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NR 509 Week 2 Alternative Writing Assignment

Respiratory

Purpose

As a family nurse practitioner, you must possess excellent physical assessment skills. This alternative writing assignment mirrors the discussion content of the debriefing session and will allow the student to expand their knowledge of physical health assessment principles specific to the advanced practice role.

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The purposes of this assignment are to: (a) identify and articulate advanced assessment health history and physical examination techniques which are relevant to a focused body system (CO 1), (b) differentiate normal and abnormal findings with regard to a disease or condition that impacts the body system (CO 2), and (c) adapt advanced assessment skills if necessary to suit the needs of specific patient populations (CO 4). NR 509 Week 2 Alternative Writing Assignment

NOTE
: 
You are to complete this alternative writing assignment ONLY if you had not participated or do not plan to participate in a debriefing session for the given week.

Due Date: 
This alternative written assignment is due no later than the 
Sunday of the week in which you did not attend the weekly debriefing session
. For example, if you did not attend a debriefing session for Week 3, this written assignment is due on Week 4.

 

Requirements:

This paper will be graded on the quality of the information, inclusion of evidence-based scholarly resources, use of citations, use of Standard English grammar, and organization based on the required components (see the paper headings and content details below).

Submit to the appropriate location in Canvas 
of the week due
.

The length of the paper is to be 
no less than 
1,500 words
, excluding title page and reference list
.

Create this assignment using Microsoft (MS) Word. You can tell that the document is saved as a MS Word document because it will end in “.docx.” NR 509 Week 2 Alternative Writing Assignment

APA format (6
th
 edition) is required in this assignment, explicitly for in-text citations and the reference list. Use 12-point Times New Roman font with 1 inch margins and double spacing.

Organize the headings and content of your paper using the outline below
:

Identify and briefly discuss the body system selected for the topic of this paper

Discuss the physiology (structure and function) of the body system including details about the major organ systems (if applicable)

Discuss relevant health history questions (subjective data) pertaining to the body system

Discuss an overview of the objective data and expected normal physical examination findings for this body system NR 509 Week 2 Alternative Writing Assignment

Discuss special physical assessment examination techniques or procedures specific to assessing this body system

Discuss how you might adapt your physical assessment skills or techniques to accommodate each of the following specific populations:

Infant/pediatric

Pregnancy

Geriatric

Identify 
one
 major disease or disease process that may significantly impact this body system

Discuss the expected abnormal physical examination findings that may be associated with this disease or disease process

Summarize the key points NR 509 Week 2 Alternative Writing Assignment

 

Preparing the Paper:

Select a focused body system from the weekly lesson which corresponds with the week of the written assignment.

Carefully read and review the selected body system in your course textbooks.

Incorporate at least 
one
scholarly peer-reviewed journal article that relates to the body system. It may be useful to identify an article that relates to a disease that impacts the body system. NR 509 Week 2 Alternative Writing Assignment

The paper must clearly articulate the relevance of advanced physical assessment skills, techniques, application of advanced practice knowledge, and assessment modification (when necessary) to accommodate for specific patient populations.

Provide concluding statements that should summarize key points of the overall assignment content.

In-text citations and reference page(s) must be written. NR 509 Week 2 Alternative Writing Assignment

NR 509 Week 2 Quiz Review

What does dullness when percussing lung fields: Jarvis pg 427

Facial sensation controlled by which CN: Jarvis 283,

Know what two salivary glands are accessible during exam

What CN is being assessed when pt shrugs shoulders Jarvis 646

What muscles are being assessed when assessing CN 11 (spinal accessory nerve)

Concern for malignant nodules versus benign lymph nodule

Know what you’d do next if you palpated a submental lymph node: Jarvis pg 253

Define visual acuity

Know what to do if your patient can’t read the largest number on the Snellen chart: Jarvis 289

Example of good visual acuity : Jarvis 289 NR 509 Week 2 Quiz Review

Example of poor visual acuity: Jarvis 289

What is expected with corneal light reflex-

Know normal variances of sclera : Jarvis 283

Know how to check for Ptosis: Jarvis 292

What does ptosis indicate: Jarvis 292

Nasal fissure of pt with 
chronic 
allergies : Jarvis 271

Acute 
allergies : Jarvis p 363 
.

What is an abnormal palpation of sinuses: Jarvis 362

Normal palpation of sinuses

Know normal variations in gingival margin

Know what a dehydrated oral cavity will look like: Jarvis 387

What is tactile fremitus, how do you test for it and what does it indicate. Jarvis 425 NR 509 Week 2 Quiz Review

NR 509 Week 7 Assignment: Completion of Immersion Program Exam

 

I’ll note that I don’t see any discolorations or lesions & the head is midline & symmetrical.

 

LYMPH NODES

Next, I’ll palpate the lymph nodes. I’ll begin with the preauricular lymph nodes & postauricular lymph nodes. Next the occipital lymph nodes. I’ll move forward to palpate the tonsillar lymph nodes, submandibular & submental. I’m palpating the anterior cervical lymph nodes & posterior cervical lymph nodes & lastly the supraclavicular lymph nodes. I don’t feel any enlargement & they’re equal bilaterally. NR 509 Week 7 Assignment: Completion of Immersion Program Exam

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FACE

I’m testing 
trigeminal nerve
, which is 
cranial nerve # 5
. Palpating over the masseter muscle as the pt clenches the jaw. I don’t feel any distortions & my pt has great strength. Now, I’m testing the sensory portion of the 
trigeminal nerve
. I’ll ask my pt to close your eyes & let me know where you feel my touch. (>> Forehead, right cheek, left cheek, chin, nose)

Next, I’ll test the 
facial nerve
, which is 
cranial nerve # 7
. I’m going to ask you to do some facial expressions. I’m going to have you smile, next, frown for me. Now raise your eyebrows & puff up your cheeks, pucker your lips. I notice all expressions have bilateral symmetry NR 509 Week 7 Assignment: Completion of Immersion Program Exam

NR 509 Week 1 Shadow Health History Assignment

Pre-brief

Obtaining an accurate history is the critical first step in determining the etiology of a patient’s problem. A large percentage of the time, you will actually be able to make a diagnosis based on the history alone. The value of the history, of course, will depend on your ability to elicit relevant information. Your sense of what constitutes important data will grow exponentially as you practice your interviewing skills and through increased exposure to patients and illness NR 509 Week 1 Shadow Health History Assignment. However, you are already in possession of the tools that will enable you to obtain a good history. Specifically, you must listen and ask appropriate questions to define the nature of a particular problem. In fact, seasoned clinicians occasionally lose sight of this important point, placing more reliance on the use of diagnostic testing rather than taking the time to listen to their patients. Interviewing patients is an art and should remain an essential skill for successful practice.

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In this activity
, you will interview Tina Jones to collect data to assess Ms. Jones’ condition. NR 509 Week 1 Shadow Health History Assignment You will also have the opportunity to educate and empathize with Tina to engage in effective therapeutic  communication; create a problem listusing evidence from the data you collected; prioritize the identified problems to differentiate immediate from non-immediate care; plan how to best address the most important concern with further assessment, interventions, and patient education; and compare your documentation to model documentation.

Ms. Jones is a pleasant, 28-year-old obese African American single woman who presents to establish care and with a recent right foot injury. She is the primary source of the history. Ms. Jones offers information freely and without contradiction. Her speech is clear and coherent and she maintains eye contact throughout the interview. 
Reason for visit
: Patient presents for an initial primary care visit today complaining of a right foot wound. NR 509 Week 1 Shadow Health History Assignment

Results Included
:

Overview

Transcript

Subjective Data Collection

Objective Data Collection

Education and Empathy  

Documentation / Electronic Health Record

Information Processing

Certificate of Completion

NR 509 Week 1 Shadow Health History Assignment

NR 509 Week 3 Shadow Health Musculoskeletal Physical Assessment Assignment

Pre Brief

Three days ago, Ms. Jones injured “tweaked” her back lifting a box. The pain is in her low back and bilateral buttocks, is a constant aching with stiffness, and does not radiate. The pain is aggravated by sitting and decreased by rest and lying flat on her back. She presents today as the pain has continued and is interfering with her activities of daily living. This case study offers the opportunity to apply principles of body mechanics and range of motion to your critical thinking process. Be sure to incorporate this knowledge with your interview questions. Reason for visit: Patient presents complaining of lower back pain. NR 509 Week 3 Shadow Health Musculoskeletal Physical Assessment Assignment

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Results Included:

Overview

Transcript

Subjective Data Collection

Objective Data Collection

Education & Empathy

Documentation

Lifespan

Review Questions

Self – Reflection

NR 509 Week 3 Shadow Health Musculoskeletal Physical Assessment Assignment

NR 509 Week 3 Shadow Health Neurological Physical Assessment Assignment

Pre Brief

Two days after a minor, low-speed car accident in which Tina was a passenger, she noticed daily bilateral headaches along with neck stiffness. She reports that it hurts to move her neck, and she believes her neck might be swollen. She did not lose consciousness in the accident and denies changes in level of consciousness since that time. She states that she gets a headache every day that lasts approximately 1-2 hours. She occasionally takes 650 mg of over the counter Tylenol with relief of the pain. This case study will allow you the opportunity to examine the patient’s optic nerve via use of the ophthalmoscope as well as assess her visual acuity. You will need to document your findings using appropriate medical terminology. Be sure to assess for foot neuropathy using the monofilament test. Reason for visit: Patient presents complaining of headache. NR 509 Week 3 Shadow Health Neurological Physical Assessment Assignment.

.

WE ARE THE SHADOW HEALTH EXPERTS, LET’S HELP YOU HANDLE YOUR 
ASSESSMENT

Chat us on the right bottom corner below to order

Results: 
Transcript

Results: 
Subjective Data Collection

Results: 
Objective Data Collection

Results: 
Education & Empathy

Results: 
Documentation / Electronic Health Record

Results: 
Pre – Survey Lifespan

Results: 
Review Questions

Results: 
Self-Reflection

NR 509 Week 3 Shadow Health Neurological Physical Assessment Assignment

 

Objective Data Collection: 36.75 of 37 (99.32%)

 Correct

 Partially correct

 Incorrect

 Missed

Confirmed orientation

1 of 1 point

 

To Person (1/3 point)

 Oriented to person

 Not oriented to person

To Place (1/3 point)

 Oriented to place

 Not oriented to place

To Time (1/3 point)

 Oriented to time

 Not oriented to time

 Evaluated abstract thinking

1 of 1 point

 

Abstractness (1/2 point)

 Abstract

 Concrete

Relevance (1/2 point)

 Relevant

 Not relevant

 Evaluated attention span

1 of 1 point

 

Serial 7s Test (1/1 point)

 Accurate

 Not accurate

 Evaluated comprehension

1 of 1 point

 

Observations (1/1 point)

 Able to follow instructions

 Unable to follow instructions

 Evaluated general knowledge

1 of 1 point

 

Accuracy (1/1 point)

 Accurate

 Not accurate

 Evaluated judgment

1 of 1 point

 

Observations (1/1 point)

 Intact

 Not intact

 
Evaluated memory

1 of 1 point

 

Remote Memory (1/3 point)

 Intact

 Not intact

Immediate Memory (1/3 point)

 Intact

 Not intact

New Learning Ability (1/3 point)

 Accurate

 Not accurate

 Observed vocabulary

1 of 1 point

 

Complexity (1/1 point)

 Expected complex for patient’s age, education level, and general ability

 Not expected complexity

 Observed articulation

1 of 1 point

 

Observations (1/1 point)

 No observed problems with pronunciation or expression

 Imprecise pronunciation of consonants

 Slurring

 Hesitation

 Stutter

Tested olfactory nerve

1 of 1 point

 

Sense Of Smell (1/2 point)

 Able to discriminate

 Not able to discriminate

Symmetric (1/2 point)

 Symmetric bilaterally

 Asymmetric

Tested visual acuity (optic nerve)

1 of 1 point

 

Right (1/2 point)

 20/100

 20/70

 20/50

 20/40

 20/30

 20/25

 20/20

 20/15

 20/13

 20/10

Left (1/2 point)

 20/100

 20/70

 20/50

 20/40

 20/30

 20/25

 20/20

 20/15

 20/13

 20/10

Examined retina with ophthalmoscope (optic nerve)

0.75 of 1 point

 

Right: Fundus (No point)

 No visible abnormal findings

 Myelinated nerve fibers

 Papilledema

.

.

.

Subjective Data Collection: 20 of 20 (100.0%)

Hover To Reveal…

Hover over the 
Patient Data
 items below to reveal important information, including 
Pro Tips
 and 
Example Questions
.

Found:

Indicates an item that you found.

Available:

Indicates an item that is available to be found.

Category

Scored Items

Experts selected these topics as essential components of a strong, thorough interview with this patient.

Patient Data

Not Scored

A combination of open and closed questions will yield better patient data. The following details are facts of the patient’s case.

Chief Complaint

Finding:

Established chief complaint

Finding:

Reports recent “fender bender”

(Found)

Pro Tip: Patients choose to seek treatment for a variety of reasons. Asking why Tina chose to seek treatment today might indicate primary concerns, the severity of her symptoms, or failure to manage symptoms herself.

Example Question:

Why are you seeking treatment today?

Finding:

Reports headaches

(Found)

Pro Tip: Symptoms often vary from patient to patient. Asking Tina if she’s had headaches specifies the way her individual symptoms and pain manifest.

Example Question:

Have you had any headaches?

Finding:

Reports neck symptoms

(Found)

Pro Tip: Symptoms often vary from patient to patient. Asking Tina if she’s had neck stiffness specifies the way her individual symptoms and pain manifest.

Example Question:

Have you had any neck stiffness?

History of Present Illness

Finding:

Asked about onset of symptoms

Finding:

Reports accident occurred 1 week ago

(Available)

Pro Tip: Soliciting a relevant history of Tina’s car accident will allow you to understand the context in which she was injured and the injuries she sustained.

Example Question:

When did the accident happen?

Finding:

Reports symptoms began 2 days after accident

(Found)

Pro Tip: Symptoms often vary from patient to patient. Asking Tina when the headaches begin specifies the way her individual symptoms and pain manifest.

Example Question:

When did the headaches begin?

Finding:

Followed up on details of car accident

Finding:

Denies loss of consciousness

(Found)

Pro Tip: Soliciting a relevant history of Tina’s car accident will allow you to understand the context in which she was injured and the injuries she sustained.

Example Question:

Did you lose consciousness during the car accident?

Finding:

Reports low vehicle speed

(Found)

Pro Tip: Soliciting a relevant history of Tina’s car accident will allow you to understand the context in which she was injured and the injuries she sustained.

Example Question:

How fast was the car going?

Finding:

Reports wearing seatbelt

.

.

.

 

Transcript

Started:
 Mar 18, 2020 | 
Total Time:
 219 min

All Lines (155)Interview Questions (94)Statements (3)Exam Actions (58)

Hello Tina. Welcome to our clinic. Am Pam, i will be interviewing you today, and later do a physical examination on you

Greet

Hey.

What brings you to the clinic today?

Question

Well, I got into a little fender bender a week ago and I’ve been getting these headaches ever since. And my neck is sore too.

Am sorry to hear that you are having headaches

Empathize

Thanks for saying that.

Have you had any neck stiffness?

Question

Yeah.

When did the neck stiffness begin?

Question

My neck started hurting about two days after the accident.

Am sorry that you got an accident (No matching questions found.)

Question

Am sorry that you got an accident

Empathize

Thanks.

And when did the headaches begin? (Clarified to When did the headache begin?.)

Question

 

.

.

.

 

Review Questions
Activity Time: 6 min

To assess spinal levels L2, L3 and L4 in Tina, which deep tendon reflexes would have to be tested?

Correct:
 The patellar deep tendon reflex involves the sensory and motor nerve fibers associated with spinal segments L2, L3, and L4. Location of abnormal reflexes may be helpful in identifying neurological pathologies of the spine.

Achilles

Biceps

Patellar (Correct Response)

Triceps

Imagine that you were preparing to irrigate a Foley catheter of a patient with a spinal cord injury at T4 in a urology clinic. Upon moving the leg bag, the patient became suddenly flushed and diaphoretic above the nipple line. What would you suspect was happening?

Correct:
 Autonomic dysreflexia is the sudden increase in blood pressure caused by dysregulation of sympathetic and parasympathetic nervous systems reacting to a noxious stimulus below the site of spinal injury. Other symptoms include bradycardia, anxiety, blurred vision, headache, flushing, and sweating. The noxious stimulus (pulling of the Foley catheter) should be alleviated to resolve the condition.

Odynophagia

Febrile reaction

Idiopathic spinal reaction

Autonomic dysreflexia (Correct Response)

Which of the following is not a common symptom of Parkinson’s disease?

Correct:
 Parkinson’s disease is characterized by tremors at rest, bradykinesia, cogwheel rigidity, postural instability, festination, lack of facial expression, reduced arm swing, autonomic and neuroendocrine dysfunctions, and a variety of psychological issues such as depression, anxiety, and sleep disturbances.

Lack of facial expression

Festination

Cogwheel rigidity

Intention tremors (Correct Response)

Name at least three ways to assess cerebellar function during a physical exam.

Student Response:
Test cerebellar function by assessing gait and instructing the patient to perform the finger-to-finger, finger-to-nose, heel-to-shin, rapid alternating movements

Model Note:
 The cerebellum is responsible for smooth and accurate coordination of voluntary movements. You can test cerebellar function by assessing gait and by instructing the patient to perform the finger-to-finger, finger-to-nose, heel-to-shin, rapid alternating movements, and Romberg tests.

If Tina had a fever and photophobia, you would have had to test for meningitis. Describe how you would have tested for the Kernig’s sign.

 

 

Lifespan
Activity Time: 10 min

Tina’s three-year-old neighbor presents to the clinic with fever, neck pain, headache, and confusion. He has no symptoms of an upper respiratory infection. The parents mention that they do not believe in immunizations. Based on the information given, what diagnosis is of the greatest concern? What is your next action?

Student Response:
Rule out bacterial meningitis, there was no immunizations to increase meningitis risk.

Model Note:
 Bacterial Meningitis needs to be ruled out immediately. He has not had immunizations which puts him at increased risk for meningitis from Haemophilus influenzae type B. Seizure disorder does not cause fever. Children with immunodeficiency syndrome are at increased risk for meningitis but this child has no previous history of chronic infections. Although children with strep throat can present with fever and neck pain, they are not confused. He needs an immediate spinal tap to determine the nature of the meningitis, and broad spectrum antibiotics should be started as soon as possible. He should be sent to the emergency room.

Tina’s 83-year-old great uncle forgets where he is during his yearly check-up. He doesn’t remember if he’s had memory problems before and no family members came to your office with him. List your differential diagnosis. What assessments would you perform?

Student Response:
Differential diagnosis include stroke…

Pre Brief

Over the last month, Tina has experienced 3-4 episodes of perceived rapid heart rate. She describes these episodes as “thumping in her chest” with a heart rate that is “way faster than usual”. She does not associate the rapid heart rate with a specific event, but notes that they usually occur about once per week in the morning on her commute to class. The episodes generally last between 5 and 10 minutes and resolve spontaneously. She denies chest pain during the episodes. Be sure to apply the supportive information learned in the cardiovascular concept lab to your critical thinking process in this case study. Reason for visit: Patient presents complaining of recent episodes of fast heartbeat.

Results Included:

Overview

Transcript

Subjective Data Collection

Objective Data Collection

Education & Empathy

Documentation

Lifespan

Review Questions

Self-Reflection

Pre Brief

This assignment provides the opportunity to conduct a focused exam on a patient presenting with recent episodes of chest pain in a non-emergency setting. Interview Mr. Foster and be sure to thoroughly assess the cardiovascular system as well as related body systems in order to compile a list of differential diagnoses. This case study offers you the opportunity to evaluate Mr. Foster’s personal and family history with heart disease and identify lifestyle risk factors. During the physical examination, thoroughly examine the cardiovascular system and carefully evaluate and document the patient’s heart sounds. Reason for visit: Patient presents complaining recurrent chest pain.

Chest Pain Results: Overview

Chest Pain Results: Transcript

Chest Pain Results: Subjective Data Collection

Chest Pain Results: Objective Data Collection

Chest Pain Results: Education & Empathy

Chest Pain Results: Documentation

Chest Pain Results: Self-Reflection

Pre Brief

Ms. Esther Park is a 78-year-old woman who comes to the clinic complaining of abdominal pain. She reports that the pain isn’t severe, but that her daughter was concerned and brought her in. It is very important to determine whether or not the situation is an emergency and that the underlying cause of Esther’s discomfort. Be sure to inquire about a variety of psychosocial factors related to the GI system, including her diet, toilet habits, immunizations, recent travel, etc. This case study will offer you the opportunity to take a complete surgical, reproductive, and current sexual history. During her physical examination, take particular note as to where Mrs. Park verbalizes pain during palpation so that you may synthesize verbal and non-verbal cues. Be sure to apply the supportive information learned in this week’s concept lab to your critical thinking process in this case study. Reason for Visit: Patient presents complaining of abdominal pain.

Results Included:

Overview

Transcript

Subjective Data Collection

Objective Data Collection

Education & Empathy

Documentation (Provider Notes & Vitals)

Self-Reflection

Pre Brief

For at least a month, Tina has been experiencing pain in her upper stomach after eating, which she describes as “kind of like heartburn, but sharper.” She notices it a little every day, but 3-4 times a week it is very painful (5/10 on pain scale). She also notices burping after she eats. She denies cough, hoarseness, sore throat, dysphagia, and chest pain. Be sure to apply the supportive information learned in this week’s concept lab to your critical thinking process in this case study. 
Reason for visit: 
Patient presents complaining of recent recurrent stomach pain.

 

Results Included
:

Overview

Transcript

Subjective
 
Data
 
Collection

Objective
 
Data
 
Collection

Education
 
&
 
Empathy

Documentation

Lifespan

Review
 
Questions

Self – Reflection