American Sentinel N522PE Module Three: Cardiovascular, Peripheral Vascular System & Respiratory Assessment Assignment 2

Discussion 3

This week you have studied cardiovascular, peripheral vascular, and respiratory advanced physical assessment. What additional resources for these advanced health assessment skills have you found beneficial in developing your knowledge and psychomotor skills this week? American Sentinel N522PE Module Three: Cardiovascular, Peripheral Vascular System & Respiratory Assessment Assignment 2

Post a concept to the discussion board that you have had difficulty with and note where you are with resolution of these difficulties. Please describe the issue completely, citing your sources so that your classmates can reference the information and provide additional “clinical pearls”. In other words, please include primary sources and/or reliable electronic sources to support your arguments.

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Discussion Participation Guidelines & Grading Criteria.

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Example Solution

The Shadow Health tool was extremely helpful and educational. I also utilized the Oxford Medicine Online (Baid, Creed and Hargreaves,2016). This document discussed normal physical assessment as well as abnormal findings. In the abnormal findings section, the authors listed assessments to help understand abnormal findings. I learned that crackles are normally heard on inspiration. Crackles are identified by the size airway that they are noted in. For example, fine crackles are noted in the smaller airways and course crackles are heard in larger airways (Sarkar, M., Madaldhavi, I., Niranjan, N. and Dogra, M., 2015). Crackles are also called Rales.

A challenge for me is listening for the appropriate heart sounds. Making notes was helpful. I think with practice, I will improve. The Shadow Health tool can be challenging sometimes. It would be helpful if there was an easy reference for all of the sounds that you are listening for. In the respiratory assessment, there 2 abnormalities that did not have a reference link. They were decreased and increased breath sounds. These two were similar sounding to me. S3 is most often heard in patient with congestive heart failure. However, S3 can also be normal in persons under the age of 40 (University of Washington Department of Medicine, 2020). S4 is heard as an added sound between the S1 and S2 like Tennessee. This sound is heard in patients with “hypertension, aortic stenosis, ischemic or hypertrophic cardiomyopathy” (University of Washington Department of Medicine, 2020). This is usually because the left ventricle has hardened. There are other sounds that we did not learn about in shadow health such as clicks and snaps. These can be heard in patients with prosthetic heart valves.

Baid, H., Creed, F., Hargreaves, J. (2016). Cardiovascular assessment and monitoring. Oxford Medicine Online. Retrieved from: https://oxfordmedicine.com/view/10.1093/med/9780198701071.001.0001/med-9780198701071-chapter-6

Sarkar, M., Madaldhavi, I., Niranjan, N., Dogra, M. (2015). Auscultation of the respiratory system. Annuals of Thoracic Medicine.10(3). 158-168. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4518345/

University of Washington Department of Medicine. (2020). Techniques: Heart sounds and murmurs. Retrieved from: https://depts.washington.edu/physdx/heart/tech2.html

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Excellent post Jill. I didn’t realize that about fine or course crackles being defined by their location. That makes sense. I also agree with you on heart sounds being difficult and challenging at times. Thanks for sharing your findings.
Kristy

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In addition to your post, I learned that S3 is not possible with severe mitral stenosis but normal in pregnant women, athletes and younger people. S3 can also mean systolic heart failure. According to Dornbush (2020), as tricuspid and mitral valves open, S3 is audible in people with overly compliant ventricles. The affected myocardium is stretched enough to passively receive load of blood causing the ventricular gallop. In physical examination, to appreciate the sound, you can auscultate using the bell of the stethoscope at the cardiac apex with the patient lying on the left side. The S3 is very faint if not audible when the diaphragm is used. The adults 35-40 years of age as well as the children have normal S3 sound called “physiologic S3,” but disappears before middle age. The reason for this is related to ventricular filling when ventricular wall is not fully expanded. This ventricular limitation causes tension reverberation, thus the S3 heart sound.

Dornbush, S. (2020, July 26). Physiology, Heart Sounds. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK541010/

176 words American Sentinel N522PE Module Three: Cardiovascular, Peripheral Vascular System & Respiratory Assessment Assignment 2

Well done. Describe each of the locations of the heart valves when auscultating.

13 words

Assignment 2

Assignment Instructions:

For this 4-5 page assignment, you will conduct a focused health history and physical assessment based upon your Practice Experience work in Shadow Health. Particularly, you will complete a focused assessment on Danny, a child who is complaining of a cough. Please submit your summary documentation in MS Word. Use the submission parameters and rubric below to guide you in completion of this written assignment. American Sentinel N522PE Module Three: Cardiovascular, Peripheral Vascular System & Respiratory Assessment Assignment 2

Submission Parameters:

For this written assignment, please use the following guidelines and criteria. Also, please refer to the rubric for point allocation and assignment expectations. The expected length of the paper is approximately 4-5 pages, which does not include the cover page and reference page(s).

Introduction (including purpose statement)
Focus of the assessment
1. Describe the focus of this particular assessment on the patient complaining of a cough
Subjective Component
1. Describe the ROS, PMH, and other relevant data in this section.
Objective Component
1. Describe the physical examination findings including techniques of examination
Documented evidence to support clinical reasoning
1. Describe the list of differential diagnoses
Plan of care
1. Describe the plan of care individualized to findings, life-span stage of development with culturally specific considerations for each focused area of assessment.
Conclusion
References (use primary and/or reliable electronic sources)

In regards to APA format, please use the following as a guide:

Include a cover page and running head (this is not part of the 4-5 pages limit)
Include transitions in your paper (i.e. headings or subheadings)
Use in-text references throughout the paper
Use double space, 12 point Times New Roman font
Apply appropriate spelling, grammar, and organization
Include a reference list (this is not part of the 4-5 pages limit)
Attempt to use primary sources only. That said, you may cite reliable electronic sources (i.e. NCSBN, AANP)

Competency	20	18	16	0	Points Earned
Focus of the Assessment is identified with Special Considerations including Documented Focused Health History	Documentation clearly shows student has completed a focused assessment with identified special considerations including a well-documented focused health history.	Documentation supports the student has completed the focused assessment with minimal identification of special concerns. The focused health history is documented.	Documentation supports the student has completed the focused assessment without identification of special concerns. The focused health history is documented and lacks depth and specificity of weekly topic.	Documentation supports the student attempted to complete the focused assessment without identification of special concerns. The focused health history is briefly documented and lacks depth and specificity of weekly topic.	/20
	20	18	16	0
Documented Physical Examination Findings including Techniques of Examination	Documentation clearly shows student has completed the physical examination and accurately describes the techniques of examination for the week. American Sentinel N522PE Module Three: Cardiovascular, Peripheral Vascular System & Respiratory Assessment Assignment 2	Documentation supports the student has completed the physical examination and describes the techniques of examination for the week.	Documentation supports student completed some of the physical examination for the focused assessment of the week. Documentation is accurate but lacks depth.	No evidence that the student is applying read concepts of advanced focused physical assessment. Documentation lacks depth and may lack coherence for understandability of tasks completed in this week.	/20
	20	18	16	0
Documented Evidence to Support Clinical Reasoning with External Course Resources	Discourse clearly shows the student has studied the topic and has given thought to the focused assessed topic and documentation for the week.	Discourse supports the student has studied the topic and has given thought to the focused assessment topic and documentation for the week.	Discourse supports student studied some of the topic for the focused assessment topic this week. Discourse is accurate but lacks depth.	No evidence that that student has read or studied the topic. Discourse lacks depth. May be presented in a rambling manner. Content is inaccurate &/or is unclear.	/20
	20	18	16	0
Individualized Plan of Care Based Upon Clinical Findings	Accurately presents an individualized plan of care based upon clinical findings.	Presents an individualized plan of care based upon clinical findings. Some minor omissions are noted.	Presents a plan of care that is not individualized based upon the clinical findings.	A plan of care is not presented or the plan of care presented lacks demonstration of competency or is irrelevant to the clinical findings.	/20
	5	4	3	0
Developmentally and Culturally Specific	Accurately documents a developmentally and culturally specific assessment and plan of care for the selected patient.	Documents a developmentally and culturally specific assessment and plan of care.	Presents a developmentally and culturally specific assessment or plan of care and one or both are not based upon the selected patient.	A developmentally and culturally specific assessment and plan of care are not presented or based upon the selected patient’s findings.	/5
	5	4	3	0
Demonstration of Compliance with Ethical and Legal Standards of Professional Nursing Practice	Compliance with the ethical and legal standards of professional nursing practice is explicitly stated in the documentation of the focused physical assessment.	Compliance with the ethical and legal standards of professional nursing practice is stated in the documentation.	Compliance with the ethical and legal standards of professional nursing practice is briefly implied in the documentation of the focused physical assessment or inaccuracies are evidenced in the written assessment.	Compliance with the ethical and legal standards of professional nursing practice is not included in the documentation of the focused physical assessment. American Sentinel N522PE Module Three: Cardiovascular, Peripheral Vascular System & Respiratory Assessment Assignment 2	/5
	10	9	8	0
Grammar, Spelling, and Punctuation APA Format	APA Format, grammar, punctuation and spelling is accurate with no errors.	APA Format, grammar, punctuation and spelling is accurate with less than two types of errors.	APA Format, grammar, punctuation and spelling is accurate with five or fewer types of errors.	APA Format, grammar, punctuation and spelling is accurate with more than five types of errors.	/10
COMMENTS:				TOTAL:	/100

American Sentinel N522PE Module Three: Cardiovascular, Peripheral Vascular System & Respiratory Assessment Assignment 2