SHIRLEY SMITH SCRIPT [without 4Ms]

1. Onboarding

1.1. [Kiosk Use]

1.1.1. Patient & daughter sits in waiting area after using kiosk to check in

1.2. Call Patient

1.2.1. PROVIDER

1.2.1.1. Shirley Smith?

1.2.2. PATIENT

1.2.2.1. Here I am.

1.2.3. PROVIDER

1.2.3.1. You can come into the exam room now

1.2.4. Patient uses arms of waiting room chair to get into standing position

1.3. Registration

1.3.1. PROVIDER

1.3.1.1. My name is Pat and I will be your practitioner today.

1.3.1.2. So, what brings you in today?

1.3.2. DAUGHTER

1.3.2.1. I've been visiting from out of town and i was surprised by the condition of my mom's house

1.3.2.2. my mother is a meticulous housekeeper, but i found clutter around the house, a pile of unpaid bills...

1.3.2.3. this is just not my mom's usual behavior

1.3.2.4. i'm worried about her memory, so i convinced her to come in and be checked because i've heard that infection can cause confusion

1.3.3. PATIENT

1.3.3.1. I'm alright, just a little absent minded lately...

1.3.3.2. I can keep my own house and don't need any help

1.3.4. PROVIDER

1.3.4.1. so, ms.smith, i understand that your daughter is concerned about some changes that she's noticed, but you don't think anything is wrong. is that correct?

1.3.5. PATIENT

1.3.5.1. that's right, but to make her happy, i said i would come here today

2. Medication Reconcilliation

2.1. PROVIDER

2.1.1. Ms. Smith, can you tell me what medications you are taking?

2.2. PATIENT

2.2.1. i take hydrochlorothiazide and lisinopril for my blood pressure, and fish oil daily. i take atorvastatin at bedtime, and Tylenol when i need it for pain

2.3. PROVIDER

2.3.1. Ok, yes, I see these match the medications listed for you in the system, and I will add the Tylenol use to your file.

3. History of Present Illness

3.1. PROVIDER

3.1.1. how long have you felt absent minded?

3.2. PATIENT

3.2.1. i'd say its only been a few days or so

3.3. DAUGHTER

3.3.1. but mom, it has to be longer than that - in the pile of bills, i saw an unpaid parking ticket from 3 weeks ago

3.4. PROVIDER

3.4.1. have you had any symptoms that are new? for example, have you had a cough? do you have any sores on your skin?

3.5. PATIENT

3.5.1. no, none that i've noticed

3.6. PROVIDER

3.6.1. sometimes, if you are not drinking enough water, dehydration can cause confusion.

3.7. PATIENT

3.7.1. well, the hydroclorothyacide makes me have to pee so often that it helps if i don't drink a lot of water

3.8. PROVIDER

3.8.1. in addition to the more frequent peeing, have you had any other changes in your urine or stool?

3.9. PATIENT

3.9.1. i have noticed my urine does have a strong smell lately

4. Physical Assessment

4.1. PROVIDER

4.1.1. So Shirley, we'll do an exam and then listen to your heart and lungs, plus check for signs of dehydration

4.2. NP takes Ms. Smith's vital signs, which are all within normal limits

4.3. PROVIDER

4.3.1. Ok, now please go ahead and get onto the exam table.

4.4. PATIENT

4.4.1. Okay

4.5. Patient uses arms of exam room chair to get into standing position

4.6. NP assists patient in getting onto the exam table, and completes the examination

4.7. NP notes that the lungs are clear, and the heart rate and rhythm are regular.

4.8. PROVIDER

4.8.1. Everything on your exam looks fine. I think we need to rule out a urinary tract infection.

4.8.2. Here's a kit to collect a urine sample. Have you done this before?

4.9. PATIENT

4.9.1. Yes, and think I remember how.

4.10. PROVIDER

4.10.1. Great! If you forget, the instructions are included in the kit.

4.11. PATIENT returns with urine sample

4.12. NP performs urinalysis dip on sample and results show +3 leucocytes, + nitrites, specific gravity is high, color is dark yellow, negative for protein and blood

5. Treatment

5.1. PROVIDER

5.1.1. From the results of your urine, you may have a urinary tract infection. We will send the sample to the lab for culture.

5.1.2. In the meantime, I will prescribe an antibiotic for you to start treatment. Be sure to take it with a full glass of water, and finish all of the medication. Also try to increase your daily intake of liquids .

5.2. PATIENT

5.2.1. do you think this will help my absent-mindedness

5.3. PROVIDER

5.3.1. i'm not sure that treating the urinary tract infection will resolve the absent-mindedness, so it's important to be reevaluated after you've completed the antibiotics

5.4. DAUGHTER

5.4.1. that's a good point mom, if you are still having problems with memory after this treatment, then we will book another appointment

5.5. NP enters prescription for antibiotic into chart

5.6. PATIENT

5.6.1. Thank you so much - i'll take the antibiotic, with lots of water, until its gone

5.7. DAUGHTER

5.7.1. since i'm in town for the next two weeks, i can help you make another appointment if your memory hasn't improved after the antibiotics are finished

5.8. PROVIDER

5.8.1. so we have a good plan - we are treating your urinary tract infection and, if needed, you can make a follow-up appointment for further evaluation of your absent mindedness

6. Discharge

6.1. PATIENT

6.1.1. Thank you again for your help, have a great day!

6.2. PROVIDER

6.2.1. You are welcome, good bye Ms. Smith and enjoy the time with your daughter!