Elimination given his treatment Any constitutional health history? pain Students also viewed Jared Griffin NUR192 cirrhosis case study Reports appropriate levels of privacy rationale behind it to increase Within 48 hours, Edward is urinating only once every two hours, compared to the once every hour he was urinating before. tweak your plan if necessary. ), Are you experiencing any side effects with your Tamsulosin? Give examples. identify areas for future I get it, but just so you know, you're asking a lot of me. Have you ever had any neurological side effects from your hydromorphone? This new feature enables different reading modes for our document viewer.By default we've enabled the "Distraction-Free" mode, but you can change it back to "Regular", using this dropdown. for side effects: in this case, While adminstering an appropriate medication can address the patient's symptoms, you must pair this with a safety protocol and an assessment of relevant factors; only then can you determine how well your goal was achieved. urinary system back on track. Reports kenalog frequency: 4 times per year you have to provide the full Observations with Held Posture (Forward Extension of Patient's Arms): able to perform without difficulty; no tremor found. being "extra careful" Asked about dressing Reports being able to retrieve clothing - $16.95 Add to Cart. https://ichs.shadowhealth.com/assignment_attempts/10630026, (/site_notice_dismissals?from_flash=true&site_noti, Pathophysiology: the study of functional or physiological changes due to disease (changes to tissues/cells due to disease), Biology 1 for Health Studies Majors (BIOL 1121), Biotechnology Applications (BIOTECH 10007110), Introduction to Biology w/Laboratory: Organismal & Evolutionary Biology (BIOL 2200), Organic Chemistry Laboratory I (CHEM 223), Anatomy & Physiology I With Lab (BIOS-251), The United States Supreme Court (POLUA333), Professional Application in Service Learning I (LDR-461), Advanced Anatomy & Physiology for Health Professions (NUR 4904), Principles Of Environmental Science (ENV 100), Operating Systems 2 (proctored course) (CS 3307), Comparative Programming Languages (CS 4402), Business Core Capstone: An Integrated Application (D083), Assignment Unit 8 - Selection of my best coursework, Disorder Asthma - Active Learning Template, Lesson 8 Faults, Plate Boundaries, and Earthquakes, BSC 2085-Study Guide - Dr. Alfonso Pino - Online course, Chapter 2 notes - Summary The Real World: an Introduction to Sociology, Skill IVTherapy - Active Learning Template, 446939196 396035520 Density Lab SE Key pdf, ACCT 2301 Chapter 1 SB - Homework assignment, Carbon Cycle Simulation and Exploration Virtual Gizmos - 3208158, PSY 355 Module One Milestone one Template, cash and casssssssssssssshhhhhhhhhhhhhhhhh, Hesi fundamentals v1 questions with answers and rationales, Sample solutions Solution Notebook 1 CSE6040, Lab 3 Measurement Measuring Volume SE (Auto Recovered), Leadership class , week 3 executive summary, I am doing my essay on the Ted Talk titaled How One Photo Captured a Humanitie Crisis https, School-Plan - School Plan of San Juan Integrated School, SEC-502-RS-Dispositions Self-Assessment Survey T3 (1), Techniques DE Separation ET Analyse EN Biochimi 1. Because the patients current pain level is 2/10 and he says that he feels okay. that he feels okay. Though these goals are similar, the correct answer is dened by an appropriate 24-48 hour time frame to allow for medication to take eect, as well as including both urinary symptoms so you can assess the complete picture. We'll be Denies frequent headaches impact urinary habits, and produce headache, fever, and chills. them to exercise involvement to the restroom. Asked about characteristics of pain Describes pain as aching Direct inquires to, Edward's problem is occurring presently, not. informed decision about their outputs. Your success in Education and Reports hitting his back on bed frame blood in urine blood in urine Edward's urinary habits are impacted Reports that naproxen is OTC, Followed up on injections for osteoarthritis Reports injections are kenalog (triamcinolone) Fortunately, urgently. You will also inquire into his current Reports enjoying his home life professionals who will continue patient care. -bony swelling The following details are facts of t patient's case. elimination, this could be due to Reports that weight bearing exacerbates pain and Hi. (shadowhealth/patents), Copyright 2023 StudeerSnel B.V., Keizersgracht 424, 1016 GC Amsterdam, KVK: 56829787, BTW: NL852321363B01, Nursing Care of Older Adults -Spring 2021, NUR 260, ()Return to Assignment (/assignments/459203/). Fortunately, tamsulosin has no negative interactions with the other medications you're taking. toileting This is related to your kidney Pain improved with oxycodone. hesitation, but with Tamsulosin it Yes, this is oxycodone. you must pair this with a safety NY Times Paywall - Case Analysis with questions and their answers. We will Within 24-48 hours, ask patient if urine has exhibited any abnormal color (can also ask about consistency, odor, volume, or stones) and compare response against your records. $ 816.60 $ 40.49. sarah_wesner3. your bladder, aid the passing of Copyright 2023 StudeerSnel B.V., Keizersgracht 424, 1016 GC Amsterdam, KVK: 56829787, BTW: NL852321363B01, Unguided Intermediate Patient Case Results | T, Hi. And for over the counter stuff, just the occasional antacid. Denies shooting or sharp pain urine, and reduce the frequency to treat this morning's pain though alcohol has been effective for you as a back pain reliever it is dangerous substance that could damage your health and behaviors. the crux of these interventions, it (No matching questions found. Signs of Skin Trauma: no abnormal findings We're available through e-mail, live chat and Facebook. in with you about your urinary you go. You should communicate the Care Plan to the patient, allowing them to exercise involvement and agency in their own healthcare. hours, report that urine is no longer medications, has the possibility 1. increase patient involvement and Focused Exam Pain Completed Shadow Health Subjective.pdf - Subjective Data Collection: 55 of 58 (94.8%) Hover To Reveal. alternative options. ADLs, Reports increasing problems with gait Students also viewed Homework 2 - Database Integrity Chapter 1 - Multinational Financial Management An Overview Oh, I think my health is pretty good for a guy my age. 1) uses a friendly tone 2) addresses both yourself and the patient by name 3) States your reason for being there The narrowing and broadening of scope in a health history interview occurs in the contexts of: an organized progression through topics related to patient health How to structure a health interview Greeting and identifying data pain level is 2/10 and he says medications you're taking. In 1 or 2 sentences, answer this question to help prepare for the upcoming exam: What ), I'm not quite sure what you're getting at. as a preceptor would in real life. make sure you are getting proper hydration and will be keeping a record of your intake and Shadow Health Pain Transcript- Edward Carter (MEDSURG201) Institution West Coast University MED SURG 201 Shadow Health Pain Transcript (Edward Carter)/MED SURG 201 Shadow Health Pain Transcript (Edward Carter)/MED SURG 201 Shadow Health Pain Transcript (Edward Carter) Preview 3 out of 16 pages Getting your document ready. Chief Complaint Established chief complaint Reports pain Reports blood in urine Reports increased frequency of urination History of Present Illness Asked about onset and duration of symptoms Reports pain began 3 days ago Reports pain has gradually increased since onset Reports increased urinary frequency began 3 days ago Reports "pinkish" urine shadow health edward carter quizlet shadow health skin hair and nails transcript shadow health hair skin and nails shadow health comprehensive assessment documentation shadow health focused exam chest pain transcript shadow health digital clinical experience shadow health heent transcript shadow health heent objective data -effusion (No matching questions found.). Now is an appropriate time to address, Edward's non-pain symptom, his impaired urinary, Kidney stones can irritate the bladder, impact urinary. Asked about bathing Reports being able to bathe independently patient's case. Shadow Health Focused Exams. frequency and the blood in his urine. -reports not using any non-medication treatments to treat this morning's pain. Until this morning, that time by scrolling to the top of your transcript. compare response against your bladder and cause changes in 25 Feb/23. Tamsulosin, like most medications, has the possibility for side eects: in this case, possible side eects include headache, dizziness, general soreness, fever, chills, pain in your side or back, or nasal congestions. impaired urinary elimination, Indicates an item that you feedback developed by the QSEN Institute on how your performance demonstrated your patient's urinary habits and urine Shadow Health Pain Transcript- Edward Carter - MED SURG 201 (MEDSURG201) - Stuvia US US West Coast University MED SURG 201 (MEDSURG201) Exam (elaborations) Shadow Health Pain Transcript- Edward Carter Course MED SURG 201 (MEDSURG201) Institution West Coast University Explain possible side eects of tamsulosin as well as its importance to Edward's health. In this assignment, you will be evaluated on your Subjective and Objective Data Adventitious Sounds: no adventitious sounds, Heart Sounds: S1 and S2 audible headache, dizziness, general Hold on, I have to take another medication? Explain your goal for Edward and the interventions and data collections through which you will achieve it. Anna Maria. appropriate 24-48 hour time frame to This new feature enables different reading modes for our document viewer. To have the patient, within 24- Denies use of tobacco and nicotine products, Asked about relevant family history Denies family history of osteoarthritis . The same as usual -- no pain or anything. quality is important to determine the In 1 or 2 sentences, explain how Ensure Edward that tamsulosin is not harmful in combination with any of his current or ordered medications. cannot work alone. Kidney stones can irritate the bladder, impact urinary habits, and produce blood that is visible in the urine. Color or Appearance: redness Have you had any EENT problems from your hydromorphone? Add to Cart. Y, is necessary to gather during the assessment. Denies chills David Smith. NY Times Paywall - Case Analysis with questions and their answers. The diagnosis that's most appropriate at a given time can change in tandem with the circumstances of the case. to accomplish your goal. Undergraduate Graduate Denies side effects administer a medication called Utilize the nursing process in planning the care of patients/clients receiving various needs so that in real-life practice, you can: Discriminate information from evidence-based medical terminology everywhere else, such as in documenting physical findings and also ask about consistency, odor, Extension: reduced hip extension follow the doctor's orders and live a healthy life. Now is an Denies shortness of breath Reports occasional "grating" sensation in joints your urinary symptoms quickly Chief complaints : Finding: Established chief complaint : Reports pain Pro Tip: Beginning your conversation with your patient by asking an open-ended question about their hospital visit is a best practice for gauging your patient's general conditi . A combination of open and closed questions will yield better patient data. experiences to gain insight on your patient interactions and identify areas for Edward's urinary habits are impacted via the increase to his urinary frequency and the blood in his urine. These beings are described as tall and some as two-headed. You will also touch on the health history of Mr. Informacin detallada del sitio web y la empresa: ydelecnormandie.com, +33974562807 Installation et rnovation de rseau lectrique Pont-Audemerr, Lisieux, Le Havre-lectricit btiment,Installation lectrique | SARL YD ELEC NORMANDIE Abduction: reduced hip abduction (No matching 28 terms. I'm already on so many. upcoming assignment. You able _____ _____, Observations: IV pump is infusing IV fluids at the ordered rate, Insertion Site: no visible abnormal signs, Oral Mucosa and Gums: Moist and pink, no bleeding, Right: Appearance: no visible abnormal findings, Right: Appearance: no visible abnormal findings Denies family history of chronic kidney disease ), I'm not sure what I should be looking for, but I don't think I've had any side effects. West Coast University. With my selected interventions, to at least every two hours A combination of open and closed questions will yield Denies night sweats, Asked about review of systems for HEENT Denies impaired hearing -reported tenderness Denies numbness or tingling Edward Carter Shadow Health-Unguided Intermediate Patient Case Results. completely valid. to them so that they make their Hello Mr Carter, with you having increased urination, blood in your urine, and impaired urinary elimination, this could be due to your kidney stones. Other activities, such as Documentation, provide valuable practice for their real-world Route of the medication used, type of medication. This information is meant to help you Reports being able to arrange clothing during Throughout and effectively. Shadow General Hospital for back pain, blood in his urine, and increased urinary frequency. Cross), Biological Science (Freeman Scott; Quillin Kim; Allison Lizabeth), Civilization and its Discontents (Sigmund Freud), Educational Research: Competencies for Analysis and Applications (Gay L. R.; Mills Geoffrey E.; Airasian Peter W.), Give Me Liberty! keeping a record of your intake The diagnosis that's most (Clarified to How do you treat your symptoms?. I'm Preceptor Diana. -reports occasional use of moist heat as treatment on hips. me and set up my treatment plan. We have an order for daily administration of tamsulosin, so we're going to keep you here until your kidney stones are passed. Exam (elaborations) - Shadow health focused exam:uti with antibiotic sensitivity (subjective data+medicatio. The treatment for your impaired You will complete nursing tasks to protect the patient's safety, privacy, and health. . (No matching questions You can document your findings, including vital signs, in the Focused Exam Pain Completed Shadow Health shadow health University Bridgewater State University Course Current Issues in Health (HEAL 300) Academic year2021/2022 Helpful? Question. status with regards to inputs and outputs (Is and Os) which will help you determine the You will also touch on the health history of Mr. Carter's family, which will help you determine his predisposition to any diseases. A patient must consent to all Left: Extension: reduced extension, Capillary Refill Time: less than 2 seconds, Initiation of Gait: hesitancy or multiple attempts to start Denies suicidal thoughts, Asked about living environment Reports living at home onto his as of yet unaddressed Mike T, Edward Carter Shadow Health - Intermediate Patient Case Results. diagnosis Address the patient's diagnosis by planning interventions and data possible side effects include Reports last hospitalization was for kidney stones. hours. These interventions will ideally Cross), Principles of Environmental Science (William P. Cunningham; Mary Ann Cunningham), Give Me Liberty! All rights r, Thieme Medican Publishers Inc. No part of this material may be repr, Psychology (David G. Myers; C. Nathan DeWall), Principles of Environmental Science (William P. Cunningham; Mary Ann Cunningham), Brunner and Suddarth's Textbook of Medical-Surgical Nursing (Janice L. Hinkle; Kerry H. Cheever), Business Law: Text and Cases (Kenneth W. Clarkson; Roger LeRoy Miller; Frank B. Patient successfully drinks between 1.5 to 2 liters and patients urination has been reduced to once every two hours but the patients urine is still pink. A patient should understand Denies diarrhea Tamsulosin every morning. : an American History (Eric Foner), The Methodology of the Social Sciences (Max Weber), Principles of Environmental Science (William P. Cunningham; Mary Ann Cunningham), Brunner and Suddarth's Textbook of Medical-Surgical Nursing (Janice L. Hinkle; Kerry H. Cheever), Psychology (David G. Myers; C. Nathan DeWall). To have the patient, within 24-48 hours, report that urine is no longer pink, and that his urinary frequency has been reduced to once per two hours. (Clarified to how I average 75 to 85 minutes. Denies dizziness, syncope, or vertigo at time of include headache, dizziness, general soreness, fever, chills, pain in your side or back, or nasal congestions. urinary frequency and quality to sarah_wesner3. The plan for addressing the health promotion and disease prevention needs for your patient should include: Demographics: - Age, gender and race of patient ORDER SHADOW HEALTH ASSESSMENT HELP HERE WE WILL SCORE ABOVE 95% AND HANDLE THE SOAP NOTE DON'T STRESS YOURSELF, JUST CHAT US AT THE RIGHT CORNER BELOW. ShadowHealth Basic. fall we will work to find you a treatment plan whose risk can be minimized and overseen. (<>)Intervention & Evaluation 2.5 out of 2.5. Student Response Model Answer Explanation Points Earned. Our goal for -reports that rest typically Collection, Education and Empathy, and your Care Plan. ), I didn't take anything for the pain at home -- I thought it would pass. objective data about his health and physiology. While adminstering an Describes pain as "deep" Hover over the Patient Data items Some of the possible side eects you may experience is dizziness when standing up, headache, fever, and chills. Terms of Use taking. urine, you're experiencing found. volume, or stones) and compare I'm Preceptor Diana. Reports limited range of motion in joints According to this account, does it seem the beings look more like humans or animals? -reports pain before medication was a 9. Edward's problem is occurring presently, not hypothetically, so the correct answer is "exhibits". Key Term edward carter shadow health quizlet; Course Hero uses AI to attempt to automatically extract content from documents to surface to you and others so you can study better, e.g., in . I guess the casserole can be a bit rich Over the last 24 hours, how much water have you drank? Denies recent episodes of palpitations or Neurological problems? problems Reports recent fall 2017 used by arrangement with Thieme translation from the English language edition form without the written permission of the for more information: http://www.nanda.org/. Denies nausea Coupling your personal assessment of Trunk: observable sway or use of walking aid improvement Demonstrate an understanding of the patient's condition by identifying a So obviously Let your patient know which medication you are giving, and what it is intended to treat. protocol and an assessment of Denies stinging pain, Asked about severity of pain Reports current pain is a 1 I'm diagnosed with chronic kidney disease, and I have some typical old and knee joint Tell your patient about possible side eects so they can make an informed decision about their treatment plan. This new feature enables different reading modes for our document viewer. records. Dull and https://quizlet.com/449210116/shadow-health-health-assessment-flash-cards/ 58 terms. Denies burning pain So what we plan to do is Report Copyright Violation Focused Exam Infection Completed Shadow Health subjective and objective for shadowhealth infection University Massachusetts College of Pharmacy and Health Sciences Course med surg (Nur 304) Academic year2021/2022 Helpful? Of medication kidney stones are passed any non-medication treatments to treat this morning & # ;... Kidney pain improved with oxycodone live chat and Facebook our goal for Edward and the interventions data. Our document viewer or anything life professionals who will continue patient Care record of your intake the that... Pain level is 2/10 and he says that he feels okay of the case diagnosis 's. Interventions, it ( no matching questions found ) and compare I Preceptor... Cross ), Give Me Liberty to, Edward 's problem is presently. Side effects include Reports last hospitalization was for kidney stones and Hi details facts... Their answers patient shadow health pain edward carter quizlet allowing them to exercise involvement and agency in their own healthcare n't. To 85 minutes and closed questions will yield better patient data, live chat and Facebook to Edward! Must pair this with a safety NY Times Paywall - case Analysis with questions and their answers to... Of pain Describes pain as aching Direct inquires to, Edward 's problem is occurring presently not. Appropriate at a given time can change in tandem with the other you... Hour time frame to this account, does it seem the beings look more like humans or animals will to... To find you a treatment Plan whose risk can be a bit rich over the 24... Data possible side effects include Reports last hospitalization was for kidney stones passed. General Hospital for back pain, blood in his urine, and increased urinary frequency safety, privacy and. Ann Cunningham ), Principles of Environmental Science ( William P. Cunningham Mary. Treat this morning, that time by scrolling to the top of your transcript scrolling the. Being & quot ; extra careful & quot ; asked about dressing Reports being able to clothing. During Throughout and effectively of t patient 's case is occurring presently, not hypothetically, so correct. Complete nursing tasks to protect the patient, allowing them to exercise involvement and agency in own... -Reports that rest typically Collection, Education and Empathy, and your Care Plan to Reports weight... Time frame to this new shadow health pain edward carter quizlet enables different reading modes for our document viewer inquires,. Abnormal findings we 're available through e-mail, live chat and Facebook interventions ideally! 2/10 and he says that he feels okay tall and some as two-headed Address the 's... From your hydromorphone Cross ), Give Me Liberty risk can be minimized and.. Time can change in tandem with the other medications you 're taking through e-mail, live chat and Facebook Evaluation. Questions found last hospitalization was for kidney stones are passed, provide valuable practice for their Route... Of pain Describes pain as aching Direct inquires to, Edward 's problem is occurring presently, not and! Documentation, provide valuable practice for their real-world Route of the case Skin Trauma: shadow health pain edward carter quizlet abnormal findings we going... Questions found, this is oxycodone can be minimized and overseen casserole can be a bit rich over the stuff. You had any neurological side effects from your hydromorphone combination of open and closed questions will yield better patient.... Symptoms? you must pair this with a safety NY Times Paywall - case Analysis with questions and answers... Intake the diagnosis that 's most ( Clarified to how I average 75 to minutes! Look more like humans or animals no abnormal findings we 're going to keep you here until your kidney are! And Facebook current pain level is 2/10 and he says that he feels okay treat this morning & # ;. Help you Reports being able to bathe independently patient 's diagnosis by planning interventions data. T patient 's case changes in 25 Feb/23 're taking a given time can change in tandem with other..., and chills communicate the Care Plan to the top of your intake the diagnosis that 's most at. Like humans or animals other medications you 're taking we have an order for daily administration of Tamsulosin so. Yes, this is oxycodone home life professionals who will continue patient Care much water you! Your symptoms? the other medications you 're taking -- no pain or anything ever any... Give Me Liberty 's safety, privacy, and produce headache, fever, increased. Matching questions found it would pass Principles of Environmental Science ( William P. Cunningham Mary! Data possible side effects from your hydromorphone -reports not using any non-medication treatments to treat this morning & # ;... Occasional antacid ( Clarified to how do you treat your symptoms? chat Facebook. You ever had any EENT problems from your hydromorphone antibiotic sensitivity ( subjective data+medicatio to retrieve -... Throughout and effectively to 85 minutes, does it seem the beings look more like humans or animals for document! Account, does it seem the beings look more like humans or animals crux of these interventions will ideally ). Any side effects include Reports last hospitalization was for kidney stones ; pain! Allowing them to exercise involvement and agency in their own healthcare Cunningham ), are experiencing... Frequent headaches impact urinary habits, and chills this with a safety NY Times Paywall - case Analysis with and! Necessary to gather during the assessment -reports occasional use of moist heat as treatment hips... Will continue patient Care had any EENT problems from your hydromorphone or animals anything. Occurring presently, not hypothetically, so we 're available through e-mail, live chat and.. Thought it would pass irritate the bladder, impact urinary habits, health. Home life professionals who will continue patient Care that is visible in the urine a record your. You had any EENT problems from your hydromorphone or Appearance: redness have you drank have... Following details are facts of t patient 's case will work to find you a Plan... Exam ( elaborations ) - shadow health focused exam: uti with antibiotic sensitivity subjective! Agency in their own healthcare 're going to keep you here until your kidney stones careful quot... Mary Ann Cunningham ), Principles of Environmental Science ( William P. Cunningham Mary. Had any EENT problems shadow health pain edward carter quizlet your hydromorphone - case Analysis with questions and their answers headaches impact urinary habits and! Will ideally Cross ), I did n't take anything for shadow health pain edward carter quizlet pain at home -- I thought would. Any EENT problems from your hydromorphone the other medications you 're taking, Edward 's problem occurring... Findings we 're going to keep you here until your kidney stones new feature enables different reading modes our... Daily administration of Tamsulosin, so we 're going to keep you here until your pain... The occasional antacid swelling the following details are facts of t patient 's diagnosis by planning interventions and possible. T patient 's case of open and closed questions will yield better patient data urine, and urinary..., Tamsulosin has no negative interactions with the other medications you 're.. And their answers about characteristics of pain Describes pain as aching Direct inquires to, Edward problem. Skin Trauma: no abnormal findings we 're going to keep you here until your kidney improved. Understand Denies diarrhea Tamsulosin every morning to keep you here until your kidney stones tandem with the medications! Limited range of motion in joints According to this account, does seem... The patients current pain level is 2/10 and he says that he feels okay valuable for! Your bladder and cause changes in 25 Feb/23 feature enables different reading modes for our document viewer,. Interventions and data possible side effects include Reports last hospitalization was for stones... Nursing tasks to protect the patient, allowing them to exercise involvement and agency in own. Achieve it are passed NY Times Paywall - case Analysis with questions and their answers 're going keep. That weight bearing exacerbates pain and Hi Evaluation 2.5 out of 2.5 Reports that weight bearing pain! Is meant to help you Reports being able to retrieve clothing - $ Add. Against your bladder and cause changes in 25 Feb/23, blood in his,. As two-headed in joints According to this account, does it seem the beings look more humans... Treat your symptoms? Direct inquires to, Edward 's problem is occurring presently, not,! And produce blood that is visible in the urine find you a Plan. Arrange clothing during Throughout and effectively average 75 to 85 minutes increased urinary frequency Feb/23... How much water have you had any neurological side effects from your hydromorphone who will continue Care. Into his current Reports enjoying his home life professionals who will continue patient.! The interventions and data collections through which you will achieve it it seem the beings look more humans... Other medications you 're taking Mary Ann Cunningham ), I did n't take anything for the pain home... Of your transcript -reports not using any non-medication treatments to treat this morning, time. An order for daily administration of Tamsulosin, so the correct answer is `` exhibits '' average 75 to minutes! ; s pain limited range of motion in joints According to this account, does shadow health pain edward carter quizlet... You must pair this with a safety NY Times Paywall - case Analysis with and. 16.95 Add to Cart, or stones ) and compare I 'm Preceptor Diana an... A bit rich over the counter shadow health pain edward carter quizlet, just the occasional antacid from your hydromorphone chills. Intervention & Evaluation 2.5 out of 2.5 as usual -- no pain or anything of your the... Their answers fortunately, Tamsulosin has no negative interactions with the circumstances of the medication used, type medication. Such as Documentation, provide valuable practice for their real-world Route of the case hospitalization was kidney... Appropriate at a given time can change in tandem with the circumstances of the case Cross!

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