/4 point)

  •  Growth curve maintained
  •  Growth curve declined

 Inspected Skin1 of 1 pointLesions (1/5 point)

  •  No visible lesions
  •  Lacerations/wounds
  •  Erythema
  •  Ecchymosis
  •  Birthmark
  •  Discolorations

Color (1/5 point)

  •  Consistent with ethnic background
  •  Jaundice
  •  Cyanosis
  •  Pallor

Texture (1/5 point)

  •  Smooth
  •  Rough

Temperature (1/5 point)

  •  Warm
  •  Cool

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Skin Hydration (1/5 point)

  •  Elastic
  •  Elastic Tenting
  •  Sluggish Turgor

 Inspected General Appearance1 of 1 pointPosture (1/2 point)

  •  Upright posture without tension or rigidity
  •  Bent or hunched posture, tension or rigidity

Clothing (1/2 point)

  •  Clean clothing, appropriate for age, fit, season and occasion
  •  Dirty, disheveled, or inappropriate to age, fit, season or occasion

 Assessed Cervical Spine RoM1 of 1 pointFlexion (1/4 point)

  •  Expected range of motion (approx. 45)
  •  Reduced range of motion

Extension (1/4 point)

  •  Expected range of motion (approx. 45)
  •  Reduced range of motion

Lateral Bending (1/4 point)

  •  Expected range of motion (approx. 40) on both sides
  •  Reduced range of motion on right
  •  Reduced range of motion on left

Rotation (1/4 point)

  •  Expected range of motion (approx. 70) on both sides
  •  Reduced range of motion on right
  •  Reduced range of motion on left

 Assessed Spine Range of Motion1 of 1 pointRotation (1/1 point)

  •  Expected range of motion (approx. 75-90 degrees)
  •  Reduced flexion

 Assessed Wrist RoM1 of 1 pointLeft Extension (1/4 point)

  •  Expected range of motion (approx. 90 degrees)
  •  Reduced flexion

Right Extension (1/4 point)

  •  Expected range of motion (approx. 90 degrees)
  •  Reduced extension

Left Flexion (1/4 point)

  •  Expected range of motion (approx. 90 degrees)
  •  Reduced flexion

Right Flexion (1/4 point)

  •  Expected range of motion (approx. 90 degrees)
  •  Reduced flexion

 Assessed Elbow RoM1 of 1 pointLeft: Flexion And Extension (1/4 point)

  •  Expected range of motion (approx. flexion of 160 degrees and 180 degrees of full extension)
  •  Reduced Extension
  •  Reduced Flexion

Right: Flexion And Extension (1/4 point)

  •  Expected range of motion (approx. flexion of 160 degrees and 180 degrees of full extension)
  •  Reduced Extension
  •  Reduced Flexion

Left: Supination And Pronation (1/4 point)

  •  Expected range of motion (approx. pronation of 90 degrees and 90 degrees of supination)
  •  Reduced Pronation
  •  Reduced Supination

Right: Supination And Pronation (1/4 point)

  •  Expected range of motion (approx. pronation of 90 degrees and 90 degrees of supination)
  •  Reduced Pronation
  •  Reduced Supination

 Assessed Shoulder RoM1 of 1 pointAdduction (1/3 point)

  •  Expected range of motion (approx. 50 degrees)
  •  Reduced range of motion

Abduction (1/3 point)

  •  Expected range of motion (approx. 50 degrees)
  •  Reduced range of motion

Strength (1/3 point)

  •  0 – No muscle contraction
  •  1 – Barely detectable contraction
  •  2 – Active movement with gravity eliminated
  •  3 – Active movement against gravity
  •  4 – Active movement against gravity and resistance
  •  5 – Active movement against full resistance without fatigue (normal)

 Assessed Trapezius Strength1 of 1 pointStrength (1/1 point)

  •  0 – No muscle contraction
  •  1 – Barely detectable contraction
  •  2 – Active movement with gravity eliminated
  •  3 – Active movement against gravity
  •  4 – Active movement against gravity and resistance
  •  5 – Active movement against full resistance without fatigue (normal)

 Assessed Deltoid Strength And Shoulder Rotation1 of 1 pointStrength & Rotation (1/3 point)

  •  Symmetric
  •  Asymmetric

Forward Flexion (1/3 point)

  •  Expected range of motion (approx. 180 degrees)
  •  Reduced range of motion

Extension (1/3 point)

  •  Expected range of motion (approx. 50 degrees)
  •  Reduced range of motion

 Assessed Hand/Finger RoM And Strength1 of 1 pointLeft (1/2 point)

  •  0 – No muscle contraction
  •  1 – Barely detectable contraction
  •  2 – Active movement with gravity eliminated
  •  3 – Active movement against gravity
  •  4 – Active movement against gravity and resistance
  •  5 – Active movement against full resistance without fatigue (normal)

Right (1/2 point)

  •  0 – No muscle contraction
  •  1 – Barely detectable contraction
  •  2 – Active movement with gravity eliminated
  •  3 – Active movement against gravity
  •  4 – Active movement against gravity and resistance
  •  5 – Active movement against full resistance without fatigue (normal)

 Assessed Symmetry of Extremities1 of 1 pointExtremities (1/1 point)

  •  Symmetrical
  •  Asymmetrical

 Assessed Leg Symmetry, Knee or Ankle Effusion1 of 1 pointEffusion (1/3 point)

  •  Present
  •  Not present

Leg Symmetry (1/3 point)

  •  Symmetric
  •  Asymmetric

Knee Symmetry (1/3 point)

  •  Symmetric
  •  Asymmetric

 Assessed Calf Symmetry, Leg Strength1 of 1 pointCalf Muscles (1/2 point)

  •  Symmetric
  •  Asymmetric

Leg Strength (1/2 point)

  •  0 – No muscle contraction
  •  1 – Barely detectable contraction
  •  2 – Active movement with gravity eliminated
  •  3 – Active movement against gravity
  •  4 – Active movement against gravity and resistance
  •  5 – Active movement against full resistance without fatigue (normal)

 Tested Hip, Knee and Ankle Range of Motion1 of 1 pointHip Range Of Motion (1/3 point)

  •  Symmetric, full range of motion without limitations
  •  Asymmetric range of motion with limitations

Knee Range Of Motion (1/3 point)

  •  Symmetric, full range of motion without limitations
  •  Asymmetric range of motion with limitations

Ankle Range Of Motion (1/3 point)

  •  Symmetric, full range of motion without limitations
  •  Asymmetric range of motion with limitations

 Tested 6 Cardinal Fields of Vision1 of 1 pointCardinal Fields (1/2 point)

  •  No abnormal findings
  •  Nystagmus
  •  Fixed Pupil

Convergence (1/2 point)

  •  No abnormal findings
  •  Unequal bilaterally
  •  Fixed Pupil

 Tested Peripheral Vision1 of 1 pointObservations (1/1 point)

  •  No abnormal findings
  •  Reduced right visual field
  •  Reduced left visual field

 Tested Visual Acuity1 of 1 pointRight (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

 Romberg Test1 of 1 pointRomberg (1/1 point)

  •  Maintains upright posture
  •  Difficulty remaining upright

 Auscultated Breath Sounds1 of 1 pointBreath Sounds (1/2 point)

  •  Clear in all areas
  •  Diminished in some areas
  •  Absent in some areas

Adventitious Sounds (1/2 point)

  •  No adventitious sounds
  •  Wheezing
  •  Fine crackles
  •  Stridor
  •  Rhonchi
  •  Rales

 Auscultated Abdominal Aorta1 of 1 pointSounds (1/1 point)

  •  No bruit
  •  Bruit

 Auscultated Heart Sounds1 of 1 pointHeart Sounds (1/3 point)

  •  S1 and S2 audible
  •  S1, S2, and S3 audible
  •  S1, S2 and S4 audible
  •  S1, S2, S3 and S4 audible

Extra Heart Sounds (1/3 point)

  •  No extra sounds
  •  Gallops
  •  Murmur
  •  Friction rub
  •  Valve clicks

Rate And Rhythm (1/3 point)

  •  Regular rate and rhythm
  •  Irregular rate and rhythm
  •  Arrhythmia

 Screened Adam’s Forward Bend1 of 1 pointIliac Crests (1/6 point)

  •  Equal height
  •  Unequal height

Scapula Prominence And Shape (1/6 point)

  •  Equal height
  •  Unequal height

Spine Contour (1/6 point)

  •  Expected curvature
  •  Decreased lordosis
  •  Increased lordosis
  •  Decreased kyphosis
  •  Increased kyphosis

Spine Symmetry (1/6 point)

  •  Symmetrical
  •  Asymmetrical

Waistline (1/6 point)

  •  Equal height
  •  Unequal height

Flexion (1/6 point)

  •  Expected range of motion (approx. 75-90 degrees)
  •  Reduced flexion

Vitals

VitalsCurrent Visit
Height157.4 cm
Weight49.9 kg
BMI20
Temp (<38° C)36.6° C
HR (60-100)78
RR (12-20)16
BP112/70

Documentation / Electronic Health Record

My Provider Notes

Student DocumentationModel Documentation
SubjectiveMs. Monroe is a 13 year old female presenting for a preparticipation evaluation so she can play soccer this year. Past Medical History: No current medical problems. Tonsillectomy as a child. Medications: No prescription medications. Takes multivitamin and apple cider vinegar. Nutrition: Eats a Mediterranean diet and avoids sweets, processed foods, and white carbs. Skips lunch 1-2 times a week. Physical Activity: Plays soccer on weekends. Family Medical History: No family history of genetic heart problems. Review of Systems HEENT: Denies eye, vision, and hearing problems. Cardiovascular: Denies chest pain during exercise, hear problems. Respiratory: Denies breathing problems during exercise. Musculoskeletal: Denies joint or muscle injuries. Genitourinary: Denies starting menses.  ORDER SHADOW HEALTH, EXAM OR WRITEN PAPER HEREMs. Monroe is a 13 year old female who presents today for her sports preparticipation evaluation so she can play soccer this year. She had her annual well visit 6 months ago. Past Medical History: No current medical concerns. Had a tonsillectomy as a child. Denies any missing organs. Medications: Currently not taking any prescription medications, Daily Multivitamin and drinks Apple Cider Vinegar, 1 tablespoon a day with water. No known medication allergies Nutrition: Eats a Mediterranean diet and avoids sweets, “white carbs” and processed foods. Skips lunch 1-2 times a week for the last month. Physical Activity: Plays recreational soccer on the weekends, but really wants to play for her school team. Family Medical History: Denies history of any family members with genetic heart conditions, denies any family members with early cardiac death. Social History: Reports following a Mediterrranean diet, avoiding “white carbs”, and processed foods. Skips lunch 1-2 times a week. Feels like she needs to lose her baby fat so she can look like her friends. Feels like she does not fit in and wants to look athletic. Review of Systems HEENT: Denies eye problems, vision difficulties, and hearing problems. Cardiovascular: Denies any chest pain during exercise, denies history of cardiac issues, denies any prior cardiac tests. Respiratory: Denies shortness of breath during exercise. Musculoskeletal: Report sprained ankle at age 10. Denies any current muscle or joint injuries. Neurological: Denies syncope with exercise, positive for intermittent dizziness 1-2 times after skipping lunch. Denies head injury or concussions, denies numbness, tingling or weakness. Integumentary: Denies rashes. Genitourinary: Denies starting menses.
ObjectiveVitals: H 62 in., W 49.9 kg, BP 112/70, T 36.6C, HR 78 RR 16 General: Pleasant 13-year old in no acute distress. HEENT: Symmetrical head. Eyes PERLA, EOM intact. Neck with full ROM Respiratory: Symmetrical chest rise and fall, lungs clear to auscultation. CV: S1, S2 present, RRR, no murmurs or gallops. Abd: No bruit in abdomen aorta. MSK: Symmetrical bilateral extremities. Full ROM. Skin: Warm, no rash or lesions. Neuro: Alert and oriented x3, intact balance, steady gait.Vital signs: Length=62 in., Weight=49.9 kg, BMI= 20, Blood pressure=112/70, Temp=36.6C, Heart rate= 78/min, Resp=16 breaths/min General: Well-appearing 13-year-old in no acute distress. Upright posture without tension or rigidity, clothing clean and appropriate for season HEENT Head: Symmetrical Eyes: PERRLA, EOM intact, peripheral vision equal to examiner, vision 20/20 bilaterally Neck: Neck with full ROM Resp: Symmetrical chest rise and fall, smooth even respirations, bilateral lungs clear to auscultation CV: Regular rate and rhythm, S1S2 present, no murmurs, pulse present, equal bilaterally Abd: Abdomen aorta with no bruit noted MSK: Bilateral extremities symmetrical, FROM equally strength 5+ all extremities, Adam’s forward bend-equal iliac crest height, expected curvature of spine, scapula equal height, cervical spine full range of motion, lumbar spine-full range of motion, trapezius strength +5 bilaterally Neuro: Alert and oriented x3, balance intact, sensation intact Skin: Warm, smooth, congruent with genetic background. Elastic turgor. No lesions noted Hearing/Vision: Vision 20/20 uncorrected. Hearing intact
AssessmentPre-participation sports physical Inappropriate diet and eating habitsPre-Participation Sports Physical Inappropriate diet and eating habits
PlanPre-participation sports physical 1. Clear to participate in sports Inappropriate diet and eating habits Educate on healthy nutrition Discuss strategies for reducing shame around eating, weight. Educate on detecting problematic eating behaviors. RTC in 4 weeks for reevaluation.Preparticipation physical 1. Clear to participate in sports Inappropriate diet and eating habits 1. Will provide education on healthy nutrition and the effects of nutrition on her body. 2. Discuss the potential life threatening problems caused by improper nutrition. 3. Healthy diet includes 3 meals a day and healthy snack options especially when exercising. 4. Discuss strategies for reducing shame around eating, weight and self-perception. Coping mechanisms around self-esteem and body image to include journaling, support group, relaxation, stress management, positive self talk and affirmations. 5. Limit media intake and refrain from watching shows on weight loss or dieting. 6. Educate on identifying problematic eating behaviors. Anticipatory Guidance Safety: Review sports safety measures including female athlete triad, injury prevention, sunscreen and sun protection, diet and nutritional supplements Follow-up Return to the clinic in 4 weeks to reevaluate nutrition and eating habits.
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