Model Documentation
Subjective
Social History: She is not aware of any environmental exposures or irritants at her job or home……
Review of Systems:
- General: Denies changes in…
- Nose/Sinuses:
- Gastrointestinal:
- Respiratory:
Objective
- General: Ms. Jones is a pleasant….
- Respiratory: Chest expansion is….
Assessment
- Mild-persistent….
Plan
Diagnostics
- Obtain office….
Education
- Encourage Ms. Jones to continue t….
Referral/Consultation
- Refer to…..
Follow-up Planning
- Order ….
- Instruct Ms. Jones …..
- Revisit….
- Tina’s second cousin was diagnosed with asthma at age 5. What would be included in your treatment plan? What factors might concern you related to compliance?
The treatment plan for this child would be to….
- Consider that Tina’s uncle is now 68 years old and has smoked heavily every day since he was fifteen. What would you expect to find in his respiratory assessment? How would this affect your oxygenation goals for this patient?
Common significant deviations of the chest for older adults include xxxx (Hogstel & Curry, 2005). xxxx become thinner, more rigid, and change shape, and muscles may become weakened. This results in a lower oxygen level with less carbon dioxide removed from the body, and decreased ability to cough. xxxx causes decreased xxx height. xxx also causes thexxxto lose their shape causing shortness of xxx. Due to diminishedxxxwith decreased sensitivity, large amounts of particles that are more difficult to expectorate can collect in the xxx. In addition, the xxxx is less sensitive to xxxx and xxx and higher residual volume. As a result of these changes, xxx are at increased risk for xxxx and xxxx (Minaker, 2011; Sharma & Goodwin, 2006). Shadow health respiratory assessment transcript.
In the respiratory assessment of this patient, I expect to find xxx, increased xxxx of the xxx, diminished chest expansion, and xxxx. The weakened muscles will result in xxx levels and lower xxxx leading to decreased xxxx capacity. xxx will also will also lose their shape leading toxxx. Therefore, x goals will hxave to take in cognizance these realities and advise the patient accordingly. Consequently, efforts to increase exercise tolerance, treat complication, and relieve symptoms will be initiated.
- If Tina had mentioned that she was just diagnosed with pneumonia, what would you have expected to find during percussion?
- If the results of Tina’s pulse oximetry had been 97%, which of the following would have been true?
- Suppose that, during your lung exam on Tina, you had heard bronchial breath sounds in the left lower lung posteriorly. What would you have suspected based on this finding?
- Suppose that while auscultating, you assessed a few scattered expiratory wheezes. Why would this be an expected finding for a patient with Tina’s history
- When you observe a patient like Tina throughout an exam, there are many ways to determine whether a patient is experiencing respiratory distress. Identify one indicator of respiratory distress that can be assessed through observation alone.
- Describe how you would assess Tina for dyspnea
Dyspnea can be assessed both……
- Explicitly describe the tasks you undertook to complete this exam.
The examination…..
- Explain the clinical reasoning behind your decisions and tasks.
- Identify how your performance could be improved and how you can apply “lessons learned” within the assignment to your professional practice Shadow health respiratory assessment transcript.
My performance could be improved by seeking more history from the patient…..
NR 509 Week 1 Shadow Health History Assignment
- | Overview
- | Transcript
- | Subjective Data Collection
- | Objective Data Collection
- | Education & Empathy
- | Documentation / Electronic Health Record
- | Information Processing
- | Lab Pass: Certificate of Completion
NR 509 Week 2 Alternate Writing Assignment: Respiratory Summer 2018
Purpose
As a family nurse practitioner, you must possess excellent physical assessment skills. This alternative writing assignment mirrors the discussion content of the debriefing session and will allow the student to expand their knowledge of physical health assessment principles specific to the advanced practice role. Shadow health respiratory assessment transcript.
Course Outcomes
This assignment is guided by the following Course Outcomes (COs):
- Apply advanced practice nursing knowledge to collecting health history information and physical examination findings for various patient populations. (PO 1, 2)
- Differentiate normal and abnormal health history and physical examination findings. (PO 1, 2)
- Adapt health history and physical examination skills to the developmental, gender-related, age-specific, and special population needs of the individual patient. (PO 1, 2)
The purposes of this assignment are to: (a) identify and articulate advanced assessment health history and physical examination techniques which are relevant to a focused body system (CO 1), (b) differentiate normal and abnormal findings with regard to a disease or condition that impacts the body system (CO 2), and (c) adapt advanced assessment skills if necessary to suit the needs of specific patient populations (CO 4).
NOTE: You are to complete this alternative writing assignment ONLY if you had not participated or do not plan to participate in a debriefing session for the given week.
Due Date: This alternative written assignment is due no later than the Sunday of the week in which you did not attend the weekly debriefing session. The standard MSN Participation Late Assignment policy applies to this assignment.
Preparing the Paper:
- Select a focused body system from the weekly lesson which corresponds with the week of the written assignment.
- Carefully read and review the selected body system in your course textbooks.
- Incorporate at least onescholarly peer-reviewed journal article that relates to the body system. It may be useful to identify an article that relates to a disease that impacts the body system.
- The paper must clearly articulate the relevance of advanced physical assessment skills, techniques, application of advanced practice knowledge, and assessment modification (when necessary) to accommodate for specific patient populations.
- Provide concluding statements that should summarize key points of the overall assignment content.
- In-text citations and reference page(s) must be written using proper APA format (6thedition).
NR 509 Week 2 Quiz
- A mother brings her two month old daughter in for an examination says “my daughter rolled over against the wall and now I have noticed that she has the spot soft on the top of her head, is there something terribly wrong?” The FNP‘s best response would be:
- During percussion the FNP knows that a dull percussion note elicited over a lung lobe. This most likely results from:
- The patient is unable to differentiate between sharp and dull stimulation to both sides of her face. The FNP suspects Damage to:
- When examining the face, the FNP is aware that the two pairs of salivary gland‘s that are accessible to examination are the _____ glands
- A patient comes to the clinic complaining of neck and shoulder pain and is unable to turn her head. The FNP suspects damage to cranial nerve ____ and proceeds with the examination by____
- When examining a patient’s cranial nerve function, the FNP remembers that the muscles in the neck that are innervated by CN XI are the:
- The patient’s laboratory data reveal an elevated thyroxine level. The FNP would proceed with an examination of the _____ gland Shadow health respiratory assessment transcript.
- A patient says that she has recently noticed a lump in the front of her neck below her “Adams apple” that seems to be getting bigger. During the assessment, the finding that leaves the FNP to suspect that this may not be a cancerous thyroid nodule is that the lump:
- The FNP notices that the patient’s submental lymph nodes are enlarged. In an effort to identify the cause of the node enlargement, the FNP would assess the patient’s:
- The FNP is aware that the four areas in the body were lymph nodes accessible are the:
- A 52-year-old patient describes the presence of occasional floaters or spots moving in front of his eyes. The FNP should know that floaters are usually not significant and are caused by:
- The FNP is preparing to assess the visual acuity of a 16-year-old patient. How should the FNP proceed?
- A patient’s vision is recorded as 20/30 when the Snellen eye chart is used. The FNP interprets these results to indicate that:
- A patient is unable to read even the largest letters on the Snellen chart. The FNP should take which action next:
- A patient’s vision is reported as 20/80 in each eye. The FNP interprets this finding to mean that
- When performing the corneal light reflex assessment, the FNP notes that the light is reflected at 2 o’clock in each eye. The FNP should
- The FNP is performing the diagnostic positions test. Normal findings would be which of these results?
- During an assessment of the sclera of an African-American patient, the FNP would consider which of these an expected finding?
- A 60-year-old man is at the clinic for an examination. The FNP suspects that he has ptosis of one eye. How should the FNP check for this?
- The FNP is doing an assessment on a 21-year-old patient and notices that his nasal mucosa appears pale gray and swollen. What would be the most appropriate question to ask the patient?
- The FNP is palpating the sinus areas. If the findings are normal, then the patient should report which sensation?
- During an oral assessment of a 30-year-old African-American patient, the FNP notices bluish lips and a dark line along the gingival margin. What would the FNP do in response to these findings
- During an assessment of a 20-year-old patient with a three day history of nausea and vomiting the FNP notices dry mucous and deep vertical fissures on the tongue. These findings are reflective of:
- The FNP is reviewing the technique of palpating for tactile fremitus with a new graduate. Which statement by the graduate FNP reflects a correct understanding of tactile fremitus?
- The FNP student is reviewing physical assessment findings of the HEENT system associated with pregnancy. Which statement by the graduate FNP reflects a correct understanding of expected HEENT changes associated with pregnancy? During pregnancy:
NR 509 Week 2 Quiz Review – (Jarvis 8,9,13,14,15,16,18), (Swartz 4,6,7,8,9,10)
NR 509 Week 2 Quiz
- A mother brings her two month old daughter in for an examination says “my daughter rolled over against the wall and now I have noticed that she has the spot soft on the top of her head, is there something terribly wrong?” The FNP‘s best response would be:
- During percussion the FNP knows that a dull percussion note elicited over a lung lobe. This most likely results from:
- The patient is unable to differentiate between sharp and dull stimulation to both sides of her face. The FNP suspects Damage to:
- When examining the face, the FNP is aware that the two pairs of salivary gland‘s that are accessible to examination are the _____ glands
- A patient comes to the clinic complaining of neck and shoulder pain and is unable to turn her head. The FNP suspects damage to cranial nerve ____ and proceeds with the examination by____
- When examining a patient’s cranial nerve function, the FNP remembers that the muscles in the neck that are innervated by CN XI are the:
- The patient’s laboratory data reveal an elevated thyroxine level. The FNP would proceed with an examination of the _____ gland
- A patient says that she has recently noticed a lump in the front of her neck below her “Adams apple” that seems to be getting bigger. During the assessment, the finding that leaves the FNP to suspect that this may not be a cancerous thyroid nodule is that the lump:
- The FNP notices that the patient’s submental lymph nodes are enlarged. In an effort to identify the cause of the node enlargement, the FNP would assess the patient’s:
- The FNP is aware that the four areas in the body were lymph nodes accessible are the:
- A 52-year-old patient describes the presence of occasional floaters or spots moving in front of his eyes. The FNP should know that floaters are usually not significant and are caused by:
- The FNP is preparing to assess the visual acuity of a 16-year-old patient. How should the FNP proceed?
- A patient’s vision is recorded as 20/30 when the Snellen eye chart is used. The FNP interprets these results to indicate that:
- A patient is unable to read even the largest letters on the Snellen chart. The FNP should take which action next:
- A patient’s vision is reported as 20/80 in each eye. The FNP interprets this finding to mean that
- When performing the corneal light reflex assessment, the FNP notes that the light is reflected at 2 o’clock in each eye. The FNP should
- The FNP is performing the diagnostic positions test. Normal findings would be which of these results?
- During an assessment of the sclera of an African-American patient, the FNP would consider which of these an expected finding?
- A 60-year-old man is at the clinic for an examination. The FNP suspects that he has ptosis of one eye. How should the FNP check for this?
- The FNP is doing an assessment on a 21-year-old patient and notices that his nasal mucosa appears pale gray and swollen. What would be the most appropriate question to ask the patient?
- The FNP is palpating the sinus areas. If the findings are normal, then the patient should report which sensation?
- During an oral assessment of a 30-year-old African-American patient, the FNP notices bluish lips and a dark line along the gingival margin. What would the FNP do in response to these findings
- During an assessment of a 20-year-old patient with a three day history of nausea and vomiting the FNP notices dry mucous and deep vertical fissures on the tongue. These findings are reflective of: Shadow health respiratory assessment transcript.
- The FNP is reviewing the technique of palpating for tactile fremitus with a new graduate. Which statement by the graduate FNP reflects a correct understanding of tactile fremitus?
- The FNP student is reviewing physical assessment findings of the HEENT system associated with pregnancy. Which statement by the graduate FNP reflects a correct understanding of expected HEENT changes associated with pregnancy? During pregnancy:
Identifying and Reliability:
Ms. Jones is an obese 28-year-old female who is
presenting to the office today with an athma
exacerbation. She is the primary and only source of
personal and medical data. Pleasent, cooperative
and readily open to freely dissiminate health
information. Good eyeye contact, well-groomed,
good posture, and comunicates clearly with logical
flow of ideas.
General Survey:
Upon entering the patient’s examination room,
patient was found to be sitting straight and erect,
good posture, well-groomed, well nourished with a
pleasent demeanor and manner of communicating.
Reason for Visit:
“Breathing problems and my inhaler just isn’t
working the way it normally does.”
HPI: Ms. Tina Jones is a 28-year-old African
American woman who walked in to the clinic
complianing of SOB and wheezing after nearly
haveing a “bad” asthma attack two days ago. Pt.
Overview
Transcript
Subjective Data Collection
Objective Data Collection
Education & Empathy
Documentation
Student Pre-Survey
Lifespan
Review Questions
Self-Reflection
reports xxx which triggered her asthma
symptoms while she was visitn her cousins house.
Initially, at the time of the climax of her near asthma
attack, xxx It lasted for 5 minutes,
following the use of her rescuexxx . Pt.
reports only chest tightness at the time, which has
continued to the present with no increase in
tightness. Pt. denies all other allergic symptoms
during the exaccerbation of her asthma. The inhalor
had amild to moderate effect, not fully resolving the
asthma symptoms. Pt. reports that since the initial
exacerbation, she has had ten similar asthma
episodes consisting of SOB, “not able to get
enough air in” to her lungs, chest tightness all occur
every 4 hours, even through the night, awakinging
her from sleep. Her symptomsare worsoned when
laying supine, including coughing fits each time she
lays down, which easily resolves once sitting
backup. Instead of using the xxx, pt. has been using xxxx with minimal to moderate relief. Most
recent episode was this morning prior to her arrival.
xxx are aggrevated by exposure
to cats, perhaps dust, and currently exacerbated by
exertion and laying supine with a subsequent
coughing fit. occur Cough is non-productive.
Pt. concerned her new albuterol inhaler is ineffective
compared to previous device. Her asthma has been
slowly interferring with her life the past year or so,
while still being manageable. Over the past 2 days,
her asthma has interferred with her daily life,
including her response that if she had not had these
past two days off of work, she “would have called in
sick for sure.” Pt. feels minimal asthma symptoms
curretly, following her xxx over an hour
ago.
Diagnosed with asthma at 2.5-years-old, She
frequented hospital visits and including five
hospitalizations before she was 16-years-old. Since
then she hasn’t been hospitalized. Pt. xxxx. Pt. doesn’t keep
asthma record of exacerbations and triggers; denies
asthma medication usage excet for albuterolresuce
inhaler. Pt. not currrently beingmanaged by a
pulmonologist or someone for her allergies. Pt.
denies using a vaporizer or nebulizer at home.
PMH:
Pt. reports Type 2 Diabetes, possible borderline
hypertension (no actual dx).
Allergies:
Cats: Develops itchy, watery eyes; an itchy, “runny
nose”; an itchy, sometimes a sore throat, and often
an asthma exacerbation – SOB, DOE, wheezing,
coughing, and chest tightness.
Dust: Develops a rash, no tiching.
Penicillin: “Rash, like, hives.”
HPI: Ms. Jones is a pleasant 28-year-old African
American woman who presented to the clinic with
complaints of xxxxx attack that she had two
days ago. She reports that she was xxxx and was exposed to cats which triggered her
asthma symptoms. At the time of the incident she
notes that her wheezes were a 6/10 severity and her
shortness of breath was a 7-8/10 severity and
lasted five minutes. She did not experience any
chest pain or allergic symptoms. At that time she
used her albuterol inhaler and her symptoms
decreased although they did not completely resolve.
Since that incident she notes that she has had 10
episodes of wheezing and has shortness of breath
approximately every four hours. Her last episode of
shortness of breath was this morning before coming
to clinic. She notes that her current symptoms seem
to be worsened by lying flat and movement and are
accompanied by a non-productive cough. She
awakens with night-time shortness of breath twice
per night. She complains that her current symptoms
are beginning to interfere with her daily activities
Medications:
Rx: xxx.
OTC: xxxfor occasional
xxxx related to readingfor prolonged periods
of . xxxx
Social History:
Pt. reports fairly severe xxx (xxx);
A moderate allergic reaction to excessive dust
accumulation (axxx); and Penicillin (report from
mom when pt.was a child, mother reports
development of a rash only; unknown if xxx and axx
occured as well. Pt. is meticullus about dust,
allergins, mildew accumulation; using hypoallergenic
practices with bed, sheets, pillows and spead.
Mattress is 12 months old. Pt. denies ever using
tabacco in any form, as well as illicit drugs and
prescription medicaton abuse. Pt. does report that
from 15-16-years old she smoked marijuana, but
hasn’t partaken in it since 21-years-old. Pt. states
she doesn’t exercise, eats “whatever”, with some
restrint in high sugar beverages and treats.
Family History: Pt. states sister has history of
asthma and hayfever.
Surgical History: Pt. denies previous surgeries.
ROS:
General: Pt. states recent changes in appetite as
she is “always hungry” even after she has eaten a
large meal. Reports exercise intolerance, usually
feels fatigued. Pt. denies recent weight changes,
fevers, chills. body aches, sweats. feels she is
generally a healthy person.
Skin: Pt. reports skin color and pigment changes
localized only around her neck – which has been
changeing the past couple of years now. Pt. reports
that moles on her back have not changed in size or
color.Skin is dryer than usual and feels dehydrated
and always thirsty. Denies sores, lesions, scabs.
Pulmonary: Pt. states that she has coughing fits
when exposed to allergens like dust adn especially
cats. Coughing also occurs when asthma “acts up”
and anytime she lays down in the past month she
begins to cough. Lately she will wake up twice a
night because of uncontrolable coughing which
resolves after she has been in a sitting or upright
position for a few minutes. Denies productive cough
or coughing up blood. Denies being exposed to
anyone sick, has not traveled.
Reports SOB when she has to hurry somewhere or
whan she climbs a large flight of stairs. Has
orthopnea twice a night with coughing fits. xxxx and denies OSA.
xxx: Pt. state she may have borderline
and she is concerned that her xxxx
seems to be less effective than previous. Currently
she states that her breathing is normal. Diagnosed
with asthma at age 2.5 years. She has no recent use
of spirometry, does not use a peak flow, does not
record attacks, and does not have a home nebulizer
or vaporizer. She has been hospitalized five times
for asthma, last at age 16. She has never been
intubated for her asthma. She does not have a
current pulmonologist or allergist.
xxx: She is not aware of any
environmental exposures or irritants at her job or
home. She changes her sheets weekly and denies
dust/mildew at her home. She uses a hypoallergenic
pillow cover and her mattress is one year old. She
denies current use of tobacco, alcohol, and illicit
drugs. She did smoke marijuana for 5 or 6 years,
her last use was at age 21 years. She does not
exercise.
Review of Systems: General: Denies changes in
weight, fatigue, weakness, fever, chills, and night
sweats.
• xxx: Denies rhinorrhea with this episode.
Denies stuffiness, sneezing, itching, previous allergy,
epistaxis, or sinus pressure.
• Gastrointestinal: No changes in appetite, no
nausea, no vomiting, no symptoms ofxxx
• xxx: Complains of shortness of breath and
cough as above. Denies sputum, xxx,
pneumonia, bronchitis, emphysema, tuberculosis.
She has a history of asthma, last hospitalization was
age 16, last chestxxxx.
hypertension. Pt. denies xxxx,
palpitations, tachycardia or racing heart, orthostatic
changes, edema, heart arrythmias and denies
sickle-cell disease.
Endocrine: Pt. reports having previous diagnosis of
diabetesxxxx, xxx,
lethargy. Pt. reposrts having xxx, dxxx,
being overweight. Pt. denies changes in hair
pattern, weight changes, node enlargement, breast
changes, galactorhea, never been pregnant,
tremors. Shadow health respiratory assessment transcript.
GI: Pt. denies N/V, anorexia, diarhea, GERD, ulcers,
colonoscopy, constipation, hematamesis,
hematechezia, recent changes in bowel evacuation
habits, dysphagia, flatulance.
GU: Pt. reports xxxx, feels
thirsty all the time now, drinks a lot of fluids which
doesn’t seem to quench thirst. She has now been
experiencing nocturia 2-3 times per night. Denies
xxx, chronic or recent xxxx, history
of or knowlingly being xxxx. Reports
haveing three sexual partners in her life, all of which
are men. Has been absinent for over a year now.
Denies incontinence.
Neurologic: Pt. denies changes in sensation,
weakness, light-headedness, dizziness, chronic
xxxxchanges in mentation,
long or short term memory, concussions,xxxx
HEENT: Pt. denies history of xxx, except for
occassionally occuring when she reads too long xxx
changes, except for “blurry eyes” after reading for
too long. Denies other visions problems, hearing
issues, nasal discharge, epistaxis, gingivitis, mouth
sores. Pt. doesn’t see dentist annually nor teetch
professionally cleaned – hasn’t been to the dentist
for “years.”
Objective
Tina is an obese 28-year-old African American
woman who does not seem to be in any acute
distress. Alert and oriented, sitting upright, ,
maintains appropriate eye contact, is
conversational, and answers questions approprietly.
Respiratory: Respiratory examination found Tina’s
chest expansion to be symetrical with respiration.
Bilaterally symetrical tactile fremitous, negative
broncophony anteriorly and posteriorly in all lung
fields. Chest resonent when percussed, devoid of
any dullness. Bilateral lower lxxxx. All other
lung fields clear to auscultation. No crackles,
rhonchi, coarseness noted in lung auscultation.
Muffled words bilaterally with prominent expiratory
wheezes in the posterior lower lobes only.
Spirometry yielded xxxxon room air, xxxx, BP
General: Ms. Jones is a pleasant, xxx 28-year-old
African American woman in no acute distress. She
is alert and oriented and sitting upright on exam
table. She maintains eye contact throughout
interview and examination.
• Respiratory: Chest expansion is symmetrical with
respirations. Normal fremitus, symmetric bilaterally.
Chest resonant to percussion; no dullness. Bilateral
expiratory wheezes in posterior lower lobes.
Bilateral muffled words with notable expiratory
wheezes in posterior lower lobes. No crackles. In
office xxx%.
x
140/81, Temperature xxxdegrees Farenhiet.
Assessment
Mild-Persistent Asthma with Exacerbation. Mild-persistent asthma with exacerbation
Plan
Diagnostics: Obtain oxygen saturation and baseline
spirometry and peak flow readings.
Medication: NMI at office one time. Continue
albuterol rescue inhalor. Initiate step up inhaled
corticosteroid.
Education: Encourage Tina to log her asthma
symptoms and episodes of exacerbation every day
and bring log in to next visit. Monitor trigger
exposures adn resultant asthma symptoms and
severity of exacerbations. Encourage Tina to
remove and/or clean all possible harborers of
allergens, including bedding, seats, pillows carpet.
Change air filters in home and car to incrased
allergiin removal from the air. Encourage an incrase
in fluid consumption, especially water. Help guide
pt. indeveloping an asthma action plan and assess
effectiveness and apropriateness of plan in next
visit.
Orders: xxxx
after each exacerbation for purposes of comparison
and establishing pt. trends.
Instruct Tina to return to clinic if ongoing symptoms.
Also inform xxx if
worsoning asthma symptoms, xxxx that is
unresolved by a short rest. Also go to xxxis
unresolved xxx, wheezing not allevaited
xxx and xxx.
Follow-Up: Return to clinic in 3 weeks for follow-up
evaluation regarding coarse of illness, medication
use and needs, as well as medication effectivenss.
Diagnostics
• Obtain office oxygen saturation
Medication
• xxxin office x 1
• Initiate step-up medication therapy with xxxx
• Continue xxx
Education
• Encourage Ms. Jones to continue to xxx
symptoms and wheezing with associated factors
and bring log to next visit
• Encourage to wash xxx and consider xxx to decrease axxe
symptoms
• Educate to increase intake of water and other
fluids
• Create Axxx
Referral/Consultation
• Refer to allergy specialist for evaluation and testing
Follow-up Planning
• Order PFTs to be completed after exacerbation to
have baseline available for future comparison
• Instruct Ms. Jones on when to seek emergent care
including episodes of chest pain or shortness of
breath unrelieved by rest, worsening asthma
symptoms or wheezing, or the sense that rescue
inhaler is not helping
• Revisit clinic in 2-4 weeks for follow up and
evaluation
Comments
If your instructor provides individual feedback on this assignment, it will appear here.
NR 509 Week 2 Quiz Review – (Jarvis 8,9,13,14,15,16,18), (Swartz 4,6,7,8,9,10)
1. What does dullness when percussing lung fields: Jarvis pg 427
2. Facial sensation controlled by which CN: Jarvis 283,
3. Know what two salivary glands are accessible during exam
4. What CN is being … when pt shrugs shoulders Jarvis 646
5. What muscles are being …. when …. CN 11 (spinal accessory nerve)
6. Concern for malignant nodules versus benign lymph nodule
7. Know what you’d do next if you palpated a submental lymph node: Jarvis pg 253
8. Define visual acuity
9. Know what to do if your patient can’t read the largest number on the Snellen chart: Jarvis 289
10. Example of good visual acuity : Jarvis 289
11. Example of poor visual acuity: Jarvis 289
12. What is …. with corneal light reflex-
13. Know normal variances of sclera : Jarvis 283
14. Know how to check for Ptosis: Jarvis 292
15. What does ptosis indicate: Jarvis 292
16. Nasal fissure of pt with chronic allergies : Jarvis 271
· Acute allergies : Jarvis p 363 .
17. What is an abnormal palpation of sinuses: Jarvis 362
· Normal palpation of sinuses
18. Know normal variations in gingival margin
19. Know what a dehydrated oral cavity will look like: Jarvis 387
20. What is tactile fremitus, how do you test for it and what does it indicate. Jarvis 425
N 518 Module 2: THE GENERAL SURVEY AND HEENT
Module 2: Discussion Question
Start by reading and following these instructions:
You are responsible for minimally at least 3 posts for each question in your discussion boards; your initial post and reply to two of your classmates. Your initial post(s) should be your response to the questions posed in the discussion question. You should research your answer and cite at least one scholarly source when appropriate, and always use quality writing.The discussion board is never a place to use text language or emoticons. You will also be asked to respond to your classmates. This is designed to enhance the academic discussion around the topic. It is all right to disagree with something posted by another, however your responses should always be thoughtful and respectful and reflect your opinions professionally.
Discussion Question:
In your professional opinion, what is the difference between chronic and acute pain? How is the assessment for each type of pain different? What must you keep in mind when assessing acute pain? What must you keep in mind when assessing chronic pain? Reflect upon a time when you assessed a patient in pain. What did you do well? What points could you have improved upon? How did the pain impact the patient? What specific treatments could have lessened the impact of the pain on the patient?
Your initial posting should be 200 to 300 words in length and utilize at least one scholarly source other than the textbook. Please reply to at least two classmates. Replies to classmates should be at least 100 words in length. To properly “thread” your discussion posting, please click on REPLY.
When you are ready for the discussion, do the following:
- Click on the discussion link above.
- Start your answer by clicking “Start a New Thread” button with the title of your answer and the body of text following the guidance above.
- To properly post your answer, please click on the “Post” button.
- After posting your contribution, you must read what others have posted, reply to at least two of those posts, and respond (when appropriate) to those you have responded to you.
To reply to a classmate’s post:
- Click on the title of another student’s post.
- Click “Reply to Thread” and type your response to the student.
- Click the “Post” button to post your reply.
N 581 Module 2: Assignment
Remember to submit your work following the file naming convention FirstInitial.LastName_M01.docx. For example, J.Smith_M01.docx. Remember that it is not necessary to manually type in the file extension; it will automatically append.
Start by reading and following these instructions:
1. Quickly skim the questions or assignment below and the assignment rubric to help you focus.
2. Read the required chapter(s) of the textbook and any additional recommended resources. Some answers may require you to do additional research on the Internet or in other reference sources. Choose your sources carefully.
3. Consider the discussion and the any insights you gained from it.
4. Create your Assignment submission and be sure to cite your sources, use APA style as required, check your spelling.
Assignment:
Exercises:
- Complete the Shadow Health HEENT assessment.
Professional Development
- Write a reflection essay of your experience with the Shadow Health virtual assessment. At least two scholarly sources in addition to your textbook should be utilized. Please be sure to address each of the following prompts:
- What went well in your assessment?
- What did not go so well? What will you change for your next assessment?
- What findings did you uncover?
- What questions yielded the most information? Why do you think these were effective?
- What diagnostic tests would you order based on your findings?
- What differential diagnoses are you currently considering?
- What patient teaching were you able to complete? What additional patient teaching is needed?
- Would you prescribe any medications at this point? Why or why not? If so, what?
- How did your assessment demonstrate sound critical thinking and clinical decision making? What could you change to make it better?
Shadow Health Physical Assessment Rubric
| Criteria | Ratings | Pts | ||||
|---|---|---|---|---|---|---|
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This criterion is linked to a Learning OutcomeSubjective Data, Organization, Communication, and Summary (DCE Score or transcript) |
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25.0 pts
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This criterion is linked to a Learning OutcomeObjective Data, Physical Examination, Interpretation of Findings, Assessment, and Documentation |
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20.0 pts
|
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This criterion is linked to a Learning OutcomeSelf-Reflection |
|
5.0 pts
|
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Total Points: 50.0
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