Nurse Manager Skills Inventory Essay

Nurse Manager Skills Inventory Essay

http://www.aone.org/resources/nurse-manager-skills-inventory.pdf

Write a reflection of 750-1,000 words in which you identify your strengths and weaknesses related to the four content areas below:

Personal and professional accountability
Career planning
Personal journey disciplines
Reflective practice reference behaviors/tenets
Discuss how you will use your current leadership skill set to advocate for change in your workplace.
Identify one personal goal for your leadership growth and discuss your implementation plan to achieve that goal.
A minimum of Five scholarly references are required for this assignment. solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, an abstract is not required, CITE WEBSITE SOURCE
You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes. Nurse Manager Skills Inventory Essay
Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.
Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.
The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)
Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.
Weekly Participation

Nurse Manager Skills Inventory Essay

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Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality
Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes
I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.
LopesWrite Policy
For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy
The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication
Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.
Nurse Manager Skills Inventory Essay

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NURS 6052 DQ Developing a Culture of Evidence-Based Practice

NURS 6052 DQ Developing a Culture of Evidence-Based Practice

As your Evidence-Based Practice skills grow, you may be called upon to share your expertise with others. While Evidence-Based Practice practice is often conducted with unique outcomes in mind, Evidence-Based Practice practitioners who share their results can both add to the general body of knowledge and serve as an advocate for the application of EBP.
In this Discussion, you will explore strategies for disseminating EBP within your organization, community, or industry.
To Prepare:
Review the Resources and reflect on the various strategies presented throughout the course that may be helpful in disseminating effective and widely cited EBP.
This may include unit-level or organizational-level presentations, poster presentations, and podium presentations at organizational, local, regional, state, and national levels, as well as publication in peer-reviewed journals.
Reflect on which type of dissemination strategy you might use to communicate EBP.
By Day 3 of Week 10
Post at least two dissemination strategies you would be most inclined to use and explain why. Explain which dissemination strategies you would be least inclined to use and explain why. Identify at least two barriers you might encounter when using the dissemination strategies you are most inclined to use. Be specific and provide examples. Explain how you might overcome the barriers you identified.
By Day 6 of Week 10
Respond to at least two of your colleagues on two different days by offering additional ideas to overcome the barriers to strategies suggested by your colleagues and/or by offering additional ideas to facilitate dissemination.
Creating a Culture of Evidence-Based Practice (EBP)
There is diverse information on evidence in health topics and medical issues, nurses have abundance of medical information, the challenge is adopting the information so that it can contribute in changing the practices and in showing evidence to other medical practitioners. Organizational policies and cultures play an influential role in resisting the changes or supporting the changes. Some of the changes have the capability of improving the effectiveness, quality and efficiency attached to the health care facilities.

NURS 6052 DQ Developing a Culture of Evidence-Based Practice

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Organizational culture is shaped by the beliefs, shared values, and norms displayed in an organization. The strategy is supported by the members of the organization once it is aligned to the organizational culture of the health care facility (Gale & Schaffer, 2009). EBP is part of the strategies designed to adopt changes in improving patient care. Health care facilities have different strategies that can be used in promoting and facilitating EBP. Common strategies of supporting EBP are connected to facilitation, managerial support, and a receptive culture among others (Marshall et al., 2003). Leaders in the healthcare centers are struggling in balancing EBP and the vision of the organizations.
Common barriers to the adoption of EBP are attached to lack of time, inadequate supplies/equipment, limited staff, unsupportive organizational culture, and insufficient time. EBP is facilitated by a supportive organizational culture, readiness for the organization to adopt changes, personal interest in EBP among the nurses, and in addressing the needs of the patients. In adapting to EBP changes, issues of facilitators and barriers in adopting EBP must be addressed.
Strategies and policies emerge from the organizational culture; Nurses can engage various strategies in advancing changes related to EBP. Organizational policies and cultures play an influential role in resisting the changes or supporting the changes
References
Gale, B. P. & Schaffer, M. A. (2009). Organizational Readiness for Evidence-Based Practice. JONA: Journal of Nursing Administration, 91 – 97.
Marshall, M. N., Mannion, R. & Nelson, E. et al. (2003). Managing change in the culture of general practice: qualitative case studies in primary care trusts. BMJ , 599–602.

 

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NURS 6521 Pharm Week 3 Discussion: Pharmacotherapy for Cardiovascular Disorders

Pharmacotherapy for Cardiovascular Disorders – As the leading cause of death in the United States for both men and women, cardiovascular disorders account for 7 million hospitalizations per year (NCSL, 2012). This is the result of the extensive treatment and care that is often required for patients with these disorders. While the incidences of hospitalizations and death are still high, the mortality rate of cardiovascular disorders has been declining since the 1960s (CDC, 2011). Improved treatment options have contributed to this decline, as well as more knowledge on patient risk factors. As an advanced practice nurse, it is your responsibility to recommend appropriate treatment options for patients with cardiovascular disorders. To ensure the safety and effectiveness of drug therapy, advanced practice nurses must consider aspects that might influence pharmacokinetic and pharmacodynamic processes such as medical history, other drugs currently prescribed, and individual patient factors.
Consider the following case studies:
NURS 6521 Pharm Week 3 Discussion: Pharmacotherapy for Cardiovascular Disorders Case Study 1:
Patient AO has a history of obesity and has recently gained 9 pounds. The patient has been diagnosed with hypertension and hyperlipidemia. Drugs currently prescribed include the following:

Atenolol 12.5 mg daily
Doxazosin 8 mg daily
Hydralazine 10 mg qid
Sertraline 25 mg daily
Simvastatin 80 mg daily

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NURS 6521 Pharm Week 3 Discussion: Pharmacotherapy for Cardiovascular Disorders Case Study 2:
Patient HM has a history of atrial fibrillation and a transient ischemic attack (TIA). The patient has been diagnosed with type 2 diabetes, hypertension, hyperlipidemia and ischemic heart disease. Drugs currently prescribed include the following:

Warfarin 5 mg daily MWF and 2.5 mg daily T, TH, Sat, Sun
Aspirin 81 mg daily
Metformin 1000 mg po bid
Glyburide 10 mg bid
Atenolol 100 mg po daily
Motrin 200 mg 1–3 tablets every 6 hours as needed for pain

NURS 6521 Pharm Week 3 Discussion: Pharmacotherapy for Cardiovascular Disorders Case Study 3:
Patient CB has a history of strokes. The patient has been diagnosed with type 2 diabetes, hypertension, and hyperlipidemia. Drugs currently prescribed include the following:

Glipizide 10 mg po daily
HCTZ 25 mg daily
Atenolol 25 mg po daily
Hydralazine 25 mg qid
Simvastatin 80 mg daily
Verapamil 180 mg CD daily

To prepare:

Review this week’s media presentation on hypertension and hyperlipidemia, as well as Chapters 19 and 20 of the Arcangelo and Peterson text.
Select one of the three case studies, as well as one the following factors: genetics, gender, ethnicity, age, or behavior factors.
Reflect on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes.
Consider how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy.
Think about how you might improve the patient’s drug therapy plan based on the pharmacokinetic and pharmacodynamic changes. Reflect on whether you would modify the current drug treatment or provide an alternative treatment option for the patient.

Post a 1 page paper APA format

an explanation of how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you selected.
Then, describe how changes in the processes might impact the patient’s recommended drug therapy.
Finally, explain how you might improve the patient’s drug therapy plan.

NURS 6521 Pharm Week 3 Discussion: Pharmacotherapy for Cardiovascular Disorders Readings

Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.

o   Chapter 19, “Hypertension” (pp. 230–246) . This chapter examines the relationships between the cardiovascular, nervous, and renal systems. It then describes diagnostic criteria for hypertension patients, drugs used to treat hypertension and possible adverse reactions, monitoring patient response, and patient education.
o   Chapter 20, “Hyperlipidemia” (pp. 247–262). This chapter explores causes of hyperlipidemia, treatments for hyperlipidemia patients, and methods for monitoring patient response. It also reviews strategies for risk assessment and patient education.
o   Chapter 21, “Chronic Stable Angina” (pp. 263–277) . This chapter begins by exploring factors that contribute to chronic stable angina, types of drugs used in treatment, and diagnostic criteria for initiating drug therapy. It also examines methods for monitoring patient response to treatment and educating patients on self-care.
o   Chapter 22, “Heart Failure” (pp. 278–297) . This chapter examines the process of prescribing drugs to treat heart failure and explores effects of prescribed drugs, proper dosages, and possible adverse reactions.
o   Chapter 49, “Anticoagulation Disturbances” (pp. 764–803) . This chapter covers drug therapy options for three disorders requiring anticoagulants: venous thromboembolism, atrial fibrillation, and ischemic stroke. It also explains the process of initiating and managing drug therapy for patients with these disorders.

Drugs.com. (2012). Retrieved from http://www.drugs.com/. This website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker.

NURS 6521 Pharm Week 3 Discussion: Pharmacotherapy for Cardiovascular Disorders Media

Laureate Education, Inc. (Executive Producer). (2012). Hypertension and hyperlipidemia. Baltimore, MD: Author. This media presentation outlines hypertension and hyperlipidemia including contributing factors, evaluation, treatment, and implications.Note: The approximate length of this media piece is 10 minutes.

NURS 6521 Pharm Week 10 Discussion Hormone Replacement Therapy
In recent years, hormone replacement therapy has become a controversial issue. When prescribing therapies, advanced practice nurses must weigh the strengths and limitations of the prescribed supplemental hormones. If advanced practice nurses determine that the limitations outweigh the strengths, then they might suggest alternative treatment options such as herbs or other natural remedies, changes in diet, and increase in exercise.
Consider the following scenario:
As an advanced practice nurse at a community health clinic, you often treat female (and sometimes male patients) with hormone deficiencies. One of your patients requests that you prescribe supplemental hormones. This poses the questions: How will you determine what kind of treatment to suggest? What patient factors should you consider? Are supplemental hormones the best option for the patient, or would they benefit from alternative treatments?
To prepare:

Review Chapter 56 of the Arcangelo and Peterson text, as well as the Holloway and Makinen and Huhtaniemi articles in the Learning Resources.
Review the provided scenario and reflect on whether or not you would support hormone replacement therapy.
Locate and review additional articles about research on hormone replacement therapy for women and/or men. Consider the strengths and limitations of hormone replacement therapy.
Based on your research of the strengths and limitations, again reflect on whether or not you would support hormone replacement therapy.
Consider whether you would prescribe supplemental hormones or recommend alternative treatments to patients with hormone deficiencies.

Post A 1 page paper APA format ( no title page)

a description of the strengths and limitations of hormone replacement therapy.
Based on these strengths and limitations, explain why you would or why you would not support hormone replacement therapy.
Explain whether you would prescribe supplemental hormones or recommend alternative treatments to patients with hormone deficiencies and why.

Resources

Holloway, D. (2010). Clinical update on hormone replacement therapy. British Journal of Nursing, 19(8), 496–504.Retrieved from the Walden Library databases.This article examines the purpose, components, and administration of hormone replacement therapy (HRT). It also presents benefits, risks, potential side effects, and alternative treatment options of HRT.
Mäkinen, J. I., & Huhtaniemi, I. (2011). Androgen replacement therapy in late-onset hypogonadism: Current concepts and controversies—A mini-review. Gerontology, 57(3), 193–202.Retrieved from the Walden Library databases.This article examines the role of testosterone levels in the development of hypogonadism. It also explores health issues that are impacted by testosterone levels and the role of testosterone replacement therapy.

Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.

Chapter 56, “Menopause and Menopausal Hormone Therapy” (pp. 884–895)This chapter presents various options for menopausal hormone therapy and examines the strengths and limitations of each form of therapy.

SAMPLE APPROACH
Case Study 2
Patient HM has an extensive cardiovascular history.  There is a history of atrial fibrillation, ischemic attack (TIA), type 2 diabetes, hypertension, hyperlipidemia, and ischemic heart disease.  The patient is prescribed a list of medications that include:

Warfarin 5 mg daily po MWF and 2.5 mg daily T, TH, Sat, Sun
Aspirin 81mg daily po
Metformin 1000 mg PO
Glyburide 10 mg PO BID
Atenolol 100 mg PO daily
Motrin 200 mg 1-3 tablets every 6 hours as needed for pain

Cardiovascular disease affects many people worldwide annually.  Kendir et al. 2018 state that cardiovascular diseases are the most common cause of death from non-communicable diseases (p.46).  Cardiovascular disease can refer to many diseases that affect the heart, and it’s vessels.  Our patient HM had many diagnosed cardiovascular disorders.  Atrial fibrillation which is an arrhythmia the heart due to loss of coordination of electrical and mechanical activity in the atria (Arcangelo,
NURS 6521 Pharm Week 3 Discussion Pharmacotherapy for Cardiovascular Disorders
Petterson, Wilbur, & Reinhold, 2017, p.864).  Clots or thrombi can develop from atrial fibrillation causing strokes or ischemic attacks.  Unfortunately, HM had a history of ischemic attacks (TIA).  According to Arcangelo et al. 2017, an ischemic stroke is described as a sudden or progressive onset of focal neurologic sign due to the inadequate blood supply to the brain (p.868).  Having hyperlipidemia which is a high blood level of cholesterol further makes heart disease worse because the cholesterol builds up in vessels affecting blood flow.  Hypertension heightens the potential of developing cardiovascular disease and chronic kidney disease.  Hypertension can go for a long period of time going undetected because it can be asymptomatic.  Finally, HM was diagnosed with type II diabetes, which is caused when adipose and muscle cells become less sensitive to the actions of insulin or the pancreas produces less insulin than the body needs (Arcangelo, Petterson, Wilbur, & Reinhold, 2017,p.785).
Patient Factor
The disorders that HM has been diagnosed with can happen at any age, however, in elderly patients, they may have a poorer prognosis because medications are not always processed by the body as well or as intended.  The development and worsening of cardiovascular disease are associated with many factors such as genetics, lifestyle choices/behaviors, ethnicity, and age.  With so many other factors as a person ages, it is worsening the disease because that is a factor that cannot be changed.  With the patient HM’s medical history as a provider, you have to be cautious when prescribing because medications are absorption may be affected because of age.
Drug Therapy Plan
The patient’s medical history puts him at higher risk of having a heart attack or stroke from complications of cardiovascular disease.  With this patient, we want to control his diabetes, hypertension, hyperlipidemia, and atrial fibrillation keeping levels within normal limits without over prescribing to this patient.  The first thing that was noticed when looking at the patient’s medication list is that he is talking two medications with anticoagulant effects.  Warfin which is a strong anticoagulant and aspirin.  When taking Warfin routine lab work is needed to check the PT, INR, and aPTT levels in the blood to determine if the medication dose needs to be adjusted.  Added aspirin in could cause increased bleeding, the elderly population with underlying malignancy and those taking interacting drugs that increase warfarins effect are at high risk for bleeding and should receive lower initial doses (Arcangelo, Petterson, Wilbur, & Reinhold, 2017,p.874).
HM has type two diabetes and is taking Atenolol 100mg daily which is a beta-blocker.  Arcangelo et al. 2017 stated, in diabetic patients, beta-blockers can mask all symptom of hypoglycemia except sweating (Arcangelo, Petterson, Wilbur, & Reinhold, 2017,p.266).  Being on this medication, the patient would have to consistent with monitoring his glucose levels and educated well on signs and symptoms of hypoglycemia.  This patient may benefit better from an Angiotensin II Receptor Blocker such as losartan.  For diabetics, losartan is a better choice because it is more effective than atenolol in lower cardiovascular morbidity and mortality in diabetic patients with hypertension and left ventricular hypertrophy (Arcangelo, Petterson, Wilbur, & Reinhold, 2017,p.267).  Being that HM is elderly, his initial dose should be losartan 50 mg Po daily.  Starting at 50 mg daily leaves enough room to adjust up if needed depending on the patient’s blood pressure (Kizior,2018).
Reference:
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017).
Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins
Kendir, C., van den Akker, M., Vos, R., & Metsemakers, J. (2018). Cardiovascular disease
patients have increased risk for comorbidity: A cross-sectional study in the Netherlands. The European Journal Of General Practice, 24(1), 45–50. https://doi-org.ezp.waldenulibrary.org/10.1080/13814788.2017.1398318
Kizior, R. (2018). Saunders Nursing Drug Handbook 2019. Elsevier – Health Sciences Division.

Rubric Detail NURS 6521 Pharm Week 3 Discussion Pharmacotherapy for Cardiovascular Disorders

Select Grid View or List View to change the rubric’s layout.

Content

Name: NURS_6521_Week3_Discussion_Rubric

Outstanding Performance
Excellent Performance
Competent Performance
Proficient Performance
Room for Improvement

Main Posting:
Response to the discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

Points Range: 44 (44%) – 44 (44%)

Thoroughly responds to the discussion question(s)
is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.
supported by at least 3 current, credible sources

Points Range: 40 (40%) – 43 (43%)

Responds to the discussion question(s)
is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.
75% of post has exceptional depth and breadth
supported by at least 3 credible references

Points Range: 35 (35%) – 39 (39%)

Responds to most of the discussion question(s)
is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.
50% of post has exceptional depth and breadth
supported by at least 3 credible references

Points Range: 31 (31%) – 34 (34%)

Responds to some of the discussion question(s)
one to two criteria are not addressed or are superficially addressed
is somewhat lacking reflection and critical analysis and synthesis
somewhat represents knowledge gained from the course readings for the module.
post is cited with fewer than 2 credible references

Points Range: 0 (0%) – 30 (30%)

Does not respond to the discussion question(s)
lacks depth or superficially addresses criteria
lacks reflection and critical analysis and synthesis
does not represent knowledge gained from the course readings for the module.
contains only 1 or no credible references

Main Posting:
Writing

Points Range: 6 (6%) – 6 (6%)

Written clearly and concisely
Contains no grammatical or spelling errors
Fully adheres to current APA manual writing rules and style

Points Range: 5.5 (5.5%) – 5.5 (5.5%)

Written clearly and concisely
May contain one or no grammatical or spelling error
Adheres to current APA manual writing rules and style

Points Range: 5 (5%) – 5 (5%)

Written concisely
May contain one to two grammatical or spelling error
Adheres to current APA manual writing rules and style

Points Range: 4.5 (4.5%) – 4.5 (4.5%)

Written somewhat concisely
May contain more than two spelling or grammatical errors
Contains some APA formatting errors

Points Range: 0 (0%) – 4 (4%)

Not written clearly or concisely
Contains more than two spelling or grammatical errors
Does not adhere to current APA manual writing rules and style

Main Posting:
Timely and full participation

Points Range: 10 (10%) – 10 (10%)

Meets requirements for timely and full participation
posts main discussion by due date

Points Range: 0 (0%) – 0 (0%)

NA

Points Range: 0 (0%) – 0 (0%)

NA

Points Range: 0 (0%) – 0 (0%)

NA

Points Range: 0 (0%) – 0 (0%)

Does not meet requirement for full participation

First Response:
Post to colleague’s main post that is reflective and justified with credible sources.

Points Range: 9 (9%) – 9 (9%)

Response exhibits critical thinking and application to practice settings
responds to questions posed by faculty
the use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives

Points Range: 8.5 (8.5%) – 8.5 (8.5%)

Response exhibits critical thinking and application to practice settings

Points Range: 7.5 (7.5%) – 8 (8%)

Response has some depth and may exhibit critical thinking or application to practice setting

Points Range: 6.5 (6.5%) – 7 (7%)

Response is on topic, may have some depth

Points Range: 0 (0%) – 6 (6%)

Response may not be on topic, lacks depth

First Response:
Writing

Points Range: 6 (6%) – 6 (6%)

Communication is professional and respectful to colleagues
Response to faculty questions are fully answered if posed
Provides clear, concise opinions and ideas that are supported by two or more credible sources
Response is effectively written in Standard Edited English

Points Range: 5.5 (5.5%) – 5.5 (5.5%)

Communication is professional and respectful to colleagues
Response to faculty questions are answered if posed
Provides clear, concise opinions and ideas that are supported by two or more credible sources
Response is effectively written in Standard Edited English

Points Range: 5 (5%) – 5 (5%)

Communication is mostly professional and respectful to colleagues
Response to faculty questions are mostly answered if posed
Provides opinions and ideas that are supported by few credible sources
Response is written in Standard Edited English

Points Range: 4.5 (4.5%) – 4.5 (4.5%)

Responses posted in the discussion may lack effective professional communication
Response to faculty questions are somewhat answered if posed
Few or no credible sources are cited

Points Range: 0 (0%) – 4 (4%)

Responses posted in the discussion lack effective
Response to faculty questions are missing
No credible sources are cited

First Response:
Timely and full participation

Points Range: 5 (5%) – 5 (5%)

Meets requirements for timely and full participation
posts by due date

Points Range: 0 (0%) – 0 (0%)

NA

Points Range: 0 (0%) – 0 (0%)

NA

Points Range: 0 (0%) – 0 (0%)

NA

Points Range: 0 (0%) – 0 (0%)

Does not meet requirement for full participation

Second Response:
Post to colleague’s main post that is reflective and justified with credible sources.

Points Range: 9 (9%) – 9 (9%)

Response exhibits critical thinking and application to practice settings * responds to questions posed by faculty
the use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives

Points Range: 8.5 (8.5%) – 8.5 (8.5%)

Response exhibits critical thinking and application to practice settings

Points Range: 7.5 (7.5%) – 8 (8%)

Response has some depth and may exhibit critical thinking or application to practice setting

Points Range: 6.5 (6.5%) – 7 (7%)

Response is on topic, may have some depth

Points Range: 0 (0%) – 6 (6%)

Response may not be on topic, lacks depth

Second Response:
Writing

Points Range: 6 (6%) – 6 (6%)

Communication is professional and respectful to colleagues
Response to faculty questions are fully answered if posed
Provides clear, concise opinions and ideas that are supported by two or more credible sources
Response is effectively written in Standard Edited English

Points Range: 5.5 (5.5%) – 5.5 (5.5%)

Communication is professional and respectful to colleagues
Response to faculty questions are answered if posed
Provides clear, concise opinions and ideas that are supported by two or more credible sources
Response is effectively written in Standard Edited English

Points Range: 5 (5%) – 5 (5%)

Communication is mostly professional and respectful to colleagues
Response to faculty questions are mostly answered if posed
Provides opinions and ideas that are supported by few credible sources
Response is written in Standard Edited English

Points Range: 4.5 (4.5%) – 4.5 (4.5%)

Responses posted in the discussion may lack effective professional communication
Response to faculty questions are somewhat answered if posed
Few or no credible sources are cited

Points Range: 0 (0%) – 4 (4%)

Responses posted in the discussion lack effective
Response to faculty questions are missing
No credible sources are cited

Second Response:
Timely and full participation

Points Range: 5 (5%) – 5 (5%)

Meets requirements for timely and full participation
Posts by due date

Points Range: 0 (0%) – 0 (0%)

NA

Points Range: 0 (0%) – 0 (0%)

NA

Points Range: 0 (0%) – 0 (0%)

NA

Points Range: 0 (0%) – 0 (0%)

Does not meet requirement for full participation

Total Points: 100

Name: NURS_6521_Week3_Discussion_Rubric

 

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Assignment 1: Case Study Assignment: Assessing Neurological Symptoms NURS 6512N-32

Assignment 1: Case Study Assignment: Assessing Neurological Symptoms NURS 6512N-32

Case 1: Headache
Patient Information:
Initials: P.K                 Age: 20 years old        Sex: Male        Race: Asian
S.
CC (chief complaint): “Headache”
HPI: P.K is a 20 years old Asian male patient who presented to the clinic complaining of intermittent headaches. He claims that the headache diffuses all over the head. However, the patient claims that the pressure and intensity are mainly located on the forehead above the eyes, the jaw, cheekbones, and the nose.
Location: head
Onset: The patient claims that the headache started 3 days before the present visit.
Character: He describes the pain as dull and pounding.
Associated signs and symptoms: photophobia, phonophobia, and nausea
Timing: Intermittent
Exacerbating/ relieving factors: Placing a cool rag on the forehead alleviates the pain, while it is worsened by noise.
Severity: 7/10 on a pain scale
Current Medications: Flonase nasal spray, which he administers 2 sprays per nostril only once a day to manage the symptoms resulting from seasonal allergies. Over-the-counter Tylenol 1g orally after every six hours, PRN for management of the headache.
Allergies: None.
PMHx: Underwent appendectomy at an early age, when he was 10 years old. In 2008, the patient underwent spinal fusion surgery L4-L5, and cervical spinal fusion T2-T3 in 2010, as a result of degenerative disk disease.
Vaccination: Last tetanus vaccine in 2010. The patient’s last flu shot was administered in October 2020. Confirms that all the childhood development immunization is up to date.
Soc Hx: The patient is an accountant and takes part in competitive throwing of darts. He is currently single, and heterosexual but with no sexual partner at the moment. He denies having any plan to date soon. He denies smoking or being a passive smoker. He does not take alcohol. Safety characters are exhibited as he uses a seat belt when driving and reports that there are no guns at his place. He confirms taking coffee up to 3 cups a day. In addition to soda and caffeinated beverages.
Fam Hx: Father is still alive at the age of 81 years, managing skin cancer, HTN, and coronary artery disease. Mother passed on at the age of 71 years from breast cancer. All the grandparents passed on with no known health complications. The patent has only one sibling who is struggling with CVA at the age of 55.
ROS:
GENERAL: No recent changes in body weight, appetite, fever, chills, fatigue, nausea, or vomiting.
HEENT: Head: No signs of trauma, with equal hair distribution. Eyes: No changes in visual acuity, yellow sclera, or a history of using visual aid. Confirms increased eye sensitivity to light when experiencing headaches. Ears: No discharge, pain, tinnitus, hearing problems, or itchiness. Nose: Reports painful sinuses during headaches, and seasonal rhinitis. Throat: No sore throat, difficulties in swallowing, or enlarged thyroid.
SKIN: Smooth and warm, with no signs of infections or pruritus.
CARDIOVASCULAR: Denies chest problems, pressure, pain, or heart racing.
RESPIRATORY: Denies congestions, coughing, dyspnea, or wheezing
GASTROINTESTINAL: No signs of abdominal distension, pain on palpation, or mass.
GENITOURINARY: No changes in urine frequency, polyuria, or burning sensation when urinating.
NEUROLOGICAL: Reports intermittent headaches. No signs of seizures, dizziness, or changes in bladder or bowel movement.
MUSCULOSKELETAL: Denies stiffness of joints or muscle fatigue and pain.
HEMATOLOGIC: No history of blood disorders.
LYMPHATICS: Denies enlargement of lymph nodes.
PSYCHIATRIC: Denies any current psychiatric symptoms. Reports a history of anxiety and depression which is resolved.
ENDOCRINOLOGIC: Denies heat or cold intolerance, polydipsia, or polyuria.
ALLERGIES: Reports latex and seasonal allergies. Denies any other allergic condition.
O.
Physical exam:
Vitals: BP 110/85; P 76; T 98.6; R 17 PsaO2 98% room air.
GENERAL: Appears well-nourished with age-appropriate clothing. Reports intermittent headache, photophobia, phonophobia, sound intolerance, and occasional nausea and vomiting as a result of the headache.
HEENT: Head: Atraumatic with equal distribution of hair. Eyes: No signs of inflammation, redness, or itchiness. Clear sclera. Equal pupil reaction to light bilaterally. Ears: PEARL tympanic membrane. No signs of erythema. Nose: patent naris, intact septum, and mild clear rhinorrhea seen. No signs of ulceration or inflammation of the gums. Throat: No signs of swollen tonsils.
NECK: Symmetric with the aligned trachea. Palpable thyroid gland with no signs of abnormalities.
CARDIOVASCULAR: S1 and S2 noted. No irregular or abnormal sounds. Regular heart rate and rhythm.
RESPIRATORY: Clear lung sounds. No rales or abnormal sounds were noted.
NEUROLOGICAL: Responds appropriately to questions. Well oriented in person, place, and time. bilaterally equal pupil with a similar light response. Displays equal handgrip strength. Long-term and short-term memories are intact (Balgetir et al., 2019). On a pain scale from 0 to 10 with 0 being mild and 10 severe, the patient rates the pain 7/10.  The headache is also associated with photophobia, nausea, and vomiting.
Diagnostic results: Routine lab tests such as CBC and white blood cell count ordered to check for signs of infection. Sinus Aspiration was performed to confirm bacterial sinusitis. Nasal smear and nasal scarping do evaluate the presence of allergic rhinitis. An allergic skin test was also performed to assess the reasons behind the seasonal allergy (Itanyi et al., 2020). Nasal endoscopy, CT scan, and MRI to assess the severity of the patient’s condition, by observing the brain tissue anatomy and the soft tissue pathology.
A.
Differential Diagnoses

Acute Sinusitis: This is a short-term inflammatory condition of the sinuses lasting for less than 4 weeks. It is most common among individuals with seasonal allergies. Patients diagnosed with this disorder normally present with facial pain, tenderness and pressure, stuffy nose, thick yellow-greenish discharge, nasal congestion, headache, fever, and ear pain (Kirsch, 2019). The patient in the provided case scenario presented most of these symptoms with the chief complaint of sinus headache, presenting as pressure around the forehead, cheeks, and eyes. This disorder meets the patient’s diagnostic threshold from the provided history and examination results.
Migraine without aura: This disorder is characterized by paroxysmal pain episodes which last for about 4 to 72 hours and are associated with symptoms such as photophobia, phonophobia, nausea, and vomiting (Diener et al., 2020). The patient in the provided case study displayed all the above four symptoms. This disorder is also diagnosed when the cause of the patient’s headaches is not associated with another disorder. The patient, however, displays several symptoms which show that the pain might be a result of other causes.
Medication rebound headache: medication overuse headache or rebound headaches normally result from long-term use of pain medication for conditions such as migraines. Common signs and symptoms include nausea, memory loss, irritability, restlessness, and intermittent headaches (Chinthapalli et al., 2018). The patient in the provided case study complains of intermittent headache and nausea. Consequently, he has been on pain medications for an extended period, as a result of the three surgeries which he went through.
Allergic Rhinitis: Commonly referred to as hey fever is an immune disorder caused by seasonal or perennial allergies. The disease is characterized by sneezing, running nose, sneezing, fatigue, itchy eyes, and frequent headaches (Ceriani, & Silberstein, 2021). The patient in the provided case study has seasonal allergies with a history of allergic rhinitis. He also presents with intermittent headache which makes allergic rhinitis a differential diagnosis.
Rhinitis medicamentosa: This is a non-allergic type of rhinitis which results from prolonged use of nasal decongestants topically. In this case, prolonged use means more than 5 straight days (Smith et al., 2019). Patients will present with sneezing, postnasal drip, or nasal congestion without rhinorrhea. Some patients might display intermittent headaches with compliance to pressure just like the patient in the provided case study.

ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT: Assignment 1: Case Study Assignment: Assessing Neurological Symptoms NURS 6512N-32

Assignment 1: Case Study Assignment: 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 Case Study Assignment, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.

To Prepare

By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style 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.

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.

The Case Study Assignment

Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the
Assignment 1 Case Study Assignment Assessing Neurological Symptoms NURS 6512N-32.PNG
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.

By Day 6 of Week 9

Submit your Assignment.

Learning Resources
Required Readings (click to expand/reduce)
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W.
(2019). Seidel’s guide to physical examination: An interprofessional
approach (9th ed.). St. Louis, MO: Elsevier Mosby.
 Chapter 7, “Mental Status”
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 23, “Neurologic System”
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. (2019). Advanced health
assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO:
Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E.,
Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright
Clearance Center.
Chapter 4, “Affective Changes”
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”
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”
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”
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.
Chapter 31, “Sleep Problems”
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”) (Previously read in
Weeks 1, 2, 3, and 5)
Note: Download the Physical Examination Objective Data Checklist to use
as you complete the Comprehensive (Head-to-Toe) Physical Assessment
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.
Credit Line: Mosby’s Guide to Physical Examination, 7th Edition by Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A.,
Solomon, B. S., & Stewart, R. W. Copyright 2011 by Elsevier. Reprinted by permission of Elsevier via the Copyright Clearance
Center.
Note: Download and review the Student Checklists and Key Points to use
during your practice neurological examination.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W.
(2019). Neurologic system: Student checklist. In Seidel’s guide to physical
examination: An interprofessional approach (9th ed.). St. Louis, MO:
Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., &
Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the
Copyright Clearance Center.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W.
(2019). Neurologic system: Key points. In Seidel’s guide to physical
examination: An interprofessional approach (9th ed.). St. Louis, MO:
Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., &
Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the
Copyright Clearance Center.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W.
(2019). Mental status: Student checklist. In Seidel’s guide to physical
examination: An interprofessional approach (9th ed.). St. Louis, MO:
Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., &
Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the
Copyright Clearance Center.
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.
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
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
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
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4036230/
Shadow Health Support and Orientation Resources
Use the following resources to guide you through your Shadow Health orientation
as well as other support resources:
Frey, C. [Chris Frey]. (2015, September 4). Student orientation [Video file].
Retrieved from https://www.youtube.com/watch?v=Rfd_8pTJBkY
Shadow Health. (n.d.). Shadow Health help desk. Retrieved
from https://support.shadowhealth.com/hc/en-us
Document: Shadow Health. (2014). Useful tips and tricks (Version 2)
(PDF)
Document: Student Acknowledgement Form (Word document)
Note: You will sign and date this form each time you complete your DCE
Assignment in Shadow Health to acknowledge your commitment to
Walden University’s Code of Conduct.
Document: DCE (Shadow Health) Documentation Template for
Comprehensive (Head-to-Toe) Physical Assessment (Word document)
Use this template to complete your Assignment 3 for this week.
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.
Required Media (click to expand/reduce)
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 7 and 23 that relate to the assessment of cognition and the
neurologic system. Refer to the Week 4 Learning Resources area for access instructions
on  https://evolve.elsevier.com/

Name: NURS_6512_Week_9_Assignment1_Rubric

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Excellent
Good
Fair
Poor

Using the Episodic/Focused SOAP Template:
· Create documentation or an episodic/focused note in SOAP format about the patient in the case study to which you were assigned.
·  Provide evidence from the literature to support diagnostic tests that would be appropriate for your case.

Points Range: 45 (45%) – 50 (50%)

The response clearly, accurately, and thoroughly follows the SOAP format to document the patient in the assigned case study. The response thoroughly and accurately provides detailed evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study.

Points Range: 39 (39%) – 44 (44%)

The response accurately follows the SOAP format to document the patient in the assigned case study. The response accurately provides detailed evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study.

Points Range: 33 (33%) – 38 (38%)

The response follows the SOAP format to document the patient in the assigned case study, with some vagueness and inaccuracy. The response provides evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study, with some vagueness or inaccuracy in the evidence selected.

Points Range: 0 (0%) – 32 (32%)

The response incompletely and inaccurately follows the SOAP format to document the patient in the assigned case study. The response provides incomplete, inaccurate, and/or missing evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study.

·   List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.

Points Range: 30 (30%) – 35 (35%)

The response lists five distinctly different and detailed possible conditions for a differential diagnosis of the patient in the assigned case study and provides a thorough, accurate, and detailed justification for each of the five conditions selected.

Points Range: 24 (24%) – 29 (29%)

The response lists four to five different possible conditions for a differential diagnosis of the patient in the assigned case study and provides an accurate justification for each of the five conditions selected.

Points Range: 18 (18%) – 23 (23%)

The response lists three to four possible conditions for a differential diagnosis of the patient in the assigned case study, with some vagueness and/or some inaccuracy in the conditions and/or justification for each.

Points Range: 0 (0%) – 17 (17%)

The response lists three or fewer, or is missing, possible conditions for a differential diagnosis of the patient in the assigned case study, with inaccurate or missing justification for each condition selected.

Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.

Points Range: 5 (5%) – 5 (5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

Points Range: 4 (4%) – 4 (4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.

Points Range: 3 (3%) – 3 (3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic.

Points Range: 0 (0%) – 2 (2%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided.

Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation

Points Range: 5 (5%) – 5 (5%)

Uses correct grammar, spelling, and punctuation with no errors.

Points Range: 4 (4%) – 4 (4%)

Contains a few (1 or 2) grammar, spelling, and punctuation errors.

Points Range: 3 (3%) – 3 (3%)

Contains several (3 or 4) grammar, spelling, and punctuation errors.

Points Range: 0 (0%) – 2 (2%)

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list.

Points Range: 5 (5%) – 5 (5%)

Uses correct APA format with no errors.

Points Range: 4 (4%) – 4 (4%)

Contains a few (1 or 2) APA format errors.

Points Range: 3 (3%) – 3 (3%)

Contains several (3 or 4) APA format errors.

Points Range: 0 (0%) – 2 (2%)

Contains many (≥ 5) APA format errors.

Total Points: 100

Name: NURS_6512_Week_9_Assignment1_Rubric

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Assignment 3: Digital Clinical Experience: Comprehensive (Head-to-Toe) Physical Assessment NURS 6512N-32

Assignment 3: Digital Clinical Experience: Comprehensive (Head-to-Toe) Physical Assessment NURS 6512N-32

Comprehensive (Head-to-Toe) Physical
Assessment
Throughout this course, you were encouraged to practice conducting various physical assessments on multiple areas of the body, ranging from the head to the toes. Each of Assignment 3 Digital Clinical Experience Comprehensive (Head-to-Toe) Physical Assessment NURS 6512N-32 these assessments, however, was conducted independently of one another. For this DCE Assignment, you connect the knowledge and skills you gained from each
individual assessment to perform a comprehensive head-to-toe physical examination in your Digital Clinical Experience.

Week 9: Shadow Health Comprehensive SOAP Note Template

Patient Initials: ___T. J____               Age: _____28__                                 Gender: __F_____

SUBJECTIVE DATA:

Chief Complaint (CC): “I came here because I am required to have a recent physical exam for the health insurance at my new job”

History of Present Illness (HPI): Ms. Tina Jones states that she is presently going to be employed at Smith, Stevens, Stewart, Silver and Company. As a prerequisite for her employment, Ms. Jones needs to have a pre-employment physical. During the interview, she states that she does not have any acute concerns. Ms. Jones last visited a facility, the Shadow Health General Clinic, four months ago for a yearly gynecological assessment. Consequently, she was diagnosed with POCS at which point the gynecologist prescribed contraceptives for her that were to be taken orally. She states that she is tolerating the contraceptives. The patient also admits to having type 2 diabetes that she manages using exercise, diet and the drug metformin that was prescribed to her some five months ago. She denies having any adverse events with any of the drugs. The patient admits to feeling healthy since she is careful with her body compared to the past and she is excited for the new job.

Medications: The patient is on Flucotisone propionate 110 mcg that she takes 2 puffs twice daily with the last use occurring in the morning. The patient is also on Metformin 859 mg PO twice daily and its last use was equally in the morning. Moreover, the patient takes Drospirenone and ethinyl estradiol PO four times daily with the last use happening in the morning. Ms. Jones also uses the Albuterol spray for her asthma and the last use was three months ago. Tina also uses Ibuprofen 600 thrice per day in order to manage her menstrual cramps. The last time she used the medication was six weeks ago.

Allergies: She is allergic to penicillin which elicits rashes. She however denies latex and food allergies. She admits being allergic to cats and dust. Upon exposure to her allergens, the patient reacts by having runny nose, swollen itchy eyes, as well as exacerbation of her asthma symptoms.

Past Medical History (PMH): Tina’s asthma was revealed when she was 21/2 years old. When around allergens such as cats, she uses the Albuterol inhaler. She used the same inhaler to resolve her last asthma exacerbation that occurred three months ago. Her asthma last resulted in hospitalization when she was in high school. She denies ever being intubated. Her type 2 diabetes was diagnosed when she was 24 years old. Her metformin management of the asthma begun 5 months ago with GI side effects initially, which have since been resolved. The patient ensures to take her blood sugar readings daily in the morning with the average readings standing at 90. She used diet and exercise to manage her hypertension history. She does not have a history of surgeries.

Past Surgical History (PSH): Denies any surgical history

Sexual/Reproductive History: She had menarche at the age of 11. She had her maiden sex at the age of 18. She identifies as heterosexual and only has sex with men. She denies ever being pregnant with her last monthly periods occurring a fortnight ago. She was also diagnosed with PCOS during her last physical exam, which occurred 4 months ago. After starting on the prescription drug Yaz, her cycles have become regular accompanied with bleeding that is moderate and which lasts five days. She has started a new relationship with a man but they have not had sex yet. She has plans to protect herself when she starts having sex. She does not have any sexually transmitted infections or HIV/AIDS with the last test occurring four months ago.
Photo Credit: Getty Images/Hero Images
To Prepare
 Review this week’s Learning Resources, and download and review the Physical Examination Objective Data Checklist as well as the Student Checklists and Key Points documents related to the neurologic system and mental status.
 Review the Shadow Health Resources provided in this week’s Learning Resources specifically, the tutorial to guide you through the documentation and interpretation with the Shadow Health platform. Review the examples also provided.
 Review the DCE (Shadow Health) Documentation Template for Comprehensive (Head-to-Toe) Physical Assessment found in this week’s Learning Resources and use this template to complete your Documentation Notes for this DCE Assignment.
 Access and login to Shadow Health using the link in the left-hand navigation of the Blackboard classroom.
 Review the Week 9 DCE Comprehensive Physical Assessment Rubric provided in the Assignment submission area for details on completing the Assessment in Shadow Health. DCE Comprehensive Physical Assessment: Complete the following in Shadow Health:
 Episodic/Focused Note for Comprehensive Physical Assessment of Tina Jones (180minutes) Note: Each Shadow Health Assessment may be attempted and reopened as many times as necessary prior to the due date to achieve a total of 80% or better (this includes your DCE and your Documentation Notes), but you must take all attempts by the Week 9 Day 7 deadline. submission and Grading Information By Day 7 of Week 9
 Complete your Comprehensive (Head-to-Toe) Physical Assessment DCE Assignment in Shadow Health via the Shadow Health link in Blackboard.
 Once you complete your Assignment in Shadow Health, you will need to download your lab pass and upload it to the corresponding Assignment in Blackboard for your faculty review.
 (Note: Please save your lab pass as “LastName_FirstName_AssignmentName”.) You can find instructions for downloading your lab pass here: https://link.shadowhealth.com/download-lab-pass

 Once you submit your Documentation Notes to Shadow Health, make sure to copy and paste the same Documentation Notes into your Assignment submission link below.
 Download, sign, date, and submit your Student Acknowledgement Form found in the Learning Resources for this week.

Grading Criteria
To access your rubric:
Week 9 Assignment 3 DCE Rubric
Submit Your Assignment by Day 7 of Week 9
To submit your Lab Pass:
Week 9 Lab Pass
To participate in this Assignment:
Week 9 Documentation Notes for Assignment 3
To Submit your Student Acknowledgement Form:
Submit your Week 9 Assignment 3 DCE Student Acknowledgement Form
What’s Coming Up in Week 10?
Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images
Next week, you will examine 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. Once again, you will use a SOAP note format to
complete your Lab Assignment for this week.
Week 10 Required Media
Photo Credit: [fergregory]/[iStock / Getty Images Plus]/Getty Images
Next week, you will need to view several videos and animations in the Seidel’s Guide to
Physical Examination as well as other media, as required, prior to completing your
Discussion. There are several videos of various lengths. Please plan ahead to ensure
you have time to view these media programs to complete your Lab Assignment on
time.
Next Week
To go to the next week:
Week 10
ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT: Assignment 3: Digital Clinical Experience: Comprehensive (Head-to-Toe) Physical Assessment NURS 6512N-32

Learning Resources
Required Readings (click to expand/reduce)
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W.
(2019). Seidel’s guide to physical examination: An interprofessional
approach (9th ed.). St. Louis, MO: Elsevier Mosby.
 Chapter 7, “Mental Status”
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 23, “Neurologic System”
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. (2019). Advanced health
assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO:
Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E.,
Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright
Clearance Center.
Chapter 4, “Affective Changes”
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”
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”
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”
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.
Chapter 31, “Sleep Problems”
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”) (Previously read in
Weeks 1, 2, 3, and 5)
Note: Download the Physical Examination Objective Data Checklist to use
as you complete the Comprehensive (Head-to-Toe) Physical Assessment
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.
Credit Line: Mosby’s Guide to Physical Examination, 7th Edition by Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A.,
Solomon, B. S., & Stewart, R. W. Copyright 2011 by Elsevier. Reprinted by permission of Elsevier via the Copyright Clearance
Center.
Note: Download and review the Student Checklists and Key Points to use
during your practice neurological examination.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W.
(2019). Neurologic system: Student checklist. In Seidel’s guide to physical
examination: An interprofessional approach (9th ed.). St. Louis, MO:
Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., &
Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the
Copyright Clearance Center.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W.
(2019). Neurologic system: Key points. In Seidel’s guide to physical
examination: An interprofessional approach (9th ed.). St. Louis, MO:
Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., &
Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the
Copyright Clearance Center.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W.
(2019). Mental status: Student checklist. In Seidel’s guide to physical
examination: An interprofessional approach (9th ed.). St. Louis, MO:
Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., &
Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the
Copyright Clearance Center.
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.
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
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
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
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4036230/
Shadow Health Support and Orientation Resources
Use the following resources to guide you through your Shadow Health orientation
as well as other support resources:
Frey, C. [Chris Frey]. (2015, September 4). Student orientation [Video file].
Retrieved from https://www.youtube.com/watch?v=Rfd_8pTJBkY
Shadow Health. (n.d.). Shadow Health help desk. Retrieved
from https://support.shadowhealth.com/hc/en-us
Document: Shadow Health. (2014). Useful tips and tricks (Version 2)
(PDF)
Document: Student Acknowledgement Form (Word document)
Note: You will sign and date this form each time you complete your DCE
Assignment in Shadow Health to acknowledge your commitment to
Walden University’s Code of Conduct.
Document: DCE (Shadow Health) Documentation Template for
Comprehensive (Head-to-Toe) Physical Assessment (Word document)
Use this template to complete your Assignment 3 for this week.
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.
Required Media (click to expand/reduce)
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 7 and 23 that relate to the assessment of cognition and the
neurologic system. Refer to the Week 4 Learning Resources area for access instructions
on  https://evolve.elsevier.com/

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Assignment: Lab Assignment: Assessing the Genitalia and Rectum NURS 6512N-32

Assignment: Lab Assignment: Assessing the Genitalia and Rectum NURS 6512N-32

Lab Assignment: Assessing the Genitalia and Rectum
The SOAP note portrays a 21-year-old White female patient presenting with external bumps on her genital area. She describes the bumps as painless and rough but denies having abnormal vaginal discharge.  The 21-year old patient tells the assessor that about 24 months ago, she suffered from chlamydia, which was managed using medication. This paper analyzes the SOAP note’s subjective, objective, and assessment portion and discusses the differential diagnoses.
Subjective Portion
Additional information needed in the HPI includes condoms use and the medication the patient used in treating chlamydia. The PMH should include information on the age the patient was diagnosed with asthma and history of the last asthma attack and hospitalization due to asthma. Additional information is required on the allergies the patient has that trigger asthma attacks. The social history needs to encompass information regarding cultural practices, hobbies, sleeping patterns, diet, exercise, health promotion exercises, employment as well as educational level. Furthermore, the subjective portion should include immunization status, surgical history, and reproductive health history. Moreover, there is a need to include a review of systems (ROS), which entails both positive and negative symptoms in the genitourinary, gastrointestinal, cardiovascular, respiratory, and general systems.
Objective Portion
The objective section of the SOAP Note for this patient should have encompassed information on the general physical examination. This includes information on dressing and grooming, general health status, mood, speech, posture, gait, eye contact, and speech.  Since it is a focused exam of the genitalia and rectum, information should be provided on speculum examination, bimanual examination, and rectal exam findings.
Assessment
The identified differential is chancre. According to Roett (2020), chancre characterizes a type of ulcer that is painless and has a spotless base and indurated margin. In the case at hand, the chancre is supported by the objective and subjective outcomes of the medical history of the patient entailing rough bumps seen on the outer parts of the genitalia, which are painless.  The chancre differential is supported by the outcomes of the assessment that revealed a hard, tiny, round, and painless ulcer on the outer parts of the labia.
Diagnostics
Diagnostics are essential for this case scenario to help determine the causative agent of the genital ulcer. A genital ulcer is a common manifestation in various STIs, including
HSV infection, chancroid, syphilis, granuloma inguinale, and lymphogranuloma venereum (Maliyar et al., 2019). There are various suggested diagnostic tests for the case such as HSV type-specific serology and the polymerase chain reaction testing. Serologic testing is needed to rule out syphilis and culture for H. ducreyi to rule out chancroid (Maliyar et al., 2019).In addition, genital swabs or bubo aspirate can be tested for C. trachomatis by different tests such as direct immunofluorescence, nucleic acid amplification or culture, to disqualify lymphogranuloma venereum.
Differential Diagnoses
The chancre is an expression that portrays a definite ulcer of the genital and not a medical diagnosis. As such, it is appropriate to decline the existing chancre diagnosis because it is not deemed as a medical diagnosis term. Essentially, the conditions that may be deemed as differential diagnoses comprise:
Herpes simplex virus (HSV) infection
There are numerous early symptoms of the HSV infection such as several painless vesicular lacerations on the labia, vagina, foreskin, or rectum. According to Roett (2020), these vesicles habitually split impulsively and develop into sore, shallow ulcers. Prodromal symptoms often occur before the ulceration, including a mild tingling sensation or sharp pain in the hips, buttocks, or legs (Roett, 2020). Genital HSV is a differential diagnosis based on findings of painless rough external genital bumps and the presence of a hard, round, small, painless ulcer on the outer labia.
Primary Syphilis
The primary syphilis is majorly manifested through a painless ulcer that has a spotless base and indurated margin. Primary syphilis typically presents with solitary lesions, but multiple lesions can occur (O’Byrne& MacPherson, 2019). Infected persons may develop unilateral or bilateral painless, non-suppurative inguinal adenopathy after the appearance of the chancre (O’Byrne& MacPherson, 2019). The medical assessment outcomes that are associated with primary syphilis include the patient’s history of irregular peripheral bumps and the discovery of solid, tiny, and painless ulcers located on the labia’s exterior. In addition, the patient admitted to having many sexual partners in the past, which makes her susceptible to STIs like syphilis.
Chancroid
Chancroid is characterized by painful and non-indurated ulcer of the genital and a friable base and a serpiginous margin. Lautenschlager et al., (2017) noted that genital ulcers build upon the penis’s prepuce and frenulum in the male gender while in female, it builds up the cervix or vulva. In addition, infected persons have tender, suppurative, unilateral inguinal lymphadenopathy (Lautenschlager et al., 2017). Chancroid is a differential diagnosis depending on the existence of an ulcer of the genital on the labia’s exterior. However, the patient’s ulcer is painless, making it a less likely primary diagnosis.
Conclusion
The subjective portion should include additional information on contraceptive use, history of asthma, surgical, reproductive history, social history, and ROS. On the other hand, the objective portion needs to comprise the outcomes from the general assessment, rectal, bimanual, and speculum assessments. It is recommended to conduct diagnostics to confirm or refute lymphogranuloma venereum, HSV infection, granuloma inguinale, syphilis, and chancroid. The possible differential diagnoses include HSV infection, syphilis, and chancroid.
Assignment: Lab Assignment: Assessing the Genitalia and Rectum

Patients are frequently uncomfortable discussing with healthcare professionals 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 Lab Assignment, you will analyze an Episodic 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.

To Prepare

Review the Episodic note case study your instructor provides you for this week’s Assignment. Please see the “Course Announcements” section of the classroom for your Episodic note case study.
Based on the Episodic note case study:

Review this week’s Learning Resources, and consider the insights they provide about the case study. Refer to Chapter 3 of the Sullivan resource to guide you as you complete your Lab Assignment.
Search the Walden Library or the Internet for evidence-based resources to support your answers to the questions provided.
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.

The Lab Assignment

Using evidence-based resources from your search, 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 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 three different references from current evidence-based literature.

By Day 7 of Week 10

Submit your Assignment.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK10Assgn+last name+first initial.(extension)” as the name.
Click the Week 10 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 10 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK10Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.

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Learning Resources
Required Readings (click to expand/reduce)
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W.
(2019). Seidel’s guide to physical examination: An interprofessional
approach (9th ed.). St. Louis, MO: Elsevier Mosby.
 Chapter 17, “Breasts and Axillae”
This chapter focuses on examining the breasts and axillae. The authors
describe the examination procedures and the anatomy and physiology of
breasts.
 Chapter 19, “Female Genitalia”
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.
 Chapter 20, “Male Genitalia”
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 21, “Anus, Rectum, and Prostate”
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. (2019). Advanced health
assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO:
Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., &
Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.
Chapter 5, “Amenorrhea”
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”
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.
Chapter 7, “Breast Pain”
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”
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”
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”
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.
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.).
Philadelphia, PA: F. A. Davis.
 Chapter 3, “SOAP Notes” (Previously read in Week 8)
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
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.
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. (2019). 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.
Document: Final Exam Review (Word document)
Optional Resource
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.
 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)
Required Media (click to expand/reduce)
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/

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NURS 6512 Lab Assignment Ethical Concerns

NURS 6512 Lab Assignment Ethical Concerns

Case Study Assignment

Case Study 1: The Parents of a 5-Year-Old Boy have accompanied their Son for his Required Physical Examination

Nurses often face ethical dilemmas in their practice.  Ethical dilemmas predispose nurses to conflicts in the soundest decision that is associated with minimal harm and optimum benefits to those involved. Nurses should have knowledge and skills in addressing ethical dilemmas in their practice. They should utilize models of ethical decision-making as well as institutional policies that guide the approaches to addressing ethical dilemmas in practice. Therefore, the purpose of this paper is an examination of a case study of parents who do not want their son to be immunized prior to joining the kindergarten.

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Assessment Information

The selected case study for analysis involves parents of a 5-year-old boy who accompanied their son for his required physical examination before starting kindergarten. The parents are opposed to him receiving any vaccines. Immunizations play an important role in promoting the health of the public. Immunizations prevent the risk of the population being affected by communicable diseases such as polio and tuberculosis. Patients are expected to ensure that children get all the prescribed immunizations to protect them from health problems (Smith et al., 2017). However, the uptake of immunizations may be low in families and communities that do not support the use of immunizations due to the effect of cultural values and beliefs.

As an advanced practice nurse, I am expected to perform a comprehensive assessment to develop an accurate diagnosis. I need to obtain information about the previous immunization history, surgical and medical history and undertake a comprehensive physical examination. Obtaining information about immunization history is important to determine whether the parents have been against it since early childhood or not. It will also be used to determine the vulnerability of the child to infections. History of medical and surgical history is important to determine whether the child has any underlying medical condition or history of surgery. Physical examination should be performed to determine any abnormalities such as injuries, abuse, and violence. I also need to obtain information about the religious history of the family, since some religious practices influence the uptake of immunizations in some communities (Quinn et al., 2018).

Responding to the Scenario

I will respond to the scenario by first educating the parents about the reasons for their decision that their son should not be immunized. Obtaining such information because it will provide insights into whether the parents have an informed basis for their decisions or not. It will also guide the determination of whether their decision is attributed to factors such as religious and cultural beliefs. The other intervention that I will embrace will be educating the parents about the importance of immunizations for their sons. Health education may increase their understanding and cause a change in their perception of immunization (Crocker-Buque et al., 2017; Hui et al., 2018). Resources such as videos and educational brochures may be used to increase their understanding.

Conclusion

Hesitancy to use immunizations is an ethical issue in nursing practice. Individuals may reject immunization services due to the influence of religious and cultural beliefs. Nurse practitioners have a critical role to play in assessing patients to make informed decisions on the uptake of immunization services. They also educate them about the importance of immunizations to facilitate informed decision-making.

NURS 6512 Lab Assignment Ethical Concerns

Photo Credit: Getty Images/Maskot

As an advanced practice nurse, you will encounter situations in which a patient’s health wishes conflict with evidence, your own experience, or the wishes of a family. This could create an ethical quandary. What do you do in these instances?

You will examine evidence-based practice guidelines and ethical considerations for specific scenarios in this Lab Assignment.

To Prepare

Review the scenarios provided by your instructor for this week’s Assignment. Please see the “Course Announcements” section of the classroom for your scenarios.

Based on the scenarios provided:
Select one scenario, and reflect on the material presented throughout this course.
What necessary information would need to be obtained about the patient through health assessments and diagnostic tests?
Consider how you would respond as an advanced practice nurse. Review evidence-based practice guidelines and ethical considerations applicable to the scenarios you selected.

The Lab Assignment

Write a detailed one-page narrative (not a formal paper) explaining the health assessment information required for a diagnosis of your selected patient (include the scenario number). Explain how you would respond to the scenario as an advanced practice nurse using evidence-based practice guidelines and applying ethical considerations. Justify your response using at least three different references from current evidence-based literature.

By Day 6 of Week 11

Submit your Assignment.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK11Assgn+last name+first initial.(extension)” as the name.
Click the Week 11 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 11 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK11Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.

Grading Criteria

To access your rubric:

Week 11 Assignment Rubric

NURS 6512 Lab Assignment Ethical Concerns

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 11 Assignment draft and review the originality report.

Submit Your Assignment by Day 6 of Week 11

To participate in this Assignment:

Week 11 Assignment

Week 11: The Ethics Behind Assessment

Consider the following scenarios:

You are a nurse at a large county hospital. One of your patients is leaning toward selecting a certain radical treatment for cancer, to which the family is in opposition. The family is concerned about making the correct decision and asks for your advice.
The state of Oregon has passed a “Death with Dignity” act that allows for euthanasia in certain situations. One of your patients suffering from terminal cancer is thinking of moving there to take advantage of this law and asks your opinion.

Throughout this course, you have explored a wide range of health assessments and abnormal examination findings. Although you have predominantly focused on the procedural aspects of health assessment, this week, you will focus on ethical considerations that should be taken into account when advising patients or their families.

This week, you will consider how evidence-based practice guidelines and ethical considerations factor into health assessments. You will also evaluate health assessment concepts related to sports physicals and well-child and well-woman examinations.

Learning Objectives

Students will:

Apply evidence-based practice guidelines to make an informed healthcare decision
Apply ethical considerations to a health assessment response
Apply concepts, theories, and principles relating to sports physicals and well-child and well-woman examinations
Identify  concepts, theories, and principles related to advanced health assessment

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Learning Resources

Required Readings (click to expand/reduce)

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Chapter 24, “Sports Participation Evaluation”In this chapter, the authors describe the process of a sports participation evaluation. The chapter also states the most common conditions encountered in a sports participation evaluation.

Chapter 25, “Putting It All Together”In this chapter, the authors tie together the concepts introduced in previous chapters. In particular, the chapter has a strong emphasis on the patient-caregiver relationship.

Tingle, J. & Cribb, A. (2014). Nursing law and ethics (4th ed.). Chichester, UK: Wiley Blackwell.

Furman, C. D., Earnshaw, L. A., Farrer, L. A. (2014). A case of inappropriate apolipoprotein E testing in Alzheimer’s disease due to lack of an informed consent discussion. American Journal of Alzheimer’s Disease & Other Dementias, 29(7), 590–595. doi:10.1177/1533317514525829.

Navarro-Illana, P., Aznar, J., & Díez-Domingo, J. (2014). Ethical considerations of universal vaccination against human papillomavirus. BMC Medical Ethics, 15(29). doi:10.1186/1472-6939-15-29. Retrieved from http://www.biomedcentral.com/1472-6939/15/29

Maron , B. J., Friedman, R. A., & Caplan, A. (2015). Ethics of preparticipation cardiovascular screening for athletes. Nature Reviews Cardiology, 12(6), 375–378. doi:10.1038/cardio.2015.21

May, K. H., Marshall, D. L., Burns, T. G., Popoli, D. M. & Polikandriotis, J. A. (2014). Pediatric sports-specific return to play guidelines following concussion. The International Journal of Sports Physical Therapy, 9(2), 242–255. PMCID: PMC4004129. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4004129/

American Academy of Pediatrics. (2008). Recommendations for preventative pediatric health care (periodicity schedule). Retrieved from https://www.harmonyhpi.com/WCAssets/illinois/assets/IL_MedicaidProviderManual_PEM_AdultPHGsForProviders.pdf

This resource provides recommendations for preventative pediatric healthcare from infancy through adolescence. The periodicity schedule covers a variety of areas, from health history to measurements, developmental/behavioral screenings, physical exams, procedural screenings, and oral health.

Rourke, L., Leduc, D., & Rourke, J. (2017). Rourke Baby Record. Retrieved from http://rourkebabyrecord.ca/

This website provides information on the Rourke Baby Record (RBR). The RBR supplies guidelines on growth and nutrition, developmental surveillance, physical exam parameters, and immunizations for well-baby and child care.

Document: Final Exam Review (Word document)

Required Media (click to expand/reduce)

Module 4 Introduction
Dr. Tara Harris reviews the overall expectations for Module 4. Consider how you will manage your time as you review your media and Learning Resources for your Case Study Lab Assignment and your Final exam (3m).

Sports Participation Evaluation – Week 11 (12m)

Assignment 1: Lab

Rubric Detail

Select Grid View or List View to change the rubric’s layout.

Content

Name: NURS_6512_Week_11_Assignment_Rubric

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Write a detailed 1-page narrative (not a formal paper) addressing the following:

·  Explain the health assessment information required for a diagnosis of your selected patient (include the scenario number).

Points Range: 30 (30%) – 35 (35%)

The response clearly, accurately, and thoroughly explains detailed health assessment information required to diagnose the selected patient, with the correct scenario number included.

Points Range: 24 (24%) – 29 (29%)

The response accurately explains the health assessment information required to diagnose the selected patient, with the correct scenario number included.

Points Range: 18 (18%) – 23 (23%)

The response vaguely explains health assessment information required to diagnose the selected patient, with scenario number, correct or inaccurate, included.

Points Range: 0 (0%) – 17 (17%)

The response lacks and/or inaccurately explains assessment information required to diagnose the selected patient, with scenario numbers inaccurate or missing.

·   Explain how you would respond to the scenario as an advanced practice nurse using evidence-based practice guidelines and applying ethical considerations. Justify your response using at least three different references from current evidence-based literature. Points Range: 45 (45%) – 50 (50%)

The response clearly, accurately, and thoroughly explains detailed evidence-based practice guidelines and ethical considerations applied by an advanced practice nurse in responding to the scenario, with clear, accurate, and thorough justification using three or more different references from current evidence-based literature.

Points Range: 39 (39%) – 44 (44%)

The response accurately explains evidence-based practice guidelines and ethical considerations applied by an advanced practice nurse in responding to the scenario, with accurate justification using at least three different references from current evidence-based literature.

Points Range: 33 (33%) – 38 (38%)

The response vaguely explains evidence-based practice guidelines and ethical considerations applied by an advanced practice nurse in responding to the scenario, with vague and/or inaccurate justification using two to three different references from current evidence-based literature.

Points Range: 0 (0%) – 32 (32%)

The response inaccurately explains or lacks evidence-based practice guidelines and ethical considerations applied by an advanced practice nurse in responding to the scenario, with inaccurate or missing justification using two or fewer references from current evidence-based literature.

Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate the continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. Points Range: 5 (5%) – 5 (5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

Points Range: 4 (4%) – 4 (4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. The purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.

Points Range: 3 (3%) – 3 (3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. The purpose, introduction, and conclusion of the assignment are vague or off-topic.

Points Range: 0 (0%) – 2 (2%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion was provided.

Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation Points Range: 5 (5%) – 5 (5%)

Uses correct grammar, spelling, and punctuation with no errors.

Points Range: 4 (4%) – 4 (4%)

Contains a few (1 or 2) grammar, spelling, and punctuation errors.

Points Range: 3 (3%) – 3 (3%)

Contains several (3 or 4) grammar, spelling, and punctuation errors.

Points Range: 0 (0%) – 2 (2%)

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

Written Expression and Formatting – The paper follows the correct APA format for the title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list. Points Range: 5 (5%) – 5 (5%)

Uses correct APA format with no errors.

Points Range: 4 (4%) – 4 (4%)

Contains a few (1 or 2) APA format errors.

Points Range: 3 (3%) – 3 (3%)

Contains several (3 or 4) APA format errors.

Points Range: 0 (0%) – 2 (2%)

Contains many (≥ 5) APA format errors.

Total Points: 100

Name: NURS_6512_Week_11_Assignment_Rubric

 

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NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics

Pharmacokinetics and Pharmacodynamics

The pharmacokinetics of a drug depends on patient-related factors as well as on the drug’s chemical properties. Some patient-related factors example, renal function, genetic makeup, sex, age can be used to predict the pharmacokinetic parameters in populations. For example, the half-life of some drugs, especially those that require both metabolism and excretion, may be remarkably long in older people.
Pharmacodynamics sometimes described as what a drug does to the body is the study of the biochemical, physiologic, and molecular effects of drugs on the body and involves receptor binding, post-receptor effects, and chemical interactions(Merck Manuals,2021).
Patient Scenario
I was assigned a month ago to an 80-year-old male Hispanic patient, admitted with cardiogenic shock, with an ejection fraction of 10%, generalized edema, and hypotension. He has underlying
Discussion Pharmacokinetics and Pharmacodynamics NURS 6521
history of substance use, coronary artery disease, MI in 2013- LAD stented x1, hypertension, diabetics type 2, hyperlipidemia, and chronic kidney disease stage 1(patient still voiding). The patient was rushed to the cath. lab for intra-Aortic balloon pumps placement to help with his cardiac output(preload/ afterload) PA catheter placement for hemodynamic monitoring. Mirilnone drip 0.125, dopamine 5 mcg/kg/min, heparin gtt 500 units, and bumex gtt started as well as other medications.
Personalized Care Plan
Decreased cardiac output- due to impaired contractility, increased afterload, and increase/ decrease ventricular filling (preload).
Goals and outcomes- Patient demonstrates adequate cardiac output as evidenced by blood pressure and pulse rate and rhythm within normal parameters for patient; strong peripheral pulses; and an ability to tolerate activity without symptoms of dyspnea, syncope, or chest pain (Wayne, 2019).
Assessment – Assess heart rate and blood pressure. Most patients have compensatory tachycardia and significantly low blood pressure in response to reduced cardiac output. Inspect fluid balance and weight gain. Weigh the patient regularly prior to breakfast. Check for pedal and sacral edema. Check for peripheral pulses, including capillary refill (Wayne, 2019).
Reference
Wayne, G. (2019). Decreased Cardiac Output – Nursing Diagnosis & Care Plan …nurseslabs.com › Nursing Care Plans › Nursing Diagnosis.
Merck Manuals. (2021). Overview of Pharmacokinetic- Clinical Pharmacology. www.merckmanuals.com>professional>overview.

NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics
Week 1 discussion
Pharmacokinetics and Pharmacodynamics
As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to not only understand the impact of disorders on the body, but also the impact of drug treatments on the body. The relationships between drugs and the body can be described by pharmacokinetics and pharmacodynamics. Pharmacokinetics describes what the body does to the drug through absorption, distribution, metabolism, and excretion, whereas pharmacodynamics describes what the drug does to the body. When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. These patient factors include genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease. In this Discussion, you reflect on a case from your past clinical experiences and consider how a particular patient’s pharmacokinetic and pharmacodynamic processes altered his or her response to a drug.

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To prepare:
Review this week’s media presentation with Dr. Terry Buttaro, as well as Chapter 2 of the Arcangelo and Peterson text, and the Scott article in the Learning Resources. Consider the principles of pharmacokinetics and pharmacodynamics.
Reflect on your experiences, observations, and/or clinical practices from the last five years. Select a case from the last five years that involves a patient whose individual differences in pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug. When referring to your patient, make sure to use a pseudonym or other false form of identification. This is to ensure the privacy and protection of the patient. NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics
Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.
Think about a personalized plan of care based on these influencing factors and patient history in your case study.
With these thoughts in mind:
By Day 3
Post a description of the case you selected. Then, describe factors that might have influenced the pharmacokinetic and pharmacodynamic processes of the patient from the case you selected. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case.
By Day 6
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by suggesting additional patient factors that might have interfered with the pharmacokinetic and pharmadynamic processes of the patients in their case studies. In addition, suggest how the personal care plan might change if the age of the patient were different and if the patient had a comorbid condition such as renal failure, heart failure, or liver failure.

NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics
Week 2 – Discussion
Ethical and Legal Implications of Prescribing Drugs
What type of drug should you prescribe based on your patient’s diagnosis? How much of the drug should the patient receive? How often should the drug be administered? When should the drug not be prescribed? Are there individual patient factors that could create complications when taking the drug? Should you be prescribing drugs to this patient?
These are some of the questions you might consider when selecting a treatment plan for a patient. As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives on a daily basis. Patients and their families will often place trust in you because of your position. With this trust comes power and responsibility, as well as an ethical and legal obligation to “do no harm.” It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority. In this Discussion, you explore the ethical and legal implications of scenarios and consider how to appropriately respond.
Scenario 1:
As a nurse practitioner, you prescribe medications for your patients. You make an error when prescribing medication to a 5-year-old patient. Rather than dosing him appropriately, you prescribe a dose suitable for an adult.
Scenario 2:
A friend calls and asks you to prescribe a medication for her. You have this autonomy, but you don’t have your friend’s medical history. You write the prescription anyway.
Scenario 3:
You see another nurse practitioner writing a prescription for her husband who is not a patient of the nurse practitioner. The prescription is for a narcotic. You can’t decide whether or not to report the incident.
Scenario 4:
During your lunch break at the hospital, you read a journal article on pharmacoeconomics. You think of a couple of patients who have recently mentioned their financial difficulties. You wonder if some of the expensive drugs you have prescribed are sufficiently managing the patients’ health conditions and improving their quality of life. NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics
To prepare:
Review Chapter 1 of the Arcangelo and Peterson text, as well as articles from the American Nurses Association, Anderson and Townsend, the Drug Enforcement Administration, and Philipsend and Soeken.
Select one of the four scenarios listed above.
Consider the ethical and legal implications of the scenario for all stakeholders involved such as the prescriber, pharmacist, patient, and the patient’s family.
Think about two strategies that you, as an advanced practice nurse, would use to guide your ethically and legally responsible decision-making in this scenario.
With these thoughts in mind:
By Day 3
Post an explanation of the ethical and legal implications of the scenario you selected on all stakeholders involved such as the prescriber, pharmacist, patient, and the patient’s family. Describe two strategies that you, as an advanced practice nurse, would use to guide your decision-making in this scenario.

NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics

By Day 6
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different scenario than you did, in one or more of the following ways:
Suggest additional ethical and legal implications for all stakeholders in your colleagues’ scenarios.
Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library. NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics
Validate an idea with your own experience and additional research.
Week 3 discussion
Pharmacotherapy for Cardiovascular Disorders
As the leading cause of death in the United States for both men and women, cardiovascular disorders account for 7 million hospitalizations per year (NCSL, 2012). This is the result of the extensive treatment and care that is often required for patients with these disorders. While the incidences of hospitalizations and death are still high, the mortality rate of cardiovascular disorders has been declining since the 1960s (CDC, 2011). Improved treatment options have contributed to this decline, as well as more knowledge on patient risk factors. As an advanced practice nurse, it is your responsibility to recommend appropriate treatment options for patients with cardiovascular disorders. To ensure the safety and effectiveness of drug therapy, advanced practice nurses must consider aspects that might influence pharmacokinetic and pharmacodynamic processes such as medical history, other drugs currently prescribed, and individual patient factors.
Consider the following:
Case Study 1:
Patient AO has a history of obesity and has recently gained 9 pounds. The patient has been diagnosed with hypertension and hyperlipidemia. Drugs currently prescribed include the following:
Atenolol 12.5 mg daily
Doxazosin 8 mg daily
Hydralazine 10 mg qid
Sertraline 25 mg daily
Simvastatin 80 mg daily
Case Study 2:
Patient HM has a history of atrial fibrillation and a transient ischemic attack (TIA). The patient has been diagnosed with type 2 diabetes, hypertension, hyperlipidemia and ischemic heart disease. Drugs currently prescribed include the following:
Warfarin 5 mg daily MWF and 2.5 mg daily T, TH, Sat, Sun
Aspirin 81 mg daily
Metformin 1000 mg po bid
Glyburide 10 mg bid
Atenolol 100 mg po daily
Motrin 200 mg 1–3 tablets every 6 hours as needed for pain
Case Study 3:
Patient CB has a history of strokes. The patient has been diagnosed with type 2 diabetes, hypertension, and hyperlipidemia. Drugs currently prescribed include the following:
Glipizide 10 mg po daily
HCTZ 25 mg daily
Atenolol 25 mg po daily
Hydralazine 25 mg qid
Simvastatin 80 mg daily
Verapamil 180 mg CD daily
To prepare:
Review this week’s media presentation on hypertension and hyperlipidemia, as well as Chapters 19 and 20 of the Arcangelo and Peterson text.
Select one of the three case studies, as well as one the following factors: genetics, gender, ethnicity, age, or behavior factors.
Reflect on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes.
Consider how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy.
Think about how you might improve the patient’s drug therapy plan based on the pharmacokinetic and pharmacodynamic changes. Reflect on whether you would modify the current drug treatment or provide an alternative treatment option for the patient.
With these thoughts in mind:
By Day 3
Post an explanation of how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you selected. Then, describe how changes in the processes might impact the patient’s recommended drug therapy. Finally, explain how you might improve the patient’s drug therapy plan.
By Day 6
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different case study than you did, in one or more of the following ways:
Provide alternative recommendations for drug treatments.
Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.
Validate an idea with your own experience and additional research.
Week 4 – Discussion
Pharmacotherapy for Respiratory Disorders
To the untrained ear, most coughs sound the same. However, as you might recall from past clinical experiences, a simple cough can lead to a patient diagnosis of a common cold, pneumonia, or even a chronic obstructive pulmonary disease (COPD). Although it can sometimes be challenging to diagnose a patient based on common respiratory symptoms such as congestion, coughing, and wheezing, it is important to be able to distinguish minor differences as even mild symptoms might require intervention with drug treatments. When recommending potential treatment options, advanced practice nurses must consider how individual patient factors might impact the effects of prescribed drugs.
To prepare:
Review Chapter 26 and Chapter 27 of the Arcangelo and Peterson text.
Select and research one of the following respiratory disorders: the common cold, pneumonia, or a chronic obstructive pulmonary disease (COPD) such as emphysema or chronic bronchitis. Consider types of drugs that would be prescribed to patients to treat symptoms associated with this disorder.
Select one of the following factors: genetics, gender, ethnicity, age, or behavior. Reflect on how this factor might impact effects of prescribed drugs, as well as any measures you might take to help reduce negative side effects. NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics
With these thoughts in mind:
By Day 3
Post a description of the respiratory disorder you selected including types of drugs that would be prescribed to patients to treat associated symptoms. Then, explain how the factor you selected might impact effects of prescribed drugs, as well as any measures you might take to help reduce negative side effects.
By Day 6
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different respiratory disorder than you did. If the disorder you selected is primarily associated with the upper respiratory system, respond to colleagues who selected disorders primarily associated with the lower respiratory system. Provide alternative recommendations for drug treatments.

Name: NURS_6521_Week1_Discussion_Rubric

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Excellent
Good
Fair
Poor

Main Posting

Points Range: 45 (45%) – 50 (50%)

Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.
Supported by at least three current, credible sources.
Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Points Range: 40 (40%) – 44 (44%)

Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.
At least 75% of post has exceptional depth and breadth.
Supported by at least three credible sources.
Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Points Range: 35 (35%) – 39 (39%)

Responds to some of the discussion question(s).
One or two criteria are not addressed or are superficially addressed.
Is somewhat lacking reflection and critical analysis and synthesis.
Somewhat represents knowledge gained from the course readings for the module.
Post is cited with two credible sources.
Written somewhat concisely; may contain more than two spelling or grammatical errors.
Contains some APA formatting errors.

Points Range: 0 (0%) – 34 (34%)

Does not respond to the discussion question(s) adequately.
Lacks depth or superficially addresses criteria.
Lacks reflection and critical analysis and synthesis.
Does not represent knowledge gained from the course readings for the module.
Contains only one or no credible sources.
Not written clearly or concisely.
Contains more than two spelling or grammatical errors.
Does not adhere to current APA manual writing rules and style.

Main Post: Timeliness

Points Range: 10 (10%) – 10 (10%)

Posts main post by day 3

Points Range: 0 (0%) – 0 (0%)

Points Range: 0 (0%) – 0 (0%)

Points Range: 0 (0%) – 0 (0%)

Does not post by day 3

First Response

Points Range: 17 (17%) – 18 (18%)

Response exhibits synthesis, critical thinking, and application to practice settings.
Responds fully to questions posed by faculty.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Communication is professional and respectful to colleagues. .
Responses to faculty questions are fully answered, if posed.
Response is effectively written in standard, edited English.

Points Range: 15 (15%) – 16 (16%)

Response exhibits synthesis, critical thinking, and application to practice settings.
Responds fully to questions posed by faculty.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Communication is professional and respectful to colleagues. .
Responses to faculty questions are fully answered, if posed.
Response is effectively written in standard, edited English.

Points Range: 13 (13%) – 14 (14%)

The response is on topic and may have some depth.
Responses posted in the discussion may lack effective professional communication.
Responses to faculty questions are somewhat answered if posed.
The response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

Points Range: 0 (0%) – 12 (12%)

The response may not be on-topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited.

Second Response

Points Range: 16 (16%) – 17 (17%)

The response exhibits synthesis, critical thinking, and application to practice settings.
Responds fully to questions posed by faculty.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Communication is professional and respectful to colleagues. .
Responses to faculty questions are fully answered if posed.
The response is effectively written in standard, edited English.

Points Range: 14 (14%) – 15 (15%)

Response exhibits critical thinking and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in standard, edited English.

Points Range: 12 (12%) – 13 (13%)

Response is on topic and may have some depth.
Responses posted in the discussion may lack effective professional communication.
Responses to faculty questions are somewhat answered, if posed. .
Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

Points Range: 0 (0%) – 11 (11%)

Response may not be on topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited.

Participation

Points Range: 5 (5%) – 5 (5%)

Meets requirements for participation by posting on three different days.

Points Range: 0 (0%) – 0 (0%)

Points Range: 0 (0%) – 0 (0%)

Points Range: 0 (0%) – 0 (0%)

Does not meet requirements for participation by posting on 3 different days

Total Points: 100

Name: NURS_6521_Week1_Discussion_Rubric

 

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NURS 6512 Week 5 Assignment 2: Digital Clinical Experience: Focused Exam: Cough

NURS 6512 Week 5 Assignment 2: Digital Clinical Experience: Focused Exam: Cough

Week 5: Shadow Health Digital Clinical Experience Focused Exam: Cough Documentation
Patient Information
Initials: D.R
Age: 8 years old
Gender: Male

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SUBJECTIVE DATA:
Chief Complaint (CC): “I guess I’m kind of sick. . . I’ve been coughing a lot’
History of Present Illness (HPI): The patient Danny Riviera is a boy aged 8, who comes to the clinic reporting that he has had a cough for the past 4 days. His description of the cough states that it is watery and clear. His cough becomes worse at night, which affects his sleep. As such, he does not focus at school
NURS 6512 Week 5 Assignment 2 Digital Clinical Experience Focused Exam Cough
and suffers from fatigue. His right ear has pain. His mother decided to use over-the-counter cough medicine, which offered temporal relief. Danny states that he suffers from a frequent runny nose as well as a cold and sore throat. He is also exposed to secondhand smoke from his father. He has also suffered pneumonia in the past year. However, he does not have a fever, breathing difficulties, abdominal pain, and chest tightness and chills.
Medications: The patient admits to taking home medications. He also takes a daily vitamin. He also takes a purple cough medication.
Allergies: NKDA
Past Medical History (PMH): Denies asthma diagnosis. Reports immunizations as current. Reports past frequent coughs and pneumonia.
Past Surgical History (PSH): None reported.
Sexual/Reproductive History: No history of reproductive disorders.
Personal/Social History: Reports living in a house with his parents and grandparents. Reports feeling safe at home. Reports park with playground near home. Reports father smokes at home. Denies pets at home
Immunization History: Immunizations are current.
Significant Family History: He has a father, mother, and both grandparents. Reports father with a history of asthma as a child. Denies family history of allergies.
Review of Systems:
General: The patient looks fatigued and also coughs whilst having the interview. He also appears stable. Denies fever, appetite loss, weight loss, chills, or night sweats.
HEENT: The mucus membrane is moist; nasal discharge is clear, while he shows redness and clobbestoning at the back of his throat. His eyes are dull while the conjunctiva is pink in color. The right tympanic membrane appears red and inflamed. The patient’s right cervical lymph nodes appear enlarged with a certain tenderness.
Respiratory: Lacks acute distress, increased respiratory rate at 28, breath sounds are clear to auscultation, speaks in full sentences while the bronchoscopy is negative. His chest wall was resonant when percussed while the fremitus was expected and equal bilaterally.
Cardiovascular/Peripheral Vascular: No chest pain, chest tightness, palpitations, edema, cyanosis, dyspnea.
Psychiatric: No depression, anxiety, or history of psychotic disorders.
Neurological: Report’s headache. Denies dizziness, loss of consciousness, or vision changes.
Lymphatics: Right cervical lymph nodes are tender on palpation.
OBJECTIVE DATA:
Physical Exam:
Vital signs:

Blood Pressure
120/76

O2 Sat
96%

Pulse
100

Resp. Rate
28

Temperature
37.2 c

General: The patient looks fatigued and also coughs whilst having the interview. He also appears stable.
HEENT: Head is normocephalic and atraumatic. The mucus membrane is moist; nasal discharge is clear, while he shows redness and clobbestoning at the back of his throat. His eyes are dull while the conjunctiva is pink in color. The right tympanic membrane appears red and inflamed. The patient’s right cervical lymph nodes appear enlarged with a certain tenderness.
Respiratory: Lacks acute distress, increased respiratory rate at 28, breath sounds are clear to auscultation, speaks in full sentences while the bronchoscopy is negative. His chest wall was resonant when percussed while the fremitus was expected and equal bilaterally.
Cardiology: No murmurs, gallops, or rubs in S1 and S2.
Lymphatics: Right cervical lymph nodes are tender on palpation
Psychiatric: No mental issues noted.

Diagnostics/Labs: Routine lab works were ordered including complete blood count, and white blood cell count to determine any signs of infection. Spirometric and peak expiratory flow measurements were collected to further evaluate the patient’s extend of cough. Bronchoprovocation testing was done to rule out differential diagnosis. Other investigations are done to assess the cough and cold include upper airway provocation studies, sinus imaging, CT scan of the thorax, and bronchoscopy (Malesker et al., 2017). For further assessment of the ear pain, nasolaryngoscopy and MRI of the head and neck were ordered.
ASSESSMENT:
Priority Diagnosis: Acute Viral Rhinitis: It is also known as common cold. It is associated with inflammation of the nasal mucosa lining as a result of respiratory viral infection. It is common among children, characterized by sneezing, running nose, congestion, cough, postnasal drip, sore throat, watery eyes, ear pain, difficulties in swallowing, and fatigue among others (Malesker et al., 2017). The patient in the case study displayed most of the above symptoms, qualifying for a common cold diagnosis.
Differential Diagnosis:

Acute sinusitis: This normally occurs when a cold virus infects the patient’s sinuses. The patient may display headache, fever, cough which is worse at night, severely stuffed up nose, green, or thick yellow mucus, itchy and watery eyes, and ear pain. The patient in the case study displayed most of these symptoms (Shoukat et al., 2019). However, he denied fever, and the nasal discharge is clear and thin, which disqualifies the diagnosis.
Influenza (flu): This is a common viral infection of the respiratory tract among children. It is characterized by fever, headache, running nose, fatigue, cough, eye, and ear pain. The patient in the case study displayed most of the above symptoms (Badyda et al., 2020). Consequently, this condition is common among patients with a history of pneumonia, just like in the provided case study.
Ear Infection: Sinus and cold infections can lead to the accumulation of fluids in the patient’s ears behind the eardrum. As a result, viruses and bacteria can grow leading to infection of the ears. Patients may display ear pressure or fullness, ear pain, drainage, muffled hearing, and loss of balance (Badyda et al., 2020). Given that most ear infections among children might start as a common cold, then the patient’s right ear pain and associated upper respiratory symptoms may be as a result of ear infection.

Treatment Plan:
Previous Diagnosis: Pneumonia and cough which were managed appropriately.
Present Diagnosis: Acute Viral Rhinitis
Pharmacological Intervention: Cold remedies such as Dimetapp 10mL every 4 hours to a maximum of 6 doses/24 hours (Malesker et al., 2017). Acetaminophen to manage the pain and fever. Dexamethasone/gentamicin drops for ear pain.
Non-pharmacological Intervention: Honey and saline nose spray to help with soothing the sore throat and cough, and managing congested nose respectively (Fernandez, & Olympia, 2017). Extra fluid and a cool-mist humidifier are also necessary for helping manage the patients’ cold symptoms.
Patient Education: Inform the patient’s mother on the importance of sticking to the treatment plan. It is also important to educate the patient’s parents on expected side effects, and adverse reactions which might call for medical attention (Malesker et al., 2017).
Health Promotion: Encourage the patient’s mother to ensure that he is always warm, with a healthy diet, and enough sleep (Badyda et al., 2020).
Follow-up: The patient should be advised to report back to the clinic in case of worsened symptoms, or if the prescribed drugs fail to relieve the patient’s symptoms within one week.
References
Badyda, A., Feleszko, W., Ratajczak, A., Czechowski, P. O., Czarnecki, A., Dubrawski, M., & Dąbrowska, A. (2020). Upper respiratory symptoms in children (3-12 years old) exposed on different levels of ambient particulate matter. DOI: 10.1183/13993003.congress-2020.1303
Fernandez, F. G., & Olympia, R. P. (2017). Ear pain, nasal congestion, and sore throat. URGENT CARE MEDICINE, 77.
Badyda, A. J., Feleszko, W., Ratajczak, A., Czechowski, P. O., Czarnecki, A., Dubrawski, M., & D&# 261; browska, A. (2020). Influence of Particulate Matter on the Occurrence of Upper Respiratory Tract Symptoms in Children Aged 3-12 Years. In D24. LUNG INFECTION (pp. A6346-A6346). American Thoracic Society. DOI:10.1164/ajrccm-conference.2020.201.1_
Malesker, M. A., Callahan-Lyon, P., Ireland, B., Irwin, R. S., Adams, T. M., Altman, K. W., … & Weir, K. (2017). Pharmacologic and nonpharmacologic treatment for acute cough associated with the common cold: CHEST Expert Panel Report. Chest, 152(5), 1021-1037. https://doi.org/10.1016/j.chest.2017.08.009
Shoukat, N., Kakar, A., Shah, S. A., & Sadiq, A. (2019). 10. Upper respiratory tract infections in children age 2 to 10 years in Quetta: A prevalence study. Pure and Applied Biology (PAB), 8(2), 1084-1091. http://dx.doi.org/10.19045/bspab.2019.80050
Assignment 2: Digital Clinical Experience: Focused Exam: Cough

In this DCE Assignment, you will conduct a focused exam related to cough in your DCE using the simulation tool, Shadow Health. You will determine what history should be collected from the patient, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions.

Photo Credit: Getty Images

To Prepare

Review this week’s Learning Resources and consider the insights they provide related to ears, nose, and throat.
Review the Shadow Health Resources provided in this week’s Learning Resources specifically the tutorial to guide you through the documentation and interpretation within the Shadow Health platform. Review the examples also provided.
Review the DCE (Shadow Health) Documentation Template for Focused Exam: Cough found in this week’s Learning Resources and use this template to complete your Documentation Notes for this DCE Assignment.
Access and login to Shadow Health using the link in the left-hand navigation of the Blackboard classroom.
Review the Week 5 Focused Exam: Cough Rubric provided in the Assignment submission area for details on completing the Assignment in Shadow Health.
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?

Focused Exam: Cough Assignment:

Complete the following in Shadow Health:

Respiratory Concept Lab (Required)
Episodic/Focused Note for Focused Exam: Cough
HEENT (Recommended but not required)

Note: Each Shadow Health Assessment may be attempted and reopened as many times as necessary prior to the due date to achieve a total of 80% or better (this includes your DCE and your Documentation Notes), but you must take all attempts by the Week 5 Day 7 deadline.

Submission and Grading Information
By Day 7 of Week 5

Complete your Focused Exam: Cough DCE Assignment in Shadow Health via the Shadow Health link in Blackboard.
Once you complete your Assignment in Shadow Health, you will need to download your lab pass and upload it to the corresponding assignment in Blackboard for your faculty review.
(Note: Please save your lab pass as “LastName_FirstName_AssignmentName”.) You can find instructions for downloading your lab pass here: https://link.shadowhealth.com/download-lab-pass
Once you submit your Documentation Notes to Shadow Health, make sure to add your documentation to the Documentation Note Template and submit it into your Assignment submission link below.
Complete the Code of Conduct Acknowledgement.

Grading Criteria
To access your rubric:
Week 5 Assignment 2 DCE Rubric
Submit Your Assignment by Day 7 of Week 5
To submit your Lab Pass:
Week 5 Lab Pass
To participate in this Assignment:
Week 5 Documentation Notes for Assignment 2
To Submit your Student Acknowledgement:

Click here and follow the instructions to confirm you have complied with Walden University’s Code of Conduct including the expectations for academic integrity while completing the Shadow Health Assessment.

Name: NURS_6512_Week_5_DCE_Assignment_2_Rubric

Description: To complete the Shadow Health assignments, it is helpful to use the text and follow along with each chapter correlating to the area of assessment to assist in covering all the subjective questions and the physical assessment areas. Review the Advanced Health Assessment Nursing Documentation Tutorial located in the Weeks 1 and 4 Resources, the model documentation in Shadow Health, as well as sample documentation in the text to assist with narrative documentation of the assessments. Shadow Health exams may be added to or repeated as many times as necessary prior to the due date to assist in achieving the desired score.

Grid View
List View

Excellent
Good
Fair
Poor

Student DCE score
(DCE percentages will be calculated automatically by Shadow Health after the assignment is completed.)
Note: DCE Score – Do not round up on the DCE score.

Points Range: 56 (56%) – 60 (60%)

DCE score>93

Points Range: 51 (51%) – 55 (55%)

DCE Score 86-92

Points Range: 46 (46%) – 50 (50%)

DCE Score 80-85

Points Range: 0 (0%) – 45 (45%)

DCE Score <79
No DCE completed.

Subjective Documentation in Provider Notes
Subjective narrative documentation in Provider Notes is detailed and organized and includes:
Chief Complaint (CC), HPI, Current Medications, Allergies, Past Medical History, Family History, Social History and Review of Systems (ROS)
ROS: covers all body systems that may help you formulate a list of differential diagnoses. 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.

Points Range: 16 (16%) – 20 (20%)

Documentation is detailed and organized with all pertinent information noted in professional language.
Documentation includes all pertinent documentation to include Chief Complaint (CC), HPI, Current Medications, Allergies, Past Medical History, Family History, Social History and Review of Systems (ROS).

Points Range: 11 (11%) – 15 (15%)

Documentation with sufficient details, some organization and some pertinent information noted in professional language.
Documentation provides some of the Chief Complaint (CC), HPI, Current Medications, Allergies, Past Medical History, Family History, Social History and Review of Systems (ROS).

Points Range: 6 (6%) – 10 (10%)

Documentation with inadequate details and/or organization; and inadequate pertinent information noted in professional language.
Limited or/minimum documentation provided to analyze students critical thinking abilities for the Chief Complaint (CC), HPI, Current Medications, Allergies, Past Medical History, Family History, Social History and Review of Systems (ROS).

Points Range: 0 (0%) – 5 (5%)

Documentation lacks any details and/or organization; and does not provide pertinent information noted in professional language.
No information is provided for the Chief Complaint (CC), HPI, Current Medications, Allergies, Past Medical History, Family History, Social History and Review of Systems (ROS).
or
No documentation provided.

Objective Documentation in Provider Notes – this is to be completed in Shadow Health
Physical exam: Document in a systematic order starting from head-to-toe, include what you see, hear, and feel when doing your physical exam using medical terminology/jargon. Document all normal and abnormal exam findings. Do not use “WNL” or “normal”.
You only need to examine the systems that are pertinent to the CC, HPI, and History.
Diagnostic result – Include any pertinent labs, x-rays, or diagnostic test that would be appropriate to support the differential diagnoses mentioned
Differential Diagnoses (list a minimum of 3 differential diagnoses). Your primary or presumptive diagnosis should be at the top of the list (#1).

Points Range: 16 (16%) – 20 (20%)

Documentation detailed and organized with all abnormal and pertinent normal assessment information described in professional language.
Each system assessed is clearly documented with measurable details of the exam.

Points Range: 11 (11%) – 15 (15%)

Documentation with sufficient details and some organization; some abnormal and some normal assessment information described in mostly professional language.
Each system assessed is somewhat clearly documented with measurable details of the exam.

Points Range: 6 (6%) – 10 (10%)

Documentation with inadequate details and/or organization; inadequate identification of abnormal and pertinent normal assessment information described; inadequate use of professional language.
Each system assessed is minimally or is not clearly documented with measurable details of the exam.

Points Range: 0 (0%) – 5 (5%)

Documentation with no details and/or organization; no identification of abnormal and pertinent normal assessment information described; no use of professional language.
None of the systems are assessed, no documentation of details of the exam.
or
No documentation provided.

Total Points: 100

Name: NURS_6512_Week_5_DCE_Assignment_2_Rubric

Description: To complete the Shadow Health assignments, it is helpful to use the text and follow along with each chapter correlating to the area of assessment to assist in covering all the subjective questions and the physical assessment areas. Review the Advanced Health Assessment Nursing Documentation Tutorial located in the Weeks 1 and 4 Resources, the model documentation in Shadow Health, as well as sample documentation in the text to assist with narrative documentation of the assessments. Shadow Health exams may be added to or repeated as many times as necessary prior to the due date to assist in achieving the desired score.

 

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Assignment 1: Lab Assignment: Assessing the Abdomen NURS 6512N-32

Assignment 1: Lab Assignment: Assessing the Abdomen NURS 6512N-32

 

Abdominal Assessment
Nurses and other healthcare providers play an important role in the promotion of the health of diverse patient populations. They utilize their knowledge and skills in patient assessment to determine the actual and potential health needs of their patients. Abdominal health problems are part of the conditions that nurses address in their daily practice. Therefore, this essay examines a case
Assignment 1 Lab Assignment Assessing the Abdomen NURS 6512N-32
study of a patient that came with an abdominal health problem. The patient is a 47-year-old male that complained of generalized abdominal pain, which started 3 days ago. The essay examines the additional subjective and objective data that should be obtained from the patient, diagnostic investigations, and differential diagnoses that should be considered.
Subjective Analysis
Subjective information refers mainly to the data that healthcare providers obtain concerning the experiences of patients with a health problem. Subjective data explores a wide range of aspects of a disease such as the concerns and feelings of the patient. A number of subjective information should be obtained from JR. One of them is the character of abdominal pain. Besides the rating and intensity of the abdominal pain, questions related to aggravating, precipitating, and relieving factors should be obtained. There is also a need to obtain information on whether the pain radiates to other parts of the body, generalized, increasing, or decreasing in severity or not. Information about the pain such as its character such as being gradual or of sudden onset should also be obtained. Additional information about diarrhea should also be obtained. For example, the frequency and number of diarrhea experienced in a day should be obtained. This is important as it provides clues into the hydration status of the patient. Information about the aggravating, precipitating, and relieving factors for diarrhea should also be obtained (Perry et al., 2021). Recent dietary history and habits should also be explored to determine the potential cause of the health problem. The history obtained from the JR indicates that he has a history of GI bleeding. It is therefore important to ask information related to whether there is a blood-stained stool, smell and color to determine the exact cause of the problem. Comprehensive acquisition of subjective information is, therefore, crucial to guide the development of the most accurate diagnosis for JR.
Objective Analysis
Objective data refers to the information that the healthcare provider obtains through physical examination. It entails the use of techniques such as observation, auscultation, percussion, and palpation. Objective data is mainly used to validate subjective data and develop an accurate diagnosis of a problem affecting a client. A number of objective data needs to be obtained from the client in the case study. The first aspect of objective data is documenting the general appearance of JR. Information about the general appearance of the patient such as if well dressed and sick looking should have been obtained. Patients with chronic illnesses such as colon cancer may appear lethargic and malnourished. JR should have also been examined for jaundice and hydration status. Inspection of the abdomen should also be done to determine whether there is abdominal distention. Abdominal distention may lead to the development of diagnoses such as organomegaly or pancreatic cancer. Observation should also aim at determining if there are any scars and distended veins. Palpation should also be done to determine if there is abdominal rigidity, tenderness, or rebound tenderness. Rigidity could indicate accumulation of fluid or abdominal matter in the peritoneal cavity, hence bowel obstruction (Cox, 2019). Therefore, the above objective data would guide the development of an accurate diagnosis for the client.
If the Assessment is supported by Subjective and Objective Information
The assessment in the case study is supported by objective and subjective information. As noted initially, subjective data focuses on the perceptions and feelings of the patient with a disease. JR reported subjective data such as diarrhea and vomiting. He also reported pain and a history of GI bleeding. Objective data focuses on the information that the healthcare provider obtains through physical assessment (Estes et al., 2019). The data such as vital signs, absence of murmurs, and intact skin without lesions are some of the objective information in the case study.
Diagnostic Tests
Additional diagnostic tests should be performed to come up with an accurate diagnosis of the health problem that the client in the case study is experiencing. One of the tests would be a stool occult test to determine if there is blood in the stool or not. The other test is a complete blood count to determine if the client has an infection. Liver function tests may also be performed to determine whether there is an abnormality with liver enzymes, which indicates liver disease. Ultrasound of the abdomen may also be needed to view the abdominal organs for any abnormality (Williams, 2021).
Accepting or Rejecting Diagnosis and Possible Conditions
I would reject the diagnosis. The assessment was not comprehensive. For example, it did not examine the lower quadrant pain to determine its character. The subjective data points towards a possible diagnosis of gastroenteritis. The presence of abdominal pain, low-grade fever, vomiting and nausea are often associated with gastroenteritis. One of the differential diagnoses for JR in this case study is abdominal obstruction. Patients with abdominal obstruction often experience symptoms such as abdominal pains, vomiting, nausea, and vomiting. However, this condition is least likely due to the presence of diarrhea (Perry et al., 2021). The other possible differential diagnosis is pancreatic cancer. Patients with pancreatic cancer may experience symptoms such as abdominal pains, nausea, and vomiting. However, this should be ruled out by performing comprehensive history taking and physical examination. Diagnostic investigations such as abdominal ultrasound will help determine if JR is suffering from pancreatic cancer. The last differential diagnosis is diverticulitis. Diverticulitis is also associated with left lower quadrant pain, nausea, fever, and vomiting (Williams, 2021). The condition should be ruled out through a CT scan of the abdomen.
Conclusion
In conclusion, comprehensive assessment and physical examination is important in patient care. Additional subjective and objective data should be obtained from the patient in the case study to develop an accurate diagnosis. In addition, diagnostic investigations should be done to determine the actual cause of the abdominal problem. Differential diagnoses should be considered to guide the development of the treatment plan.

Assignment 1: Lab Assignment: Assessing the Abdomen

Photo Credit: Getty Images/Hero Images

A woman went to the emergency room for severe abdominal cramping. She was diagnosed with diverticulitis; however, as a precaution, the doctor ordered a CT scan. The CT scan revealed a growth on the pancreas, which turned out to be pancreatic cancer—the real cause of the cramping.
Because of a high potential for misdiagnosis, determining the precise cause of abdominal pain can be time consuming and challenging. By analyzing case studies of abnormal abdominal findings, nurses can prepare themselves to better diagnose conditions in the abdomen.

In this Lab Assignment, you will analyze an Episodic 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.

To Prepare

Review the Episodic note case study your instructor provides you for this week’s Assignment. Please see the “Course Announcements” section of the classroom for your Episodic note case study.

With regard to the Episodic 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.

The Assignment

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?
What diagnostic tests would 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 three different references from current evidence-based literature.

By Day 7 of Week 6

Submit your Lab Assignment.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK6Assgn1+last name+first initial.(extension)” as the name.
Click the Week 6 Assignment 1 Rubric to review the Grading Criteria for the Assignment.
Click the Week 6 Assignment 1 link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK6Assgn1+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.

Grading Criteria
To access your rubric:
Week 6 Assignment 1 Rubric
Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:
Submit your Week 6 Assignment 1 draft and review the originality report.
Submit Your Assignment by Day 7 of Week 6
To participate in this Assignment:
Week 6 Assignment 1

Exam: Week 6 Midterm Exam

This exam is a test of your knowledge in preparation for your certification exam. No outside resources, including books, notes, websites, or any other type of resource, are to be used to complete this exam. You are expected to comply with Walden University’s Code of Conduct.
This exam will be on topics covered in weeks 1, 2, 3, 4, 5, and 6. Prior to starting the exam, you should review all of your materials. This exam is timed with a limit of 2 hours for completion. When time is up, your exam will automatically submit.

By Day 7 of Week 6

Submit your Midterm Exam.

Submission and Grading Information
Submit Your Midterm Exam by Day 7 of Week 6.
To Complete this Exam:
Week 6 Exam

Assignment 2: Lab Assignment DCE

The causes of abdominal pain can be extremely varied due to the sheer number of structures, organs, and functions within the abdomen. If abdominal pain is caused by a life-threatening condition, then swift and accurate assessment is essential.
In preparation for the Comprehensive (Head-to-Toe) Physical Assessment due in Week 9, it is recommended that you practice performing an abdominal examination this week.

Focused Exam: Abdominal Assignment:

Complete the following in Shadow Health:
Abdominal  Concept Lab (Required)
Gastrointestinal (Practice)
Focused Exam: Abdominal Pain (Practice)

What’s Coming Up in Week 7?

Next week, you will explore how to assess the heart, lungs, and peripheral vascular system as you complete your Discussion.

Week 7 Required Media

Next week, you will need to view several videos and animations in the Seidel’s Guide to Physical Examination as well as other media, as required, prior to completing your Discussion. There are several videos of various lengths. Please plan ahead to ensure you have time to view these media programs to complete your Discussion on time.

Next Week

ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT: Assignment 1: Lab Assignment: Assessing the Abdomen NURS 6512N-32

Learning Resources
Required Readings (click to expand/reduce)
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W.
(2019). Seidel’s guide to physical examination: An interprofessional
approach (9th ed.). St. Louis, MO: Elsevier Mosby.
 Chapter 6, “Vital Signs and Pain Assessment”
This chapter describes the experience of pain and its causes. The authors
also describe the process of pain assessment.
 Chapter 18, “Abdomen”
In this chapter, the authors summarize the anatomy and physiology of the
abdomen. The authors also explain how to conduct an assessment of the
abdomen.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health
assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO:
Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., &
Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.
Chapter 3, “Abdominal Pain”
This chapter outlines how to collect a focused history on abdominal pain.
This is followed by what to look for in a physical examination in order to
make an accurate diagnosis.
Chapter 10, “Constipation”
The focus of this chapter is on identifying the causes of constipation
through taking a focused history, conducting physical examinations, and
performing laboratory tests.
Chapter 12, “Diarrhea”
In this chapter, the authors focus on diagnosing the cause of diarrhea. The
chapter includes questions to ask patients about the condition, things to
look for in a physical exam, and suggested laboratory or diagnostic
studies to perform.
Chapter 29, “Rectal Pain, Itching, and Bleeding”
This chapter focuses on how to diagnose rectal bleeding and pain. It
includes a table containing possible diagnoses, the accompanying
physical signs, and suggested diagnostic studies.
Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia,
PA: F. A. Davis.
Credit Line: Advanced practice nursing procedures, 1st Edition by Colyar, M. R. Copyright 2015 by F. A. Davis Company.
Reprinted by permission of F. A. Davis Company via the Copyright Clearance Center.
These sections below explain the procedural knowledge needed to
perform gastrointestinal procedures.
Chapter 107, “X-Ray Interpretation: Chest (pp. 480–487)
Chapter 115, “X-Ray Interpretation of Abdomen” (pp. 514–520)
Note: Download this Student Checklist and Abdomen Key Points to use
during your practice abdominal examination.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W.
(2019). Abdomen: Student checklist. In Seidel’s guide to physical
examination: An interprofessional approach (9th ed.). St. Louis, MO:
Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., &
Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the
Copyright Clearance Center.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W.
(2019). Abdomen: Key points. In Seidel’s guide to physical examination:
An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., &
Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the
Copyright Clearance Center.
Document: Midterm Exam Review (Word document)
Optional Resource
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s
diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.
 Chapter 9, “The Abdomen, Perineum, Anus, and Rectosigmoid” (pp.
445–527)
This chapter explores the health assessment processes for the abdomen,
perineum, anus, and rectosigmoid. This chapter also examines the
symptoms of many conditions in these areas.
 Chapter 10, “The Urinary System” (pp. 528–540)
In this chapter, the authors provide an overview of the physiology of the
urinary system. The chapter also lists symptoms and conditions of the
urinary system.
Required Media (click to expand/reduce)
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 Chapter 17 that relate to the assessment of the abdomen and
gastrointestinal system. Refer to Week 4 for access instructions

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