Education & Empathy Maya Parker Preschooler Sick Visit Ear Pain Health

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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

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2 Body ImageFollowed Up

3 MenstruationFollowed Up

4 Skipping MealsFollowed Up

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)

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 Selection	Model 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: 3 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.

Learner Selection

Model 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: 3 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 Selection	Model 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: 5 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

Learner Selection

Model 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: 5 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 Selection	Model Documentation
Pharmacological InterventionSelected: NoLearner Rationale:No disease or problem was indicated by the patientScore: 1 out of 1	Recommended: 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: 1 out of 1	Recommended: 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: 1 out of 1	Recommended: 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: 1 out of 1	Recommended: 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: 1 out of 1	Recommended: 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: 1 out of 1	Recommended: 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: 1 out of 1	Recommended: 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 Selection	Model 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: 1 out of 1	Recommended: 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: 1 out of 1	Recommended: 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: 1 out of 1	Recommended: 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: 1 out of 1	Recommended: 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: 1 out of 1	Recommended: 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: 1 out of 1	Recommended: 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 Response	Model 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.

Learner Response

Model 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.

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

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 Response	Model 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.

Learner Response

Model 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.

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.

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 Response	Model Response
You can try journalling, relaxation and stress management techniques, and affirmations	Now 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.

Learner Response

Model Response

You can try journalling, relaxation and stress management techniques, and affirmations

Now 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.

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

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

ORDER SHADOW HEALTH, EXAM OR WRITEN PAPER HERE

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

Vitals	Current Visit
Height	157.4 cm
Weight	49.9 kg
BMI	20
Temp (<38° C)	36.6° C
HR (60-100)	78
RR (12-20)	16
BP	112/70

Documentation / Electronic Health Record

My Provider Notes

Student Documentation	Model 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 HERE	Ms. 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 habits	Pre-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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	Description: Samantha feels like she doesn’t fit in with her peers.
	Do you want to lose weight? (Clarified to: Why do you think you need to lose weight?)	Question 06:29 AM EST
	Just . . . to look more athletic, you know. Like I fit in with everybody. (Clarified to: why I think I need to lose weight)
	You should not try to fit in. Everyone is unique.	Educate 06:30 AM EST
	Um, 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.”

	Description: Samantha has insecurities about her body image.
	Do you feel your weight is okay? (Clarified to: How do you feel about your weight?)	Question 06:27 AM EST
	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)
	I understand your concerns but you should not try to fit in or compare yourself to others.	Educate 06:29 AM EST
	Gotcha.
	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.”

	Description: Samantha has concerns that she should have had her first period already.
	Have you started your periods?	Question 06:17 AM EST
	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. Education & Empathy Maya parker preschooler sick visit ear pain health Just to fit in.
	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
	Cool. 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

	Description: Samantha says that she skips lunch once or twice a week to reduce her caloric intake.
	Do you skip any meals?	Question 06:32 AM EST
	Yeah, I skip lunch once or twice each week.
	It is not advisable to skip any meal at your age because you are still growing	Educate 06:33 AM EST
	For 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

	Hello. My name is xxxx, I will interview you and later conduct a physical exam.\	Greet 03/05/22 5:41 AM EST
	Hello.
	What is your relationship with the patient?	Question 03/05/22 5:42 AM EST
	Oh, this is my mom.
	Hey, I’m Jackie Monroe. This is my daughter, Samantha.
	Why are you here today?	Question 03/05/22 5:42 AM EST
	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
	Any medical issue?ORDER SHADOW HEALTH, EXAM OR WRITEN PAPER HERE	Question 03/05/22 5:43 AM EST
	Uh, nope. No health issues.
	Any history of surgery?	Question 03/05/22 5:43 AM EST
	I had my tonsils removed when I was like 9, but that’s it.
	Yeah, that was Samantha’s only surgery.
	Any missing organ? (No matching questions found.)	Question 03/05/22 5:45 AM EST
	Does your daughter have any missing organ? (No matching questions found.)	Question 03/05/22 5:46 AM EST
	Have you had any of your organs removed?	Question 03/05/22 5:46 AM EST
	Uh . . . no. All my organs are 100% present.
	Any allergies?	Question 03/05/22 5:49 AM EST
	No, I’ve never had any allergies before.
	Are your vaccinations current?	Question 03/05/22 5:50 AM EST
	Yeah, I’ve had all my vaccines.
	I always made sure she was up to date on her vaccinations.
	Are you using any medications?	Question 03/05/22 5:50 AM EST
	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.Do you want to lose weight? (Clarified to: Why do you think you need to lose weight?)Question 06:29 AM ESTJust . . . to look more athletic, you know. Like I fit in with everybody. (Clarified to: why I think I need to lose weight)You should not try to fit in. Everyone is unique Adolescent Sports Evaluation Samantha Monroe shadow health.Educate 06:30 AM ESTUm, 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.Do you feel your weight is okay? (Clarified to: How do you feel about your weight?)Question 06:27 AM ESTUm, 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)I understand your concerns but you should not try to fit in or compare yourself to others.Educate 06:29 AM ESTGotcha. 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.Have you started your periods?Question 06:17 AM ESTNo, 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.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 ESTCool. 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.Do you skip any meals?Question 06:32 AM ESTYeah, I skip lunch once or twice each week.It is not advisable to skip any meal at your age because you are still growingEducate 06:33 AM ESTFor 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: 3 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.













	Nope. My head’s fine.
	Have you had a concussion?	Question 03/05/22 6:03 AM EST
	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.
	Any numbness or tingling? Adolescent Sports Evaluation Samantha Monroe shadow health	Question 03/05/22 6:04 AM EST
	No numbness or tingling. That sounds weird.
	Any weakness in your limbs?	Question 03/05/22 6:09 AM EST
	Nope, no weakness.
	Do you exercise in the heat?	Question 03/05/22 6:14 AM EST
	Sure. We do gym outside sometimes. When soccer season starts, practice and games are outside.
	Any eye problems?	Question 03/05/22 6:16 AM EST
	My eyes are fine.
	Have you started your periods?	Question 03/05/22 6:17 AM EST
	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.
	She asked how old I was when I got my first period. I told her I was about 12.
	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
	Cool. Good to know.
	Tell me about your family medical history.	Question 03/05/22 6:21 AM EST
	Wait, like the entire family medical history or do you mean something more specific?
	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
	I don’t know. Mom? (Clarified to if anyone in my family has a genetic heart condition.)
	No, no one in the family has any genetic heart conditions.
	Any heart problems in your family?	Question 03/05/22 6:22 AM EST
	I don’t think anyone has heart problems, but I’m not totally sure.
	You know, I can’t think of anybody in the family who’s had heart problems.
	Any history of unexpected deaths in your family? (No matching questions found.)	Question 03/05/22 6:23 AM EST
	Any family history of unexpected deaths before the age of 35? (No matching questions found.)	Question 03/05/22 6:24 AM EST
	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 health	Question 03/05/22 6:25 AM EST
	I’m not sure about the pacemaker thing. (Clarified to if anyone in my family had a pacemaker before thirty five.)
	To my knowledge, there isn’t anyone in the family who’s ever had a pacemaker.
	Do you feel your weight is okay? (Clarified to How do you feel about your weight?.)	Question 03/05/22 6:27 AM EST
	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.)
	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.
	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
	Gotcha.
	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
	Just . . . to look more athletic, you know. Like I fit in with everybody. (Clarified to why I think I need to lose weight.)
	You should not try to fit in. Everyone is unique.	Educate 03/05/22 6:30 AM EST
	Um, that makes sense.
	Tell me about your diet.	Question 03/05/22 6:31 AM EST
	I do the Mediterranean diet. It’s healthy. I try not to eat bad stuff. No candy, white carbs, processed food.
	Do you skip any meals?	Question 03/05/22 6:32 AM EST
	Yeah, I skip lunch once or twice each week.
	It is not advisable to skip any meal at your age because you are still growing	Educate 03/05/22 6:33 AM EST
	For sure. OK.
	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
	I started skipping lunch maybe a month ago? (Clarified to how long I have been skipping lunch.)
	Inspected weight and height growth chart	Exam Action 03/05/22 6:35 AM EST
	Inspected Skin	Exam Action 03/05/22 6:48 AM EST
	Assessed appearance	Exam Action 03/05/22 6:49 AM EST
	Assessed Cervical Spine Range of Motion	Exam Action 03/05/22 6:52 AM EST
	Assessed Spine Range of Motion: Full range of motion performed without discomfort	Exam Action 03/05/22 6:53 AM EST
	Assessed wrist range of motion	Exam Action 03/05/22 7:01 AM EST
	Assessed Elbow Range of Motion	Exam Action 03/05/22 7:03 AM EST
	Assessed range of motion of shoulders – adduction and abduction: Strength equal bilaterally against full resistance	Exam Action 03/05/22 7:06 AM EST
	Assessed Trapezius Strength: Strength equal bilaterally against full resistance	Exam Action 03/05/22 7:06 AM EST
	Assessed deltoid strength and shoulder rotation	Exam Action 03/05/22 7:07 AM EST
	Assessed Hand and Finger Range of Motion and Strength: Right and left hand strength equal bilaterally against resistance	Exam Action 03/05/22 7:08 AM EST
	Assessed Symmetry of Extremities	Exam Action 03/05/22 7:09 AM EST
	Assessed leg symmetry, knee and ankle effusion	Exam Action 03/05/22 7:09 AM EST
	Assessed Calf Symmetry and Leg Strength	Exam Action 03/05/22 7:10 AM EST
	Tested Hip, Knee, and Ankle ROM	Exam Action 03/05/22 7:11 AM EST
	Tested Cardinal Fields of Vision	Exam Action 03/05/22 7:14 AM EST
	Tested peripheral vision	Exam Action 03/05/22 7:15 AM EST
	Tested visual acuity	Exam Action 03/05/22 7:15 AM EST
	Tested balance: Expected	Exam Action 03/05/22 7:16 AM EST
	Auscultated lungs	Exam Action 03/05/22 7:17 AM EST
	Auscultated abdomen	Exam Action 03/05/22 7:18 AM EST
	Auscultated heart	Exam Action 03/05/22 7:18 AM EST
	Screened Adam’s Forward Bend	Exam Action 03/05/22 7:20 AM EST
	Mrs. Monroe please step out so I can have a private conversation with your daughter.	Educate 03/05/22 7:34 AM EST
	Sure, no problem.
	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
	OK. That sounds alright.
	Tell me about your school life, friends and hobbies. Adolescent Sports Evaluation Samantha Monroe shadow health	Question 03/05/22 7:38 AM EST
	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.
	Am sorry about that. Everything will be fine.	Empathize 03/05/22 7:39 AM EST
	Thanks. I’m glad you understand.
	Tell me about your support system.ORDER SHADOW HEALTH, EXAM OR WRITEN PAPER HERE	Question 03/05/22 7:41 AM EST
	Yeah, me and my mom are pretty close, and I have some friends who get it. We talk and stuff.
	Have you ever used tobacco?	Question 03/05/22 7:42 AM EST
	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.
	Have you used any drugs?	Question 03/05/22 7:43 AM EST
	No. I wouldn’t ever do drugs.
	Have you used alcohol?	Question 03/05/22 7:44 AM EST
	I don’t drink. No way.
	Are you interested in relationships and dating?	Question 03/05/22 7:45 AM EST
	I’m not really interested in that yet.
	Are you sexually active?	Question 03/05/22 7:45 AM EST
	No.
	I would like to know more about your feeling of nervousness or anxiety.	Question 03/05/22 7:54 AM EST
	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.
	Am sorry about that.	Empathize 03/05/22 7:55 AM EST
	Thanks.
	I noticed that you are concerned about your body image, weight, and diet.	Question 03/05/22 7:57 AM EST
	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?
	Have you ever considered doing anything more extreme to manage your weight?	Question 03/05/22 7:58 AM EST
	No, I wouldn’t do anything dangerous. I promise.
	Do you have any questions for me?	Question 03/05/22 7:59 AM EST
	No, I don’t think so.
	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
	I am ready to begin the conversation with Samantha.	Question 03/06/22 8:20 AM EST
	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
	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
	Oh, um yeah. That makes sense. I don’t want any of that to happen.
	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.	Exam Action 03/06/22 8:24 AM EST
	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
	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.
	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.	Exam Action 03/06/22 8:33 AM EST
	You can try journalling, relaxation and stress management techniques, and affirmations	Question 03/06/22 8:58 AM EST
	Yeah, that make sense. It’s not like I want to feel this way, you know?
	I’m just glad we figured out that this was an issue. I had no idea.
	You have provided Samantha and her mother education on all appropriate non-pharmacological interventions. Adolescent Sports Evaluation Samantha Monroe shadow health

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Adolescent Sports Evaluation Samantha Monroe Shadow Health

Transcript

Chief Complaint

Past Medical History

Home Medications

Review Of Systems

Family Medical History

Social History

Comments

Primary Diagnosis

Additional Diagnosis

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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.

Education

Objective Data Shadow Health – Samantha Monroe

Objective Data Collection: 23 Of 23 (100%)

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Vitals

Documentation / Electronic Health Record

My Provider Notes

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