Assessment of Nutrition in Children NURS 6512

• Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2023). Seidel’s guide to physical examination: An interprofessional approach (10th ed.). St. Louis, MO: Elsevier Mosby.
  • Chapter 3, “Examination Techniques and Equipment”
    This chapter explains the physical examination techniques of inspection, palpation, percussion, and auscultation. This chapter also explores special issues and equipment relevant to the physical exam process.
  • Chapter 8, “Growth and Nutrition”
    In this chapter, the authors explain examinations for growth, gestational age, and pubertal development. The authors also differentiate growth among the organ systems.

• Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Student checklist: Health history guide Download Student checklist: Health history guide. In Seidel’s guide to physical examination (9th ed.). St. Louis, MO: Elsevier Mosby.
  Credit Line:  Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
• Centers for Disease Control and Prevention. (2021, April 9). Childhood overweight & obesity. http://www.cdc.gov/obesity/childhood/
  This website provides information about overweight and obese children. Additionally, the website provides basic facts about obesity and strategies to counteracting obesity.
• Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
  Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.
  • Chapter 1, “Clinical Reasoning, Evidence-Based Practice, and Symptom Analysis”
    This chapter introduces the diagnostic process, which includes performing an analysis of the symptoms and then formulating and testing a hypothesis. The authors discuss how becoming an expert clinician takes time and practice in developing clinical judgment.

• Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
  • Chapter 2, “The Comprehensive History and Physical Exam” (Previously read in Week 1)
  • Chapter 5, “Pediatric Preventative Care Visits” (pp. 91 101)

Assessment of Nutrition in Children Example

In considering the case of a 2-year-old girl of normal weight who resides with her obese mother and normal-weight father, it is important to delve into the various health issues and risks she may encounter. This scenario presents a unique blend of genetic, environmental, and behavioral factors that could influence the child’s future health. This family dynamic presents a multifaceted view of health risks and considerations, primarily influenced by genetic, environmental, and behavioral factors. Genetically, a child may inherit a predisposition to obesity from her mother despite having a normal weight during infancy (Cavalli & Heard, 2019). This genetic factor underscores the importance of vigilance in her health management as she grows.

Environmentally, the child’s exposure to her mother’s obesity could influence her own health behaviors. Dietary habits within the household, driven by the mother’s choices, might lean towards unhealthy patterns, posing a risk to the child’s nutritional status. Conversely, the presence of a father with a normal weight provides an opportunity for balanced dietary and lifestyle modeling. Behaviorally, the child is at a critical stage where habits are formed. The mixed health status of her parents could lead to inconsistent health behaviors, which, according to Milne-Ives et al. (2020), emphasizes the need for structured guidance in her diet and physical activity. Additionally, the psychosocial aspect of living with an obese parent could impact the child’s self-esteem and body image, making supportive and positive family dynamics crucial.

Additional information is needed in several key areas to further assess the 2-year-old girl’s weight-related health. Firstly, a detailed family health history would be essential, especially concerning any chronic diseases like diabetes, heart conditions, or obesity-related complications in both the maternal and paternal lineage. This information would offer insights into the genetic predispositions the child might have. Secondly, understanding the dietary habits of the household is crucial. Details about the types of foods regularly consumed, meal patterns, portion sizes, and the balance of nutrients would provide a clearer picture of a child’s nutritional intake (Sheldrick et al., 2019), which is crucial in this case. Information about the mother’s eating habits, given her obesity, would be particularly relevant in assessing the potential influence on the child’s diet.

Physical activity levels are also important. Data on how often the child engages in physical play, the types of activities she participates in, and the overall sedentary versus active time spent daily would help evaluate her physical health and development needs. According to Sheldrick et al. (2019), a child’s developmental milestones and current growth metrics, such as weight-for-age and height-for-age ratios, are vital. These would help determine if she is on track with expected growth patterns for her age. Additionally, understanding the family’s socio-economic status could provide context, as it often influences access to healthy food options and recreational activities. Lastly, information on the family’s general attitude and knowledge about health, nutrition, and physical activity would help assess the likelihood of the child adopting healthy lifestyle habits.

Several risks are primarily related to potential genetic predispositions and environmental influences on the child’s health. The child may be at a higher risk of developing obesity due to genetic factors, given her mother’s obesity. Additionally, the family’s dietary and lifestyle habits could significantly influence the child’s long-term health, with potential risks including poor nutrition, inadequate physical activity, and the development of unhealthy eating behaviors. To fully understand the child’s health, collecting more information in a sensitive and non-intrusive manner is necessary. Detailed family health history, particularly concerning obesity-related conditions (Sheldrick et al., 2019), would be crucial for this case.

Understanding the family’s daily dietary practices, meal routines, and physical activity patterns would provide insight into the child’s lifestyle. Monitoring the child’s developmental milestones and growth parameters would also be essential to assess her physical development accurately. Gathering this information could be approached sensitively through regular pediatric consultations where the healthcare provider can gently inquire about family health history, dietary habits, and lifestyle practices. Using routine health check-ups as an opportunity for education and guidance on nutrition and physical activity can also be beneficial. Engaging with the family in a supportive, non-judgmental manner is key to encouraging openness and cooperation and ensuring the child’s health is monitored and supported effectively.

Specific Questions

1. Nutritional Inquiry: Could you tell me about your child’s favorite foods and meals? What does a typical day of eating look like for her?
2. Activity Level: What activities or games does your child enjoy? How does she like to spend her playtime?
3. Family Health Patterns: Are there any common health concerns or conditions in your family history that you think we should be aware of for your child’s overall health?

Strategies

One effective approach is to focus on family-centric health education. This involves engaging the family in discussions about the importance of healthy eating and physical activity tailored to their specific situation. The family can be guided towards healthier eating habits by providing practical advice on preparing balanced meals that meet both the child’s growth needs and the mother’s health requirements (Patel et al., 2021). Additionally, suggesting family-oriented physical activities that everyone can participate in, like evening walks or weekend outings to the park, can foster a positive environment for the child’s physical development.

Another strategy is to leverage the role of the normal-weight father as a positive influence. Encouraging him to lead by example in adopting healthy behaviors can have a ripple effect on the entire family. This could include involving the father more in meal planning and preparation, emphasizing the importance of his role in shaping the child’s dietary habits. Similarly, initiating family-wide lifestyle changes, such as setting aside time for joint physical activities or play, benefits the child and provides an opportunity for the obese mother to engage in healthier behaviors (Milne-Ives et al., 2020). By fostering an inclusive and supportive family environment, these strategies aim to encourage long-term, sustainable changes that will positively impact the child’s health and well-being.

Assessment of Nutrition in Children NURS 6512 References

Cavalli, G., & Heard, E. (2019). Advances in epigenetics link genetics to the environment and disease. Nature, 571(7766), 489–499. https://doi.org/10.1038/s41586-019-1411-0

Konttinen, H. (2020). Emotional eating and obesity in adults: the role of depression, sleep and genes. Proceedings of the Nutrition Society, 79(3), 283-289. https://doi.org/10.1017/S0029665120000166

Milne-Ives, M., Lam, C., De Cock, C., Van Velthoven, M. H., & Meinert, E. (2020). Mobile apps for health behavior change in physical activity, diet, drug and alcohol use, and mental health: systematic review. JMIR mHealth and uHealth, 8(3), e17046. https://doi.org/10.2196/17046

Patel, B. P., Hadjiyannakis, S., Clark, L., Buchholz, A., Noseworthy, R., Bernard-Genest, J., & Hamilton, J. K. (2021). Evaluation of a pediatric obesity management toolkit for health care professionals: A quasi-experimental study. International Journal of Environmental Research and Public Health, 18(14), 7568. https://doi.org/10.3390/ijerph18147568

Sheldrick, R. C., Schlichting, L. E., Berger, B., Clyne, A., Ni, P., Perrin, E. C., & Vivier, P. M. (2019). Establishing new norms for developmental milestones. Pediatrics, 144(6). https://doi.org/10.1542/peds.2019-0374

Shadow Health Support and Orientation Resources

• Shadow Health. (2021). Welcome to your introduction to Shadow HealthLinks to an external site.. https://link.shadowhealth.com/Student-Orientation-Video
• Shadow Health. (n.d.). Shadow Health help deskLinks to an external site.. Retrieved from https://support.shadowhealth.com/hc/en-us
• Shadow Health. (2021). Walden University quick start guide: NURS 6512 NP students. Download Walden University quick start guide: NURS 6512 NP students. https://link.shadowhealth.com/Walden-NURS-6512-Student-Guide
• Document: Shadow Health Nursing Documentation Tutorial Download Shadow Health Nursing Documentation Tutorial(Word document)

Taking a Health History

[music playing]

NARRATOR: Nurses play a critical role in gathering information and assessing a patient’s health.

MARIANNE SHAUGHNESSY: The health assessment is one of the most critically important pieces of our patient interaction.

NARRATOR: With more demands on their time, this critical step can suffer.

MARIANNE SHAUGHNESSY: Certainly, practicing nurses are extremely busy people. But if you rush through a health interview or a patient interview, chances are good there’s going
to be information you’re going to miss. And if that information is missed, the consequences could be dire for the patient.

NARRATOR: Doctor Marianne Shaughnessy shares her expertise on how to conduct an in-depth health assessment interview, and provides a demonstration of effective strategies. [music playing]

MARIANNE SHAUGHNESSY: Capturing all health-related information in a systematic way,
documenting that information, creates a foundation, a database, for us to build upon. In fact, all members of the healthcare team can utilize the nursing database if it’s well-constructed and contains the information necessary to then build a plan for managing a patient’s health in conjunction with the patient over the course of time. [knock knock]

MS. HUDGENS: Come in.

MARIANNE SHAUGHNESSY: Ms. Hudgens?

MS. HUDGENS: Yes.

MARIANNE SHAUGHNESSY: Good morning. My name is Marianne Shaugnessy. I’m a nurser practitioner, and I’ll be doing your history and physical this morning.

MS. HUDGENS: Good, thank you.

MARIANNE SHAUGHNESSY: It’s nice to meet to you.

MS. HUDGENS: Nice meeting you.

MARIANNE SHAUGHNESSY: When I walked into the room, I was able to immediately
established a rapport with the patient by speaking with her cordially but professionally. When starting an interview with a patient, it’s very important to try and establish an environment that is conducive to communication. We’ve all been in doctors’ offices with exam rooms that have paper thin walls where you can hear noise on either side.

We’d like to try and avoid that as much as possible by providing an environment in which a patient feels safe to open up and talk, and has a reasonable expectation that it’ll be private. Good morning. You walk into a room, sit down, calmly relax and establish eye contact. That sends a message to a patient that you have all the time in the world for them, and as nurses that’s rarely actually the case.

It’s also important, if you can, to make sure to be on eye-level with the patient, and to try and avoid the superior position, where you are looking down on a patient. We started with some very global, open-ended questions. So what brings you in today?

MS. HUDGENS: Well, we haven’t had insurance for awhile. My husband was laid off, but we have insurance now, so I just wanted to kind of cover a couple of things, get a physical.

MARIANNE SHAUGHNESSY: Great. OK. Have you been feeling well? Find out first what’s
on the patient’s mind, because that’s why they’re there, and it’s critical to address the issues of importance in the patient’s mind, whether or not those issues actually may be the most
life-threatening issues. We move the interview from open-ended questions to closed-ended
questions, and by that I mean asking the patient to embellish or talk more about a particular concern.

OK, then I need to ask you about some exposure in your early years. The reason that the
history was so in-depth is because it’s important to capture not only what the patient is telling you they want to address when they come in for an appointment, but also to do some routine surveillance and screening to capture issues that patients may not even be aware of. Do you have any history of anemia in the past?

MS. HUDGENS: No, I haven’t.

MARIANNE SHAUGHNESSY: OK. OK. Have you been having any problems with fatigue?

MS. HUDGENS: No, there’s been stress, but other than the stress, really, no fatigue.

MARIANNE SHAUGHNESSY: Weakness?

MS. HUDGENS: No, I’ve been OK.

MARIANNE SHAUGHNESSY: So your energy levels are normal?

MS. HUDGENS: Yes.

MARIANNE SHAUGHNESSY: All right. Have you noticed any problems with unusual bruising?

MS. HUDGENS: Bruising? No.

MARIANNE SHAUGHNESSY: No? OK. And your periods are regular?

MS. HUDGENS: Well, I’m 48 so they’re becoming irregular a little bit, and I’m a little bit heavier. I have a family history of uterine fibroids, and I think that might be coming up with me, too.

MARIANNE SHAUGHNESSY: OK. In terms of this particular interview, the patient brought up a
number of significant points, primarily concerns about anemia, which ordinarily could be caused by any number of things, and it wasn’t until I began to question her about her aspirin use that I became very suspicious that her anemia may actually be caused by a GI bleed as opposed to iron deficiency anemia, which is so very common in women. Are you taking any medication?

MS. HUDGENS: No, not at this time.

MARIANNE SHAUGHNESSY: None whatsoever?

MS. HUDGENS: No.

MARIANNE SHAUGHNESSY: How about over the counter?

MS. HUDGENS: Over the counter [inaudible] aspirins or Tylenol when I get a headache
or leg aches, or–

MARIANNE SHAUGHNESSY: You’re not simply asking a question, and accepting a yes or no answer, and moving on to the next question because it’s very important to follow up with probing questions when a patient reports a positive finding. Do you take aspirin or do you take Tylenol?

MS. HUDGENS: Usually just aspirin.

MARIANNE SHAUGHNESSY: OK. How many times a week are you taking it?

MS. HUDGENS: About two time– a couple of times a week.

MARIANNE SHAUGHNESSY: And how much do you take?

MS. HUDGENS: Just the two that the label says. If I need–

MARIANNE SHAUGHNESSY: Regular adult strength, right?

MS. HUDGENS: Yes.

MARIANNE SHAUGHNESSY: OK. So you’re taking probably 650 milligrams, two 325 milligram tabs.

MS. HUDGENS: OK. MARIANNE SHAUGHNESSY: OK, twice a week. OK. We’re going to need
talk a little bit more about that aspirin, especially in light of your anemia. The most common
mistake that’s made is rushing through it, because we all have multiple demands on our time at any given moment.

Certainly practicing nurses are extremely busy people, but if you rush through a health interview, or a patient interview, chances are good there’s going to be information you’re going to miss, and if that information is missed, the consequences could be dire for the patient. If you take your time, use a systematic approach, and probe the positive responses
for additional information, nine times out of 10 you’ll capture all the information you need in order to help complete a comprehensive database and have a structure, then, for advancing
management and treatment strategies.

Please forgive my note taking, I’m just trying to organize the information as it’s coming in. When you’re performing a health assessment, there’s going to be a certain degree of note taking. You have to. Patients are divulging a lot of information. Once you get into the habit
of taking a health assessment, you can actually reduce your note taking to a minimum. However, a little bit of note taking is fine. You want to make sure not to lose the eye contact that you’ve established with the patient, because that goes a long way toward building rapport. It’s perfectly fine, as you get to know a person, to relax a little bit and have a cordial and friendly interchange.

MS. HUDGENS: My younger sister had the melanoma when she was in her 30s. She worked at the lake with me several years.

MARIANNE SHAUGHNESSY: Ah. Lifeguards, were you?

MS. HUDGENS: Well, close to it, yes.

MARIANNE SHAUGHNESSY: However, it’s very important for the professional nurse to maintain a professional demeanor, and make sure that the questions that she’s asking patients, the responses that she’s recording, and additional questions that she’s asking stay within the realm of professional nursing practice.

MS. HUDGENS: My husband said that there’s a spot on my back that looks a little funny. I’ve had other moles taken off before and they were never cancerous, but I just wanted to have that checked out.

MARIANNE SHAUGHNESSY: The baccalaureate prepared nurse has advanced skills in terms of capturing depth of information. For example, when this morning’s patient told me that she had a history of sun exposure, and now had a lesion of concern on her back, that led to probing questions about the history of early sun exposure and prior mole identification and removal. Also looking for pathologies of lesions that had been removed in the past. Let’s talk a little bit about the mole on your back. Do you have– you mentioned that you had some moles removed previously.

MS. HUDGENS: Yes.

MARIANNE SHAUGHNESSY: And how long ago are we talking?

MS. HUDGENS: I had one removed off of my leg just about four years ago.

MARIANNE SHAUGHNESSY: Mmhm. And the pathology on that, do you–?

MS. HUDGENS: They said it was fine. There was no problems with it.

MARIANNE SHAUGHNESSY: OK.

MS. HUDGENS: But my sister does have– did have a history of melanoma, and so I’m always worried about it.

MARIANNE SHAUGHNESSY: OK. Let’s talk a little bit about your sun exposure.

MS. HUDGENS: I grew up in Phoenix.

MARIANNE SHAUGHNESSY: You did?

MS. HUDGENS: Yes, and lots of time on the water, lot of sunburns. I spent a couple of summers working at the lake, and didn’t take care of it very well.

MARIANNE SHAUGHNESSY: And you only apply sunscreen if you’re going to be going outside?

MS. HUDGENS: Yes.

MARIANNE SHAUGHNESSY: OK. What number do you use?

MS. HUDGENS: 15.

MARIANNE SHAUGHNESSY: OK. Well, for somebody like you we would recommend that
you actually go up to 30 or above and every day.

MS. HUDGENS: OK.

MARIANNE SHAUGHNESSY: It’s very important to take every opportunity to pull in health promotion strategies. In this interview, we utilized not only the opportunity to educate the patient about SPF, but also weight loss, diet, exercise. I take every opportunity to work health promotion strategies into every interaction with a patient whenever I can. Would you like to try and lose some weight?

MS. HUDGENS: Yes.

MARIANNE SHAUGHNESSY: OK. Well, we can talk more about that, because I can provide you with some– a recommended diet for you to follow if you’re interested in doing that. When you’re dealing with sensitive issues in general, the communication strategies really do come into play. It’s very important to watch the tone of your voice so that you’re not in any way conveying a judgment, but allowing them to openly communicate and share with you what
sensitive issues they feel comfortable disclosing. OK, and your fourth pregnancy?

MS. HUDGENS: The fourth pregnancy I was 23, and that did end in a termination. My husband was laid off at the time, so we chose to terminate the pregnancy.

MARIANNE SHAUGHNESSY: OK. I think one thing that I would caution RNs about is you know that the time you need to set aside to do an interview with a younger person is going to be significantly different from the time you need to set aside to do with an older person. In the world of gerontology, it wouldn’t be unusual at all for an interview like that to go upwards of 45 minutes, and would include a lot more questions about functional assessment, day to day activities, cognitive status, and things like that that can impact the life of a senior.

If you work in a setting where you have patients from a number of different cultures, you learn very quickly what the issues are surrounding health care, patient interviewing, physical exams, how someone is either willing or unwilling to disrobe for a man or woman in the room,
about their comfort level with making eye contact.

All of those things are very setting-dependent, but the nurse who’s working, no matter where, has to be aware that some of these influences can come into play at any time and keep the radar up for when those issues may come into play, because the most important thing is making sure that the patient is comfortable. We’re going to go back to the review of systems. I’m going to go from head to toe.

MS. HUDGENS: OK.

MARIANNE SHAUGHNESSY: All right? And we’re going to start with your general, overall health. Have you noticed in the last six months any changes in your weight?

MS. HUDGENS: No. MARIANNE SHAUGHNESSY: The review of systems is the close of the interview. It’s a final opportunity to capture any issues that may have been missed to that point in the interview. The laws vary according to state in terms of mandatory reporting
for domestic violence, but it’s critically important to make sure and ask that screening
question, which I asked at the end of the interview.

And the last question is are there any times that you don’t feel safe at home? That’s a very globally worded question, but it allows the door to be opened. OK, you’re afraid of falling. OK. OK, I have to– I ask that question of everyone only because you never know.

I always conclude an interview by asking a patient, is there anything else you wanted to discuss that we have not yet discussed? The reason for this is I’m trying to avoid what we typically refer to as a doorknob agenda item, meaning when you’ve completed the interview, given the patient a gown, and asked them to undress for the physical exam, as you’re moving
toward the door, as you place your hand on the doorknob, a patient will sometimes say, oh, yes, there’s one more thing.

Now, before we wrap up the interview, are there any other issues that you want to talk about that we have not yet discussed?

MS. HUDGENS: No, I think that’s all.

MARIANNE SHAUGHNESSY: OK. All right, then. Well, we’re going to go ahead and proceed to your physical exam, then.

MS. HUDGENS: OK, great. Thank you.

MARIANNE SHAUGHNESSY: So once the interview is complete, it guides your physical examination. By talking to a patient, you can identify 90% of what your physical exam is going to need to be. Students are very, very focused on learning techniques that are involved
in physical exam, and they sometimes tend to ignore the interview. But the interview is probably the most critical component. That’s where you start– with what the patient tells you.

Somewhat ironic, I think, that most of the physical assessment textbooks really do emphasize
the physical assessment aspect much more so than the interview, when the interview actually plays such a critical role in establishing where things go moving forward in terms of physical exam techniques that are chosen from that point forward, and from specific systems
that a provider may need to pay special attention to.

That information is captured in the interview, and in the health history. There’s always a great deal of professional satisfaction derived from capturing information, from making someone
feel at home, and for establishing yourself as a partner in their healthcare. [music playing]

Assessment Tool, Diagnostics, Growth, Measurements, and Nutrition in Adults and Children – Week 3 (11m)

LACHANDA BROWN: Hello, everyone and welcome to 6512: Advance Health Assessment. I’m Dr. LaChanda Brown, and I’m one of the contributing faculty members in the Advance Health Assessment course. In this week, week 3, we will focus on assessment tools, diagnostics
and growth, measurements, and nutrition, in adults and children.

One of the major issues in health care today is obesity. Obesity is an ever-growing problem. It has increased the mortality rate, morbidity, and increases in health care costs as well as utilization. We have also seen an increase in obesity in children over the past 30 years. When we are looking at all of this, we want to make sure that we get an overall health overview.

We want to look at nutritional status, as well as body measurements, as well as other factors like socioeconomic, culture, religion. There are several ways that we can look at our patients as far as providing care. One such way is cultural competency. As mentioned previously,
cultural competency is very important. We want to make sure that we are culturally sensitive, being sensitive to the needs of our patients, as well as being aware of diversity.

We know that not everyone is the same. We want to be aware of a patient’s religion, how it may affect their health care, as well as socioeconomic status, as well as any other thing that can affect the patient’s care. We want to be sensitive to that, and we want to assess the
needs of that patient. By being culturally competent, we can help to define the culture broadly. We can look at a client’s cultural beliefs.

Again, how does that affect their patient care? How does that affect how they take care of themselves, if they’re taking their medication, how they interact with you? We also want to
recognize the complexity in language and interpretation. We also want to facilitate learning between providers and communities. So you may be in a community that may be poor socioeconomic or possible language barriers.

You want to try to figure out ways to be able to interact with your patients. And you also want to be able to collaborate with other agencies, if possible, for your patient. And also provide
training, making sure that you have that you are trained in cultural sensitivity and diversity, as well as staff. So when we look at assessment tools with our patients, we want to make
sure that we have tools that will accurately test the patients and assess their needs.

For example, if a patient comes in with issues of sore throat, most likely, you will do a rapid strep test. But you also want to make sure that you are aware that that strep test may be invalid. You want to look at the patient’s overall symptoms. Another example is looking at BMIs. You want to look at the BMI of a patient. A patient’s BMI may be higher. You may have one ethnicity that may have a higher BMI, but not necessarily be obese by looking. But if you calculate the height and weight, it will automatically say obesity.

But by looking at the patient, they may not look obese. So you want to be aware of your assessment tools. You want to look at your reliability and validity of your tools. And then you want to look at diagnostic costs. We never want to order tests that are unnecessary, but we also want to order tests that will be effective for the patient.

So being aware of that, one of the main issues that we have seen in health care [AUDIO OUT] One of the issues that we look at is treatment. Is it effective? When we order tests, will it make a difference in the morbidity or mortality of the condition, if it’s caught early or if it’s detected late. So you want to be aware of that. Another issue is that more than 50% of orders that have been made will be a big eye-opener to policyholders to your patient. They may not know why this test is ordered. So you want to make sure that you explain the tests that you’re
ordering and why, and making sure that the patient is aware of it, and that they’re OK with
the diagnostic test.

So this week, you will have a case study, and you will use week 3. You will apply, from your reading material, diagnostic tools, growth, and measurements. Your case study will be posted
by day 1 by your instructor. Your next assignment is your Shadow Health. I’ve been discussing
Shadow Health since week 1, but this is the first week that your orientation is due. Please remember, if you haven’t purchased Shadow Health, please purchase Shadow Health. You can purchase shadow health through your Walden U book store.

And once you purchase Shadow Health, you will receive a confirmation email. You do not need a PIN number from your instructor. If you have any issues regarding Shadow Health– uploading or accessing– please contact Shadow Health IT or your instructor. And again, please go through your Shadow Health orientation. I did point on here links for you guys, also, note the IT, as well as Shadow Health tips for success.

And please note the documentation tutorial, it is very important. In the documentation tutorial, it will give you a clear, concise way of how to look at the patient. You want to make sure that you look at the subjective data. Subjective is what the patient is telling you. What is going on with the patient– the chief complaint, the history of present illness, the review system– those are all subjective data. And then your objective data is what you see– your vital signs, assessing heart and lungs. So you want to make sure that the difference of the subjective and the objective data.

And then once you complete your assignment in Shadow Health, there is a student acknowledgment form that you will manually sign and upload on Blackboard. That needs to be uploaded every time you turn in a Shadow Health assessment. So, again, for week 3,
your second assignment is your Digital Clinical Experience Health History Assessment, your DCE. You want to make sure you review the learning resources, as well as take a Health
History media program. You want to download and review the student checklists on the subjective data, as well as the learning resources. Your DCE orientation in Shadow Health is 15 minutes.

Your Conversion Concept Lab is 50 minutes. That does not need to be uploaded in Blackboard. That is practice. Your Health History of Tina Jones is what you’re going to be
uploading in Blackboard. Again, I repeat– Tina Jones Health. History is what you will be submitting in Blackboard. Do not submit the Conversion Concept Lab. You should be submitting your DCE score. Your DCE score will have a number at the bottom and it will say whatever percentage that you have. And also, just remember, in each Shadow Health assessment, it may be opened as many times as you like.

But on the last day, it’s the deadline, day 7. And you must have at least the 80%. So again, your DCE score– it is a combination of your Digital Clinical Experience, as well as your
documentation notes. Tina health does not have to be turned in until week 4, and please note week 4.

This week is more of a practice. So if you haven’t already started practicing, you can begin to practice in Shadow Health. I do recommend that you start as soon as possible. And if you have any questions or concerns, please reach out to your instructor. Thank you.

• LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2020). DeGowin’s diagnostic examination (11th ed.). New York, NY: McGraw Hill Medical.
  • Chapter 3, “The Screening Physical Examination”
  • Chapter 17, “Principles of Diagnostic Testing”
  • Chapter 18, “Common Laboratory Tests”