N522PE-20A Advanced Physical Assessment Course Papers
N522PE-20A Advanced Physical Assessment Course Papers
Module One: Introduction to the Course & Implementing Clinical Reasoning in Practice
N522PE-20A Advanced Physical Assessment Course Papers 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.
Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Discussion Participation Guidelines & Grading Criteria.
Assignment 1
N522PE-20A Advanced Physical Assessment Course Papers 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.
N522PE-20A Advanced Physical Assessment Course Papers 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)
N522PE-20A Advanced Physical Assessment Course Papers: 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. | 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 |
Module Two: HEENT and Skin Assessment
Discussion 2 – N522PE-20A Advanced Physical Assessment Course Papers
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.
Sample Approach to Discussion 2
Skin rashes are temporary disruptions of the skin. Dermatological disorders are classified according to lesion type (Primary), lesion configuration (Secondary), texture, location and distribution, and color.
A. Primary lesions – acquired
1. Macules – flat, <10 mm; large macula is called patch (rubella)
2. Papules – elevated, <10 mm (acne)
3. Plaques – elevated/depressed, >10 mm (psoriasis)
4. Nodules – firm papules extending to dermis or subcutaneous tissue (cysts)
5. Vesicles – clear, vesicle, fluid-filled blisters <10 mm (herpes infections)
6. Bullae – clear fluid-filled blister >10 (allergic contact dermatitis)
7. Pustules – pus-filled vesicle (pustular psoriasis)
8. Urticaria – red pruritic wheals or hives (medication allergies)
9. Scale -horny epithelium (seborrheic dermatitis)
10. Crusts /Scabs – (impetigo)
11. Erosions – open skin areas (excoriation)
12. Ulcers – epidermal loss (decubitus)
13. Petechiae – hemorrhage (vasculitis)
14. Purpura – palpable hemorrhage (ecchymoses/bruises)
15. Atrophy – skin thinning (lupus)
16. Scars – fibrotic skin (keloid)
17. Telangiectases – small dilated blood vessels (rosacea)
B. Secondary lesions – develops overtime as a result of disease progression
1. Annular – center-cleared rings (tinea)
2. Target (bull’seye or iris) – rings w/centered duskiness (erythema multiforme)
3. Serpiginous – linear, branched, curving; fungal and parasitic infections (cutaneous larva migrants)
4.Numular – coin-shaped (numular eczema)
5. Herpetiform – grouped papules or vesicles (herpes simplex)
6. Reticulated – lacy, networked (cutis marmorata)
6. Zosteriform – dermatomal clustered lesions (herpes zoster)
C. Texture – skin appearance or consistency
1. Verrucous lesions – irregular pebbly rough surface (warts)
2.Lichenification -skin thickening (repeated rubbing)
3. Induration – deep skin thickening (paniniculitis)
4. Umbilical – central indentation; viral (molluscum contagiosum)
5. Xanthomas – yellowish waxy (lipid disorders)
D. Location and Distribution
1. Psoriasis – scalp, elbows, kneees, umbilicus, gluteal cleft
2. Lichen planus – wrists, forearms, genitals, Lower legs
3. Vitiligo – patchy isolated; distal extremities and face, peri-orbital and peri-oral
4. Discoid lupus erythomatosus -sun-exposed area, forehead, nose, cochal bowl of the ear
5. Hidradenitis suppurativa – apocrie gland-dense skin areas; axilla, groin, ulcer breasts
E. Color
1. Red – Erythema
2. Orange – Hypercarotenemia
3. Yellow – Xanthomas
4. Green fingernails – pseudomonas aeruginosa
5. Violet – cutaneous hemorrhage (kaposi sarcoma)
6. Blue, silver and gray – drug/metal deposits ( mini cyclone. Amiodarone); argyria (silver)
7.Black – melanocytes (melanoma), infarction (anthrax)
F. Other Clinical signs
1. Dermatologist – urticaria wheal
2. Carrier sign – rapid swelling when lesion is stroked (mastocytosis)
3. Nikon sky sign – epidermal shear after lateral pressure (bullous disease)
4. Auzpitz sign – pinpoint bleeding appears after scale removal (psoriasis)
5. Koebner phenomenon – lesions within traumatized areas (lichen planus)
There were several communication techniques that I had to use during the interview process to get a quality relevant answer. Rephrasing the questions oftentimes redirect the answer. The Shadow health is of course limited since it’s a digitized one. Communications would have been easier if it was a real clinician-client interaction.
In our profession, observing nonverbal cues and silence and empathy would garner additional qualifying patient information to our database. Therapeutic communication is not just confined to asking questions to elicit response. Touch, sharing hope and humor and empathy can help build rapport. Sometimes providing information, clarifications and confrontation are needed when there are inconsistencies in the patient history.
But the latter can only be done when trust and comfort have been established. Reflection and stating patient observation will bring patient attention to one’s demeanor without cultivating embarrassment. Self-disclosure can promote the therapeutic relationship by providing framework for respect and hope.
While all of these communication techniques are helpful, cultural competence and sensitivity will further reinforce the positive patient-provider relationship.
I need to increase my databank for illness scripts to be able to maximize the potential for clinical reasoning skills while doing physical and assessment. During the actual diagnostic testing of the eyes, ears, mouth and nose, I found it handy to have an ample background knowledge of the normal and abnormal anatomical concepts of human body systems. It helps to focus on the details that may contribute to the current health concern.
However, my limited exposure to the use of otoscope and ophthalmoscope, I unfortunately had to repeat my examination procedure to make sure that I correctly diagnosed the abnormality that I saw specially in the retinal structure. If it was in the real life situation, it would be comfortable for the patient and detrimental to the trusting relationship that has been established. Realistically, professionals can ask colleagues or a physician if there’s something that was unsure of in terms of abnormal findings.
N522PE-20A Advanced Physical Assessment Course Papers References:
- Benedetti, J., By, Benedetti, J., & Last full review/revision Feb 2019| Content last modified Feb 2019. (n.d.). Description of Skin Lesions – Dermatologic Disorders. Retrieved September 27, 2020, from https://www.merckmanuals.com/professional/dermatologic-disorders/approach-to-the-dermatologic-patient/description-of-skin-lesions
- Leoni-Scheiber, C., Mayer, H., & Müller-Staub, M. (2019, November 8). Relationships between the Advanced Nursing Process quality and nurses’ and patient’ characteristics: A cross-sectional study. Retrieved September 28, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6917982/
796 words
In reply to Honey Variacion Brojan N522PE-20A Advanced Physical Assessment Course Papers
Re: Discussion 2
In reply to Dona Clarin
Re: Discussion 2 – N522PE-20A Advanced Physical Assessment Course Papers
The term “tinea” exclusively refers to dermatophyte infections. Dermatophyte (tinea) infections are common fungal infections of the skin, hair, and nails and are classified according to body site. Dermatophytes are filamentous fungi that metabolize and subsist upon keratin in the skin, hair and nails.
The major clinical subtypes are tinea capitis (scalp), tinea corporis (skin other than bearded area, feet, groin, face, scalp or beard hair), tinea barbae/sycosis/barber’s itch (beard), tinea pedis (foot), tinea cruris (groin, perineum, and perineal areas), tinea manuum (hands) and tinea unguium (nail) also called dermatophyte onychomycosis.
Dermatophytes cause a red skin rash that forms around a normal-looking skin. Tinea infections or dermatophytosis symptoms include ring-shaped rash, itchy skin, red-scaly cracked skin and hair loss. Clinical picture of the rash is a circular or ovoid in appearance with patches and plaques with sharp marginations and raised erythematous scaly edge which may contain vesicles.
The lesions advance centrifugally from a core, leaving a central clearing and mild residual scaling; this appears as a “ring” like pattern thus the term “ringworm.” Tinea infections are spread by skin-to-skin contact, and usually favors warm weather. Treatment includes topical or oral anti fungal.
Subclassifications of dermatophytosis or tinea infections
Tinea capitis – scaly, itchy red circular bald spot; Rounded, patchy hair loss on scalp, leaving broken-off hairs, pustules, and scales on skin; mostly affects children; can be confused with dandruff or cradle cap.
Tinea barbae – scaly, itchy, red spots on the cheeks, chin, and upper neck; spots may be crusted over or filled with pus, and the affected hair might fall out.
Tinea cruris (jock itch) – scaly, itchy, red spots the moist, warm areas of inner sides of skin folds and thighs; mostly affects boys
Tinea pedis(athlete’s foot) – red, swollen, peeling, itchy skin between the toes; common in adolescents
Tines corporis – hyperpigmented in whites, depigmented in dark-skinned people; on chest, abdomen, back of arms forming multiple circular lesions with clear centers; tinea gladiatorum wrestlers
Tinea unguium – infection of the toenails, and sometimes fingernails; thickened, deformed, and discolored nails instead of a rash.
Tinea manuum – slightly raised red, scaly rash in hands
Tinea versicolor or pityriasis versicolor – caused by a slow-growing fungus (Pityrosporum orbiculare) that is a type of yeast. It is a mild infection that can occur on many parts of the body.
N522PE-20A Advanced Physical Assessment Course Papers Reference:
420 words
Module 3
Module Three: Cardiovascular, Peripheral Vascular System & Respiratory Assessment
N522PE-20A Advanced Physical Assessment Course 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.
N522PE-20A Advanced Physical Assessment Course Papers
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).
- Introduction (including purpose statement)
- Focus of the assessment
- Describe the focus of this particular assessment on the patient complaining of a cough
- Subjective Component
- Describe the ROS, PMH, and other relevant data in this section.
- Objective Component
- Describe the physical examination findings including techniques of examination
- Documented evidence to support clinical reasoning
- Describe the list of differential diagnoses
- Plan of care
- 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. | Documentation supports the student has completed the focused assessment with minimal identification of special concerns. The focused health history is documented. | Documentation supports the student has completed the focused assessment without identification of special concerns. The focused health history is documented and lacks depth and specificity of weekly topic. | Documentation supports the student attempted to complete the focused assessment without identification of special concerns. The focused health history is briefly documented and lacks depth and specificity of weekly topic. | /20 |
| 20 | 18 | 16 | 0 | ||
| Documented Physical Examination Findings including Techniques of Examination | Documentation clearly shows student has completed the physical examination and accurately describes the techniques of examination for the week. | Documentation supports the student has completed the physical examination and describes the techniques of examination for the week. | Documentation supports student completed some of the physical examination for the focused assessment of the week. Documentation is accurate but lacks depth. | No evidence that the student is applying read concepts of advanced focused physical assessment. Documentation lacks depth and may lack coherence for understandability of tasks completed in this week. | /20 |
| 20 | 18 | 16 | 0 | ||
| Documented Evidence to Support Clinical Reasoning with External Course Resources | Discourse clearly shows the student has studied the topic and has given thought to the focused assessed topic and documentation for the week. | Discourse supports the student has studied the topic and has given thought to the focused assessment topic and documentation for the week. | Discourse supports student studied some of the topic for the focused assessment topic this week. Discourse is accurate but lacks depth. | No evidence that that student has read or studied the topic. Discourse lacks depth. May be presented in a rambling manner. Content is inaccurate &/or is unclear. | /20 |
| 20 | 18 | 16 | 0 | ||
| Individualized Plan of Care Based Upon Clinical Findings | Accurately presents an individualized plan of care based upon clinical findings. | Presents an individualized plan of care based upon clinical findings. Some minor omissions are noted. | Presents a plan of care that is not individualized based upon the clinical findings. | A plan of care is not presented or the plan of care presented lacks demonstration of competency or is irrelevant to the clinical findings. | /20 |
| 5 | 4 | 3 | 0 | ||
| Developmentally and Culturally Specific | Accurately documents a developmentally and culturally specific assessment and plan of care for the selected patient. | Documents a developmentally and culturally specific assessment and plan of care. | Presents a developmentally and culturally specific assessment or plan of care and one or both are not based upon the selected patient. | A developmentally and culturally specific assessment and plan of care are not presented or based upon the selected patient’s findings. | /5 |
| 5 | 4 | 3 | 0 | ||
| Demonstration of Compliance with Ethical and Legal Standards of Professional Nursing Practice | Compliance with the ethical and legal standards of professional nursing practice is explicitly stated in the documentation of the focused physical assessment. | Compliance with the ethical and legal standards of professional nursing practice is stated in the documentation. | Compliance with the ethical and legal standards of professional nursing practice is briefly implied in the documentation of the focused physical assessment or inaccuracies are evidenced in the written assessment. | Compliance with the ethical and legal standards of professional nursing practice is not included in the documentation of the focused physical assessment. | /5 |
| 10 | 9 | 8 | 0 | ||
| Grammar, Spelling, and Punctuation APA Format | APA Format, grammar, punctuation and spelling is accurate with no errors. | APA Format, grammar, punctuation and spelling is accurate with less than two types of errors. | APA Format, grammar, punctuation and spelling is accurate with five or fewer types of errors. | APA Format, grammar, punctuation and spelling is accurate with more than five types of errors. | /10 |
| COMMENTS: | TOTAL: | /100
| |||
Module Four: Gastrointestinal, Breast and Axilla Assessment
Discussion 4 – N522PE-20A Advanced Physical Assessment Course Papers
Module 5
Module Five: Neurological & Musculoskeletal Assessment
N522PE-20A Advanced Physical Assessment Course 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.
N522PE-20A Advanced Physical Assessment Course 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
- Describe the focus of this particular assessment on the patient complaining of chest pain
- Subjective Component
- Describe the ROS, PMH, and other relevant data in this section.
- Objective Component
- Describe the physical examination findings including techniques of examination
- Documented evidence to support clinical reasoning
- Describe the list of differential diagnoses
- Plan of care
- 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. | Documentation supports the student has completed the focused assessment with minimal identification of special concerns. The focused health history is documented. | Documentation supports the student has completed the focused assessment without identification of special concerns. The focused health history is documented and lacks depth and specificity of weekly topic. | Documentation supports the student attempted to complete the focused assessment without identification of special concerns. The focused health history is briefly documented and lacks depth and specificity of weekly topic. | /20 |
|
| 20 | 18 | 16 | 0 |
|
| Documented Physical Examination Findings including Techniques of Examination | Documentation clearly shows student has completed the physical examination and accurately describes the techniques of examination for the week. | Documentation supports the student has completed the physical examination and describes the techniques of examination for the week. | Documentation supports student completed some of the physical examination for the focused assessment of the week. Documentation is accurate but lacks depth. | No evidence that the student is applying read concepts of advanced focused physical assessment. Documentation lacks depth and may lack coherence for understandability of tasks completed in this week. | /20 |
| 20 | 18 | 16 | 0 | ||
| Documented Evidence to Support Clinical Reasoning with External Course Resources | Discourse clearly shows the student has studied the topic and has given thought to the focused assessed topic and documentation for the week. | Discourse supports the student has studied the topic and has given thought to the focused assessment topic and documentation for the week. | Discourse supports student studied some of the topic for the focused assessment topic this week. Discourse is accurate but lacks depth. | No evidence that that student has read or studied the topic. Discourse lacks depth. May be presented in a rambling manner. Content is inaccurate &/or is unclear. | /20 |
| 20 | 18 | 16 | 0 | ||
| Individualized Plan of Care Based Upon Clinical Findings | Accurately presents an individualized plan of care based upon clinical findings. | Presents an individualized plan of care based upon clinical findings. Some minor omissions are noted. | Presents a plan of care that is not individualized based upon the clinical findings. | A plan of care is not presented or the plan of care presented lacks demonstration of competency or is irrelevant to the clinical findings. | /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?
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 – N522PE-20A Advanced Physical Assessment Course Papers
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).
- Introduction (including purpose statement)
- Focus of the assessment
- Describe the focus of this particular assessment on the patient complaining of abdominal discomfort.
- Subjective Component
- Describe the ROS, PMH, and other relevant data in this section.
- Objective Component
- Describe the physical examination findings including techniques of examination
- Documented evidence to support clinical reasoning
- Describe the list of differential diagnoses
- Plan of care
- 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. | Documentation supports the student has completed the focused assessment with minimal identification of special concerns. The focused health history is documented. | Documentation supports the student has completed the focused assessment without identification of special concerns. The focused health history is documented and lacks depth and specificity of weekly topic. | Documentation supports the student attempted to complete the focused assessment without identification of special concerns. The focused health history is briefly documented and lacks depth and specificity of weekly topic. | /20 |
| 20 | 18 | 16 | 0 | ||
| Documented Physical Examination Findings including Techniques of Examination | Documentation clearly shows student has completed the physical examination and accurately describes the techniques of examination for the week. | Documentation supports the student has completed the physical examination and describes the techniques of examination for the week. | Documentation supports student completed some of the physical examination for the focused assessment of the week. Documentation is accurate but lacks depth. | No evidence that the student is applying read concepts of advanced focused physical assessment. Documentation lacks depth and may lack coherence for understandability of tasks completed in this week. | /20 |
| 20 | 18 | 16 | 0 | ||
| Documented Evidence to Support Clinical Reasoning with External Course Resources | Discourse clearly shows the student has studied the topic and has given thought to the focused assessed topic and documentation for the week. | Discourse supports the student has studied the topic and has given thought to the focused assessment topic and documentation for the week. | Discourse supports student studied some of the topic for the focused assessment topic this week. Discourse is accurate but lacks depth. | No evidence that that student has read or studied the topic. Discourse lacks depth. May be presented in a rambling manner. Content is inaccurate &/or is unclear. | /20 |
| 20 | 18 | 16 | 0 | ||
| Individualized Plan of Care Based Upon Clinical Findings | Accurately presents an individualized plan of care based upon clinical findings. | Presents an individualized plan of care based upon clinical findings. Some minor omissions are noted. | Presents a plan of care that is not individualized based upon the clinical findings. | A plan of care is not presented or the plan of care presented lacks demonstration of competency or is irrelevant to the clinical findings. | /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.
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.
Final Project – N522PE-20A Advanced Physical Assessment Course Papers
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
- Apply one nursing theory in planning care for this patient
- Incorporate Healthy People 2020 Objectives into the plan of care prioritized to meet the health needs of the patient
- Document evidence to support clinical reasoning for selected evidence-based plan of care
- 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.
N522PE-20A Advanced Physical Assessment Course Papers 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. | Documentation supports the student has completed the assessment without documentation of key findings. | Documentation supports the student attempted to complete the comprehensive assessment without identification of key findings. The comprehensive health history is briefly documented and lacks depth and specificity. | /20 |
| 20 | 18 | 16 | 0 | ||
| Documented Prioritized Physical Examination Findings | Documentation clearly shows student has completed the physical examination with findings prioritized. | Documentation supports the student has completed the physical examination with findings. | Documentation supports student completed some of the physical examination. Documentation is accurate but lacks depth. | No evidence that the student is applying read concepts of advanced focused physical assessment. Documentation lacks depth and may lack coherence for understandability. | /20 |
| 20 | 18 | 16 | 0 | ||
| Documented Evidence to Support Clinical Reasoning with External Course Resources | Discourse clearly shows the student has studied the topic and has given thought in developing the final plan of care with one nursing theory applied and integration of Healthy People 2020. | Discourse supports the student has studied the topic and has given thought in developing the final plan of care. Lacks integration of either one applied nursing theory or integration of Healthy People 2020. | Discourse supports student studied some of the topic, however, lacks detail and depth in developing the final plan of care. Lacks integration of either one applied nursing theory or integration of Healthy People 2020. | No evidence that that student has read or studied the topic. Discourse lacks depth. May be presented in a rambling manner. Content is inaccurate &/or is unclear. No use of one applied nursing theory or integration of Healthy People 2020. | /20 |
| 20 | 18 | 16 | 0 | ||
| Individualized and Prioritized Plan of Care is Based Upon Clinical Findings | Accurately presents an individualized plan of care based upon clinical findings. | Presents an individualized plan of care based upon clinical findings. Some minor omissions are noted. | Presents a plan of care that is not individualized based upon the clinical findings. | A plan of care is not presented or the plan of care presented lacks demonstration of competency or is irrelevant to the clinical findings. | /20 |
| 5 | 4 | 3 | 0 | ||
| Developmentally and Culturally Specific | Accurately documents a development-ally and culturally specific assessment and plan of care for the selected patient. | Documents a development-ally and culturally specific assessment and plan of care. | Presents a development-ally and culturally specific assessment or plan of care and one or both are not based upon the selected patient. | A development-ally and culturally specific assessment and plan of care are not presented or based upon the selected patient’s findings. | /5 |
| 5 | 4 | 3 | 0 | ||
| Demonstration of Compliance with Ethical and Legal Standards of Professional Nursing Practice | Compliance with the ethical and legal standards of professional nursing practice is explicitly stated in the documentation of the comprehensive physical assessment. | Compliance with the ethical and legal standards of professional nursing practice is stated in the documentation. | Compliance with the ethical and legal standards of professional nursing practice is briefly implied in the documentation of the comprehensive physical assessment or inaccuracies are evidenced in the written assessment. | Compliance with the ethical and legal standards of professional nursing practice is not included in the documentation of the physical assessment. | /5 |
| 10 | 9 | 8 | 0 | ||
| Grammar, Spelling, and Punctuation APA Format | APA Format, grammar, punctuation and spelling is accurate with errors. | APA Format, grammar, punctuation and spelling is accurate with less than two types of errors. | APA Format, grammar, punctuation and spelling is accurate with five or fewer types of errors. | APA Format, grammar, punctuation and spelling is accurate with more than five types of errors. | /10 |
| COMMENTS: | TOTAL: | /100 | |||
Module 8
Module Eight: Special Topics – Pain Assessment & Cultural Competency
Discussion 8 – N522PE-20A Advanced Physical Assessment Course Papers
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.
Example Discussion 8 Approach
Culture can influence how one expresses, manages, and experiences pain. Pain is universal, but the way one person says pain can differ from another individual. Other factors that play a role in the way someone interprets and tolerate pain rates are family beliefs and religion. For example, I recently took care of a gentleman in the ICU suffering from COVID, who was of Japanese descent, and his father was a former Marine.
He was taught that stoicism was part of his heritage from a young age, and he needed to act “tough” like “a Marine.” Although this is just a basic example, the identification and treatment of pain can be much more challenging for a provider if they cannot understand the complexity of pain in an individual.
According to the Institute for Clinical Systems Improvement, pain scales have been part of pain treatment for many years and have become standard practice (2018). In my facility, we use various pain scales such as the Critical Care Pain Observation Tool (CPOT), Wong-Baker Faces Pain Scale, FLACC Scale, and a Numerical Rating Pain Scale.
Our hospital policy requires us to assess pain a minimum of every 4 hours or sooner as needed. If we give pain medicine due to pain, we are required to re-assess for the effectiveness within one hour of giving the medication. Suppose a patient is in the ICU and sedated.
In that case, we use the CPOT scale, which “is the most reliable tool currently available to assess pain in patients” (Phillips et al., 2019) who are unable to communicate. We assess our pain assessment on various factors such as increased heart rate, respiration, blood pressure, facial grimacing, and an increase in restlessness.
References
Institute for Clinical Systems Improvement (2018). Asses, quality of life, function, and pain. https://www.icsi.org/guideline/pain/assess-quality-of-life-function-and-pain/
Phillips, M. L., Kuruvilla, V., & Bailey, M. (2019). Implementation of the Critical Care Pain Observation Tool increases the frequency of pain assessment for non-communicative ICU patients. Australian critical care: official journal of the Confederation of Australian Critical Care Nurses, 32(5), 367–372. https://doi.org/10.1016/j.aucc.2018.08.007
