Tag: Clinical-Nursing

  • Developing Organizational Policies and Practices

    Assignment: Developing Organizational Policies and Practices

    Competing needs arise within any organization as employees seek to meet their targets and leaders seek to meet company goals. As a leader, successful management of these goals requires establishing priorities and allocating resources accordingly.

    Within a healthcare setting, the needs of the workforce, resources, and patients are often in conflict. Mandatory overtime, implementation of staffing ratios, use of unlicensed assisting personnel, and employer reductions of education benefits are examples of practices that might lead to conflicting needs in practice.

    Leaders can contribute to both the problem and the solution through policies, action, and inaction. In this Assignment, you will further develop the white paper you began work on in Module 1 by addressing competing needs within your organization. Developing Organizational Policies and Practices.

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    To Prepare:

    • Review the national healthcare issue/stressor you examined in your Assignment for Module 1, and review the analysis of the healthcare issue/stressor you selected. NOTE: The healthcare issue/stressor is HOSPITAL ACQUIRED PNEUMONIA

    • Identify and review two evidence-based scholarly resources that focus on proposed policies/practices to apply to your selected healthcare issue/stressor. Developing Organizational Policies and Practices.

    • Reflect on the feedback you received from your colleagues on your Discussion post regarding competing needs.

    The Assignment (4-pages):

    Developing Organizational Policies and Practices

    Add a section to the paper you submitted in Module 1. The new section should address the following:

    • Identify and describe at least two competing needs impacting your selected healthcare issue/stressor.

    • Describe a relevant policy or practice in your organization that may influence your selected healthcare issue/stressor.

    • Critique the policy for ethical considerations, and explain the policy’s strengths and challenges in promoting ethics.

    • Recommend one or more policy or practice changes designed to balance the competing needs of resources, workers, and patients, while addressing any ethical shortcomings of the existing policies. Be specific and provide examples. Developing Organizational Policies and Practices

    • Cite evidence that informs the healthcare issue/stressor and/or the policies, and provide two scholarly resources in support of your policy or practice recommendations.

    Required Readings

    American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Author. Retrieved from https://www.nursingworld.org/coe-view-only

    Note: Review all, with special attention to “Provision 6” (pp. 23–26).

    Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6. doi:10.3912/OJIN.Vol23No01Man06. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.html Developing Organizational Policies and Practices

    Milliken, A. (2018). Ethical awareness: What it is and why it matters. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 1. doi:10.3912/OJIN.Vol23No01Man01. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Awareness.html

    Required Media

    Laureate Education (Producer). (2012). Ethical, Moral, and Legal Leadership [Video file]. Baltimore, MD: Author.

    Laureate Education (Producer). (2009b). Working with Individuals [Video file]. Baltimore, MD: Author. Developing Organizational Policies and Practices

  • NURS 7101: Theoretical and Philosophical Foundations of Nursing Science

    NURS 7101: Theoretical and Philosophical Foundations of Nursing Science

    Darla has just been hired as the chief nurse practitioner at a community health clinic. Upon starting her new job, Darla notices that the clinic serves a disproportionately large percentage of female immigrants, many of whom have sexually transmitted infections and/or appear to be victims of sexual and physical abuse. Darla immediately begins to analyze various factors that may be contributing to this phenomenon, including the possibility of sex trafficking in the neighborhood.

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    Describe how Darla might use feminist theory, critical social theory, or Human Liberation theory (choose one) to better understand the female immigrants’ situation and work to improve their situation. Consider both Darla’s role and the role of the women in seeking liberation/emancipation/social justice. (DNP Essential: #8, Advanced Nursing Practice). NURS 7101: Theoretical and Philosophical Foundations of Nursing Science

  • The Importance of Nursing Informatics and the Multidisciplinary teams

    The Importance of Nursing Informatics and the Multidisciplinary teams

    As a healthcare professional, it is imperative to have excellent communication skills. Nurses should always know what is going on with their patients, too many times; nurses miss urgent orders due to a lack of communication. Nursing informatics is essential; having computerized charting makes it easier for the nurse to check orders and to know the plan of care.

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    According to YoeniTo, improve the quality of nursing care, we developed and evaluated an Electronic Medical Record (EMR) program designed to maximize productivity and efficiency in our nursing documentation system. Electronic medical records are useful communication tools that can alert anyone on the interdisciplinary team of the patient’s progress. An electronic document can share relevant patient information among care providers to coordinate care, aid in decision-making, and achieve improvements in quality (Burnett, 2016). Benefits of EMRs are they provide a virtual state of the art multidisciplinary rounding record, so when doctors are not available, they can log on and access what every interdisciplinary team discussed. EMRs increases efficiency’s, reduce readmit rate due to patient having access to their medical records online, decreases in readmissions, and have fewer mistakes and redundancies then paper charting. However, I believe that the patients should always have a physician on call available to answer patients’ questions to cut down on unnecessary ER visits. The Importance of Nursing Informatics and the Multidisciplinary teams

    Consistently getting team members together, for instance, requires constant coordination; with the electronic medical record, doctors can pull up labs and diagnostic tests with patients and families. Computers have proven to be a great communicator between teams in the health care setting. Nursing informatics provides a haven for better patient care when dealing with Large multidisciplinary teams and deliver better outcomes for patients.

    References:

    Burnett, M. (2016). Does Use of an Electronic Display of a Discharge Clinical Summary Improve the Perceived Quality of Multidisciplinary Discharge Rounds and Care Coordination?. On-Line Journal of Nursing Informatics, 20(1). The Importance of Nursing Informatics and the Multidisciplinary teams

    yoenyi@samsung.co.kr, E. (n.d.). Retrieved from https://synapse.koreamed.org/search.php?where=aview&id=10.4258/jksmi.2000.6.4.87&code=0088JKSMI&vmode=PUBREADER

    Please responde to Deana Gil ‘s post below offering one or more additional interaction strategies in support of the examples/observations shared or by offering further insight to the thoughts shared about the future of these interactions.

    please and add 3 refrences with your response.

    Nurses must be able to provide safe care and treatment to patients. Most of my career was working in a Level one Trauma Center Emergency Department (ED) in downtown Phoenix, Arizona. In the ED,

    we had one system that we used for charting, and the rest of the hospital had a different charting system. If our patient was admitted to the hospital, we had to print off the ED visit note and send it with

    the patient for the nurses receiving the patient. This created problems. Just a few of these were: if the patient had medications that were ordered in the ED, but were not given for whatever reason, the

    receiving nurse was not aware unless the sending nurse specifically gave it in report, if the patient had STAT lab orders, the ED nurse would not see these as the admitting providers would put them in the

    inpatient admitting orders, and at times the admitting provider would discontinue medications that the ED nurse had orders to give by the ED provider before sending them to the floor. The Importance of Nursing Informatics and the Multidisciplinary teams

    By getting input from ED staff, providers, and inpatient nurses, the nurse informaticist (NI) advocated for the team to administration. They helped implement the ED charting system that was the same

    system that the rest of the hospital had. The NIs include staff in change decisions to ensure the change would not have negative effects on the workflow and to increase staff buy-in (Tyler, 2019, p. 19). The

    NI’s trained a staff member on each shift to be a superuser and helped during the transition to the new program. As stated by Tyler (2019), ”The informatics nurse is essential to the success of super users

    in any organization” (p. 19). The super users had direct communication with the NI’s and were able to alert them to issues or ideas for a smoother process recommended by the staff.

    NI’s trained the providers and the ED staff on using the new system. When the providers needed changes in the system for different documentation within the system, the NI collaborated with the charting

    company, and the changes were made. The Importance of Nursing Informatics and the Multidisciplinary teams

    One strategy recommendation for improvement would be to have the NI come to the unit once a week for any suggestions or complaints and have a suggestion box for those that may be busy or not

    present when the NI was there. The form placed in the box would have an answer section that would go back to the person that wrote it with a week return response timeframe.

    Nursing informatics have the benefit of their ability to interact with various clinicians, clinical practice knowledge and can relate to staff with the experience the workflow change (Mastrian & McGonigle,

    2018, p. 257). As we rely on technology in so many aspects of our lives, NI’s are a necessity in healthcare. The use of NI’s and their specialty will enable hospital staff to have the most recent evidence-based

    practice, patient safety with alerts and check-offs in the electronic medical record (EMR), and track specific trends good and bad for change and education. Nursing executives can use nursing informatics to help with things like budgeting tools and trending costs and savings (McGonigle, Hunter, Sipes, & Hebda, 2014, p. 324).

    References

    Mastrian, K. G., & McGonigle, D. (2018). Nursing informatics and the foundation of knowledge (4th ed.). Jones & Bartlett.

    McGonigle, D., Hunter, K., Sipes, C., & Hebda, T. (2014). Why nurses need to understand nursing informatics: Everyday informatics the official voice of perioperative nursing the official voice of perioperative

    nursing. AORN Journal, 100(3), 324-327. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1016/j.aorn.2014.06.012

    Tyler, D. D. (2019). A day in the life of a nurse informaticist. Journal of Informatics Nursing, 4(1), 18-20. Retrieved from https://ezp.waldenulibrary.org/login? The Importance of Nursing Informatics and the Multidisciplinary teams

    qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview%2F2194530266%3Fac

    Tyler, D. D. (2019). A day in the life of a nurse informaticist: Organizational change. Journal of Informatics Nursing, 4(2), 18-20. Retrieved from https://ezp.waldenulibrary.org/login?

    qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview%2F2291990769%3Facc The Importance of Nursing Informatics and the Multidisciplinary teams

  • Contemporary Issues and Trends in Nursing

    Contemporary Issues and Trends in Nursing

    Identify one specific contemporary issue or trend that you are interested in learning more about. Choose from the categories below. For example you might want to learn more about why it is more difficult for some groups to receive care than others, which would fall under Client Access to Care. Or, you might want to compare nursing practice in the U.S. with how nurses practice in Japan, which would fall under the category of Global Healthcare and Nursing.

    Global Healthcare and Nursing

    Healthcare Reform

    U.S. Healthcare Financing

    Nursing’s Role in the U.S. Healthcare System

    Integrative Healthcare

    Nursing Leadership and Management

    Nursing Education

    Nursing Practice

    Nursing Professionalism

    Advancing Nursing as a Profession

    Client Access to Care

    Delivering Client Care

    Interdisciplinary Teamwork and Collaboration

    Ethical Practices in Healthcare

    Quality and Safety in Healthcare Delivery

    Health/Nursing Informatics

    Once the issue or trend is identified, find five important/significant facts about it, substantiated by an evidence-based article. Include the article in your submission.

    Create an 8-10 slide PowerPoint presentation with speaker notes, in-text citations and a reference page slide. Contemporary Issues and Trends in Nursing

  • Benchmark – Effective Approaches in Leadership and Management

    In this Benchmark – Effective Approaches in Leadership and Management assignment, you will be writing a 1,000-1,250 word paper describing the differing approaches of nursing leaders and managers to issues in practice. To complete this assignment, do the following:

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    Select an issue from the following list: bullying, unit closers and restructuring, floating, nurse turnover, nurse staffing ratios, use of contract employees (i.e., registry and travel nurses), or magnet designation.

    Describe the selected issue. Discuss how it impacts quality of care and patient safety in the setting in which it occurs.

    Discuss how professional standards of practice should be demonstrated in this situation to help rectify the issue or maintain professional conduct. Benchmark – Effective Approaches in Leadership and Management.

    Explain the differing roles of nursing leaders and nursing managers in this instance and discuss the different approaches they take to address the selected issue and promote patient safety and quality care. Support your rationale by using the theories, principles, skills, and roles of the leader versus manager described in your readings.

    Discuss what additional aspects mangers and leaders would need to initiate in order to ensure professionalism throughout diverse health care settings while addressing the selected issue. Benchmark – Effective Approaches in Leadership and Management.

    Describe a leadership style that would best address the chosen issue. Explain why this style could be successful in this setting.

    Use at least three peer-reviewed journal articles other than those presented in your text or provided in the course.

    Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. Benchmark – Effective Approaches in Leadership and Management.

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

    You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

    This benchmark assignment assesses the following programmatic competencies:

    RN to BSN

    1.1: Exemplify professionalism in diverse health care settings.

    1.3: Exercise professional nursing leadership and management roles in the promotion of patient safety and quality care.

    3.4: Demonstrate professional standards of practice. Benchmark – Effective Approaches in Leadership and Management.

  • NURS 6512 Week 6 Midterm Exam: Advanced Health Assessment

    NURS 6512 
    Week 6 Midterm Exam: Advanced Health Assessment: Walden University

     

    1. Before performing an abdominal examination, the examiner should:

    2. During an interview, tears appear in the patient’s eyes and his voice becomes shaky. Initially, you should:

    3. Which of the following is the most accurate reflection of an individual’s food intake?

    4. Percussing at the right midclavicular line, below the umbilicus, and continuing upward is the correct technique for locating the:

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    5. A fixed image of any group that rejects its potential for originality or individuality is known as a:

    6. Peritonitis produces bowel sounds that are

    7. Brittle nails are typical findings in:

    8. Which of the following is an expected change in the assessment of the thyroid during pregnancy?

    9. You are planning to palpate the abdomen of your patient. Which part of the examiner’s hand is best for palpating vibration?

    10. A 5-year-old child presents with nasal congestion and a headache to assess for sinus tenderness you should palpate over the: NURS 6512 Week 6 Midterm Exam: Advanced Health Assessment

    11. During physical examination of a 30-year-old Chinese man you notice a slight asymmetry of his face. the cranial nerve examination is normal. Your best action is to

    12. Unusual white areas on the skin may be due to

    13. You are using an ophthalmoscope to examine a patient’s inner eye. You rotate the lens selector clockwise, then counterclockwise to compensate for:

    14. Mrs. Webb is a 38-year old patient who has been changing her lifestyle to eat in a healthy way and lose weight: during your health promotion education regarding her nutritional status, you explain the function of dietary protein as:

    15. Mr. Akins is a 78-y/o patient who presents to the clinic with complaints of hearing loss. Which of the following are changes in hearing that occur in the elderly? Select all that apply.

    16. The most superior part of the stomach is the

    17. Mrs. Grace is a 58-year-old patient who has a diagnosis of pernicious anemia. Which B vitamin is deficient in patients with pernicious anemia?

    18. A 51-y/o woman calls with complaints of weight loss and constipation. She reports enlarged hemorrhoids and rectal bleeding. You advise her to: NURS 6512 Week 6 Midterm Exam: Advanced Health Assessment

    19. Placing the base of a vibrating tuning fork on the midline vertex of the patient’s head is a test for:

    20. Which technique is most likely to result in the patients understanding of questions?

    21. Mr. Williams, age 25, has recovered recently from an upper and lower respiratory infection. He describes a long-standing nasal dripping. He is seeking treatment for a mild hearing loss that has not gone away. Information concerning his chronic postnasal drip should be documented within which section of the history?

    22. Nasal symptoms that imply an allergic response include:

    23. Mr. Franklin is speaking with you the health care provider, about his respiratory problem. Mr. Franklin says, “I’ve had this cough for 3 days and it’s getting worse.” You reply, “Tell me more about your cough.” Mr. Franklin states, “I wish I could tell you more, that’s why I am here! You tell me what’s wrong.” Which caregiver response would be the most appropriate for enhancing communication?

    24. When taking a history, you should:

    25. Which of the following formats would be used for visits that address problems not yet identified in the problem-oriented medical record (POMR)?

    26. Mr. and Mrs. Johnson have presented to the office with their infant son with complaints of ear drainage. When examining an infant’s middle ear, the nurse should use one hand to stabilize the otoscope against the head while using the other hand to:

    27. Which question would be considered a leading question?

    28. Mr. Black is a 44y/o patient who presents to the clinic with complaints of neck pain that he thinks is from his job involving computer data entry.  As the examiner, you are checking the range of motion in his neck and note the greatest degree of cervical mobility is at?

    29. The term denoting the caregiver’s need to do no harm to the patient is:

    30. A tool used to screen adolescents for alcoholism is the:

    31. Under normal circumstances, how much water is lost daily by the body?

    32. You have just completed a skin assessment on Mr. Baker. During your assessment, you have transilluminated a skin lesion. During the physical examination, you know that skin lesions are transilluminated to distinguish:

    33. Mr. Mills is a 55/y/o patient who presents to the office for an initial visit for health promotion. A survey of mobility and activities of activities of daily living is part of a(n):

    34. Sweat glands, hair, and nails are all formed from?

    35. A brief statement of the reason the patient is seeking health care is called the?

    36. Which part of the information contained in the patient’s record may be used in court?

    37. Which cranial nerves innervate the face? NURS 6512 Week 6 Midterm Exam: Advanced Health Assessment

    38. In counseling a client regarding nutrition education, you explain that linoleic acid, a major fatty acid, is thought to be essential for?

    39. When are open-ended questions generally most useful?

    40. Knowledge of the culture or cultures represented by the patient should be used to?

    41. Mrs. Berger is a 39-year-old woman who presents with a complaint of epigastric abdominal pain. You have completed the inspection of the abdomen. What is your next step in the assessment process?

    42. A guideline for history taking is for caregivers to?

    43. Which type of speculum should be used to examine a patient’s tympanic membrane?

    44. You are palpating a patient’s thyroid and find that its broadest dimension measures 4cm. the right lobe is 25% larger than the left. These data would indicate?

    45. Mr. L. presents to the clinic with severe groin pain and a history of kidney stones. Mr. L.’s son tells you that, for religious reasons, his father wishes to keep any stone that is passed into the urine filter that he has been using. What is your most appropriate response?

    46. Before performing an abdominal examination, the examiner should?

    47. You are examining a pregnant patient and have noted a vascular lesion. When you blanche over the vascular lesion, the site blanches and refills evenly from the center outward. The nurse documents this lesion as a?

    48. As you explain your patient’s condition to her husband, you notice that he is leaning toward you and pointedly blinking his eyes. Knowing that he is from England, your most appropriate response to this behavior is to?

    49. When palpating the abdomen, you should note whether the liver is enlarged in the?

    50. Expected normal percussion tones include?

    51. Mr. Abdul is a 40-year-old Middle Eastern man who presents to the office for a first visit with the complaint of new abdominal pain. You ate concerned about violating a cultural prohibition when you prepare to do his rectal examination. The best tactic would be to?

    52. Fluorescing lesions are best distinguished using a(n)?

    53. Mrs. Hartzell is a 34-year-old patient who has presented for nutritional counseling because she is a vegetarian. Deficiency of which of the following is a concern in the vegetarian diet?

    54. Underestimation of blood pressure will occur if the blood pressure cuff’s width covers?

    55. Mrs. Britton is a 34-year-old patient who presents to the office with complaints of skin rashes. You have noted a 4’3cm, rough, elevated area of psoriasis. This is an example of a? NURS 6512 Week 6 Midterm Exam: Advanced Health Assessment

    56. Penicillin is considered a?

    57. Small, minute bruises are called?

    58. After thorough inspection of the abdomen, the next assessment step is?

    59. When you are questioning a patient regarding alcohol intake, she tells you that she is only a social drinker. Which initial response is appropriate?

    60. Regardless of the origin, discharge is described by noting?

    61. Recommended carbohydrate content of total dietary intake (% total calories) is?

    62. Tuning forks with a frequency of 500 to 1000 Hz are most commonly used to measure?

    63. Auscultation should be carried out last, except when examining the?

    64. Mr. Kevin Marks is a new health care provider. What is the best method to develop cultural competence?

    65. Which of the following is an “ABCD” characteristic of malignant melanoma?

    66. Tracheal tug suggests the presence of a(n)?

    67. Your patient presents with symptoms that lead you to suspect acute appendicitis. Which assessment finding is least likely to be associated with this condition early in its course?

    68. The review of systems is a component of the:

    69. Cherry angiomas are a common finding in:

    70. Mr. Donalds is a 45-year-old roofer. Your inspection to determine color variations of the skin is best conducted:

    71. To correctly document absent bowel sounds, one must listen continuously for:

    72. The adult recommended dietary fat intake should be ____g/day.

    73. Mr. Jones is a 45-year-old patient who presents for a physical examination. On examination, you note costochondral beading, enlarged skull, and bowed legs and diagnose him with rickets. A deficiency of which fat-soluble micronutrient can result in rickets?

    74. A flat, nonplapable lesion is described as a macule if the diameter is:

    75. Mrs. Raymonds is a 24-year-old patient who has presented for a routine concern over her current weight.  In your patient teaching with her, you explain the importance of macronutrients. Which of the following is a macronutrient?

    76. Which of the following organs is part of the alimentary tract?

    77. Mr. Sanchez is a 45-year-old gentleman who has presented to the office for a physical examination to establish a new primary care health care provider. Which of the following describes a physical, not a cultural, differentiator?

    78. To approximate vocal frequencies, which tuning fork should be used to assess hearing?

    79. During percussion, a dull tone is expected to be heard over:

    80. The attitudes of the health care professional:

    81. When recording physical findings, which data are recorded first for all systems?

    82. Spasmodic muscular contractions of the head, face, or neck are called:

    83. Which of the following occurs when firm pressure is used to apply the stethoscope’s bell end-piece to the skin?

    84. Differential diagnoses belong in the: NURS 6512 Week 6 Midterm Exam: Advanced Health Assessment

    85. Pigmented, raised, warty lesions over the face and trunk should be assessed by an experienced practitioner who can distinguish:

    86. Mr. Walter’s, a 32-year-old patient, tells you that his ears are “stopped up.” An objective assessment of this complaint is achieved by using the:

    87. Mrs. Leonard brings her newborn infant into the pediatrician’s office for a first well-baby visit. As the health care provider, you teach her that newborns are more vulnerable to hypothermia due to:

    88. Tympanic thermometers measure body temperature when a probe is placed:

    89. A serous membrane that lines the abdominal cavity and forms a protective cover for many abdominal structures is the:

    90. White, rounded, or oval ulcerations surrounded by a red halo and found on the oral mucosa are:

    91. When assessing abdominal pain in a college-age woman, one must include:

    92. Your patient is complaining of acute, intense sharp epigastric pain that radiates to the back and left scapula with nausea and vomiting. Based on this history, your prioritized physical examination should be to:

    93. The infant should be placed in which position to have his or her height or length measured?

    94. Mr. Marks is a 66-year-old patient who presents for a physical examination to the clinic. Which question has the most potential for exploring a patient’s cultural beliefs related to a health problem?

    95. Which of the following is the most vital nutrient?

    96. What finding is unique to the documentation of a physical examination of an infant?

    97. Mrs. G. reports an increase in her alcohol intake over the past 5 years. To screen her for problem drinking, you would use the:

    98. Mr. D. complains of a headache. During the history he mentions his use of alcohol and illicit drugs. This information would most likely belong in the:

    99. You are completing a general physical examination on Mr. Rock, a 39-year-old man with complaints of constipation. When examining a patient with tense abdominal musculature, a helpful technique is to have the patient:

    100. When communicating with older children and teenagers, you should be sensitive to their:

    101
    . 
    Periods of silence during the interview can serve important purposes, such as: NURS 6512 Week 6 Midterm Exam: Advanced Health Assessment

  • NR 509 Week 3 Shadow Health Neurological Physical Assessment Assignment

    NR 509 Week 3 Shadow Health Neurological Physical Assessment Assignment

    Pre Brief

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

    .

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

    Chat us on the right bottom corner below to order

    Results: 
    Transcript

    Results: 
    Subjective Data Collection

    Results: 
    Objective Data Collection

    Results: 
    Education & Empathy

    Results: 
    Documentation / Electronic Health Record

    Results: 
    Pre – Survey Lifespan

    Results: 
    Review Questions

    Results: 
    Self-Reflection

    NR 509 Week 3 Shadow Health Neurological Physical Assessment Assignment

     

    Objective Data Collection: 36.75 of 37 (99.32%)

     Correct

     Partially correct

     Incorrect

     Missed

    Confirmed orientation

    1 of 1 point

     

    To Person (1/3 point)

     Oriented to person

     Not oriented to person

    To Place (1/3 point)

     Oriented to place

     Not oriented to place

    To Time (1/3 point)

     Oriented to time

     Not oriented to time

     Evaluated abstract thinking

    1 of 1 point

     

    Abstractness (1/2 point)

     Abstract

     Concrete

    Relevance (1/2 point)

     Relevant

     Not relevant

     Evaluated attention span

    1 of 1 point

     

    Serial 7s Test (1/1 point)

     Accurate

     Not accurate

     Evaluated comprehension

    1 of 1 point

     

    Observations (1/1 point)

     Able to follow instructions

     Unable to follow instructions

     Evaluated general knowledge

    1 of 1 point

     

    Accuracy (1/1 point)

     Accurate

     Not accurate

     Evaluated judgment

    1 of 1 point

     

    Observations (1/1 point)

     Intact

     Not intact

     
    Evaluated memory

    1 of 1 point

     

    Remote Memory (1/3 point)

     Intact

     Not intact

    Immediate Memory (1/3 point)

     Intact

     Not intact

    New Learning Ability (1/3 point)

     Accurate

     Not accurate

     Observed vocabulary

    1 of 1 point

     

    Complexity (1/1 point)

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

     Not expected complexity

     Observed articulation

    1 of 1 point

     

    Observations (1/1 point)

     No observed problems with pronunciation or expression

     Imprecise pronunciation of consonants

     Slurring

     Hesitation

     Stutter

    Tested olfactory nerve

    1 of 1 point

     

    Sense Of Smell (1/2 point)

     Able to discriminate

     Not able to discriminate

    Symmetric (1/2 point)

     Symmetric bilaterally

     Asymmetric

    Tested visual acuity (optic nerve)

    1 of 1 point

     

    Right (1/2 point)

     20/100

     20/70

     20/50

     20/40

     20/30

     20/25

     20/20

     20/15

     20/13

     20/10

    Left (1/2 point)

     20/100

     20/70

     20/50

     20/40

     20/30

     20/25

     20/20

     20/15

     20/13

     20/10

    Examined retina with ophthalmoscope (optic nerve)

    0.75 of 1 point

     

    Right: Fundus (No point)

     No visible abnormal findings

     Myelinated nerve fibers

     Papilledema

    .

    .

    .

    Subjective Data Collection: 20 of 20 (100.0%)

    Hover To Reveal…

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

    Found:

    Indicates an item that you found.

    Available:

    Indicates an item that is available to be found.

    Category

    Scored Items

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

    Patient Data

    Not Scored

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

    Chief Complaint

    Finding:

    Established chief complaint

    Finding:

    Reports recent “fender bender”

    (Found)

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

    Example Question:

    Why are you seeking treatment today?

    Finding:

    Reports headaches

    (Found)

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

    Example Question:

    Have you had any headaches?

    Finding:

    Reports neck symptoms

    (Found)

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

    Example Question:

    Have you had any neck stiffness?

    History of Present Illness

    Finding:

    Asked about onset of symptoms

    Finding:

    Reports accident occurred 1 week ago

    (Available)

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

    Example Question:

    When did the accident happen?

    Finding:

    Reports symptoms began 2 days after accident

    (Found)

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

    Example Question:

    When did the headaches begin?

    Finding:

    Followed up on details of car accident

    Finding:

    Denies loss of consciousness

    (Found)

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

    Example Question:

    Did you lose consciousness during the car accident?

    Finding:

    Reports low vehicle speed

    (Found)

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

    Example Question:

    How fast was the car going?

    Finding:

    Reports wearing seatbelt

    .

    .

    .

     

    Transcript

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

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

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

    Greet

    Hey.

    What brings you to the clinic today?

    Question

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

    Am sorry to hear that you are having headaches

    Empathize

    Thanks for saying that.

    Have you had any neck stiffness?

    Question

    Yeah.

    When did the neck stiffness begin?

    Question

    My neck started hurting about two days after the accident.

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

    Question

    Am sorry that you got an accident

    Empathize

    Thanks.

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

    Question

     

    .

    .

    .

     

    Review Questions
    Activity Time: 6 min

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

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

    Achilles

    Biceps

    Patellar (Correct Response)

    Triceps

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

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

    Odynophagia

    Febrile reaction

    Idiopathic spinal reaction

    Autonomic dysreflexia (Correct Response)

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

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

    Lack of facial expression

    Festination

    Cogwheel rigidity

    Intention tremors (Correct Response)

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

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

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

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

     

     

    Lifespan
    Activity Time: 10 min

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

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

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

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

    Student Response:
    Differential diagnosis include stroke…

  • NR 602 MIDTERM STUDY GUIDE

    NR 602 Midterm Study Guide

    Week 1: Early child development notes (chapter 6):

    Toddler: 12-24 months

    Preschoolers: 2-5 years old

    WHO growth charts should be used to measure weight and length for children less than 24 months

    CDC weight and length charts used for children older than 24 months

    Average 24 month weighs 26 lbs, length 33.5 in and HC 18.5 in

    Most have no palpable fontanelle by 12 months NR 602 Midterm Study Guide

    Ant fontanelle closes by 18-19 months

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    3-6 yrs weight gain expectation is 4.5-6.5 lbs/year

    3-6 yrs height gain expectation is 2.5-3.5 inches/yr

    4 yrs length at birth has doubled

    4-5 years old legs grow faster than rest of the body

    Use of dominant hand may appear as early as 8-12 months generally emerges 2-4 years old; handedness established at 5yrs

    May develop bowel and bladder control by age 3, but many will not. Boys usually take longer than girls to maintain bedtime bladder control.

    Articulation:

    -24 months- 25% is understood by a stranger

    -24m-36m- 66% is understood by a stranger

    -3 years old- 90% should be understood by a stranger

    3 and 4-year-old have a normal hesitance or show stuttering, considered abnormal if beyond 5 years of age

    Speech problems often can be from lack of stimulation, hearing problems, ear infections, developmental delay. Early detection important. NR 602 Midterm Study Guide

    Lexicon:

    girls typically say their first word between 8-11 months; boys by 14 months

    2 year olds: have more than 200 words in their vocabulary

    3 years old: 900 words in vocabulary

    3-4 yrs old: able to follow simple commands, talks incessantly

    4-5 year olds: add at least 50 new words a month; 1500-2100 words in vocabulary (including names, coins, colors, knows days of the week) NR 602 Midterm Study Guide

    5 year olds: should be able to define certain words with other words (cup: something you drink with)

    Syntax:

    8 months: develop receptive language- they understand what a word means before they are able to use it themselves

    12-28 months: use holophrases (single words) to express whole ideas

    18 months: use telegraphic speech (get milk, go bye-bye)

    2 years old: short sentences

    3 years old: add plurals, 3-4 word sentences

    4 years old: past tense

    5 years old: syntax is close to adult style, 5-6 word sentences NR 602 Midterm Study Guide

  • NR 509 Week 3 Shadow Health Musculoskeletal Physical Assessment Assignment

    NR 509 Week 3 Shadow Health Musculoskeletal Physical Assessment Assignment

    Pre Brief

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

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    Results Included:

    Overview

    Transcript

    Subjective Data Collection

    Objective Data Collection

    Education & Empathy

    Documentation

    Lifespan

    Review Questions

    Self – Reflection

    NR 509 Week 3 Shadow Health Musculoskeletal Physical Assessment Assignment

  • NR 511 WEEK 1

    NR 511 WEEK 1

    Define diagnostic reasoning.

    Identify subjective & objective data.

    Identify the components of the HPI.

    Develop an appropriate differential.

    Describe the differences between medical billing and medical coding.

    Compare and contrast the two coding classification systems that are currently used in the U.S. healthcare system.

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    Discuss how specificity, sensitivity, and predictive value contribute to the usefulness of diagnostic data.

    Discuss the elements that need to be considered when developing a plan.

    Describe the components of medical decision making in E&M coding.

    Correctly order the E&M office visit codes based on complexity from least to most complex

    Define the components of a SOAP note.

    Discuss a minimum of three purposes of the written history and physical in relation to the importance of documentation. NR 511 WEEK 1

    Accurately document why every procedure code must have a corresponding diagnosis code.

    Correctly identify a patient as new or established given the historical information.

    Identify the three components required in determining an outpatient, office visit E&M code.

    Describe the components of medical decision making in E&M coding.

    Explain what a “well rounded” clinical experience means.

    Discuss the maximum number of hours that time can … spent “rounding” in a facility.

    Discuss nine things that must … documented when inputting data into clinical encounter logs.

    Explain each part of the acronym the SNAPPS presentation. NR 511 WEEK 1