N522PE-20A Advanced Physical Assessment Papers

N522PE-20A Advanced Physical Assessment Papers

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

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 Papers

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

Example Discussion 1 Approach

A planned approach in communicating with someone who speaks another language is essential when performing through health assessment. The language barriers can make it challenging for healthcare providers to exchange clinical information, educate patients, and discuss the plan of care. Effective communication is imperative to provide safe and high-quality services to our patients. Bickley (2017) explained that it is vital to remember that “when a patient speaks a different language, make every effort to find a trained interpreter” (p. 90). That where I would start if I had a patient that spoke another language by finding an in-person interpreter or phone interpreter. This is essential because a communication gap or miscommunication can lead to poor comprehension between the patient and a healthcare provider, which can directly impact the patient’s health care outcomes. Using professional interpreters improves communication, encourages appropriate use of resources, and drastically increases patient and providers’ satisfaction.

This week’s module, “Conversation Concept Lab” on Shadow Health, outlined how to use a combination of multiple types of questioners when assessing a patient to communicate effectively with a digital standardized patient. For example, an open and close-ended question is best for understanding a patient better and getting more information about their chief complaint. After practicing communication with digital patients, I learned the importance of asking specific questions, which can help the provider put a holistic clinical picture together, enabling them to make a proper diagnosis with an appropriate treatment plan.

According to Barratt (2018), “Clinical reasoning processes are designed to enable the nurse to establish the nature of a patient’s presenting condition before focusing on problem-solving techniques that can guide the appropriate course of treatment” (p.1). Therefore, effective communication has a tremendous impact on the clinical reasoning for a nurse to make appropriate clinical decisions regarding treatment plan based on the diagnosis made through subjective and objective assessment. A vital part of clinical reasoning is to accurately understand and analyze a patent’s chief complaint, which can only be possible with proper and effective communication.

References:

Bickley, L. S. (2017). Bate’s guide to physical examination and history taking (12th ed.). Philadelphia, PA: Wolters Kluwer Health | Lippincott Williams & Wilkins.

Barratt J. (2018). Developing clinical reasoning and effective communication skills in advanced practice. Nursing standard (Royal College of Nursing (Great Britain): 1987), 10.7748/ns.2018.e11109. Advance online publication. https://doi.org/10.7748/ns.2018.e11109

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 Papers	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 Papers	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

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. N522PE-20A Advanced Physical Assessment Papers

Example Discussion 2 Approach

Lesions can be difficult to differentiate at first, with practice you can easily differentiate one from the other. As I first looked at cells under the microscope, they all seemed to look similar. However, as I continued to study the different classes of bacteria and viruses, I was able to differentiate one from the other.

Integumentary is a similar experience for me. Skin lesions and rashes are assessed by the location of the disorder, and how they are manifested. Is the skin disorder apparent over the entire body or local to one area? When did the skin disorder first start? Which phase has the skin disorder been identified? Just like the shape of the bacteria is important to view under the microscope, the skin lesion’s shape is important to view as well. The surrounding area of the lesion is important to note. The texture of the skin disorder is important to inspect and palpate. The skin disorder should be measured and monitored for size of growth or worsening of the condition (Dains et al., 2020).

In continuing my readings in advanced health assessment, I’ve learned a variety of skin conditions. I have seen a lot in my career, but I haven’t seen all of the skin lesions personally. I have found using a pen light very beneficial in the assessment of the skin, eyes and mouth (Bickley et al., 2017). A concept I have had difficulty with is memorizing all the skin disorders, lesions and treatment in one reading, however as I continue to read and study; I become familiar with the disease process at greater depth. This week I learned about Toxic Epidermal Necrolysis (TEN), a skin disorder that can result in death due to an adverse reaction caused by non-specific medications. Lesions affect the head, thoracic, abdomen and can eventually spread from head to toe. The skin tissue can become necrotic and lead to detached epidermis tissue. The treatment consist of immunoglobulin therapy and corticosteroids. The hyperlink is available with references for pictures of the skin disorder (Ferreira et al., 2019).

Bickley, L. S., Szilagyi, P. G., & Bates, B. (2017). Bates’ guide to physical examination and history taking (12th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Dains, J.E., Baumann, L.C., Scheibel, P. (2020). Advanced health assessment and clinical diagnosis in primary care. (8^th ed.). St. Louis, MO: Elsevier.

Ferreira, J. C., Santos, M. L. B., Souza, M. A., Silva, G. M., Monteiro, A. C. S., & Yogui, H. (2019). A Case Report: Toxic Epidermal Necrolysis in Children. EWMA Journal, 20(1), 43–47.

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). N522PE-20A Advanced Physical Assessment Papers

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

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

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

Competency	20	18	16	0	Points Earned
Focus of the Assessment is identified with Special Considerations including Documented Focused Health History	Documentation clearly shows student has completed a focused assessment with identified special considerations including a well-documented focused health history. N522PE-20A Advanced Physical Assessment Papers	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 Papers	/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 Three: Cardiovascular, Peripheral Vascular System & Respiratory Assessment (N522PE-20A Advanced Physical Assessment Papers)

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.

Example Discussion 3 Approach

This week I was able to complete the respiratory and cardiovascular concept labs within Shadow Health. These labs are great and allowed me to understand the various breath sounds and compare the adventitious breath sounds with normal breath sounds. Working in the post-anesthesia recovery unit (PACU), I feel that I can differentiate between the various breath sounds reasonably well. However, I do believe that the respiratory concept lab was beneficial to my learning. The cardiovascular concept lab was extremely helpful in deciphering the various heart sounds and locations for best auscultation. Another resource that I used was the Merck Manual Professional Version ().

The Merck Manual Professional Version website also has detailed case studies with questions testing your knowledge and understanding. Under medical chapters and topics, the website also has patient education. When obtaining more information on mitral valve prolapse, the website has real patient audio. One of the difficulties I have is deciphering between the different heart murmurs and other heart sounds. This valuable resource can also be downloaded as an app on your phone. This week when I return to the PACU, I will take extra time to auscultate my patient’s heart sounds. I want to make sure that I am applying the newly gained knowledge to help reinforce these skills. In order for me to improve, I need to practice my auscultation assessment skills, otherwise, I will lose this newly acquired knowledge.

I also found the Bate’s textbook useful for the Tina Jones assessments and understanding what I am looking for during these assessments. I am a visual person, and the Bate’s textbook has pictures that have been incredibly beneficial for my learning type. As an example, our textbook shows an image and description of how to assess the systolic impulse of the right ventricle on page 374. N522PE-20A Advanced Physical Assessment Papers

References

Armstrong, G. P. (2020, February). Mitral valve prolapse (MVP): Cardiovascular disorders. Merck Manuals Professional Edition.

Bickley, L. S., & Szilagyi, P. G. (2013). Bate’s guide to physical examination and history taking (11th ed.). Wolters Kluwer Health Lippincott Williams & Wilkins.

Sample 2

Working in the emergency department requires keen assessment skills. The fast-paced environment is never stagnant, consistent, or linear. Nurses have a limited amount of time to gather information (electronic health record, historical information, and preliminary testing) and then have to intervene and prioritize accordingly. This week’s review of systems (cardiovascular, peripheral vascular, and respiratory) mirror one another. Patients present to the ambulatory setting with multiple complaints and have chronic medical problems. For example, a 62-year-old male presents with fatigue and intermittent dyspnea for the past week. He reports symptoms are worse with activity to the point of almost fainting. His past medical history includes hypertension and congestive heart failure. When conducting the physical exam, the nurse needs to listen to heart and lung sounds. More importantly, knowing where to place the stethoscope is crucial. The assigned readings provide a plethora of information on assessing and describing heart murmurs.

According to Bickley (2017), murmurs are loudest at the apex. The nurse will hear a consistent murmur during the cardiac cycle (S1 and S2) regarding the patient scenario. There is this equal volume and intensity between S1 and S2 and the pitch decreases with inspiration, instead of S1 > S2 (Bickley, 2017, p. 252). Based on other physical findings such as coarse crackles in the lungs’ bases, 2+ pitting pedal edema, cool skins, right jugular venous distention, and grade 2 murmur point to an incompetent mitral valve. This faulty valve causes the backflow of blood in the heart (Dains et al., 2016, p. 88). As a result, mitral regurgitation can cause consequential events, like congestive heart failure and peripheral vascular disease. Oxygenated blood is not being passed to other parts of the body, and is why the patient is feeling fatigued and short of breath. Properly identifying root causes will help make the appropriate working diagnosis.

The respiratory and cardiovascular concept tutorials showcased normal vs. abnormal cardiac and lung sounds. Previously, I found it challenging to discern heart murmurs. For example, extra sounds in diastole (S3 and S4) are low pitched and are best heard using the stethoscope bell (Bickley, 2017, p. 248). More importantly, different murmurs signify different pathology. There is a classification system in place that is useful for the provider. Murmurs are defined by time, shape, location, radiation, pitch, quality, and intensity (Bickley, 2017, p. 250). My goal is to be able to link murmur with the disorder. With practice and repetition, I find this possible. Once there is a working diagnosis, other findings are anticipated, enabling the decision-making process.

Reference:

Bickley, L. S. (2017). Bate’s guide to physical examination and history taking (12th ed.). Philadelphia, PA: Wolters Kluwer. ISBN-13: 978-1-4698-9341-9

Dains, J., Baumann, L., & Scheibel, P. (2016). Advanced health assessment & clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier. ISBN-13: 978-0323266253, ISBN-10: 0323266258

Module Five: Neurological & Musculoskeletal Assessment (N522PE-20A Advanced Physical Assessment Papers)

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).

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)

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 Papers	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. N522PE-20A Advanced Physical Assessment Papers	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. N522PE-20A Advanced Physical Assessment Papers	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

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. N522PE-20A Advanced Physical Assessment Papers

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).

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)

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 Papers	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. N522PE-20A Advanced Physical Assessment Papers	/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, N522PE-20A Advanced Physical Assessment Papers	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 Papers)

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.

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). N522PE-20A Advanced Physical Assessment Papers

Introduction (including purpose statement)
Focus of the assessment
1. Describe the focus of this particular assessment on the patient complaining of abdominal discomfort.
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 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. N522PE-20A Advanced Physical Assessment Papers	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. N522PE-20A Advanced Physical Assessment Papers	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 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 (N522PE-20A Advanced Physical Assessment Papers)

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 Papers

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).

Introduction (including purpose statement)
Subjective Findings Synthesis
Objective Findings Synthesis
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.
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 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 Papers	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 N522PE-20A Advanced Physical Assessment Papers	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 N522PE-20A Advanced Physical Assessment Papers	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

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. N522PE-20A Advanced Physical Assessment Papers

N522PE-20A Advanced Physical Assessment Papers