Standardized Patient Encounters : An Insightful Experience

Mr. XXXX is a 44 years old Caucasian male, a general construction worker who works on a nearby highway for the bridge project, and checked in this urgent care center for complaining of chest pain and shortness of breath (SOB). The chest pain is constant dull and pressure like pain, and started 3 hours ago. The pain is located on the center of chest. He rates the pain 4 out of 10 on a pain scale 0 to 10 while resting. The pain gets worse and increases after eating. He experienced increased chest pain and SOB with simple walking from the parking lot to this office. The pain was not resolved with taking PO 365mg of Aspirin 2 hours ago and resting. He was diagnosed with hyperlipedemia 10 years ago. He is taking medication to manage his high cholesterol level. He denies past history of chest pain, hypertension, and coronary artery disease. He denies any history of heart surgery or cardio artery bypass surgery. He is anxious and fearful for his first chest and SOB. He smokes a half pack a day for past 20 years. He drinks one bottle of bear every evening with meals. He denies taking any herbal medication or illicit drugs. He has been a good appetite. He reported 20 lbs weight gain since his retirement from military. He has an irregular meal time and does not exercise as much as he used to do in the military.

40 year old man presents to A&E with lip swelling. Over the next 20 minutes he develops itching of the hands and feet, increasing breathlessness and chest tightness, fall in PEFR (peak expiratory flow rate) to 200l/min, fall in BP to 80/30mmHg and Oxygen saturations are 88% on room air.

States that it started 3 days back and uses oxygen at home. States that he is a former smoker and laying on his back feels better. Also says he has a list of medication, more than 20. Pt has a history of COPD, CHF, DM,morbid obesity, HTN, HLM, hypothyroid, and sleep apnea. Has no accessory muscle use. CC is shortness of breath. Assessment is that there is no deformities or trauma of the head or neck area. Chest shows no signs of deformities or trauma. The abdominal area is tender and warm to the touch. Pelvis and back was not assessed. The upper and lower extremities show signs of low circulation and swelling. PMS=4. I helped with placing the BP cuff on the left arm and attaching it to the monitor. First vitals were recorded. O2 was given by the Nurse and then Albuterol by nebulizer. After 30 minutes, I assisted the Nurse and other hospital workers in moving the PT to a bigger bed. Second set of vitals were recorded. After becoming stable the Pt was moved up to the floor.

On the early morning of August 17, 2002, James C., a patient in one of the wards under the supervision of Ellen Hughes Finnerty, RN, went into respiratory depression. Between 3:00 and 4:00 a.m., Ann Mugi, the patient’s primary nurse, sought the assistance of a respiratory therapist, Hiran Obeyesekere, to help her care for the patient. As Obeyesekere suctioned the patient airway, Mugi called the service of the patient’s primary care physician, Dr. Jackson, to report the changes in the patient’s respiratory status, e.g., respiratory rate of 40 breaths per minute and low urine output.

Patient “DD” is a 56-year-old woman who was admitted to a nearby hospital for respiratory failure. With the only previous medical history being chronic bronchitis, she was diagnosed upon admission with COPD, anemia, hypoxia, moderate anxiety, and dyspnea.

The patient tells me his last visit with Peter Dourdoufis, MD was just last week. I do not yet have a note from that visit. He says that he underwent an EKG and a stress test evaluation. To his knowledge, everything was okay, but he actually has an appointment tomorrow with Dr. Dourdoufis to review everything. No medication changes have been made per his report. He tells me that his blood pressures have been in a good range. Here today, his blood pressure is 126/76. He is not having problems with chest pain, shortness of breath, dyspnea on exertion or lower extremity swelling. He is still working

Patients would come in for a common cold or a broken foot, even though I have seen a lot of different cases, it was always interesting watching the clinical staff work with the patient to help them feel better. I appreciate both settings because I like seeing new random office visits and routine visits as well. As long as I’m helping someone feel better or see that a patient gets great care. I am able to adapt to any setting and learn procedures fast.

Patient 2: The patient had an infection in her lungs with an unknown cause. I was on alert for drops in oxygen levels below the patient’s normal range, increases in blood pressure above the patient’s normal range, and the patient’s activity tolerance without the BiPAP machine. I was also looking for signs of a DVT.

“The patient is Adam Rudd, a 78 y/o white male with a history of hypertension. He has been diagnosed with hypertension past 15 years and is on anti-hypertensive medications and aspirin. He is very weak and short of breath. He is accompanied with his longtime friend Jennifer, who reports that Rudd was looking very weak and was complaining of severe headache and blurred vision before coming to the hospital. He is 5’9” and weighs 270 lb. Vital signs recorded were: oral temperature 98.20 F, BP 224/120 mm Hg with a heart rate of 102 beats/minute and respiration of 24 breaths per minute. The pulse oximetry reading was 94% on room air. He is complaining of severe headache and blurred vision. Rudd said that he did not take his antihypertensive medication or aspirin since he ran out of pills. He has not been taking his medication for past 15 days. He reports no known allergies to any medications or other substances.”

c. 34 years old male who complained of shortness of breath. He was obese and had a history of COPD. He was on two liters nasal cannula. After admitting at the ER, he was tranfered to med-surge floor for further evaluation.

I felt nervous because the patient was complaining of having a difficult time breathing, so I was afraid that he would stop breathing while I was taking care of him

I stayed close to the patient during this whole period, but I was not paying enough attention to her low oxygen level. The patient was a healthcare aid and she kept telling me that, “It’s ok, I am always a shallow breather”. However, I should have my own judgement ability and provide more competent care with timely evaluation of the effectiveness of the interventions.

Countless of different patients come to seek healthcare and advice for a variety of reasons including certain signs and symptoms they feel that their health is threatened by. It is a crucial skill that health practitioners have a working knowledge of different pathologies patients can present with to direct the patient appropriately towards the correct diagnosis and thus, prescribe the most effective treatment in return. Mr Smith is a 63-year-old male suffering from hypertension and diabetes for the last 20 years. He irregularly monitors blood pressure and blood glucose levels as well as inconsistently uses Minidiab and Tritace for treatment. He presents with shortness of breath worsening over the past five weeks as well as other multiple symptomologies. Throughout this case study, we will examine the pathophysiology of Mr Smith’s health concerns, clarify and interpret the physical examination outcomes and laboratory tests. Through the exams, we will then propose a number of possible and justified diagnoses and after that lead to further diagnostic tests suggested as a result of these interpretations.

Nurses encounter many different perceptions during a single patient interaction. Understanding each patient and their situation centers around understanding those perceptions. Perception is a way of regarding, understanding, or interpreting something; a mental impression. This paper will outline the main tenants of regarding, understanding, or interpreting.

The scenario 1 indicated that patients may show similar symptoms that could be the result of different causes. The cause of dyspnea and shortness of breath could be a result of heart failure or even pneumonia. The practitioner should analyze each set of evidence carefully and compare the information to different possible diagnosis. The information in the case study pointed out the importance of not reaching an early conclusion without a thorough evaluation. The patient’s subjective information could significantly help the NP in identifying the cause of the problem. The subjective information provided specific indications for the NP on what physical evaluations are necessary for the patient (Seidel et al., 2011). The use of such resources contributed