American Sentinel N522PE Module 5: Neurological & Musculoskeletal 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. American Sentinel N522PE Module 5: Neurological & Musculoskeletal Assessment

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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 chest pain
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)

Rubric

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.	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. American Sentinel N522PE Module 5: Neurological & Musculoskeletal Assessment	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.	/5
	10	9	8	0
Grammar, Spelling, and Punctuation APA Format	APA Format, grammar, punctuation and spelling is accurate with no errors. American Sentinel N522PE Module 5: Neurological & Musculoskeletal Assessment	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

Competency

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

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

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. American Sentinel N522PE Module 5: Neurological & Musculoskeletal Assessment

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

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

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. American Sentinel N522PE Module 5: Neurological & Musculoskeletal Assessment

A developmentally and culturally specific assessment and plan of care are not presented or based upon the selected patient’s findings.

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.

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

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 Discussion Solution and Responses

N522PE Discussion 5

In the nursing process, the most difficult assessment to remember for me has always been the neurologic exam, not so much as the steps, but in connecting each step with the nerve it was assessing. I still had to focus on remembering the function of each nerve. To remember the order, I came across this acronym, “On, On, On, They Traveled And Found Voldemort Guarding Very Ancient Horcruxes” (Vasković, 2020). With this, I was able to keep the nerves in order. The olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, accessory, and hypoglossal. However, to remember whether they are sensory, motor or both, I found this other acronym: “Some Say Money Matters, But My Brother Says Big Brains Matter Most”, to be just as helpful as the previous acronym (Vasković, 2020).

The autonomic nervous system, cranial nerves, muscle strength, reflexes, mental status, balance, coordination, sensation, and the motor system are included in the neurologic exam. Although I work in an intensive care unit (ICU), the MMSE is still used with other test in order to differentiate between diagnosis of dementia and altered scores due to physical conditions like sleep apnea, which can cause cognitive and memory problems, physical injuries, and depression (Norris et al., 2016).

Of all the information on the internet, one that I have been using the most to assist me in is the videos from ICU Advantage. With them, I have been able to continuously practice my weak points, in the hopes to become proficient in the cranial nerves and other physical assessments. American Sentinel N522PE Module 5: Neurological & Musculoskeletal Assessment

References

Cranial Nerve BASICS – The 12 cranial nerves and how to REMEMBER them! (2020). ICU Advantage. https://www.youtube.com/watch?v=GJBnwZQ60Ss&feature=emb_rel_pause

Norris, D., Clark, M. S., & Shipley, S. (2016). The Mental Status Examination. American family physician, 94(8), 635–641.

Vasković, J. (2020). 12 cranial nerves. Retrieved October 22, 2020, from https://www.kenhub.com/en/study/overview-of-cranial

325 words

Great insights. Describe the process of assessing the deep tendon reflexes.

11 words

Hi Robert!
I also work in an ICU. We use a CAM and RASS score to assess the patient’s level of consciousness and delirium. I feel as though I do practice neurological assessments, I am not as competent as I should be in the aspects of visual acuity, hearing exams, sensory exams, and deep tendon reflexes. Thanks for sharing your helpful videos!

62 words

Thank you, Robert, for your post on acronyms to remember the neurologic exam and the use of ICU advantage. The 12 cranial nerves originate from the brain stem or brain (Bickley & Szilagyi, 2017). Paired nerves relay information from the head and the neck to both sides of the brain (Watson, 2020). The location of the nerves includes the cerebrum, midbrain, pons, pontomedullary, and medulla oblongata. Interestingly, there are five nerves associated with eye function (Watson, 2020). I learned from the ICU advantage video the neuron differences between afferent (sensory) and efferent (motor) (Watson, 2020). The videos have color-coded nerves to identify their location. In addition to the mnemonics you used in your post, they visually used a pictorial representation of the face with the numbers (Watson, 2020). To memorize sensory or motor functions, the author used the pneumonic for the 12 nerves, “some say money matters, but my brother says big brains matter more” (Watson, 2020). I appreciate the use of humor in the work of learning the cranial nerves.

References

Bickley, L. M., & Szilagyi, P. G. (2017). The Nervous System. In R. M. Hoffman (Ed.), Bates’ guide to physical examination and history taking (12th ed., pp. 711–796). Wolters Kluwer.

Watson, E. (2020, February 10). Cranial nerves basics. YouTube. Retrieved October 23, 2020, from https://www.youtube.com/watch?v=GJBnwZQ60Ss

222 words

Hello Robert!

Thank you greatly for your post on acronyms in regards to the neurologic exam. I too find some difficulty when it comes to the memorization of functions of nerves. The cranial nerves supply afferent and efferent (sensory, motor, and autonomic) innervation to the structures of the head and neck. ( Lopez, 2020)

Sonne J, Lopez-Ojeda W. Neuroanatomy, Cranial Nerve. [Updated 2020 Jul 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470353/

Turnitin ID: 1426477395

84 words

Robert,
I appreciate you sharing the sensory/motor mnemonic. I had remembered that there was a mnemonic for those, but had forgotten it. I think that it will help me a lot to memorize the actions of each of the nerves if I can associate them with that second mnemonic. I also appreciate you bringing up the fact that many medical diagnoses can alter a person’s mental status, so it is important to not get caught on one thing. For instance, an elevated ammonia level can cause patients to be altered, as well as a simple UTI in older patients. It is important to explore all alleys before getting caught on the fact that a patient may have a decreased or altered mental status, and understand it may root from many different causes.

133 words American Sentinel N522PE Module 5: Neurological & Musculoskeletal Assessment

American Sentinel N522PE Module 5: Neurological & Musculoskeletal Assessment