NP 601 Advanced Physical Health Assessment Summer Immersion ...

of 25

NP 601 Advanced Physical Health Assessment Summer Immersion Course

Summer Session Syllabus (Two week course)

SUMMER SESSION NUMBER AND DATE:

NP 601: Advanced Physical Health Assessment Summer Immersion Course

COURSE DESCRIPTION

NP 601 provides the student advanced practice nurse with the tools to perform a comprehensive health assessment on patients throughout the lifespan. The course builds on knowledge of anatomy, physiology, pathophysiology, and health assessment skills previously attained in undergraduate nursing education. The major focus of this course is to ensure that the student has the ability to perform a high quality health history, review of systems, and head-to-toe comprehensive physical exam, and is able to communicate that information in both written and oral form to members of the multi-disciplinary health care team.

COURSE PREREQUISITE AND/OR MINIMAL TECHNICAL SKILLS

NP 602, NP 603, and basic physical assessment and interview skills acquired in an undergraduate BSN program.

COURSE OBJECTIVES

Upon completion of this course, you should be able to do the following:

1. Describe the role of the Advanced Practice Nurse (APN) in advanced physical health assessment process across the lifespan by eliciting a comprehensive health history while incorporating the bio-psychosocial, environmental, cultural, and spiritual factors that enhance or impede an individual’s health. 2. Develop competency in physical exam techniques for all body systems. 3. Demonstrate competency in documenting and describing verbally the findings of the comprehensive health history and physical examination in a format appropriate to accurate communication in the multi-disciplinary health care setting.

of 25

4. Perform integrated physical examination for the adult client without the use of reference material during the exam.

5. Use effective verbal and non-verbal communication skills in the comprehensive health assessment process.

To successfully meet the course outcome objectives, the student will log 45 patient contact hours in the Comprehensive Health Assessment Practice Experience (CHAPE) during the second week of this summer immersion course. The focus of the CHAPE will be performing comprehensive health assessment in a real-time clinical setting.

COURSE FORMAT

This is an accelerated two-week course. During the two weeks, you will complete five classes and the CHAPE as outlined below. Each lesson will have clearly defined learning outcomes, which you will meet with related readings, activities, and/or discussion questions. Essential to the successful completion of the course will be completing the in-class complete physical exam with a passing grade. REQUIRED TEXT

Bickley, L. (2013) Bates' guide to physical examination and history taking (11th ed.).

Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN: 978-1-60913-762-

5.

There will be required readings and media assignments throughout the course, but the above is

the only required text.

If you have any questions regarding your course materials, please contact your academic advisor and/or our book vendor EDMAP. You can reach EDMAP by phone at 1-(800)-274-9104 or website at http://www.edmapbookstore.com/storefront/index/STJSP

COURSE SCHEDULE

Class Period 1: -Overview of the Advanced Health Assessment Process -The Patient History

http://www.edmapbookstore.com/storefront/index/STJSP

of 25

In this class you will do the following:

1. Demonstrate understanding of the role of the NP in the Advanced Health Assessment

Process. Explore the difference between comprehensive assessment as an RN and an APN.

2. Describe the role of the NP in collaborative practice as a part of the multidisciplinary

provider team.

3. Define the term cultural humility in the context of a comprehensive health assessment.

4. Describe the ethical framework that guides interviewer/client interactions.

5. Demonstrate success at differentiating Subjective and Objective Data

6. Practice eliciting and documenting a Patient History, including a Chief Complaint, History of Present Illness, Past Medical and Surgical History, Family History and Personal Social History.

REQUIRED READINGS

Bickley Text: Chapter 1, pp. 3-12, and 25

Chapters 2 and 3

National Organization of Nurse Practitioner Faculties (NONPF). (2006). Domains and Core

Competencies of Nurse Practitioner Practice.

http://www.nonpf.com/associations/10789/files/DomainsandCoreComps2006.pdf

Spain, M.P., et al. (2004). Educating advanced practice nurses for collaborative practice in the

multidisciplinary provider team. Journal of the American Academy of Nurse Practitioners, 6 (11)

535-546. HYPERLINK http://web.ebscohost.com/ehost/detail?vid=1&hid=101&sid=9454e414-

05a6-4cd6-8532-

9ba4a1d303ab%40sessionmgr111&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=aph&AN

=15395079

ASSESSMENTS: 1. Describe three key points from the Spain article, emphasizing the differences in the RN and

NP role. (Group Discussion)

2. Describe a professional experience in which you were aware of cultural differences, which

shaped the interview process. Describe three approaches you might use to create a positive and

http://www.nonpf.com/associations/10789/files/DomainsandCoreComps2006.pdf

http://web.ebscohost.com/ehost/detail?vid=1&hid=101&sid=9454e414-05a6-4cd6-8532-9ba4a1d303ab%40sessionmgr111&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=aph&AN=15395079




of 25

non-biased approach to the interview using the guidelines for ensuring cultural humility outlined

in the Bickley text. (Group Discussion)

3. Using the Checklist For A Clear and Accurate Record (p. 40, Bickley) as a guideline, give an

example from your own practice experience where inaccurate recording of data had a negative

result on patient outcome. (Group Discussion)

4. Complete the Subjective/Objective Interactive Exercise (Group Discussion)

CLASSROOM ACTIVITIES:

Watch and Learn: Approach to Patient Video: Introduction (2 K).

Watch and Learn: Approach to Patient Video: The Successful Clinician (2 K).

Watch and Learn: Approach to Patient Video: Preparing for the History Taking Interview and

Examination (2 K).

Watch and Learn: Approach to Patient Video: The Health History Taking Interview (2 K).

WRITTEN ASSIGNMENT: With a class partner, conduct and document a Patient History, including a Chief Complaint,

History of Present Illness, Past Medical and Surgical History, Family History and Personal

Social History. (Using the outline in the Bickley textbook, pages 6-12).

Review the Grading Rubric below, which will guide you as you prepare to demonstrate

proficiency in your documentation of the Health History.

SUBMITTING ASSIGNMENTS

As you complete each assignment in a Class Period, add each assignment on a new page to your

word processing document. Complete and submit all the assignments for a Class Period in a

single word processing document if requested.

For instructions on how to submit your assignments, you can find an icon in your course called

“Submit an Assignment” or by clicking on the following link and fill out the Assignment

Submission Form: http://www.sjcme.edu/gps/assignments .

Documentation of History

(For the purpose of this assignment, no need to include HPI, ROS, or physical exam)

http://www.sjcme.edu/gps/assignments

of 25

Content Excellent (10 pts.)

Documentation well done with all areas completely discussed from subjective perspective.

Satisfactory (8.5 pts.)

Documentation missing some areas

Unsatisfactory (0 pts.)

Documentation poor, missing key areas.

Identifying Data

Source of History

Chief Complaint

Present Illness

Medications

Allergies

Past Med Hx

Past Surg Hx

Family Hx

Social Hx

Total Points / 140

Class Period 2: -Practicing, Sequencing and Coordinating the Comprehensive Health Assessment -Beginning the Comprehensive Physical Exam of the Adult Patient

In this lesson you will do the following:

1. Elicit a complete Review of Systems (ROS) from a classmate.

2. Demonstrate understanding the meaning of Pertinent Positives and Negatives.

3. Accurately document Subjective Abnormal Data.

4. Demonstrate the components of symptom analysis using The “Seven Attributes of a

Symptom.”

of 25

5. Begin the practice of sequencing and coordinating the Comprehensive Physical Exam of

the Adult Patient

6. Identify the anatomical landmarks of the human body of these systems.

7. Correlate examination techniques of the following body systems using the correct

sequence and anatomical landmarks in an adult patient:

a. General Survey, Vital Signs, Pain

b. Behavior and Mental Status

c. Skin, Hair, and Nails

d. Lymphatic System

e. Head and Neck

8. Use correct terminology to record objective components of the physical examination

findings

READINGS Bickley Text: Chapter 1, pp. 6-13, Chapters 2 and 3, “Seven Attributes of a Symptom” found on

page 70-71.

Bickley Text:

Please focus your reading for this unit on the sections of each chapter that detail system

anatomical landmarks and general examination techniques as follows. For the most part, this

reading assignment, while extensive, is a review of material previously mastered at the

undergraduate level.

There is a tremendous amount of useful and important information in these chapters, which will

become more useful as you gain skills and increasing expertise in performing the physical exam.

The goal of this course is to gain proficiency in the exam itself, and to be able to document your

findings. As you read, keep this in mind.

The only way to become comfortable and proficient in physical exam skills is to practice them.

We strongly suggest that you practice your assessment skills for each system at least 10 times on

different classmates. You will get even more experience in the upcoming CHAPE next week.

This text will be very helpful in your future clinical courses as well, when you begin to focus on

the problem-oriented visit.

Chapter 4: Beginning the Physical Examination: General Survey, Vital Signs, Pain Chapter 5:

Behavior and Mental Status

Chapter 6: The Skin, Hair and Nails

Chapter 7: The Head and Neck

of 25

ASSESSMENTS

1. Using the guidelines presented in the “Components of the Health History” pages 7-12 in the

current Bickley text, obtain and document a complete ROS on you class partner. Document

Pertinent Positives and Negatives while taking this ROS, using the Components of the Health

History in the Bickley text, found under “Present Illness.” Include a thorough description of

each positive finding on the elicited ROS.

The Bickley text pages 31-33, the “Case of Mrs. N” gives an excellent example of this type of write-up for you to use as a guideline. We will complete this exercise in class, with the assignment submitted to APD before the next class.

2. Complete a separate one page document and choose one of the Subjective Abnormal Findings

mentioned by your patient in the CC, History of Present Illness, or Review of Systems.

Document your understanding of how to use the “Seven Attributes” for symptom analysis found

in the Bickley text.

This assignment should be completed in class, with the assignment submitted to APD before the

next class.

Review the Grading Rubric below which will guide you as you prepare to demonstrate

proficiency in your documentation of the Review of Systems and the Seven Attributes of

symptom analysis.

Grading Rubric for the Comprehensive Review of Systems

Content Excellent (100 pts.) Satisfactory (85 pts.) Unsatisfactory (0 pts.)

History Questions Appropriate ROS questions in each system area, including documentation of pertinent positives and negatives.

Missing some pertinent ROS or questions.

Lack of understanding of what history questions are appropriate and pertinent for this system or abnormal finding.

Rationale Appropriate rationale for each history question related to an abnormal finding.

Missing some depth and rationale for history questions related to an abnormal finding.

Lacks understanding and rationale, without explanation of why the questions are pertinent.

of 25

Grading Rubric for Symptom Analysis Using the Seven Attributes

Content Excellent (100 pts.) Satisfactory (75 pts.) Unsatisfactory (0 pts.)

Seven Attributes All attributes of the symptoms are evaluated and documented

Missing one or two attributes.

Lack of understanding of what attributes are and fail to ask appropriate questions.

Rationale Appropriate rationale for each question related to an abnormal finding.

Missing some depth and rationale for questions related to an abnormal finding.

Lacks understanding and rationale, without explanation of why the questions are pertinent.

During your CHAPE, you will be practicing physical exam skills in a supervised setting.

In this lesson, focus on the areas listed below.

View Watch and Learn videos accessible through the website associated with your text,

http://thePoint.lww.com/Bickley.

Approach to the Patient

- The Examination Head-to-Toe Assessment

- Introduction

- Importance of Patient Comfort

- General Survey

- Vital Signs

- The Skin

- HEENT

- Thyroid

Watch and Learn videos on the following two systems can be reached at the sites listed:

-Lymphatic System

http://www.youtube.com/watch?v=kpJ_IzfJDtw&list=PLE4453033A0DF8DE6&index=55&feat

ure=plpp_video

-Thyroid

http://www.youtube.com/watch?v=krXoyP5j5lk&feature=related

To guide the thoroughness of your practice exams in this lesson and the lessons in the next two

Units, I would strongly suggest that you use the grading rubric found in Unit 5.

http://www.youtube.com/watch?v=kpJ_IzfJDtw&list=PLE4453033A0DF8DE6&index=55&feature=plpp_video

http://www.youtube.com/watch?v=kpJ_IzfJDtw&list=PLE4453033A0DF8DE6&index=55&feature=plpp_video

http://www.youtube.com/watch?v=krXoyP5j5lk&feature=related

of 25

Graded Written Assignment:

Submit a write-up of the physical exam on your classmate, focusing on the systems we

are studying in this class. Pay attention to the proper sequencing of the exam in your

write-up, and please limit to 300-400 words. As you write, be aware of using proper

terminology and technical writing skills appropriate to sharing this information in a

multi-disciplinary forum.

You will find the “Recording Your Findings” section at the end of each Bickley Chapter very

helpful in your documentation for the above assignment. I would suggest using it as your

guideline. This assignment will be done in class.

Class Period 3: Conducting the Comprehensive Physical Exam of the Adult Patient, Continued In this lesson you will do the following:

1. Practice the sequencing and coordination of the Comprehensive Physical Exam of the

Adult Patient




a. Thorax and Lungs

b. Cardiovascular

c. Breasts and Axilla

d. Abdomen

e. Peripheral Vascular

f. Male Genitalia and Hernia*

g. Female Genitalia*

h. Anus Rectum and Prostate*

*Note: Genital exam sequencing and techniques to be discussed only, no genital

exams will be conducted in classroom setting.


findings.

of 25

REQUIRED READINGS Bickley Text:





Chapter 8: The Thorax and Lungs

Chapter 9: The Cardiovascular System

Chapter 10: The Breasts and Axillae

Chapter 11: The Abdomen

Chapter 12: The Peripheral Vascular System

Chapter 13: Male Genitalia and Hernia

Chapter 14: Female Genitalia

Chapter 15: The Anus, Rectum, and Prostate

ASSESSMENTS Graded Written Assignment:

Submit a write-up of the physical exam on your classmate, focusing on the systems we are

studying in this class. Pay attention to the proper sequencing of the exam in your write-up, and

please limit to 300-400 words. As you write, be aware of using proper terminology and

technical writing skills appropriate to sharing this information in a multi-disciplinary forum.

You will find the “Recording Your Findings” section at the end of each Bickley Chapter very

helpful in your documentation for the above assignment. I would suggest using it as your

guideline. This assignment will be done in class.

Class Period 4: -Conducting the Comprehensive Physical Exam of the Adult Patient, Continued - Assessment of the Pediatric, Geriatric, and Pregnant Patient



Adult Patient, focusing only on the systems listed below in this lesson.




of 25

a. Musculoskeletal System

b. Nervous


findings.

You will be focusing on the care of children, adolescents, pregnant women and older adults in

your NP clinical courses, and will learn the physical assessment skills in detail at that time.

However, it will be useful for you to understand how the approach and sequence of the exam is

different from that of the adult patient.

The purpose in this lesson is to give you an opportunity to review how the techniques of

examination differ in these populations.


1. Review techniques of examination for the newborn.

2. Review techniques of examination for the infant.

3. Review techniques of examination for the young and school-aged child.

4. Review techniques of examination for adolescents.

5. Review the techniques of examination for the older adult.

6. Review the techniques of examination for the pregnant woman.

REQUIRED READINGS Bickley Text:





Chapter 16: The Musculoskeletal System

Chapter 17: The Nervous System

Chapter 18: pp. 775, 780-814, pp. 819-856, and pp. 857-860, 862-872

Chapter 20, pages 926-930, 940-953

Chapter 19, pages, 897-900, 903-912

We will return to these chapters later to explore further details and clinical reasoning processes.

ACTIVITIES / ASSESSMENTS In class activity:

View Watch and Learn videos online at http://thePoint.lww.com/Bickley :

http://thepoint.lww.com/Bickley

of 25

The Musculoskeletal System

The Neurological Exam

Additional watch and learn videos:

Cranial Nerves: http://www.youtube.com/watch?v=vU8-PLsdJ-w&feature=relmfu

Reflexes: http://www.youtube.com/watch?v=SrZZ2XbNZnE&feature=related

Musculoskeletal: http://www.youtube.com/watch?v=17rvkifyylc&feature=related

1. Graded Written Assignment:

Complete a write-up of the physical exam on a classmate, focusing on the systems we are

studying in this lesson. Pay attention to the proper sequencing of the exam in your write-

up, and please limit to 300 words. As you write, be aware of using proper terminology

and technical writing skills appropriate to sharing this information in a multi-disciplinary

forum.

Again, you will find the “Recording Your Findings” section at the end of each Bickley

Chapter very helpful in your documentation for the above assignment. I would suggest

using these sections as your guideline for this assignment.

This assignment will be done in class.

2. For each pediatric age group above, discuss an approach to the physical exam, which

differs, from that of the adult patient. (Classroom Discussion)

3. Discuss what is meant by assessment of the “functional status” of the older patient.

Limit this response to 100 words or less. This assignment will count for 50% of your

grade for this lesson. (Classroom Discussion)

4. Discuss one approach to the physical exam of the pregnant woman, which differs, from

that of the adult patient.

Class Period 5: Performing the Complete Physical Exam on a Classmate In this lesson you will do the following:

1. Perform a comprehensive head-to-toe physical exam on your classmate without the use of

notes or a written guideline.

READINGS

None.

http://www.youtube.com/watch?v=vU8-PLsdJ-w&feature=relmfu

http://www.youtube.com/watch?v=SrZZ2XbNZnE&feature=related

http://www.youtube.com/watch?v=17rvkifyylc&feature=related

of 25

Relevant chapters in the Bickley text may be of use when writing up the health history and

physical exam findings in the post-residency section of the course.

ASSESSMENTS In this graded assignment, you will complete a complete physical examination performed on a

classmate. You must receive a grade of 90% or above to successfully complete the assignment.

You do not need to include the Health History and Review of Systems done in the previous

lesson in this this exam must be performed without the use of a written guideline or notes.

For the purpose of this exam the genital, breast, and rectal exams are deferred.

This will be an interactive activity done with a faculty member present during the exam. During the exam the faculty member will provide feedback and guidance. This exam should be completed within a one hour time period The grading rubric for this exam is below. You are already aware that there are different “routines” for doing certain systems. For example, if you prefer to do check all the cranial nerves in one group, or all the deep tendon reflexes grouped together, that is your choice.

of 25

Physical Examination Grading Rubric

Grades for the items checked off for the systems you have chosen are awarded as follows:

0 = Did not do or did not do correctly 1 = Demonstrated 2 = Demonstrated thoroughly with correct technique

Use this checklist as you do your video – go step-by-step, narrating throughout.

Skin assessment is done throughout exam and includes examination for color, temperature,

moisture, texture, edema, turgor, bruising, scars, lesions, nevi (c, t, m, t, e, t, b, s, l, n)

HEAD AND FACE

Inspects skin – c, t, m, t, e, t, b, s, l, n 2 1 0

Inspect head for size, symmetry, midline position 2 1 0

Inspect and palpate head and scalp for:

Hair distribution, hair color, hair texture, lesions, masses, tenderness,

depressions, or infestations

2 1 0

Palpate temporal arteries for tenderness 2 1 0

Palpates lymph nodes of the head and neck

Preauricular

Postauricular

Occipital

Tonsillar

Submandibular

Submental

Anterior cervical

Posterior cervical

Supraclavicular

2 1 0

CN 5

Motor – palpate over the masseter muscle as patient clenches jaw

Sensory – light touch sensation to forehead, cheeks, chin, nose

2 1 0

CN 7

Inspect for facial symmetry with smile, frown, raise eyebrows, puff

cheeks, pucker lips

2 1 0

EAR

Inspect outer ear for shape and position 2 1 0

Inspect auditory canal (and TM if otoscope available) 2 1 0

Palpate pinnae and tragus for masses and tenderness 2 1 0

CN 8

Assess hearing with whisper test, Weber (for lateralization), Rinne

(AC> BC)

2 1 0

EYE

Inspects lashes, brows, and palpebral fissures 2 1 0

Inspects sclera and conjunctiva for color, lesions, discharge 2 1 0

Assesses gross visual acuity and peripheral/central vision (CN 2) 2 1 0

Tests for direct/consensual pupillary response to light (CN 3) 2 1 0

Tests for accommodation/convergence (CN 3) 2 1 0

of 25

Tests for conjugate gaze with EOM (CN 3, 4, 6) 2 1 0

Assesses for red reflex and other internal eye structures (if

opthalmoscope available)

2 1 0

NOSE

Inspect nose midline and straight 2 1 0

Assesses for nasal patency 2 1 0

Palpates frontal and maxillary sinuses 2 1 0

THROAT AND MOUTH

Inspect lips, teeth, gums, buccal mucosa, palate, tongue, the floor of

the mouth (under

The tongue), salivary ducts, posterior pharynx, and tonsils (grade, if

present)

2 1 0

Palpate TMJ for any subluxation, tenderness, or crepitus 2 1 0

CN 9 and 10

Soft palate and uvula rise symmetrically with phonation

2 1 0

CN 12

Tongue midline without fasiculations

2 1 0

NECK

Inspects skin – c, t, m, t, e, t, b, s, l, n 2 1 0

Palpates trachea – midline 2 1 0

Palpates thyroid gland 2 1 0

Palpates carotid artery pulsation 2 1 0

Auscultate over the carotid for bruits 2 1 0

Test ROM – flexion, extension, hyperextension, lateral flexion,

rotation

2 1 0

CN 11

Shrug shoulders against resistance

2 1 0

POSTERIOR CHEST

Inspect skin – c, t, m, t, e, t, b, s, l, n 2 1 0

Inspect for s/s respiratory distress – use of accessory muscles, tripod

position, nasal flaring, retractions, tachypnea, cyanosis

2 1 0

Inspect for obvious deformities and symmetry 2 1 0

Palpate – symmetrical chest expansion 2 1 0

Palpate for symmetrical tactile fremitus 2 1 0

Percuss over posterior lung fields (in intercostal spaces) 2 1 0

Auscultate posterior lung fields

Start above scapula

Alternating side-to-side in intercostal spaces

Go down into bases of lungs

Assess lateral lung fields (get right middle lobe)

2 1 0

Auscultate posterior lung fields

Egophony

Bronchophony

Whisper pectoriloquy

2 1 0

ANTERIOR CHEST

Inspect skin – c, t, m, t, e, t, b, l, s, n 2 1 0

Inspect for obvious deformities and symmetry 2 1 0

Palpate chest expansion and tactile fremitus anteriorly 2 1 0

Auscultate lung sounds in anterior lung fields 2 1 0

of 25

HEART

Auscultate in all 5 areas with the bell and diaphragm with the patient

sitting

Aortic

Pulmonic

Erb’s point

Tricuspid

Mitral

2 1 0

Identify and palpate the PMI 2 1 0

Auscultate the apical pulse for a full minute and report findings – rate

and rhythm

2 1 0

Have patient lie down now

Inspect for any heaves or lifts 2 1 0

Palpate for any thrills over each auscultation point 2 1 0

Repeat the cardiac auscultation with patient supine 2 1 0

Assess for JVD and for jugular pulsation with HOB up 30-45 degrees 2 1 0

ABDOMEN

Inspect skin – c, m, t, t, t, e, b, s, l ,n 2 1 0

Inspect abdominal contours and symmetry 2 1 0

Auscultate for bruits – aorta, renal arteries, iliac arteries, femoral

arteries

2 1 0

Auscultate for bowel sounds in all 4 quadrants 2 1 0

Percuss in all 4 quadrants for tympany, dullness, flatness 2 1 0

Palpate for tenderness, masses 2 1 0

Palpate liver and spleen 2 1 0

Have patient sit up again

Percuss for CVA tenderness 2 1 0

UPPER EXTREMITIES

Inspect and palpate the joints of the hands – redness, swelling,

deformity, tenderness, nodules, crepitus, symmetry

2 1 0

Palpate for capillary refill 2 1 0

Assess radial pulses 2 1 0

Assess overall warmth, color, skin integrity of upper extremities.

Assess for edema.

2 1 0

Assess ROM of the fingers (flexion, extension, hyperextension,

abduction, adduction, thumb opposition)

2 1 0

Assess hand grips – 5/5 strength 2 1 0

Inspect and palpate the wrists – redness, swelling, deformity,

tenderness, nodules, crepitus, symmetry

2 1 0

Assess ROM of the wrist (flexion, extension, hyperextension, ulnar

deviation, radial deviation, rotation)

2 1 0

Inspect and palpate the elbows – redness, swelling, deformity,


2 1 0

Assess ROM of the elbow (flexion, extension, hyperextension) 2 1 0

Assess strength of biceps, triceps – flex/extend elbow against

resistance – 5/5 strength

2 1 0

Inspect and palpate the shoulders – redness, swelling, deformity,


2 1 0

Assess ROM of the shoulder (flexion, extension, hyperextension, 2 1 0

of 25

internal rotation, external rotation, abduction, adduction,

circumduction)

Assess strength of shoulder girdle – abduct/adduct shoulder against

resistance – 5/5

2 1 0

Assess light touch sensation to upper extremities 2 1 0

Assess stereognosis and graphesthesia 2 1 0

Assess vibratory sensation at the wrist – over proximal ulnar

prominence

2 1 0

Assess cerebellar coordination with rapid alternating movement

Serial finger opposition

Hand flip-flop

Finger-to-finger

2 1 0

Assess DTRs

Brachioradialis

Biceps

Triceps

Patellar

Achilles

Babinski

2 1 0

LOWER EXTREMITIES

Inspect and palpate the toes – redness, swelling, deformity, tenderness,

nodules, crepitus, symmetry

2 1 0

Assess ROM in toes (flexion, extension, hyperextension, abduction,

adduction)

2 1 0

Assess capillary refill in toes 2 1 0

Assess dorsalis pedis and posterior tibial pulses 2 1 0

Assess overall warmth, color, skin integrity of lower extremities.

Assess for edema.

2 1 0

Inspect and palpate the ankles – redness, swelling, deformity,


2 1 0

Assess ROM of the ankles (dorsiflexion, plantar flexion, inversion,

eversion, rotation)

2 1 0

Assess strength at ankles – dorsi/plantar flex against resistance – 5/5

strength

2 1 0

Inspect and palpate the knees – redness, swelling, deformity,


2 1 0

Assess strength at the knees – flex/extend against resistance – 5/5

strength

2 1 0

Assess strength at the hips – abduct/adduct against resistance – 5/5

strength

2 1 0

Assess for light touch sensation in the lower extremities 2 1 0

Assess vibratory sensation over medial malleolus 2 1 0

Have patient stand up at this point

Inspect and palpate the hip joints – redness, swelling, deformity,


2 1 0

Assess ROM of hip (flexion, extension, hyperextension,

circumduction, abduction, adduction, internal rotation, external

rotation)

2 1 0

Assess ROM of the knees (flexion, extension, hyperextension) 2 1 0

of 25

Yes No

Proceeds in systemic, professional manner 10 0

Demonstrates appropriate technique for inspection 10 0

Demonstrates appropriate technique for palpation 10 0

Demonstrates appropriate technique for percussion 10 0

Demonstrates appropriate technique for auscultation 10 0

SUBTOTAL ______/50

GRADE FOR THIS LESSON ______/250 =

POST-RESIDENCY ASSIGNMENT

Accurately document the complete physical exam of your classmate using language and format

appropriate to sharing the write-up with a multi-disciplinary team.

READINGS Bickley text, “Recording Your Findings” sections of each chapter for specific systems will be of help in doing this assessment.

ACTIVITIES / ASSESSMENTS The student will write up a two-three-page summary of the findings of the complete history and physical exam done in lesson 10. The “Case of Mrs. N” in our Bickley text (p. 34-35) gives and excellent example to use as a reference for this assignment.

Please submit this assignment using the assignment submission form. This assignment

is due by August 9th

.

Inspect and palpate the spine – expected curvatures, alignment,

tenderness

2 1 0

Assess ROM of the spine (flexion, extension, hyperextension, lateral

flexion, and rotation)

2 1 0

Assess for scoliosis while patient in spinal flexion 2 1 0

Assess Romberg 2 1 0

Assess gait – regular and tandem 2 1 0

Hop in place – hop on one foot (unless concerned about patient safety) 2 1 0

SUBTOTAL ______/200

of 25

PLEASE NOTE: All graded assignments for this post-residency assignment should be grouped

together and submitted using the Assignment Submission form accessed from your course

homepage or http://www.sjcme.edu/gps/assignments .

ONSITE CHAPE DESCRIPTION:

The summer onsite CHAPE will provide the student with hands-on experience conducting a

comprehensive health assessment with adult volunteer patients in a simulated clinic setting. The

experience will be conducted by nurse practitioner faculty members and will prepare the student

for the clinical year of the MSN FNP program. Successful completion of the summer CHAPE

completes the 45 hour requirement for the NP601 summer immersion course. Attendance is

required at all summer CHAPE sessions to meet course requirements.

Each day of the summer CHAPE will include the following elements:

I. Pre-conference session to include skills labs and NP role development

II. Two comprehensive history and examinations on volunteer patients

III. Practice performing verbal case presentations with peer and faculty feedback

IV. Real time practice of patient history and physical exam documentation

V. Post-conference session to include population specific skill development

Sample daily schedule:

8:00-9:00 Pre-conference

9:00-9:30 Students set up for exams

9:30-11:00 History taking/interview volunteer patient – #1

11:00-11:15 Verbal case synopsis presentation to faculty

11:15-12:30 Physical exam* patient #1

12:30-1:30 Lunch and post-conference patient #1

1:30-3:00 History taking/interview volunteer patient #2

3:00-3:15 Verbal case synopsis presentation to faculty

3:00-4:30 Physical exam* patient #2

4:30-5:00 Post-conference patient #2

*Day One physical exams will be conducted as time allows

Assignment submission:

Written assignments will be submitted concurrently during the CHAPE experience to the on-site

faculty members. NP601 grading rubrics will be applied per course syllabus.

Day ONE: Focus of day one will be on history taking. Physical exams will be conducted as

time allows.


of 25

AM session objectives:

1. Elicit, verbally present and document the patient history, including:

a. Chief Complaint

b. History of Present Illness (HPI)

c. Past Medical and Surgical History

d. Family History

e. Personal Social History

PM session objectives:

1. Obtain, verbally present, and document a complete ROS on a patient

a. Document Pertinent Positives and Negatives while taking this ROS

b. Using the Components of the Health History in the Bickley text as a guidelines,

include a thorough description of each positive finding on the elicited ROS.

Pre and post-conference discussion foci:

1. Orientation to CHAPE experience and procedures

2. Skills lab: effective patient case verbal presentation skills.

3. Population specific questions and history elements for pediatric population, pregnant

females, and elders

DAY TWO objectives:

1. Elicit a comprehensive health history and ROS (no chief complaint or HPI included) on

each volunteer patient:


Adult Patient

a. Identify the anatomical landmarks of the human body of the focus systems.

b. Correlate examination techniques of the following body systems using the correct


i. General Survey, Vital Signs, Pain

ii. Behavior and Mental Status

iii. Skin, Hair, and Nails

iv. Lymphatic System

v. Head and Neck

of 25

3. Use correct terminology to verbally present and document subjective history elements

and objective components of the physical examination findings.


1. Skills lab: use of the otoscope and opthalmascope; documentation of mental status.

2. Population specific examination techniques and unique findings with pediatric patients,

pregnant females, elders for systems examined in this session.

DAY THREE objectives:

1. Elicit a comprehensive health history, ROS, CC, HPI (if applicable) on each volunteer

patient.


Adult Patient



sequence and anatomical landmarks in an adult patient with a focus on the

following systems (in addition to Day 2 systems):

i. Thorax and Lungs

ii. Cardiovascular

iii. Breasts and Axilla




1. Skills lab: Discrimination of normal and abnormal heart and lung sounds



DAY FOUR objectives:


patient.


Adult Patient


of 25


sequence and anatomical landmarks in an adult patient with a focus on these

systems in addition to systems from Day 2 and Day 3:

i. Abdomen

ii. Peripheral Vascular

iii. Male Genitalia and Hernia

iv. External Female Genitalia

Note: the following systems to be discussed in seminar only, no pelvic exams to be performed in

volunteer patient experience:

a. Female pelvic exam

b. Anus Rectum and Prostate




1. Skills lab: female and male pelvic exam techniques



DAY FIVE objectives:


patient.


Adult Patient



sequence and anatomical landmarks in an adult patient with a focus on these

systems in addition to systems from Days 2,3 and 4:

i. Musculoskeletal System

ii. Nervous System

of 25

3. Use correct terminology to record subjective history elements and objective components

of the physical examination findings.


1. Skills lab: Focusing and abbreviating the physical exam based upon key history elements;

e.g. the Trauma Survey

2. Specific examination techniques and unique findings with pediatric patients, pregnant

females, elders for systems examined in this session.

GRADING BREAKDOWN

In Class Written Assignments 25

Class Participation 25

CHAPE and Post-Residency Assignment 25

Class 5: Class Complete Physical Exam 25

RUBRICS Score Discussion Grading Criteria

A Responses are on topic, original, and contribute to the quality of the discussion. Responses make frequent, informed references to unit material. Responses are clearly written. Substantial original answers to the questions that furthers the work of the class. Typically in the 100 words range or responses meet length requirements as posted in the classroom. Two or more thoughtful responses per discussion question to classmates that advance the discussion.

B Responses are on topic, largely original, and contribute to the quality of the discussion. Responses make some informed references to unit material. Responses are generally clearly written. Substantial original answers to the questions that further the work of the class. Typically in the 75-100 words range or responses meet only 80% of the length requirements as posted in the classroom. One response per discussion question to a classmate that is thoughtful and advances the discussion.

C Responses are on topic, but they lack originality and lack a significant contribution to the quality of the discussion. Responses make vague or summary references to unit material. Responses have several mechanical or stylistic errors. Short posting. Normally in the 50-75 words range or responses meet only 70% of the length requirements as posted in the classroom. Response(s) to others does not advance the discussion.

D Responses are only partially on topic, lack originality, and lack a significant contribution to the quality of the discussion. Responses make little or no references to unit material. Responses have several mechanical or stylistic errors. Minimal posting. Normally in the 25-50 words range or responses meet only 60% of the length requirements as posted in the classroom. No responses to classmates. If there are two questions, student did not respond to one.

of 25

Written Assignment Grade Content, Focus, Use of

Text/Research Analysis and Critical

Thinking Writing Style, Grammar, APA Format

50% 30% 20%

A Response successfully answers the assignment question(s); thoroughly uses the text and other literature.

Response exhibits strong higher-order critical thinking and analysis (e.g., evaluation).

Sentences are clear, concise, and direct; tone is appropriate. Grammatical skills are strong with almost no errors per page. Correct use of APA format when assigned.

B Response answers the assignment question(s) with only minor digressions; sufficiently uses the text and other literature.

Response generally exhibits higher-order critical thinking and analysis (e.g., true analysis).

Sentences are generally clear, concise, and direct; tone is appropriate. Grammatical skills are competent with very few errors per page. Correct use of APA format when assigned.

C Response answers the assignment question(s) with some digression; sufficiently uses the text and other literature.

Response exhibits limited higher-order critical thinking and analysis (e.g., application of information).

Sentences are occasionally wordy or ambiguous; tone is too informal. Grammatical skills are adequate with few errors per page. Adequate use of APA format when assigned.

D Response answers the assignment question(s) but digresses significantly; insufficiently uses the text and other literature.

Response exhibits simplistic or reductive thinking and analysis but does demonstrate comprehension.

Sentences are generally wordy and/or ambiguous; tone is too informal. Grammatical skills are inadequate, clarity and meaning are impaired, numerous errors per page. Inadequate use of APA format when assigned.

COURSE POLICIES AND PROCEDURES

Current information regarding College policies affecting your course can be found on the

Resources/Policy section of the course homepage. On this page, you will find vital information,

including the following:

Current Student Handbook, outlining course-specific policies

Access to support resources, including advising and online tutorial services

Student Success Guides

SUBMITTING ASSIGNMENTS

As you complete each assignment in a Class Period, add each assignment on a new page to your

word processing document. Complete and submit all the assignments for a Class Period in a

single word processing document.

For instructions on how to submit your assignments, you can find an icon in your course called

“Submit an Assignment” or by clicking on the following link and fill out the Assignment

Submission Form: http://www.sjcme.edu/gps/assignments .


of 25

How Do I Access Disabilities Services?

Anyone who would like information or needs access to accommodations or services related to

disabilities should contact the college’s Accommodations Office. Please contact your Academic

Advisor or refer to the Student Handbook for more information.

Saint Joseph’s College developed this course for the exclusive use of students enrolled in the

College’s Division of Graduate and Professional Studies.

Copyright 2013 by Saint Joseph’s College Online - All Rights Reserved

NP 601 Advanced Physical Health Assessment Summer Immersion ...

Documents

Transcript of NP 601 Advanced Physical Health Assessment Summer Immersion ...