Tina Jones Respiratory Results
Tina Jones Respiratory Results
Experience Overview
Patient: Tina Jones
Digital Clinical Experience Score
92.3%
This score measures your performance on the Student Performance Index in relation to other students in comparable academic programs. Your instructor has chosen to scale your Student Performance Index score so that the average score on the index is a 80.0%. This score may not be your final grade if your instructor chooses to include additional components, such as documentation or time spent.
Student Performance Index
| 28
out of 31 |
Proficiency Level:
Proficient
Students rated as “proficient” demonstrate an entry-level expertise in advanced practice competencies and clinical reasoning skills. In comparable programs, the top 25% of students perform at the level of a proficient practitioner.
Subjective Data Collection
21
out of
21
Objective Data Collection
6
out of
6
Education and Empathy
1
out of
4
Time
| 54 minutes total spent in assignment |
Interaction with patient
54 minutes
Transcript
Started: Apr 11, 2025 | Total Time: 54 min
All Lines (142)Interview Questions (36)Statements (1)Exam Actions (105)
| Hello, my name is Mileidy. I will be your nurse today | Greet 04/11/25 5:20 AM EDT |
|
| Hey. | ||
| What brings you here today? | Question 04/11/25 5:21 AM EDT |
|
| I came in because I’ve been having breathing problems, and my inhaler just isn’t working the way it normally does. | ||
| I am sorry for that | Empathize 04/11/25 5:21 AM EDT |
|
| I appreciate you telling me that. | ||
| When did the symptoms start? | Question 04/11/25 5:21 AM EDT |
|
| I don’t know if I’d call it an asthma attack, but my asthma started acting up two days ago at my cousin’s house. She has cats, and I’m allergic, so I’m used to it being a problem there, but usually the inhaler fixes it. . . it doesn’t feel totally under control, though. | ||
| What are the frequency of the episodes? (No matching questions found.) | Question 04/11/25 5:22 AM EDT |
|
| How severe are the symptoms? | Question 04/11/25 5:22 AM EDT |
|
| My asthma used to be really scary. I haven’t had a full attack in years, and if you had asked me before this I would have said my asthma wasn’t that bad anymore, but the last couple days I’ve had a lot of trouble breathing. | ||
| How frequent are the asthma attacks? | Question 04/11/25 5:23 AM EDT |
|
| I haven’t had a full attack in years, though lately my asthma’s definitely been worse than usual. | ||
| What are the characteristics of the symptoms? (Clarified to What would you describe your symptoms as?.) | Question 04/11/25 5:23 AM EDT |
|
| Well, I’m having breathing problems. I keep feeling tight in my chest and I’ve had some wheezing. (Clarified to how I would describe my symptoms.) | ||
| Do you cough? | Question 04/11/25 5:23 AM EDT |
|
| I’ve been coughing a lot, yeah. | ||
| What aggravates the symptoms? | Question 04/11/25 5:23 AM EDT |
|
| If I move around or try to be too active, I cough more. | ||
| How frequently do you have shortness of breath? | Question 04/11/25 5:24 AM EDT |
|
| Maybe as much as every four hours? It’s a lot. | ||
| Do you use medications? | Question 04/11/25 5:25 AM EDT |
|
| No. | ||
| Have you been using any medications? | Question 04/11/25 5:25 AM EDT |
|
| I don’t take anything, unless my inhaler counts. | ||
| When did you know you have asthma? (Clarified to When did your asthma start?.) | Question 04/11/25 5:26 AM EDT |
|
| I think I was about two and a half? I used to have a lot of trouble with asthma attacks back then. (Clarified to when I first got asthma.) | ||
| Have you been hospitalized for asthma? | Question 04/11/25 5:26 AM EDT |
|
| I went a bunch of times when I was little, for asthma attacks. | ||
| How do you manage the asthma? | Question 04/11/25 5:27 AM EDT |
|
| I try to avoid things that give me breathing problems, but when my asthma starts to act up, I just use my inhaler. | ||
| What are the forms of non-medication forms of asthma management? (No matching questions found.) | Question 04/11/25 5:28 AM EDT |
|
| do you use any non-medical form of asthma management? | Question 04/11/25 5:28 AM EDT |
|
| All I really do is keep my inhaler with me and use it if I need it. | ||
| How do you control your environment? | Question 04/11/25 5:29 AM EDT |
|
| I’m not sure what you mean by “control.” [AUDIO COMING SOON] | ||
| Where do you leave? (Clarified to Where do you live?.) | Question 04/11/25 5:29 AM EDT |
|
| Right now I’m living at my mom’s place, which is out in the suburbs a bit. It’s like a half hour from here. (Clarified to where I live.) | ||
| How is the condition of where to live? (No matching questions found.) | Question 04/11/25 5:30 AM EDT |
|
| Do you exercise? | Question 04/11/25 5:30 AM EDT |
|
| It’s really not my thing. I get some exercise by being on my feet at work and walking around campus, that sort of thing. But jumping around in spandex is not my idea of a good time. | ||
| Do you smoke? | Question 04/11/25 5:30 AM EDT |
|
| No. I think it’s gross. | ||
| Do you have any other respiratory issue? | Question 04/11/25 5:31 AM EDT |
|
| Other than what I’ve told you? I don’t think so. It’s just needing my inhaler so much and the cough that’s been bothering me. | ||
| Do you have a family history of respiratory issue? | Question 04/11/25 5:31 AM EDT |
|
| My baby sister has asthma, too, but no one else in the family has lung problems, I don’t think. | ||
| Do you have a history of COPD? | Question 04/11/25 5:38 AM EDT |
|
| No, I don’t think so. | ||
| Do you have a history of COPD? | Question 04/11/25 5:43 AM EDT |
|
| No, I don’t think so. | ||
| Have you had eczema? | Question 04/11/25 5:48 AM EDT |
|
| No, I don’t have that kind of skin problem. | ||
| Do you have allergy? | Question 04/11/25 5:52 AM EDT |
|
| Yeah, I’m allergic to cats. | ||
| are you exposed to allergens? | Question 04/11/25 5:53 AM EDT |
|
| Two days ago, at my cousin’s house. She has three of them, and my asthma always goes crazy when I’m there. | ||
| What started your recent asthma problem? | Question 04/11/25 5:53 AM EDT |
|
| This all started at my cousin’s house. She has cats, and I’m allergic, so my asthma always goes crazy when I’m there. | ||
| Does being around dust trigger the asthma? | Question 04/11/25 5:54 AM EDT |
|
| Yeah, being around a lot of dust, especially hanging out in a really dusty house, can make my asthma act up. | ||
| Do changes in weather make your asthma worse? | Question 04/11/25 5:56 AM EDT |
|
| Not that I’ve noticed. | ||
| Do you have seasonal asthma problems? | Question 04/11/25 5:57 AM EDT |
|
| A little while ago, I had some seasonal allergies, but it didn’t really bother my asthma, and it’s better now. | ||
| Do you have environmental exposures at home or at work? | Question 04/11/25 5:58 AM EDT |
|
| No, unless cats count. | ||
| How is your social determinant of health? | Question 04/11/25 5:58 AM EDT |
|
| I’ve known most of my girlfriends since high school. We’ve been a pretty tight group for a long time. I am really close to people at church too, especially the ones in my bible study group. I sometimes get drinks with the other shift-supervisors at work, but we’re not super close. | ||
| Are you exposed to secondhand smoke? | Question 04/11/25 6:00 AM EDT |
|
| Some of my friends smoke when we go out drinking. But I don’t smoke, and nobody at home smokes. | ||
| Inspected anterior chest wall | Exam Action 04/11/25 6:04 AM EDT |
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| Inspected right side chest wall | Exam Action 04/11/25 6:04 AM EDT |
|
| Inspected posterior chest wall | Exam Action 04/11/25 6:04 AM EDT |
|
| Inspected left side chest wall | Exam Action 04/11/25 6:04 AM EDT |
|
| Inspected anterior chest wall | Exam Action 04/11/25 6:04 AM EDT |
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| Inspected left side chest wall | Exam Action 04/11/25 6:04 AM EDT |
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| Inspected posterior chest wall | Exam Action 04/11/25 6:04 AM EDT |
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| Inspected right side chest wall | Exam Action 04/11/25 6:04 AM EDT |
|
| Inspected anterior chest wall | Exam Action 04/11/25 6:04 AM EDT |
|
| Palpated chest expansion: Both sides rise symmetrically | Exam Action 04/11/25 6:05 AM EDT |
|
| Palpated fremitus in anterior upper chest wall: Equal bilaterally, expected vibration | Exam Action 04/11/25 6:05 AM EDT |
|
| Ninety-nine. | ||
| Palpated fremitus in anterior lower chest wall: Equal bilaterally, expected vibration | Exam Action 04/11/25 6:05 AM EDT |
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| Ninety-nine. | ||
| Palpated fremitus in posterior upper chest wall: Equal bilaterally, expected vibration | Exam Action 04/11/25 6:05 AM EDT |
|
| Ninety-nine. | ||
| Palpated fremitus in posterior middle chest wall: Equal bilaterally, expected vibration | Exam Action 04/11/25 6:05 AM EDT |
|
| Ninety-nine. | ||
| Palpated fremitus in posterior lower chest wall: Equal bilaterally, expected vibration | Exam Action 04/11/25 6:05 AM EDT |
|
| Ninety-nine. | ||
| Percussed anterior right upper lobe | Exam Action 04/11/25 6:06 AM EDT |
|
| Percussed anterior left upper lobe | Exam Action 04/11/25 6:06 AM EDT |
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| Percussed anterior right middle lobe | Exam Action 04/11/25 6:06 AM EDT |
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| Percussed anterior left mid-chest (upper lobe) | Exam Action 04/11/25 6:06 AM EDT |
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| Percussed anterior right lower lobe | Exam Action 04/11/25 6:06 AM EDT |
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| Percussed anterior left lower lobe | Exam Action 04/11/25 6:06 AM EDT |
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| Percussed posterior left upper lobe | Exam Action 04/11/25 6:06 AM EDT |
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| Percussed posterior right upper lobe | Exam Action 04/11/25 6:06 AM EDT |
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| Percussed posterior left mid-back (lower lobe) | Exam Action 04/11/25 6:06 AM EDT |
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| Percussed posterior right mid-back (lower lobe) | Exam Action 04/11/25 6:06 AM EDT |
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| Percussed posterior left lower lobe | Exam Action 04/11/25 6:06 AM EDT |
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| Percussed posterior right lower lobe | Exam Action 04/11/25 6:06 AM EDT |
|
| Percussed posterior left lower lobe on side | Exam Action 04/11/25 6:06 AM EDT |
|
| Percussed posterior left lower lobe near spine | Exam Action 04/11/25 6:06 AM EDT |
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| Percussed posterior right lower lobe near spine | Exam Action 04/11/25 6:06 AM EDT |
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| Percussed posterior right lower lobe on side | Exam Action 04/11/25 6:06 AM EDT |
|
| Auscultated breath sounds in anterior right upper lobe | Exam Action 04/11/25 6:07 AM EDT |
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| Auscultated breath sounds in anterior left upper lobe | Exam Action 04/11/25 6:07 AM EDT |
|
| Auscultated breath sounds in anterior right middle lobe | Exam Action 04/11/25 6:07 AM EDT |
|
| Auscultated breath sounds in anterior left mid-chest (upper lobe) | Exam Action 04/11/25 6:07 AM EDT |
|
| Auscultated breath sounds in anterior right lower lobe | Exam Action 04/11/25 6:07 AM EDT |
|
| Auscultated breath sounds in anterior left lower lobe | Exam Action 04/11/25 6:07 AM EDT |
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| Auscultated breath sounds in posterior left upper lobe | Exam Action 04/11/25 6:07 AM EDT |
|
| Auscultated breath sounds in posterior right upper lobe | Exam Action 04/11/25 6:07 AM EDT |
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| Auscultated breath sounds in posterior left mid-back (lower lobe) | Exam Action 04/11/25 6:07 AM EDT |
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| Auscultated breath sounds in posterior right mid-back (lower lobe) | Exam Action 04/11/25 6:07 AM EDT |
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| Auscultated breath sounds in posterior left lower lobe | Exam Action 04/11/25 6:07 AM EDT |
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| Auscultated breath sounds in posterior right lower lobe | Exam Action 04/11/25 6:07 AM EDT |
|
| Auscultated breath sounds in posterior left lower lobe on side | Exam Action 04/11/25 6:07 AM EDT |
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| Auscultated breath sounds in posterior left lower lobe near spine | Exam Action 04/11/25 6:07 AM EDT |
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| Auscultated breath sounds in posterior right lower lobe near spine | Exam Action 04/11/25 6:08 AM EDT |
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| Auscultated breath sounds in posterior right lower lobe on side | Exam Action 04/11/25 6:08 AM EDT |
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| Auscultated voice sounds in anterior right upper lobe | Exam Action 04/11/25 6:08 AM EDT |
|
| Ninety-nine. | ||
| Auscultated voice sounds in anterior left upper lobe | Exam Action 04/11/25 6:08 AM EDT |
|
| Ninety-nine. | ||
| Auscultated voice sounds in anterior right middle lobe | Exam Action 04/11/25 6:08 AM EDT |
|
| Ninety-nine. | ||
| Auscultated voice sounds in anterior left mid-chest (upper lobe) | Exam Action 04/11/25 6:08 AM EDT |
|
| Auscultated voice sounds in anterior right lower lobe | Exam Action 04/11/25 6:08 AM EDT |
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| Auscultated voice sounds in anterior left lower lobe | Exam Action 04/11/25 6:08 AM EDT |
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| Ninety-nine. | ||
| Ninety-nine. | ||
| Ninety-nine. | ||
| Auscultated voice sounds in anterior right upper lobe | Exam Action 04/11/25 6:13 AM EDT |
|
| Auscultated voice sounds in anterior left upper lobe | Exam Action 04/11/25 6:13 AM EDT |
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| Auscultated voice sounds in anterior right middle lobe | Exam Action 04/11/25 6:13 AM EDT |
|
| Ninety-nine. | ||
| Auscultated voice sounds in anterior left mid-chest (upper lobe) | Exam Action 04/11/25 6:13 AM EDT |
|
| Auscultated voice sounds in anterior right lower lobe | Exam Action 04/11/25 6:13 AM EDT |
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| Auscultated voice sounds in anterior left lower lobe | Exam Action 04/11/25 6:13 AM EDT |
|
| Ninety-nine. | ||
| Auscultated voice sounds in posterior left upper lobe | Exam Action 04/11/25 6:14 AM EDT |
|
| Ninety-nine. | ||
| Auscultated voice sounds in posterior right upper lobe | Exam Action 04/11/25 6:14 AM EDT |
|
| Auscultated voice sounds in posterior left mid-back (lower lobe) | Exam Action 04/11/25 6:14 AM EDT |
|
| Ninety-nine. | ||
| Auscultated voice sounds in posterior right mid-back (lower lobe) | Exam Action 04/11/25 6:14 AM EDT |
|
| Ninety-nine. | ||
| Auscultated voice sounds in posterior left lower lobe | Exam Action 04/11/25 6:14 AM EDT |
|
| Auscultated voice sounds in posterior right lower lobe | Exam Action 04/11/25 6:14 AM EDT |
|
| Ninety-nine. | ||
| Auscultated voice sounds in posterior left lower lobe on side | Exam Action 04/11/25 6:14 AM EDT |
|
| Auscultated voice sounds in posterior left lower lobe near spine | Exam Action 04/11/25 6:14 AM EDT |
|
| Ninety-nine. | ||
| Auscultated voice sounds in posterior right lower lobe near spine | Exam Action 04/11/25 6:14 AM EDT |
|
| Ninety-nine. | ||
| Auscultated voice sounds in posterior right lower lobe on side | Exam Action 04/11/25 6:14 AM EDT |
|
| Ninety-nine. | ||
| Auscultated breath sounds in anterior right upper lobe | Exam Action 04/11/25 6:14 AM EDT |
|
| Auscultated breath sounds in anterior left upper lobe | Exam Action 04/11/25 6:14 AM EDT |
|
| Auscultated breath sounds in anterior right middle lobe | Exam Action 04/11/25 6:14 AM EDT |
|
| Auscultated breath sounds in anterior left mid-chest (upper lobe) | Exam Action 04/11/25 6:14 AM EDT |
|
| Auscultated breath sounds in anterior left lower lobe | Exam Action 04/11/25 6:14 AM EDT |
|
| Auscultated breath sounds in anterior right lower lobe | Exam Action 04/11/25 6:14 AM EDT |
|
| Auscultated breath sounds in posterior left upper lobe | Exam Action 04/11/25 6:15 AM EDT |
|
| Auscultated breath sounds in posterior right upper lobe | Exam Action 04/11/25 6:15 AM EDT |
|
| Auscultated breath sounds in posterior left mid-back (lower lobe) | Exam Action 04/11/25 6:15 AM EDT |
|
| Auscultated breath sounds in posterior right mid-back (lower lobe) | Exam Action 04/11/25 6:15 AM EDT |
|
| Auscultated breath sounds in posterior left lower lobe | Exam Action 04/11/25 6:15 AM EDT |
|
| Auscultated breath sounds in posterior right lower lobe | Exam Action 04/11/25 6:15 AM EDT |
|
| Auscultated breath sounds in posterior left lower lobe on side | Exam Action 04/11/25 6:15 AM EDT |
|
| Auscultated breath sounds in posterior left lower lobe near spine | Exam Action 04/11/25 6:15 AM EDT |
|
| Auscultated breath sounds in posterior right lower lobe near spine | Exam Action 04/11/25 6:15 AM EDT |
|
| Auscultated breath sounds in posterior right lower lobe on side | Exam Action 04/11/25 6:15 AM EDT |
|
| Percussed anterior right upper lobe | Exam Action 04/11/25 6:15 AM EDT |
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| Percussed anterior left upper lobe | Exam Action 04/11/25 6:15 AM EDT |
|
| Percussed anterior right middle lobe | Exam Action 04/11/25 6:15 AM EDT |
|
| Percussed anterior left mid-chest (upper lobe) | Exam Action 04/11/25 6:16 AM EDT |
|
| Percussed anterior right lower lobe | Exam Action 04/11/25 6:16 AM EDT |
|
| Percussed anterior left lower lobe | Exam Action 04/11/25 6:16 AM EDT |
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| Percussed posterior left upper lobe | Exam Action 04/11/25 6:16 AM EDT |
|
| Percussed posterior left mid-back (lower lobe) | Exam Action 04/11/25 6:16 AM EDT |
|
| Percussed posterior right upper lobe | Exam Action 04/11/25 6:16 AM EDT |
|
| Percussed posterior right mid-back (lower lobe) | Exam Action 04/11/25 6:16 AM EDT |
|
| Percussed posterior left lower lobe | Exam Action 04/11/25 6:16 AM EDT |
|
| Percussed posterior right lower lobe | Exam Action 04/11/25 6:16 AM EDT |
|
| Percussed posterior left lower lobe on side | Exam Action 04/11/25 6:16 AM EDT |
|
| Percussed posterior left lower lobe near spine | Exam Action 04/11/25 6:16 AM EDT |
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| Percussed posterior right lower lobe near spine | Exam Action 04/11/25 6:16 AM EDT |
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| Percussed posterior right lower lobe on side | Exam Action 04/11/25 6:17 AM EDT |
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| Check pulse oximetry using right hand | Exam Action 04/11/25 6:17 AM EDT |
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| Checked pulse oximetry using left hand | Exam Action 04/11/25 6:17 AM EDT |
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| Blow into the spirometer? | Question 04/11/25 6:18 AM EDT |
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| Checked spirometer | Exam Action 04/11/25 6:18 AM EDT |
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| Checked patient’s inhaler | Exam Action 04/11/25 6:18 AM EDT |
Subjective Data Collection: 21 of 21 (100.0%)
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.
Category
Scored Items
Experts selected these topics as essential components of a strong, thorough interview with this patient.
Patient Data
Not Scored
A combination of open and closed questions will yield better patient data. The following details are facts of the patient’s case.
Chief Complaint
Finding:
Established chief complaint
Finding:
Reports increased breathing problems and shortness of breath
(Found)
Pro Tip: Foundational questions about general well-being are important in assessing how a patient feels at the current moment. This creates a space for Tina to contextualize her current feeling in relation to a chief complaint.
Example Question:
What brings you in today?
Finding:
Reports decreased effectiveness of inhaler
(Found)
Pro Tip: Initially establishing a chief complaint allows the patient to express their reason for seeking care, primary concerns, or condition they are presenting with.
Example Question:
Why did you decide to seek treatment?
History of Presenting Illness
Finding:
Asked about onset of symptoms
Finding:
Reports symptoms began two days ago
(Found)
Pro Tip: Determining the onset of a health problem is the first step to understanding if the underlying condition is acute or chronic.
Example Question:
How long have you had breathing problems?
Finding:
Asked about frequency and duration of SOB episodes
Finding:
Reports exacerbations lasting several minutes
(Available)
Pro Tip: Knowing the duration of an asthma or shortness of breath episode will give you insight into how effective the patient’s interventions are, and how severe the episode is.
Example Question:
How long do your asthma episodes last?
Finding:
Reports exacerbated breathing about every 4 hours since original episode
(Found)
Pro Tip: The frequency of asthma episodes or shortness of breath might vary over time. Asking Tina about her recent experience will expound upon her current condition.
Example Question:
How many times have you had breathing problems in the past two days?
Finding:
Reports waking up twice a night with asthma the past 2 nights
(Available)
Pro Tip: Many patients with asthma report trouble sleeping. Asking Tina if she has trouble sleeping can indicate the severity of her asthma.
Example Question:
How many times in the past two nights did asthma wake you up?
Finding:
Asked about severity of symptoms
Finding:
Describes asthma severity as “not full attack,” but worse than usual
(Found)
Pro Tip: Asthma severity might change over time for a variety of reasons. Asking Tina about the severity of her asthma will allow her to assess her condition.
Example Question:
How severe is your asthma?
Finding:
Reports asthma has been interfering with activities of daily life
(Available)
Pro Tip: Severe asthma can interfere with daily life. Asking Tina the degree to which asthma impacts her daily life can be illustrative of the relative severity of her asthma.
Example Question:
Is there anything you can’t do because of your asthma?
Finding:
Asked about character of symptoms
Finding:
Reports recent wheezing
(Found)
Pro Tip: Some people who experience chronic asthma may be accustomed to wheezing and, as a result, might not volunteer this information. Asking Tina if she’s been wheezing illustrates how her asthma is presenting.
Example Question:
Do you wheeze during an asthma exacerbation?
Finding:
Reports chest tightness
(Found)
Pro Tip: Symptoms often vary from patient to patient. Asking Tina to describe what happens when her asthma acts up will indicate how her individual symptoms manifest.
Example Question:
What happens when your asthma acts up?
Finding:
Denies chest pain
(Available)
Pro Tip: Symptoms often vary from patient to patient. Asking Tina whether she experiences chest pain during an attack will indicate how her individual symptoms manifest.
Example Question:
Are the shortness of breath episodes associated with chest pain?
Finding:
Asked about cough
Finding:
Reports cough
(Found)
Pro Tip: A shallow history of a patient’s condition can provide a comparative baseline for juxtaposing an attack, exacerbation, and more regular breathing. Soliciting this information from Tina allows her to explain any recent developments with her asthma.
Example Question:
Have you been coughing?
Finding:
Cough has persisted since original asthma exacerbation 2 days ago
(Available)
Pro Tip: Some people who experience chronic asthma may be accustomed to coughing and thus might not volunteer this information. Asking Tina how long she has been coughing illustrates how her asthma is presenting.
Example Question:
How long have you had a cough?
Finding:
Describes cough as “dry”
(Available)
Pro Tip: Symptoms often vary from patient to patient. Asking Tina to describe her cough specifies the way her individual symptoms manifest.
Example Question:
How would you describe your cough?
Finding:
Describes cough as “small” and not severe
(Available)
Pro Tip: Symptoms often vary from patient to patient. Asking Tina to describe her cough specifies the way her individual symptoms manifest.
Example Question:
How severe is your cough?
Finding:
Reports cough slightly relieved by drinking water
(Available)
Pro Tip: Coughing can be a symptom of a constricted airway. Assessing what relieves Tina’s cough can open up a conversation about asthma management.
Example Question:
What makes your cough better?
Finding:
Has not treated cough with medication or home remedies
(Available)
Pro Tip: Some people who experience chronic asthma may be accustomed to coughing and thus might not treat this symptom. Asking Tina how she is treating her cough might reveal her current symptom management and health literacy.
Example Question:
Have you tried to treat your cough?
Finding:
Asked about aggravating factors
Finding:
Reports symptoms worse at night
(Available)
Pro Tip: Sometimes a condition will fluctuate during the course of the day. By asking Tina how her asthma differentially impacts her both during the day and at night, you are assessing an important change over time.
Example Question:
Is your asthma worse at night?
Finding:
Reports symptoms increase when lying flat on back
(Available)
Pro Tip: Asthma can be aggravated by movements that constrict the respiratory airways. By asking Tina if lying down causes shortness of breath, you’re assessing which positions might cause exacerbation.
Example Question:
Does lying down make your asthma worse?
Finding:
Reports symptoms aggravated by movement
(Found)
Pro Tip: Asthma can be aggravated by movements that constrict the respiratory airways. Inquiring into what activities make Tina short of breath can indicate possible triggers.
Example Question:
Is there anything you can’t do because of your asthma?
Medical History
Finding:
Confirmed use of medications
Finding:
Confirms medications (no new medications reported)
(Found)
Pro Tip: Determining what, if any, medications a patient is taking is a crucial element of a thorough health history and will help you avoid unwanted drug interactions.
Example Question:
What medications do you take?
Finding:
Followed up about inhaler use
Finding:
Uses an inhaler to treat asthma symptoms
(Found)
Pro Tip: It’s essential to ask specifically what medications a patient is using to treat her current complaint or any ongoing medical conditions.
Example Question:
Do you use an inhaler for your asthma?
Finding:
Inhaler is Proventil
(Available)
Pro Tip: The medication that a patient takes reveals a current treatment plan and healthcare access. Asking Tina what medication she takes for her asthma will indicate her treatment plan and the degree to which she complies with it.
Example Question:
What is the name of the inhaler you are currently using?
Finding:
Reports most recent inhaler use was this morning
(Available)
Pro Tip: Soliciting a shallow history of a patient’s medication history can reveal recent exacerbation. Asking Tina when she last used her inhaler will indicate when her symptoms most recently required medical treatment.
Example Question:
When did you last use your inhaler?
Finding:
Reports using inhaler every 4 hours or so since exacerbation
(Found)
Pro Tip: After an asthma exacerbation, patients often will become more reliant on medical tools like inhalers. Asking Tina how many times she’s used her inhaler in the past two days will point to the severity of her recent exacerbation.
Example Question:
How many times have you used your inhaler in the past two days?
Finding:
Prescribed usage is 2 puffs
(Available)
Pro Tip: The medication that a patient takes reveals a current treatment plan and healthcare access. Asking Tina how many puffs of her inhaler she’s prescribed will indicate her treatment plan and the degree to which she complies with it.
Example Question:
How many puffs of your inhaler are you prescribed?
Finding:
Reports needing more than 2 puffs to resolve asthma symptoms
(Available)
Pro Tip: Inhaler effectiveness can vary over time for a variety of reasons. Asking Tina about the number on inhaler puffs she needs to resolve symptoms can indicate whether her asthma has worsened or point to potential problems like poor inhaler technique.
Example Question:
How many inhaler puffs do you need?
Finding:
Confirmed allergies
Finding:
Confirms allergies (no new allergies reported)
(Found)
Pro Tip: It’s best practice to ask a patient about her allergies each visit, even with an established patient, to uncover any new allergy triggers or symptoms.
Example Question:
Do you have any new allergies?
Finding:
Followed up on exposure to allergy and asthma triggers
Finding:
Reports cat allergy triggered recent episodes
(Found)
Pro Tip: Questions about what factors might have caused an illness can point to a patient’s environmental stressors, habits, and general wellbeing. Asking Tina what caused her asthma might indicate her health literacy and understanding of what factors impact her breathing.
Example Question:
What started your recent asthma problems?
Finding:
Reports dust as a known trigger
(Found)
Pro Tip: Environmental factors can often be primary allergy triggers. Asking whether Tina has a dust allergy can reveal one such trigger.
Example Question:
Does being around dust trigger your asthma?
Finding:
Reports activity such as walking up stairs as a known trigger
(Available)
Pro Tip: Shortness of breath or asthma can be exercise-induced. Asking whether climbing stairs can be a trigger for Tina might reveal a possible provocation.
Example Question:
Does climbing stairs trigger your asthma?
Finding:
Denies seasonal pattern
(Found)
Pro Tip: Discerning what’s making Tina’s asthma worse can point to possible triggers like environmental factors, bodily positions, or movement that may have a bearing on Tina’s breathing. Asking Tina whether she has seasonal triggers will indicate, in part, Tina’s health literacy.
Example Question:
Do you have seasonal asthma triggers?
Finding:
Denies changes in weather as a trigger
(Found)
Pro Tip: For some patients, weather changes can be asthma irritants. Asking Tina if the weather impacts her asthma will indicate if weather is an irritant for Tina’s condition.
Example Question:
Do changes in weather make your asthma worse?
Finding:
Reports minimal exposure to asthma triggers at work
(Available)
Pro Tip: Environmental factors at home or work can often be primary allergy triggers. Asking Tina about possible allergens at work might indicate a relevant factor in her recent exacerbation.
Example Question:
Does anything at work make your asthma worse?
Finding:
Asked detailed questions about asthma history
Finding:
No current asthma doctor
(Available)
Pro Tip: Seeing a specialist, like an asthma doctor, can help patients to manage symptoms. Asking whether Tina is seeing an asthma doctor will allow you to assess her current treatment plan and healthcare access.
Example Question:
Do you have an asthma doctor?
Finding:
Diagnosed with asthma in childhood
(Found)
Pro Tip: By determining the onset of asthma you can get a sense for Tina’s asthma history, instance, and frequency of exacerbation.
Example Question:
How long have you had asthma?
Finding:
Age of diagnosis was 2 1/2 years old
(Found)
Pro Tip: By determining the onset of asthma you can get a sense for Tina’s asthma history, instance, and frequency of exacerbation.
Example Question:
How old were you when you were diagnosed with asthma?
Finding:
Asked about hospitalizations for asthma
Finding:
Reports prior hospitalizations for asthma
(Found)
Pro Tip: Hospitalization for a condition, like asthma, can reveal its severity. By asking Tina if she’s been hospitalized, you are soliciting information about the history and severity of her condition.
Example Question:
Have you ever been hospitalized for asthma?
Finding:
Reports last hospitalization was age 16
(Available)
Pro Tip: Hospitalization for a condition, like asthma, can reveal its severity. By asking Tina when she was last hospitalized, you are soliciting information about the history and severity of her condition.
Example Question:
When was your last hospitalization for asthma?
Finding:
Estimates 5 total hospitalizations for asthma
(Available)
Pro Tip: Hospitalization for a condition, like asthma, can reveal its severity. By asking Tina the number of times she’s been hospitalized, you are soliciting information about the history and severity of her condition.
Example Question:
How many times have you been to the hospital?
Finding:
Reports she has never been intubated
(Available)
Pro Tip: Intubation for a condition, like asthma, can reveal its severity. By asking Tina if she’s been intubated, you are soliciting information about the history and severity of her condition.
Example Question:
Have you ever been put on a breathing tube?
Finding:
Followed up about non-medication forms of asthma management
Finding:
Denies record keeping of asthma exacerbation or shortness of breath episodes
(Available)
Pro Tip: For some patients, keeping records of asthma exacerbation allows them to monitor their conditions. Soliciting this information from Tina will show health literacy.
Example Question:
Do you use a chart to monitor your asthma?
Finding:
Denies using peak flow meter
(Available)
Pro Tip: A peak flow meter measures how well a patient’s lungs can expel air. By asking whether Tina uses a peak flow meter, you are asking about her health literacy and what kind of medical tools she uses to manage her asthma.
Example Question:
Do you check your peak flow regularly?
Finding:
Denies nebulizer use
(Available)
Pro Tip: The medication that a patient takes reveals a current treatment plan and healthcare access. Asking Tina if she uses a nebulizer for her asthma will indicate her treatment plan and the degree to which she complies with it.
Example Question:
Do you use a nebulizer?
Social Determinants of Health
Finding:
Asked about environmental control
Finding:
Reports living situation is tidy and free of dust
(Available)
Pro Tip: Asking a patient about Social Determinants of Health (SDOH) can unearth underlying social, political, or economic barriers to their health and wellbeing. Recognizing a patient’s SDOH can lead you to provide more informed and empathetic care for your patients, because you will have a greater understanding of the challenges they face.
Example Question:
Have you noticed anything at home that aggravates your asthma?
Finding:
Reports hypoallergenic bedding hygiene
(Available)
Pro Tip: Asking a patient about Social Determinants of Health (SDOH) can unearth underlying social, political, or economic barriers to their health and wellbeing. Recognizing a patient’s SDOH can lead you to provide more informed and empathetic care for your patients, because you will have a greater understanding of the challenges they face.
Example Question:
Do you change your bedding regularly?
Finding:
Reports avoiding animals and has no pets at home
(Available)
Pro Tip: Asking a patient about Social Determinants of Health (SDOH) can unearth underlying social, political, or economic barriers to their health and wellbeing. Recognizing a patient’s SDOH can lead you to provide more informed and empathetic care for your patients, because you will have a greater understanding of the challenges they face.
Example Question:
Do you have pets at home?
Finding:
Reports avoiding exposure to secondhand smoke
(Found)
Pro Tip: Asking a patient about Social Determinants of Health (SDOH) can unearth underlying social, political, or economic barriers to their health and wellbeing. Recognizing a patient’s SDOH can lead you to provide more informed and empathetic care for your patients, because you will have a greater understanding of the challenges they face.
Example Question:
Does anyone in your house smoke?
Social History
Finding:
Asked about exercise and activity level
Finding:
Reports general low activity level
(Found)
Pro Tip: Learning about a patient’s typical exercise habits helps
Example Question:
Do you exercise?
Finding:
Reports diminished activity due to asthma
(Available)
Pro Tip: Asking a patient if her current complaint affects her exercise level or (vice version) helps you understand if there is a causal relationship in symptoms.
Example Question:
Have you been able to exercise?
Finding:
Asked about possible contributing factors in health history
Finding:
Denies history of eczema
(Found)
Pro Tip: Children with eczema are often at a higher risk of developing asthma. In soliciting a medical history from Tina, you are getting a sense for the history of Tina’s asthma and related conditions.
Example Question:
Have you had eczema?
Finding:
Denies history of sinus problems
(Available)
Pro Tip: People with asthma are likely to also experience sinus problems. It is important to determine whether Tina has sinus problems as they can cause complicating symptoms in patients who also experience asthma.
Example Question:
Do you have a history of sinus problems?
Finding:
Denies history of GERD, heartburn, or indigestion
(Available)
Pro Tip: People with asthma are almost twice as likely to also experience GERD. It is important to determine whether Tina has GERD as GERD can cause shortness of breath in patients who also experience asthma.
Example Question:
Do you have gastroesophageal reflux disease?
Finding:
Denies history of COPD or emphysema
(Available)
Pro Tip: For a patient with a known history of COPD or emphesyma, the symptoms of cough or shortness of breath could be caused by that disease.
Example Question:
Have you ever been diagnosed with COPD?
Finding:
Asked about smoking, inhalants, or tobacco
Finding:
Denies history of tobacco use, including cigarettes
(Found)
Pro Tip: Smoking or inhaling substances can have adverse respiratory effects. Asking Tina is she ever smoked cigarettes can help you to discern whether smoking was an exacerbating factor for Tina’s asthma.
Example Question:
Have you ever smoked cigarettes?
Finding:
Reports past history of marijuana use
(Available)
Pro Tip: Smoking or inhaling substances can have adverse respiratory effects. Asking Tina is she ever smoked marijuana can help you to discern whether smoking was an exacerbating factor for Tina’s asthma.
Example Question:
Have you ever smoked marijuana?
Finding:
Last use of marijuana was age 20 or 21
(Available)
Pro Tip: Smoking or inhaling substances can have adverse respiratory effects. Asking Tina is she ever smoked marijuana can help you to discern whether smoking was an exacerbating factor for Tina’s asthma.
Example Question:
When was the last time you smoked marijuana?
Finding:
Denies inhaling substances
(Available)
Pro Tip: Smoking or inhaling substances can have adverse respiratory effects. Asking Tina when she quit smoking marijuana can help you to discern whether smoking recently exacerbated Tina’s asthma.
Example Question:
Have you ever experimented with inhaling substances?
Review of Systems
Finding:
Asked about general symptoms
Finding:
Denies recent respiratory or other illness
(Available)
Pro Tip: Broad, open questions will allow Tina to describe, in her own words, the specific pain and discomfort that she is experiencing.
Example Question:
Have you been sick recently?
Finding:
Denies fever
(Available)
Pro Tip: The presence or absence of fever can indicate if an infection is approaching sepsis, a life-threatening condition.
Example Question:
Have you had any fever symptoms?
Finding:
Denies nausea or vomiting
(Available)
Pro Tip: Symptoms often vary from patient to patient. Asking Tina about the symptoms she is experiencing with her pain, like nausea, details the way her individual symptoms and pain manifest.
Example Question:
Have you had nausea or vomiting?
Finding:
Denies chills
(Available)
Pro Tip: Symptoms often vary from patient to patient. Asking Tina about the symptoms she is experiencing with her pain, like getting chills, details the way her individual symptoms and pain manifest.
Example Question:
Have you had chills?
Finding:
Reports low energy level
(Available)
Pro Tip: Symptoms often vary from patient to patient. Asking Tina about the symptoms she is experiencing with her pain, like fatigue, details the way her individual symptoms and pain manifest.
Example Question:
Are you fatigued?
Finding:
Denies night sweats
(Available)
Pro Tip: Symptoms often vary from patient to patient. Asking Tina about the symptoms she is experiencing with her injury, like night sweats, details the way her individual symptoms and pain manifest.
Example Question:
Have you had night sweats?
Finding:
Asked review of systems for respiratory
Finding:
Denies phlegm or sputum
(Available)
Pro Tip: A productive asthma cough can expel sputum from the lungs. By asking whether Tina has been coughing up phlegm or sputum you are discovering the nature of Tina’s cough since exacerbation.
Example Question:
Have you been coughing anything up?
Finding:
Denies sore throat, swelling, or difficulty swallowing
(Available)
Pro Tip: Difficulty swallowing could indicate a more severe allergic reaction, or a physical problem with the throat.
Example Question:
Do you have any problems swallowing?
Finding:
Denies nasal drainage
(Available)
Pro Tip: Nasal drainage could suggest that the patient’s symptoms are caused by a viral or bacterial infection, or an allergy attack.
Example Question:
Do you have any nasal drainage?
Family History
Finding:
Asked about relevant family history
Finding:
Reports no recent illnesses with family members at home
(Available)
Pro Tip: For people with asthma, getting sick can increase their risk for exacerbation. If Tina’s had any family members recently sick, that might have caused her recent exacerbation.
Example Question:
Has anyone at home been sick?
Finding:
Reports younger sister as only family with asthma
(Found)
Pro Tip: Soliciting a family history helps you to determine which, if any, conditions are inherited. In asking Tina whether anyone in her family has asthma, you’re ascertaining whether Tina’s condition is inherited.
Example Question:
Does anyone in your family have asthma?
Finding:
Reports younger sister as only family member with allergies
(Available)
Pro Tip: A family history of allergies is an important factor to determine whether a patient is at risk for developing allergies.
Example Question:
Does anyone in your family have allergies?
Finding:
Reports no family history of eczema
(Available)
Pro Tip: People with a family history of eczema are often at a higher risk of developing asthma.
Example Question:
Does anyone in your family have eczema?
Finding:
Reports no family history of chronic nasal or sinus problems
(Available)
Pro Tip: People with a family history of sinus problems are often at a higher risk for asthma. If Tina has a family history of sinus problems, this could suggest inherited sensitivity.
Example Question:
Do you have a family history of sinus problems?
Finding:
Reports no family history of COPD or emphysema
Objective Data Collection: 6 of 6 (100%)
- Correct
- Partially correct
- Incorrect
- Missed
Symmetry (1/2 point)
- Symmetric
Appearance (1/2 point)
- No visible abnormal findings
Symmetry (1/1 point)
- Equal bilaterally
Symmetry (1/2 point)
- Equal bilaterally
Vibration (1/2 point)
- Expected fremitus
Observations (1/2 point)
- All areas resonant
Location (1/2 point)
- No areas of dullness
Breath Sounds (1/3 point)
- Present in all areas
Adventitious Sounds (1/3 point)
- Wheezing
Location (1/3 point)
- Adventitious sounds in posterior right lower lobe
- Adventitious sounds in posterior left lower lobe
Bronchophony (1/1 point)
- Negative
Education & Empathy : 1 of 4 (25.0%)
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.
- 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
| Description: Tina describes the symptoms that have been bothering her. | ||
| What brings you here today? | Question 05:21 AM EDT |
|
| I came in because I’ve been having breathing problems, and my inhaler just isn’t working the way it normally does. | ||
| I am sorry for that | Empathize 05:21 AM EDT |
|
| I appreciate you telling me that. | ||
| Model Statement: “Breathing problems can be scary and uncomfortable. I’m sorry you’ve been experiencing these symptoms. Let me learn a little more about your breathing problems, and we will be able to find ways to improve your breathing.” |
| Description: Tina describes her perceived asthma triggers. | ||
| are you exposed to allergens? | Question 05:53 AM EDT |
|
| Two days ago, at my cousin’s house. She has three of them, and my asthma always goes crazy when I’m there. | ||
| What started your recent asthma problem? | Question 05:53 AM EDT |
|
| This all started at my cousin’s house. She has cats, and I’m allergic, so my asthma always goes crazy when I’m there. | ||
| Does being around dust trigger the asthma? | Question 05:54 AM EDT |
|
| Yeah, being around a lot of dust, especially hanging out in a really dusty house, can make my asthma act up. | ||
| Do changes in weather make your asthma worse? | Question 05:56 AM EDT |
|
| Not that I’ve noticed. | ||
| Do you have seasonal asthma problems? | Question 05:57 AM EDT |
|
| A little while ago, I had some seasonal allergies, but it didn’t really bother my asthma, and it’s better now. | ||
| Do you have environmental exposures at home or at work? | Question 05:58 AM EDT |
|
| No, unless cats count. | ||
| How is your social determinant of health? | Question 05:58 AM EDT |
|
| I’ve known most of my girlfriends since high school. We’ve been a pretty tight group for a long time. I am really close to people at church too, especially the ones in my bible study group. I sometimes get drinks with the other shift-supervisors at work, but we’re not super close. | ||
| Model Statement: “It’s important that I learn about what things may be triggering your asthma, so that we can figure out what you can avoid to improve your breathing.” |
| Description: Tina describes her inhaler use and medication regimen. | ||
| Have you been using any medications? | Question 05:25 AM EDT |
|
| I don’t take anything, unless my inhaler counts. | ||
| When did you know you have asthma? (Clarified to: When did your asthma start?) | Question 05:26 AM EDT |
|
| I think I was about two and a half? I used to have a lot of trouble with asthma attacks back then. (Clarified to: when I first got asthma) | ||
| Have you been hospitalized for asthma? | Question 05:26 AM EDT |
|
| I went a bunch of times when I was little, for asthma attacks. | ||
| Model Statement: “Thank you for letting me know that you’re using your inhaler pretty often. It’s important for me to know how you’re using all of your medications.” |
| Description: Tina describes her lack of exposure to cigarette smoke, secondhand smoke, and other inhalants. | ||
| Are you exposed to secondhand smoke? | Question 06:00 AM EDT |
|
| Some of my friends smoke when we go out drinking. But I don’t smoke, and nobody at home smokes. | ||
| Ninety-nine. | ||
| Ninety-nine. | ||
| Ninety-nine. | ||
| Ninety-nine. | ||
| Ninety-nine. | ||
| Ninety-nine. | ||
| Ninety-nine. | ||
| Ninety-nine. | ||
| Ninety-nine. | ||
| Ninety-nine. | ||
| Ninety-nine. | ||
| Ninety-nine. | ||
| Ninety-nine. | ||
| Ninety-nine. | ||
| Ninety-nine. | ||
| Ninety-nine. | ||
| Ninety-nine. | ||
| Ninety-nine. | ||
| Ninety-nine. | ||
| Ninety-nine. | ||
| Model Statement: “I’m glad to hear that you don’t smoke and avoid smoke in your life. Your lungs are better off for it!” |
Documentation / Electronic Health Record
Document: Provider Notes
| Student Documentation | Model Documentation |
| Subjective
Ms. Jones is a 28y/o African American woman who presents to clinic with a complaints of SOB and wheezing. She had a near asthma attack two days ago. She was exposed to cat which triggered the asthma symptoms. She has a 6/10 severity and her SOB was a 8/10 and lasted for five minutes. She did not experience any chest pain or allergic symptoms. She used her albuterol inhaler and her symptoms decreased although they did not completely resolve. She had an episode today morning before coming to clinic. She usually has SOB twice a night. |
HPI: Ms. Jones is a pleasant 28-year-old African American woman who presented to the clinic with complaints of shortness of breath and wheezing following a near asthma attack that she had two days ago. She reports that she was at her cousin’s house and was exposed to cats which triggered her asthma symptoms. At the time of the incident she notes that her wheezes were a 6/10 severity and her shortness of breath was a 7-8/10 severity and lasted five minutes. She did not experience any chest pain or allergic symptoms. At that time she used her albuterol inhaler and her symptoms decreased although they did not completely resolve. Since that incident she notes that she has had 10 episodes of wheezing and has shortness of breath approximately every four hours. Her last episode of shortness of breath was this morning before coming to clinic. She notes that her current symptoms seem to be worsened by lying flat and movement and are accompanied by a non-productive cough. She awakens with night-time shortness of breath twice per night. She complains that her current symptoms are beginning to interfere with her daily activities and she is concerned that her albuterol inhaler seems to be less effective than previous. Currently she states that her breathing is normal. Diagnosed with asthma at age 2.5 years. She has no recent use of spirometry, does not use a peak flow, does not record attacks, and does not have a home nebulizer or vaporizer. She has been hospitalized five times for asthma, last at age 16. She has never been intubated for her asthma. She does not have a current pulmonologist or allergist. Social History: She is not aware of any environmental exposures or irritants at her job or home. She changes her sheets weekly and denies dust/mildew at her home. She uses a hypoallergenic pillow cover and her mattress is one year old. She denies current use of tobacco, alcohol, and illicit drugs. She did smoke marijuana for 5 or 6 years, her last use was at age 21 years. She does not exercise. Review of Systems: General: Denies changes in weight, fatigue, weakness, fever, chills, and night sweats. • Nose/Sinuses: Denies rhinorrhea with this episode. Denies stuffiness, sneezing, itching, previous allergy, epistaxis, or sinus pressure. • Gastrointestinal: No changes in appetite, no nausea, no vomiting, no symptoms of GERD or abdominal pain • Respiratory: Complains of shortness of breath and cough as above. Denies sputum, hemoptysis, pneumonia, bronchitis, emphysema, tuberculosis. She has a history of asthma, last hospitalization was age 16, last chest XR was age 16. |
| Objective
She has no acute distress. She is alert and orinted. She maintains eye contact. Chest expansion is symmetrical. Chst resonant to percussion, no dullness. Bilateral expiratory wheezes in posterior lower lobes. Bilaterial muffled words with notable expiratory wheezes in posterior lower lobes. No crackles. Spirometry FVC 3.91L, FEV1/FVC ratio 80.56%, SpO2 97%. |
General: Ms. Jones is a pleasant, obese 28-year-old African American woman in no acute distress. She is alert and oriented and sitting upright on exam table. She maintains eye contact throughout interview and examination. • Respiratory: Chest expansion is symmetrical with respirations. Normal fremitus, symmetric bilaterally. Chest resonant to percussion; no dullness. Bilateral expiratory wheezes in posterior lower lobes. Bilateral muffled words with notable expiratory wheezes in posterior lower lobes. No crackles. In office spirometry: FVC 1.78 FEV1/FVC ratio 87.02% SpO2: 97%. |
| Assessment
Asthma exacerbation |
Asthma exacerbation |
| Plan
Continue monitoring symptoms and log episodes of asthma symptoms. Obtain oxygen saturation Order PFTs after exacerbation Wash beddings regularly Seek emergent care in case of SOB Revisit clinic in 2-4 weeks for check-up |
Encourage Ms. Jones to continue to monitor symptoms and log her episodes of asthma symptoms and wheezing with associated factors and bring log to next visit. • Obtain office oxygen saturation. • Order PFTs to be completed after exacerbation to have baseline available for future comparison. • Encourage to wash bedding and consider dust mite covers to decrease allergic nighttime symptoms. • NMT in office x 1. • Educate to increase intake of water and other fluids. • Educate Ms. Jones on when to seek emergent care including episodes of chest pain or shortness of breath unrelieved by rest, worsening asthma symptoms or wheezing, or the sense that rescue inhaler is not helping. • Revisit clinic in 2-4 weeks for follow up and evaluation. |
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