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N522PE-20A Advanced Physical Assessment

N522PE-20A Advanced Physical Assessment

N522PE-20A Advanced Physical Assessment

Module One: Introduction to the Course & Implementing Clinical Reasoning in Practice

N522PE-20A Advanced Physical Assessment Discussion 1

Post to the discussion board a planned approach to communicating with someone who speaks another language.  What type of questions will you need to ask?  Was there any communication issues discussed this week in Shadow Health? How does communication impact the concept of clinical reasoning in nursing? Please discuss the issues completely, citing your sources so that your classmates can reference the information. Include one insight gained this week from your readings or interaction in Shadow Health. N522PE-20A Advanced Physical Assessment

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

Assignment 1

Assignment Instructions:

Write a three-page paper on the use of clinical reasoning in developing and applying advanced health history and physical assessment skills at the graduate level. Consider contemporary nursing literature on the development of clinical reasoning and decision-making. How does the use of the nursing process enhance critical thinking, clinical reasoning, and clinical judgment in professional nursing practice at the graduate level. Please use the submission parameters and rubric below to guide you when completing this assignment.

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 3 pages, which does not include the cover page and reference page(s).

I.        Introduction (including purpose statement)

II.        Clinical Reasoning

  • Describe how clinical reasoning is used in developing and applying advanced health history and physical assessment skills at the graduate level.

III.        Nursing Process

  • Describe how the use of the nursing process enhance critical thinking, clinical reasoning, and clinical judgment in professional nursing practice at the graduate level.

IV.        Clinical Example

  • Discuss an example demonstrating the nurse’s use of critical thinking, clinical judgment, and clinical reasoning.
  • Discuss how nursing care is provided when each of these concepts are evidenced in nursing care of the patient.

V.        Conclusion

VI.        References (consider contemporary nursing research studies or reliable electronic sources)

Permalink: https://ulcius.com/n522pe-20a-advan…sical-assessment/

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 3 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 3 pages limit)
  • Attempt to use primary sources only. That said, you may cite reliable electronic sources (i.e. NCSBN, AANP)

Assignment 1 Rubric

Competency

30

27

25

0

Points
Define, compare and contrast clinical reasoning and decision-making. How is this related to critical thinking and clinical judgment in graduate level nursing practice? N522PE-20A Advanced Physical Assessment Defines, compares, and contrasts clinical reasoning and decision-making with cited references in addition to course readings for Week 1.
Answers posed questions.		 Defines, compares, and contrasts clinical reasoning and decision-making with cited references from course readings for Week 1.
Answers posed questions.		 Describes clinical reasoning and decision-making. Briefly answers how is this related to critical thinking and clinical judgment in graduate level nursing practice? Does not define, compare and contrast clinical reasoning and decision-making. Does not answer how is this related to critical thinking and clinical judgment in graduate level nursing practice? /30
30 27 25 0  
Consider contemporary literature and apply the concept of clinical reasoning to advanced physical assessment in nursing. Considers contemporary literature and applies the concept of clinical reasoning to advanced physical assessment in nursing. Considers textbook literature and references within text book without further consideration of external literature support. Considers and applies concept of clinical reasoning to advanced physical assessment in nursing without reference to expert opinion or research literature. Does not consider and apply concept of clinical reasoning to advanced physical assessment in nursing. /30
30 27 25 0  
Provides one clinical example demonstrating the nurse’s use of critical thinking, clinical judgment, and clinical reasoning. How is nursing care provided or modified when each of these concepts are evidenced in nursing care of the well-adult, family, and one special population? Provides one clinical example demonstrating the nurse’s use of critical thinking, clinical judgment, and clinical reasoning. Discusses how nursing care was provided or modified when each of these concepts were evidenced in nursing care of the well-adult, family, and one special population. Provides one clinical example demonstrating the nurse’s use of critical thinking, clinical judgment, and clinical reasoning. Discusses how nursing care was provided or modified when each of these concepts were evidenced in nursing care of the well-adult, family, or one special population. Demonstrates the nurse’s use of critical thinking, clinical judgment, or clinical reasoning. Discusses how nursing care was provided or modified when these concepts were evidenced in nursing care of the well-adult, family, or one special population. N522PE-20A Advanced Physical Assessment Does not demonstrate the nurse’s use of critical thinking, clinical judgment, or clinical reasoning. Does not discuss how nursing care was provided or modified when these concepts were evidenced in nursing care of the well-adult, family, or one special population. /30
10 9 8 0  
APA Format, grammar, punctuation and spelling. 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

Module Two: HEENT and Skin Assessment

N522PE-20A Advanced Physical Assessment Discussion 2

This week you have studied advanced physical assessment of the eyes, ears, nose, throat, head, neck and skin (HEENT). Describe the classification of rashes.  What additional resources for HEENT advanced health assessment skills have you found beneficial in developing your knowledge and psychomotor skills this week? Post a concept to the discussion board that you have had difficulty with and note where you are with resolution of your 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.

Module Three: Cardiovascular, Peripheral Vascular System & Respiratory Assessment

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?

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.

N522PE-20A Advanced Physical Assessment 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.

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).

  1. Introduction (including purpose statement)
  2. Focus of the assessment
    1. Describe the focus of this particular assessment on the patient complaining of a cough
  3. Subjective Component
    1. Describe the ROS, PMH, and other relevant data in this section.
  4. Objective Component
    1. Describe the physical examination findings including techniques of examination
  5. Documented evidence to support clinical reasoning
    1. Describe the list of differential diagnoses
  6. 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.
  7. Conclusion
  8. 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. N522PE-20A Advanced Physical Assessment 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. 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. N522PE-20A Advanced Physical Assessment /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. /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

Module Four: Gastrointestinal, Breast and Axilla Assessment

Discussion 4

As you know, abdominal pain can be a challenging patient complaint because it is frequently benign, but can also herald serious acute pathology. The history and physical examination are critical to narrowing the differential diagnosis of abdominal pain and guiding the evaluation. Acute abdominal pain frequently requires urgent investigation and management. Some patients may require the assessment of their airway, breathing, and circulation, followed by appropriate resuscitation. Many patients will require analgesics, which can be administered judiciously without compromising the physical assessment of peritoneal signs. That said, what are the common differential diagnoses of abdominal pain in emergency situations? Also, does your healthcare institution have a specific policy, algorithm and/or protocol on how to assess, manage, and treat abdominal pain? Please share an example of the protocol for abdominal pain from practice or the literature.

Module Five: Neurological & Musculoskeletal Assessment

N522PE-20A Advanced Physical Assessment Discussion 5

This week you have studied neurological and musculoskeletal advanced physical assessment. While a diverse set of advanced physical assessment skills where do you place your greatest level of confidence and what areas need more development. What methods do you use to remember assessment of cranial nerves, mental status, or other important clinical assessments of persons with neurological or musculoskeletal problems? Of these areas of advanced physical assessment what psychomotor skill is most challenging for you to accomplish? Why?

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 clinical 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.

Example Approach for Discussion 5

This was the most challenging week for me in Shadow Health. The mental assessment is definitely my weakest. I remember in nursing school struggling with the psych nursing component. Unfortunately, I have not made much progress.

I found an illustrative guide to help me with cranial nerve assessments (Ghalli, 2016). In this guide, the author includes word association, picture association and actual pictures of assessment technique as well as abnormal findings. In the word association, the document showed this picture with the year 1973 and explained that the cranial nerves 3,7,9 and 10 had parasympathetic fibers. N522PE-20A Advanced Physical Assessment 

Injuries to cranial nerve 7 can cause paralysis. Parasympathetic nervous system control the functions that you do not have to think about such as saliva production, taste, information exchange to the ears. Damage to the cranial nerve 7 can affect these functions (Dulak & Navqi, 2020).  Testing cranial nerve 7 involves asking the patient to wrinkle his forehead, smile, puff out his cheeks and close his eyes. I would be assessing for symmetry.

If a patient has injury to the 7th cranial nerve, they are at an increased risk of other complications. For example, if the eyelids do not open and close appropriately, the eye can become unable to properly lacrimate, which can lead to corneal ulcerations.

Findings from the cranial nerve 7 assessment can help identify possible causes of the injury such as stroke versus cranial nerve damage, skull fractures, and neuromas to name a few. Swelling can occur around the 7th nerve, which can cause bell’s palsy. Others may be infectious diseases like herpes or lymes disease may also affect the 7th cranial nerve.

Dulak D, Naqvi IA. (2020). Neuroanatomy, Cranial Nerve 7 (Facial). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK526119/

Ghalli, F. (2016). An illustrative guide to cranial nerve examination. http://www.cardiffandvaleuhb.wales.nhs.uk/sitesplus/documents/1143/Cranial%20Nerves%20Clinical%20Examination%202016.pdf

323 words

In reply to Jill Hulin

Re: Jill  Discussion 5

by Dona – 
Well done. Describe a tool that you can use to assess for depression in the office setting.

17 words

In reply to Dona Clarin

Re: Jill Discussion 5 – N522PE-20A Advanced Physical Assessment 

by Jill – 

The US Preventative Services Taskforce published a tool from Pfizer for assessing depression, called Patient Health Questionnaire (PHQ-9). This is a very simple tool for a person to complete. Based on the patient’s responses, a risk of depression from mild to severe. This appears to be a beneficial tool for providers. Kroenke, Pritzer, & Williams (2001) conducted a study on the tool and indicated that after reviewing 6000 charts where the patients completed the tool, and interviewed a sample of 580 patients. They found that the tool was very effective in identifying depression and the severity of depression.

Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of general internal medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x

131 words

In reply to Jill 

Re: Jill Hulin Discussion 5

by Dona  – 
PHQ-9 is a good tool. Another one is the PHQ-2. Super simple and quick.

14 words

In reply to Jill 

Re: Jill  Discussion 5 – N522PE-20A Advanced Physical Assessment 

by Ihuoma  – 
Good post Jill, I will add to your post.
I agree with you on the damage to cranial nerve # 7. There are other cranial nerves injuries that can lead to a lasting injury to individuals. Example one of the most common impairment to nerves at the time of head injury is found on cranial nerve #1 the olfactory nerve. The harm will not only affect the patient sense of smell, it will also affect their ability to taste, considering the fact that smell is vital to taste. Also, if any harm affects the cranial nerve V11, facial nerve will be injured, altering the ability of expression and taste, because one side of the persons face will not be functional(Lakhan, 2020),
At the same token, the cranial nerve 11 optic nerve damage, can also lead to permanent blindness to the person’s eye. Each nerve displays unique signs after damage. (Lakhan, 2020), indicated that if a nerve is cut into two, that it cannot be repaired, but if hurt or strained and remain intact chances of recovery is promising. It will take a while, with unpleasant feelings.
Reference
Lakhan, (2020). Cranial Nerve Damage from Head Trauma. Retrieved from:
https://www.verywellhealth.com/cranial-nerve-damage-from-head-trauma-1720018

202 words

In reply to Jill Hulin

Re: Jill  Discussion 5

by Alissa  – 

Hi Jill! My personal struggle this week was regarding assessment of the cranial nerves, however, I remembered a catchy phrase to assist me with remembering the progression of the nerve assessments- “oh, oh, oh to touch and feel very good velvet. Ah, heaven.” Then from there, I utilized Damodaran (2013) et. al. that assisted with anatomy and cranial nerve examination techniques and tips. The article also reviewed common mistakes in cranial nerve examination, which may seem obvious, but are things that I didn’t personally think of at the time when assessing Tina on Shadow Health. Examples include being aware if your patient is at risk for aspiration when testing swallowing, ask about corrective lens use, inspect for hearing aids or scars, and if the patient has facial asymmetry this may cause a misleading impression of an asymmetrical tongue. However, I feel that this resource was missing pictures. Ghalli et. al. (2016) that you mentioned in your post I found to be extremely beneficial. It was great to see the examination methods in a friendly, easy to follow format. Thank you for sharing! N522PE-20A Advanced Physical Assessment 

Damodaran, O., Rizk, E., Rodriguez, J., & Lee, G. (2013). Cranial nerve assessment: A concise guide to clinical examination. Clinical Anatomy, 27(1), 25–30. https://doi.org/10.1002/ca.22336

Ghalli, F. (2016). An illustrative guide to cranial nerve examination. http://www.cardiffandvaleuhb.wales.nhs.uk/sitesplus/documents/1143/Cranial%20Nerves%20Clinical%20Examination%202016.pdf

237 words

In reply to Alissa 

Re: Jill Discussion 5

by Honey  – 

Dr. Clarin and Alissa,

     Assessment of cranial nerves can always be a challenge specially in a clinical setting where it’s not routinely used. However it’s is suggested that neurological examination can be used as part of screening exam during physical examination. This makes more sense since subconsciously, nurses almost always make neuro-assessment as part of the daily patient-care routine. The best way to understand the process is to just study its purpose. I saw a video about assessment of cranial nerves and the mnemonic made more sense. ‘Old Operator Occasionally Troubleshoots Tricky Abducted Family Veterans Galloping Valiantly Across History.” The motor and sensory functions of the cranial nerves are easily memorized using this mnemonic, “Some Say Marry Money, But My Brother Says Big Brains Matter More.” The following lists the cranial nerves and how they’re assessed:
1(Olfactory): Only recognizable non-corrosive, mild scent is used. Because of cultural diversity, patients may not be familiar with the objects that are specific to one country. With patient’s eyes closed, the sense of smell is elicited with one nostril closed. The same is done for the other nostril but with different scent. Peppermint, menthol, and ammonia are to be avoided since they may stimulate trigeminal nerve endings or taste buds which do not specifically test smell.
CN II(Optic Nerve): Ask the patient use eyeglasses if prescribed to wear one. This tests for visual acuity using the Snellen Chart, which is placed 6ft. away from the patient. Each eye is tested independently but make sure that lighting is adequate and that the opposite eye is covered completely. In Visual Field Test, the patient is asked to count the fingers they see that are presented to both sides at the same time. In Color perception test, each eye is tested for ability to distinguish color saturation, using Ishihara chart. Fundoscopy examination uses ophthalmoscope to assess the optic disc, retina, and retinal vessels. To reduce the awkward facial contact, the examiner can use the right hand for the examination of the right eye and examine the left eye with ophthalmoscope held by the left hand. All quadrants are examined. The patient is asked to look superiorly, inferiority, nasally and temporally making note of cotton wool bodies, exudates and hemorrhages.
III, IV, VI (ExtraOcular Movements: oculomotor, trochlear, abducens nerves) – Pupillary Reflex is tested using a penlight (PERRLA).This tests for consensual and direct constriction of pupils after light exposure. Tests for 6 gaze directions.
V (Trigeminal Nerve): Facial Sensation in ophthalmic, maxillary, and mandibular zones – In testing for light sensation, the patient is asked to close eyes and face is wiped with cotton wisp at the forehead. Testing for deep sensation uses blunt to sharp ends object. Sensation of warmth and cold is tested. Blink reflex is elicited by asking client to look upwards and touch lateral sclera. Ask patient to clench the jaw. Feel for the contraction of the masseter and temporal muscles. Sense of taste is elicited at anterior 2/3 of the tongue (with the eyes closed.)
VII (Facial Nerve): This tests facial symmetry and skull symmetry. Patient is asked to puff out cheeks, frown, close eyes tightly and smile.
VIII (Vestibulocochlear nerve): Check for hearing aids. This tests hearing and balance. May use Weber and Rinne tests; whisper words to both sides and let patient repeat. Ask patient to walk to observe gait and balance.
IX (Glossopharyngeal): Patient is asked to say “ah” and yawn to test for upward soft palate movement; this elicits gag reflex and ability to swallow.
X (Vagus): This tests articulation. Note hoarseness when patient is asked to swallow and talk. ( IX and X are usually tested together and the examiner has to be cautious on patients with dysphagia )
X1(Accessory): This tests the trapezius and sternocleidomastoid muscle strength (0-5) against resistance. Patient is asked to shrug shoulders.
X11 (Hypoglossal): Patient is asked to protrude tongue and move to sides. Examiner is looking for fasciculations and atrophy.
     Knowing how to execute cranial nerve assessment gives me more confidence in my therapeutic relationship with the client. Knowledge on extensive neurological assessment can help identify emergency issues that need immediate intervention. It’s true that clinical eye develops with experience but if professional nurses are equipped with vast medical knowledge, then treatment is more efficient. 

Bickley, L. S., & Szilagyi, P. G. (2017). Bates’ pocket guide to physical examination and history taking. Wolters Kluwer. 

Dains, J., Baumann, L., & Scheibel, P. (2016). Advanced health assessment & clinical diagnosis in primary care (5th ed.). Mosby Elsevier. N522PE-20A Advanced Physical Assessment 

751 words

In reply to Honey 

Re: Jill Discussion 5

by Dona Clarin – 
Well done!

2 words N522PE-20A Advanced Physical Assessment 

N522PE-20A Advanced Physical Assessment Assignment 3

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 Brian, an adult who is complaining of chest pain. Please submit your summary documentation in MS Word. Use the submission parameters and rubric below to guide you in completion of this written assignment.

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).

  1. Introduction (including purpose statement)
  2. Focus of the assessment
    1. Describe the focus of this particular assessment on the patient complaining of chest pain
  3. Subjective Component
    1. Describe the ROS, PMH, and other relevant data in this section.
  4. Objective Component
    1. Describe the physical examination findings including techniques of examination
  5. Documented evidence to support clinical reasoning
    1. Describe the list of differential diagnoses
  6. 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.
  7. Conclusion
  8. 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. N522PE-20A Advanced Physical Assessment 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. 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. N522PE-20A Advanced Physical Assessment		 /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. /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

Module Six: Mental Health Assessment & Male and Female Urinary and Reproductive Systems. N522PE-20A Advanced Physical Assessment

Discussion 6

This week you have studied mental health (psychological); urinary and reproductive systems of the male and female in advanced physical assessment. While this is a diverse set of advanced physical assessment skills where do you place your greatest level of confidence and what areas need more development.  Of these areas of advanced physical assessment where to you struggle in your nursing practice most when providing patient-centered education?

Please cite sources for additional knowledge, skill development, or professional development related to reproductive health and provide additional “clinical pearls” learned this week. 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.

N522PE-20A Advanced Physical Assessment Assignment 4

Assignment 4

Assignment Instructions:

For this 4-5 pages 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 Esther, an elderly patient who is complaining of abdominal discomfort. Please submit your summary documentation in MS Word. Use the submission parameters and rubric below to guide you in completion of this written assignment.

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).

  1. Introduction (including purpose statement)
  2. Focus of the assessment
    1. Describe the focus of this particular assessment on the patient complaining of abdominal discomfort.
  3. Subjective Component
    1. Describe the ROS, PMH, and other relevant data in this section.
  4. Objective Component
    1. Describe the physical examination findings including techniques of examination
  5. Documented evidence to support clinical reasoning
    1. Describe the list of differential diagnoses
  6. 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.
  7. Conclusion
  8. 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 fonta
  • 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. N522PE-20A Advanced Physical Assessment 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. 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. N522PE-20A Advanced Physical Assessment 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. /5
10 9 8 0  
Grammar, Spelling, and Punctuation APA Format APA Format, grammar, punctuation and spelling is accurate with 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

 

Module Seven: Special Topics – Life-Span Assessments, Ethics & Legal Issues

Discussion 7

Caring for persons across the life span and from very diverse cultural backgrounds can present challenges in nursing practice. As you studied the ethical and legal issues related to advanced physical assessment what insights have you gained to advance your clinical reasoning? Describe knowledge gained or re-affirmed through a de-identified clinical story.

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

N522PE-20A Advanced Physical Assessment Final Project

Final Project

The Final Project (6-8 page paper) synthesizes the previous weeks’ study of advanced physical assessment by conducting a comprehensive assessment in ShadowHealth. The final project synthesis is focused upon designing evidence-based, culturally competent nursing interventions through the development of an individualized health plan. Assessment of competency is based on the Comprehensive Patient Interview, Physical Examination and Individualized Plan of Care incorporating Healthy People 2020 and evidence-based interventions and patient-centered goals.

You will use one comprehensive digital clinical experience health history and physical assessment for this assignment: Comprehensive Assessment. Please submit your summary documentation in MS Word. Use the submission parameters and rubric below to guide you in completion of this written assignment. The use of Headers in your paper is strongly encouraged.

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 6-8 pages, which does not include the cover page and reference page(s). N522PE-20A Advanced Physical Assessment

  1. Introduction (including purpose statement)
  2. Subjective Findings Synthesis
  3. Objective Findings Synthesis
  4. Plan of Care
    1. Apply one nursing theory in planning care for this patient
    2. Incorporate Healthy People 2020 Objectives into the plan of care prioritized to meet the health needs of the patient
    3. Document evidence to support clinical reasoning for selected evidence-based plan of care
    4. Plan of care is individualized to findings, life-span stage of development with culturally specific considerations, and patient-centered.
  5. Conclusion
  6. 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 6-8 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 6-8 pages limit)
  • Attempt to use primary sources only. That said, you may cite reliable electronic sources (i.e. NCSBN, AANP)

The Final Project documentation is due in Week Seven.  Please see the Final Project below to help you complete the assignment.

Final Project Rubric

Competency

20 

18 

 16

0 

Earned/ Possible Points
The history, assessment and key findings are synthesized Documentation clearly shows student has completed a comprehensive assessment with a written synthesis of key findings. Documentation supports the student has completed the comprehensive assessment with key findings. N522PE-20A Advanced Physical Assessment Documentation supports the student has completed the assessment without documentation of key findings. Documentation supports the student attempted to complete the comprehensive assessment without identification of key findings. The comprehensive health history is briefly documented and lacks depth and specificity. /20
20 18 16 0  
Documented  Prioritized Physical Examination Findings Documentation clearly shows student has completed the physical examination with findings prioritized. Documentation supports the student has completed the physical examination with findings. Documentation supports student completed some of the physical examination. 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. /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 in developing the final plan of care with one nursing theory applied and integration of Healthy People 2020. Discourse supports the student has studied the topic and has given thought in developing the final plan of care. Lacks integration of either one applied nursing theory or integration of Healthy People 2020. Discourse supports student studied some of the topic, however, lacks detail and depth in developing the final plan of care.
Lacks integration of either one applied nursing theory or integration of Healthy People 2020.		 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. No use of one applied nursing theory or integration of Healthy People 2020.		 /20
20 18 16 0  
Individualized and Prioritized Plan of Care is 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 development-ally and culturally specific assessment and plan of care for the selected patient. Documents a development-ally and culturally specific assessment and plan of care. Presents a development-ally and culturally specific assessment or plan of care and one or both are not based upon the selected patient. A development-ally 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 comprehensive 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 comprehensive 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 physical assessment. /5
10 9 8 0  
Grammar, Spelling, and Punctuation APA Format APA Format, grammar, punctuation and spelling is accurate with 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

 

Module Eight: Special Topics – Pain Assessment & Cultural Competency

N522PE-20A Advanced Physical Assessment Discussion 8

Consider the special topics of pain assessment and cultural competency. How are these nursing assessments conducted in your nursing practice? Are your assessments current and based upon contemporary evidence or are these in need of policy and procedural revision? If revision is needed, what might you suggest be changed? If you perceive the assessments are clinically relevant what evidence supports your current practice?

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

Sample Discussion 8 Solution

Culture can influence how one expresses, manages, and experiences pain.  Pain is universal, but the way one person says pain can differ from another individual.  Other factors that play a role in the way someone interprets and tolerate pain rates are family beliefs and religion.  For example, I recently took care of a gentleman in the ICU suffering from COVID, who was of Japanese descent, and his father was a former Marine.  He was taught that stoicism was part of his heritage from a young age, and he needed to act “tough” like “a Marine.”   Although this is just a basic example, the identification and treatment of pain can be much more challenging for a provider if they cannot understand the complexity of pain in an individual.

According to the Institute for Clinical Systems Improvement, pain scales have been part of pain treatment for many years and have become standard practice (2018). In my facility, we use various pain scales such as the Critical Care Pain Observation Tool (CPOT), Wong-Baker Faces Pain Scale, FLACC Scale, and a Numerical Rating Pain Scale. 

Our hospital policy requires us to assess pain a minimum of every 4 hours or sooner as needed. If we give pain medicine due to pain, we are required to re-assess for the effectiveness within one hour of giving the medication.  Suppose a patient is in the ICU and sedated. In that case, we use the CPOT scale, which “is the most reliable tool currently available to assess pain in patients” (Phillips et al., 2019) who are unable to communicate.  We assess our pain assessment on various factors such as increased heart rate, respiration, blood pressure, facial grimacing, and an increase in restlessness.

References

Institute for Clinical Systems Improvement (2018).  Asses, quality of life, function, and pain. https://www.icsi.org/guideline/pain/assess-quality-of-life-function-and-pain/

Phillips, M. L., Kuruvilla, V., & Bailey, M. (2019). Implementation of the Critical Care Pain Observation Tool increases the frequency of pain assessment for non-communicative ICU patients.  Australian critical care: official journal of the Confederation of Australian Critical Care Nurses, 32(5), 367–372. https://doi.org/10.1016/j.aucc.2018.08.007 N522PE-20A Advanced Physical Assessment