N522PE-20A Advanced Physical Assessment Assignments

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N522PE-20A Advanced Physical Assessment Assignments

N522PE-20A Advanced Physical Assessment Assignments

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

Discussion 1 (N522PE-20A Advanced Physical Assessment Assignments)

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 Assignments

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

Sample Approach.

When meeting a patient for a first encounter I often arrive assuming the patient’s primary language is English, as this is the language that I use day to day.  I work in a Magnet hospital in a rural area, so our patient populations are not diverse as a metropolitan area would be.  During an inpatient admission learning assessment, the questions I ask are, “what is your primary language that you utilize to communicate?”, and “what is your primary language that you utilize to read/learn?” If a language other than English is the patient’s primary language, we utilize a program called Language Line, which is an interpreting service via an iPad, so I am able to properly communicate and assess the patient.  According to Taira et. al. (2019) patients that have limited English proficiency have worst health outcomes due to less understanding of their medical condition and poor understanding of their care.  This can impact clinical reasoning in nursing as we may think the patient is noncompliant with something, but truly it’s because they may not understand the instructions or the interventions we are trying to do. That is why it is pivotal to ask the right questions during a patient interview to acknowledge the language barrier and act right away by providing interpreter services. Dowbor et. al. (2015) study showed that the use of interpreter services yields better patient-provider relationships, increase the likelihood to schedule follow-up appointments, increase patient compliance to follow providers instructions, and increases the amount of questions patients ask.  This week in Shadow Health, it focused on the use of asking general, open, or closed ended questions, and quantifying questions.  Given the language barrier, it would be appropriate to ask one question at a time to not overwhelm the patient, focusing more on the yes/no questions as this may be easier for the patient to understand.

Dowbor, T., Zerger, S., Pedersen, C., Devotta, K., Solomon, R., Dobbin, K., & OCampo, P. (2015). Shrinking the language accessibility gap: A mixed methods evaluation of telephone interpretation services in a large, diverse urban health care system. International Journal for Equity in Health, 14 Retrieved from http://americansentinel.idm.oclc.org/login?url=https://www-proquest-com.americansentinel.idm.oclc.org/docview/1780120306?accountid=169658

Taira, B. R., & Orue, A. (2019). Language assistance for limited english proficiency patients in a public ED: Determining the unmet need. BMC Health Services Research, 19 doi:http://dx.doi.org.americansentinel.idm.oclc.org/10.1186/s12913-018-3823-1

410 words

In reply to Alissa Heeman

Re: Alissa Heeman- D1

by Dona Clarin – 
Well done. I remember when “its been a minute” was a new phrase. It took me awhile to remember to ask what that mean. Sometimes it meant a minute, sometimes it meant 9 months ago. Consider differences in the parts of the U.S. as well.

46 words

In reply to Alissa Heeman

Re: Alissa Heeman- D1

by Honey Variacion Brojan – 

Hi Alissa,

I agree to your statement that limited English proficient patients are at a disadvantage for quality health outcomes because of the lack of knowledge about their conditions due to language differences (Squires, 2017). Providing interpreters is ideal but not realistic in some areas. I believe that ensuring cultural competence among the staff will have an impact on healthcare quality in terms of client-patient relationship. Cultural sensitivity opens the door to understanding nonverbal cues displayed by patients of varied ethnic backgrounds. However gestures and nonverbal cues are not enough to synthesize data for accurate clinical judgment. According to Nierra (2018), a cultural competent healthcare organization can expect an improvement in patient engagements and data collection, cost-saving benefits from the reduction of medical errors, treatments and legal costs, and increase in mutual respect between patient and the organization. I had experienced admitting for dialysis treatment a Korean patient with zero English knowledge and it was indeed difficult to convey anything. I had to use a phone app to translate English to Korean language to convey my message. I would let him read it and he would just approve or deny. Eventually, the company had to use language services.

Nierra, L. (2018, August 22). The Importance of Addressing Language Barriers in the US Health System. Retrieved September 22, 2020, from https://dukepersonalizedhealth.org/2018/07/the-importance-of-addressing-language-barriers-in-the-us-health-system/

Squires, A. (2017). Evidence-based approaches to breaking down language barriers. Nursing, 47(9), 34–40. doi: 10.1097/01.NURSE.0000522002.60278.ca. N522PE-20A Advanced Physical Assessment Assignments

246 words

N522PE-20A Advanced Physical Assessment Assignments 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)

 

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? Defines, compares, and contrasts clinical reasoning and decision-making with cited references in addition to course readings for Week 1.
Answers posed questions. N522PE-20A Advanced Physical Assessment Assignments		 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. 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

Discussion 2 – N522PE-20A Advanced Physical Assessment Assignments

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 Assignments

N522PE-20A Advanced Physical Assessment Assignments 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. 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 Assignments 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. 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

N522PE-20A Advanced Physical Assessment Assignments 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

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.

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) N522PE-20A Advanced Physical Assessment Assignments

 

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. N522PE-20A Advanced Physical Assessment Assignments 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. /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

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?  N522PE-20A Advanced Physical Assessment Assignments

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.

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 Assignments 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. N522PE-20A Advanced Physical Assessment Assignments 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 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 – N522PE-20A Advanced Physical Assessment Assignments

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.

Example Discussion 7 Approach

Cultural differences can often be misinterpreted and applied only when caring for individuals with a foreign language and those from various religious backgrounds that appear different from us. I have learned through studying cultural competency in many courses through this program and through conducting an assessment and exam through Shadow health on patients from different backgrounds that it is not enough to be educated about various cultures and beliefs. The most crucial aspect of gaining cultural competence is recalling one’s own biases and assumptions and being aware of them to identify them as they appear. A practitioner needs to be able to reassess their own sensitivities and what biases they might have to approach patients without any prejudice (Henderson et al., 2018). The only way we can do that is to be exposed to various ethical situations and types of patients to build our own “moral reasoning,” where we need to make tough decisions (Henderson et al., 2018). For example, during my interview with Ms. Park, an older woman with abdominal pain, I thought nothing of merely asking if she has experienced an increase in gas production and expelling gas. Her answer was very vague at first, and she appeared very modest. I realized that might not be appropriate in Korean culture, or even for an elderly lady who seems very modest. I also made assumptions when interviewing Tina initially, as she appeared not to care for her well-being, therefore not checking her glucose levels, not checking her blood pressure, etc. In further assessment, I realized that Tina required my understanding and undivided attention between lack of knowledge and stress related to work and school, so I can understand her needs and plan her care appropriately.

       In my clinical experience, I have had multiple encounters with various situations where ethical decisions needed to be made. The lack of cultural sensitivity on the clinical team’s part made the decisions worse for the patient outcome. I feel that elderly patients could be misunderstood and mismanaged because practitioners can sometimes be less culturally sensitive to their needs. I had patients who would shake their heads in agreement during education on diabetes and insulin injections, as they were hearing impaired and felt embarrassed to keep asking me to repeat myself. Later, when I asked for a returned demonstration, they could not do that, so they finally admitted that they could not hear me. That was a bias on my part for assuming and not asking if they are able to understand and hear. It was reported that 50% of older adults have hearing problems (Bickley & Szilagyi., 2017).

     I had an elderly patient I was caring for that came in with abdominal pain. She lived by herself and had three children, who all lived far away, so they could not travel quickly to see her when she was admitted to the hospital. Upon admission, I noticed that she was not oriented, which is not her usual state, and did not have a living will with her. I voiced my concern to the clinical team, as her condition was getting worse, and they dismissed my worry and encouragement to call her family to discuss this topic further. The family did not question it either. I walked in to check on the patient, and she was not breathing and turned greying color. I called the code, and CPR was started with chest compressions on this frail woman. Every time we compressed the chest she was vomiting stool content that we all had to take a turn every couple of minutes as it was unberable. After 25 minutes, patient’s pulse returned. She was intubated and sent to intensive care. She suffered broken ribs, ended up with the aspiration of fecal content in her lungs, and became septic. When her family arrived the next day, they were mortified, as they brought her living will where she clearly stated she was to be DNR and DNI. They did not think to question the clinical team and assumed that the team already had this information. I felt that my team failed, as they did not question her family and inquire further due to their assumption that she was a full code. The patient was extubated that day and passed away after what I felt was severe trauma at her last moments of life. N522PE-20A Advanced Physical Assessment Assignments

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

       (12th ed.). Wolters Kluwer.

Dains, J.E., Baumann, L.C., & Scheibel, P. (2016). Advanced health assessment and clinical

       diagnosis in primary care (5th ed.). Elsevier.

Henderson, S., Horne, M., Hills, R., Kendall, E. (2018). Cultural competence in healthcare in the

       community:  A concept analysis. Health Soc Care Community, (26), 590–603.

       

N522PE-20A Advanced Physical Assessment Assignments 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).

  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. N522PE-20A Advanced Physical Assessment Assignments Documentation supports the student has completed the comprehensive assessment with key findings. 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. N522PE-20A Advanced Physical Assessment Assignments /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

 

Discussion 8 – N522PE-20A Advanced Physical Assessment Assignments

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 Solution for Discussion 8

Pain management by providers is something that has always irked me as a nurse. I feel that there is a large range of comfort and go-to’s from providers in how they treat pain, which is understandable, however not always fair to the patient. As the bedside nurse it’s frustrating because we’re spending the most time with the patient and see the level of pain, and how each intervention works, however I can see how as a provider it may be harder to gauge which pharmacological treatments to utilize for the big picture of the patients health. 

My hospital is rather culturally diverse and it is the only one I’ve worked in thus far. I can’t say I’ve considered how many disparities there are in pain treatment until now. “Health disparities in pain treatment and delivery of care are well documented, ranging from lower use of analgesics in emergency rooms for African-American and Hispanic pattens to disparities in use of analgesics for cancer, postoperative, and low back pain. Studies show that clinician stereotypes, language barriers, and unconscious clinician biases in decision making all contribute to these disparities (Bickley & Szilagyi, 2017).” N522PE-20A Advanced Physical Assessment Assignments

As incoming practitioners I think it’s important that we work to lessen these disparities beginning with our own potential cultural biases. Bickley & Szilagyi (2017), state a great way to start doing this is to “critique your own communication style, seek information and best practice standards, and improve your techniques of patient education and empowerment as first steps to ensure uniform and effective pain management.”

The policy for pain assessment and management as my medical center is the following: “all patients be systematically assessed for pain and receive effective pain relief utilizing an inter professional approach based upon self-reported or observed pain. Patients shall be informed that effective pain relief is an important goal of their treatment plan; communication of unrelieved pain is essential; and the health care team will respond quickly with efforts to achieve the foal of pain relief (ARMC, 2020).” One aspect I believe we can become more educated in and streamlined with is our management of pain in patients that are a part of a Methadone program. We have a large population of patients on Methadone in our area, and I feel the communication between the facility and the clinic is outdated, slow, and not beneficial to the patients overall goals of pain management and recovery. 

References

ARMC, AtlantiCare Regional Medical Center. (2020). Policy & Procedure: Pain Assessment and Management. 

Bickley, L. S., & Szilagyi, P. G. (2017). Bates’ Guide to Physical Examination and History Taking (12th ed.). Wolters Kluwer. N522PE-20A Advanced Physical Assessment Assignments

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