The physical and emotional well-being of patients and families can be complex and multifaceted. Advanced practice nurses need to have the knowledge and ability to provide safe, competent, and comprehensive physical health assessments. Students in this course focus on concepts and skills to assess patients across the lifespan. They learn to use diagnostic reasoning, advanced communication, and physical assessment skills to identify changes in health patterns. Students also use a systematic approach through which they focus on the assessment of patients with acute and chronic health problems. The advanced skills of suturing, reading 12 Lead EKGs, and interpreting X-rays will be covered. Students engage in course assignments that emphasize risk assessment, diagnostic reasoning, and evidence-based assessment across the lifespan.
Module 1: Comprehensive Health History
What’s Happening in This Module?
This course is composed of four (4) separate modules. Each module consists of an overarching topic in which each week within the module includes specific subtopics for learning. As you work through each module, you will have an opportunity to draw upon the knowledge you gain in various Digital Clinical Experiences (DCE) and lab assignment components that will be due throughout each of the modules.
Module 1: Comprehensive Health History is a 1-week module, Week 1 of the course, in which you will examine how social determinants of health such as age, gender, ethnicity, and environmental situations impact the health and risk assessment of the patients you serve. You will also consider how social determinants of health influence your interview and communication techniques as you work in partnership with a patient to gather data to build an accurate health history.
| What do I have to do? |
When do I have to do it? |
| Review your Learning Resources |
Days 1–7, Week 1 |
| Discussion: Building a Comprehensive Health History |
Post by Day 3 of Week 1, and respond to your colleagues by Day 6 of Week 1. |
| What’s Coming Up in Module 2: Looking Ahead |
Review the “Looking Ahead” section for this week. You are encouraged to further review the requirements for the Shadow Health registration process for your digital clinical experiences. |
Go to the Week’s Content
Week 1: Building a Comprehensive Health History
According to a 2011 Gallup poll, nurses are ranked as the most trusted professionals in the United States. One of the most admired nursing skills is the ability to put patients at ease. When patients enter into a healthcare setting, they are often apprehensive about sharing personal health information. Caring nurses can alleviate the hesitance of patients and encourage them to be forthcoming with this information.
The initial health history interview can be an excellent opportunity to develop supportive relationships between patients and nurses. Nurses may employ a variety of communication skills and interview techniques to foster strong bonds with patients and to effectively facilitate the diagnostic process. In conducting interviews, advanced practice nurses must also take into account a range of patient-specific factors that may impact the questions they ask, how they ask those questions, and their complete assessment of the patient’s health.
This week, you will consider how social determinants of health such as age, gender, ethnicity, and environmental situation impact the health and risk assessment of the patients you serve. You will also consider how social determinants of health influence your interview and communication techniques as you work in partnership with a patient to gather data to build an accurate health history.
Learning Objectives
Students will:
- Analyze communication techniques used to obtain patients’ health histories based upon social determinants of health
- Analyze health-related risk
- Apply concepts, theories, and principles related to patient interviewing, diagnostic reasoning, and recording patient information
Learning Resources
Required Readings
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
- Chapter 1, “The History and Interviewing Process”
This chapter explains the process of developing relationships with patients in order to build an effective health history. The authors offer suggestions for adapting the creation of a health history according to age, gender, and disability.
- Chapter 5, “Recording Information”
This chapter provides rationale and methods for maintaining clear and accurate records. The authors also explore the legal aspects of patient records.
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
- Chapter 2, “The Comprehensive History and Physical Exam” (pp. 19–29)
Deckx, L., van den Akker, M., Daniels, L., De Jonge, E. T., Bulens, P., Tjan-Heijnen, V. C. G., … Buntinx, F. (2015). Geriatric screening tools are of limited value to predict decline in functional status and quality of life: Results of a cohort study. BMC Family Practice, 16, 1–12. https://doi-org.ezp.waldenulibrary.org/10.1186/s12875-015-0241- x
Wu, R. R., & Orlando, L. A. (2015). Implementation of health risk assessments with family health history: Barriers and benefits. Postgraduate Medical Journal, (1079), 508–513.
Lushniak, B. D. (2015). Surgeon general’s perspectives: Family health history: Using the past to improve future health. Public Health Reports, (1), 3.
Jardim, T. V., Sousa, A. L. L., Povoa, T. I. R., Barroso, W. K. S., Chinem, B., Jardim, L., … Jardim, P. C. B. V. (2015). The natural history of cardiovascular risk factors in health professionals: 20-year follow-up. BMC Public Health, 15(1111), 1–7. https://doi-org.ezp.waldenulibrary.org/10.1186/s12889-015-2477-8
Shadow Health Support and Orientation Resources
Use the following resources to guide you through your Shadow Health orientation as well as other support resources:
Frey, C. [Chris Frey]. (2015, September 4). Student orientation [Video file]. Retrieved from https://www.youtube.com/watch?v=Rfd_8pTJBkY
Shadow Health. (n.d.). Shadow Health help desk. Retrieved from https://support.shadowhealth.com/hc/en-us
Document: Shadow Health. (2014). Useful tips and tricks (Version 2) (PDF)
Document: Shadow Health Nursing Documentation Tutorial (Word document)
Optional Resource
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw- Hill Medical.
- Chapter 2, “History Taking and the Medical Record” (pp. 15–33)
Required Media
Welcome and General Course Guidelines
Dr. Tara Harris reviews the overall guidelines and the expectations for the course. Consider how you will manage your time as you review your media and Learning Resources throughout the course to better prepare for your Discussions, Case Study Lab Assignments, Digital Clinical Experience (DCE) Assignments, and your Midterm and Final Exams (14m).
Module 1 Introduction
Dr. Tara Harris reviews the overall expectations for Module 1. Please pay special attention to the registration requirements for your use of Shadow Health for your Digital Clinical Experience (DCE) Assignments as well as the criteria for the DCE Assignments (3m).
Building a Comprehensive Health History – Week 1 (19m)
Discussion: Building a Health History
Effective communication is vital to constructing an accurate and detailed patient history. A patient’s health or illness is influenced by many factors, including age, gender, ethnicity, and environmental setting. As an advanced practice nurse, you must be aware of these factors and tailor your communication techniques accordingly. Doing so will not only help you establish rapport with your patients, but it will also enable you to more effectively gather the information needed to assess your patients’ health risks.
For this Discussion, you will take on the role of a clinician who is building a health history for a particular new patient assigned by your Instructor.
To prepare:
With the information presented in Chapter 1 of Ball et al. in mind, consider the following:
- By Day 1 of this week, you will be assigned a new patient profile by your Instructor for this Discussion. Note: Please see the “Course Announcements” section of the classroom for your new patient profile assignment.
- How would your communication and interview techniques for building a health history differ with each patient?
- How might you target your questions for building a health history based on the patient’s social determinants of health?
- What risk assessment instruments would be appropriate to use with each patient, or what questions would you ask each patient to assess his or her health risks?
- Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration.
- Select one of the risk assessment instruments presented in Chapter 1 or Chapter 5 of the Seidel’s Guide to Physical Examination text, or another tool with which you are familiar, related to your selected patient.
- Develop at least five targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history.
By Day 3 of Week 1
Post a summary of the interview and a description of the communication techniques you would use with your assigned patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Read a selection of your colleagues’ responses.
By Day 6 of Week 1
Respond to at least two of your colleagues on 2 different days who selected a different patient than you, using one or more of the following approaches:
- Share additional interview and communication techniques that could be effective with your colleague’s selected patient.
- Suggest additional health-related risks that might be considered.
- Validate an idea with your own experience and additional research.
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 1 Discussion Rubric
Post by Day 3 of Week 1 and Respond by Day 6 of Week 1
To Participate in this Discussion:
Week 1 Discussion Sample Paper
NURS 6512 – Advance Health Assessment and Diagnostic Reasoning
Clinical Assessment
Student’s Name:
Institutional Affiliation:
Clinical Assessment
A 55 Year Old Asian Female Living in a High-Density Public Housing Complex
The patient in this scenario is a 55-year-old Asian female living in a high-density poverty housing complex. The first thing I will do is to find out if she understands English. In case she doesn’t, I will make arrangements to have a translator. While interviewing, I need to be competent in the cultural aspect to avoid any actions or words that would be inflicted on her culture. I will be able to do this by maintaining a high level of sensitivity to her heritage, sexual orientation, and social-economic conditions (Aranda, Davies & Jackevicius, 2019). I would also pay attention to her ethnicity and general cultural background.
Communication Techniques
At 55 years is the end of middle-aged adults and the beginning of older adults. That age is a vulnerable time in a person’s healthy life. Considering her place of dwelling, which is a high-density public complex, she may be going through severe social, economic challenges. Such difficulties would make her not easy to open up in most of the conversation (Deckx et al., 2015). Extracting information from a person undergoing such challenges can be quite difficult. At equal measure, it is also essential to provide such information with privacy. Therefore, as a clinician, I will be seeking to get the chief concern for her seeking health care services. If I find, she is not able to open up in the presence of family members, I would request them to step out of the clinic room for further engagement with the patient. I will start my conversation with the patient’s day to day activities.
I will always remember to respect her and gain her trust (Quinn & Gordon, 2015). When faced with silence, I have to recognize that too. However, I will try to figure out if her silence is out of anger, her economic situation, or if she is just unwilling to share. My objective will try to seek out in detail her concerns, by presenting genuine interest and curiosity towards addressing her concerns (Rosenberger & Lachin, 2015). I will use simple and understandable language and avoid any form of confrontation. I will listen keenly to what the patient says. Once I determine the principal concern, I will go on to discuss other sensitive health issues based on the information I gather from her.
Risk Assessment Instrument/Tool
Knowing that older adults have many health risks, and because assessment must be individualized multiple assessment tools will be necessary. I would use self- report information and the clinician-rated scales. The clinician-rated scale will help to conduct a clinically first diagnostic test. The clinical examination will be useful in narrowing down the patient’s conditions and results in proper medication. Besides, patient medical history will help in determining the most appropriate diagnosis (Wright, Tobias & Hickman, 2017). Even though HEEADSSS is for assessing adolescents, I would use it to determine her home environment, employment, eating pattern, and her other daily activities. This assessment tool will play a fundamental role in undertaking the most appropriate diagnosis.
Questions that I would ask
- How are things at the place of residence? In terms of pollution from area residence or industries around?
- How old are you?
- What type of occupation do you do?
- What do you expect from this medical visit?
- Have you taken any medication in the recent past? And if yes what was it?
- Do you involve yourself in physical exercise?
Such open-ended questions will enable my patient to open up and talk more about areas that are troubling her.
References.
Aranda, J. P., Davies, M. L., & Jackevicius, C. A. (2019). Student pharmacists’ performance and perceptions on an evidence-based medicine objective structured clinical examination. Currents in Pharmacy Teaching and Learning, 11(3), 302-308.
Deckx, L., van den Akker, M., Daniels, L., De Jonge, E. T., Bulens, P., Tjan-Heijnen, V. C. G., Buntinx, F. (2015). Geriatric screening tools are of limited value to predict decline in functional status and quality of life: Results of a cohort study. BMC Family Practice, 16, 1–12. https://doi-org.ezp.waldenulibrary.org/10.1186/s12875-015-0241-x
Quinn, L., & Gordon, J. (2015). Documentation for Rehabilitation-E-Book: A Guide to Clinical Decision Making in Physical Therapy. Elsevier Health Sciences.
Rosenberger, W. F., & Lachin, J. M. (2015). Randomization in clinical trials: theory and practice. John Wiley & Sons.
Wright, L., Tobias, S. M., & Hickman, A. (2017). Coding and Documentation Compliance for the ICD and DSM: A Comprehensive Guide for Clinicians. Routledge.
What’s Coming Up in Module 2?
In Module 2, you explore the impact of functional assessments, diversity, and sensitivity in conducting health assessments. You also examine various assessment tools and diagnostic tests used to gather information about patients’ conditions and examine their validity, reliability, and impact in conducting health assessments.
Next week, you will specifically examine functional assessments as they relate to diversity and sensitivity
Registration for Shadow Health
Throughout this course, you will participate in digital clinical experiences using the online simulation tool Shadow Health. The Shadow Health digital clinical experience provides a dynamic, immersive experience designed to improve nursing skills and clinical reasoning through the examination of digital standardized patients. Using Shadow Health you will participate in health histories, focused exams, and a comprehensive assessment.
There will be four Shadow Health assessment components that you will need to complete in Module’s 2 and 3:
- Health History Assessment (Week 3 & 4)
- Focused Exam: Cough (Week 5) for a pediatric patient presenting with cough
- Focused Exam: Chest Pain (Week 7) for an adult patient presenting with chest pain
- Comprehensive (Head-to-Toe) Physical Assessment (Week 9)
Before you can participate in these simulations, you will need to register for a Shadow Health account. To do this:
- Go to the Walden Bookstore and purchase access to Shadow Health and the required texts.
- Once Shadow Health has been purchased, an access code will be emailed to you from the bookstore.
- Review this video explaining how to register in Shadow Health: https://vimeo.com/275921826/c12d50ee6e
- Use the Shadow Health link located in the navigation menu on the left in the Blackboard course.
- Follow the prompts to register in Shadow Health. You will need the access code provided from the bookstore to register. Once registered, Shadow Health should always be accessed via the link in Blackboard.
- Use only Google Chrome when accessing Shadow Health and make sure all other programs are turned off on your computer. Other browsers do not work well and will not allow the Shadow Health speech to text function to work.
- Once registered, complete the Shadow Health Orientation in the Shadow Health website/program and review the videos designed to assist with navigating and completing assignments.
- Read the Shadow Health Nursing Documentation Tutorial located in the Week 1 Learning Resources.
Note: As nurses you typically use the word assessment to mean completing the physical exam. However, in the SOAP Note format, assessment means diagnosis so start getting in the habit of calling the physical exam exactly that.
Week 2 Case Studies
In Week 2, your Instructor will assign you a case study related to your Discussion by Day 1 of the week. Please make sure to review the “Course Announcements” area of the course to verify your assigned case study. Please plan ahead to ensure you have time to review your case study and your Learning Resources so that you can complete your Discussions and Assignments on time.
Practicum – Upcoming Deadline
In the Nurse Practitioner programs of study (FNP, AGACNP, AGPCNP, and PMHNP) you are required to take several practicum courses. If you plan on taking a practicum course within the next two terms, you will need to submit your application via Meditrek .
For information on the practicum application process and deadlines, please visit the Field Experience: College of Nursing: Application Process – Graduate web page.
Please take the time to review the Appropriate Preceptors and Field Sites for your courses.
Please take the time to review the practicum manuals, FAQs, Webinars and any required forms on the Field Experience: College of Nursing: Student Resources and Manuals web page.
Next Module
Module 2: Functional Assessments and Assessment Tools
What’s Happening in This Module?
Module 2: Functional Assessments and Assessment Tools is a 2-week module, Weeks 2 and 3. In this module, you consider the impact of functional assessments, diversity, and sensitivity in conducting health assessments. You also explore various assessment tools and diagnostic tests that are used to gather information about patients’ conditions and examine the validity and reliability of these tests and tools. Finally, you examine assessment techniques, health risks and concerns, and recommendations for care related to patient growth, weight, and nutrition.
| What do I have to do? |
When do I have to do it? |
| Review your Learning Resources. |
Days 1–7, Weeks 2 and 3 |
| Discussion: Diversity and Health Assessments |
Post by Day 3 of Week 2, and respond to your colleagues by Day 6 of Week 2. |
| Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children |
Submit your Case Study Assignment by Day 6 of Week 3. |
| DCE: Health History Assessment |
You are encouraged to work on your DCE every week. However, this Assessment is not due until Day 7 of Week 4. |
Go to the Module’s Content
Week 2: Functional Assessments and Cultural and Diversity Awareness in Health Assessment
Diversity is not about how we differ. Diversity is about embracing one another’s uniqueness.
—Ola Joseph
Countless assessments can be conducted on patients, but they may not be useful. In order to ensure that health assessments result in the necessary care, health assessments should take into account the impact of factors such as cultures and developmental circumstances.
Learning Objectives
Students will:
- Analyze diversity considerations in health assessments
- Apply concepts, theories, and principles related to examination techniques, functional assessments, and cultural and diversity awareness in health assessment
Learning Resources
Required Readings
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
· Chapter 1, “The History and Interviewing Process” (Previously read in Week 1)
This chapter highlights history and interviewing processes. The authors explore a variety of communication techniques, professionalism, and functional assessment concepts when developing relationships with patients.
· Chapter 2, “Cultural Competency”
This chapter highlights the importance of cultural awareness when conducting health assessments. The authors explore the impact of culture on health beliefs and practices.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.
· Chapter 2, “Evidenced-Based Clinical Practice Guidelines”
Melton, C., Graff, C., Holmes, G., Brown, L., & Bailey, J. (2014). Health literacy and asthma management among African-American adults: An interpretative phenomenological analysis. Journal of Asthma, 51(7), 703–713. doi:10.3109/02770903.2014.906605
Credit Line: Health literacy and asthma management among African-American adults: An interpretative phenomenological analysis by Melton, C., Graff, C., Holmes, G., Brown, L., & Bailey, J., in Journal of Asthma, Vol. 51/Issue 7. Copyright 2014 by Taylor & Francis, Inc. Reprinted by permission of Taylor & Francis, Inc. via the Copyright Clearance Center.
The authors of this study discuss the relationship between health literacy and health outcomes in African American patients with asthma.
Centers for Disease Control and Prevention. (2015). Cultural competence. Retrieved from https://npin.cdc.gov/pages/cultural-competence
This website discusses cultural competence as defined by the Centers for Disease Control and Prevention (CDC). Understanding the difference between cultural competence, awareness, and sensitivity can be obtained on this website.
United States Department of Human & Health Services. Office of Minority Health. (n.d.). A physician’s practical guide to culturally competent care. Retrieved June 10, 2019, from https://cccm.thinkculturalhealth.hhs.gov/
From the Office of Minority Health, this website offers CME and CEU credit and equips healthcare professionals with awareness, knowledge, and skills to better treat the increasingly diverse U.S. population they serve.
Espey , D. K., Jim, M. A., Cobb, N., Bartholomew, M., Becker, T., Haverkamp, D., & Plescia, M. (2014). Leading causes of death and all-cause mortality in American Indians and Alaska Natives. American Journal of Public Health, 104(Suppl 3), S303–S311.
The authors of this article present patterns and trends in all-cause mortality and leading cause of death in American Indians and Alaskan Natives.
Wannasirikul, P., Termsirikulchai, L., Sujirarat, D., Benjakul, S., & Tanasugarn, C. (2016). Health literacy, medication adherence, and blood pressure level among hypertension older adults treated at primary health care centers. Southeast Asian Journal of Tropical Medicine and Public Health, 47(1), 109–120.
The authors of this study explore the causal relationships between health literacy, individual characteristics, literacy, culture and society, cognitive ability, medication adherence, and the blood pressure levels of hypertensive older adults receiving healthcare services at primary healthcare centers.
Required Media
Module 2 Introduction
Dr. Tara Harris reviews the overall expectations for Module 2. Consider how you will manage your time as you review your media and Learning Resources for your Discussion, Case Study Lab Assignment, and your DCE Assignment (3m).
Functional Assessments and Cultural and Diversity Awareness in Health Assessment – Week 2 (10m)
Discussion: Diversity and Health Assessments
May 2012, Alice Randall wrote an article for The New York Times on the cultural factors that encouraged black women to maintain a weight above what is considered healthy. Randall explained—from her observations and her personal experience as a black woman—that many African-American communities and cultures consider women who are overweight to be more beautiful and desirable than women at a healthier weight. As she put it, “Many black women are fat because we want to be” (Randall, 2012).
Randall’s statements sparked a great deal of controversy and debate; however, they emphasize an underlying reality in the healthcare field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and healthcare professionals should be aware of this reality and adapt their health assessment techniques and recommendations to accommodate diversity.
In this Discussion, you will consider different socioeconomic, spiritual, lifestyle, and other cultural factors that should be taken into considerations when building a health history for patients with diverse backgrounds. Your Instructor will assign a case study to you for this Discussion.
To prepare:
- Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments.
- By Day 1 of this week, you will be assigned a case study by your Instructor. Note: Please see the “Course Announcements” section of the classroom for your case study assignment.
- Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient assigned to you.
- Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.
- Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information?
By Day 3 of Week 2
Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Read a selection of your colleagues’ responses.
By Day 6 of Week 2
Respond on or before Day 6 on 2 different days to at least two of your colleagues who were assigned a different patient than you. Critique your colleague’s targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to your patient, and why.
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 2 Discussion Rubric
Post by Day 3 of Week 2 and Respond by Day 6 of Week 2
To Participate in this Discussion:
Week 2 Discussion Sample Paper
NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning
Week 2 Discussion
Student’s Name:
Institutional Affiliation:
Case Scenario
At-risk 86-year-old Asian male who feels like a burden to his daughter, and is physically and financially dependent on his daughter, a single mother who has little time or money for her father’s health needs. Patient has a history of hypertension (HTN), gastroesophageal reflux disease (GERD), b12 deficiency and chronic prostatitis, and S/P cholecystectomy. Current Medications: Lisinopril 10mg daily, Prilosec 20mg daily, B12 injections monthly, and Cipro 100mg daily.
Introduction
The US population is composed of different ethnic groups which require the health care practitioners to be aware, sensitive and competent with the patient diversity (Betancourt et al. 2016). A health care provider who is culturally competent understands the unique needs of patients from different backgrounds
Cultural Factors
The fact that the man depends on his daughter physically and financially and that the daughter is a single mother shows that the man is from a low economic background. This man has language problems. He is not fluent in English. A large percentage of the population of Asian people living in the United States has language difficulties. The language difficulties may lead to the wrong diagnosis of the disease. This man is also from an ethnic minority. According to Ball, et al. (2014), Asians and Pacific Islanders are the fastest growing ethnic minorities in the United States. Also, it is possible that the man uses traditional medicine and seeks medical help if conventional medicine fails to work. Most of the Asians trust traditional medicine.
Issues to be Sensitive About
While speaking with the patient, I would be slow and polite because most of the older people take time to process information and give a reply. I would also consider having an interpreter to help in case he does not understand my language or I do not understand his. Avoiding jargon would enhance patient compliance (Bing-Jonsson et al. 2016). I would also avoid a firm gaze since it might seem rude.
Questions that I would ask to assess his Health Risks
- How many meals do you take in a day?
- Is there anyone who helps you with your medication?
- Have you ever used any traditional medicine for your treatment?
- Do you have any friends or relatives or a social group who you can talk to when depressed?
- Is there a charity organisation or a social group that helps you with basic needs such as food?
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2014). Cultural competency. Seidel’s guide to a physical examination, 8th edn. Amsterdam: Elsevier, 21-9.
Betancourt, J. R., Green, A. R., Carrillo, J. E., & Owusu Ananeh-Firempong, I. I. (2016). Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public health reports.
Bing-Jonsson, P. C., Hofoss, D., Kirkevold, M., Bjørk, I. T., & Foss, C. (2016). Sufficient competence in community elderly care? Results from a competence measurement of nursing staff. BMC nursing, 15(1), 5.
What’s Coming Up in Week 3?
Next week, you examine assessment techniques, health risks and concerns, and recommendations for care related to patient growth, weight, and nutrition. You will also begin your first DCE: Health History Assessment which will be due in Week 4. Plan your time accordingly.
Overview of Digital Clinical Experiences (DCE) and Lab Components
Throughout this course, you are required to not only complete your standard course assignments and discussions, but you will also complete DCE and Lab Components that are either structured as optional or required assignment submissions. Please take the time to review your DCEand Lab Components for this course that are required submissions. See the table below and the attached table for specific DCE and Lab Components for the course.
Note: Each Shadow Health Assessment may be attempted and reopened as many times as necessary prior to the due date to achieve a total score of 80% or better, but you must take all attempts by the Day 7 deadline. You must pass BOTH the Health History and Comprehensive (head-to-toe) Physical Exam of at least a total score of 80% in order to pass the course.
| Week |
Digital Clinical Experiences |
Lab Components |
| Module 1: Comprehensive Health History |
| Week 1: Building a Comprehensive Health History |
|
|
| Module 2: Functional Assessments and Assessment Tools |
| Week 2: Functional Assessments and Cultural and Diversity Awareness in Health Assessment |
|
|
| Week 3: Assessment Tools, Diagnostics, Growth, Measurement, and Nutrition in Adults and Children |
DCE: Health History Assessment (assigned in Week 3, due in Week 4) |
Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children |
| Module 3: Approach to System Focused Advanced Health Assessments |
| Week 4: Assessment of the Skin, Hair, and Nails |
DCE: Health History Assessment |
Lab Assignment: Differential Diagnosis for Skin Conditions (SOAP Note for differential diagnosis) |
| Week 5: Assessment of Head, Neck, Eyes, Ears, Nose, and Throat |
DCE: Focused Exam: Cough |
Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat (Episodic SOAP Note) |
| Week 6: Assessment of the Abdomen and Gastrointestinal System |
|
Lab Assignment: Assessing the Abdomen (Analyze SOAP Note) |
| Week 7: Assessment of the Heart, Lungs, and Peripheral Vascular System |
DCE: Focused Exam: Chest Pain |
|
| Week 8: Assessment of the Musculoskeletal System |
|
Discussion: Assessing Musculoskeletal Pain (Episodic SOAP Note) |
| Week 9: Assessment of Cognition and the Neurologic System |
DCE: Comprehensive (head-to-toe) Physical Assessment |
Case Study Assignment: Assessing Neurological Symptoms (Episodic SOAP Note) |
| Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal |
|
Lab Assignment: Assessing the Genitalia and Rectum (analyze SOAP Note) |
| Module 4: Ethics in Assessment |
| Week 11: The Ethics Behind Assessment |
|
Lab Assignment: Ethical Concerns |
Next Week
To go to the next week:
Week 3
Week 3: Assessment Tools, Diagnostics, Growth, Measurement, and Nutrition in Adults and Children
Many experts predict that genetic testing for disease susceptibility is well on its way to becoming a routine part of clinical care. Yet many of the genetic tests currently being developed are, in the words of the World Health Organization (WHO), of “questionable prognostic value.”
—Leslie Pray, PhD
Obesity remains one of the most common chronic diseases in the United States. As a leading cause of United States mortality, morbidity, disability, healthcare utilization and healthcare costs, the high prevalence of obesity continues to strain the United States healthcare system (Obesity Society, 2016). More than one-third (39.8%) of U.S. adults have obesity (CDC, 2018). The estimated annual medical cost of obesity in the U.S. was $147 billion in 2008 U.S. dollars; the medical costs for people who are obese were $1,429 higher than those of normal weight (CDC, 2018).
According to the Centers for Disease Control and Prevention (CDC), the rate of childhood obesity has tripled in the past 30 years, with an estimated 13.7 million children and adolescents considered obese (CDC, 2018). When seeking insights about a patient’s overall health and nutritional state, body measurements can provide a valuable perspective. This is particularly important with pediatric patients. Measurements such as height and weight can provide clues to potential health problems and help predict how children will respond to illness. Nurses need to be proficient at using assessment tools, such as the Body Mass Index (BMI) and growth charts, in order to assess nutrition-related health risks and pediatric development while being sensitive to other factors that may affect these measures. Body Mass Index is also used as a predictor for measurement of adult weight and health.
Assessments are constantly being conducted on patients, but they may not provide useful information. In order to ensure that health assessments provide relevant data, nurses should familiarize themselves with test-specific factors that may affect the validity, reliability, and value of these tools.
This week, you will explore various assessment tools and diagnostic tests that are used to gather information about patients’ conditions. You will examine the validity and reliability of these tests and tools. You will also examine assessment techniques, health risks and concerns, and recommendations for care related to patient growth, weight, and nutrition.
Learning Objectives
Students will:
- Evaluate validity and reliability of assessment tools and diagnostic tests
- Analyze diversity considerations in health assessments
- Apply concepts, theories, and principles related to examination techniques, functional assessments, and cultural and diversity awareness in health assessment
- Apply assessment skills to collect patient health histories
Learning Resources
Required Readings
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
· Chapter 3, “Examination Techniques and Equipment”
This chapter explains the physical examination techniques of inspection, palpation, percussion, and auscultation. This chapter also explores special issues and equipment relevant to the physical exam process.
· Chapter 8, “Growth and Nutrition”
In this chapter, the authors explain examinations for growth, gestational age, and pubertal development. The authors also differentiate growth among the organ systems.
· Chapter 5, “Recording Information” (Previously read in Week 1)
This chapter provides rationale and methods for maintaining clear and accurate records. The text also explores the legal aspects of patient records.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Student checklist: Health history guide. In Seidel’s guide to physical examination (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Centers for Disease Control and Prevention. (2018). Childhood overweight and obesity. Retrieved from http://www.cdc.gov/obesity/childhood
This website provides information about overweight and obese children. Additionally, the website provides basic facts about obesity and strategies to counteracting obesity.
Chaudhry, M. A. I., & Nisar, A. (2017). Escalating health care cost due to unnecessary diagnostic testing. Mehran University Research Journal of Engineering and Technology, (3), 569.
This study explores the escalating healthcare cost due the unnecessary use of diagnostic testing. Consider the impact of health insurance coverage in each state and how nursing professionals must be cognizant when ordering diagnostics for different individuals.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.
· Chapter 1, “Clinical Reasoning, Evidence-Based Practice, and Symptom Analysis”
This chapter introduces the diagnostic process, which includes performing an analysis of the symptoms and then formulating and testing a hypothesis. The authors discuss how becoming an expert clinician takes time and practice in developing clinical judgment.
Gibbs , H., & Chapman-Novakofski, K. (2012). Exploring nutrition literacy: Attention to assessment and the skills clients need. Health, 4(3), 120–124.
This study explores nutrition literacy. The authors examine the level of attention paid to health literacy among nutrition professionals and the skills and knowledge needed to understand nutrition education.
Martin, B. C., Dalton, W. T., Williams, S. L., Slawson, D. L., Dunn, M. S., & Johns-Wommack, R. (2014). Weight status misperception as related to selected health risk behaviors among middle school students. Journal of School Health, 84(2), 116–123. doi:10.1111/josh.12128
Credit Line: Weight status misperception as related to selected health risk behaviors among middle school students by Martin, B. C., Dalton, W. T., Williams, S. L., Slawson, D. L., Dunn, M. S., & Johns-Wommack, R., in Journal of School Health, Vol. 84/Issue 2. Copyright 2014 by Blackwell Publishing. Reprinted by permission of Blackwell Publishing via the Copyright Clearance Center.
Noble, H., & Smith, J. (2015) Issues of validity and reliability in qualitative research . Evidence Based Nursing, 18(2), pp. 34–35.
Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). History subjective data checklist. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Mosby’s Guide to Physical Examination, 7th Edition by Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2011 by Elsevier. Reprinted by permission of Elsevier via the Copyright Clearance Center.
This History Subjective Data Checklist was published as a companion to Seidel’s Guide to Physical Examination (8th ed.) by Ball, J. W., Dains, J. E., & Flynn, J.A. Copyright Elsevier (2015). From https://evolve.elsevier.com
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
- Chapter 2, “The Comprehensive History and Physical Exam” (Previously read in Week 1)
- Chapter 5, “Pediatric Preventative Care Visits” (pp. 91 101)
Shadow Health Support and Orientation Resources
Use the following resources to guide you through your Shadow Health orientation as well as other support resources:
Frey, C. [Chris Frey]. (2015, September 4). Student orientation [Video file]. Retrieved from https://www.youtube.com/watch?v=Rfd_8pTJBkY
Document: Shadow Health Support and Orientation Resources (PDF)
Shadow Health. (n.d.). Shadow Health help desk. Retrieved from https://support.shadowhealth.com/hc/en-us
Document: Shadow Health. (2014). Useful tips and tricks (Version 2) (PDF)
Document: Shadow Health Nursing Documentation Tutorial (Word document)
Document: Student Acknowledgement Form (Word document)
Note: You will sign and date this form each time you complete your DCE Assignment in Shadow Health to acknowledge your commitment to Walden University’s Code of Conduct.
Optional Resource
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.
- Chapter 3, “The Physical Screening Examination”
- Chapter 17, “Principles of Diagnostic Testing”
- Chapter 18, “Common Laboratory Tests”
Required Media
Taking a Health History
How do nurses gather information and assess a patient’s health? Consider the importance of conducting an in-depth health assessment interview and the strategies you might use as you watch. (16m)
Assessment Tool, Diagnostics, Growth, Measurements, and Nutrition in Adults and Children – Week 3 (11m)
Assignment 1: Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children
When seeking to identify a patient’s health condition, advanced practice nurses can use a diverse selection of diagnostic tests and assessment tools; however, different factors affect the validity and reliability of the results produced by these tests or tools. Nurses must be aware of these factors in order to select the most appropriate test or tool and to accurately interpret the results.
Not only do these diagnostic tests affect adults, body measurements can provide a general picture of whether a child is receiving adequate nutrition or is at risk for health issues. These data, however, are just one aspect to be considered. Lifestyle, family history, and culture—among other factors—are also relevant. That said, gathering and communicating this information can be a delicate process.
For this Assignment, you will consider the validity and reliability of different assessment tools and diagnostic tests. You will explore issues such as sensitivity, specificity, and positive and negative predictive values. You will also consider examples of children with various weight issues. You will explore how you could effectively gather information and encourage parents and caregivers to be proactive about their children’s health and weight.
To Prepare
- Review this week’s Learning Resources and consider factors that impact the validity and reliability of various assessment tools and diagnostic tests. You also will review examples of pediatric patients and their families as it relates to BMI.
- By Day 1 of this week, you will be assigned to one of the following Assignment options by your Instructor: Adult Assessment Tools or Diagnostic Tests (option 1), or Child Health Case (Option 2). Note: Please see the “Course Announcements” section of the classroom for your assignments from your Instructor.
- Search the Walden Library and credible sources for resources explaining the tool or test you were assigned. What is its purpose, how is it conducted, and what information does it gather?
- Also, as you search the Walden library and credible sources, consider what the literature discusses regarding the validity, reliability, sensitivity, specificity, predictive values, ethical dilemmas, and controversies related to the test or tool.
- If you are assigned Assignment Option 2 (Child), consider what health issues and risks may be relevant to the child in the health example.
- Based on the risks you identified, consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this information in a sensitive fashion.
- Consider how you could encourage parents or caregivers to be proactive toward the child’s health.
The Assignment
Assignment (3–4 pages, not including title and reference pages):
Assignment Option 1: Adult Assessment Tools or Diagnostic Tests:
Include the following:
- A description of how the assessment tool or diagnostic test you were assigned is used in healthcare.
- What is its purpose?
- How is it conducted?
- What information does it gather?
- Based on your research, evaluate the test or the tool’s validity and reliability, and explain any issues with sensitivity, reliability, and predictive values. Include references in appropriate APA formatting.
Assignment Option 2: Child Health Case:
Include the following:
- An explanation of the health issues and risks that are relevant to the child you were assigned.
- Describe additional information you would need in order to further assess his or her weight-related health.
- Identify and describe any risks and consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this information in a sensitive fashion.
- Taking into account the parents’ and caregivers’ potential sensitivities, list at least three specific questions you would ask about the child to gather more information.
- Provide at least two strategies you could employ to encourage the parents or caregivers to be proactive about their child’s health and weight.
Week 2 Discussion Sample Paper
NURS 6512 – Assessment Tools and Diagnostic Tests in Adults and Children
BMI Assessment Tool
Student’s Name:
Institutional Affiliation:
Uses of BMI in Healthcare
Body Mass Index (BMI) is in the present times is one of the most effective anthropometric estimates of fatness for all public health purposes. BMI indicates the body size of an individual by comparing the person’s weight with their height (Hall & Cole, 2016). The results of a BMI provide a clear indication of whether a subject will have the ideal weight for their height. The BMI helps indicate if a person is underweight, has excess weight, is obese, or has healthy weight. If an individual’s BMI range is above the healthy range, such people will experience substantial health risks. For instance, having excess weight will increase the dangers of developing chronic conditions such as type 2 diabetes, cardiovascular problems and high blood pressure (Hall & Cole, 2016). Among adults, BMI is not linked with their age or their sex. However, for teens and children age and sex. Will be considered in calculating BMI. This is because, among children, girls and boys grow at different rates and will have varying levels of body fat in varying ages. For these reasons, when taking BMI measurements for children and teens, sex and age have to be taken into consideration. In measuring the BMI for children and teens, health practitioners have to locate the BMI numbers and the child’s specific age on a sex-specific BMI –for- age- chart (CDC, 2018). Such measurements provide a clear picture of whether a child has a healthy weight, is underweight or is overweight or obese. Children will be considered obese if they have a BMI for –age- equal to or greater than 95th percentile and overweight when they post a BMI for age percentile of 84th to 94th percentile (CDC, 2018).
BMI’s Validity and Reliability
The validity and reliability of BMI as a tool for determining the risk of obesity is questionable on different levels in that the measurement of body fat should be reliable and correlate with the body fat an individual may have regardless of their age, sex or ethnicity. On this count, BMI cannot be categorized as a reliable and valid measure of body fat in that the relationship between BMI and the fat percentage will be affected by different factors such as age, physical activity level, ethnicity and gender (Freedman & Sherry, 2015). Considering individual factors, other measures of adiposity may be more reliable and useful than BMI. For example, aging will be associated with many changes in the composition of the body. As a person grows older, there will be a massive reduction in muscle mass and fat-free mass and subsequent increase visceral fat even though their body weight will remain general unchanged (Zhang, Fos, Johnson, Kamali, Cox, Zuniga, & Kittle, 2018). Health risks will be more associated with visceral fat mass. Therefore as BMI does not correlate accurately with visceral fat mass, it may therefore not be considered a reliable indicator of whether a given individual is healthy or not especially children. Among children, there are considerable disparities in body mass among different sexes such as in boys and girls. Such disparities affect the reliability and validity of BMI as tools for measuring adiposity in such a population. Apart from age and gender, there are substantial ethnicity differences in body composition. Among races such as African Americans, Asians, and Hispanics, different BMI values will predispose the population to different health risks. Using BMI to determine the risk of individuals to specific issues may, therefore, not be sufficient (Freedman & Sherry, 2015).
Health Issues/Risks Relevant To the 5- Year Old Overweight African American Boy
As the 5-year-old African American boy is already overweight and spends their time after schools with their grandmother, which means they are not that much physically active, they risk developing different health complications and risks. This includes accumulating high cholesterol rates and high blood pressures which are significant risk factors for cardiovascular diseases and developing breathing problems such as sleep apnea and asthma (Gibbs & Chapman-Novakofski, 2012). The overweight African American boy is also at a high risk of developing impaired glucose resistance which may lead to type 2 diabetes, fatty liver diseases, musculoskeletal discomfort and joint problems, gastro-esophageal reflux and gallstones, among many health risks (Gibbs & Chapman-Novakofski, 2012).
Additional Information on the 5- Year Old Overweight African American Boy
To assess the weight-related health of the African American boy, one of the primary additional information I would need is information related to the nutrition the boy receives. This would include the food the family consumes based on the five food groups, the availability of food, whether the meals are healthy, snacks consumed, the method of preparation of food and the mealtime environment (Gibbs & Chapman-Novakofski, 2012).
Identification of Risks to the Childs Health
By asking about the types of food, the child is feed and also their social behaviors such, and if they play more often friends, I would be able to discern the health risks which may be facing the boy. For example, by taking a high amount of fast foods and processed foods such as snacks and not participating in physical activities, the boy could be more susceptible to obesity and accompanying health risks.
Such sensitive information would be gathered from parents. By explaining the goal of the study and the benefits it can have on the health of their children, such parents would agree to cooperate. Promising confidentiality of the information provided to the parents would also help encourage the parents to cooperate fully in the assessment of their child (Ball, Dains, Flynn, Solomon, & Stewart, 2019).
Specific Question Relating to the Child
- How many meals does the child consume in a day?
- What is the composition of meals the child consumes throughout the day?
- Is the child involved in any physical activities? How frequently?
Strategies to help Parents Control Child’s Weight and Health
One of the strategies that the African American boy’s parents would adopt to be proactive about their child’s health and weight would be encouraging the child to be involved in physical activities, for example, taking walks, cycling, and swimming. The parents would need to create time to perform such activities with their children. The next strategy would be to provide the parents with a food pyramid which they would use to determine the healthy foods and the right food combination to give their children to ensure a healthy weight. Such tools would guide the parents’ decision in preparing meals and would help the child and the parents to lose weight gradually.
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to
physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Centers for Disease Control and Prevention. (2018). Childhood overweight and obesity.
Retrieved from http://www.cdc.gov/obesity/childhood.
Freedman, D. S., & Sherry, B. (2015). The Validity of BMI as an Indicator of Body Fatness and
Risk Among Children. Pediatrics, 124(Supplement 1), S23–S34. DOI:10.1542/peds.2008-3586e
Gibbs, H., & Chapman-Novakofski, K. (2012). Exploring nutrition literacy: Attention to
assessment and the skills clients need. Health, 4(3), 120–124.
Hall, D. M., & Cole, T. J. (2016). What use is the BMI?. Archives of disease in childhood, 91(4),
283–286. DOI:10.1136/adc.2005.077339.
Zhang, L., Fos, P. J., Johnson, W. D., Kamali, V., Cox, R. G., Zuniga, M. A., & Kittle, T. (2018).
Body mass index and health-related quality of life in elementary school children: a pilot study. Health and quality of life outcomes, 6, 77. DOI:10.1186/1477-7525-6-77.
By Day 6 of Week 3
Submit your Assignment.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
- Please save your Assignment using the naming convention “WK3Assgn1+last name+first initial.(extension)” as the name.
- Click the Week 3 Assignment 1 Rubric to review the Grading Criteria for the Assignment.
- Click the Week 3 Assignment 1 link. You will also be able to “View Rubric” for grading criteria from this area.
- Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK3Assgn1+last name+first initial.(extension)” and click Open.
- If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
- Click on the Submit button to complete your submission.
Grading Criteria
To access your rubric:
Week 3 Assignment 1 Option 1 Rubric
To access your rubric:
Week 3 Assignment 1 Option 2 Rubric
To check your Assignment draft for authenticity:
Submit your Week 3 Assignment 1 draft and review the originality report.
Submit Your Assignment by Day 6 of Week 3
To participate in this Assignment:
Week 3 Assignment 1
Assignment 2: Digital Clinical Experience (DCE): Health History Assessment
A comprehensive health history is essential to providing quality care for patients across the lifespan, as it helps to properly identify health risks, diagnose patients, and develop individualized treatment plans. To effectively collect these heath histories, you must not only have strong communication skills, but also the ability to quickly establish trust and confidence with your patients. For this DCE Assignment, you begin building your communication and assessment skills as you collect a health history from a volunteer “patient.”
To Prepare
- Review this week’s Learning Resources as well as the Taking a Health History media program, and consider how you might incorporate these strategies. Download and review the Student Checklist: Health History Guide and the History Subjective Data Checklist, provided in this week’s Learning Resources, to guide you through the necessary components of the assessment.
- Access and login to Shadow Health using the link in the left-hand navigation of the Blackboard classroom.
- Review the Shadow Health Student Orientation media program and the Useful Tips and Tricks document provided in the week’s Learning Resources to guide you through Shadow Health.
- Review the Week 4 DCE Health History Assessment Rubric, provided in the Assignment submission area, for details on completing the Assignment.
DCE Health History Assessment:
Complete the following in Shadow Health:
Orientation (Required, you will not be able to access the Health History without completing the requirements).
- DCE Orientation (15 minutes)
- Conversation Concept Lab (50 minutes)
Health History
- Health History of Tina Jones (180 minutes)
Note: Each Shadow Health Assessment may be attempted and reopened as many times as necessary prior to the due date to achieve total score of 80% or better(includes BOTH DCE and Documentation), but you must take all attempts by the Week 4 Day 7 deadline.
Submission and Grading Information
No Assignment submission due this week but will be due Day 7, Week 4.
Grading Criteria
To access your rubric:
Week 4 Assignment 2 DCE Rubric
What’s Coming Up in Module 3?
In Module 3, you will examine advanced health assessments using a system focused approach.
Next week, you will specifically explore how to assess the skin, hair, and nails, as well as how to evaluate abnormal skin findings while conducting health assessments. You will also complete your first Lab Assignment: Differential Diagnosis for Skin Conditions as well as complete your DCE: Health History Assessment in the simulation tool, Shadow Health.
Week 4 Required Media
Next week, you will need to view several videos and animations in Seidel’s Guide to Physical Examination as well as other media, as required, prior to completing your Lab Assignment. There are several videos in varied lengths. Please plan ahead to ensure you have time to view these media programs to complete your Assignment on time.
Next Module
To go to the next module:
Module 3
Module 3: Approach to System-Focused Advanced Health Assessments
What’s Happening in This Module?
Module 3: Approach to System-Focused Advanced Health Assessments is a 7-week module that spans Weeks 4–10. In this module, you explore advanced health assessments using a system-focused approach. Assessments such as skin, hair, and nails as well as head, neck eyes, ears, nose, and throat (HEENT) help you to begin considering abnormalities as you move forward in your assessments. You continue the module by assessing the abdomen and gastrointestinal system and move to other systems—such as heart, lungs, vascular, musculoskeletal, neurologic—before finishing with other special examinations.
| What do I have to do? |
When do I have to do it? |
| Review your Learning Resources. |
Days 1–7, Weeks 4, 5, 6, 7, 8, 9, and 10 |
| DCE: Health History Assessment |
Complete and submit your DCE: Health History Assessment by Day 7 of Week 4. |
| Lab Assignment: Differential Diagnosis for Skin Conditions |
Submit your Lab Assignment by Day 7 of Week 4. |
| Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat |
Submit your Case Study Assignment by Day 6 of Week 5. |
| DCE: Focused Exam: Cough |
Complete and submit your DCE: Focused Exam: Cough by Day 7 of Week 5. |
| Lab Assignment: Assessing the Abdomen |
Submit your Lab Assignment by Day 7 of Week 6. |
| Midterm Exam |
Complete by Day 7 of Week 6. |
| DCE: Focused Exam: Chest Pain |
Complete and submit your DCE: Focused Exam: Chest Pain by Day 6 of Week 7. |
| Discussion: Assessing Musculoskeletal Pain |
Post by Day 3 of Week 8 and respond to your colleagues by Day 6 of Week 8. |
| Case Study Assignment: Assessing Neurological Symptoms |
Submit your Case Study Assignment by Day 6 of Week 9. |
| DCE: Comprehensive (Head-to-Toe) Physical Assessment |
Complete and submit your DCE: Comprehensive Physical Assessment by Day 7 of Week 9. |
| Lab Assignment: Assessing the Genitalia and Rectum |
Submit your Lab Assignment by Day 7 of Week 10. |
Week 4: Assessment of the Skin, Hair, and Nails
Something as small and simple as a mole or a discolored toenail can offer meaningful clues about a patient’s health. Abnormalities in skin, hair, and nails can provide non-invasive external clues to internal disorders or even prove to be disorders themselves. Being able to evaluate such abnormalities of the skin, hair, and nails is a diagnostic benefit for any nurse conducting health assessments.
This week, you will explore how to assess the skin, hair, and nails, as well as how to evaluate abnormal skin findings.
Learning Objectives
Students will:
- Apply assessment skills to diagnose skin conditions
- Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for the skin, hair, and nails
Learning Resources
Required Readings
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
- Chapter 9, “Skin, Hair, and Nails”
This chapter reviews the basic anatomy and physiology of skin, hair, and nails. The chapter also describes guidelines for proper skin, hair, and nails assessments.
Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.
Credit Line: Advanced practice nursing procedures, 1st Edition by Colyar, M. R. Copyright 2015 by F. A. Davis Company. Reprinted by permission of F. A. Davis Company via the Copyright Clearance Center.
This section explains the procedural knowledge needed prior to performing various dermatological procedures.
Chapter 1, “Punch Biopsy”
Chapter 2, “Skin Biopsy”
Chapter 10, “Nail Removal”
Chapter 15, “Skin Lesion Removals: Keloids, Moles, Corns, Calluses”
Chapter 16, “Skin Tag (Acrochordon) Removal”
Chapter 22, “Suture Insertion”
Chapter 24, “Suture Removal”
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.
Chapter 28, “Rashes and Skin Lesions”
This chapter explains the steps in an initial examination of someone with dermatological problems, including the type of information that needs to be gathered and assessed.
Note: Download and use the Student Checklist and the Key Points when you conduct your assessment of the skin, hair, and nails in this Week’s Lab Assignment.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Skin, hair, and nails: Student checklist. In Seidel’s guide to physical examination (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Skin, hair, and nails: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
· Chapter 2, “The Comprehensive History and Physical Exam” (Previously read in Weeks 1 and 3)
VisualDx. (n.d.). Clinical decision support. Retrieved June 11, 2019, from http://www.skinsight.com/info/for_professionals
This interactive website allows you to explore skin conditions according to age, gender, and area of the body.
Clothier, A. (2014). Assessing and managing skin tears in older people. Nurse Prescribing, 12(6), 278–282.
Document: Skin Conditions (Word document)
This document contains five images of different skin conditions. You will use this information in this week’s Discussion.
Document: Comprehensive SOAP Exemplar (Word document)
Document: Comprehensive SOAP Template (Word document)
Shadow Health Support and Orientation Resources
Use the following resources to guide you through your Shadow Health orientation as well as other support resources:
Frey, C. [Chris Frey]. (2015, September 4). Student orientation [Video file]. Retrieved from https://www.youtube.com/watch?v=Rfd_8pTJBkY
Document: Shadow Health Support and Orientation Resources (PDF)
Shadow Health. (n.d.). Shadow Health help desk. Retrieved from https://support.shadowhealth.com/hc/en-us
Document: Shadow Health. (2014). Useful tips and tricks (Version 2) (PDF)
Document: Shadow Health Nursing Documentation Tutorial (Word document)
Document: Student Acknowledgement Form (Word document)
Note: You will sign and date this form each time you complete your DCE Assignment in Shadow Health to acknowledge your commitment to Walden University’s Code of Conduct.
Document: DCE (Shadow Health) Documentation Template for Health History (Word document)
Use this template to complete your Assignment 2 for this week.
Optional Resources
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.
Chapter 6, “The Skin and Nails”
In this chapter, the authors provide guidelines and procedures to aid in the diagnosis of skin and nail disorders. The chapter supplies descriptions and pictures of common skin and nail conditions.
Ethicon, Inc. (n.d.-a). Absorbable synthetic suture material. Retrieved from https://web.archive.org/web/20170215015223/http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/absorbable_suture_chart.pdf
Ethicon, Inc. (2006). Dermabond topical skin adhesive application technique. Retrieved from https://web.archive.org/web/20150921174121/http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/db_application_poster.pdf
Ethicon, Inc. (2001). Ethicon needle sales types. Retrieved from https://web.archive.org/web/20150921171922/http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/needle_template.pdf
Ethicon, Inc. (n.d.-b). Ethicon sutures. Retrieved from https://web.archive.org/web/20150921202525/http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/suture_chart_ethicon.pdf
Ethicon, Inc. (2002). How to care for your wound after it’s treated with Dermabond topical skin adhesive. Retrieved from https://web.archive.org/web/20150926002534/http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/db_wound_care.pdf
Ethicon, Inc. (2005). Knot tying manual. Retrieved from https://web.archive.org/web/20160915214422/http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/knot_tying_manual.pdf
Ethicon, Inc. (n.d.-c). Wound closure manual. Retrieved from http://www.uphs.upenn.edu/surgery/Education/facilities/measey/Wound_Closure_Manual.pdf
Week 4 Assignment Sample Paper
NURS 6512 – Lab Assignment: Differential Diagnosis for Skin Conditions
SOAP Note
Student’s Name:
Institutional Affiliation:
Comprehensive SOAP NOTE
Patient Initials: ___N/A____ Age: ___N/A____ Gender: ___N/A____
SUBJECTIVE DATA:
Chief Complaint (CC): #3
History of Present Illness (HPI): A Caucasian male whose age is unknown presents with non-scaly annual papules distributed along his nape. The papules have undiluted borders and appear reddish in color.
Medications: No medical history provided.
Allergies: No known allergies.
Past Medical History (PMH): Past medical history not provided.
Past Surgical History (PSH): No surgical history provided.
Sexual/Reproductive History: Not provided. Ask about his sexuality, the number of sexual partners, pregnancy, and whether the patient has a history of sexually transmitted infections.
Personal/Social History: Not provided. Enquire on his hobbies, place of work, traveling history, and whether he smokes or use any recreational drugs.
Immunization History: Not provided. Collect the patient immunization details.
Significant Family History: Not provided. Inquire if there are family members with any skin complications. Inquire about other family’s medical conditions that might contribute to skin infections.
Review of Systems:
General: Not reported. Inquire for symptoms of fatigue, fever, sweating, or any significant weight changes.
HEENT: Not reported. Inquire about any vision or hearing changes, any chewing or swallowing difficulty, and any nasal complications.
Neck: Red lesions distributed on the back of the neck.
Breasts: No reported complications. Ask if the patient has a history of lesions, masses, or rashes.
Respiratory: No reported complications.
CV: No reported complications.
GI: No reported complications.
GU: No reported complications. Ask if the patient has had any lesions or rashes on his genital areas.
MS: No reported complications.
Psych: No reported complications.
Neuro: No reported complications.
Integument/Heme/Lymph: Red lesions at the back of the neck. Ask if the lesions are present in other parts of the body.
Endocrine: No endocrine symptoms reported.
Allergic/Immunologic: No known allergies.
OBJECTIVE DATA
Physical Exam:
Check for the patient’s vital signs. Vital signs include blood pressure, temperature, heart rate, and body mass index.
General: Check for the patient’s appearance and signs of fatigue and discomfort.
HEENT: Investigate the eyes, ears, and nose for any abnormalities.
Neck: Non-scaly annual papules at the back of the neck. Palpate the lesions to determine the texture and warmness.
Chest/Lungs: Check the chest for the presence or rashes or lesions.
Heart/Peripheral Vascular: N/A
ABD: Check the abdomen for the presence of rashes or lesions
Genital/Rectal: Investigate the genitalia for the presence of rashes.
Musculoskeletal: N/A
Neuro: N/A
Skin/Lymph Nodes: Non-scaly annual lesions at the back of the neck. Check whether there are further lesions on other skin regions.
ASSESSMENT:
Diagnostics:
Lab:
Various laboratory procedures can be used to guide the diagnosis. The following are some of the recommended procedures.
Dermoscopy. The procedure uses a skin surface microscope known as a dermatoscope to magnify the lesion (Colyar, 2015). The process aims at providing a more detailed investigation of the lesion to make a diagnosis and determine the skin lesions that require a biopsy (Colyar, 2015).
Diascopy. The process involves pressing a glass or plastic slide on the lesion and noting any color changes (Colyar, 2015). The procedure determines whether determining the type of lesions. For example, whether it is hemorrhagic or not (Colyar, 2015).
Punch Biopsy. This involves collecting a cylindrically shaped tissue sample (Colyar, 2015). The medical practitioner first cleans the skin and administers local anesthesia. The practitioner then stretches the skin and rotates a biopsy instrument while exerting downward pressure (Colyar, 2015). The procedure obtains a specimen that is then sent for culture to identify the bacteria or virus, causing the condition (Colyar, 2015).
Differential Diagnosis (DDx):
Tinea corporis. This is a skin condition that causes red, itchy, and circular rashes on the skin (Halder & Nootheti, 2014). Symptoms include itchy ring-shaped lesions that appear commonly on the arms and legs (Halder & Nootheti, 2014). However, the rashes may also appear on any part of the body. The rings may also overlap and appear red in color (Halder & Nootheti, 2014). Common causes of tinea corporis are skin to skin contact with an infected person or an animal (Halder & Nootheti, 2014).
Pityriasis rosea. This is a form of skin rash that starts as an oval spot on the back or the chest that then spreads to the other body parts (Halder & Nootheti, 2014). It commonly affects individuals between ages 10-35 and may clear on its own after around ten weeks (Halder & Nootheti, 2014). Symptoms of the condition are large and slightly raised red patches, fatigue, fever, and itching (Halder & Nootheti, 2014). The causes of pityriasis rosea are not clearly known, but some viruses are suspected of causing the infection (Halder & Nootheti, 2014).
Lupus. This is an autoimmune infection that occurs when the immune system attacks the body’s tissues and organs (Halder & Nootheti, 2014). Lupus causes an inflammation that may affect the skin, lungs, brain, kidneys, or joints (Halder & Nootheti, 2014). Lupus can be difficult to diagnose since it affects various body parts, and the symptoms vary from the type of lupus (Halder & Nootheti, 2014). Some symptoms of Lupus include red skin lesions that appear in areas exposed to the Sun., butterfly-shaped rashes in various body parts, fever, fatigue, chest pain, dry eyes, and headaches (Halder & Nootheti, 2014).
Guttate psoriasis. This is a form of a skin condition that appears as a red small itchy lesion (Dains, Baumann, & Scheibel, 2015). It is a form of an autoimmune disease that might occur more than once in a lifetime (Dains et al., 2015). Gutate psoriasis usually occurs on the face, ears, scalp, neck, legs, and arms (Dains et al., 2015). Guttate psoriasis is usually caused by bacterial infections, especially streptococcus (Dains et al., 2015). In some cases, genetic factors can play a role if there are several family members with the condition (Dains et al., 2015).
Patient’ problem/diagnosis:
Granuloma annulare. This a skin condition that causes circular reddish lesions. It is usually triggered by skin injuries or particular drugs (Halder & Nootheti, 2014). The condition may disappear on its own after approximately two years without treatment (Halder & Nootheti, 2014). However, treatment can help speed up healing. The symptoms of granuloma annulare depend on the type of infection (Halder & Nootheti, 2014). For example, localized granuloma annulare causes skin-colored lesions that occur on the feet, wrists, and hands (Halder & Nootheti, 2014). Generalized granuloma annulare causes red lesions on areas such as the neck, legs, and arms (Halder & Nootheti, 2014). The lesions in granuloma annulare are usually annular bumps that might spread to various parts of the body (Halder & Nootheti, 2014).
Discussion:
Making a diagnosis for skin conditions can be difficult since the symptoms are often similar to those of other conditions. In the case of this discussion, it is particularly difficult because the patient was not physically present, and the diagnosis depended on an image interpretation. The selected primary diagnosis for this discussion was granuloma annulare because the patient had symptoms of non-scaly annual papules distributed along his nape. The symptoms are similar to what shows in cases of granuloma annulare. However, it is also possible for the patient to have conditions such as tinea corporis, pityriasis rosea, and lupus because the conditions also manifest red circular lesions in some cases. Therefore, further lab assessment and physical exams may be needed for an accurate diagnosis.
References
Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2015). Advanced Health Assessment & Clinical Diagnosis in Primary Care-E-Book. Elsevier Health Sciences.
Halder, R. M., & Nootheti, P. K. (2014). Ethnic skin disorders overview. Journal of the American Academy of Dermatology, 48(6), S143-S148.
Module 3 Introduction
Dr. Tara Harris reviews the overall expectations for Module 3. Consider how you will manage your time as you review your media and Learning Resources for your Discussions, Case Study Lab Assignments, DCE Assignments, and your Midterm exam (12m).
Skin, Hair, and Nails – Week 4 (19m)
Online media for Seidel’s Guide to Physical Examination
In addition to this week’s media, it is highly recommended that you access and view the online resources included with the text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapter 8 that relate to the assessment of the skin, hair, and nails.
Note: To access the online resources included with the text, you need to complete the FREE online registration that is located at https://evolve.elsevier.com/cs/product/9780323172660?role=student .
To Register to View the Content
- Go to https://evolve.elsevier.com/cs/product/9780323172660?role=student
- Enter the name of the textbook, Seidel’s Guide to Physical Examination (name of text without the edition number) in the Search textbox.
- Complete the registration process.
To View the Content for this Text
- Go to https://evolve.elsevier.com/
- Click on Student Site.
- Type in your username and password.
- Click on the Login button.
- Click on the plus sign icon for Resources on the left side of the screen.
- Click on the name of the textbook for this course.
- Expand the menu on the left to locate all the chapters.
- Navigate to the desired content (checklists, videos, animations, etc.).
Note: Clicking on the URLs in the APA citations for the Resources from the textbook will not link directly to the desired online content. Use the online menu to navigate to the desired content.
Suturing Tutorials
The following suturing tutorials provide instruction on the basic interrupted suture, as well as the vertical and horizontal mattress suturing techniques
Tulane Center for Advanced Medical Simulation & Team Training. (2010, July 8). Suturing technique [Video file]. Retrieved from https://www.youtube.com/watch?v=c-LDmCVtL0o
Note: Approximate length of this media program is 5 minutes.
Mikheil. (2014, April 22). Basic suturing: Simple, interrupted, vertical mattress, horizontal mattress [Video file]. Retrieved from https://www.youtube.com/watch?v=MFP90aQvEVM
Note: Approximate length of this media program is 9 minutes.
Incision and Drainage of an Abscess (a common procedure in primary care)
New England Journal of Medicine (NEJM). (2013, September 30). NEJM abscess incision and drainage [Video file]. Retrieved from https://www.youtube.com/watch?v=MwgNdrA18fM&list=PL9UKTUFtRDcNq4–Vf2NYfUANEyObfeNm&index=8
Note: Approximate length of this media program is 10 minutes.
Dermablade Use for Shave Biopsies
Dermablade®. (2012, November 9). PersonnaBlades [Video file]. Retrieved from https://www.youtube.com/watch?v=D8u1Y18L9DQ
Note: Approximate length of this media program is 5 minutes.
Assignment 1: Lab Assignment: Differential Diagnosis for Skin Conditions
Properly identifying the cause and type of a patient’s skin condition involves a process of elimination known as differential diagnosis. Using this process, a health professional can take a given set of physical abnormalities, vital signs, health assessment findings, and patient descriptions of symptoms, and incrementally narrow them down until one diagnosis is determined as the most likely cause.
In this Lab Assignment, you will examine several visual representations of various skin conditions, describe your observations, and use the techniques of differential diagnosis to determine the most likely condition.
To Prepare
- Review the Skin Conditions document provided in this week’s Learning Resources, and select one condition to closely examine for this Lab Assignment.
- Consider the abnormal physical characteristics you observe in the graphic you selected. How would you describe the characteristics using clinical terminologies?
- Explore different conditions that could be the cause of the skin abnormalities in the graphics you selected.
- Consider which of the conditions is most likely to be the correct diagnosis, and why.
- Search the Walden library for one evidence-based practice, peer-reviewed article based on the skin condition you chose for this Lab Assignment.
- Review the Comprehensive SOAP Exemplar found in this week’s Learning Resources to guide you as you prepare your SOAP note.
- Download the SOAP Template found in this week’s Learning Resources, and use this template to complete this Lab Assignment.
The Lab Assignment
- Choose one skin condition graphic (identify by number in your Chief Complaint) to document your assignment in the SOAP (Subjective, Objective, Assessment, and Plan) note format rather than the traditional narrative style. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in this week’s Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case.
- Use clinical terminologies to explain the physical characteristics featured in the graphic. Formulate a differential diagnosis of three to five possible conditions for the skin graphic that you chose. Determine which is most likely to be the correct diagnosis and explain your reasoning using at least three different references, one reference from current evidence-based literature from your search and two different references from this week’s Learning Resources.
By Day 7 of Week 4
Submit your Lab Assignment.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
- Please save your Assignment using the naming convention “WK4Assgn1+last name+first initial.(extension)” as the name.
- Click the Week 4 Assignment 1 Rubric to review the Grading Criteria for the Assignment.
- Click the Week 4 Assignment 1 link. You will also be able to “View Rubric” for grading criteria from this area.
- Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK4Assgn1+last name+first initial.(extension)” and click Open.
- If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
- Click on the Submit button to complete your submission.
Grading Criteria
To access your rubric:
Week 4 Assignment 1 Rubric
Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:
Submit your Week 4 Assignment 1 draft and review the originality report.
Week 4 Assignment Sample Paper
NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning
Advanced Health Assessment and Diagnostic Reasoning
Student’s Name:
Institutional Affiliation:
Patients Initials: Age: Gender: Male
Subjective Data
Chief Complaint: The patient no. 1 is a middle aged white male who complains of multiple red, oval-shaped bumps on the chest that bleeds when scratched or cut open.
History of the illness: The patient presents with red moles that started developing since the early thirties and increases in size and number as the patient ages.
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Objective Data
The physical examination shows that the patient 1 presents with chest skin growths referred to as lesions, which vary in appearance, ranging from small red macules to a larger dome-topped polypoid papule. The color of the lesions ranges from bright red to dark red, depending on their stage of development and trauma applied on them.
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ASSESSMENT
Differential Diagnosis
One of the differential diagnoses, in this case, is acute Urticarial. It refers to a vascular reaction of the skin. Clinical presentations include smooth, slightly elevated papules and plaques that are erythematous and that are often attended by severe pruritus. However, unlike in the current scenario, urticarial is self-limited and of short duration. The papules last between several hours to several days and resolve without scarring, and without any clinical intervention (Guastafierro et al. 2019). In cases of Chronic urticarial, there is the recurrence of the lesions and can last for as long as six weeks. Additionally, the lesions reaction is unsystematic in that they don’t attack any specific body part. They are equitably distributed to all body parts.
Insect bite from blood feeders such as bed bugs is another differential diagnosis in this case. Once bitten by such insects, blood-filled lesions appear several hours in the bitten area after the bite. However, unlike in the current scenario, in blood feeder insect bites, the lesion is as large as 6 cm and worsen just after sleep episodes. They also mostly appear in the linear form, in exposed body parts such as legs, arms, and face and keep relocating due to new bites.
Bacillary angiomatosis is another differential diagnosis in this scenario. It refers to the development of multiple red, purple, flesh-colored, or colorless Cutaneous lesions that vary in sizes, with the smallest being about 1mm. They are caused by immunodeficiency thus are commonest in immunocompromised persons such as HIV positive individuals. However, unlike in the current scenario, the Lesions mostly affect the oral mucosa, tongue, oropharynx, nose, penis, and anus. The lesions are also accompanied by other symptoms including Bone pain, Fever, chills, malaise, night sweats, anorexia, and weight loss.
Melanoma is another differential diagnosis.it refers to a type of skin cancer. Clinical presentation entails skin changes, such as a skin sore that fails to heal and a firm red lump that bleeds when scratched and a flat, red spot that is rough, dry, or scaly (Swetter & Geller, 2018). It is caused by mutation of melanocytes, the pigment-producing cells, in to cancerous cells. The lesions mostly affect the chest and back. However, it is most common in women than in men.
Most Likely Correct Diagnosis
The most likely accurate diagnosis in this scenario is Cherry Angioma. It refers to a skin tumor that results from the overgrowth of blood capillaries. It is most common in older adults after 30 years of age and affects 60% of adults. It is characterized by oval-shaped lesions whose color ranges from bright red, due to dilated capillaries to dark red, when pressure is applied, that bleed when scratched, increases in size and number as the own ages (Espinosa et al. 2018). The lesions are painless but uncomfortable if burst open. The angiomas affect mostly the chest, stomach, and back often appear in groups.
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Plan of Care
Since the lesions are mostly painless therefore not a health concern, the method of care takes a cosmetic dimension. An excision process that entails shaving the lesion off the skin is recommended. An anesthetic is applied to minimize pain during the process. They can also be removed through electrodesiccation, which involves burning the skin growth with an electric needle to destroy the blood vessels. However, both processes leave scars. A biopsy on lesions is preferred in removing traumatized lesions where scarring is a concern |
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References
Espinosa Lara, P., Medina-Puente, C., Riquelme Oliveira, A., & Jiménez-Reyes, J. (2018). Eruptive cherry angiomas developing in a patient treated with ramucirumab. Acta Oncologica, 57(5), 709-711.
Guastafierro, A., Verdura, V., Di Pace, B., Faenza, M., & Rubino, C. (2019). The Influence of Breast Cancer on the Distribution of Cherry Angiomas on the Anterior Thoracic Wall: A Case Series Study. Dermatology, 235(1), 65-70.
Swetter, S., & Geller, A. (2018). Melanoma: Clinical features and diagnosis. U: UpToDate.
Submit Your Assignment by Day 7 of Week 4
To participate in this Assignment:
Week 4 Assignment 1
Assignment 2: Digital Clinical Experience (DCE): Health History Assessment
In Week 3, you began your DCE: Health History Assessment. For this week, you will complete this Health History Assessment in your simulation tool, Shadow Health and finalize for submission.
To Prepare
- Review this week’s Learning Resources as well as the Taking a Health History media program in Week 3, and consider how you might incorporate these strategies. Download and review the Student Checklist: Health History Guide and the History Subjective Data Checklist, provided in this week’s Learning Resources, to guide you through the necessary components of the assessment.
- Review the DCE (Shadow Health) Documentation Template for Health History found in this week’s Learning Resources and use this template to complete your Documentation Notes for this DCE Assignment.
- Access and login to Shadow Health using the link in the left-hand navigation of the Blackboard classroom.
- Review the Shadow Health Student Orientation media program and the Useful Tips and Tricks document provided in the week’s Learning Resources to guide you through Shadow Health.
- Review the Week 4 DCE Health History Assessment Rubric, provided in the Assignment submission area, for details on completing the Assignment.
Note: There are 2 parts to this assignment – the lab pass and the documentation. You must achieve a total score of 80% in order to pass this assignment. Carefully review the rubric and video presentation in order to fully understand the requirements of this assignment.
DCE Health History Assessment:
Complete the following in Shadow Health:
Orientation
- DCE Orientation (15 minutes)
- Conversation Concept Lab (50 minutes)
Health History
- Health History of Tina Jones (180 minutes)
Note: Each Shadow Health Assessment may be attempted and reopened as many times as necessary prior to the due date to achieve a total of 80% or better (this includes your DCE and your Documentation Notes), but you must take all attempts by the Week 4 Day 7 deadline.
Submission and Grading Information
By Day 7 of Week 4
- Complete your Health Assessment DCE assignments in Shadow Health via the Shadow Health link in Blackboard.
- Once you complete your assignment in Shadow Health, you will need to download your lab pass and upload it to the corresponding assignment in Blackboard for your faculty review.
- (Note: Please save your lab pass as “LastName_FirstName_AssignmentName”.) You can find instructions for downloading your lab pass here: https://link.shadowhealth.com/download-lab-pass
- Once you submit your Documentation Notes to Shadow Health, make sure to copy and paste the same Documentation Notes into your Assignment submission link below.
- Download, sign, date, and submit your Student Acknowledgement Form found in the Learning Resources for this week.
- Note: You must pass this assignment with a minimum score of 80% in order to pass the class. Once submitted, there are not any opportunities to revise or repeat this assignment.
Grading Criteria
To access your rubric:
Week 4 Assignment 2 DCE Rubric
Submit Your Assignment by Day 7 of Week 4
To submit your Lab Pass:
Week 4 Lab Pass
To submit this required part of the Assignment:
Week 4 Documentation Notes for Assignment 2
To Submit your Student Acknowledgement Form:
Submit your Week 4 Assignment 2 DCE Student Acknowledgement Form
Assignment 3 (Optional) Practice Assessment: Skin, Hair, and Nails Examination
Advanced practice nurses are required to have the skills and knowledge necessary to perform many different physical assessments and health examinations. In this course, you will demonstrate your abilities in this area by conducting various optional examinations on a volunteer “patient.”
In preparation for the Comprehensive (Head-to-Toe) Physical Assessment due in Week 9, it is recommended that you practice conducting an assessment of the skin, hair, and nails this week.
Note: This is an optional practice physical assessment.
To Prepare
- Arrange an appropriate time and setting with your volunteer “patient” to perform a skin, hair, and nails examination.
- Download and review the Skin, Hair, and Nails Student Checklist and Key Points, provided in this week’s Learning Resources, and review the Seidel’s Guide to Physical Examination online media.
Optional Lab Assignment
- Perform the skin, hair, and nails examination, covering all of the areas listed in the checklist.
What’s Coming Up in Week 5?
Next week, you examine how to properly assess the head, neck, eyes, ears, nose, and throat in order to form accurate diagnoses as you complete your Case Study Assignment of the Skin, Hair, Nails, and HEENT. You will once again complete a DCE related to a Focused Exam for cough. Make sure to plan ahead with your Please plan your time accordingly.
Week 5 Required Media
Next week, you will need to view several videos and animations in the Seidel’s Guide to Physical Examination as well as other media, as required, prior to completing your Case Study Assignment. There are several videos of various lengths. Please plan ahead to ensure you have time to view these videos and animations to complete your Assignment on time.
Next Week
To go to the next week:
Week 5
Week 5: Assessment of Head, Neck, Eyes, Ears, Nose, and Throat
Emily, age 15, is brought to your clinic complaining of chills, aches, and a sore throat. Without any testing, consider all of the possible diagnoses. It could be a cold, the flu, bronchitis, or even something more serious, such as meningitis or mononucleosis. Assessing the actual cause will involve much more than simple visual inspection. Some conditions are so subtle that they require the use of special instruments and tests in addition to a trained eye and ear.
This week, you will explore how to assess the head, neck, eyes, ears, nose, and throat. Whether dealing with a detached retina, sinusitis, meningitis, or even cough, advanced practice nurses need to know the proper assessment techniques in order to form accurate diagnoses.
Learning Objectives
Students will:
- Apply assessment skills to diagnose eye, ear, and throat conditions
- Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for the head, neck, eyes, ears, nose, and throat
Learning Resources
Required Readings
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
· Chapter 11, “Head and Neck”
This chapter reviews the anatomy and physiology of the head and neck. The authors also describe the procedures for conducting a physical examination of the head and neck.
· Chapter 12, “Eyes”
In this chapter, the authors describe the anatomy and function of the eyes. In addition, the authors explain the steps involved in conducting a physical examination of the eyes.
· Chapter 13, “Ears, Nose, and Throat”
The authors of this chapter detail the proper procedures for conducting a physical exam of the ears, nose, and throat. The chapter also provides pictures and descriptions of common abnormalities in the ears, nose, and throat.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.
· Chapter 15, “Earache”
This chapter covers the main questions that need to be asked about the patient’s condition prior to the physical examination as well as how these questions lead to a focused physical examination.
· Chapter 21, “Hoarseness”
This chapter focuses on the most common causes of hoarseness. It provides strategies for evaluating the patient, both through questions and through physical exams.
· Chapter 25, “Nasal Symptoms and Sinus Congestion”
In this chapter, the authors highlight the key questions to ask about the patients symptoms, the key parts of the physical examination, and potential laboratory work that might be needed to provide an accurate diagnosis of nasal and sinus conditions.
· Chapter 30, “Red Eye”
The focus of this chapter is on how to determine the cause of red eyes in a patient, including key symptoms to consider and possible diagnoses.
· Chapter 32, “Sore Throat”
A sore throat is one most common concerns patients describe. This chapter includes questions to ask when taking the patient’s history, things to look for while conducting the physical exam, and possible causes for the sore throat.
· Chapter 38, “Vision Loss”
This chapter highlights the causes of vision loss and how the causes of the condition can be diagnosed.
Note: Download the six documents (Student Checklists and Key Points) below, and use them as you practice conducting assessments of the head, neck, eyes, ears, nose, and throat.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Head and neck: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Ball, J. W., Dains, J. E., Flynn, J. A., & Solomon, B. S., & Stewart, R. W. (2019). Head and neck: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Eyes: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Eyes: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Ears, nose, and throat: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Ears, nose, and throat: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.
Credit Line: Advanced practice nursing procedures, 1st Edition by Colyar, M. R. Copyright 2015 by F. A. Davis Company. Reprinted by permission of F. A. Davis Company via the Copyright Clearance Center.
· Chapter 71, “Visual Function Evaluation: Snellen, Illiterate E, Pictorial
This section explains the procedural knowledge needed to perform eyes, ears, nose, and mouth procedures.
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
· Chapter 2, “The Comprehensive History and Physical Exam” (Previously read in Weeks 1, 3, 4, and 5)
Bedell, H. E., & Stevenson, S. B. (2013). Eye movement testing in clinical examination. Vision Research 90, 32–37. doi:10.1016/j.visres.2013.02.001. Retrieved from https://www.sciencedirect.com/science/article/pii/S0042698913000217
Rubin, G. S. (2013). Measuring reading performance. Vision Research, 90, 43–51. doi:10.1016/j.visres.2013.02.015. Retrieved from http://www.sciencedirect.com/science/article/pii/S0042698913000436
Harmes, K. M., Blackwood, R. A., Burrows, H. L., Cooke, J. M., Harrison, R. V., & Passamani, P. P. (2013). Otitis media: Diagnosis and treatment. American Family Physicians, 88(7), 435–440.
Otolaryngology Houston. (2014). Imaging of maxillary sinusitis (X-ray, CT, and MRI). Retrieved from http://www.ghorayeb.com/ImagingMaxillarySinusitis.html
This website provides medical images of sinusitis, including X-rays, CT scans, and MRIs (magnetic resonance imaging).
Document: Episodic/Focused SOAP Note Exemplar (Word document)
Document: Episodic/Focused SOAP Note Template (Word document)
Document: Midterm Exam Review (Word document)
Shadow Health Support and Orientation Resources
Frey, C. [Chris Frey]. (2015, September 4). Student orientation [Video file]. Retrieved from https://www.youtube.com/watch?v=Rfd_8pTJBkY
Shadow Health. (n.d.). Shadow Health help desk. Retrieved from https://support.shadowhealth.com/hc/en-us
Document: Shadow Health. (2014). Useful tips and tricks (Version 2) (PDF)
Document: Student Acknowledgement Form (Word document)
Note: You will sign and date this form each time you complete your DCE Assignment in Shadow Health to acknowledge your commitment to Walden University’s Code of Conduct.
Document: DCE (Shadow Health) Documentation Template for Focused Exam: Cough (Word document)
Use this template to complete your Assignment 2 for this week.
Optional Resource
Use the following resources to guide you through your Shadow Health orientation as well as other support resources:
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.
· Chapter 7, “The Head and Neck” (pp. 178–301)
This chapter describes head and neck examinations that can be made with general clinical resources. Also, the authors detail syndromes of common head and neck conditions.
Required Media
Assessment of the Head, Neck, Eyes, Ears, Nose, and Throat – Week 5 (29m)
Online media for Seidel’s Guide to Physical Examination
It is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapters 10, 11, and 12 that relate to the assessment of the head, neck, eyes, ears, nose, and throat. Refer to the Week 4 Learning Resources area for access instructions on https://evolve.elsevier.com/.
University of Iowa Ophthalmology. (2016, December 19). Fluorescein staining of the cornea. Retrieved from https://vimeo.com/198695974
Credit Line: University of Iowa Ophthalmology. (n.d.). Fluorescein staining of the cornea [Video file]. Retrieved from https://vimeo.com/198695974. The author(s) and publishers acknowledge the University of Iowa and EyeRounds.org for permission to reproduce this copyrighted material.
Note: Approximate length of this media program is 25 seconds.
Assignment 1: Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat
Most ear, nose, and throat conditions that arise in non-critical care settings are minor in nature. However, subtle symptoms can sometimes escalate into life-threatening conditions that require prompt assessment and treatment.
Nurses conducting assessments of the ears, nose, and throat must be able to identify the small differences between life-threatening conditions and benign ones. For instance, if a patient with a sore throat and a runny nose also has inflamed lymph nodes, the inflammation is probably due to the pathogen causing the sore throat rather than a case of throat cancer. With this knowledge and a sufficient patient health history, a nurse would not need to escalate the assessment to a biopsy or an MRI of the lymph nodes but would probably perform a simple strep test.
In this Case Study Assignment, you consider case studies of abnormal findings from patients in a clinical setting. You determine what history should be collected from the patients, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions.
To Prepare
- By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
- Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP Notes have specific data included in every patient case.
With regard to the case study you were assigned:
- Review this week’s Learning Resources and consider the insights they provide.
- Consider what history would be necessary to collect from the patient.
- Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
- Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
The Assignment
Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis and justify why you selected each.
By Day 6 of Week 5
Submit your Assignment.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
- Please save your Assignment using the naming convention “WK5Assgn1+last name+first initial.(extension)” as the name.
- Click the Week 5 Assignment 1 Rubric to review the Grading Criteria for the Assignment.
- Click the Week 5 Assignment 1 link. You will also be able to “View Rubric” for grading criteria from this area.
- Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK5Assgn1+last name+first initial.(extension)” and click Open.
- If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
- Click on the Submit button to complete your submission.
Grading Criteria
To access your rubric:
Week 5 Assignment 1 Rubric
Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:
Submit your Week 5 Assignment 1 draft and review the originality report.
Submit Your Assignment by Day 6 of Week 5
To participate in this Assignment:
Week 5 Assignment 1
Week 5 Assignment Sample Paper
NURS 6512 – Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat
Episodic/Focused SOAP Note Template
Patient Information:
65 year Old AA male
S.
CC Chest pain.
HPI: The individual in this case is a 65 year Old AA male. The patient indicates that he developed an abrupt commencement of chest pain that commenced early in the morning. The patient indicates the pain as crushing and is ranked 9/10 in pain scale. The aching’s location is in the interior of the ribcage, and this is complemented by shortness of breath. On probing, the individuals indicated feeling nauseated. The individual has also tried medication such as antacid with negligible reprieve of his signs. The patient has a positive history of GERD and hypertension that have previously been controlled.
The patient also indicates the mother passed on at 78 of breast cancer, Father at 75 of CVA. The patient does not exhibit an account of untimely cardiac disease in first degree relations. The patient has been married for the last 39 years.
Location: Chest.
Onset: early in the morning.
Character: Crushing pain in the middle of the chest.
Associated signs and symptoms: nauseous without vomiting.
Timing: no sufficient information.
Exacerbating/ relieving factors: antacid with minimal relief of the symptoms.
Severity: 9/10 pain scale
Current Medications: antacids with minimal relief on the symptoms.
Allergies: No known allergies.
PMHx: positive history of GERD and hypertension is controlled.
Soc Hx: currently consumes moderate alcohol and negative for tobacco use.
Fam Hx: The mother passed on at 78 of breast cancer, Father at 75 of CVA. There is no account of untimely cardiac ailment in first degree.
ROS:
GENERAL: negative for fever, chills, fatigue.
HEENT: No evidence of HEENT examination.
SKIN: No evidence of skin examination.
CARDIOVASCULAR: negative for orthopnea, PND, positive for sporadic lower extremity edema.
RESPIRATORY: no evidence of respiratory examination.
GASTROINTESTINAL: positive for nausea without vomiting, negative for diarrhea, abdominal pain.
GENITOURINARY: not applicable.
NEUROLOGICAL: no evidence of neurological examination.
MUSCULOSKELETAL: no evidence of musculoskeletal examination.
HEMATOLOGIC: no evidence of hematologic examination.
LYMPHATICS: no report of lymphatic examination.
PSYCHIATRIC: no report of psychiatric examination.
ENDOCRINOLOGIC: no report of endocrinologic examination.
ALLERGIES: no report of allergies.
O.
VS: BP 186/102; P 94; R 22; T 97.8; 02 96% Wt 235lbs; Ht 70”
Physical exam: The results of electrocardiography (EKG), chest radiograph (CXR), and CK-MB test, indicate that the lungs are clear to auscultation and percussion bilaterally. The Pt looks diaphretic and restless. PMI is in the 5th inter costal space at the mid clavicular line. A grade 2/6 systolic decrescendo murmur is perceived best at the second right inner costal space that discharges to the neck. A third heart sound is heard at the Apex. No fourth heart sound or rub are heard. No cyanosis, clubbing, noted, positive for bilateral 2+LE edema is noted.
The abdomen is proportioned devoid of distention, bowel noises are ordinary quality and concentration in all parts, a bruit is heard in the right para umbilical area. No masses or splenomegaly are eminent. Positive for mid-epigastric inflammation with profound palpation. The lungs are flawless to auscultation and percussion jointly.
Diagnostic results: EKG, CXR, CK-MB.
A.
Differential Diagnoses
The physical exam comprises of an active observational examination of the individual. According to Balogh, Miller, and Ball (2015), the nurse should first observe the patient’s behavior, complexion, posture, level or distress, and any other signs which might contribute to the understanding of the health of the patient. A physical exam can include the entire HEENT examination, which can assist the nurse to enhance the steps taken in the diagnostic process. In the long run, this can avert unnecessary diagnostic testing and build trust with the patient (Balogh, Miller & Ball, 2015). Some of the physical examinations that should be conducted on the patient can include the following.
First, inspection where the clinician can look at or inspect specific areas for abnormalities. Second, palpation where the nursing practitioner can use their hands to feel for abnormalities during the health assessment (“Techniques of Physical Assessment: NCLEX-RN”, 2020). In the basic HEENT examination, the nursing practitioner can commence by checking for any deformities or asymmetry. After completing the head, the clinician should proceed to the eyes, ears, nose, and mouth. In checking the eyes, the nurse should assess for eye movement (Haber et al., 2015). For this patient experiencing chest pains, one of the most recommended tests is the ECG/EKG, CXR, CK-MB test that can determine if the patient suffers from a heart-related issue (Chamley, Holdsworth, Rajappan & Nicol, 2019).
Based on the symptoms depicted by the patient, they most probably have the following illnesses.
GERD: GERD is also known as gastroesophageal reflux disease. The patient has a past history of GERD. GERD is chronic acid reflux, and it makes the patients experience pain in the chest.
Hypertrophic cardiomyopathy: this occurs when the heart grows too thick because of genetic factors (Marian & Braunwald, 2017). The thickening of the heart can can prevent blood from flowing from the heart properly. Some of the symptoms include chest pains, shortness of breath, and dizziness.
Myocardial ischemia: occurs when there is little blood flow to the heart muscles, thereby preventing the heart from receiving enough oxygen (Heusch, 2016). Some of the symptoms of myocardial ischemia include shortness of breath and pain in the chest.
Pulmonary embolism: this entails the blockage of the pulmonary arteries in the lungs. It is caused by blood clots that travel to the lungs from deep veins in the legs. Some of the symptoms include shortness of breath and chest pain.
Chronic obstructive pulmonary disease (COPD): this is a chronic inflammatory lung disease that causes obstructed airflow from the lung (Qureshi, Sharafkhaneh & Hanania, 2014). COPD also has distinct symptoms that cause shortness of breath and chest pain.
For the nursing practitioner to understand the root cause of the pain in the chest this necessitates an ECG test that can check all the underlying patient conditions.
References
Balogh, E., Miller, B., & Ball, J. (2015). The Diagnostic Process. Retrieved 26 December 2020, from https://www.ncbi.nlm.nih.gov/books/NBK338593/
Chamley, R., Holdsworth, D., Rajappan, K., & Nicol, E. (2019). ECG interpretation. European Heart Journal, 40(32), 2663-2666. doi: 10.1093/eurheartj/ehz559
Haber, J., Hartnett, E., Allen, K., Hallas, D., Dorsen, C., & Lange-Kessler, J. et al. (2015). Putting the Mouth Back in the Head: HEENT to HEENOT. American Journal Of Public Health, 105(3), 437-441. doi: 10.2105/ajph.2014.302495
Heusch, G. (2016). Myocardial Ischemia. Circulation Research, 119(2), 194-196. doi: 10.1161/circresaha.116.308925
History & Physical Exam | SEER Training. (2020). Retrieved 26 December 2020, from https://training.seer.cancer.gov/diagnostic/history.html
Marian, A., & Braunwald, E. (2017). Hypertrophic Cardiomyopathy. Circulation Research, 121(7), 749-770. doi: 10.1161/circresaha.117.311059
Qureshi, H., Sharafkhaneh, A., & Hanania, N. (2014). Chronic obstructive pulmonary disease exacerbations: latest evidence and clinical implications. Therapeutic Advances In Chronic Disease, 5(5), 212-227. doi: 10.1177/2040622314532862
Techniques of Physical Assessment: NCLEX-RN. (2020). Retrieved 26 December 2020, from https://www.registerednursing.org/nclex/techniques-physical-assessment/
Assignment 2: Digital Clinical Experience: Focused Exam: Cough
In this DCE Assignment, you will conduct a focused exam related to cough in your DCE using the simulation tool, Shadow Health. You will determine what history should be collected from the patient, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions.
To Prepare
- Review this week’s Learning Resources and consider the insights they provide related to ears, nose, and throat.
- Review the Shadow Health Resources provided in this week’s Learning Resources specifically the tutorial to guide you through the documentation and interpretation within the Shadow Health platform. Review the examples also provided.
- Review the DCE (Shadow Health) Documentation Template for Focused Exam: Cough found in this week’s Learning Resources and use this template to complete your Documentation Notes for this DCE Assignment.
- Access and login to Shadow Health using the link in the left-hand navigation of the Blackboard classroom.
- Review the Week 5 Focused Exam: Cough Rubric provided in the Assignment submission area for details on completing the Assignment in Shadow Health.
- Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
Focused Exam: Cough Assignment:
Complete the following in Shadow Health:
- Respiratory Concept Lab (Required)
- Episodic/Focused Note for Focused Exam: Cough
- HEENT (Recommended but not required)
Note: Each Shadow Health Assessment may be attempted and reopened as many times as necessary prior to the due date to achieve a total of 80% or better (this includes your DCE and your Documentation Notes), but you must take all attempts by the Week 5 Day 7 deadline.
Submission and Grading Information
By Day 7 of Week 5
- Complete your Focused Exam: Cough DCE Assignment in Shadow Health via the Shadow Health link in Blackboard.
- Once you complete your Assignment in Shadow Health, you will need to download your lab pass and upload it to the corresponding assignment in Blackboard for your faculty review.
- (Note: Please save your lab pass as “LastName_FirstName_AssignmentName”.) You can find instructions for downloading your lab pass here: https://link.shadowhealth.com/download-lab-pass
- Once you submit your Documentation Notes to Shadow Health, make sure to copy and paste the same Documentation Notes into your Assignment submission link below.
- Download, sign, date, and submit your Student Acknowledgement Form found in the Learning Resources for this week.
Grading Criteria
To access your rubric:
Week 5 Assignment 2 DCE Rubric
Submit Your Assignment by Day 7 of Week 5
To submit your Lab Pass:
Week 5 Lab Pass
To participate in this Assignment:
Week 5 Documentation Notes for Assignment 2
To Submit your Student Acknowledgement Form:
Submit your Week 5 Assignment 2 DCE Student Acknowledgement Form
What’s Coming Up in Week 6?
Next week, you will evaluate abnormal findings in the area of the abdomen and the gastrointestinal system. In addition, you will appraise health assessment techniques and diagnoses for the heart, lungs, and peripheral vascular system as you complete your Lab Assignment in assessing the abdomen in a SOAP note format. You will also take your Midterm Exam, which covers the topics in Weeks 1–6. Please review the previous weekly content and resources to help you prepare for your exam. Plan your time accordingly.
Week 6 Required Media
Next week, you will need to view several videos and animations in the Seidel’s Guide to Physical Examination as well as other media, as required, prior to completing your Lab Assignment. There are several videos of various lengths. Please plan ahead to ensure you have time to view these media programs to complete your Assignment on time.
Next Week
To go to the next week:
Week 6
Week 6: Assessment of the Abdomen and Gastrointestinal System
On your way home from dinner, you start experiencing sharp pains in your abdomen. You ate seafood—could you have food poisoning? What else might be causing your pain? Appendicitis? Should you head to the emergency room, or should you wait and see how you feel in the morning?
Numerous ailments can affect the GI system and the abdomen. Because the organs are so close, it can be difficult to conduct an accurate assessment. Also, pain in another area of the body can affect the GI system. For example, patients with chronic migraines often report nausea.
This week, you will explore how to assess the abdomen and gastrointestinal system.
Learning Objectives
Students will:
- Evaluate abnormal abdomen and gastrointestinal findings
- Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for the abdomen and gastrointestinal system
- Identify concepts, theories, and principles related to advanced health assessment
Learning Resources
Required Readings
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
· Chapter 6, “Vital Signs and Pain Assessment”
This chapter describes the experience of pain and its causes. The authors also describe the process of pain assessment.
· Chapter 18, “Abdomen”
In this chapter, the authors summarize the anatomy and physiology of the abdomen. The authors also explain how to conduct an assessment of the abdomen.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.
· Chapter 3, “Abdominal Pain”
This chapter outlines how to collect a focused history on abdominal pain. This is followed by what to look for in a physical examination in order to make an accurate diagnosis.
· Chapter 10, “Constipation”
The focus of this chapter is on identifying the causes of constipation through taking a focused history, conducting physical examinations, and performing laboratory tests.
· Chapter 12, “Diarrhea”
In this chapter, the authors focus on diagnosing the cause of diarrhea. The chapter includes questions to ask patients about the condition, things to look for in a physical exam, and suggested laboratory or diagnostic studies to perform.
· Chapter 29, “Rectal Pain, Itching, and Bleeding”
This chapter focuses on how to diagnose rectal bleeding and pain. It includes a table containing possible diagnoses, the accompanying physical signs, and suggested diagnostic studies.
Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.
Credit Line: Advanced practice nursing procedures, 1st Edition by Colyar, M. R. Copyright 2015 by F. A. Davis Company. Reprinted by permission of F. A. Davis Company via the Copyright Clearance Center.
These sections below explain the procedural knowledge needed to perform gastrointestinal procedures.
Chapter 107, “X-Ray Interpretation: Chest (pp. 480–487)
Chapter 115, “X-Ray Interpretation of Abdomen” (pp. 514–520)
Note: Download this Student Checklist and Abdomen Key Points to use during your practice abdominal examination.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Abdomen: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Abdomen: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Document: Midterm Exam Review (Word document)
Optional Resource
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.
· Chapter 9, “The Abdomen, Perineum, Anus, and Rectosigmoid” (pp. 445–527)
This chapter explores the health assessment processes for the abdomen, perineum, anus, and rectosigmoid. This chapter also examines the symptoms of many conditions in these areas.
· Chapter 10, “The Urinary System” (pp. 528–540)
In this chapter, the authors provide an overview of the physiology of the urinary system. The chapter also lists symptoms and conditions of the urinary system.
Required Media
Assessment of the Abdomen and Gastrointestinal System – Week 6 (14m)
Online media for Seidel’s Guide to Physical Examination
It is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapter 17 that relate to the assessment of the abdomen and gastrointestinal system. Refer to Week 4 for access instructions on https://evolve.elsevier.com/
Assignment 1: Lab Assignment: Assessing the Abdomen
A woman went to the emergency room for severe abdominal cramping. She was diagnosed with diverticulitis; however, as a precaution, the doctor ordered a CT scan. The CT scan revealed a growth on the pancreas, which turned out to be pancreatic cancer—the real cause of the cramping.
Because of a high potential for misdiagnosis, determining the precise cause of abdominal pain can be time consuming and challenging. By analyzing case studies of abnormal abdominal findings, nurses can prepare themselves to better diagnose conditions in the abdomen.
In this Lab Assignment, you will analyze an Episodic note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.
To Prepare
Review the Episodic note case study your instructor provides you for this week’s Assignment. Please see the “Course Announcements” section of the classroom for your Episodic note case study.
- With regard to the Episodic note case study provided:
- Review this week’s Learning Resources, and consider the insights they provide about the case study.
- Consider what history would be necessary to collect from the patient in the case study.
- Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
- Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
The Assignment
- Analyze the subjective portion of the note. List additional information that should be included in the documentation.
- Analyze the objective portion of the note. List additional information that should be included in the documentation.
- Is the assessment supported by the subjective and objective information? Why or why not?
- What diagnostic tests would be appropriate for this case, and how would the results be used to make a diagnosis?
- Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.
By Day 7 of Week 6
Submit your Lab Assignment.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
- Please save your Assignment using the naming convention “WK6Assgn1+last name+first initial. (extension)” as the name.
- Click the Week 6 Assignment 1 Rubric to review the Grading Criteria for the Assignment.
- Click the Week 6 Assignment 1 link. You will also be able to “View Rubric” for grading criteria from this area.
- Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK6Assgn1+last name+first initial. (extension)” and click Open.
- If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
- Click on the Submit button to complete your submission.
Grading Criteria
To access your rubric:
Week 6 Assignment 1 Rubric
Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:
Submit your Week 6 Assignment 1 draft and review the originality report.
Submit Your Assignment by Day 7 of Week 6
To participate in this Assignment:
Week 6 Assignment 1
Week 6 Assignment Sample Paper
NURS 6512 – Assignment 1: Lab Assignment: Assessing the Abdomen
Assessing the Abdomen
Student’s Name:
Institutional Affiliation:
Course:
Instructor’s Name:
Date:
Assessing the Abdomen
SOAP Note
S:
CC: “My stomach hurts, I have diarrhea, and nothing seems to help.”
HPI: M.N, a 47-year-old woman, presents with an abdominal pain complaint that began three days ago. She hasn’t taken any medicines since she didn’t know what to take. She states her pain rate is 5/10 better than it first began.
PMH: Hypertension, Diabetes, GI bleeding history four years back.
Medications: Amlodipine 5 mg, Lisinopril 10mg and Metformin 1000mg.
Allergies: NKDA
Family History: No history of colon cancer, Father has DMT2, Hypertension, Mother as well has HTN, Hyperlipidemia, and GERD
Social: Doesn’t smoke, married with three kids (2 girls and a boy)
O:
Vital signs: Temp 99.8; RR 16; P 92; BP 160/86; Height 5’10”; Weight 248lbs
Heart: No hums
Lungs: Regular chest walls
Skin: Intact without urticaria and lesions
Abdomen: hyperactive bowel reverberations, soft,
Assessment:
Gastroenteritis
Subjective Portion Analysis
The emotional part of the SOAP note helps in analyzing how the patient is feeling. It emphasizes on what patient reports. The subjective part must be systematic, covering a patient’s critical details. Several areas in this soap note have been covered, whereas others haven’t. The covered areas involved chief complaints, history of present disease, past medicinal history, current medications, social history, allergies, and history. Although covered areas helped comprehend the patient’s ailment, the doctor must gather additional information in this particular section. The physician would have collected additional information to provide a complete analysis of the history of the present illness, ask the patient where she was when the symptoms started. The doctor should similarly ask the type of foods the patient had consumed just before the onset of symptoms. The subjective section would as well have emphasized her history of injuries (Colyar 2015). Previous injuries like falling or car accidents may be an aim for current symptoms.
Objective Portion Analysis
The objective part of a SOAP note focuses on the physician’s review. The review should be thorough and should entail a head-to-toe assessment. The objective part of the SOAP focused on the patient’s vital signs, lungs, heart, skin, and abdominal review. Additional information that may be added includes the patient’s overall appearance, general appearance aids in identifying how a patient looks relay to illness. The objective part must similarly contain a review from head to toe. Full body review helps determine the primary diagnosis, and in case the diagnosis is causing the symptoms on numerous body regions. The physician must review the head, nose, eyes, mouth, neck, and chest for the SOAP note. The doctor should similarly assess the patient’s respiratory performance, genitourinary symptoms, neurological and musculoskeletal functioning.
Assessment
The assessment was supported by both the subjective and objective data (Dains, Baumann & Scheibel 2019). Subjective data that supported assessment includes M. Ns chief’s complaint, history of present and past illness, family, and social history. Objective data that supported assessment included an abdominal review that revealed results of LLQ pain. However, the objective analysis was not enough for evaluation as it did not have the laboratory tests and full body review.
Diagnostic Tests
Diagnostic tests suitable for the patient include stool culture to determine parasites, viruses, or bacteria. Endoscopy can as well be used to find the diagnosis. Endoscopy encompasses inserting a camera through the throat to the stomach to check problems like ulcers. A colonoscopy may as well be used to determine intestinal injury or tumors. Colonoscopy inserts a camera through the rectum. Lower gastrointestinal tract radiography may similarly be used to determine intestinal obstructions or the rest of stomach conditions (LeBlond, Brown & DeGowin 2014).
Current Diagnosis
The current diagnosis for the patient is gastroenteritis. This is a condition where the stomach is infected, triggering diarrhea symptoms, vomiting and nausea, and abdominal pain (Bányai et al. 2018). Symptoms might last for a couple of days and vanish without treatment after some days. The illness usually occurs as a result of bacterial or viral infection. I agree with the current diagnosis since the patient reports abdominal pain, diarrhea, and nausea, all of which is gastroenteritis. The patient’s symptoms have as well decreased with no treatment.
Differential Diagnosis
Amebiasis is a parasitic infection of the intestines triggered by protozoan Entamoeba histolytica. Patients may present with signs and symptoms such as diarrhea, cramping, stomach pains, nausea, appetite loss, and fever.
- Bacterial gastroenteritis
Bacterial gastroenteritis transpires when the bacteria cause infection in an individual’s gut (Barrett & Fhogartaigh 2017). This causes inflammation in the intestines and stomach. The affected individual may as well experience symptoms such as vomiting, serious stomach cramps, and diarrhea.
Food poisoning is a disease triggered by eating polluted food. It is not generally severe, and most individuals feel better in a few days with no treatment. Food poisoning symptoms might involve nausea, cramping, vomiting, or diarrhea.
References
Bányai, K., Estes, M. K., Martella, V., & Parashar, U. D. (2018). Viral gastroenteritis. The Lancet, 392(10142), 175-186. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S0140673618311280
Barrett, J., & Fhogartaigh, C. N. (2017). Bacterial gastroenteritis. Medicine, 45(11), 683-689. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S1357303917302177
Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.
Exam: Week 6 Midterm Exam
This exam is a test of your knowledge in preparation for your certification exam. No outside resources, including books, notes, websites, or any other type of resource, are to be used to complete this exam. You are expected to comply with Walden University’s Code of Conduct.
This exam will be on topics covered in weeks 1, 2, 3, 4, 5, and 6. Prior to starting the exam, you should review all of your materials. This exam is timed with a limit of 2 hours for completion. When time is up, your exam will automatically submit.
By Day 7 of Week 6
Submit your Midterm Exam.
Submission and Grading Information
Submit Your Midterm Exam by Day 7 of Week 6.
To Complete this Exam:
Week 6 Exam
Assignment 2: Lab Assignment DCE
The causes of abdominal pain can be extremely varied due to the sheer number of structures, organs, and functions within the abdomen. If abdominal pain is caused by a life-threatening condition, then swift and accurate assessment is essential.
In preparation for the Comprehensive (Head-to-Toe) Physical Assessment due in Week 9, it is recommended that you practice performing an abdominal examination this week.
Focused Exam: Abdominal Assignment:
- Complete the following in Shadow Health:
- Abdominal Concept Lab (Required)
- Gastrointestinal (Practice)
- Focused Exam: Abdominal Pain (Practice)
What’s Coming Up in Week 7?
Next week, you will explore how to assess the heart, lungs, and peripheral vascular system as you complete your Discussion.
Week 7 Required Media
Next week, you will need to view several videos and animations in the Seidel’s Guide to Physical Examination as well as other media, as required, prior to completing your Discussion. There are several videos of various lengths. Please plan ahead to ensure you have time to view these media programs to complete your Discussion on time.
Next Week
To go to the next week:
Week 7
Week 7: Assessment of the Heart, Lungs, and Peripheral Vascular System
Cardiovascular disease (CVD) is the largest cause of death worldwide. Accounting for 610,000 deaths annually (CDC, 2017), CVD frequently goes unnoticed until it is too late. Early detection and prevention measures can save the lives of many patients who have CVD. Conducting an assessment of the heart, lungs, and peripheral vascular system is one of the first steps that can be taken to detect CVD and many more conditions that may occur in the thorax or chest area.
This week, you will evaluate abnormal findings in the area of the chest and lungs. In addition, you will appraise health assessment techniques and diagnoses for the heart, lungs, and peripheral vascular system.
Learning Objectives
Students will:
- Evaluate abnormal cardiac and respiratory findings
- Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for the heart, lungs, and peripheral vascular system
Learning Resources
Required Readings
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
· Chapter 14, “Chest and Lungs”
This chapter explains the physical exam process for the chest and lungs. The authors also include descriptions of common abnormalities in the chest and lungs.
· Chapter 15, “Heart”
The authors of this chapter explain the structure and function of the heart. The text also describes the steps used to conduct an exam of the heart.
· Chapter 16, “Blood Vessels”
This chapter describes how to properly conduct a physical examination of the blood vessels. The chapter also supplies descriptions of common heart disorders.
Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.
· Chapter 107, “X-Ray Interpretation: Chest (pp. 480–487) (previously read in Week 6; specifically focus on pp. 480–481)
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.
· Chapter 8, “Chest Pain”
This chapter focuses on diagnosing the cause of chest pain and highlights the importance of first determining whether the patient is in a life-threatening condition. It includes questions that can help pinpoint the type and severity of pain and then describes how to perform a physical examination. Finally, the authors outline potential laboratory and diagnostic studies.
· Chapter 11, “Cough”
A cough is a very common symptom in patients and usually indicates a minor health problem. This chapter focuses on how to determine the cause of the cough by asking questions and performing a physical exam.
· Chapter 14, “Dyspnea”
The focus of this chapter is dyspnea, or shortness of breath. The chapter includes strategies for determining the cause of the problem through evaluation of the patient’s history, through physical examination, and through additional laboratory and diagnostic tests.
· Chapter 26, “Palpitations”
This chapter describes the different causes of heart palpitations and details how the specific cause in a patient can be determined.
· Chapter 33, “Syncope”
This chapter focuses on syncope, or loss of consciousness. The authors describe the difficulty of ascertaining the cause, because the patient is usually seen after the loss of consciousness has happened. The chapter includes information on potential causes and the symptoms of each.
Note: Download the Student Checklists and Key Points to use during your practice cardiac and respiratory examination.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Chest and lungs: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Chest and lungs: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Heart: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Heart: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Katz, J. N., Lyons, N., Wolff, L. S., Silverman, J., Emrani, P., Holt, H. L., … Losina, E. (2011). Medical decision-making among Hispanics and non-Hispanic Whites with chronic back and knee pain: A qualitative study. BMC Musculoskeletal Disorders, 12(1), 78–85.
This study examines the medical decision making among Hispanics and non-Hispanic whites. The authors also analyze the preferred information sources used for making decisions in these populations.
Smuck, M., Kao, M., Brar, N., Martinez-Ith, A., Choi, J., & Tomkins-Lane, C. C. (2014). Does physical activity influence the relationship between low back pain and obesity? The Spine Journal, 14(2), 209–216. doi:10.1016/j.spinee.2013.11.010
Shiri, R., Solovieva , S., Husgafvel-Pursiainen, K., Telama, R., Yang, X., Viikari, J., Raitakari, O. T., & Viikari-Juntura, E. (2013). The role of obesity and physical activity in non-specific and radiating low back pain: The Young Finns study. Seminars in Arthritis & Rheumatism, 42(6), 640–650. doi:10.1016/j.semarthrit.2012.09.002
McCabe, C., & Wiggins, J. (2010a). Differential diagnosis of respiratory disease part 1. Practice Nurse, 40(1), 35–41.
This article describes the warning signs of impending deterioration of the respiratory system. The authors also explain the features of common respiratory conditions.
McCabe, C., & Wiggins, J. (2010b). Differential diagnosis of respiratory diseases part 2. Practice Nurse, 40(2), 33–41.
The authors of this article specify how to identify the major causes of acute breathlessness. Additionally, they explain how to interpret a variety of findings from respiratory investigations.
Shadow Health Support and Orientation Resources
Use the following resources to guide you through your Shadow Health orientation as well as other support resources:
Frey, C. [Chris Frey]. (2015, September 4). Student orientation [Video file]. Retrieved from https://www.youtube.com/watch?v=Rfd_8pTJBkY
Shadow Health. (n.d.). Shadow Health help desk. Retrieved from https://support.shadowhealth.com/hc/en-us
Document: Shadow Health. (2014). Useful tips and tricks (Version 2) (PDF)
Document: Student Acknowledgement Form (Word document)
Note: You will sign and date this form each time you complete your DCE Assignment in Shadow Health to acknowledge your commitment to Walden University’s Code of Conduct.
Document: DCE (Shadow Health) Documentation Template for Focused Exam: Chest Pain (Word document)
Use this template to complete your Assignment 1 for this week.
Optional Resource
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.
Chapter 8, “The Chest: Chest Wall, Pulmonary, and Cardiovascular Systems; The Breasts” (Section 1, “Chest Wall, Pulmonary, and Cardiovascular Systems,” pp. 302–433)
Note: Section 2 of this chapter will be addressed in Week 10.
This section of Chapter 8 describes the anatomy of the chest wall, pulmonary, and cardiovascular systems. Section 1 also explains how to properly conduct examinations of these areas.
Required Media
Advanced Health Assessment and Diagnostic Reasoning
Thoughtful, reasoned questioning leads from initial complaint to diagnosis in these three scenarios.
Note: Close the viewing window after the intro segment and after each diagnosis segment to view the menu. (12m)
Photo Credit:Provided courtesy of the Laureate International Network of Universities.
Assessment of the Heart, Lungs, and Peripheral Vascular System – Week 7 (28m)
SkillStat Learning, Inc. (2019). The 6 second ECG. Retrieved from http://www.skillstat.com/tools/ecg-simulator#/-home
This interactive website allows you to explore common cardiac rhythms. It also offers the Six Second ECG game so you can practice identifying rhythms.
Online media for Seidel’s Guide to Physical Examination
In addition to this week’s media, it is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapters 13 and 14 that relate to the assessment of the chest, heart, and lungs. Refer to Week 4 for access instructions on https://evolve.elsevier.com/
Assignment 1: Digital Clinical Experience: Assessing the Heart, Lungs, and Peripheral Vascular System
Take a moment to observe your breathing. Notice the sensation of your chest expanding as air flows into your lungs. Feel your chest contract as you exhale. How might this experience be different for someone with chronic lung disease or someone experiencing an asthma attack?
In order to adequately assess the chest region of a patient, nurses need to be aware of a patient’s history, potential abnormal findings, and what physical exams and diagnostic tests should be conducted to determine the causes and severity of abnormalities.
In this DCE Assignment, you will conduct a focused exam related to chest pain using the simulation too, Shadow Health. Consider how a patient’s initial symptoms can result in very different diagnoses when further assessment is conducted.
To Prepare
- Review this week’s Learning Resources and the Advanced Health Assessment and Diagnostic Reasoning media program and consider the insights they provide related to heart, lungs, and peripheral vascular system.
- Review the Shadow Health Resources provided in this week’s Learning Resources specifically the tutorial to guide you through the documentation and interpretation with the Shadow Health platform. Review the examples also provided.
- Review the DCE (Shadow Health) Documentation Template for Focused Exam: Chest Pain found in this week’s Learning Resources and use this template to complete your Documentation Notes for this DCE Assignment.
- Access and login to Shadow Health using the link in the left-hand navigation of the Blackboard classroom.
- Review the Week 7 DCE Focused Exam: Chest Pain Rubric provided in the Assignment submission area for details on completing the Assignment in Shadow Health.
- Consider what history would be necessary to collect from the patient.
- Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
DCE Focused Exam: Chest Pain Assignment:
Complete the following in Shadow Health:
- Cardiovascular Concept Lab (Required)
- Respiratory(Recommended but not required)
- Cardiovascular (Recommended but not required)
- Episodic/Focused Note for Focused Exam (Required): Chest Pain
Note: Each Shadow Health Assessment may be attempted and reopened as many times as necessary prior to the due date to achieve a total of 80% or better (this includes your DCE and your Documentation Notes), but you must take all attempts by the Week 7 Day 7 deadline.
Submission and Grading Information
By Day 7 of Week 7
- Complete your Focused Exam: Chest Pain DCE Assignment in Shadow Health via the Shadow Health link in Blackboard.
- Once you complete your Assignment in Shadow Health, you will need to download your lab pass and upload it to the corresponding Assignment in Blackboard for your faculty review.
- (Note: Please save your lab pass as “LastName_FirstName_AssignmentName”.) You can find instructions for downloading your lab pass here: https://link.shadowhealth.com/download-lab-pass
- Once you submit your Documentation Notes to Shadow Health, make sure to copy and paste the same Documentation Notes into your Assignment submission link below.
- Download, sign, date, and submit your Student Acknowledgement Form found in the Learning Resources for this week.
Grading Criteria
To access your rubric:
Week 7 Assignment 1 DCE Rubric
Submit Your Assignment by Day 7 of Week 7
To submit your Lab Pass:
Week 7 Lab Pass
To participate in this Assignment:
Week 7 Documentation Notes for Assignment 1
To Submit your Student Acknowledgement Form:
Submit your Week 7 Assignment 1 DCE Student Acknowledgement Form
Assignment 2: Lab Assignment (Optional): Practice Assessment: Cardiac and Respiratory Examination
It is crucial to diagnose cardiac and respiratory conditions early due to the critical nature of these organs. Before a condition can be diagnosed, an examination must be conducted. Properly conducting a cardiac and respiratory examination requires detailed knowledge of the examination procedure and experience in performing this assessment.
In preparation for the Comprehensive (Head-to-Toe) Physical Assessment due in Week 9, it is recommended that you practice performing a cardiac and respiratory examination this week.
Note: This is an optional practice physical assessment.
To Prepare
- Arrange an appropriate time and setting with your volunteer “patient” to perform a cardiac and respiratory examination.
- Download and review the Cardiac and Respiratory Checklists provided in this week’s Learning Resources as well as review the Seidel’s Guide to Physical Examination online media.
- Ensure that you have a stethoscope to perform the examination.
Optional Lab Assignment
- Perform the cardiac and respiratory examination. Be sure to cover all of the areas listed in the checklist and to use the equipment appropriately.
What’s Coming Up in Week 8?
Next week, you will explore how to accurately assess the musculoskeletal system.
Week 8 Required Media
Next week, you will need to view several videos and animations in the Seidel’s Guide to Physical Examination prior to completing your Discussion. There are several videos of various lengths. Please plan ahead to ensure you have time to view these media programs to complete your Discussion on time.
Next Week
To go to the next week:
Week 8
Week 8: Assessment of the Musculoskeletal System
A 46-year-old man walks into a doctor’s office complaining of tripping over doorways more frequently. He does not know why. What could be the causes of this condition?
Without the ability to use the complex structure and range of movement afforded by the musculoskeletal system, many of the physical activities individuals enjoy would be curtailed. Maintaining the health of the musculoskeletal system will ensure that patients live a life of full mobility. One of the most basic steps that can be taken to preserve the health of the musculoskeletal system is to perform an assessment.
This week, you will explore how to assess the musculoskeletal system.
Learning Objectives
Students will:
- Evaluate abnormal musculoskeletal findings
- Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for the musculoskeletal system
Learning Resources
Required Readings
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
- Chapter 4, “Vital Signs and Pain Assessment” (Previously read in Week 6)
- Chapter 22, “Musculoskeletal System”
This chapter describes the process of assessing the musculoskeletal system. In addition, the authors explore the anatomy and physiology of the musculoskeletal system.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.
Chapter 22, “Lower Extremity Limb Pain”
This chapter outlines how to take a focused history and perform a physical exam to determine the cause of limb pain. It includes a discussion of the most common tests used to assess musculoskeletal disorders.
Chapter 24, “Low Back Pain (Acute)”
The focus of this chapter is the identification of the causes of lower back pain. It includes suggested physical exams and potential diagnoses.
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
- Chapter 2, “The Comprehensive History and Physical Exam” (“Muscle Strength Grading”) (Previously read in Weeks 1, 2, 3, 4, and 5)
- Chapter 3, “SOAP Notes”
This section explains the procedural knowledge needed to perform musculoskeletal procedures.
Note: Download this Student Checklist and Abdomen Key Points to use during your practice abdominal examination.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Musculoskeletal system: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Musculoskeletal system: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Katz, J. N., Lyons, N., Wolff, L. S., Silverman, J., Emrani, P., Holt, H. L., … Losina, E. (2011). Medical decision-making among Hispanics and non-Hispanic Whites with chronic back and knee pain: A qualitative study. BMC Musculoskeletal Disorders, 12(1), 78–85.
This study examines the medical decision making among Hispanics and non-Hispanic whites. The authors also analyze the preferred information sources used for making decisions in these populations.
Smuck, M., Kao, M., Brar, N., Martinez-Ith, A., Choi, J., & Tomkins-Lane, C. C. (2014). Does physical activity influence the relationship between low back pain and obesity? The Spine Journal, 14(2), 209–216. doi:10.1016/j.spinee.2013.11.010
Shiri, R., Solovieva, S., Husgafvel-Pursiainen, K., Telama, R., Yang, X., Viikari, J., Raitakari, O. T., & Viikari-Juntura, E. (2013). The role of obesity and physical activity in non-specific and radiating low back pain: The Young Finns study. Seminars in Arthritis & Rheumatism, 42(6), 640–650. doi:10.1016/j.semarthrit.2012.09.002
Document: Episodic/Focused SOAP Note Exemplar (Word document)
Document: Episodic/Focused SOAP Note Template (Word document)
Optional Resource
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.
Chapter 13, “The Spine, Pelvis, and Extremities” (pp. 585–682)
In this chapter, the authors explain the physiology of the spine, pelvis, and extremities. The chapter also describes how to examine the spine, pelvis, and extremities.
Required Media
Musculoskeletal System – Week 8 (12m)
Online media for Seidel’s Guide to Physical Examination
In addition to this week’s resources, it is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapter 21 that relate to the assessment of the musculoskeletal system. Refer to the Week 4 Learning Resources area for access instructions on https://evolve.elsevier.com/
Discussion: Assessing Musculoskeletal Pain
The body is constantly sending signals about its health. One of the most easily recognized signals is pain. Musculoskeletal conditions comprise one of the leading causes of severe long-term pain in patients. The musculoskeletal system is an elaborate system of interconnected levers that provides the body with support and mobility. Because of the interconnectedness of the musculoskeletal system, identifying the causes of pain can be challenging. Accurately interpreting the cause of musculoskeletal pain requires an assessment process informed by patient history and physical exams.
In this Discussion, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.
To prepare:
- By Day 1 of this week, you will be assigned to one of the following specific case studies for this Discussion. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
- Your Discussion post should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes have specific data included in every patient case.
- Review the following case studies:
Week 8 Assignment Sample Paper
NURS 6512 – Assessing Musculoskeletal Pain
Assessing Musculoskeletal Pain
Student’s Name:
Institutional Affiliation:
Musculoskeletal pain is a common phenomenon of which nearly everyone has to experience at a given point in their lives. There are different causes of musculoskeletal pain, but the most common causes are trauma, strain from daily activities and diseases (Baker et al., 2017). The regions that may elicit pain are the muscles, joints, bones, and periarticular tissues but the impact depends on the severity and nature of injury. In assessing a patient with Musculoskeletal pain both subjective and objective approaches are used for proper diagnosis and treatment. The caregiver has to assess the current symptoms of the patient, how it evolved, surrounding factors, and the impact of the problem on the individual’s health and quality of life. This paper aims to conduct a review of an ankle pain case study of a soccer player to assess her condition and recommend the right treatment.
Episodic/Focused SOAP Note
Focused SOAP Note for a patient with ankle pain.
Patient Information
The patient is a 46-year-old white female
S.
Chief complaint: Ankle pain
The patient visited complaining of pain in both legs, mainly within the ankle areas. Her most significant concern was with her right leg. She explains that she felt a pop in the ankle region during a game of soccer. From a general view when she entered, she can bear her weight but she is limping uncomfortably. The patient does also look stressed and fatigued.
HPI: Using LOCATES.
- Location: Leg, right ankle
- Onset: 2 days ago
- Character: Uncomfortable pain, popping sound at the heel during injury, difficulty walking and moving the ankle, limping.
- Associated signs and symptoms: Swelling, stiffness, ankle at odd angle, and inability to bear the body’s weight.
- Timing: During a soccer match at the weekend.
- Exacerbating/relieving factors: Uncomfortable pain when the region is subjected to the body weight when walking, palpated, or squeezed. The pain is reduced when the area is iced or at rest.
- Severity: 8/10 pain scale
Current Medications: The patient was subjected to over the counter NSAIDs, with a dosage of Ibuprofen 200mg, one pill for every six hours for the past two days. The reason for taking the pills was to relieve the pain felt in the ankle. The patient had also tied the ankle region with a bandage for support. The patient did also take alcohol to sedate the pain.
Allergies: The patient has no history of any allergies, either for food or drugs
Soc Hx: The patient is a soccer player, married for 20 years, has negative use of tobacco or any smoking drugs, consumes a lot of coffee, and moderate alcohol.
ROS:
General- The patient seems to be in pain, stressed, and fatigued.
Cardiovascular–Negative of complicated heart conditions and diseases
Gastrointestinal–Positive for vomiting but it is after excessive alcohol intake; negative for stomach upsets and abdominal pain.
Constitutional – The patient admits to weight increase recently and frequent fatigue.
Eyes – no changes in vision; wears glasses only when reading.
ENT – Hearing is definite: does not wear hearing aids.
Skin/Breast – no allergies or rashes; Warm and red on the right ankle
Pulmonary – Easy to breathe in and out; no shortness of breath; no cough
Endocrine – Appetite still intact
Genito Urinary – No pain or irregularity in urination frequency. Some urge was due to alcohol intake; Negative of infections.
Musculo Skeletal – Changes in strength, pain in both legs, swelling, strain during walking.
Neurologic – Memory is unaffected
Psychology – Appears stressed, uncomfortable, and restless.
Heme/Lymph – Negative of easy bruising
O.
Head to toe examination.
Vitals: Temp: 98°F BP: 125/86mmHg BMI: 28
General: The patient looks calm though stressed and fatigued, weight/ height are proportionate.
Skin: Warm, dry, well-perfused; No visible rashes, the right leg ankle region is swollen, with redness.
Extremities: positive lower extremity pain or edema when palpated; symmetric legs
A.
Differential diagnosis
- Broken ankle: The sudden sharp pain during the soccer match and a popping sound during the injury are likely due to a snap in an ankle bone (Fraser, Feger & Hertel, 2016). Supported by difficulty in walking and the oddness of the ankle angle could likely be a broken ankle.
- Achilles tendonitis: This does also result in pain I the ankle and the heel region, and presents difficulty in walking or standing.
- sprained ankle: With the intensity of a soccer match, the condition could be a sprain, supported by the symptoms of pain, swelling, repetitive exercise during the game, redness, and bruising.
Presumptive diagnosis: Broken ankle.
A thorough physical examination is required before proposing costly radiographic diagnoses and scanning. The Ottawa Ankle Rules have proven to be effective in assessing fractures of the ankle and near regions such as the midfoot (Beckenkamp et al., 2017). The procedure has proven to produce modest specificity and accurate sensitivity. Ottawa Ankle Rules is efficient as it saves time and costs of treatment, and with its diagnostic accuracy midfoot fractures and injuries on the ankle can be detected (Beckenkamp et al., 2017). The procedure can explore the involvement of soft tissues, ligament, tendons, and vertebral fractures.
Not applicable in this section.
References
Baker, S., McBeth, J., Chew-Graham, C. A., & Wilkie, R. (2017). Musculoskeletal pain and co-
morbid insomnia in adults; a population study of the prevalence and impact on restricted
social participation. BMC family practice, 18(1), 17.
Beckenkamp, P. R., Lin, C. W. C., Macaskill, P., Michaleff, Z. A., Maher, C. G., & Moseley, A.
- (2017). Diagnostic accuracy of the Ottawa Ankle and Midfoot Rules: a systematic
review with meta-analysis. Br J Sports Med, 51(6), 504-510.
Fraser, J. J., Feger, M. A., & Hertel, J. (2016). Midfoot and forefoot involvement in lateral ankle
sprains and chronic ankle instability. Part 1: anatomy and biomechanics. International
journal of sports physical therapy, 11(6), 992.
Case 1: Back Pain
Photo Credit: University of Virginia. (n.d.). Lumbar Spine Anatomy [Photograph]. Retrieved from http://www.med-ed.virginia.edu/courses/rad/ext/5lumbar/01anatomy.html. Used with permission of University of Virginia.
A 42-year-old male reports pain in his lower back for the past month. The pain sometimes radiates to his left leg. In determining the cause of the back pain, based on your knowledge of anatomy, what nerve roots might be involved? How would you test for each of them? What other symptoms need to be explored? What are your differential diagnoses for acute low back pain? Consider the possible origins using the Agency for Healthcare Research and Quality (AHRQ) guidelines as a framework. What physical examination will you perform? What special maneuvers will you perform?
Case 2: Ankle Pain
Photo Credit: University of Virginia. (n.d.). Lateral view of ankle showing Boehler’s angle [Photograph]. Retrieved from http://www.med-ed.virginia.edu/courses/rad/ext/8ankle/01anatomy.html. Used with permission of University of Virginia.
A 46-year-old female reports pain in both of her ankles, but she is more concerned about her right ankle. She was playing soccer over the weekend and heard a “pop.” She is able to bear weight, but it is uncomfortable. In determining the cause of the ankle pain, based on your knowledge of anatomy, what foot structures are likely involved? What other symptoms need to be explored? What are your differential diagnoses for ankle pain? What physical examination will you perform? What special maneuvers will you perform? Should you apply the Ottawa ankle rules to determine if you need additional testing?
Case 3: Knee Pain
Photo Credit: University of Virginia. (n.d.). Normal Knee Anatomy [Photograph]. Retrieved from http://www.med-ed.virginia.edu/courses/rad/ext/7knee/01anatomy.html. Used with permission of University of Virginia.
A 15-year-old male reports dull pain in both knees. Sometimes one or both knees click, and the patient describes a catching sensation under the patella. In determining the causes of the knee pain, what additional history do you need? What categories can you use to differentiate knee pain? What are your specific differential diagnoses for knee pain? What physical examination will you perform? What anatomic structures are you assessing as part of the physical examination? What special maneuvers will you perform?
With regard to the case study you were assigned:
- Review this week’s Learning Resources, and consider the insights they provide about the case study.
- Consider what history would be necessary to collect from the patient in the case study you were assigned.
- Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
- Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
Note: Before you submit your initial post, replace the subject line (“Discussion – Week 8”) with “Review of Case Study ___.” Fill in the blank with the number of the case study you were assigned.
By Day 3 of Week 8
Post an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Read a selection of your colleagues’ responses.
By Day 6 of Week 8
Respond to at least two of your colleagues on 2 different days who were assigned different case studies than you. Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition, and justify your reasoning.
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 8 Discussion Rubric
Post by Day 3 of Week 8 and Respond by Day 6 of Week 8
To Participate in this Discussion:
Week 8 Discussion
Assignment: Lab Assignment (Optional): Practice Assessment: Musculoskeletal Examination
A description of symptoms alone is not enough to form an accurate diagnosis of musculoskeletal conditions. Before forming a diagnosis, advanced practice nurses need to perform a physical examination. Although the musculoskeletal examination is relatively simple, it still needs to be performed multiple times before it can be mastered.
In preparation for the Comprehensive (Head-to-Toe) Physical Assessment due in Week 9, it is recommended that you practice performing a musculoskeletal examination this week.
Note: This is a practice physical assessment.
To Prepare
- Arrange an appropriate time and setting with your volunteer “patient” to perform a musculoskeletal examination.
- Download and review the Musculoskeletal Checklist provided in this week’s Learning Resources as well as review the Seidel’s Guide to Physical Examination online media.
The Lab Assignment
Complete the following in Shadow Health:
- Musculoskeletal (Practice)
What’s Coming Up in Week 9?
Next week, you will examine appropriate methods for assessing the cognition and the neurologic systems during your Discussion. You also will complete the last assessment, Comprehensive (Head-to-Toe) Physical Assessment. Once again, you will conduct this assessment in the Digital Clinical Experience using the simulation tool, Shadow Health. Make sure to plan your time accordingly.
Week 9 Required Media
Next week, you will need to view several videos and animations in the Seidel’s Guide to Physical Examination as well as other media, as required, prior to completing your Discussion. There are several videos of various lengths. Please plan ahead to ensure you have time to view these media programs to complete your Discussion on time.
Next Week
To go to the next week:
Week 9
Week 9: Assessment of Cognition and the Neurologic System
A 63-year-old woman comes to your office because she’s been forgetting things…a young mother comes in concerned because her baby fails to make eye contact and is unresponsive to touch…a teenager comes in and a parent complains that the teen obsessively washes his hands.
An array of neurological conditions could be causing the above symptoms. When assessing the neurologic system, it is vital to formulate an accurate diagnosis as early as possible to prevent continued damage and deterioration of a patient’s quality of life.
This week, you will explore methods for assessing the cognition and the neurologic system.
Learning Objectives
Students will:
- Evaluate abnormal neurological symptoms
- Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for cognition and the neurologic system
- Assess health conditions based on a head-to-toe physical examination
Learning Resources
Required Readings
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
· Chapter 7, “Mental Status”
This chapter revolves around the mental status evaluation of an individual’s overall cognitive state. The chapter includes a list of mental abnormalities and their symptoms.
· Chapter 23, “Neurologic System”
The authors of this chapter explore the anatomy and physiology of the neurologic system. The authors also describe neurological examinations and potential findings.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.
· Chapter 4, “Affective Changes”
This chapter outlines how to identify the potential cause of affective changes in a patient. The authors provide a suggested approach to the evaluation of this type of change, and they include specific tools that can be used as part of the diagnosis.
· Chapter 9, “Confusion in Older Adults”
This chapter focuses on causes of confusion in older adults, with an emphasis on dementia. The authors include suggested questions for taking a focused history as well as what to look for in a physical examination.
· Chapter 13, “Dizziness”
Dizziness can be a symptom of many underlying conditions. This chapter outlines the questions to ask a patient in taking a focused history and different tests to use in a physical examination.
· Chapter 19, “Headache”
The focus of this chapter is the identification of the causes of headaches. The first step is to ensure that the headache is not a life-threatening condition. The authors give suggestions for taking a thorough history and performing a physical exam.
· Chapter 31, “Sleep Problems”
In this chapter, the authors highlight the main causes of sleep problems. They also provide possible questions to use in taking the patient’s history, things to look for when performing a physical exam, and possible laboratory and diagnostic studies that might be useful in making the diagnosis.
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
- Chapter 2, “The Comprehensive History and Physical Exam” (“Cranial Nerves and Their Function” and “Grading Reflexes”) (Previously read in Weeks 1, 2, 3, and 5)
Note: Download the Physical Examination Objective Data Checklist to use as you complete the Comprehensive (Head-to-Toe) Physical Assessment assignment.
Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Physical examination objective data checklist. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Mosby’s Guide to Physical Examination, 7th Edition by Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2011 by Elsevier. Reprinted by permission of Elsevier via the Copyright Clearance Center.
Note: Download and review the Student Checklists and Key Points to use during your practice neurological examination.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Neurologic system: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Neurologic system: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Mental status: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Bearden , S. T., & Nay, L. B. (2011). Utility of EEG in differential diagnosis of adults with unexplained acute alteration of mental status. American Journal of Electroneurodiagnostic Technology, 51(2), 92–104.
This article reviews the use of electrocenographs (EEG) to assist in differential diagnoses. The authors provide differential diagnostic scenarios in which the EEG was useful.
Athilingam, P ., Visovsky, C., & Elliott, A. F. (2015). Cognitive screening in persons with chronic diseases in primary care: Challenges and recommendations for practice. American Journal of Alzheimer’s Disease & Other Dementias, 30(6), 547–558. doi:10.1177/1533317515577127
Sinclair , A. J., Gadsby, R., Hillson, R., Forbes, A., & Bayer, A. J. (2013). Brief report: Use of the Mini-Cog as a screening tool for cognitive impairment in diabetes in primary care. Diabetes Research and Clinical Practice, 100(1), e23–e25. doi:10.1016/j.diabres.2013.01.001
Roalf, D. R., Moberg, P. J., Xei, S. X., Wolk, D. A., Moelter, S. T., & Arnold, S. E. (2013). Comparative accuracies of two common screening instruments for classification of Alzheimer’s disease, mild cognitive impairment, and healthy aging. Alzheimer’s & Dementia, 9(5), 529–537. doi:10.1016/j.jalz.2012.10.001. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4036230/
Shadow Health Support and Orientation Resources
Use the following resources to guide you through your Shadow Health orientation as well as other support resources:
Frey, C. [Chris Frey]. (2015, September 4). Student orientation [Video file]. Retrieved from https://www.youtube.com/watch?v=Rfd_8pTJBkY
Shadow Health. (n.d.). Shadow Health help desk. Retrieved from https://support.shadowhealth.com/hc/en-us
Document: Shadow Health. (2014). Useful tips and tricks (Version 2) (PDF)
Document: Student Acknowledgement Form (Word document)
Note: You will sign and date this form each time you complete your DCE Assignment in Shadow Health to acknowledge your commitment to Walden University’s Code of Conduct.
Document: DCE (Shadow Health) Documentation Template for Comprehensive (Head-to-Toe) Physical Assessment (Word document)
Use this template to complete your Assignment 3 for this week.
Optional Resources
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.
· Chapter 14, “The Neurologic Examination” (pp. 683–765)
This chapter provides an overview of the nervous system. The authors also explain the basics of neurological exams.
· Chapter 15, “Mental Status, Psychiatric, and Social Evaluations” (pp. 766–786)
In this chapter, the authors provide a list of common psychiatric syndromes. The authors also explain the mental, psychiatric, and social evaluation process.
Mahlknecht, P., Hotter, A., Hussl, A., Esterhammer, R., Schockey, M., & Seppi, K. (2010). Significance of MRI in diagnosis and differential diagnosis of Parkinson’s disease. Neurodegenerative Diseases, 7(5), 300–318.
Required Media
Neurologic System – Week 9 (16m)
Online media for Seidel’s Guide to Physical Examination
It is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapters 7 and 23 that relate to the assessment of cognition and the neurologic system. Refer to the Week 4 Learning Resources area for access instructions on https://evolve.elsevier.com/
Assignment 1: Case Study Assignment: Assessing Neurological Symptoms
Imagine not being able to form new memories. This is the reality patients with anterograde amnesia face. Although this form of amnesia is rare, it can result from severe brain trauma. Anterograde amnesia demonstrates just how impactful brain disorders can be to a patient’s quality of living. Accurately assessing neurological symptoms is a complex process that involves the analysis of many factors.
In this Case Study Assignment, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.
To Prepare
- By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
- Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes have specific data included in every patient case.
With regard to the case study you were assigned:
- Review this week’s Learning Resources, and consider the insights they provide about the case study.
- Consider what history would be necessary to collect from the patient in the case study you were assigned.
- Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
- Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
Week 9 Assignment Sample Paper
NURS 6512 – Assignment 1: Case Study Assignment: Assessing Neurological Symptoms
Episodic/Focused SOAP Note Template
Patient Information:
Initials: GM Age: 33 y.o Sex: Female Race: African American
SUBJECTIVE DATA:
Chief complaint: She states, I have a drooping on the right side of my face
HPI: G.M is a 33-year-old African American woman who presents in the clinic complaining of a right-sided facial drooping. She states that she noted it after waking up in the morning. She further says that her right eye has been watering continuously, and she cannot stop drooling out of her mouths side right. She has no pain.
Current Medications: Multivitamin every day, Tylenol 325mg-2 PO every 4 hours as required, Ibuprofen 200mg-2 PO as required, Valtrex 500mg – PO 3 x every day
Allergies: NKDA
Past Medical History: Asthma when she was a child and genital herpes some years back.
Past Surgical History: Cholecystectomy in the year 2000 and extraction of wisdom teeth while young
Social History: She takes alcohol rarely; denies making illicit drug use or smoking.
Family History: She has one brother with hypertension and a daughter who is 13years old healthy and living at home
Immunizations History: Her vaccinations are up to date. She had a flu vaccine lastly on February and had tetanus shot the previous two years when she had injured her arm on a metal piece.
REVIEW OF SYSTEMS
General: Pleasant 33-year-old woman posing in a chair talking reasonably fast. She appears very worried and is anxious; she has had a stroke. She is a good historian.
HEENT: No variations in hearing or vision; she had an eye test previous two years. GL stated no glaucoma, floaters, diplopia, photophobia, or extreme tearing history. She never before had any current infections of the ear, release, or tinnitus from her ears. Intact smell sense. GL has had no epistaxis episodes. She has no nasal polyp’s history or current sinus infection. Her previous dental examination was three years. She denied lesions, ulceration, bleeding gums, gingivitis, and she has no dental applications. No trouble swallowing or eating.
Throat: No sneezing, loss of hearing, congestion, sore throat, or runny nose.
Skin: No itching or rash.
Cardiovascular: No chest distress, palpitations murmurs, no history of arrhythmias, paroxysmal nocturnal dyspnea, orthopnea, claudication, or edema history.
Respiratory: Denied hemoptysis and has no trouble breathing at rest.
Gastrointestinal: No nausea. No abdomen ache, no variations in the bowel pattern.
Genitourinary: No variation in her urinary form, incontinence, or dysuria. GL is heterosexual. She has consistent menses. Human Papilloma Virus is positive and is not sexually active presently.
Neurological: No episodes of syncopal or dizziness, headaches, and paresthesia. No variation in the original patterns; no abnormal movements or twitches; no gait disorder history or difficulties with coordination. No seizure or falls history.
Musculoskeletal: No myalgia or arthralgia, gout or restraint in her motion range by the report, no arthritis. No history of fractures or trauma.
Hematologic: No anemia, bleeding, or bruising.
Lymphatic: No itching or staining, rashes. G.I use lotion to avert dry skin. No skin cancer history or removal of the lesion. She has no blood loss conditions, clotting problems, or transfusions history.
Psychiatric: No depression or anxiety history. No delusions sleep disruption or a history of mental condition. Denied homicidal or suicidal history
Endocrine: No signs of endocrine or hormone therapies
Allergies: She has no recognized immune shortages. Had an HIV test lastly the previous two years
OBJECTIVE DATA
Physical Exam:
Vital signs: B/P: 120/80, RR 18, T 98.8 orally; Wt. 115, Ht: 5’2 and BMI 21
General: Nothing Abnormal Detected, appears to be contented
HEENT: EOMI, PERRLA, clear oronasopharynx; extreme tearing right eye; faces right side drooping as well as mild nasolabial fold destruction
Neck: No JVD or legally and bruit
Chest: CTA AP&L
Heart: RRR with no murmurs, gallop or rub; pulsations, two bilat pedal, and two radial
Abdomen: benign, no organomegaly; no suprapubic sensitivity; no reverberation
Genital/Rectal: Peripheral genitalia complete no cervical wave sensitivity, no adnexal crowds.
Musculoskeletal: Asymmetric muscle growth. All joints are ordinary.
Neuro: CN II – XII grossly complete, Deep Tendon Reflex perfect for paresis on the faces right side and for trouble making facial languages.
Skin/Lymph Nodes: No clubbing, edema, or cyanosis; no tangible nodes
History essential to obtain from the patient
If the patient has any pain, burning, loss of feeling anywhere in her body if she is having problems with her vision. History of her recent illness, history of stroke in her family, her past medical history, surgeries, and medications would be necessary as well.
Additional Physical Examinations:
Performing an original Cincinnati Stroke Scale and Glasgow Coma Scale to evaluate mentation and stroke possibility, thoroughly inspect her face, head, and neck, neurovascular valuation in all the 4 extremities, swallow assessment, and cost of her facial cranial nerve function through raising her eyebrows, squeezing her eyes shut, puff out her cheeks, smile and purse her lips and blow out. This will indicate more of Bell’s palsy.
Additional Diagnostic Testing
In an outpatient situation, I would reach out for 911 for transport to an emergency unit for further assessment, and insist on a head CT to rule out a severe stroke. I would then consider extra electrophysiological testing on a cranial facial nerve in case an acute stroke was ruled out to find if the facial nerve is the culprit.
ASSESSMENT:
- Priority Diagnosis: Facial Nerve Paralysis (Bell’s Palsy)-Classically presents as one-sided upper and lower facial paralysis with reduced eyelid cessation to the affected side and trouble tearing, sensory variations to the affected side occasionally noted, and flattened forehead with incapability of creating creases whenever raising eyebrows on affected side (Eviston, Croxson, Kennedy, Hadlock & Krishnan 2015).
Differential Diagnoses
- Stroke: Frequently present with the facial drooping, but affects one side of body Writing, (Mozaffarian, Benjamin, Go, Arnett, Blaha & Fullerton 2016). If a patient can raise their eyebrows usually and correspondingly, but the inferior part of their face remains paralyzed, the health care provider will need to rule out stroke
- Tetanus: Cephalic tetanus, although uncommon, generally occurs after an ear infection or trauma, and presents with cranial nerve palsy, which might be localized
- Mastoiditis: This is a bacterial infection of the temporal bone and presents with otalgia, otorrhea, tenderness, swelling like symptoms, and facial palsy is an intertemporal problem (Mather, Yates, Powell & Zammit-Maempel 2019).
- Lyme disease: A disease triggered by a bacteria that ticks may carry. Lyme disease causes Bell’s palsy since advanced signs of Lyme illness can affect the nervous system.
- Guillain-Barre Syndrome: Generally begins as weakness and paresthesias weakness and gradually ascending, the symptoms include facial droop, dysphagia, diplopia, dysarthria, and pupillary disorders (Willison, Jacobs & van Doorn 2016).
References
Eviston, T. J., Croxson, G. R., Kennedy, P. G., Hadlock, T., & Krishnan, A. V. (2015). Bell’s palsy: etiology, clinical features, and multidisciplinary care. J Neurol Neurosurg Psychiatry, 86(12), 1356-1361.
Mather, M. W., Yates, P. D., Powell, J., & Zammit-Maempel, I. (2019). Radiology of acute mastoiditis and its complications: a pictorial review and interpretation checklist. The Journal of Laryngology & Otology, 1-6.
Willison, H. J., Jacobs, B. C., & van Doorn, P. A. (2016). Guillain-barre syndrome. The Lancet, 388(10045), 717-727.
Writing, G. M., Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., … & Fullerton, H. J. (2016). Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation, 133(4), e38.
The Case Study Assignment
Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.
By Day 6 of Week 9
Submit your Assignment.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
- Please save your Assignment using the naming convention “WK9Assgn1+last name+first initial.(extension)” as the name.
- Click the Week 9 Assignment 1 Rubric to review the Grading Criteria for the Assignment.
- Click the Week 9 Assignment 1 link. You will also be able to “View Rubric” for grading criteria from this area.
- Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK9Assgn1+last name+first initial.(extension)” and click Open.
- If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
- Click on the Submit button to complete your submission.
Grading Criteria
To access your rubric:
Week 9 Assignment 1 Rubric
Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:
Submit your Week 9 Assignment 1 draft and review the originality report.
Submit Your Assignment by Day 6 of Week 9
To participate in this Assignment:
Week 9 Assignment 1
Assignment 2: Lab Assignment: Practice Assessment: Neurological Examination
Short of opening a patient’s cranium or requesting a brain scan, what can an advanced practice nurse do to determine the cause of neurological symptoms? A multitude of techniques can be used to generate a neurological diagnosis.
In preparation for the Comprehensive (Head-to-Toe) Physical Assessment due this week, it is recommended that you practice performing a neurological examination.
Note: This is a practice physical assessment.
To Prepare
- Arrange an appropriate time and setting with a volunteer “patient” to perform a neurological examination.
- Download and review the Neurological Checklist provided in this week’s Learning Resources as well as review Seidel’s Guide to Physical Examination online media.
The Lab Assignment
Complete the following in Shadow Health:
Assignment 3: Digital Clinical Experience: Comprehensive (Head-to-Toe) Physical Assessment
Throughout this course, you were encouraged to practice conducting various physical assessments on multiple areas of the body, ranging from the head to the toes. Each of these assessments, however, was conducted independently of one another. For this DCE Assignment, you connect the knowledge and skills you gained from each individual assessment to perform a comprehensive head-to-toe physical examination in your Digital Clinical Experience.
To Prepare
- Review this week’s Learning Resources, and download and review the Physical Examination Objective Data Checklist as well as the Student Checklists and Key Points documents related to neurologic system and mental status.
- Review the Shadow Health Resources provided in this week’s Learning Resources specifically the tutorial to guide you through the documentation and interpretation with the Shadow Health platform. Review the examples also provided.
- Review the DCE (Shadow Health) Documentation Template for Comprehensive (Head-to-Toe) Physical Assessment found in this week’s Learning Resources and use this template to complete your Documentation Notes for this DCE Assignment.
- Access and login to Shadow Health using the link in the left-hand navigation of the Blackboard classroom.
- Review the Week 9 DCE Comprehensive Physical Assessment Rubric provided in the Assignment submission area for details on completing the Assessment in Shadow Health.
Note: There are 2 parts to this assignment – the lab pass and the documentation. You must achieve a total score of 80% in order to pass this assignment. Carefully review the rubric and video presentation in order to fully understand the requirements of this assignment.
DCE Comprehensive Physical Assessment:
Complete the following in Shadow Health:
- Episodic/Focused Note for Comprehensive Physical Assessment of Tina Jones (180 minutes)
Note: Each Shadow Health Assessment may be attempted and reopened as many times as necessary prior to the due date to achieve a total of 80% or better (this includes your DCE and your Documentation Notes), but you must take all attempts by the Week 9 Day 7 deadline.
Submission and Grading Information
By Day 7 of Week 9
- Complete your Comprehensive (Head-to-Toe) Physical Assessment DCE Assignment in Shadow Health via the Shadow Health link in Blackboard.
- Once you complete your Assignment in Shadow Health, you will need to download your lab pass and upload it to the corresponding Assignment in Blackboard for your faculty review.
- (Note: Please save your lab pass as “LastName_FirstName_AssignmentName”.) You can find instructions for downloading your lab pass here: https://link.shadowhealth.com/download-lab-pass
- Once you submit your Documentation Notes to Shadow Health, make sure to copy and paste the same Documentation Notes into your Assignment submission link below.
- Download, sign, date, and submit your Student Acknowledgement Form found in the Learning Resources for this week.
- Note: You must pass this assignment with a minimum score of 80% in order to pass the class. Once submitted, there are not any opportunities to revise or repeat this assignment.
Grading Criteria
To access your rubric:
Week 9 Assignment 3 DCE Rubric
Submit Your Assignment by Day 7 of Week 9
To submit your Lab Pass:
Week 9 Lab Pass
To sumit this required part of the Assignment:
Week 9 Documentation Notes for Assignment 3
To Submit your Student Acknowledgement Form:
Submit your Week 9 Assignment 3 DCE Student Acknowledgement Form
What’s Coming Up in Week 10?
Next week, you will examine how to assess problems with the breasts, genitalia, rectum, and prostate while making the patient feel safe, listened to, and cared about using a non-invasive approach. Once again, you will use a SOAP note format to complete your Lab Assignment for this week.
Week 10 Required Media
Next week, you will need to view several videos and animations in the Seidel’s Guide to Physical Examination as well as other media, as required, prior to completing your Discussion. There are several videos of various lengths. Please plan ahead to ensure you have time to view these media programs to complete your Lab Assignment on time.
Next Week
To go to the next week:
Week 10
Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal
One critical element of any physical exam is the ability of the examiner to put the patient at ease. By putting the patient at ease, nurses are more likely to glean quality, meaningful information that will help the patient get the best care possible. When someone feels safe, listened to, and cared about, exams often go more smoothly. This is especially true when dealing with issues concerning breasts, genitals, prostates, and rectums, which are subjects that many patients find difficult to talk about. As a result, it is important to gain a firm understanding of how to gain vital information and perform the necessary assessment techniques in as non-invasive a manner as possible.
For this week, you explore how to assess problems with the breasts, genitalia, rectum, and prostate.
Learning Objectives
Students will:
- Evaluate abnormal findings on the genitalia and rectum
- Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for the breasts, genitalia, prostate, and rectum
Learning Resources
Required Readings
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
· Chapter 17, “Breasts and Axillae”
This chapter focuses on examining the breasts and axillae. The authors describe the examination procedures and the anatomy and physiology of breasts.
· Chapter 19, “Female Genitalia”
In this chapter, the authors explain how to conduct an examination of female genitalia. The chapter also describes the form and function of female genitalia.
· Chapter 20, “Male Genitalia”
The authors explain the biology of the penis, testicles, epididymides, scrotum, prostate gland, and seminal vesicles. Additionally, the chapter explains how to perform an exam of these areas.
· Chapter 21, “Anus, Rectum, and Prostate”
This chapter focuses on performing an exam of the anus, rectum, and prostate. The authors also explain the anatomy and physiology of the anus, rectum, and prostate.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.
· Chapter 5, “Amenorrhea”
Amenorrhea, or the absence of menstruation, is the focus of this chapter. The authors include key questions to ask patients when taking histories and explain what to look for in the physical exam.
· Chapter 6, “Breast Lumps and Nipple Discharge”
This chapter focuses on the important topic of breast lumps and nipple discharge. Because breast cancer is the most common type of cancer in women, it is important to get an accurate diagnosis. Information in the chapter includes key questions to ask and what to look for in the physical exam.
· Chapter 7, “Breast Pain”
Determining the cause of breast pain can be difficult. This chapter examines how to determine the likely cause of the pain through diagnostic tests, physical examination, and careful analysis of a patient’s health history.
· Chapter 27, “Penile Discharge”
The focus of this chapter is on how to diagnose the causes of penile discharge. The authors include specific questions to ask when gathering a patient’s history to narrow down the likely diagnosis. They also give advice on performing a focused physical exam.
· Chapter 36, “Vaginal Bleeding”
In this chapter, the causes of vaginal bleeding are explored. The authors focus on symptoms outside the regular menstrual cycle. The authors discuss key questions to ask the patient as well as specific physical examination procedures and laboratory studies that may be useful in reaching a diagnosis.
· Chapter 37, “Vaginal Discharge and Itching”
This chapter examines the process of identifying causes of vaginal discharge and itching. The authors include questions on the characteristics of the discharge, the possibility of the issues being the result of a sexually transmitted infection, and how often the discharge occurs. A chart highlights potential diagnoses based on patient history, physical findings, and diagnostic studies.
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
- Chapter 3, “SOAP Notes” (Previously read in Week 8)
Cucci, E., Santoro, A., DiGesu, C., DiCerce, R., & Sallustio, G. (2015). Sclerosing adenosis of the breast: Report of two cases and review of the literature. Polish Journal of Radiology, 80, 122–127. doi:10.12659/PJR.892706. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356184/
Sabbagh , C., Mauvis, F., Vecten, A., Ainseba, N., Cosse, C., Diouf, M., & Regimbeau, J. M. (2014). What is the best position for analyzing the lower and middle rectum and sphincter function in a digital rectal examination? A randomized, controlled study in men. Digestive and Liver Disease, 46(12), 1082–1085. doi:10.1016/j.dld.2014.08.045
Westhoff , C. L., Jones, H. E., & Guiahi, M. (2011). Do new guidelines and technology make the routine pelvic examination obsolete? Journal of Women’s Health, 20(1), 5–10.
This article describes the benefits of new technology and guidelines for pelvic exams. The authors also detail which guidelines and technology may become obsolete.
Centers for Disease Control and Prevention. (2019). Sexually transmitted diseases (STDs). Retrieved from http://www.cdc.gov/std/#
This section of the CDC website provides a range of information on sexually transmitted diseases (STDs). The website includes reports on STDs, related projects and initiatives, treatment information, and program tools.
Document: Final Exam Review (Word document)
Optional Resource
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.
- Chapter 8, “The Chest: Chest Wall, Pulmonary, and Cardiovascular Systems; The Breasts” (Section 2, “The Breasts,” pp. 434–444)Section 2 of this chapter focuses on the anatomy and physiology of breasts. The section provides descriptions of breast examinations and common breast conditions.
- Chapter 11, “The Female Genitalia and Reproductive System” (pp. 541–562)In this chapter, the authors provide an overview of the female reproductive system. The authors also describe symptoms of disorders in the reproductive system.
- Chapter 12, “The Male Genitalia and Reproductive System” (pp. 563–584)The authors of this chapter detail the anatomy of the male reproductive system. Additionally, the authors describe how to conduct an exam of the male reproductive system.
- Review of Chapter 9, “The Abdomen, Perineum, Anus, and Rectosigmoid” (pp. 445–527)
Required Media
Special Examinations – Breast, Genital, Prostate, and Rectal – Week 10 (14m)
Online media for Seidel’s Guide to Physical Examination
It is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapters 16 and 18–20 that relate to special examinations, including breast, genital, prostate, and rectal. Refer to the Week 4 Learning Resources area for access instructions on https://evolve.elsevier.com/
Assignment: Lab Assignment: Assessing the Genitalia and Rectum
Patients are frequently uncomfortable discussing with healthcare professional’s issues that involve the genitalia and rectum; however, gathering an adequate history and properly conducting a physical exam are vital. Examining case studies of genital and rectal abnormalities can help prepare advanced practice nurses to accurately assess patients with problems in these areas.
In this Lab Assignment, you will analyze an Episodic note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.
To Prepare
- Review the Episodic note case study your instructor provides you for this week’s Assignment. Please see the “Course Announcements” section of the classroom for your Episodic note case study.
- Based on the Episodic note case study:
- Review this week’s Learning Resources, and consider the insights they provide about the case study. Refer to Chapter 3 of the Sullivan resource to guide you as you complete your Lab Assignment.
- Search the Walden library or the Internet for evidence-based resources to support your answers to the questions provided.
- Consider what history would be necessary to collect from the patient in the case study.
- Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
- Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
The Lab Assignment
Using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature.
- Analyze the subjective portion of the note. List additional information that should be included in the documentation.
- Analyze the objective portion of the note. List additional information that should be included in the documentation.
- Is the assessment supported by the subjective and objective information? Why or why not?
- Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis?
- Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.
By Day 7 of Week 10
Submit your Assignment.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
- Please save your Assignment using the naming convention “WK10Assgn+last name+first initial.(extension)” as the name.
- Click the Week 10 Assignment Rubric to review the Grading Criteria for the Assignment.
- Click the Week 10 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
- Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK10Assgn+last name+first initial.(extension)” and click Open.
- If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
- Click on the Submit button to complete your submission.
Grading Criteria
To access your rubric:
Week 10 Assignment Rubric
Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:
Submit your Week 10 Assignment draft and review the originality report.
Submit Your Assignment by Day 7 of Week 10
To participate in this Assignment:
Week 10 Assignment Sample Paper
NURS 6512 – Special Examinations—Breast, Genital, Prostate, and Rectal
Special Examinations-Breast, Genital, Prostate, and Rectal
Student’s Name:
Institutional Affiliation:
Additional Subjective Data
During the physical examination, the nurse should conduct a more detailed analysis of the symptoms to determine their size, shape, color, and pattern. The patient should be asked to give a more detailed description of her symptoms. The patient will be asked whether it is the first time she is experiencing the signs, or she has had them previously. If it is not the first time, she will be asked to describe when she last experienced them and the medication used to manage the previous episodes. The nurse should enquire whether the patent has noticed the bumps in any other body part other than the genitals, such as the skin (Ball, Dains, Flynn, Solomon & Stewart, 2014).
Sometimes bumps in the genitourinary tract are associated with other general conditions. Therefore, the physician should check for other conditions such as the presence of skin rash, recent weight loss, loss of body hair, a fever, sores on the anus, dysuria, fatigue, and muscle aches.
The patient will be asked whether any of her sex partners had had the symptoms, what she was doing when she noticed the bumps, and whether her house is infested with parasites such as lice or scabies. The nurse should also enquire whether the patient has experienced any itching or burning currently or before noticing the bumps.
It will also be essential to determine whether the bumps have looked the same all week or their appearance has changed and whether they are spreading, present 100% of the time, or do they come and go. The patient should report if she is aware of anything that aggravates the bumps or decreases the number of cracks and whether she has tried home remedies and what outcomes were achieved.
The patient should be asked about exposure to genital bump risk factors such as douching, use of scented and medicated genital soaps, lotion, and sanitary pads.
Under the past medical history, the patient should be asked about any recent surgeries or procedures requiring anesthesia, recently started medications and the drugs that were prescribed for her previous chlamydia infection. The physician should inquire whether the patient has any skin conditions, allergies, a full course of immunization, and the age of asthma diagnosis.
The medical history should also entail the patient’s gynecological history regarding menstrual onset, frequency, duration, volume, date of last menstrual period, contraception use, and HIV status. It helps eliminate hormonal imbalance, pregnancy, and HIV, which could be responsible for genital bumps.
On the sexual history, the patient’s preference for risky sexual practices such as unprotected sex, anal sex, and multiple sexual partners, should be documented t determine the exposure to STD risk factors. The client’s occupational history is very significant in determining exposure to STD risk factors (Westhoff, Jones & Guiahi, 2011).
Additional Objective Data
Documentation of the overall patient’s appearance regarding the level of cleanliness and grooming helps determine the level of body hygiene, which could be a factor in the development of genital bumps.
HEENT exam should also entail throat assessment to check for redness, drainage, edema, enlarged tonsils, cold sores, lesions, and nodal tenderness. It should also entail cervical evaluation to check for enlarged cervical nodes. A mouth examination to check for mouth sores is also essential. These assessments help in determining the presence of viral infection.
The Chest exam should also check for non-labored breathing, enlarged axillary nodes, discharge, and tenderness over the nipples, which could also be signs of viral infection.
In the genito-urinary exam, it would be essential to assess for cervix tenderness, vaginal bleeding, and foul-smelling vaginal discharge. A rectal exam to ascertain any lesions, hemorrhoids, masses, and trauma is also necessary.
Do Subjective and Objective Data support the Assessment?
The patient was diagnosed with Chancre, a highly infectious painless ulcer, which is a primary stage of syphilis. A chancre is a sexually transmitted infection that usually develops over the genital area. In females, chancres can also present over the vagina, anus, or the vulva and take between 3 weeks to 3 months to show after infection.
Subjective data support the diagnosis because the patient reportedly noticed a painless and rough lump over her genital area and reported no vaginal discharge. She also said to be sexually active, have more than one sex partner, which increases her risk of a sexually transmitted infection. Objective data also support the diagnosis. The objective data ascertain that the client had around, a small painless ulcer on the external labia. Additionally, the performed HSV specimen test is the primary diagnostic test for chancre. However, other HEET examinations were normal (Cucci, Santoro, Di Gesù, Cerce & Sallustio, 2015).
The Relevance of Diagnostics and Its Use to Make a Diagnosis
The diagnostics approach used in this case was an HSV specimen, which was sent to the lab for viral culture. The test is relevant in this case because it assesses for the presence of bacteria Haemophilus ducreyi, which is the chancre causative agent. Additional diagnostics are crucial to rule out the differential diagnosis since many STDs present with similar symptoms. A Polymerase Chain Reaction can also be done to test for herpes simplex antibodies to confirm the diagnosis of herpes simplex. A serology test should be done to rule out syphilis. To rule out Chlamydia and Gonorrhea, rapid Nucleic Acid Amplification tests should be the most recommended.
Would You Reject or Accept the Current Diagnosis?
I would accept the current diagnosis. This is because the patient presents with chancre clinical presentation, rough and painless bumps on the genitals. The patient also confirms exposure to chancre risk factors, such as a history of chlamydia, multiple sex partners. An HSV specimen culture is also positive for bacteria Haemophilus ducreyi, which is the chancre causative agent (Dains, Baumann & Scheibel, 2018).
Possible Differential Diagnoses
The primary diagnosis, in this case, is chancre. The patient presents with chancre clinical presentation, and an HSV specimen culture is positive for bacteria Haemophilus ducreyi, which is the chancre causative agent.
The most potential differential diagnoses, in this case, include syphilis, herpes simplex II and acute contact dermatitis. These conditions are STD’s and present with clinical presentations and risk factors similar to chancre. Syphilis can, however, be ruled out through a serological test that assesses the presence of Treponema pallidum bacteria, a syphilis causative agent.
Herpes Simplex II also presents with similar symptoms and risk factors as a chancre. However, in Herpes Simplex II, the genital bumps are very painful bumps and lesions with a burning sensation during urination. Diagnostic tests also show the presence of a viral infection.
Squamous cell carcinoma is another differential diagnosis with similar symptoms as a chancre. It is a form of skin cancer. However, laboratory tests show no presence of infection, and a skin biopsy reveals the presence of cancerous cells (Centers for Disease Control and Prevention, 2019).
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2014). Seidel’s Guide to Physical Examination-E-Book. Elsevier Health Sciences.
Centers for Disease Control and Prevention. (2019). Sexually transmitted diseases (STDs)
Cucci, E., Santoro, A., Di Gesù, C., Di Cerce, R., & Sallustio, G. (2015). Sclerosing adenosis of the breast: report of two cases and review of the literature. Polish journal of radiology, 80, 122.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2018). Advanced Health Assessment & Clinical Diagnosis in Primary Care E-Book. Elsevier Health Sciences.
Westhoff, C. L., Jones, H. E., & Guiahi, M. (2011). Do new guidelines and technology make the routine pelvic examination obsolete?. Journal of Women’s Health, 20(1), 5-10.
Week 10 Assignment
What’s Coming Up in Module 4?
Next week, you will consider how evidence-based practice guidelines and ethical considerations factor into health assessments. You specifically explore evidence-based practice guidelines and ethical considerations for specific scenarios.
Week 11 Final Exam
Next week, you take your Final Exam, which will cover the topics and resources from Weeks 7, 8, 9, and 10 for this course. Please take the time to review and plan your time accordingly so that you may be better prepared for your exam.
Next Module
To go to the next Module:
Module 4
Module 4: Ethics in Assessments
What’s Happening in This Module?
Module 4: Ethics in Assessments is a 1-week module, Week 11 of the course and the last module in which you examine evidence-based practice guidelines and ethical considerations factor into health assessments.
| What do I have to do? |
When do I have to do it? |
| Review your Learning Resources |
Days 1–7, Week 11 |
| Lab Assignment: Ethical Concerns |
Submit by Day 6 of Week 11. |
| Final Exam |
Complete and Submit By Day 7 of Week 11. |
Go to the Module’s Content
Week 11
Week 11: The Ethics Behind Assessment
Consider the following scenarios:
- You are a nurse at a large county hospital. One of your patients is leaning toward selecting a certain radical treatment for cancer, to which the family is in opposition. The family is concerned about making the correct decision and asks for your advice.
- The state of Oregon has passed a “Death with Dignity” act that allows for euthanasia in certain situations. One of your patients suffering from terminal cancer is thinking of moving there to take advantage of this law and asks your opinion.
Throughout this course, you have explored a wide range of health assessments and abnormal examination findings. Although you have predominantly focused on the procedural aspects of health assessment, this week, you will focus on ethical considerations that should be taken into account when advising patients or their families.
This week, you will consider how evidence-based practice guidelines and ethical considerations factor into health assessments. You will also evaluate health assessment concepts related to sports physicals and well-child and well-woman examinations.
Learning Objectives
Students will:
- Apply evidence-based practice guidelines to make an informed healthcare decision
- Apply ethical considerations to a health assessment response
- Apply concepts, theories, and principles relating to sports physicals and well-child and well-woman examinations
- Identify concepts, theories, and principles related to advanced health assessment
Learning Resources
Required Readings
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
· Chapter 24, “Sports Participation Evaluation”
In this chapter, the authors describe the process of a sports participation evaluation. The chapter also states the most common conditions encountered in a sports participation evaluation.
· Chapter 25, “Putting It All Together”
In this chapter, the authors tie together the concepts introduced in previous chapters. In particular, the chapter has a strong emphasis on the patient-caregiver relationship.
Tingle, J. & Cribb, A. (2014). Nursing law and ethics (4th ed.). Chichester, UK: Wiley Blackwell.
Furman , C. D., Earnshaw, L. A., Farrer, L. A. (2014). A case of inappropriate apolipoprotein E testing in Alzheimer’s disease due to lack of an informed consent discussion. American Journal of Alzheimer’s Disease & Other Dementias, 29(7), 590–595. doi:10.1177/1533317514525829.
Navarro-Illana, P., Aznar, J., & Díez-Domingo, J. (2014). Ethical considerations of universal vaccination against human papilloma virus. BMC Medical Ethics, 15(29). doi:10.1186/1472-6939-15-29. Retrieved from http://www.biomedcentral.com/1472-6939/15/29
Maron , B. J., Friedman, R. A., & Caplan, A. (2015). Ethics of preparticipation cardiovascular screening for athletes. Nature Reviews Cardiology, 12(6), 375–378. doi:10.1038/nrcardio.2015.21
May, K. H., Marshall, D. L., Burns, T. G., Popoli, D. M. & Polikandriotis, J. A. (2014). Pediatric sports specific return to play guidelines following concussion. The International Journal of Sports Physical Therapy, 9(2), 242–255. PMCID: PMC4004129. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4004129/
American Academy of Pediatrics. (2008). Recommendations for preventative pediatric health care (periodicity schedule). Retrieved from https://www.harmonyhpi.com/WCAssets/illinois/assets/IL_MedicaidProviderManual_PEM_AdultPHGsForProviders.pdf
This resource provides recommendations for preventative pediatric healthcare from infancy through adolescence. The periodicity schedule covers a variety of areas, from health history to measurements, developmental/behavioral screenings, physical exams, procedural screenings, and oral health.
Rourke, L., Leduc, D., & Rourke, J. (2017). Rourke Baby Record. Retrieved from http://rourkebabyrecord.ca/
This website provides information on the Rourke Baby Record (RBR). The RBR supplies guidelines on growth and nutrition, developmental surveillance, physical exam parameters, and immunizations for well-baby and child care.
Document: Final Exam Review (Word document)
Required Media
Module 4 Introduction
Dr. Tara Harris reviews the overall expectations for Module 4. Consider how you will manage your time as you review your media and Learning Resources for your Case Study Lab Assignment and your Final exam (3m).
Sports Participation Evaluation – Week 11 (12m)
Assignment 1: Lab Assignment: Ethical Concerns
As an advanced practice nurse, you will run into situations where a patient’s wishes about his or her health conflict with evidence, your own experience, or a family’s wishes. This may create an ethical dilemma. What do you do when these situations occur?
In this Lab Assignment, you will explore evidence-based practice guidelines and ethical considerations for specific scenarios.
To Prepare
Review the scenarios provided by your instructor for this week’s Assignment. Please see the “Course Announcements” section of the classroom for your scenarios.
- Based on the scenarios provided:
- Select one scenario, and reflect on the material presented throughout this course.
- What necessary information would need to be obtained about the patient through health assessments and diagnostic tests?
- Consider how you would respond as an advanced practice nurse. Review evidence-based practice guidelines and ethical considerations applicable to the scenarios you selected.
The Lab Assignment
Write a detailed one-page narrative (not a formal paper) explaining the health assessment information required for a diagnosis of your selected patient (include the scenario number). Explain how you would respond to the scenario as an advanced practice nurse using evidence-based practice guidelines and applying ethical considerations. Justify your response using at least three different references from current evidence-based literature.
By Day 6 of Week 11
Submit your Assignment.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
- Please save your Assignment using the naming convention “WK11Assgn+last name+first initial.(extension)” as the name.
- Click the Week 11 Assignment Rubric to review the Grading Criteria for the Assignment.
- Click the Week 11 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
- Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK11Assgn+last name+first initial.(extension)” and click Open.
- If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
- Click on the Submit button to complete your submission.
Grading Criteria
To access your rubric:
Week 11 Assignment Rubric
Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:
Submit your Week 11 Assignment draft and review the originality report.
Submit Your Assignment by Day 6 of Week 11
To participate in this Assignment:
Week 11 Assignment
Week 11 Assignment Sample Paper
NURS 6512 – Assignment, Lab Assignment: Ethical Concerns
Lab Assignment: Ethical Concerns
Student’s Name:
Institutional Affiliation:
Health Assessment Information
For the 49 -year -old patient with advanced cancer admitted with a cardiac arrest; an adequate health assessment would be required to make an adequate diagnosis. A comprehensive health assessment would provide details related to the patient’s physical status through measurement of vital signs, observation, and the patient’s self-reported symptoms. The comprehensive health assessment of the 49- year- the old patient would entail a medical history of the patient, a general survey, and a complete physical examination (Ingram, 2017). The general survey would be the first stage in the patient examination. This would include recording the patient’s age, height, weight, posture, build, gait, and hygiene. The general survey of the patient would provide baseline data and help build rapport with patients to establish a trusting relationship with the patient and ease anxiety. The general survey would then be followed by comprehensive health assessments, which would utilize different techniques, including inspection, auscultation, palpation, and percussion. Inspection is one of the most employed methods of assessment. Through inspections, different indications of health problems would be identified on the 49-year-old patient. An inspection would include inspecting skin color and lesions, rashes, as well as abnormal odors and sounds (Zambas, Smythe, & Koziol-Mclain, 2016). Another technique that would be utilized in health assessment is auscultations. This would include listening to the abdomen’s sounds by placing the bell of a stethoscope or diaphragm on the bare skin of patients. Before a comprehensive health assessment is adopted, the patient’s health history would be taken. This would include the patient’s medical compliance, past health records, presents the state of health, family history, psychosocial status, and family history. The health history would provide in-depth information on the symptoms of the 49 years old patient. Medical experiences, childhood illnesses, and the risk of developing certain diseases (Ingram, 2017). The health history collection would then be followed by a detailed physical examination of the patients, which would include a review of the patient’s body systems. A head-to-toe examination of the patients would include assessment of the patient, neurological functions, skin, eyes, nose, and throat. The respiratory functions of the patients would also be reviewed, and their cardiac, pulmonary system. This would be the central determinant of a cardiac arrest diagnosis. The patient’s muscle joints, abdomen reproductive systems, shoulders, limbs, ankles, hips, and feet would also be examined, with the patient’s reproductive system and nutrition being considered. The patient’s respiratory function results and cardiac and pulmonary system results would help determine the diagnosis of a cardiac arrest (Zambas et al., 2016).
Response to the Scenario as an APRN
As an advanced practice nurse, there are several evidence based emergency practices that I would need to perform to help the 49-year-old with a cardiac arrest. This would include rapid resuscitation to guarantee the survival of the patient as an advanced practice nurse the use of an automated external defibrillator (AED) would therefore be necessary to help detect life-threatening arrhythmias in the patient’s chest and deliver a shock to restore a normal heart rhythm if such incidents were detected (Zègre-Hemsey, 2020). High-quality cardiopulmonary resuscitations (CPR) would also be adopted to help save the life of the 49-year-old patient. The use of AED on the patient would be followed by CPR as a way of treating cardiac arrest on the patients. The ethical considerations that would be utilized to make the decisions to administer AED and CPR to the 49-year-old patient suspected to have a cardiac arrest would be beneficence and non-maleficence. The adopted procedures would avoid the harm of death occurring on the patients while they would actively be positive actions meant to benefit the patients and save their life.
References
Ingram, S. (2017). Taking a comprehensive health Assessment: learning through practice and
reflection. British Journal of Nursing, 26(18), 1033–1037. doi:10.12968/bjon.2017.26.18.1033.
Zambas, S. I., Smythe, E. A., & Koziol-Mclain, J. (2016). The consequences of using advanced
physical assessment skills in medical and surgical nursing: A hermeneutic pragmatic study. International journal of qualitative studies on health and well-being, 11, 32090. https://doi.org/10.3402/qhw.v11.32090.
Zègre-Hemsey, J.K., (2020).Optimizing Patient Outcomes in Emergency Cardiac Care through
Advances in Technology: Nurse Scientists in Action. DOI:https://doi.org/10.1016/j.jen.2020.01.007. Vol.46, Iss 2, P136-138.
Assignment 2: Lab Assignment: Practice Assessment: Mental Health Examination
The Lab Assignment
Complete the following in Shadow Health:
Exam: Week 11 Final Exam
This exam is a test of your knowledge in preparation for your certification exam. No outside resources, including books, notes, websites, or any other type of resource, are to be used to complete this exam. You are expected to comply with Walden University’s Code of Conduct.
This exam will be on topics covered in weeks 7, 8, 9, 10, and 11. Prior to starting the exam, you should review all of your materials. This exam is timed with a limit of 2 hours for completion. When time is up, your exam will automatically submit.
By Day 7 of Week 11
Complete the Final Exam.
Submission and Grading Information
Submit Your Final Exam by Day 7 of Week 11.
To Complete this Exam:
Week 11 Exam
What’s Coming Up?
Congratulations! After you have finished all of the assignments for this week, you have completed the course. Please submit your Course Evaluation by Day 7.
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