Tag: Clinical-Nursing

  • Nurs 6640 week 1 discussion – Psychotherapy and Biology Sample essay

    Nurs 6640 week 1 discussion – Psychotherapy and Biology Sample essay

    Psychotherapy and Biology

    Before the question of whether psychotherapy has a biological basis, we must first understand what psychotherapy means. Psychotherapy is “any alteration in an individual’s interpersonal environment, relationships, or life situation brought about especially by a qualified therapist and intended to have the effect of alleviating symptoms of mental or emotional disturbance” (Merriam-Webster, 2018).

    There is an increasing consensus with evidence provided by neuroscience, psychology, and the cognitive sciences the psychotherapy does have a biological basis (Prosser, Helfer, & Leucht, 2016). The combination of these three sciences developed the free-energy principle which acknowledges that the environments we inhabit are complex and ever changing and the brain must constantly adapt to these changes (Prosser, Helfer, & Leuch, 2016). The free-energy framework claims that the brain attempts to adapt to the changing environment by minimizing prediction error, and by doing this the brain changes how the structure of the environment is encoded in the brain sometimes causing mental disorders (Prosser, Helfer, & Leucht, 2016). Nurs 6640 week 1 discussion – Psychotherapy and Biology Sample essay.

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    Psychotherapy has also been shown to change activity levels in the prefrontal cortex. According to a UCLA study on depression people with this condition had abnormally high activity in the prefrontal cortex (Deen, 2015). The researchers found that the patients who participated in interpersonal therapy had a decrease in prefrontal cortex activity (Deen, 2015). The author continues with a study preformed in the Netherlands with individuals with chronic fatigue syndrome (CFS). It was found the people with CFS have a decrease in the gray matter in the brain but after several sessions of cognitive behavioral therapy there was a significant increase in gray matter volume in the prefrontal cortex (Deen, 2015).

    Influences on Psychotherapy Treatment

    There are many factors that influence a person’s value of psychotherapy including socioeconomic status, race and racial beliefs, racial match, and religious factors. Nurs 6640 week 1 discussion – Psychotherapy and Biology Sample essay. With many factors potentially influencing the clients perspective of psychotherapy it is important that the practitioner become culturally competent.

    Racial factors can hinder quality care for the mental health patient. In some studies racial match of clients can be associated with an increase in the utilization of mental health services and promote favorable outcomes (Meyer & Zane, 2013, p. 3). The increase in more favorable outcomes could be because the ethnic minority clients may view ethnically similar psychotherapists as a more credible source of help because the assume a shared culture or values (Meyer & Zane, 2013, p. 3) Nurs 6640 week 1 discussion – Psychotherapy and Biology Sample essay.

    As stated before, there are many factors that can influence the value a person placed on psychotherapy, even the words used can increase the value a client places on therapy. Regarding the Navajo and psychotherapy, they see it as a practice pertaining to illness and healing and the terminology used becomes important (Lewis-Fernández, 2011, p. 5). When the word belief is applied to aspects of therapy it carries the connotation of falsehood, instead of saying what is your belief on mental illness and psych therapy one should use the terms values, attitudes on, view, but never beliefs (Lewis-Fernández, 2011, p. 6). Nurs 6640 week 1 discussion – Psychotherapy and Biology Sample essay In this example of culture and how it influences psychotherapy it would be very important to be culturally competent in the Navajo culture because just the verbiage used could alter the outcome of psychotherapy.

    References

    Deen, S. (2015). How Psychotherapy Changes the Brain.
    American Psychiatric Association
    .

    Lewis-Fernández, R. (2011). Commentary on “Elements of Psychotherapy in Navaho Religion”: A Perspective from Contemporary Cultural Psychiatry.
    Psychiatry: Interpersonal and Biological Processes
    ,
    74
    (4), 293-300. doi:10.1521/psyc.2011.74.4.293 Nurs 6640 week 1 discussion – Psychotherapy and Biology Sample essay

    Merriam-Webster. (2018, February 24). PSYCHOTHERAPY. Retrieved from https://www.merriam-webster.com/dictionary/psychotherapy

    Meyer, O. L., & Zane, N. (2013). THE INFLUENCE OF RACE AND ETHNICITY IN CLIENTS’ EXPERIENCES OF MENTAL HEALTH TREATMENT.
    Journal of Community Psychology
    ,
    41
    (7), 884-901. doi:10.1002/jcop.21580

    Prosser, A., Helfer, B., & Leucht, S. (2016). Biological v. psychosocial treatments: A myth about pharmacotherapy v. psychotherapy.
    British Journal of Psychiatry
    ,
    208
    (04), 309-311. doi:10.1192/bjp.bp.115.178368 Nurs 6640 week 1 discussion – Psychotherapy and Biology Sample essay

  • DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

    DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

    Week Two Assignment Instructions DNP 820

    Please read the instructions thoroughly there are strict requirements

    I need at least 10 different articles/literature reviews added to the ones in the 815 attachment. I have also included the chart to be filled out All within 5 years and pertinent to the subject.

    Tutor MUST have a good command of the English language

    The Rubric must be followed,

    and all the requirements met DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

    ORDER A CUSTOM-WRITTEN, PLAGIARISM-FREE PAPER NOW

    This is a thorough professor, and she has strict requirements

    I have attached the PICOT and the first 10 points (DNP 815) assignment. This is a continuation of that assignment. Please read the attachments

    The following needs to be addressed:

    Please note the followings: The introduction and the literature review are complete and thorough. The problem statement is written clearly PICOT is clear and very good Sample: 

    ·
    How will you determine the sample size? 

    ·
    What are the inclusion/exclusion criteria of the subjects? Methodology: Why is the selected methodology is appropriate? Please justify! 

    ·
    Data collection approach needs to be clear. How will you collect your data? What is needed here is to describe the process of collecting data form signing the informed consent until completing the measuring.

    ·
    Data analysis-What test will you use to answer your research question? 

    Clinical/PICOT Questions:  

    “In adult patients with CVC

    at a Clear Lake Regional Medical Center, does interventional staff education about hub hygiene provided to RN’s who access the CVC impact CLABSI rates compared to standard care over a one-month period?” DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

    P: Patients with Central Venous Catheters

    I: Staff re-education related to Hygiene of the hub

    C: Other hospitals

    O: Reduce probability of CLABSIs

    T: Two months

    “In Patients > 65 years of age with central line catheters at a Clear Lake Regional Medical Center, how does staff training of key personnel and reinforcement of central line catheter hub hygiene after its insertion, along with the apt cleansing of the insertion site, before every approach compared with other area hospitals, reduce the incidence of CLABSIs (Central Line Associated Blood-stream Infections) over a one-month period?”

    P: Patients > 65 years of age with a Central line

    I: Staff training and reinforcement of Central Catheter, Hub Hygiene 

    C: Other area hospitals 

    O: Reduce probability of CLABSIs

    “In adult patients, with

    define CVC (CVC), does interventional staff education about hub hygiene provided to RN’s who access the CVC impact CLABSI rates compared to pre and post-intervention assessments 

    1. I used central Missouri as an example, replace with a description of your site. 

    2. While you might be interested in CLASBI rates as a primary variable, there are other patient outcomes that would also be important to consider DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

    3. Ensure you can find validity and reliability measures on CLASBI rates if you cannot, we need to determine another question to help

    4. How are your two comparison groups different, as they are currently stated the groups seem very much the same, could you state, standard care instead of pre and post intervention assessments? 

    5. One month is the longest time you can use for a prospective project

    Please note the following regarding the instructors grading

    IMPORTANT INFORMATION ABOUT MY GRADING STYLE

    As you prepare for written papers and manuscripts I’d like to give you some details about my grading style. I provide significant feedback on your papers, this is because I believe you should be working towards improving your writing so that at the end of this program you are able to successfully write your DPI project. In order to write well, you need feedback and you need to review that feedback and make progress on the next written work. To that end I always grade accordingly. This means that if I provide feedback one an item (for example APA format of your reference page) I expect that this will be improved on the next written submission. Otherwise I will deduct additional points. In addition, some other criteria to get down pat now. References should always DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

    1.

    Be current, no older than 5 years that means 5 years from your proposed graduation date (2014-2019). Otherwise you will have to redo everything in DNP 955.

    2.

    Be primary sources. You can no longer cite Young declared literary war in 1956 (as cited by Brown 2006). You must cite Young 1956. That means go find that paper and read it and make sure that you agree with what Brown said. What if you don’t agree due to some very valid points? Then the literary war is not what occurred, but instead you have concerns regarding point ____, ____, and ____.

    3.

    You may no longer cite textbooks, they are 1) secondary sources and 2) not current enough, and please use peer reviewed manuscripts.

    One more item that is not a reference. You may not use direct quotes any longer. There is no need. This may be difficult at first, but you are moving towards a different type of writing. This is manuscript writing (scientific writing). Scientific writing is terse, clear, and concise. No frilly words. In order to avoid the use of direct quotes you will synthesize the literature. There is a great resource for synthesizing the literature under Resources – Add-ons. These are also some other great writing resources there.

    Details:

    In the prospectus, proposal, and scholarly project there are 10 strategic points that need to be clear, simple, correct, and aligned to ensure the research is doable, valuable, and credible. The 10 strategic points emerge from researching literature on a topic that is based on or aligned with the learner’s personal passion, future career purpose, and degree area. These 10 points provide a guiding vision for DPI Project. In this assignment, you will continue the work begun in DNP-815, working on your draft of a document addressing the 10 key strategic points that define your intended research focus and approach. DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project.

    General Requirements:

    Use the following information to ensure successful completion of the assignment:

    Locate      the “The 10 Strategic Points for the      Prospectus, Proposal, and Direct Practice Improvement Project” that      you completed in DNP-815.

    Doctoral      learners are required to use APA style for their writing assignments. The      APA Style Guide is located in the      Student Success Center. An abstract is not required.

    This      assignment uses a rubric. Please Review the rubric prior to the beginning to become familiar with the      expectations for successful completion.

    You      are required to submit this assignment to Turnitin. Please refer to the      directions in the Student Success Center.

    Directions:

    Use the “The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project” resource to draft statements for each of the 10 points for your intended research study.

    You worked on this last in DNP 815. Pick up from where you left off
    (if you transferred in and did not complete this, you will have to begin fresh).
    Please include a copy of your last instructor feedback when you submit this assignment. You can either copy and paste the instructor feedback into your current paper (as an appendix and clearly marked); or upload two separate papers. I expect significant improvement from your last submission.

    Please review the 10 Strategic Points document for additional instructions and an example. Add references to this document,
    I suggest 5-10 at this point.
    You need to realize that your literature review chapter will need at least 50+ articles by the time you get to DNP 955, so work on expanding your literature search each week, to include more and more to this paper as you move through each course. If you cannot locate 50+ articles you can ask your faculty for assistance or chose a different topic. DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

     

    For the methodology and design sections. Methodology should cover the broad methods you plan to use (qualitative, quantitative, or mixed methods). The design portion will then go into more detail and discuss the design (i.e. correlational, cross-sectional, pre/posttest, etc.). Describe each and explain why your chosen methodology and design are appropriate to your topic and project questions. You may NOT use qualitative, GCU leadership does not support a qualitative methodology.

    Intervention. You must have an intervention that you implement. Since you cannot evaluate a project that has already been implemented, please write up a description of your intervention and what your role will be in implementing this intervention. This is not a section listed on your 10 Strategic Points document as of yet, so add it after the methodology and design sections. Describe step by step what the intervention consists of, how it is evidence based, how you will implement, and your role in implementation.

    Data collection should go step by step (extremely over-detailed) on how you will collect the data. Tell me about all instruments, surveys, and/or questions you will ask of participants. One MUST be a valid and reliable tool.

    Data Analysis. Tell me the specific statistics you will use. Start with descriptive statistics, which ones will you use, why (cite current primary sources). Then tell me how you will compare your data (which statistic), what your p value will be before you start your data collection.

    Apply Rubrics

     

     

    1

    Unsatisfactory

    0.00%

    2

    Does Not Meet Expectations

    74.00%

    3

    Approaching Meeting Expectations

    87.00%

    4

    Meets Expectations

    100.00%

    100.0 %Content

     

    10.0 %Topic: Provides a broad project topic area/title.

    Item is not present.

    Not all components are present. Large gaps are present in the components that leave the reader with significant questions.

    Component is present and adequate. Small gaps are present that leave the reader with questions.

    Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.

    15.0 %Literature Review: Lists primary points for four sections in the Literature Review: (a) Background of the problem/gap and the need for the project based on citations from the literature; (b) Theoretical foundations (models and theories to be foundation for study); (c) Review of literature topics with key concept (??) for each one; (d) Summary.

    Item is not present.

    Not all components are present. Large gaps are present in the components that leave the reader with significant questions.

    Component is present and adequate. Small gaps are present that leave the reader with questions.

    Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.

    10.0 %Problem Statement: Describes the problem to address through the project based on defined gaps or needs from the literature.

    Item is not present.

    Not all components are present. Large gaps are present in the components that leave the reader with significant questions.

    Component is present and adequate. Small gaps are present that leave the reader with questions.

    Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.

    10.0 %Sample and Location: Identifies sample, needed sample size, and location.

    Item is not present.

    Not all components are present. Large gaps are present in the components that leave the reader with significant questions.

    Component is present and adequate. Small gaps are present that leave the reader with questions.

    Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.

    10.0 %Clinical/PICOT Questions: Provides clinical/PICOT questions to all of the collected data needed to address the problem statement.

    Item is not present.

    Not all components are present. Large gaps are present in the components that leave the reader with significant questions.

    Component is present and adequate. Small gaps are present that leave the reader with questions.

    Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.

    5.0 %Variables

    Item is not present.

    Not all components are present. Large gaps are present in the components that leave the reader with significant questions.

    Component is present and adequate. Small gaps are present that leave the reader with questions.

    Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.

    10.0 %Methodology and Design: Describes the selected methodology and specific research design to address problem statement and clinical/PICOT questions.

    Item is not present.

    Not all components are present. Large gaps are present in the components that leave the reader with significant questions.

    Component is present and adequate. Small gaps are present that leave the reader with questions.

    Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.

    10.0 %Purpose Statement: Provides one sentence statement of purpose including the problem statement, methodology, design, population sample, and location.

    Item is not present.

    Not all components are present. Large gaps are present in the components that leave the reader with significant questions.

    Component is present and adequate. Small gaps are present that leave the reader with questions.

    Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.

    10.0 %Data Collection: Describes primary instruments and sources of data to answer research questions. Reliability and Validity of the instruments are addressed.

    Item is not present.

    Not all components are present. Large gaps are present in the components that leave the reader with significant questions.

    Component is present and adequate. Small gaps are present that leave the reader with questions.

    Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.

    10.0 %Data Analysis: Describes the specific data analysis approaches to be used to address clinical/PICOT questions. The statistical test(s) that will be used must be identified and must be appropriate for the level of data and the clinical/PICOT question.

    Item is not present.

    Not all components are present. Large gaps are present in the components that leave the reader with significant questions.

    Component is present and adequate. Small gaps are present that leave the reader with questions.

    Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.

     

    The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project

    Introduction

    In the Prospectus, Proposal, and Direct Practice Improvement Project there are
    10 key or strategic points
    that need to be
    clear, simple, correct, and aligned
    to ensure the project is
    doable, valuable, and credible
    . These points, which provide a guide or vision for the project, are present in almost any research. They are defined within “The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project” (10 Strategic Points) document.

    The ten strategic points are developed in table format.

    The 10 Strategic Points

    The 10 strategic points emerge from researching literature on a topic that is based on, or aligned with, the defined need in the literature as well as the learner’s personal passion, future career purpose, and degree area. The 10 Strategic Points document
    includes
    the following 10 key or strategic points that define the project focus and approach:

    Topic (10%)
    – Provides a broad project topic area/title.

    Literature Review (15%)
    – Lists primary points for four sections in the Literature Review:

    Background of the problem/gap and the need for the project based on citations from the literature.

    Theoretical foundations (models and theories to be foundation for project).

    Review of literature topics with key theme for each one.

    Summary.

    Problem Statement (10%)
    – Describes the problem to address through the project based on defined needs or gaps in practice from the literature.

    Sample and Location (10%)
    – Identifies sample, needed sample size, and location.

    Clinical/PICOT Questions (10%)
    – Provides clinical/PICOT questions to collect data to address the problem statement.

    Variables (5%)
    – Identifies and describes independent and dependent variables.

    Methodology and Design

    (10%)
    – Describes the selected methodology and specific project design to address problem statement and clinical questions

    Purpose Statement (10%)
    – Provides one sentence statement of purpose including the problem statement, methodology, design, population sample, and location.

    Data Collection (10%)
    – Describes primary instruments to answer clinical questions.

    Data Analysis

    (10%)
    – Describes the specific data analysis approaches to be used to address clinical/PICOT questions.

    The Process for Defining the 10 Strategic Points

    The order of the 10 strategic points listed above reflects the order in which the learner completes the work product. The first five strategic points focus primarily on defining the focus for the project based on a clearly defined need or gap from the literature as well as the learner’s passion, purpose, and specialty area focus. First, learners identify a broad topic area to investigate for their Direct Practice Improvement (DPI) Project based on a clearly defined need or gap from the literature or practice problem, and one in which they are interested based on personal passion, future career purpose, and degree being pursued. Second, learners complete a review of the literature to define the need or gap to be addressed, the theories and models that will provide a foundation for the project, related topics that are needed to demonstrate the learner’s expertise in the field, and to define the key strategic points behind the learner’s proposed research. Third, the learners develop a clear, simple, one-sentence problem statement that defines the problem or gap that will be addressed by the DPI project. Fourth, learners identify potential population samples for which they would have access in order to collect the data for the project, considering the fact the quantitative study sample sizes need to be much larger than those for qualitative studies. Fifth, learners develop the clinical/PICOT question(s) that will define the data needed to address the problem statement.

    Based on the first five strategic points above, learners next define the key aspects of the project methodology through the last five strategic points. The sixth point describes the independent and dependent variables. Seventh, learners determine if the project will be a qualitative, quantitative or mixed methodology. Due to the nature of the DPI project requirements, most projects will be utilizing a quantitative method because learners are not creating new research in a qualitative study. Qualitative projects often do not facilitate the intervention needed to demonstrate direct practice improvement. Please note that if you choose a qualitative project, you are still responsible for ensuring practice improvement is demonstrated through your work. Additionally, learners must be able to perform both qualitative and quantitative data analysis. A qualitative project with numbers or descriptive statistics does not mean it is mixed method study. Qualitative data can be displayed using tables, charts, graphs and descriptive statistics. Following are samples for a quantitative project and a qualitative project. A mixed method project, which includes quantitative and qualitative methods, takes much more time and many more resources to complete and
    is not recommended
    unless learners have a significant amount of extra time and resources to complete it.

    For the eighth strategic point, learners develop a purpose statement by integrating the problem statement, methodology, design, sample, and location. Ninth, learners identify the data they will need to collect to address the clinical questions or hypotheses and how they will collect the data (e.g., interviews, focus groups, observations, tested and validated instruments or surveys, databases, public media, etc.). Tenth and last, learners identify the appropriate data analysis, based on their project design, which will be used to answer the clinical questions and address the problem statement.

    Criteria for Evaluating the 10 Strategic Points: Clear, Simple, Correct, and Aligned

    When developing a project, it is important to define the 10 strategic points so they are
    simple
    ,
    clear
    , and
    correct
    in order to ensure that anyone who reviews them will easily understand them. It is important to
    align
    all of the 10 strategic points to ensure it will be possible to conduct and complete the project. The problem statement must come out of the literature or practice problem. The clinical questions must collect the data needed to answer the problem statement. The methodology and design must be appropriate for the problem statement and PICOT questions. The data collection and data analysis must provide the information to answer the PICOT questions.

    Developing the 10 Strategic Points document as a two- or three-page document can help ensure clarity, simplicity, correctness, and alignment of each of these 10 key or strategic points in the prospectus, proposal, and Direct Practice Improvement Project. Developing these 10 strategic points in this format also provides an easy-to-use use template to ensure the 10 strategic points will always be worded the same throughout the prospectus, proposal, and Direct Practice Improvement Project. DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project.

    Value of the 10 Strategic Points Document

    The 10 Strategic Points document can be used for communicating and aligning key stakeholders for the Direct Practice Improvement Project. This document can be used to obtain agreement between the learner and the chair regarding the initial focus and approach for the project. The document can be used to review the proposed project with the people or organizations from whom learners need to gain permission to conduct their research, a critical step required before learners can develop their proposal. The document also proves useful for communicating the Direct Practice Improvement Project focus when attracting a Content Expert, as well as for reviewing the proposal with the Direct Practice Improvement Project committee and the AQR reviewers. Learners may choose to consult methodologists, statisticians, and editors in the process of developing the final manuscript. DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project.

    Examples of the 10 Strategic Points Document

    It is important that the 10 strategic points are clear, concise, doable, and aligned throughout the prospectus, proposal, and Direct Practice Improvement Project. Provided below is an example of a completed 10 Strategic Points document for a quantitative project. A blank 10 Strategic Points Table template is provided following the example for learners to use when developing their own 10 Strategic Point documents.

    Example: 10 Strategic Points Document for a Quantitative Project

    The 10 Strategic Points

    Comments or Feedback

    Broad Topic Area

    1.     
    Broad Topic Area:

    Hint: What would I title my project?

    Literature Review

    2.     
    Literature Review:

    List primary points for four sections in the Literature Review: Background of the problem/gap; theoretical foundations (models and theories to be foundation for study); review of literature topics with key theme for each one; and summary.

    a.     
    Background of the Problem/Gap:

    ·         Rural ambulatory clinics have had to reorganize their management structures to enhance reimbursement.

    ·         Access to appropriate health services for rural Americans needs to be improved in areas where specialists are not available (Schoenberg, 2012).

    ·         Telehealth nursing services can be provided through rural health clinics to support specialty clinics (Schoenberg, 2012).

    ·         Approximately 200 telemedicine networks have been established nationwide. (American Telemedicine Association, 2017)

    b.     
    Theoretical Foundations (models and theories to be foundation for study):

    ·         The Greenhalgh’s Dissemination of Innovations model (Greenhalgh, Robert, Bate, Macfarlane, & Kyriakidau, 2005) can be used to implement rural telehealth services for rural Americans.

    ·         The D&M Information System Success model (DeLone &McLean, 2003) is a framework to conceptualize and operationalize information system success.

    ·         Path constitution theory combines two contrasting perspectives on technology, path dependence, and path creation (Singh, Mathiassen, & Mishra, 2015).

    c.      
    Review of Literature Topics With Key Organizing Concepts or Topics for Each One

    Rural Telehealth Services:

    ·         Rural telehealth can improve care in burn patients (McWilliams, Hendricks, Twigg, Wood, & Giles, 2016); smoking cessation (Carlson, Lounsberry, Maciejewski, Wright, Collacutt, & Taenzer, 2011), psychotherapy (Gonzales & Brossart, 2015);  cancer education (Doorenbos et al., 2011); diabetes (Holloway, Coon, Kersten, & Clemins, 2011).

    Population Specific Telehealth Services:

    ·         Community based telehealth: Home-based telehealth can enhance older adults’ access to care and facilitate patient-provider collaboration which may in turn improve patient self-management (Hsieh, Tsai, Chic, & Lin, 2015).

    ·         Chronically ill: Disease management needs of chronically ill patients include prescription refills, medication and symptom management, lab results, and patient education (Vinson, McCallum, Thornlow, & Champagne, 2011).

    ·         Rural Native American telehealth:  Telehealth can improve health disparities in Native American communities (Kruse, Bouffard, Dougherty, & Parro, 2016).

    ·         Diabetes education and management:  Telehealth education improves glycemic control (Barker, Mallow, Theeke, & Schwertfeger, 2016).

    ·         Mental health emergencies can be managed effectively through telehealth services (Saurman et al., 2011).

    Settings:

    ·         Rural health clinic/hospital (Carlson et al., 2011); Doorenbos et al., 2011; Gonzales & Brossart, 2015; Holloway et al., 2011).

    ·         Home-based (Demiris et al., 2103).

    ·         Community center (Demiris et al., 2103).

    ·         Library (Demiris et al., 2103).

    ·         Smart phone, computer-based (Forchuk et al., 2016).

    Certifications:

    ·         National Committee for Quality Assurance (n.d). Disease Management Accreditation. Retrieved from http://www.ncqa.org/programs/accreditation/disease-management-dm

    ·         American Association of Critical Care Nurses (n.d.). CCRN-E: Certification for Tele-ICU Nurses. Retrieved from https://www.aacn.org/certification?tab=First-Time%20Certification

    ·         Acute stroke ready designation (Slivinski, Johes, Whitehead, & Hooper, 2017).

    Network Systems
    :

    ·         American Telemedicine Association: approximately 200 telemedicine networks have been established nationwide (Frederick, 2013).

    ·         Tablet PC Enabled Body Sensor System: real-time continuous collection of physiological parameters (Panicker, Kumar, 2016).

    d.     
    Summary

    ·         Gap/Problem: There is a need to implement evidence-based methods of improving health outcomes of rural residents through the use of telehealth.

    ·         Prior studies: Prior studies show that telehealth improves patient outcomes in diverse settings, including rural areas. DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

    ·         Quantitative application: Sources of data exist to collect numerical data on the rate of follow-up with primary care provider in rural areas.

    ·         Significance: Improving rate of follow-up with primary care provider will improve health outcomes of rural residents.

    DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

    Problem Statement

    3.     
    Problem Statement:

    Describe the variables/groups to study, in one sentence.

     

    A well-written problem statement begins with the big picture of the issue (
    macro)
    and works to the small, narrower, and more specific problem (
    micro
    ). It clearly communicates the significance, magnitude, and importance of the problem and transitions into the Purpose of the Project with a declarative statement such as: “It is not known if and to what degree/extent…” or “It is not known how/why and….”

    Other examples are:

    ·         While the literature indicates ____________, it is not known in _________ (organization/community) if __________.

    ·         It is not known how or to what extent ________________.

    While the literature indicates that telehealth is an important emerging technology for rural patient access, it is unknown if the implementation of telehealth impacts the rate of patient follow up for patients living in a rural area. DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

    Clinical/

    PICOT Questions

    4.     
    Clinical/PICOT Questions:

    Provide PICOT question to guide the implementation and data collection of findings of the project:

    (P)
    Among adult patients in a rural care setting,
    (I)
    how does implementation of a telehealth program
    (C)
    compare to traditional commute-for-care (
    O)
    impact rate of follow-up with the primary care provider (
    T)
    over a period of four weeks.

    Sample

    5.     
    Sample (and Location):

    Identify sample, needed sample size, and location (study phenomena with small numbers and variables/groups with large numbers).

    a.       Location: Arizona

    b.      Population: Two neighboring rural towns equal distance from the nearest primary care provider.

    c.       Sample: 40 participants include a power analysis if appropriate. DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

    Define Variables

    6.     
    Define Variables:

    a.      
    Independent Variable:
    Telehealth program.

    b.     
    Dependent Variable:
    Follow-up rate with primary care provider.

    Methodology  and Design

    7.     
    Methodology and Design:

    Name the selected methodology and specific design to address the problem statement and clinical questions:

    This project will use a quantitative methodology with a quasi-experimental design.

    Purpose Statement

    8.     
    Purpose Statement:

    Provide one sentence statement of purpose including the problem statement, sample, methodology, and design:

    Creswell (2003) provided some sample templates for developing purpose statements aligned with the different project methods as follows:

    The purpose of this
    quantitative
    ___________ (correlational, descriptive, etc.) project is to ____________ (compare or see to what degree a relationship exists) between/among ______________________ (independent variable) to ___________________ (dependent variable) for ________________ (participants) at ___________________ (project site/geographical location). The ________ (independent variable) will be defined/measured as/by _______ (provide a general definition). The
                                     
     (dependent variable) will be defined/measured as/by ______ (provide a general definition).

     

     

    Data Collection Approach

    9.     
    Data Collection Approach:

    Describe primary instruments that will be used to answer clinical question.

    Data Analysis Approach

    10. 
    Data Analysis Approach:

    Descriptive statistics will describe the sample characteristics and variable results. An independent t-tests will test for difference between the two groups of 40 participants (telehealth and commute-for-care) follow-up with primary physician. A priori analysis will be used to justify the sample size.

     

     

    10 Strategic Points Table

    (Use this table to complete the 10 Strategic Points document for your project.)

    10 Strategic Points

    Comments/Feedback

    Broad Topic Area

    Literature Review

    DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

    Problem Statement

    Clinical/PICO Questions

    Sample

    Define Variables

    Methodology  and Design

    Purpose Statement

     

     

    Data Collection Approach

    Data Analysis Approach

     

    DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

  • Assignment 1: Assessing The Genitalia And Rectum

    Assignment 1: Assessing The Genitalia And Rectum

    Patients are frequently uncomfortable discussing with health care professional’s issues that involve the genitalia and rectum; however, gathering an adequate history and properly conducting a physical exam are vital. Examining case studies of genital and rectal abnormalities can help prepare advanced practice nurses to accurately assess patients with problems in these areas.

    In this assignment, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.

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    In this assignment, you will analyze a SOAP note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions. Assignment 1: Assessing The Genitalia And Rectum

    GENITALIA ASSESSMENT

    Subjective:

    CC: “I have bumps on my bottom that I want to have checked out.”

    HPI: AB, a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the bumps are painless and feel rough. She states she is sexually active and has had more than one partner over the past year. Her initial sexual contact occurred at age 18. She reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She reports one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed. Assignment 1: Assessing The Genitalia And Rectum.

    PMH: Asthma

    Medications: Symbicort 160/4.5mcg

    Allergies: NKDA

    FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD

    Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)

    Objective:

    VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs

    Heart: RRR, no murmurs

    Lungs: CTA, chest wall symmetrical

    Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact with a healed episiotomy scar present. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia

    Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, neg McBurney

    Diagnostics: HSV specimen obtained

    Assessment:

    Chancre

    PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses. Assignment 1: Assessing The Genitalia And Rectum

    To prepare:

    With regard to the SOAP note case study provided:

    Review this week’s Learning Resources, and consider the insights they provide about the case study.

    Consider what history would be necessary to collect from the patient in the case study.

    Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?

    Identify 
    at least five
     possible conditions that may be considered in a differential diagnosis for the patient.

    To complete:

    Refer to Chapter 5 of the Sullivan text. Analyze the SOAP note case study.  Using evidence based resources, answer the following questions and support your answers using current evidence from the literature.

    Analyze the subjective portion of the note. List additional information that should be included in the documentation.

    Analyze the objective portion of the note. List additional information that should be included in the documentation.

    Is the assessment supported by the subjective and objective information? Why or Why not?

    Would diagnostics be appropriate for this case and how would the results be used to make a diagnosis?

    Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Assignment 1: Assessing The Genitalia And Rectum. Explain your reasoning using at least 3 different references from current evidence based literature.

    CALSS RESOURCES

    Learning Resources

    Note:

    To access this week’s required library resources, please click on the link to the Course Readings List, found in the

    Course Materials

    section of your Syllabus.

    Required Readings

    Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015).
    Seidel’s guide to physical examination
    (8th ed.). St. Louis, MO: Elsevier Mosby.

    Chapter 16, “Breasts and Axillae” (pp. 350-369)

    This chapter focuses on examining the breasts and axillae. The authors describe the examination procedures and the anatomy and physiology of breasts.

    Chapter 18, “Female Genitalia” (pp. 416-465)

    In this chapter, the authors explain how to conduct an examination of female genitalia. The chapter also describes the form and function of female genitalia Assignment 1: Assessing The Genitalia And Rectum.

    Chapter 19, “Male Genitalia” (pp. 466-484)

    The authors explain the biology of the penis, testicles, epididymides, scrotum, prostate gland, and seminal vesicles. Additionally, the chapter explains how to perform an exam of these areas.

    Chapter 20, “Anus, Rectum, and Prostate” (pp. 485-500)

    This chapter focuses on performing an exam of the anus, rectum, and prostate. The authors also explain the anatomy and physiology of the anus, rectum, and prostate.

    Dains, J. E., Baumann, L. C., & Scheibel, P. (2016).
    Advanced health assessment and clinical diagnosis in primary care
    (5th ed.). St. Louis, MO: Elsevier Mosby.

    Chapter 5, “Amenorrhea” (pp. 47-60)

    Amenorrhea, or the absence of menstruation, is the focus of this chapter. The authors include key questions to ask patients when taking histories and explain what to look for in the physical exam.

    Chapter 6, “Breast Lumps and Nipple Discharge” (pp. 61-72)

    This chapter focuses on the important topic of breast lumps and nipple discharge. Because breast cancer is the most common type of cancer in women, it is important to get an accurate diagnosis. Information in the chapter includes key questions to ask and what to look for in the physical exam Assignment 1: Assessing The Genitalia And Rectum.

    Chapter 7, “Breast Pain” (pp. 73-80)

    Determining the cause of breast pain can be difficult. This chapter examines how to determine the likely cause of the pain through diagnostic tests, physical examination, and careful analysis of a patient’s health history.

    Chapter 27, “Penile Discharge” (pp. 318-324)

    The focus of this chapter is on how to diagnose the causes of penile discharge. The authors include specific questions to ask when gathering a patient’s history to narrow down the likely diagnosis. They also give advice on performing a focused physical exam.

    Chapter 36, “Vaginal Bleeding” (pp. 419-433)

    In this chapter, the causes of vaginal bleeding are explored. The authors focus on symptoms outside the regular menstrual cycle. The authors discuss key questions to ask the patient, as well as specific physical examination procedures and laboratory studies that may be useful in reaching a diagnosis.

    Chapter 37, “Vaginal Discharge and Itching” (pp. 434-445)

    This chapter examines the process of identifying causes of vaginal discharge and itching. The authors include questions on the characteristics of the discharge, the possibility of the issues being the result of a sexually transmitted infection, and how often the discharge occurs. A chart highlights potential diagnoses based on patient history, physical findings, and diagnostic studies. Assignment 1: Assessing The Genitalia And Rectum.

    Sullivan, D. D. (2012).
    Guide to clinical documentation
    (2nd ed.). Philadelphia, PA: F. A. Davis.

    Chapter 3, “Adult Preventative Care Visits” (“Gender Specific Screenings”; pp. 48–49)
    Note:
    Download the Physical Examination Objective Data Checklist to use as you complete the Head-to-Toe Physical Assessment Video assignment.

    Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Physical examination objective data checklist. In
    Mosby’s guide to physical examination
    (7th ed.). St. Louis, MO: Elsevier Mosby.

    This Physical Examination Objective Data Checklist was published as a companion to
    Seidel’s guide to physical examination
    (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

    Cucci, E. Santoro, A., DiGesu, C., DiCerce, R., & Sallustio, G. (2015). Sclerosing adenosis of the breast: Report of two cases and review of the literature. Polish Journal of Radiology, 80, 122–127. doi:10.12659/PJR.892706. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356184/ 

    Sabbagh, C., Mauvis, F., Vecten, A., Ainseba, N., Cosse, C., Diouf, M., & Regimbeau, J. M. (2014). What is the best position for analyzing the lower and middle rectum and sphincter function in a digital rectal examination? A randomized, controlled study in men. Digestive and Liver Disease, 46(12), 1082–1085. doi:10.1016/j.dld.2014.08.045

    Retrieved from the Walden Library Databases. Assignment 1: Assessing The Genitalia And Rectum

    Westhoff, C. L., Jones, H. E., & Guiahi, M. (2011). Do new guidelines and technology make the routine pelvic examination obsolete?
    Journal of Women’s Health, 20
    (1), 5–10.

    Retrieved from the Walden Library databases.

    This article describes the benefits of new technology and guidelines for pelvic exams. The authors also detail which guidelines and technology may become obsolete.

    Centers for Disease Control and Prevention. (2012).
    Sexually transmitted diseases (STDs)
    . Retrieved from http://www.cdc.gov/std/#

    This section of the CDC website provides a range of information on sexually transmitted diseases (STDs). The website includes reports on STDs, related projects and initiatives, treatment information, and program tools.

    University of Virginia. (n.d.).
    Introduction to radiology: An online interactive tutorial
    . Retrieved from http://www.med-ed.virginia.edu/courses/rad/index.html

    This website provides an introduction to radiology and imaging. For this week, focus on genitourinary radiology, as well as the cross-sectional female pelvis and the cross-sectional male pelvis in abdominal radiology.

    Required Media

    Online media for
    Seidel’s Guide to Physical Examination

    It is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapters 16 and 18–20 that relate to special examinations, including breast, genital, prostate, and rectal. Refer to the Week 4 Learning Resources area for access instructions on https://evolve.elsevier.com/.

    Optional Resources

    LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014).
    DeGowin’s diagnostic examination
    (10th ed.). New York, NY: McGraw Hill Medical.

    Chapter 8, “The Chest: Chest Wall, Pulmonary, and Cardiovascular Systems; The Breasts” (Section 2, “The Breasts,” pp. 434–444)

    Section 2 of this chapter focuses on the anatomy and physiology of breasts. The section provides descriptions of breast examinations and common breast conditions. Assignment 1: Assessing The Genitalia And Rectum

    Chapter 11, “The Female Genitalia and Reproductive System” (pp. 541–562)

    In this chapter, the authors provide an overview of the female reproductive system. The authors also describe symptoms of disorders in the reproductive system.

    Chapter 12, “The Male Genitalia and Reproductive System” (pp. 563–584)

    The authors of this chapter detail the anatomy of the male reproductive system. Additionally, the authors describe how to conduct an exam of the male reproductive system.

    Review of Chapter 9, “The Abdomen, Perineum, Anus, and Rectosigmoid” (pp. 445–527) Assignment 1: Assessing The Genitalia And Rectum

  • The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project

    The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project

    Introduction

    In the Prospectus, Proposal, and Direct Practice Improvement Project there are
    10 key or strategic points
    that need to be
    clear, simple, correct, and aligned
    to ensure the project is
    doable, valuable, and credible
    . These points, which provide a guide or vision for the project, are present in almost any research. They are defined within “The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project” (10 Strategic Points) document.

    ORDER A CUSTOM-WRITTEN, PLAGIARISM-FREE PAPER NOW

    The ten strategic points are developed in table format.

    The 10 Strategic Points

    The 10 strategic points emerge from researching literature on a topic that is based on, or aligned with, the defined need in the literature as well as the learner’s personal passion, future career purpose, and degree area. The 10 Strategic Points document
    includes
    the following 10 key or strategic points that define the project focus and approach: The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project.

    Topic (10%)
    – Provides a broad project topic area/title.

    Literature Review (15%)
    – Lists primary points for four sections in the Literature Review:

    Background of the problem/gap and the need for the project based on citations from the literature.

    Theoretical foundations (models and theories to be foundation for project).

    Review of literature topics with key theme for each one.

    Summary.

    Problem Statement (10%)
    – Describes the problem to address through the project based on defined needs or gaps in practice from the literature.

    Sample and Location (10%)
    – Identifies sample, needed sample size, and location.

    Clinical/PICOT Questions (10%)
    – Provides clinical/PICOT questions to collect data to address the problem statement. The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project.

    Variables (5%)
    – Identifies and describes independent and dependent variables.

    Methodology and Design

    (10%)
    – Describes the selected methodology and specific project design to address problem statement and clinical questions

    Purpose Statement (10%)
    – Provides one sentence statement of purpose including the problem statement, methodology, design, population sample, and location.

    Data Collection (10%)
    – Describes primary instruments to answer clinical questions.

    Data Analysis

    (10%)
    – Describes the specific data analysis approaches to be used to address clinical/PICOT questions.

    The Process for Defining the 10 Strategic Points

    The order of the 10 strategic points listed above reflects the order in which the learner completes the work product. The first five strategic points focus primarily on defining the focus for the project based on a clearly defined need or gap from the literature as well as the learner’s passion, purpose, and specialty area focus. First, learners identify a broad topic area to investigate for their Direct Practice Improvement (DPI) Project based on a clearly defined need or gap from the literature or practice problem, and one in which they are interested based on personal passion, future career purpose, and degree being pursued. Second, learners complete a review of the literature to define the need or gap to be addressed, the theories and models that will provide a foundation for the project, related topics that are needed to demonstrate the learner’s expertise in the field, and to define the key strategic points behind the learner’s proposed research. Third, the learners develop a clear, simple, one-sentence problem statement that defines the problem or gap that will be addressed by the DPI project. Fourth, learners identify potential population samples for which they would have access in order to collect the data for the project, considering the fact the quantitative study sample sizes need to be much larger than those for qualitative studies. Fifth, learners develop the clinical/PICOT question(s) that will define the data needed to address the problem statement. The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project.

    Based on the first five strategic points above, learners next define the key aspects of the project methodology through the last five strategic points. The sixth point describes the independent and dependent variables. Seventh, learners determine if the project will be a qualitative, quantitative or mixed methodology. Due to the nature of the DPI project requirements, most projects will be utilizing a quantitative method because learners are not creating new research in a qualitative study. Qualitative projects often do not facilitate the intervention needed to demonstrate direct practice improvement. Please note that if you choose a qualitative project, you are still responsible for ensuring practice improvement is demonstrated through your work. Additionally, learners must be able to perform both qualitative and quantitative data analysis. A qualitative project with numbers or descriptive statistics does not mean it is mixed method study. Qualitative data can be displayed using tables, charts, graphs and descriptive statistics. Following are samples for a quantitative project and a qualitative project. A mixed method project, which includes quantitative and qualitative methods, takes much more time and many more resources to complete and
    is not recommended
    unless learners have a significant amount of extra time and resources to complete it. The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project.

    For the eighth strategic point, learners develop a purpose statement by integrating the problem statement, methodology, design, sample, and location. Ninth, learners identify the data they will need to collect to address the clinical questions or hypotheses and how they will collect the data (e.g., interviews, focus groups, observations, tested and validated instruments or surveys, databases, public media, etc.). Tenth and last, learners identify the appropriate data analysis, based on their project design, which will be used to answer the clinical questions and address the problem statement.

    Criteria for Evaluating the 10 Strategic Points: Clear, Simple, Correct, and Aligned

    When developing a project, it is important to define the 10 strategic points so they are
    simple
    ,
    clear
    , and
    correct
    in order to ensure that anyone who reviews them will easily understand them. It is important to
    align
    all of the 10 strategic points to ensure it will be possible to conduct and complete the project. The problem statement must come out of the literature or practice problem. The clinical questions must collect the data needed to answer the problem statement. The methodology and design must be appropriate for the problem statement and PICOT questions. The data collection and data analysis must provide the information to answer the PICOT questions.

    Developing the 10 Strategic Points document as a two- or three-page document can help ensure clarity, simplicity, correctness, and alignment of each of these 10 key or strategic points in the prospectus, proposal, and Direct Practice Improvement Project. Developing these 10 strategic points in this format also provides an easy-to-use use template to ensure the 10 strategic points will always be worded the same throughout the prospectus, proposal, and Direct Practice Improvement Project. The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project.

    Value of the 10 Strategic Points Document

    The 10 Strategic Points document can be used for communicating and aligning key stakeholders for the Direct Practice Improvement Project. This document can be used to obtain agreement between the learner and the chair regarding the initial focus and approach for the project. The document can be used to review the proposed project with the people or organizations from whom learners need to gain permission to conduct their research, a critical step required before learners can develop their proposal. The document also proves useful for communicating the Direct Practice Improvement Project focus when attracting a Content Expert, as well as for reviewing the proposal with the Direct Practice Improvement Project committee and the AQR reviewers. Learners may choose to consult methodologists, statisticians, and editors in the process of developing the final manuscript.

    Examples of the 10 Strategic Points Document

    It is important that the 10 strategic points are clear, concise, doable, and aligned throughout the prospectus, proposal, and Direct Practice Improvement Project. Provided below is an example of a completed 10 Strategic Points document for a quantitative project. A blank 10 Strategic Points Table template is provided following the example for learners to use when developing their own 10 Strategic Point documents.

    Example: 10 Strategic Points Document for a Quantitative Project

    The 10 Strategic Points

    Comments or Feedback

    Broad Topic Area

    1.     
    Broad Topic Area:

    Hint: What would I title my project?

    Literature Review

    2.     
    Literature Review:

    List primary points for four sections in the Literature Review: Background of the problem/gap; theoretical foundations (models and theories to be foundation for study); review of literature topics with key theme for each one; and summary.

    a.     
    Background of the Problem/Gap:

    ·         Rural ambulatory clinics have had to reorganize their management structures to enhance reimbursement.

    ·         Access to appropriate health services for rural Americans needs to be improved in areas where specialists are not available (Schoenberg, 2012).

    ·         Telehealth nursing services can be provided through rural health clinics to support specialty clinics (Schoenberg, 2012).

    ·         Approximately 200 telemedicine networks have been established nationwide. (American Telemedicine Association, 2017)

    b.     
    Theoretical Foundations (models and theories to be foundation for study):

    ·         The Greenhalgh’s Dissemination of Innovations model (Greenhalgh, Robert, Bate, Macfarlane, & Kyriakidau, 2005) can be used to implement rural telehealth services for rural Americans.

    ·         The D&M Information System Success model (DeLone &McLean, 2003) is a framework to conceptualize and operationalize information system success. The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project

    ·         Path constitution theory combines two contrasting perspectives on technology, path dependence, and path creation (Singh, Mathiassen, & Mishra, 2015).

    c.      
    Review of Literature Topics With Key Organizing Concepts or Topics for Each One

    Rural Telehealth Services:

    ·         Rural telehealth can improve care in burn patients (McWilliams, Hendricks, Twigg, Wood, & Giles, 2016); smoking cessation (Carlson, Lounsberry, Maciejewski, Wright, Collacutt, & Taenzer, 2011), psychotherapy (Gonzales & Brossart, 2015);  cancer education (Doorenbos et al., 2011); diabetes (Holloway, Coon, Kersten, & Clemins, 2011).

    Population Specific Telehealth Services:

    ·         Community based telehealth: Home-based telehealth can enhance older adults’ access to care and facilitate patient-provider collaboration which may in turn improve patient self-management (Hsieh, Tsai, Chic, & Lin, 2015).

    ·         Chronically ill: Disease management needs of chronically ill patients include prescription refills, medication and symptom management, lab results, and patient education (Vinson, McCallum, Thornlow, & Champagne, 2011).

    ·         Rural Native American telehealth:  Telehealth can improve health disparities in Native American communities (Kruse, Bouffard, Dougherty, & Parro, 2016).

    ·         Diabetes education and management:  Telehealth education improves glycemic control (Barker, Mallow, Theeke, & Schwertfeger, 2016).

    ·         Mental health emergencies can be managed effectively through telehealth services (Saurman et al., 2011).

    Settings:

    ·         Rural health clinic/hospital (Carlson et al., 2011); Doorenbos et al., 2011; Gonzales & Brossart, 2015; Holloway et al., 2011). The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project

    ·         Home-based (Demiris et al., 2103).

    ·         Community center (Demiris et al., 2103).

    ·         Library (Demiris et al., 2103).

    ·         Smart phone, computer-based (Forchuk et al., 2016).

    Certifications:

    ·         National Committee for Quality Assurance (n.d). Disease Management Accreditation. Retrieved from http://www.ncqa.org/programs/accreditation/disease-management-dm

    ·         American Association of Critical Care Nurses (n.d.). CCRN-E: Certification for Tele-ICU Nurses. Retrieved from https://www.aacn.org/certification?tab=First-Time%20Certification

    ·         Acute stroke ready designation (Slivinski, Johes, Whitehead, & Hooper, 2017).

    Network Systems
    :

    ·         American Telemedicine Association: approximately 200 telemedicine networks have been established nationwide (Frederick, 2013).

    ·         Tablet PC Enabled Body Sensor System: real-time continuous collection of physiological parameters (Panicker, Kumar, 2016).

    d.     
    Summary

    ·         Gap/Problem: There is a need to implement evidence-based methods of improving health outcomes of rural residents through the use of telehealth.

    ·         Prior studies: Prior studies show that telehealth improves patient outcomes in diverse settings, including rural areas.

    ·         Quantitative application: Sources of data exist to collect numerical data on the rate of follow-up with primary care provider in rural areas.

    ·         Significance: Improving rate of follow-up with primary care provider will improve health outcomes of rural residents.

    Problem Statement

    3.     
    Problem Statement:

    Describe the variables/groups to study, in one sentence.

     

    A well-written problem statement begins with the big picture of the issue (
    macro)
    and works to the small, narrower, and more specific problem (
    micro
    ). It clearly communicates the significance, magnitude, and importance of the problem and transitions into the Purpose of the Project with a declarative statement such as: “It is not known if and to what degree/extent…” or “It is not known how/why and….”

    Other examples are:

    ·         While the literature indicates ____________, it is not known in _________ (organization/community) if __________.

    ·         It is not known how or to what extent ________________.

    While the literature indicates that telehealth is an important emerging technology for rural patient access, it is unknown if the implementation of telehealth impacts the rate of patient follow up for patients living in a rural area.

    Clinical/

    PICOT Questions

    4.     
    Clinical/PICOT Questions:

    Provide PICOT question to guide the implementation and data collection of findings of the project:

    (P)
    Among adult patients in a rural care setting,
    (I)
    how does implementation of a telehealth program
    (C)
    compare to traditional commute-for-care (
    O)
    impact rate of follow-up with the primary care provider (
    T)
    over a period of four weeks.

    Sample

    5.     
    Sample (and Location):

    Identify sample, needed sample size, and location (study phenomena with small numbers and variables/groups with large numbers).

    a.       Location: Arizona

    b.      Population: Two neighboring rural towns equal distance from the nearest primary care provider.

    c.       Sample: 40 participants include a power analysis if appropriate.

    Define Variables

    6.     
    Define Variables:

    a.      
    Independent Variable:
    Telehealth program.

    b.     
    Dependent Variable:
    Follow-up rate with primary care provider. The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project

    Methodology  and Design

    7.     
    Methodology and Design:

    Name the selected methodology and specific design to address the problem statement and clinical questions:

    This project will use a quantitative methodology with a quasi-experimental design.

    Purpose Statement

    8.     
    Purpose Statement:

    Provide one sentence statement of purpose including the problem statement, sample, methodology, and design:

    Creswell (2003) provided some sample templates for developing purpose statements aligned with the different project methods as follows:

    The purpose of this
    quantitative
    ___________ (correlational, descriptive, etc.) project is to ____________ (compare or see to what degree a relationship exists) between/among ______________________ (independent variable) to ___________________ (dependent variable) for ________________ (participants) at ___________________ (project site/geographical location). The ________ (independent variable) will be defined/measured as/by _______ (provide a general definition). The
                                     
     (dependent variable) will be defined/measured as/by ______ (provide a general definition).

     

     

    Data Collection Approach

    9.     
    Data Collection Approach:

    Describe primary instruments that will be used to answer clinical question.

    Data Analysis Approach

    10. 
    Data Analysis Approach:

    Descriptive statistics will describe the sample characteristics and variable results. An independent t-tests will test for difference between the two groups of 40 participants (telehealth and commute-for-care) follow-up with primary physician. A priori analysis will be used to justify the sample size.

    The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project

     

     

    10 Strategic Points Table

    (Use this table to complete the 10 Strategic Points document for your project.)

    10 Strategic Points

    Comments/Feedback

    Broad Topic Area

    Literature Review

    Problem Statement

    The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project

    Clinical/PICO Questions

    Sample

    Define Variables

    Methodology  and Design

    Purpose Statement

    The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project

     

     

    Data Collection Approach

    Data Analysis Approach

    The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project

  • Episodic/Focused SOAP Note Template Examples

    Episodic/Focused SOAP Note Template Examples

    Patient Information:

    Initials  Age, Sex, Race

    S.

    CC
    (chief complaint) a BRIEF statement identifying why the patient is here – in the patient’s own words – for instance “headache”, NOT “bad headache for 3 days”.

    HPI
    : This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. Use LOCATES Mnemonic to complete your HPI. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes of each principal symptom in paragraph form not a list. If the CC was “headache”, the LOCATES for the HPI might look like the following example: Episodic/Focused SOAP Note Template Examples.

    BUY A PLAGIARISM-FREE PAPER HERE

    Location: head

    Onset: 3 days ago

    Character: pounding, pressure around the eyes and temples

    Associated signs and symptoms: nausea, vomiting, photophobia, phonophobia

    Timing: after being on the computer all day at work

    Exacerbating/ relieving factors: light bothers eyes, Aleve makes it tolerable but not completely better

    Severity: 7/10 pain scale

    Current Medications
    : include dosage, frequency, length of time used and reason for use; also include OTC or homeopathic products.

    Allergies:
    include medication, food, and environmental allergies separately (a description of what the allergy is ie angioedema, anaphylaxis, etc. This will help determine a true reaction vs intolerance).

    PMHx
    : include immunization status (note date of
    last tetanus
    for all adults), past major illnesses and surgeries. Depending on the CC, more info is sometimes needed

    Soc Hx
    : include occupation and major hobbies, family status, tobacco & alcohol use (previous and current use), any other pertinent data. Always add some health promo question here – such as whether they use seat belts all the time or whether they have working smoke detectors in the house, living environment, text/cell phone use while driving, and support system. Episodic/Focused SOAP Note Template Examples.

    Fam Hx
    : illnesses with possible genetic predisposition, contagious or chronic illnesses. Reason for death of any deceased first degree relatives should be included. Include parents, grandparents, siblings, and children. Include grandchildren if pertinent.

    ROS
    : cover all body systems that may help you include or rule out a differential diagnosis You should list each system as follows:
    General:

    Head
    :
    EENT
    : etc. You should list these in bullet format and document the systems in order from head to toe.

    Example of Complete ROS:

    GENERAL:  No weight loss, fever, chills, weakness or fatigue.

    HEENT:  Eyes:  No visual loss, blurred vision, double vision or yellow sclerae. Ears, Nose, Throat:  No hearing loss, sneezing, congestion, runny nose or sore throat. Episodic/Focused SOAP Note Template Examples.

    SKIN:  No rash or itching.

    CARDIOVASCULAR:  No chest pain, chest pressure or chest discomfort. No palpitations or edema.

    RESPIRATORY:  No shortness of breath, cough or sputum.

    GASTROINTESTINAL:  No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.

    GENITOURINARY:  Burning on urination. Pregnancy. Last menstrual period, MM/DD/YYYY.

    NEUROLOGICAL:  No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.

    MUSCULOSKELETAL:  No muscle, back pain, joint pain or stiffness.

    HEMATOLOGIC:  No anemia, bleeding or bruising. Episodic/Focused SOAP Note Template Examples.

    LYMPHATICS:  No enlarged nodes. No history of splenectomy.

    PSYCHIATRIC:  No history of depression or anxiety.

    ENDOCRINOLOGIC:  No reports of sweating, cold or heat intolerance. No polyuria or polydipsia.

    ALLERGIES:  No history of asthma, hives, eczema or rhinitis.

    O.

    Physical exam
    : From head-to-toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History.
    Do not use “WNL” or “normal.” You must describe what you see.
    Always document in head to toe format i.e. General: Head: EENT: etc.

    Diagnostic results
    : Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines) Episodic/Focused SOAP Note Template Examples.

    A
    .

    Differential Diagnoses
    (list a minimum of 3 differential diagnoses).Your primary or presumptive diagnosis should be at the top of the list. For each diagnosis, provide supportive documentation with evidence based guidelines.

    This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

    References

    You are required to include at least three evidence based peer-reviewed journal articles or evidenced based guidelines which relates to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 6
    th
    edition formatting.

     

     

    Episodic/Focused SOAP Note Template – Episodic/Focused SOAP Note Template Examples 2

     

    Patient Information:

    L., 20, F, Caucasian

    SUBJECTIVE.

    CC:
    “I have been having sore throat for three days, and I also have decreased appetite, headache, and pain with swallowing.”

    HPI
    : Ms. L is a 20-year-old female college student who presents with sore throat for three days, with additional decreased appetite, headache, and pain with swallowing. She recounts that similar “flu-like” symptoms recently affecting multiple students on campus. Ms. L also noted runny nose and a slight hoarseness in her voice but doesn’t sound congested. She took Tylenol and Chloraseptic lozenges, but did little for relief. Episodic/Focused SOAP Note Template Examples.

    Location:
    throat

    Onset:
    3 days ago

    Character:
    throat is sore

    Associated signs and symptoms
    : decreased appetite, headache, and pain with swallowing.

    Timing
    : constant

    Exacerbating/ relieving factors
    : light bothers eyes, Tylenol makes it tolerable but not completely better.

    Severity:
    8/10 pain scale

    Problem-Specific Questions
    :

    Have you been coughing? Any drainage or phlegm? Is it productive, if so how much? What is the color of the phlegm?

    Have you been running a fever or exhibiting chills?

    Are you taking any medications for this? Are they helping?

    Are you having any pain or pressure in your face, head, or sinuses? Have you recently had a head injury? Any nasal bleeding noted?

    Do you smoke or have you been around anyone who smokes?

    Do you experience gastroesophageal reflux or heartburn?

    Does it hurt to swallow solids, liquids, or both?

    Do you feel like something is stuck in your throat? Episodic/Focused SOAP Note Template Examples.

    Do you cough or choke when swallowing?

    Do you have any changes in your appetite? Did it start with the onset of your sore throat?

    Any changes in your weight? Did you lose or gain weight?

    What have you eaten in the last twenty-four hours?

    Have you had any nausea or vomiting?

    Current Medications
    : Multivitamins 1 tablet daily; and Blisovi Fe 1/20 1 tab daily

    Allergies:
    Penicillin (Hives)

    PMHx
    : No pertinent medical history reported, it is unremarkable. No recent hospitalizations reported in the past. Immunizations are current. Last tetanus shot was taken June 2010. Last flu shot was taken September 2016. Denies any history of accidents/injury or falls.

    Soc Hx
    : Ms. L was born in Galveston, TX, and currently attends a community college at Houston Community College – Katy Campus. She attends classes Mon-Fri from 8am to 3pm. She works at daycare center on the weekends while in school, and during the week on Summer break. She is Single, and heterosexual. She is in a monogamous relationship with her boyfriend, and sexually active. She exercises 3x/week, and eats a diet consisting of meat/fish, vegetables, fruits, rice and beans. She drives a vehicle, and always put on her seatbelt. She is a social drinker, takes 1-2 glasses of wine every 2 weeks. Never smoked, and denies use of illicit/recreational drugs. Drinks green tea daily.

    Fam Hx
    :

    Maternal Grandmother
    : deceased at age 83 related to Stroke

    Maternal Grandfather:
    deceased at age 98, no health conditions noted

    Paternal Grandmother:
    deceased at age 38, post-partum hemorrhage

    Paternal Grandfather:
    deceased at age 102 related to uncontrolled HTN

    Mother:
    age 57, No health conditions reported Episodic/Focused SOAP Note Template Examples

    Father:
    age 63, has Arthritis, and HTN

    Siblings:
    She has 2 sisters age 18 and 16. Both are alive and well, no health conditions reported

    Review of Systems
    :

    GENERAL:  The patient is awake, alert, oriented and appears generally well. See HPI.

    HEENT:  Eyes:  No visual loss, blurred vision, double vision or yellow sclera. No decreased hearing. No hearing loss, sneezing, or congestion. Has complaints of runny nose, sore throat, headaches, and hoarse voice.

    SKIN:  No rash or itching.

    CARDIOVASCULAR:  No chest pain, chest pressure or chest discomfort. No palpitations or edema.

    RESPIRATORY:  Respirations are regular and unlabored. No shortness of breath, cough or sputum.

    GASTROINTESTINAL:  No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood. Complaints of decreased appetite

    GENITOURINARY:  Denies burning in urination, never been pregnant. Menses are regular, last menstrual period, 05/28/2017.

    NEUROLOGICAL:  No dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control. Complains of headache that started with the onset of sore throat.

    MUSCULOSKELETAL:  No muscle, back pain, joint pain or stiffness. Episodic/Focused SOAP Note Template Examples.

    HEMATOLOGIC:  No anemia, bleeding or bruising.

    LYMPHATICS:  No history of splenectomy. Swollen nodes in the neck

    PSYCHIATRIC:  No history of depression or anxiety.

    ENDOCRINOLOGIC:  No reports of sweating, cold or heat intolerance. No polyuria or polydipsia.

    ALLERGIES:  Allergic to PCN, gives her hives.

    OBJECTIVE.

    Physical exam
    : The patient is awake, alert, oriented and appears generally well. The patient is in no distress. Vital signs revealed a Ht. 5’10”, Wt. 150 lbs; BMI= 21.5; pulse of 96, respirations of 18, temperature of 101.6 and O2 saturation on room air of 98%. HEENT: Pupils are equal, round and reactive to light. There is no sinus tenderness. Ears are clear. Throat is slightly red with some swelling and exudate. Neck is supple with anterior cervical lymphadenopathy. Note runny nose and hoarse voice. Lungs are clear. Heart has regular rate and rhythm without murmur or gallop. Back showed no CVA tenderness. Abdomen is soft and non-tender. No organomegaly. Extremities: No edema or tenderness. Skin/Hair/Nails: Normal color for ethnicity and turgor without rash.

    Diagnostic results
    : CBC and CMP ordered; throat swab was obtained and sent to the lab for rapid strep testing, rapid influenza diagnostic testing, and follow-up throat culture.

    ASSESSMENT
    .

    Differential Diagnoses

    Influenza
    : Patient is exhibiting classic signs of sore throat, fever, headache, and nasal discharge (National Foundation for Infectious Diseases, 2016), with exposure to multiple infectious sources on her close-quartered college campus, this condition may be likely pending diagnostics.

    Group A streptococcal pharyngitis
    : I would consider this due to her sore throat, but would need to visualize her mouth and throat to observe for possible erythematous and exudative tonsils and uvula, as well as other symptoms common to this diagnosis (Vincent et al, 2004). Episodic/Focused SOAP Note Template Examples.

    Diphtheria
    : Common clinical manifestation includes low grade fever, sore throat, headache, malaise, and hoarseness (Centers for Disease Control and Prevention, 2016), very similar to my patient’s symptoms. However, this may be unlikely in United States as most people are vaccinated, though still prevalent in developing countries. In addition, Children under 5 and adults over 60 years old are particularly at risk for contracting the infection.

    Epiglottitis
    : Because of her sore throat and vocal changes, this should be ruled out as it can advance to emergent airway obstruction, however, my suspicions would tell me that this is not probable as these patients often present in respiratory distress and it is a potentially life-threatening illness. This condition is historically a condition more common in children, but it is becoming more frequent in adults. It requires prompt diagnosis and treatment in anyone, but especially in children, who are more vulnerable to breathing complications (Marcin, 2017).

    Epstein-Barr virus (EBV) infectious mononucleosis
    : Typically, these viruses spread most commonly through bodily fluids, especially saliva. Though classic signs of EBV is prolonged malaise, sore throat is a very prevalent sign, and the condition more common for those between ages 15-30 years, and close quarters being a common factor for transmission (Vincent et al, 2004), however, EBV should also be ruled out due to short time onset, and no enlarged spleen or liver noted.

    PLAN.

    This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

    References

    Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015).
    Seidel’s guide to physical examination
    (8th ed.). St. Louis, MO: Elsevier Mosby.

    Centers for Disease Control and Prevention (2016). About Diphtheria. Retrieved from

    https://www.cdc.gov/diphtheria/about/index.html Episodic/Focused SOAP Note Template Examples

     

    Marcin, J. (2017). Epiglottis. Retrieved from

    http://www.healthline.com/health/epiglottitis#overview1

     

    National Foundation for Infectious Diseases (2016). Influenza (Flu). Retrieved from

    http://www.nfid.org/idinfo/influenza

     

    Vincent, M., et al (2004). Pharyngitis. Retrieved from

    http://www.aafp.org/afp/2004/0315/p1465.html Episodic/Focused SOAP Note Template Examples

  • Translational Research Graphic Organizer

    Use the “Translational Research Graphic Organizer Template” to compare three types of translational research with traditional (qualitative or quantitative) research. Make sure to include methodology, goals, and data collection in your organizer.

    You are required to cite three to five sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

    ORDER A CUSTOM-WRITTEN, PLAGIARISM-FREE PAPER NOW

    Translational Research Graphic Organizer Template

     

     

    Observations (Similarities/Differences)

    Methodology

     

     

    Translational Research Graphic Organizer

     

     

     

     

     

    Goals

     

     

     

     

     

     

     

     

    Data Collection

     

     

     

     

     

     

     

    Translational Research Graphic Organizer

  • Episodic/Focused SOAP Note Template – Assessing the Genitalia and Rectum

    Episodic/Focused SOAP Note Template – Assessing the Genitalia and Rectum

    Assessing the Genitalia and Rectum

    Episodic/Focused SOAP Note Template

    Patient Information:

    JW       Age: 21         Sex: Female                 Race: Caucasian

    S.

    BUY A PLAGIARISM-FREE PAPER HERE

    CC
    (chief complaint) “I have bumps on my bottom that I want to have checked out. ”

    HPI
    :  This 21-year-old Caucasian female presents to our clinic complaining of painless, rough bumps on her genital region.  The onset of these bumps was approximately one week ago.  JW reports being sexually active with more than one partner over the past year.  She also has a history of chlamydia 2 years ago with completed treatments.  She reports being sexually active since the age of 18 years of age.

    Current Medications
    :  Symbicort 160/4.5mcg PO twice daily

    Allergies:
    NKDA

    PMHx
    : Chlamydia, Asthma

    Soc Hx
    : Denies tobacco use; occasional ETOH, married, 3 children (1 girl, 2 boys)

    Fam Hx
    :  No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD

    ROS
    :

    Example of Complete ROS:

    GENERAL:  Denies weight loss, fever, chills, weakness or fatigue.

    HEENT:  Eyes:  Denies visual loss, blurred vision, double vision or yellow sclerae. Ears, Nose, Throat:  Denies hearing loss, sneezing, congestion, runny nose or sore throat. Episodic/Focused SOAP Note Template – Assessing the Genitalia and Rectum

    SKIN:  Reports bumps on around genital region, no vaginal discharge reported.

    CARDIOVASCULAR:  Denies chest pain, chest pressure or chest discomfort. Denies palpitations or edema.

    RESPIRATORY:  Denies shortness of breath, cough or sputum.

    GASTROINTESTINAL:  Denies anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.

    GENITOURINARY:  Denies urinary symptoms. LMP: 03/22/18. Last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal.

    NEUROLOGICAL:  Denies headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. Denies change in bowel or bladder control.

    MUSCULOSKELETAL:  Denies muscle, back pain, joint pain or stiffness.

    HEMATOLOGIC:  Denies anemia, bleeding or bruising.

    LYMPHATICS:  Denies enlarged nodes. No history of splenectomy.

    PSYCHIATRIC:  Denies history of depression or anxiety.

    ENDOCRINOLOGIC:  Denies reports of sweating, cold or heat intolerance. No polyuria or polydipsia.

    ALLERGIES:  history of asthma;  denies hives, eczema or rhinitis.

    O.

    VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs

    General:  
    Awake, alert, and oriented x4 female.  She is well groomed and well-nourished.  Denies fever, chills, fatigue, nausea, and vomiting.

    Cardiovascular:  +
    S1, S2, heart rate and rhythm regular, no murmur, no peripheral edema observed.

    Respiratory: 
    CTA, chest wall symmetrical

    Gastrointestinal:
    Abdomen
     
    soft, normoactive bowel sounds, neg rebound, neg murphy’s, neg McBurney

    Genitourinary: 
    Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact with a healed episiotomy scar present. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia

    Diagnostic results
    :  HSV results pending

    A
    .

    Differential Diagnoses 

    1)
    Human Papilloma Virus (HPV)  
    HPV infection commonly causes warts. Some  HPV infections may cause cervical cancers. There are more than 100 varieties of HPV (Hammer & McPhee, 2014).  Most HPV infections will not lead to cancer. However, some types of genital HPV may cause cervical cancer (Hammer & McPhee, 2014).  HPV may be responsible for cancers of the anus, penis, vagina, vulva, and oropharyngeal. Episodic/Focused SOAP Note Template – Assessing the Genitalia and Rectum

    Signs and Symptoms

    The body’s immune system combats  HPV before creating warts.  When warts appear, they vary in appearance depending on the type of HPV involved: genital warts, common warts, plantar warts, and flat warts (Hammer & McPhee, 2014).  Genital warts in women appear mostly on the vulva but may also appear near the anus, cervix, and vagina.

    Risk Factors

    An increased amount of sexual partners makes it more likely to contract HPV.  Genital warts are most common in adolescents and young adults (Hammer & McPhee, 2014).  Patients with a weakened immune system are at greater risk of HPV.  Exposed areas of skin that have been punctured or opened are at risk of developing common warts (Hammer & McPhee, 2014).

    Diagnostic Tests

    The following tests may be recommended if the genital warts are not visible.

    Acetic acid solution test
    consists of a vinegar solution applied to HPV-infected genital areas and turns these areas white (Hammer & McPhee, 2014).

    Pap Smear 
    consists of a clinician collecting a sample of cells from the cervix or vagina to send for laboratory analysis. A Pap test may be able to reveal abnormal cells that may lead to cancer (Hammer & McPhee, 2014).

    DNA test
    consists of analyzing cells from a patient’s cervix and is able to recognize DNA that is considered high-risk of HPV and linked to genital cancers (Hammer & McPhee, 2014).

     

    2)
    Genital Herpes:  
    A  sexually transmitted infection (STI) caused by the herpes simplex virus (HSV) (Goljan, 2014).  The virus is primarily transmitted sexually.  The virus typically lies dormant and may emerge several times a year (Goljan, 2014).

    Signs and Symptoms

    Symptoms may begin between two to 12 days after exposure to HSV.  Symptoms if present may include:

    Pain or itching in the genital region

    Red bumps or white blisters

    Ulcers that may ooze or bleed

    Scabs (Goljan, 2014).

     

    During the initial outbreak,  flu-like symptoms may present such as swollen lymph nodes in the groin, headache, muscle aches, and fever (Goljan, 2014). Episodic/Focused SOAP Note Template – Assessing the Genitalia and Rectum

    Risk Factors

    The risk of becoming infected with genital herpes may increase the patient:

    Is Female.  The mode of transportation is much easier from men to women than it is women to men.

    Multiple sexual partners (Goljan, 2014).

     

    Diagnostic Tests

    A clinician may diagnose genital herpes by the physical examination along with the results of some of the following lab results:

    Viral culture of the sore

    Polymerase chain reaction (PCR) test

    HSV antibody test. This test may detect past infection of HSV (Goljan, 2014).

     

    3) 
    Bartholin’s cyst:  
    The Bartholin’s glands are located on each side of the vaginal opening and secreted fluid that helps lubricate the vagina (McCance , Huether, Brashers, & Rote, 2014).  When the openings of the Bartholin’s glands become obstructed, fluid will back up into the gland.  This will result in a painless swelling called the Bartholin’s cyst (McCance et al., 2014).  The fluid within the cyst may become infected and collect pus which will develop into an abscess (McCance et al., 2014).

    Signs and Symptoms

    The cyst may present as a lump or mass near the vaginal opening.  The cyst may usually be painless, it can be tender.  When a cyst is infected the following symptoms may be present:

    A tender, painful lump near the vaginal opening

    Discomfort while walking or sitting

    Pain during intercourse

    Fever (McCance et al., 2014).

     

    Diagnostic Tests

    Diagnosing a Bartholin’s cyst may be possible by acquiring a thorough health history, performing a pelvic exam, obtaining a sample of secretions from the vagina to r/o STIs, and biopsy of the mass for women over 40 years of age (McCance et al., 2014). 
     

    4)
    Sebaceous cyst:   
    Cysts are abnormalities in the body that contain noncancerous liquid material (McCance et al., 2014).  These cysts are mostly found on the face, neck, or torso.  Their growth is slow and is not life-threatening, but they may become uncomfortable if left untreated (McCance et al., 2014). Episodic/Focused SOAP Note Template – Assessing the Genitalia and Rectum

    Signs and Symptoms

    Small cysts are typically not painful.  Large cysts can range from uncomfortable to painful.  Large cysts on the face and neck cause pressure and pain.  The areas on the body where cysts are usually found include the scalp, face, neck, and back (McCance et al., 2014).

    Diagnostic Tests

    The clinician is able to diagnose a sebaceous cyst during the physical examination. If the cyst is seen as unusual, the clinician may order tests to rule out cancer.  The most common tests used for a sebaceous cyst include:  CT scans for a possible surgical route, ultrasounds for the internal structure of cyst, and biopsy (McCance et al., 2014).

    5)
    Syphilis:  
    A bacterial infection primarily spread sexually.  It presents as a painless sore on the genitals, rectum or mouth (Hammer & McPhee, 2014).  Syphilis may spread via skin or mucous membrane contact with these sores  (Hammer & McPhee, 2014).  Post initial infection, syphilis can remain dormant for several decades before resurfacing.  Early treatment may rid the infection with antibiotics, however, when left untreated it can severely damage the heart, brain, and can be life-threatening, and maybe also passed from mother to unborn child (Hammer & McPhee, 2014).

    Signs and Symptoms

    Syphilis may present in different stages which may overlap at times.  The stages include:  primary syphilis, secondary syphilis, latent syphilis, tertiary syphilis, and congenital syphilis (Hammer & McPhee, 2014).

    Primary syphilis:  
    The first sign of syphilis is a small sore that appears at the spot where the bacteria entered the body.  This sore is also called a chancre.  The sore develops about three weeks after exposure, is usually painless and hidden within the vagina or rectum (Hammer & McPhee, 2014) .

    Secondary syphilis:  
    Within a few weeks of healing the patient may experience a rash that begins on the trunk and may eventually cover the entire body including the palms of the hands and soles of the feet (Hammer & McPhee, 2014).  The rash is usually not itchy and may be accompanied by wart-like sores in the mouth or genital area (Hammer & McPhee, 2014).

    Latent syphilis
    :  If left untreated the infection may be dormant for several years or never return.

    Tertiary syphilis:  
    This is considered the late stage of syphilis, the disease may damage the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints (Hammer & McPhee, 2014). Episodic/Focused SOAP Note Template – Assessing the Genitalia and Rectum

     

    Risk Factors

    Unprotected sex

    Multiple sexual partners

    Homosexual man engaging in sex with other men

    Patient infected with HIV (Hammer & McPhee, 2014)

     

    Diagnostics

    Serum 
    tests can confirm the presence of antibodies that the body produces to fight infection (McCance et al., 2014).  The antibodies to the bacteria that cause the infection remain in the body for years, therefore the test can be used to determine a current or past infection (McCance et al., 2014).

    Cerebral spinal fluid.
    If it’s suspected that the nervous system has been compromised by syphilis a lumbar puncture may be recommended.

     

    References

    Goljan, E. F. (2014).
    Rapid review: Pathology
    (4th ed.). Philadelphia, PA: Elsevier.

    Hammer, G. D., & McPhee, S. J. (2014).
    Pathophysiology of disease: An introduction to clinical medicine
    (7th ed.). China: McGraw Hill.

    McCance , K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2014).
    Pathophysiology: The biologic basis for disease in adults and children
    (7th ed.). St. Louis, MS: Elsevier.

     

    Assessing The Genitalia And Rectum

    Patients are frequently uncomfortable discussing with health care professional’s issues that involve the genitalia and rectum; however, gathering an adequate history and properly conducting a physical exam is vital. Examining case studies of genital and rectal abnormalities can help prepare advanced practice nurses to accurately assess patients with problems in these areas.

    In this assignment, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.

    In this assignment, you will analyze a SOAP note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions. Episodic/Focused SOAP Note Template – Assessing the Genitalia and Rectum

    GENITALIA ASSESSMENT

    Subjective:

    CC: “I have bumps on my bottom that I want to have checked out.”

    HPI: AB, a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the bumps are painless and feel rough. She states she is sexually active and has had more than one partner over the past year. Her initial sexual contact occurred at age 18. She reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She reports one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed.

    PMH: Asthma

    Medications: Symbicort 160/4.5mcg

    Allergies: NKDA

    FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD

    Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)

    Objective:

    VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs

    Heart: RRR, no murmurs

    Lungs: CTA, chest wall symmetrical

    Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact with a healed episiotomy scar present. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia

    Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, neg McBurney

    Diagnostics: HSV specimen obtained

    Assessment:

    Chancre

    PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

    To prepare:

    With regard to the SOAP note case study provided:

    Review this week’s Learning Resources, and consider the insights they provide about the case study.

    Consider what history would be necessary to collect from the patient in the case study.

    Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?

    Identify 
    at least five
     possible conditions that may be considered in a differential diagnosis for the patient.

    To complete:

    Refer to Chapter 5 of the Sullivan text. Analyze the SOAP note case study.  Using evidence-based resources, answer the following questions and support your answers using current evidence from the literature.

    Analyze the subjective portion of the note. List additional information that should be included in the documentation.

    Analyze the objective portion of the note. List additional information that should be included in the documentation. Episodic/Focused SOAP Note Template – Assessing the Genitalia and Rectum

    Is the assessment supported by the subjective and objective information? Why or Why not?

    Would diagnostics be appropriate for this case and how would the results be used to make a diagnosis?

    Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least 3 different references from the current evidence-based literature. Episodic/Focused SOAP Note Template – Assessing the Genitalia and Rectum

  • NURS 6512 Health Assessment, Week 11 Quiz, Neuro/Spinal/Muscles

    NURS 6512 Health Assessment, Week 11 Quiz, Neuro/Spinal/Muscles

    Question 1

    Which of the following factors is not known to affect patient compliance with his or her treatment regimen?

     

    Response Feedback:

    The controlling factors of compliance include the nature of the relationship you have developed, your recognition of the patient s autonomy, your success in communicating the basics of the patient s condition, and the clarity of your instructions. Always ask the patient to repeat the instructions to you to make sure they are understood. Equally important factors are the patient s ability to understand the problem and the value the patient places on resolving the problem.

    Question 2

    One of the most important aspects to consider in the orthopedic screening examination is:

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    Response Feedback:

    The most important aspect to consider when conducting an orthopedic examination is to look for symmetry of muscle, stature, and joint movement.

    Question 3

    The sequence of the physical examination should be individualized to:

     

    Response Feedback:

    There is no one right way to put together the parts of the physical examination. The sequence should be individualized to minimize the number of times the patient has to change positions to conserve the patient s energy.

    Question 4

    As you greet the patient, which examination technique is first implemented?

     

    Response Feedback:

    Begin to inspect the patient as you greet them, as you look for signs of distress or disease. Inspect their appearance, gait, orientation, and difficulty in hearing or speech.

    Question 5

    Which of the following is most likely to enhance examiner reliability? NURS 6512 Health Assessment, Week 11 Quiz, Neuro/Spinal/Muscles

     

    Response Feedback:

    The examiner may not always be correct, but questioning yourself and seeking confirmation from others when necessary will serve to assure your reliability. A person should never be prejudged because this can interfere with your examination and findings. Showing that you are uncomfortable with your skills can make the patient feel uncomfortable and see you as unreliable. The use of unselective technology should not substitute for a well-honed history and physical.

    Question 6

    Premature infant respiratory distress is often manifested by:

     

    Response Feedback:

    Respiratory distress of premature infants is indicated by a sustained increased rate, grunting, retraction of intercostal and subcostal spaces and suprasternal notch, seesaw sinking of the chest with rising abdomen in contrast to the normal synchronous motions, and flaring nose. The other choices are not expected findings in premature infants.

    Question 7

    A common method of estimating gestational age of a newborn is to assess:

     

    Response Feedback:

    To determine gestational age, look at the soles of the feet. Before 36 weeks gestation, only one or two transverse creases are present; by 40 weeks gestation, many creases are present on the soles of the feet. Other clues to gestational age include breast nodule less than 3 cm, cartilage in the helix of the ear, descending of the scrotum and amount of rugae, and extremities in flexed positions.

    Question 8

    Proprioception should be assessed while the patient is:

     

    Response Feedback:

    Proprioception examination involves the Romberg test, heel-to-toe walking, standing on one foot and then on the other with eyes closed, hopping in place, and deep knee bends. The standing position is required to conduct these examinations.

    Question 9

    The examination of the newborn should begin with:

     

    Response Feedback:

    The examination of a newborn should begin with inspection noting skin color, flaccidity, tension, gross deformities, or distortions of facies. All of the other examination techniques follow inspection.

    Question 10

    When assessing the abdomen, one needs to expose the patient:

     

    Response Feedback:

    While the patient is in the supine position, the examiner can assess the abdomen. Arrange draping to expose the abdomen from pubis to epigastrium, ensuring to cover the private areas of the patient. All of the other options would not allow for a thorough inspection and examination or they would expose the patient inappropriately.

    Question 11

    Functional assessment is most important during the examination of a(n):

     

    Response Feedback:

    Functional assessment is most important when examining the older adult. Initial observation and interaction can provide a great deal of information about the individual s independent functional capacity. Attention should be given to self-care activities and instrumental activities.

    Question 12 NURS 6512 Health Assessment, Week 11 Quiz, Neuro/Spinal/Muscles

    The goals of preparticipation sports evaluation include:

     

    Response Feedback:

    The ultimate goal of preparticipation physical evaluation is to ensure safe participation in an appropriate sports activity. A preparticipation evaluation may not predict a brain injury and concussion, but it can help you learn the normal neuropsychologic status of the person involved before injury.

    Question 13

    Part of the screening orthopedic component of the examination includes evaluating the person while:

     

    Response Feedback:

    Duck walking for four steps assesses hip, knee, and ankle range of motion, strength, and balance.

    Question 14

    You are conducting a preparticipation physical examination for a 10-year-old girl with Down syndrome who will be playing basketball. She has slight torticollis and mild ankle clonus. What additional diagnostic testing would be required for her?

     

    Response Feedback:

    This girl is experiencing symptoms of atlantoaxial joint instability and should therefore have a cervical spine radiograph with neurologic consultation before beginning sports activities.

    Question 15

    An ophthalmoscopic eye examination involves:

     

    Response Feedback:

    Ophthalmoscope eye examination involves testing the red reflex and inspecting the lens, disc, cup margins, vessels, and retinal surface. The other assessments do not involve the use of the ophthalmoscope.

    Question 16

    Which of the following is true regarding the relationship between the examiner and the patient?

     

    Response Feedback:

    The patient is a full partner with the examiner. The examiner should keep the patient informed and should develop a relationship to ensure trust. Cultural issues should be acknowledged, not ignored. Clinical judgment can allow deviations from rigid structures and allow adaptations to a particular circumstance.

    Question 17

    The best way to ease the apprehension of a 3-year-old child before a physical examination is to:

     

    Response Feedback:

    The best way to ease the apprehension of a 3-year-old child before a physical examination is to encourage the child to participate by helping you. Ask the child to hold the end piece of the stethoscope or to blow out your flashlight.

    Question 18

    Which one of the following patient characteristics is most likely to limit patient reliability during history taking?

     

    Response Feedback:

    A partial or total loss of any of the senses can limit a patient s reliability as a historian. Emotional constraints, language barriers, cultural barriers, and an unresponsive or comatose patient can all affect a patient s ability to be a thorough historian. All of the other options would not limit a patient s reliability.

    Question 19

    The greatest risk for potential health problems occurs in which age group?

     

    Response Feedback:

    The newborn is at greater risk for potential health problems than other ages but also has the potential for better health than the other age groups.

    Question 20

    To inspect the abdominal muscles, ask the:

     

    Response Feedback:

    Asking the patient to raise the head will contract the rectus abdominis muscles, which produces muscle prominence, making abdominal wall masses visible. All of the choices would not show the abdominal muscles contracting.

     

    Question 1

    A therapeutic technique for dealing with grieving individuals is to:

    Response Feedback:

    When a patient dies, the grieving family and friends need attention for their emotional needs. It is often difficult to find words, and often the words may be cliché and not seem appropriate for the moment. It is all right to tell them that it is good to cry and to share feelings. It is permissible to talk about what has been lost and what will not be realized for the future. All of the other answers are not therapeutic for a grieving family member or friend.

    Question 2

    The examination of the newborn should begin with:

    Response Feedback:

    The examination of a newborn should begin with inspection noting skin color, flaccidity, tension, gross deformities, or distortions of facies. All of the other examination techniques follow inspection.

    Question 3

    Which one of the following patient characteristics is most likely to limit patient reliability during history taking?

    Response Feedback:

    A partial or total loss of any of the senses can limit a patient s reliability as a historian. Emotional constraints, language barriers, cultural barriers, and an unresponsive or comatose patient can all affect a patient s ability to be a thorough historian. All of the other options would not limit a patient s reliability.

    Question 4

    In crying infants, it is often difficult to:

    Response Feedback:

    For the crying infant, lungs can be auscultated between consolable moments. While crying, the examiner can assess the lustiness of cry, tactile fremitus, lung excursion, facial symmetry, and appearance of the mouth and pharynx. Between breaths, heart tone can be auscultated.

    Question 5

    Which of the following is true regarding the relationship between the examiner and the patient?

    Response Feedback:

    The patient is a full partner with the examiner. The examiner should keep the patient informed and should develop a relationship to ensure trust. Cultural issues should be acknowledged, not ignored. Clinical judgment can allow deviations from rigid structures and allow adaptations to a particular circumstance. NURS 6512 Health Assessment, Week 11 Quiz, Neuro/Spinal/Muscles

    Question 6

    Which of the following are examined with the patient in a reclining 45-degree position?

    Response Feedback:

    With the patient in a reclining 45-degree position, you can examine jugular venous pulsations and measure jugular venous pressure. All of the other choices can be examined with the patient in a sitting position.

    Question 7

    The greatest risk for potential health problems occurs in which age group?

    Response Feedback:

    The newborn is at greater risk for potential health problems than other ages but also has the potential for better health than the other age groups.

    Question 8

    Examination of the patient in the lithotomy, or knee-chest, position includes:

    Response Feedback:

    With the patient in the lithotomy position, the examiner can inspect the external and internal female genitalia and perform rectal examination to assess and palpate anal sphincter tone. The other answers require the patient to be in the supine or standing position.

    Question 9

    Which portion of the physical examination is best done with the patient standing?

    Response Feedback:

    With the patient in the standing position, the examiner can inspect and palpate the spine as the patient bends over at the waist and test a patient s range of motion.

    Question 10

    A parent is advised to restrict contact or collision sports participation for their child. An example of a sport in which this child could participate is:

    Response Feedback:

    Hockey and diving are considered a contact or collision sport; roller skating and skateboarding are considered to be limited-contact sports. Track is a noncontact sport.

    Question 11

    One of the most important aspects to consider in the orthopedic screening examination is:

    Response Feedback:

    The most important aspect to consider when conducting an orthopedic examination is to look for symmetry of muscle, stature, and joint movement.

    Question 12

    Functional assessment is most important during the examination of a(n):

    Response Feedback:

    Functional assessment is most important when examining the older adult. Initial observation and interaction can provide a great deal of information about the individual s independent functional capacity. Attention should be given to self-care activities and instrumental activities.

    Question 13

    The checkout station for pre participation physical evaluation (PPE) is critical because at this point:

    Response Feedback:

    At the checkout station, data collected during the evaluation are reviewed and necessary follow-up actions are shared with the athlete and/or parents. In addition, the written report is distributed. If the PPE is not itself a comprehensive service that addresses issues unrelated to sports participation, the need for routine primary care remains.

    Question 14 NURS 6512 Health Assessment, Week 11 Quiz, Neuro/Spinal/Muscles

    A common method of estimating gestational age of a newborn is to assess:

    Response Feedback:

    To determine gestational age, look at the soles of the feet. Before 36 weeks gestation, only one or two transverse creases are present; by 40 weeks gestation, many creases are present on the soles of the feet. Other clues to gestational age include breast nodule less than 3 cm, cartilage in the helix of the ear, descending of the scrotum and amount of rugae, and extremities in flexed positions.

    Question 15

    Palpation of epitrochlear nodes is part of the:

    Response Feedback:

    Palpation of epitrochlear nodes is part of the examination of the upper extremities. To palpate the epitrochlear nodes, support the elbow in one hand and palpate in the depression above and posterior to the medial condyle of the humerus.

    Question 16

    Observation of the child playing in the playroom provides information about which two systems?

    Response Feedback:

    The child playing on the floor offers an opportunity to evaluate both the musculoskeletal and neurologic systems by noting the child s coordination of activities, such as when throwing a ball, drawing, coloring, walking, and jumping.

    Question 17

    As you greet the patient, which examination technique is first implemented?

    Response Feedback:

    Begin to inspect the patient as you greet them, as you look for signs of distress or disease. Inspect their appearance, gait, orientation, and difficulty in hearing or speech.

    Question 18

    Part of the screening orthopedic component of the examination includes evaluating the person while:

    Response Feedback:

    Duck walking for four steps assesses hip, knee, and ankle range of motion, strength, and balance.

    Question 19

    The best way to ease the apprehension of a 3-year-old child before a physical examination is to:

    Question 20

    The sequence of the physical examination should be individualized to:

    Response Feedback:

    There is no one right way to put together the parts of the physical examination. The sequence should be individualized to minimize the number of times the patient has to change positions to conserve the patient s energy. NURS 6512 Health Assessment, Week 11 Quiz, Neuro/Spinal/Muscles

  • NURS 6512-COMPREHENSIVE PHYSICAL EXAMINATION CHECKLIST

    NURS 6512-COMPREHENSIVE PHYSICAL EXAMINATION CHECKLIST

    The following list will be used to determine the grade for the physical examination demonstration.  It does not constitute a complete list of everything that could be included in a physical examination, but rather a list of those things that should be done at a minimum for every individual having a “complete physical examination”.

    BUY A PLAGIARISM-FREE PAPER HERE

    IMPORTANT INSTRUCTIONS: Adjust your camera to show a full view of both you and your patient volunteer, show your government issued photo ID/passport for verification of who you are, scan the room that you are using for verification that notes are not being used or posted, then begin the video. You may not take notes during the examination. Omitting these instructions or obtaining a score of less than 69.5% will result in a failure of the video assignment and the course.

    Possible

    Points

    Score

    Skin

    2

    Inspects all areas of body esp. feet

    2

    Head & Neck

    6

    Inspect & Palpates skull

    1

    Palpates lymph nodes for adenopathy

    2

    Palpates thyroid (with H2O/swallowing)

    2

    Palpates tracheal placement

    1

    Eyes

    12

    Checks visual acuity  (Snellen chart required)

    1

    Checks peripheral fields

    2

    Checks EOMs

    2

    Checks conjunctiva for pallor

    1

    Checks pupillary reaction

    1

    Opthalmoscopic exam (opthamoloscope is required)

    5

    describes discs, checks for microaneurysms,

    hemorrhages, neovascularization

    Ears, Nose,

    Sinuses, Mouth 

    Determines gross hearing/whisper test (Tuning Forks are required. Frequency of 500-1000Hz to be used)

    2

    8

    Otoscopic exam (describes landmarks) (otoscope is required)

    2

    Inspect & Assess Nares

    1

    Palpate & percuss  sinuses

    2

    Examines mouth (hard palate/soft palate, salivary glands, tongue, gag reflex)

    1

    Chest and Lungs

    8

    Inspect chest & Observes respiratory movements

    1

    Posterior chest

    5

    Palpates & percuss respiratory excursion. Assess  tactile fremitus; Thoracic  expansion

    Auscultates breath sounds

    Anterior chest

    2

    Palpate & percuss ant chest. Auscultate breath sounds

    NURS 6512-COMPREHENSIVE PHYSICAL EXAMINATION CHECKLIST

    Breasts

    Explanation only –do not demonstrate

    1

    1

    Palpates axillae, inspects breasts

    Palpates axillary lymph nodes

    Cardiovascular

    8

    Inspect & Observes neck veins and measures JVD (two pocket ruler required)

    1

    Palpates PMI and precordium

    2

    Auscultates cardiac sites (Aortic area, Pulmonic area, Tricuspid area, Mitral Area (Apex) and
    state sounds

    5

    With diaphragm and bell sitting position

    then diaphragm supine/left lateral decubitus

    Peripheral Vascular

    5

    Inspect & Palpates pulses: carotids, radials, tibialis, pedals

    2

    Palpates for lower extremity edema

    1

    Auscultates for  carotid bruit

    2

    Abdomen

    10

    Inspect & Auscultates bowel sounds

    1

    Auscultates renal arteries

    2

    Percuss liver to determine span

     

    2

    Palpates abdomen for tenderness(light and deep palpation, including McBurney’s point and rebound tenderness)

    2

    Check for splenic & liver enlargement

    3

    Neurological

    30

    Mental status—MMSE or clock drawing

    1

    Cranial nerves:

    12

    Olfactory: smell

    Optic: visual acuity, fields

    Oculomotor, trochlear, abduces: EOMs

    Trigeminal: sensation & jaw strength

    Facial: frown, smile, corneal reflex

    Acoustic: gross hearing

    Glossopharyngeal, vagus: gag reflex

    Spinal accessory: shrug shoulders

    Hypoglossal: moves tongue

    Reflexes: all DTRs and Babinski (reflex hammer is required)

    5

    Sensory:

    L ight touch/monofilament on feet (Monofilament tool required)

    1

    Vibration

    1

    Stereognosis or graphesthesia

    1

    Motor:

    Strength—upper and lower extremities

    2

    Muscle tone

    2

    Gait

    1

    Cerebellar:

    Test for coordination(any coordination test covered in your text readings)

    1

    One test for balance

    1

    One test for meningeal irritation

    1

    One test for nerve root irritation

    1

    Musculoskeletal

    10

    Inspects spine

    1

    Palpates spine

    2

    Palpates major joints

    2

    (Shoulders, Hips, Knees, Elbows)

    Active ROM of spine, knee, shoulders, hips

    5

    Overall approach

    -20 points for every editing/cut/paste in video

    -20 points using notes or wall notes for each instance

    -10 points if order is illogical or fragmented

    -10 points for repeating the video due to not following instructions

    –

    -10  points for hesitation or evidence of lack of practice

    -5 points for not wearing a lab coat AND professional dress attire

    Video over 30 mins- video stopped at 30 mins and 10 points deducted in addition to point deductions for systems not covered. Faculty must watch the video to determine if all criteria were met to pass video.

    –

    Failure-  not using appropriate equipment;

    Failure-  to perform a system assessment as this is a complete physical exam

    Failure- not showing photo ID

    Total

     

    You MUST pass the video with 69.5% or higher or you will fail the course.

    NURS 6512-COMPREHENSIVE PHYSICAL EXAMINATION CHECKLIST

     

    Comments:

  • NURS 6512 Week 9: Assessment of Cognition and the Neurologic System

    NURS 6512 Week 9: Assessment of Cognition and the Neurologic System

    Week 9: Assessment of Cognition and the Neurologic System

                   
    NURS 6512-COMPREHENSIVE PHYSICAL EXAMINATION CHECKLIST

    The following list will be used to determine the grade for the physical examination demonstration.  It does not constitute a complete list of everything that could be included in a physical examination, but rather a list of those things that should be done at a minimum for every individual having a “complete physical examination”.

    BUY A PLAGIARISM-FREE PAPER HERE

    IMPORTANT INSTRUCTIONS: Adjust your camera to show a full view of both you and your patient volunteer, show your government issued photo ID/passport for verification of who you are, scan the room that you are using for verification that notes are not being used or posted, then begin the video. You may not take notes during the examination. Omitting these instructions or obtaining a score of less than 69.5% will result in a failure of the video assignment and the course. NURS 6512 Week 9: Assessment of Cognition and the Neurologic System.

    Possible

    Points

    Score

    Skin

    2

    Inspects all areas of body esp. feet

    2

    Head & Neck

    6

    Inspect & Palpates skull

    1

    Palpates lymph nodes for adenopathy

    2

    Palpates thyroid (with H2O/swallowing)

    2

    Palpates tracheal placement

    1

    Eyes

    12

    Checks visual acuity  (Snellen chart required)

    1

    Checks peripheral fields

    2

    Checks EOMs

    2

    Checks conjunctiva for pallor

    1

    Checks pupillary reaction

    1

    Opthalmoscopic exam (opthamoloscope is required)

    5

    describes discs, checks for microaneurysms,

    hemorrhages, neovascularization

    Ears, Nose,

    Sinuses, Mouth 

    Determines gross hearing/whisper test (Tuning Forks are required. Frequency of 500-1000Hz to be used)

    2

    8

    Otoscopic exam (describes landmarks) (otoscope is required)

    2

    Inspect & Assess Nares

    1

    Palpate & percuss  sinuses

    2

    Examines mouth (hard palate/soft palate, salivary glands, tongue, gag reflex)

    1

    Chest and Lungs

    8

    Inspect chest & Observes respiratory movements

    1

    Posterior chest

    5

    Palpates & percuss respiratory excursion. Assess  tactile fremitus; Thoracic  expansion

    Auscultates breath sounds

    Anterior chest

    2

    Palpate & percuss ant chest. Auscultate breath sounds

    Breasts

    Explanation only –do not demonstrate

    1

    1

    Palpates axillae, inspects breasts

    Palpates axillary lymph nodes

    Cardiovascular

    8

    Inspect & Observes neck veins and measures JVD (two pocket ruler required)

    1

    Palpates PMI and precordium

    2

    Auscultates cardiac sites (Aortic area, Pulmonic area, Tricuspid area, Mitral Area (Apex) and
    state sounds

    5

    With diaphragm and bell sitting position

    then diaphragm supine/left lateral decubitus

    Peripheral Vascular

    5

    Inspect & Palpates pulses: carotids, radials, tibialis, pedals

    2

    Palpates for lower extremity edema

    1

    Auscultates for  carotid bruit

    2

    Abdomen

    10

    Inspect & Auscultates bowel sounds

    1

    Auscultates renal arteries

    2

    Percuss liver to determine span

    NURS 6512 Week 9: Assessment of Cognition and the Neurologic System

     

    2

    Palpates abdomen for tenderness(light and deep palpation, including McBurney’s point and rebound tenderness)

    2

    Check for splenic & liver enlargement

    3

    Neurological

    30

    Mental status—MMSE or clock drawing

    1

    Cranial nerves:

    12

    Olfactory: smell

    Optic: visual acuity, fields

    Oculomotor, trochlear, abduces: EOMs

    Trigeminal: sensation & jaw strength

    Facial: frown, smile, corneal reflex

    Acoustic: gross hearing

    Glossopharyngeal, vagus: gag reflex

    Spinal accessory: shrug shoulders

    Hypoglossal: moves tongue

    Reflexes: all DTRs and Babinski (reflex hammer is required)

    5

    Sensory:

    L ight touch/monofilament on feet (Monofilament tool required)

    1

    Vibration

    1

    Stereognosis or graphesthesia

    1

    Motor:

    Strength—upper and lower extremities

    2

    Muscle tone

    2

    Gait

    1

    Cerebellar:

    Test for coordination(any coordination test covered in your text readings)

    1

    One test for balance

    1

    One test for meningeal irritation

    1

    One test for nerve root irritation

    1

    Musculoskeletal

    10

    Inspects spine

    1

    Palpates spine

    2

    Palpates major joints

    2

    (Shoulders, Hips, Knees, Elbows)

    Active ROM of spine, knee, shoulders, hips

    5

    Overall approach

    -20 points for every editing/cut/paste in video

    -20 points using notes or wall notes for each instance

    -10 points if order is illogical or fragmented

    -10 points for repeating the video due to not following instructions

    –

    -10  points for hesitation or evidence of lack of practice

    -5 points for not wearing a lab coat AND professional dress attire

    Video over 30 mins- video stopped at 30 mins and 10 points deducted in addition to point deductions for systems not covered. Faculty must watch the video to determine if all criteria were met to pass video.

    –

    Failure-  not using appropriate equipment;

    Failure-  to perform a system assessment as this is a complete physical exam

    Failure- not showing photo ID

    Total

     

    You MUST pass the video with 69.5% or higher or you will fail the course.

    Comments:

    A 63-year-old woman comes to your office because she’s been forgetting things…a young mother comes in concerned because her baby fails to make eye contact and is unresponsive to touch…a teenager comes in and a parent complains that the teen obsessively washes his hands.

    An array of neurological conditions could be causing the above symptoms. When assessing the neurologic system, it is vital to formulate an accurate diagnosis as early as possible to prevent continued damage and deterioration of a patient’s quality of life. NURS 6512 Week 9: Assessment of Cognition and the Neurologic System.

    This week, you will explore methods for assessing the cognition and the neurologic system.

    Learning Objectives – Week 9: Assessment of Cognition and the Neurologic System

    Students will:

    Evaluate abnormal neurological symptoms

    Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for cognition and the neurologic system

    Photo Credit: Kurt Drubbel/E+/Getty Images

    Learning Resources – Week 9: Assessment of Cognition and the Neurologic System

    Note:
     To access this week’s required library resources, please click on the link to the Course Readings List, found in the 
    Course Materials
    section of your Syllabus. NURS 6512 Week 9: Assessment of Cognition and the Neurologic System.

    Required Readings

    Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). 
    Seidel’s guide to physical examination
     (8th ed.). St. Louis, MO: Elsevier Mosby.

    Chapter 5, “Mental Status” (64-78)This chapter revolves around the mental status evaluation of an individual’s overall cognitive state. The chapter includes a list of mental abnormalities and their symptoms.

    Chapter 22, “Neurologic System” (pp. 544-580)The authors of this chapter explore the anatomy and physiology of the neurologic system. The authors also describe neurological examinations and potential findings.

    Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). 
    Advanced health assessment and clinical diagnosis in primary care
     (5th ed.). St. Louis, MO: Elsevier Mosby.

    Chapter 4, “Affective Changes” (pp. 33-46)This chapter outlines how to identify the potential cause of affective changes in a patient. The authors provide a suggested approach to the evaluation of this type of change, and they include specific tools that can be used as part of the diagnosis.

    Chapter 9, “Confusion in Older Adults” (pp. 97-109)This chapter focuses on causes of confusion in older adults, with an emphasis on dementia. The authors include suggested questions for taking a focused history, as well as what to look for in a physical examination.

    Chapter 13, “Dizziness” (pp. 148-157)Dizziness can be a symptom of many underlying conditions. This chapter outlines the questions to ask a patient in taking a focused history and different tests to use in a physical examination.

    Chapter 19, “Headache” (pp. 221-234)The focus of this chapter is the identification of the causes of headaches. The first step is to ensure that the headache is not a life-threatening condition. The authors give suggestions for taking a thorough history and performing a physical exam. NURS 6512 Week 9: Assessment of Cognition and the Neurologic System.

    Chapter 28, “Sleep Problems” (pp. 345–355)In this chapter, the authors highlight the main causes of sleep problems. They also provide possible questions to use in taking the patient’s history, things to look for when performing a physical exam, and possible laboratory and diagnostic studies that might be useful in making the diagnosis.

    Sullivan, D. D. (2019). 
    Guide to clinical documentation
     (3rd ed.). Philadelphia, PA: F. A. Davis.

    Chapter 2, “The Comprehensive History and Physical Exam” (“Cranial Nerves and Their Function” and “Grading Reflexes”; p. 29)

    Chapter 4, “Pediatric Preventative Care Visits” (” Neurological Reflexes That Should Be Tested During Infancy”; (p. 108)

    Chapter 9, “Prescription Writing and Electronic Prescribing” (pp. 195-206)

    Note:
     Download and review these Adult Examination Checklists and Physical Exam Summary to use during your practice neurological examination.

    Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Adult examination checklist: Guide for mental assessment. In 
    Mosby’s guide to physical examination
     (7th ed.). St. Louis, MO: Elsevier Mosby. This Adult Examination Checklist: Guide for Mental Assessment was published as a companion to 
    Seidel’s guide to physical examination
     (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

    Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Adult examination checklist: Guide for neurologic assessment. In 
    Mosby’s guide to physical examination
     (7th ed.). St. Louis, MO: Elsevier Mosby. This Adult Examination Checklist: Guide for Neurologic Assessment was published as a companion to 
    Seidel’s guide to physical examination
     (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

    Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Physical exam summary: Neurologic system. In 
    Mosby’s guide to physical examination
     (7th ed.). St. Louis, MO: Elsevier Mosby. This Neurologic System Physical Exam Summary was published as a companion to 
    Seidel’s guide to physical examination
     (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

    Bearden, S. T., & Nay, L. B. (2011). Utility of EEG in differential diagnosis of adults with unexplained acute alteration of mental status. 
    American Journal of Electroneurodiagnostic Technology, 51
    (2), 92–104. This article reviews the use of electrocenographs (EEG) to assist in differential diagnoses. The authors provide differential diagnostic scenarios in which the EEG was useful. NURS 6512 Week 9: Assessment of Cognition and the Neurologic System

    Athilingam, P., Visovsky, C., & Elliott, A. F. (2015). Cognitive screening in persons with chronic diseases in primary care: challenges and recommendations for practice. American Journal of Alzheimer’s Disease & Other Dementias, 30(6), 547–558. doi:10.1177/1533317515577127. Retrieved from the Walden Library Databases.

    Sinclair, A. J., Gadsby, R., Hillson, R., Forbes, A., & Bayer, A. J. (2013). Brief report: Use of the Mini-Cog as a screening tool for cognitive impairment in diabetes in primary care. Diabetes Research and Clinical Practice, 100(1), e23–e25. doi:10.1016/j.diabres.2013.01.001

    Retrieved from the Walden Library Databases.

    Roalf, D. R., Moberg, P. J., Xei, S. X., Wolk, D. A., Moelter, S. T., & Arnold, S. E. (2013). Comparative accuracies of two common screening instruments for classification of Alzheimer’s disease, mild cognitive impairment, and healthy aging. Alzheimer’s & Dementia, 9(5), 529–537. doi:10.1016/j.jalz.2012.10.001 Retrieved from http://www.alzheimersanddementia.com/article/S1552-5260(12)02463-6/abstract

    University of Virginia. (n.d.). 
    Introduction to radiology: An online interactive tutorial
    . Retrieved from http://www.med-ed.virginia.edu/courses/rad/index.html

    This website provides an introduction to radiology and imaging. For this week, focus on head CTs in neuroradiology.

    Required Media

    Online media for 
    Seidel’s Guide to Physical Examination

    It is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapters 5 and 22 that relate to the assessment of cognition and the neurologic system. Refer to the Week 4 Learning Resources area for access instructions.

    Optional Resources

    LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). 
    DeGowin’s diagnostic examination
     (10th ed.). New York, NY: McGraw Hill Medical.

    Chapter 14, “The Neurologic Examination” (pp. 683–765)This chapter provides an overview of the nervous system. The authors also explain the basics of neurological exams.

    Chapter 15, “Mental Status, Psychiatric, and Social Evaluations” (pp. 766–786)In this chapter, the authors provide a list of common psychiatric syndromes. The authors also explain the mental, psychiatric, and social evaluation process.

    Mahlknecht, P., Hotter, A., Hussl, A., Esterhammer, R., Schockey, M., & Seppi, K. (2010). Significance of MRI in diagnosis and differential diagnosis of Parkinson’s disease. 
    Neurodegenerative Diseases, 7
    (5), 300–318. NURS 6512 Week 9: Assessment of Cognition and the Neurologic System

    Discussion: Assessing Neurological Symptoms

    Imagine not being able to form new memories. This is the reality patients with anterograde amnesia face. Although this form of amnesia is rare, it can result from severe brain trauma. Anterograde amnesia demonstrates just how impactful brain disorders can be to a patient’s quality of living. Accurately assessing neurological symptoms is a complex process that involves the analysis of many factors.

    In this Discussion, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.

    Note:
     By 
    Day 1
    of this week, your Instructor will have assigned you to one of the following specific case studies for this Discussion. Also, your Discussion post should be in the Episodic/Focused SOAP Note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes have specific data included in every patient case. NURS 6512 Week 9: Assessment of Cognition and the Neurologic System

    Case 1:
     Headaches

    A 20-year-old male complains of experiencing intermittent headaches. The headaches diffuse all over the head, but the greatest intensity and pressure occurs above the eyes and spreads through the nose, cheekbones, and jaw.

    Case 2:
     Numbness and Pain

    A 47-year-old obese female complains of pain in her right wrist, with tingling and numbness in the thumb and index and middle fingers for the past 2 weeks. She has been frustrated because the pain causes her to drop her hair-styling tools.

    Case 3:
     Drooping of Face

    A 33-year-old female comes to your clinic alarmed about sudden “drooping” on the right side of the face that began this morning. She complains of excessive tearing and drooling on her right side as well.

    To prepare:

    With regard to the case study you were assigned:

    Review this week’s Learning Resources, and consider the insights they provide about the case study.

    Consider what history would be necessary to collect from the patient in the case study you were assigned.

    Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?

    Identify 
    at least five
     possible conditions that may be considered in a differential diagnosis for the patient.

    Note:
     Before you submit your initial post, replace the subject line (“Discussion – Week 9”) with “Review of Case Study ___.” Fill in the blank with the number of the case study you were assigned.

    By Day 3

    Post
     an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis and justify why you selected each.

    Note:
     For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on 
    Submit!

    Read
     a selection of your colleagues’ responses.

    By Day 6

    Respond
     to 
    at least two
     of your colleagues on 
    two
    different days who were assigned different case studies than you. Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition, and justify your reasoning. NURS 6512 Week 9: Assessment of Cognition and the Neurologic System

    Submission and Grading Information

    Grading Criteria

    To access your rubric:

    Week 9 Discussion Rubric

    Post by Day 3 and Respond by Day 6

    To participate in this Discussion:

    Week 9 Discussion

    Assignment (Optional): Practice Assessment: Neurological Examination

    Short of opening a patient’s cranium or requesting a brain scan, what can an advanced practice nurse do to determine the cause of neurological symptoms? A multitude of techniques can be used to generate a neurological diagnosis.

    In preparation for the Head-to-Toe Physical Assessment Video due in Week 10, it is recommended that you practice performing a neurological examination this week.

    Note:
     This is an 
    optional
     practice physical assessment. You do not have to capture a video of this assessment, as no submission is required.

    To prepare:

    Arrange an appropriate time and setting with your volunteer “patient” to perform a neurological examination.

    Download and review the Neurological Checklist provided in this week’s Learning Resources.

    Ensure that you have a plexor (reflex hammer) to perform the examination.

    To complete:

    Perform the neurological examination. Be sure to cover all of the areas listed in the checklist and to use the plexor appropriately.

    Looking Ahead: Head-to-Toe Physical Assessment Video

    In 
    Week 10
    , you will videotape yourself conducting a head-to-toe physical assessment.

    By Day 7 of Week 10

    This video is due. Refer to Week 10 for additional guidance.

    Week in Review

    This week,
     you properly applied the assessment techniques and diagnoses for cognition and the neurological system. In addition, you evaluated abnormal neurological symptoms and explained which physical exams and diagnostic tests would render the appropriate results needed to make a diagnosis.

    Next week,
    you will explore how to assess problems with the breasts, genitalia, rectum, and prostate while making the patient feel safe, listened to and cared about using a non-invasive approach. NURS 6512 Week 9: Assessment of Cognition and the Neurologic System