For adults with acute cough or breathlessness seen on video, the MN690 Unit 4 protocol sorts every examination element into observed, substituted or deferred, with thresholds attached. Searches like "mn 690 unit 4 assignment example", "mn690 unit 4 sample" and "mn690 unit 4 example" land here.
Remote Examination Protocol: Video Visits for Adults With Acute Cough and Breathlessness
[Student Name]
Purdue University Global
MN690: Telehealth Application
Unit 4 Assignment
[Instructor Name]
[Date]
Written for a composite virtual clinic as a model document. Thresholds are illustrative and should be set by the clinic's medical leadership.
1. Purpose and Scope
This protocol guides video visits for adults aged 18 and older with acute cough, breathlessness or both, lasting less than three weeks. Its purpose is to decide whether the patient can be managed at home today, needs same-day in-person assessment or needs emergency care. It does not replace clinical judgment and does not apply to patients with known chronic lung disease who have their own action plans.
2. Setup, Before Any Clinical Question
Confirm identity with two identifiers. Record the patient's current address and a callback number. Ask who else is present and whether someone can help move the camera. Adjust lighting and camera angle so the face, neck and upper chest are visible. Ask what devices are at hand: thermometer, pulse oximeter, blood pressure cuff.
3. Examination Table
Observed. Respiratory rate, counted over 30 seconds with the chest in view and doubled. Speech: ask the patient to count aloud to 20 in one breath; record the number reached. Work of breathing: accessory muscle use at the neck, tripod posture. Color of lips and face in natural light. Level of alertness and whether answers are coherent.
Substituted. Oxygen saturation from a home pulse oximeter held up to the camera, with the pulse rate shown on the device. Temperature from the patient's own thermometer. A family member moves the camera to show the neck and lower ribs for retractions. Heart rate from the oximeter display.
Deferred. Auscultation, percussion and tactile fremitus cannot be performed by video. The protocol accepts that loss when no red flag is present; when a red flag is present, the deferred elements are part of the reason for in-person care.
4. Oximeter Caveat
Home pulse oximeters can overestimate oxygen saturation, and the U.S. Food and Drug Administration has warned that accuracy may be reduced in people with darker skin pigmentation (U.S. Food and Drug Administration, 2021). Paired arterial and oximeter readings showed that hidden low oxygen, missed by the oximeter, was about three times as frequent among Black patients as among White patients (Sjoding et al., 2020). A borderline reading in a patient with darker skin lowers the threshold for in-person care rather than reassuring the clinician.
5. Red Flags for Same-Day In-Person or Emergency Care
Emergency services now: oxygen saturation below 90 percent, inability to speak more than a few words, new confusion, blue lips or chest pain suggesting a cardiac cause. Same-day in-person assessment: saturation 90 to 93 percent, or 94 percent with darker skin pigmentation and other concerning findings; respiratory rate above 24; counting to fewer than 10 in one breath; temperature above 39 C with breathlessness; coughing blood; or the patient or family feels the patient is getting worse. These thresholds draw on published guidance for remote assessment of breathlessness in primary care (Greenhalgh et al., 2020).
6. If the Connection Drops
If video fails, call the callback number within 2 minutes. If there is no answer after two attempts and a red flag had been noted, contact emergency services at the recorded address. Document the time of the drop, the attempts and the outcome.
7. Documentation
Record the patient's location, who was present, each observed and substituted finding with the device used, the deferred elements, the decision and the safety-net advice given, including when to call back or seek emergency care.
References
Greenhalgh, T., Koh, G. C. H., & Car, J. (2020). Covid-19: A remote assessment in primary care. BMJ, 368, m1182. https://doi.org/10.1136/bmj.m1182
Sjoding, M. W., Dickson, R. P., Iwashyna, T. J., Gay, S. E., & Valley, T. S. (2020). Racial bias in pulse oximetry measurement. New England Journal of Medicine, 383(25), 2477-2478. https://doi.org/10.1056/NEJMc2029240
U.S. Food and Drug Administration. (2021). Pulse oximeter accuracy and limitations: FDA safety communication. U.S. Food and Drug Administration.
How this MN690 Unit 4 example is structured
The protocol is built around a decision rather than a complete exam: whether this patient can safely stay home today. Setup precedes history because location and callback number are what make an emergency response possible if the patient deteriorates mid-visit. Observation is prescribed precisely, since vague looking produces vague notes; respiratory rate is counted, not estimated, and the patient is asked to count aloud to 20 in one breath. Substitutes carry their limits in the same row. The oximeter row cites the FDA's 2021 safety communication on reduced accuracy in darker skin pigmentation, so a borderline reading in such a patient lowers the threshold for in-person care. Deferral is not failure: auscultation is named as the element the visit gives up, and the red-flag thresholds decide when giving it up stops being acceptable. Connection loss triggers a phone call within two minutes.
Get an MN690 Unit 4 example written to your instructions
Name the presentation or visit type your protocol covers, the setting and any home devices patients have; upload the Unit 4 prompt and rubric too. The protocol returns with setup steps, an observed-substituted-deferred table, numeric red flags and a failure path. Free on a first custom sample; delivered in 24-48h. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
MN690 Unit 4 questions, answered
Which examination elements can a video visit reliably observe?
General appearance, work of breathing, speech, skin color in good light, gait, range of motion, affect and much of a neurological screen can be observed with reasonable confidence. Anything requiring touch, sound through a stethoscope or special equipment cannot. The protocol's job is to say which category each element falls into for the presentation at hand, and what happens to the ones that cannot be observed.
How reliable are home pulse oximeters?
Useful but imperfect. Readings depend on device quality, circulation, nail polish, motion and skin pigmentation, and the FDA issued a safety communication in 2021 on reduced accuracy in people with darker skin. A protocol can still use them, provided it treats borderline values cautiously, pairs them with observed work of breathing and names the reading that triggers in-person assessment.
Should a protocol include what to do if the connection fails?
Yes, and markers tend to look for it. A dropped video during a breathing assessment leaves the clinician uncertain whether the patient is safe. The protocol names a fallback, usually an immediate phone call to the confirmed number, and a point at which emergency services are sent to the confirmed address. Without that path, the rest of the protocol has no safety floor.