NURS 6512 Assignment 1: Case Study Assignment: Assessing Neurological Symptoms

NURS 6512 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 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.

Please use my course resources as one of my references as instructed. Please include 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 as one of the references

Learning Resources

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 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.

Kim, H., Lee, S., Ku, B. D., Ham, S. G., & Park, W. (2019). Associated factors for cognitive impairment in the rural highly elderly. Brain and Behavior, 9(5), e01203. https://doi.org/10.1002/brb3.1203

Lee, K., Puga, F., Pickering, C. E., Masoud, S. S., & White, C. L. (2019). Transitioning into the caregiver role following a diagnosis of Alzheimer’s disease or related dementia: A scoping review. International Journal of Nursing Studies, 96, 119–131. https://doi.org/10.1016/j.ijnurstu.2019.02.007

O’Caoimh, R., & Molloy, D. W. (2019). Comparing the diagnostic accuracy of two cognitive screening instruments in different dementia subtypes and clinical depression. Diagnostics, 9(3), 93. https://doi.org/10.3390/diagnostics9030093

Shadow Health Support and Orientation Resources

Use the following resources to guide you through your Shadow Health orientation as well as other support resources:

Shadow Health. (2021). Welcome to your introduction to Shadow Health. https://link.shadowhealth.com/Student-Orientation-Video

Shadow Health. (n.d.). Shadow Health help desk. Retrieved from https://support.shadowhealth.com/hc/en-us

Shadow Health. (2021). Walden University quick start guide: NURS 6512 NP students. https://link.shadowhealth.com/Walden-NURS-6512-Student-Guide

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. (2020). DeGowin’s diagnostic examination (11th ed.). New York, NY: McGraw Hill Medical.

Chapter 14, The Neurologic Examination

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

In this chapter, the authors provide a list of common psychiatric syndromes. The authors also explain the mental, psychiatric, and social evaluation process. 

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

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. 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.  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.

CASE STUDY: Forgetfulness

Asia brings her 67-year-old father into the office stating he is very forgetful. He has lost his car keys several times. She also states he has driven to the store and called her asking for directions to get back home. 

Example Episodic/Focused SOAP Note of Forgetfulness Case Study

Patient Information: Mr. J. A., a 67-year-old non-Hispanic

CC (chief complaint) “My father is very forgetful.”

HPI: A 67-year-old patient brought to the healthcare facility by his daughter complains of being forgetful. The problem has lasted for over a month, and the last episode, where he drove to the store and called her daughter to explain the direction back home, evoked the clinic visit. The primary informant is the daughter.

She complains that her father is very forgetful and has repeatedly lost his car keys. He reports that the symptoms worsened in the recent month after he began his alcohol withdrawal program. He is often irritable and agitated. His remote memory is intact, and he has problems recalling recent events. He cannot explain how he got to the facility and denies forgetfulness.

Current Medications: Insulin 10IU SC TDS (after meals, last taken today morning). Diazepam 5mg tablets PO TDS

Allergies: Allergic to dust and cat fur (he has no pets). He develops a cough, nasal congestion, stuffiness, and rhinorrhea on exposure. Denies any food and drug allergies

PMHx: Diagnosed with epilepsy at six, which subsided over time. The patient was also admitted at 17 following fracture femurs after an RTA. He sustained minor head injuries and underwent an intramural nail insertion surgery. He was an alcoholic, started at 50 after losing his wife of 25 years, and is currently on a withdrawal program.

Soc Hx: Mr. J. A. is a retired teacher who loves to go shopping and on road trips with his family and friends. He currently lives with his daughter and the house help; his eldest son is married. He is an active smoker but verbalizes the urge to cease smoking. He was an alcoholic but has been in AA and currently taking diazepam to manage withdrawal symptoms.

Mr. J. A. uses seat belts when driving or in public transport, has active smoke detectors in the house, and has a gun for personal protection. He has a strong social support system consisting of his daughter and the church clergy.

Fam Hx: Paternal grandfather had epilepsy and died of a stroke at 68. His paternal grandmother had diabetes and died of an RTA at 70. Father was alcoholic, hypercholesterolemic, and succumbed to a stroke at 80.

Brother, 76, is hypercholesterolemic and epileptic. Sister, 65, has diabetes and was diagnosed with breast cancer six years ago, which resolved after surgery. Her daughter, 25, was diagnosed with MDD 2 years ago, which resolved after treatment.

ROS:

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

HEENT:  Eyes: Denies visual changes, pain, or drainage. Ears: Denies auditory changes, pain, or discharge. Nose: Denies pain, congestion, and runny nose. Throat:  Denies sore throat, pain in swallowing.

SKIN:  Denies itchiness, rashes, or lesions.

CARDIOVASCULAR:  Denies chest pain, pressure, or discomfort. Denies a racing heart or edema

RESPIRATORY:  Denies SOB, cough, fast breathing, or sputum production.

GASTROINTESTINAL:  Denies bloating, indigestion, abdominal upset, nausea, vomiting, diarrhea, or constipation

GENITOURINARY:  Denies any pain in micturition and or blood in the urine. Sexually inactive for a while with no recent sexual drive changes

NEUROLOGICAL:  Daughter reports recent changes in coordination with keys and other items falling from his hands unawares. Denies headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. Denies bowel or bladder control changes

MUSCULOSKELETAL: Reports occasional back pain and tiredness. Denies back and joint pain and joint stiffness.

HEMATOLOGIC:  Denies anemia, easy bleeding or bruising, reports blood coagulates first

LYMPHATICS: Denies having enlarged lymph nodes or any history of splenectomy

PSYCHIATRIC:  Reports a temporary depressive episode after losing his wife. Denies anxiety or other mental health illnesses.

ENDOCRINOLOGIC:  Denies excessive thirst, hunger, or urination, and cold or heat intolerance

ALLERGIES: Reports a recent history of allergic rhinitis six weeks ago. Denies other recent allergic reaction episodes

O.

Physical exam:

Vitals: BP-125/89: P-88: T: 36.70C: RR: 17 Pain: 0/10, SpO2 – 98% of room air

General: The patient appears irritated and confused but appropriately dressed for the occasion and weather. He is well-oriented to place and person but is disoriented to time and event. He appears emaciated and sad.

Head: The patient has grey hair with visible hair loss and a resending hairline. A visible scar on the left parietal aspect of the skull

Neck: Trachea midline, no enlarged cervical lymph nodes

Chest: Symmetrical rising on breathing. Resonant to percussion, no crackles or wheezes, and vesicular breath sounds auscultated. S1 and S2 present, no S3, S4, murmurs, or bruits, and the apical pulse is 88

Abdomen: Globular shape, no scars, flank discoloration, or bruising. Bowel sounds are present in all quadrants.

Extremities: Symmetrical with appreciable muscle tone

Neuromuscular: Muscle and tendon reflexes present. Tinetti Balance Assessment positive, patient-oriented to persons, place, and disoriented to time and occasion, Glasgow coma scale score of 13, Mini-Mental Status Examination (MMSE)- reveals distorted immediate recall and retention and recent memory. Back muscle mild pain and tiredness with no gait changes

Psychiatric/MSE: All muscles with appreciable muscle tone. Immediate recall and retention memory distorted- the patient cannot recall a short story narrated. Recent memory distorted- patient remembers scanty details of their previous day’s activities.

Diagnostic results: Head CT scan- helps differentiate idiopathic amnesia from amnesia resulting from brain degeneration and trauma. Head CT and MRI scans help study brain activity and unearth any abnormal activity. In addition, an electroencephalogram will help understand brain activity. Full hemogram tests to determine thiamine and other hormone and electrolyte levels will help rule out other conditions.

A.

Differential Diagnoses (list a minimum of 3 differential diagnoses)

The presumptive diagnosis is anterograde amnesia. Anterograde amnesia is a transient idiopathic condition whose cause is not permanent, such as those caused by degenerative brain disorders (Garland et al., 2021). The patient presents with various confounders that could predispose an individual to the condition.

He is an active smoker and is currently on diazepam to manage alcohol withdrawal syndrome. Some causes of the condition are psychotropic medications and traumatic brain injury. Patients with this condition should be attended to with attention due to the risk of self-harm, especially forgetfulness.

Drug-induced amnesia is a possible diagnosis for this patient. Benzodiazepines are medications known for inducing amnesia. Jain (2021) notes that benzodiazepines interfere with memory formation, causing difficulty in remembering recent events under the drug’s influence. Memory returns when the drug’s influence wears off. Mr. J. A’s condition began earlier before starting the medication. In addition, his memory of recent events is simply absent, not just forgotten.

The client could also be suffering from transient epileptic amnesia. The condition is rare and results from temporal lobe epilepsy and can be defined as brief and frequently occurring symptoms of amnesia. The patient’s caregiver reports several recurring episodes of amnesia, such as losing keys.

An assessment of the patient these client reveals a lack of immediate recall and retention and recent memory, ruling out the condition (Ball et al., 2019). Physical exam, including psychiatric and mental health examination, helps diagnose underlying conditions and remedy them

Another possible diagnosis is transient global amnesia. The condition refers to an episode of memory loss that is sudden and idiopathic without a physical or neurologic cause (Sparaco et al., 2022).

Patients often forget where they are and how they got there; the episodes last less than 24 hours. Alessandro et al. (2019) note that the condition is associated with other underlying conditions, such as hippocampal interference and migraines, which are common in individuals with transient global amnesia. 

An MRI or CT scan can help diagnose the condition by studying the brain structure. Mr. J. A. has exhibited similar symptoms, but his condition has been recurrent, and the client cannot create memories at all. Memory loss in TGA is episodic, and the client can remember the details, which is not the case for this patient, ruling out the condition.

The client could have suffered from dissociative amnesia. The condition results from a past psychologically painful event, such as losing a loved one. The condition manifests through episodic memory loss that occurs over an hour, a day, days, and even years, depending on the intensity of the psychological pain (Manguilli et al., 2022). 

However, the condition leads to a total blackout with memory loss, especially of the event and their identity. However, the patient remembers their details and identity and has a vivid remote memory ruling out the condition. In this case study, the patient and her daughter present limited knowledge and gaps, and it is impossible to rule out these conditions entirely. Thus, further clinical and diagnostic interventions are vital before diagnosing this patient.

P. 

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

References

Alessandro, L., Calandri, I. L., Suarez, M. F., Heredia, M. L., Chaves, H., Allegri, R. F., & Farez, M. F. (2019). Transient global amnesia: clinical features and prognostic factors suggesting recurrence. Arquivos de Neuro-Psiquiatria, 77, 3-9. https://doi.org/10.1590/0004-282X20180157

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 as one of the references

Garland, M. M., Vaidya, J. G., Tranel, D., Watson, D., & Feinstein, J. S. (2021). Who Are You? The Study of Personality in Patients With Anterograde Amnesia. Psychological Science, 32(10), 1649-1661. https://doi.org/10.1177/09567976211007463

Jain, K. K. (2021). Drug-Induced Disorders of Memory and Dementia. In Drug-induced Neurological Disorders (pp. 209-231). Springer, Cham. https://doi.org/10.1007/978-3-030-73503-6_14

Mangiulli, I., Otgaar, H., Jelicic, M., & Merckelbach, H. (2022). A critical review of case studies on dissociative amnesia. Clinical Psychological Science, 10(2), 191-211. https://doi.org/10.1177/21677026211018194

Sparaco, M., Pascarella, R., Muccio, C. F., & Zedde, M. (2022). Forgetting the unforgettable: transient global amnesia part I: pathophysiology and etiology. Journal of Clinical Medicine, 11(12), 3373. https://doi.org/10.3390/jcm11123373

Module 2: Functional Assessments and Assessment Tools

WEEK 2: AT A GLANCE

FUNCTIONAL ASSESSMENTS AND CULTURAL AND DIVERSITY AWARENESS IN HEALTH ASSESSMENT

INTRODUCTION

Diversity is not about how we differ. Diversity is about embracing one another’s uniqueness.

—Ola Joseph

Countless assessments can be conducted on patients, but they may not be useful. In order to ensure that health assessments result in the necessary care, health assessments should take into account the impact of factors such as cultures and developmental circumstances.

LEARNING OBJECTIVES

Students will:

• Analyze diversity considerations in health assessments
• Apply concepts, theories, and principles related to examination techniques, functional assessments, and cultural and diversity awareness in health assessment  

Week 2: Discussion – DIVERSITY AND HEALTH ASSESSMENTS

May 2012, Alice Randall wrote an article for The New York Times on the cultural factors that encouraged black women to maintain a weight above what is considered healthy.

Randall explained—from her observations and her personal experience as a black woman—that many African-American communities and cultures consider women who are overweight to be more beautiful and desirable than women at a healthier weight. As she put it, “Many black women are fat because we want to be” (Randall, 2012).

Randall’s statements sparked a great deal of controversy and debate; however, they emphasize an underlying reality in the healthcare field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and healthcare professionals should be aware of this reality and adapt their health assessment techniques and recommendations to accommodate diversity.

In this Discussion, you will consider different socioeconomic, spiritual, lifestyle, and other cultural factors that should be taken into considerations when building a health history for patients with diverse backgrounds. Your Instructor will assign a case study to you for this Discussion.

To prepare:

• Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments.
• By Day 1 of this week, you will be assigned a case study by your Instructor. Note: Please see the “Course Announcements” section of the classroom for your case study assignment.
• Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient assigned to you.
• Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.
• Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information?

BY DAY 3 OF WEEK 2

Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

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

Read a selection of your colleagues’ responses.

BY DAY 6 OF WEEK 2

Respond on or before Day 6 on 2 different days to at least two of your colleagues who were assigned a different patient than you. Critique your colleague’s targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to your patient, and why.

Case Study 3:    

Paloma Hernandez, 26-year-old, Spanish-speaking patient who presents to the clinic for the last 2 days in a row complaining of abdominal pain that is getting worse. The first visit the staff relied on her younger bilingual daughter to translate. She was treated with Omeprazole and encouraged to take OTC medication. Today she presents with the same problem. Her daughter states it is the same problem but worse today.

Case Study 4:  

Mono Nu, a 44-year-old Filipino patient comes to the clinic today to have his “blood thinner” labs drawn since he started them two weeks ago. Upon assessing the labs, the nurse practitioner notes that he is still out of range. When assessing the patient’s compliance both stated that he had been taking them just as prescribed. He has been doing well and eating a diet rich in fish and tofu. He doesn’t understand why his medications are not working.

Case Study 5

Shawn Billings, a 28-year-old African American patient comes in to the clinic today. He has been deemed a “frequent flyer” by the staff at the clinic and was at the clinic last week and 4 days ago with a migraine, given a shot of Toradol and Ativan and sent home. He is here today again for an extreme headache. He is very agitated today. He is here with his father and worried that he will not get any medication.

By Day 6 of Week 2

Respond on or before Day 6 on 2 different days to at least two of your colleagues who were assigned a different patient than you. Critique your colleague’s targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to your patient, and why.

Have a good week!

LEARNING RESOURCES

• Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2023). Seidel’s guide to physical examination: An interprofessional approach (10th ed.). St. Louis, MO: Elsevier Mosby.

Chapter 1, “Cultural Competency”
This chapter highlights the importance of cultural awareness when conducting health assessments. The authors explore the impact of culture on health beliefs and practices.

• 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 2, “Evidenced-Based Clinical Practice Guidelines”

• Centers for Disease Control and Prevention. (2020, October 21). Cultural competence in health and human servicesLinks to an external site.. Retrieved from https://npin.cdc.gov/pages/cultural-competence
  This website discusses cultural competence as defined by the Centers for Disease Control and Prevention (CDC). Understanding the difference between cultural competence, awareness, and sensitivity can be obtained on this website.
• United States Department of Human & Health Services. Office of Minority Health. (n.d.). A physician’s practical guide to culturally competent careLinks to an external site.. Retrieved June 10, 2019, from https://cccm.thinkculturalhealth.hhs.gov/
  From the Office of Minority Health, this website offers CME and CEU credit and equips healthcare professionals with awareness, knowledge, and skills to better treat the increasingly diverse U.S. population they serve.
• Coleman, D. E. (2019). Evidence based nursing practice: The challenges of health care and cultural diversityLinks to an external site.. Journal of Hospital Librarianship, 19(4), 330–338. https://doi.org/10.1080/15323269.2019.1661734
• Young, S., & Guo, K. L. (2016). Cultural diversity training. The Health Care Manager, 35(2), 94–102. https://doi.org/10.1097/hcm.0000000000000100

Module 2 Introduction

Dr. Tara Harris reviews the overall expectations for Module 2. Consider how you will manage your time as you review your media and Learning Resources for your Discussion, Case Study Lab Assignment, and your DCE Assignment (3m).

Functional Assessments and Cultural and Diversity Awareness in Health Assessment – Week 2 (10m)

• Walden University. (n.d.). Instructor feedback. https://cdn-media.waldenu.edu/2dett4d/Walden/WWOW/1001/pulse_check/instructor_feedback/index.html#/

NURS 6512 Week 4: Assessment of the Skin, Hair, and Nails

INTRODUCTION

One of the more common biology analogies refers to cells as the “building blocks” of life. This rightfully places an emphasis on understanding cells, cellular behavior, and the impact of the environment in which they function.

Such an understanding helps explain how healthy cell activity contributes to good health. Just as importantly, it helps explain how breakdowns in cellular behavior cells lead to health issues.

LEARNING OBJECTIVES

Students will:

• Apply assessment skills to diagnose skin conditions
• Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for the skin, hair, and nails
• Analyze dermatologic procedures to include skin biopsy, punch biopsy, suture insertion and removal, nail removal, skin lesion removal

Week 4: Assignment 1 LAB ASSIGNMENT: DIFFERENTIAL DIAGNOSIS FOR SKIN CONDITIONS

Properly identifying the cause and type of a patient’s skin condition involves a process of elimination known as differential diagnosis. Using this process, a health professional can take a given set of physical abnormalities, vital signs, health assessment findings, and patient descriptions of symptoms, and incrementally narrow them down until one diagnosis is determined as the most likely cause.

In this Lab Assignment, you will examine several visual representations of various skin conditions, describe your observations, and use the techniques of differential diagnosis to determine the most likely condition.

To Prepare:

• Review the Skin Conditions document provided in this week’s Learning Resources, and select one condition to closely examine for this Lab Assignment.
• Consider the abnormal physical characteristics you observe in the graphic you selected. How would you describe the characteristics using clinical terminologies?
• Explore different conditions that could be the cause of the skin abnormalities in the graphics you selected.
• Consider which of the conditions is most likely to be the correct diagnosis, and why.
• Search the Walden library for one evidence-based practice, peer-reviewed article based on the skin condition you chose for this Lab Assignment.
• Review the Comprehensive SOAP Exemplar found in this week’s Learning Resources to guide you as you prepare your SOAP note.
• Download the SOAP Template found in this week’s Learning Resources, and use this template to complete this Lab Assignment.

THE LAB ASSIGNMENT

• Choose one skin condition graphic (identify by number in your Chief Complaint) to document your assignment in the SOAP (Subjective, Objective, Assessment, and Plan) note format rather than the traditional narrative style. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in this week’s Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case.
• Use clinical terminologies to explain the physical characteristics featured in the graphic. Formulate a differential diagnosis of five possible conditions for the skin graphic that you chose. Determine which is most likely to be the correct diagnosis and explain your reasoning using at least three different references, one reference from current evidence-based literature from your search and two different references from this week’s Learning Resources.

LEARNING RESOURCES

Required Readings

• Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2023). Seidel’s guide to physical examination: An interprofessional approach (10th ed.). St. Louis, MO: Elsevier Mosby.

Chapter 9, “Skin, Hair, and Nails”
This chapter reviews the basic anatomy and physiology of skin, hair, and nails. The chapter also describes guidelines for proper skin, hair, and nails assessments.

• 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.
  This section explains the procedural knowledge needed prior to performing various dermatological procedures.

o   Chapter 1, “Punch Biopsy Download Chapter 1, “Punch Biopsy”

o   Chapter 2, “Skin Biopsy”Download Chapter 2, “Skin Biopsy”

o   Chapter 10, “Nail Removal”Download Chapter 10, “Nail Removal”

o   Chapter 15, “Skin Lesion Removals: Keloids, Moles, Corns, Calluses”Download Chapter 15, “Skin Lesion Removals: Keloids, Moles, Corns, Calluses”

o   Chapter 16, “Skin Tag (Acrochordon) Removal”Download Chapter 16, “Skin Tag (Acrochordon) Removal”

o   Chapter 22, “Suture Insertion”Download Chapter 22, “Suture Insertion”

o   Chapter 24, “Suture Removal”Download Chapter 24, “Suture Removal”

• 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.

o   Chapter 28, “Rashes and Skin Lesions”Download Chapter 28, “Rashes and Skin Lesions”
This chapter explains the steps in an initial examination of someone with dermatological problems, including the type of information that needs to be gathered and assessed.
Note: Download and use the Student Checklist and the Key Points when you conduct your assessment of the skin, hair, and nails in this Week’s Lab Assignment.

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

o   Chapter 2, “The Comprehensive History and Physical Exam” (Previously read in Weeks 1 and 3)

• VisualDx. (2021). Clinical decision supportLinks to an external site.: For professionals. Retrieved July 16, 2021, from http://www.skinsight.com/professionals
  This interactive website allows you to explore skin conditions according to age, gender, and area of the body.
• Bonifant, H., & Holloway, S. (2019). A review of the effects of ageing on skin integrity and wound healingLinks to an external site.. British Journal of Community Nursing, 24(Sup3), S28–S33. https://doi.org/10.12968/bjcn.2019.24.sup3.s28
• Document: Skin Conditions Download Skin Conditions(Word document)
  This document contains images of different skin conditions. You will use this information in this week’s Discussion.
• Document: Comprehensive SOAP Exemplar Download Comprehensive SOAP Exemplar(Word document)
• Document: Comprehensive SOAP Template Download Comprehensive SOAP Template(Word document)

Shadow Health Support and Orientation Resources

Use the following resources to guide you through your Shadow Health orientation as well as other support resources:

• Shadow Health. (2021). Welcome to your introduction to Shadow HealthLinks to an external site.. https://link.shadowhealth.com/Student-Orientation-Video
• Shadow Health. (n.d.). Shadow Health help deskLinks to an external site. Retrieved from https://support.shadowhealth.com/hc/en-us
• Shadow Health. (2021). Walden University quick start guide: NURS 6512 NP students. Download Walden University quick start guide: NURS 6512 NP students. https://link.shadowhealth.com/Walden-NURS-6512-Student-Guide
• Document: Shadow Health Nursing Documentation Tutorial  Download Shadow Health Nursing Documentation Tutorial(Word document)
• Document: DCE (Shadow Health) Documentation Template for Health History Download DCE (Shadow Health) Documentation Template for Health History (Word document) Use this template to complete your Assignment 2 for this week.

Module 3 Introduction

Dr. Tara Harris reviews the overall expectations for Module 3. Consider how you will manage your time as you review your media and Learning Resources for your Discussions, Case Study Lab Assignments, DCE Assignments, and your Midterm exam (12m).

Skin, Hair, and Nails – Week 4 (19m)

Suturing Tutorials

The following suturing tutorials provide instruction on the basic interrupted suture, as well as the vertical and horizontal mattress suturing techniques

• Tulane Center for Advanced Medical Simulation & Team Training. (2010, July 8). Suturing techniqueLinks to an external site. [Video file]. Retrieved from https://www.youtube.com/watch?v=c-LDmCVtL0o
  Note: Approximate length of this media program is 5 minutes.
• Mikheil. (2014, April 22). Basic suturing: Simple, interrupted, vertical mattress, horizontal mattressLinks to an external site. [Video file]. Retrieved from https://www.youtube.com/watch?v=MFP90aQvEVM
  Note: Approximate length of this media program is 9 minutes.

Incision and Drainage of an Abscess (a common procedure in primary care)

• New England Journal of Medicine (NEJM). (2013, September 30). NEJM abscess incision and drainageLinks to an external site. [Video file]. Retrieved from https://www.youtube.com/watch?v=MwgNdrA18fM&list=PL9UKTUFtRDcNq4–Vf2NYfUANEyObfeNm&index=8
  Note: Approximate length of this media program is 10 minutes.

Dermablade Use for Shave Biopsies

• Dermablade®. (2012, November 9). PersonnaBladesLinks to an external site. [Video file]. Retrieved from https://www.youtube.com/watch?v=D8u1Y18L9DQ
  Note: Approximate length of this media program is 5 minutes.

Optional Resources

• LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2020). DeGowin’s diagnostic examination (11th ed.). New York, NY: McGraw Hill Medical.

Chapter 6, “The Skin and Nails”
In this chapter, the authors provide guidelines and procedures to aid in the diagnosis of skin and nail disorders. The chapter supplies descriptions and pictures of common skin and nail conditions.

• Ethicon, Inc. (n.d.-a). Absorbable synthetic suture material. Retrieved from https://web.archive.org/web/20170215015223/http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/absorbable_suture_chart.pdf
• Ethicon, Inc. (n.d.-b). Ethicon sutures. Retrieved from https://web.archive.org/web/20150921202525/http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/suture_chart_ethicon.pdf
• Ethicon, Inc. (n.d.-c). Wound closure manualLinks to an external site.Retrieved from http://www.uphs.upenn.edu/surgery/Education/facilities/measey/Wound_Closure_Manual.pdf
• MEDSimplifiedLinks to an external site.. (2019, September 17). Simple interrupted sutures-Suturing techniques for beginners [Video]. YouTube. https://www.youtube.com/watch?v=nT0lOlb5pe8
• Surgical TeachingLinks to an external site.. (2019, June 21). Basics of sutures part 1 | Learn the different sizes and shapes of suture needles? [Video]. YouTube. https://www.youtube.com/watch?v=Ec1Fb6eeOcA
• VATA. (2017, June 30). Suture techniques course videoLinks to an external site. [Video]. YouTube. https://www.youtube.com/watch?v=Akyr4zlBS9E

NURS_6512_Week_4_Assignment_1_Rubric

NURS 6512 Week 5: Assessment of Head, Neck, Eyes, Ears, Nose, and Throat

Emily, age 15, is brought to your clinic complaining of chills, aches, and a sore throat. Without any testing, consider all of the possible diagnoses. It could be a cold, the flu, bronchitis, or even something more serious, such as meningitis or mononucleosis.

Assessing the actual cause will involve much more than simple visual inspection. Some conditions are so subtle that they require the use of special instruments and tests in addition to a trained eye and ear.

This week, you will explore how to assess the head, neck, eyes, ears, nose, and throat. Whether dealing with a detached retina, sinusitis, meningitis, or even cough, advanced practice nurses need to know the proper assessment techniques in order to form accurate diagnoses.

LEARNING OBJECTIVES

Students will:

• Apply assessment skills to diagnose eye, ear, and throat conditions
• Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for the head, neck, eyes, ears, nose, and throat

CASE STUDY ASSIGNMENT: ASSESSING THE HEAD, EYES, EARS, NOSE, AND THROAT

Nurses conducting assessments of the ears, nose, and throat must be able to identify the small differences between life-threatening conditions and benign ones. For instance, if a patient with a sore throat and a runny nose also has inflamed lymph nodes, the inflammation is probably due to the pathogen causing the sore throat rather than a case of throat cancer.

With this knowledge and a sufficient patient health history, a nurse would not need to escalate the assessment to a biopsy or an MRI of the lymph nodes but would probably perform a simple strep test.

Most ear, nose, and throat conditions that arise in non-critical care settings are minor in nature. However, subtle symptoms can sometimes escalate into life-threatening conditions that require prompt assessment and treatment.

In this Case Study Assignment, you consider case studies of abnormal findings from patients in a clinical setting. You determine what history should be collected from the patients, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions.

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.
• Consider what history would be necessary to collect from the patient.
• 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

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 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 5

Submit your Assignment. 

LEARNING RESOURCES

Required Readings

• Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2023). Seidel’s guide to physical examination: An interprofessional approach (10th ed.). St. Louis, MO: Elsevier Mosby.

Chapter 11, “Head and Neck”

This chapter reviews the anatomy and physiology of the head and neck. The authors also describe the procedures for conducting a physical examination of the head and neck.

Chapter 12, “Eyes”

In this chapter, the authors describe the anatomy and function of the eyes. In addition, the authors explain the steps involved in conducting a physical examination of the eyes.

Chapter 13, “Ears, Nose, and Throat”

The authors of this chapter detail the proper procedures for conducting a physical exam of the ears, nose, and throat. The chapter also provides pictures and descriptions of common abnormalities in the ears, nose, and throat

• 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 15, “Earache”Download Chapter 15, “Earache”
This chapter covers the main questions that need to be asked about the patient’s condition prior to the physical examination as well as how these questions lead to a focused physical examination.

Chapter 21, “Hoarseness”Download Chapter 21, “Hoarseness”
This chapter focuses on the most common causes of hoarseness. It provides strategies for evaluating the patient, both through questions and through physical exams.

Chapter 25, “Nasal Symptoms and Sinus Congestion”Download Chapter 25, “Nasal Symptoms and Sinus Congestion”
In this chapter, the authors highlight the key questions to ask about the patients symptoms, the key parts of the physical examination, and potential laboratory work that might be needed to provide an accurate diagnosis of nasal and sinus conditions.

Chapter 30, “Red Eye”Download Chapter 30, “Red Eye”
The focus of this chapter is on how to determine the cause of red eyes in a patient, including key symptoms to consider and possible diagnoses.

Chapter 32, “Sore Throat”Download Chapter 32, “Sore Throat”
A sore throat is one most common concerns patients describe. This chapter includes questions to ask when taking the patient’s history, things to look for while conducting the physical exam, and possible causes for the sore throat.

Chapter 38, “Vision Loss”Download Chapter 38, “Vision Loss”
This chapter highlights the causes of vision loss and how the causes of the condition can be diagnosed.
Note: Download the six documents (Student Checklists and Key Points) below, and use them as you practice conducting assessments of the head, neck, eyes, ears, nose, and throat.

• Document: Episodic/Focused SOAP Note Exemplar Download Episodic/Focused SOAP Note Exemplar(Word document)
• Document: Episodic/Focused SOAP Note Template Download Episodic/Focused SOAP Note Template(Word document)
• Document: Midterm Exam Review Download Midterm Exam Review(Word document)

Shadow Health Support and Orientation Resources

• Shadow Health. (2021). Welcome to your introduction to Shadow Health. https://link.shadowhealth.com/Student-Orientation-Video
• Shadow Health. (n.d.). Shadow Health help desk. Retrieved from https://support.shadowhealth.com/hc/en-us
• Shadow Health. (2021). Walden University quick start guide: NURS 6512 NP students. Download Walden University quick start guide: NURS 6512 NP students. https://link.shadowhealth.com/Walden-NURS-6512-Student-Guide
• Document: DCE (Shadow Health) Documentation Template Download DCE (Shadow Health) Documentation Templatefor Focused Exam: Cough (Word document)
  Use this template to complete your Assignment 2 for this week.

Assessment of the Head, Neck, Eyes, Ears, Nose, and Throat – Week 5 (29m)

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 10, 11, and 12 that relate to the assessment of the head, neck, eyes, ears, nose, and throat. Refer to the Week 4 Learning Resources 

• Geeky Medics. (2020, June 5).Fundoscopy (Ophthalmoscopy)Links to an external site. – OSCE guide [Video]. YouTube. https://www.youtube.com/watch?v=SVuP5Td23AQ&feature=youtu.be
• Health4TheWorld Academy Videos Channel. (2020, February 15).Paranasal sinus imagingLinks to an external site. [Video]. YouTube. https://www.youtube.com/watch?v=8TQBtdbEY-I
• University of Iowa Ophthalmology. (2016, December 19).Fluorescein staining of the corneaLinks to an external site. Retrieved from https://vimeo.com/198695974
  Credit Line: University of Iowa Ophthalmology. (n.d.). Fluorescein staining of the cornea [Video file]. Retrieved from ​https://vimeo.com/198695974. The author(s) and publishers acknowledge the University of Iowa and EyeRounds.org for permission to reproduce this copyrighted material.
  Note: Approximate length of this media program is 25 seconds.

Optional Resources

• Hayashi, T., Kitamura, K., Hashimoto, S., Hotomi, M., Kojima, H., Kudo, F., Maruyama, Y., Sawada, S., Taiji, H., Takahashi, G., Takahashi, H., Uno, Y., & Yano, H. (2020). Clinical practice guidelines for the diagnosis and management of acute otitis media in children—2018 updateLinks to an external site.. Auris Nasus Larynx, 47(4), 493–526. https://doi.org/10.1016/j.anl.2020.05.019
• Mustafa, Z., & Ghaffari, M. (2020). Diagnostic methods, clinical guidelines, and antibiotic treatment for Group A streptococcal pharyngitis: A narrative reviewLinks to an external site.. Frontiers in Cellular and Infection Microbiology, 10. https://doi.org/10.3389/fcimb.2020.563627
• Patel, G. B., Kern, R. C., Bernstein, J. A., Hae-Sim, P., & Peters, A. T. (2020). Current and future treatments of rhinitis and sinusitisLinks to an external site.. The Journal of Allergy and Clinical Immunology: In Practice, 8(5), 1522–1531. https://doi.org/10.1016/j.jaip.2020.01.031Links to an external site.

Use the following resources to guide you through your Shadow Health orientation as well as other support resources:
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2020). DeGowin’s diagnostic examination (11th ed.). New York, NY: McGraw Hill Medical.

Chapter 7, “The Head and Neck”
This chapter describes head and neck examinations that can be made with general clinical resources. Also, the authors detail syndromes of common head and neck conditions.

NURS 6512 Week 5 Assignment 1 Rubric