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NRS 434 Assignment: Shadow Health: Comprehensive Assessment

NRS 434 Assignment Shadow Health Comprehensive Assessment

Identifying Data & Reliability

Tina Jones is a pleasant, 28-year-old African-American single woman who presents for a pre-employment physical examination. She is the primary source of the offered history. Ms. Jones gives information freely minus contradiction. Speech is clear and coherent. She maintains eye contact throughout the entire interview.

General Survey

Ms. Tina Jones is alert and oriented, seated upright on the examination table, and is in no apparent distress. She is well-developed, well-nourshed and dressed appropriately with good hygiene.

Reason for Visit

” I came in because I am required to have a recent physical examination for the health insurance at my new job. “

History of Present Illness

Ms. Jones reports that she recently was hired by Smith, Stevens, Stewart, Silver and Company. She needs to obtain a pre-employment physical prior to initiating employment. Today she denies any acute concerns. Her last healthcare visit was 4 months ago, when she received her annual gynaecological exam at Shadow Health General Clinic. Ms. Jones states that the gynaecologist diagnosed her with polycystic ovarian syndrome and prescribed oral contraceptives at that visit, which she is well-tolerating. She has type II diabetes, which she is controling with diet, exercise, and metformin, which she just started five months ago. She has no medication side effects at this time. She states that she feels healthy, is taking better care of herself than in the past, and is looking forward to beginning the new job.


Fluticasone Propionate, 110 mcg, 2 puffs BID (last use: this morning) Metformin, 850 mg PO BID (last use this morning) Drospirenone and ethinyl estradiol PO QD (last use: this morning) Albuterol 90 mcg/ spray MDI 2 puffs, Q4H prn (last use three months ago) Acetaminophen 500-1000 mg PO PRN (FOR HEADACHES) Ibuprofen 600 mg PO TID prn (menstrual cramps; last used 6 weeks ago)


Penicillin: rash Denies food and latex allergy Allergic to dust and cats: When exposed to alkergens, Ms. Jones states that she has runny nose, itchy and swollen eyes, and increased asthma symptoms.

Medical History

Asthma diagnosed at age 2 1/2. She uses her albuterol inhaler when she is around cats. Her last asthma exacerbation was three months ago, which she resolved using her inhaler. She was last hospitalized for asthma in high school. Never intubated. Type 2 diabetes, diagnosed at age 24. She began metformin 5 months ago and intially had some gastrointestinal side effects, which have since dissipated. She monitors her blood sugar once daily in the morning with average readings being around 90. She has a history of hypertension, which normalized when she initiated diet and exercise. No surgeries. OB/GYN: Menarche, age 11. First sexual encounter at age 18, sex with men, identifies as heterosexual. Never pregnant. Last menstrual period 2 weeks ago. Diagnosed with PCOS four months ago. For the past four months, after initiating Yaz, cycles regular with moderate bleeding lasting 5 days. Has new male relationship, sexual contact not initiated. She plans to use condoms with sexual activity. Tested negative for HIV/AIDS and STIs four months ago.

Health Maintenance

Last papsmear 4 months ago. Last eye exam three months ago. Last dental exam 5 months ago. PPD negative – 2 years ago. Immunizations: Tetanus boster was received within the past year, influenza is not current. and human papillovirus has not been received. She reports that she believes she is up to date on childhood vaccines and received the meingoccocal vaccine for college. Safety: Has smoke detectors at home, wears seatbelt in car, and does not ride a bike. Uses sunscreen. Guns having belonged to her dad are in the home, locked in the prent’s bedroom.

Family History

Mother: age 50, hypertension, elevated cholesterol. Father: deceased in a car accident one year ago at age 58, hypertension, high cholesterol, and type 2 diabetes. Brother (Michael): 25, overweight. Sister (Brittany, 14); asthma. Maternal grandmother; died age 73 of a stroke, history of hypertension, high cholesterol. Maternal grandfather: died at age 78 of a stroke, history of hypertension, high cholesterol. Paternal grandmother: still alive, age 82, hypertension. Paternal grandfather: died at age 65 of colon cancer, history of type 2 diabetes. Paternal uncle: alcoholism Negative for mental illness, other cancers, sudden death, kidney disease, sickle cell anemia, thyroid problems.


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For the middle-aged adult, exercise can reduce the risk of various health problems. Choose two at-risk health issues that regular

NRS 434 Assignment Shadow Health Comprehensive Assessment

NRS 434 Assignment Shadow Health Comprehensive Assessment

physical exercise and activity can help prevent and manage. Discuss the prevalence of each of these health problems in society today. Describe measures that you would take as a nurse to assist clients with health promotion measures to incorporate exercise and physical activity into their lives. Include the kind of activities you would recommend, the amount of exercise, and the approach you would use to gain cooperation from the client. Support your response with evidence-based literature.


Middle- aged adults experience a variety of health concerns, varying from terminal illness to minor problems. Though our health is very important to us, the reality should be addressed with the individual early on in the diagnosis. Two health issues that can be improved with regular activity are hypertension and high cholesterol. According to Falkner, “Proper nutrition and physical activity are essential and lead to positive effects on overall health and help to prevent disease”…“ For instance, if the patient does not have access or financial means to join a gym, the nurse could help them develop a home workout regimen or a walking plan. The nurse should also provide proper nutrition recommendations such as those described on the Unites States Food and Drug Administration (USDA) website” (2018).

Hypertension is a pesky illness that may stay borderline for years, but the body can only tolerate the higher pressures within the blood vessels before it starts to damage vital organs and cause further health issues. The CDC conducted a study which showed “During 2015–2016, the prevalence of hypertension was 29.0% and increased with age: age group 18–39, 7.5%; 40–59, 33.2%; and 60 and over, 63.1%” (CDC, 2017). The fact is, these rates will continue to climb unless action is taken to reverse these illnesses. Increasing physical activity and exercise will allow these individuals to improve heart health, as well as become more aware of other health improvements. Along with changing your lifestyle, you should also encourage the individuals to monitor blood pressure daily, provide better dietary choices low in fats and salts, and also giving the individual the ability to still feel like they have options.

High Cholesterol is another illness that can be modified if lifestyle and dietary changes are made. According to the CDC, “Nearly 94 million U.S. adults age 20 or older have total cholesterol levels higher than 200 mg/dL. Twenty-eight million adults in the United States have total cholesterol levels higher than 240 mg/dL” (CDC, 2017). The goal for optimal cholesterol is anything less than 200 mg/dL. According to Heart, “Eat a heart-healthy diet. Focus on plant-based foods, including fruits, vegetables and whole grains. Limit saturated fats and trans fats. Monounsaturated fat, found in olive and canola oils, is a healthier option. Avocados, nuts and oily fish are other sources of healthy fat” (2021). They also suggest “Exercise regularly. With your doctor’s OK, work up to at least 30 minutes of moderate intensity exercise five times a week. Don’t smoke. If you smoke, find a way to quit” (Heart, 2021).



Centers for Disease Control and Prevention. (2017d). New CDC report: More than 100 million Americans

have diabetes or prediabetes. Retrieved from


My cholesterol guide. American Heart Association. https://www.heart.org/en/health-

topics/cholesterol/cholesterol-tools-and-resources. Accessed March 10, 2021.


Rizalina Orencia

Posted Date

Feb 20, 2022, 9:02 PM


According to Erikson’s stage of development, the middle-aged adult is in the generativity versus stagnation stage wherein roles within the society and contribution to the society are balanced with personal success ( Grand Canyon University, 2018). This equates to stress and less attention to health. Diabetes in the United States has increased to 100 million cases according to the CDC (CDC, 2017). The prevalence of diabetes among adults from 2018-2019 also depends on education level, with 13.4% has less than high school education, 9.2% with high school education, and 7.1% with higher than high school learning ( CDC, 2021). Diabetes also may go hand in hand with the other health risk issue of coronary heart disease for a middle-aged adult. Both these risk factors may be prevented or managed by an increase in physical exercise and a change in lifestyle (Folsom et. al, 2003).

The first measure to take as a nurse to assist patients with health promotion measures is to do a thorough assessment on the patient, including their willingness to learn and change their lifestyle. Then the patient can be enrolled and assisted in proper education using evidence-based materials, connecting them to the right health care team such as the cardiac rehab program that will tailor the exercise program and the lifestyle changes needed, for example, the target heart rate, the proper exercise activity to start the program then to increase the intensity (Healthwise, 2022). Ensuring the patient that the exercise program will be tailored to their initial capacity, and to enumerate the benefits they will get may get a better result



Grand Canyon University (Ed). (2018). Health assessment: Foundations for effective practice. Retrieved from https://lc.gcumedia.com/nrs434vn/health-assessment-foundations-for-effective-practice/v1.1/


Healthwise. (2022). Peace Health. Retrieved from: Coronary Artery Disease: Exercising for a Healthy Heart | PeaceHealth


Prevalence of Diagnosed Diabetes | Diabetes | (2021). Retrieved from: Prevalence of Diagnosed Diabetes | Diabetes | CDC


Folsom, A. R., Chambless, L. E., Duncan, B. B., Gilbert, A. C., Pankow, J. S., & Atherosclerosis Risk in Communities Study Investigators (2003). Prediction of coronary heart disease in middle-aged adults with diabetes. Diabetes care26(10), 2777–2784. https://doi.org/10.2337/diacare.26.10.2777

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