Posts in category: Nursing Papers

NURS6052 Week 10 Developing a Culture of Evidence-Based Practice

NURS6052 Essentials of Evidence-Based Practice Week 10 Discussion: Developing a Culture of Evidence-Based Practice

As your EBP skills grow, you may be called upon to share your expertise with others. While EBP practice is often conducted with unique outcomes in mind, EBP practitioners who share their results can both add to the general body of knowledge and serve as an advocate for the application of EBP.
In this Discussion, you will explore strategies for disseminating EBP within your organization, community, or industry.
To Prepare:
Review the Resources and reflect on the various strategies presented throughout the course that may be helpful in disseminating effective and widely cited EBP.
This may include: unit-level or organizational-level presentations, poster presentations, and podium presentations at organizational, local, regional, state, and national levels, as well as publication in peer-reviewed journals.
Reflect on which type of dissemination strategy you might use to communicate EBP.
By Day 3 of Week 10
Post at least two dissemination strategies you would be most inclined to use and explain why. Explain which dissemination strategies you would be least inclined to use and explain why. Identify at least two barriers you might encounter when using the dissemination strategies you are most inclined to use. Be specific and provide examples. Explain how you might overcome the barriers you identified.
By Day 6 of Week 10
Respond to at least two of your colleagues on two different days by offering additional ideas to overcome the barriers to strategies suggested by your colleagues and/or by offering additional ideas to facilitate dissemination. NURS6052 Week 10 Developing a Culture of Evidence-Based Practice

NURS6512 Advanced Health Assessment and Diagnostic Reasoning Week 11 Assignment
Lab Assignment: Ethical Concerns
As an advanced practice nurse, you will run into situations where a patient’s wishes about his or her health conflict with evidence, your own experience, or a family’s wishes. This may create an ethical dilemma. What do you do when these situations occur?
In this Lab Assignment, you will explore evidence-based practice guidelines and ethical considerations for specific scenarios.
To Prepare
Review the scenarios provided by your instructor for this week’s Assignment. Please see the “Course Announcements” section of the classroom for your scenarios.
Based on the scenarios provided:
Select one scenario, and reflect on the material presented throughout this course.
What necessary information would need to be obtained about the patient through health assessments and diagnostic tests?
Consider how you would respond as an advanced practice nurse. Review evidence-based practice guidelines and ethical considerations applicable to the scenarios you selected.
The Lab Assignment
Write a detailed one-page narrative (not a formal paper) explaining the health assessment information required for a diagnosis of your selected patient (include the scenario number). Explain how you would respond to the scenario as an advanced practice nurse using evidence-based practice guidelines and applying ethical considerations. Justify your response using at least three different references from current evidence-based literature.
Select one scenario, in Week 11 and reflect on the material presented throughout this course.
CASE STUDY 1
A single mother has accompanied her two daughters, aged 15 and 13, to a women’s health clinic and has requested that the girls receive a pelvic examination and be put on birth control. The girls have consented to the exam but seem unsettled.
OR
CASE STUDY 2
A 57-year-old man who was diagnosed with motor neuron disease 2 years ago is experiencing a rapid decline in his condition. He prefers to be admitted to the in-patient unit at a hospice to receive end-of-life care, but his wife wants him to remain at home.
What necessary information would need to be obtained about the patient through health assessments and diagnostic tests?
Consider how you would respond as an advanced practice nurse. Review evidence-based practice guidelines and ethical considerations applicable to the scenarios you selected.
Write a detailed one-page narrative (not a formal paper) explaining the health assessment information required for a diagnosis of your selected patient (include the scenario number). Explain how you would respond to the scenario as an advanced practice nurse using evidence-based practice guidelines and applying ethical considerations. Justify your response using at least three different references from current evidence-based literature.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

SCORE A+ WITH HELP FROM OUR PROFESSIONAL WRITERS – NURS6512 Week 11 Assignment

We will process your orders through multiple stages and checks to ensure that what we are delivering to you, in the end, is something that is precise as you envisioned it. All of our essay writing service products are 100% original, ensuring that there is no plagiarism in them. The sources are well-researched and cited so it is interesting. Our goal is to help as many students as possible with their assignments, i.e. our prices are affordable and services premium.

• Discussion Questions (DQ)

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

• Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

• APA Format and Writing Quality

Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.

• Use of Direct Quotes

I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source.

• LopesWrite Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for tips on improving your paper and SI score.

• Late Policy

The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

• Communication

Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

• Guarantee

  

• Zero Plagiarism
• On-time delivery
• A-Grade Papers
• Free Revision
• 24/7 Support
• 100% Confidentiality
• Professional Writers

• Services Offered

• Custom paper writing
• Question and answers
• Essay paper writing
• Editing and proofreading
• Plagiarism removal services
• Multiple answer questions

We will process your orders through multiple stages and checks to ensure that what we are delivering to you, in the end, is something that is precise as you envisioned it. All of our essay writing service products are 100% original, ensuring that there is no plagiarism in them. The sources are well-researched and cited so it is interesting. Our goal is to help as many students as possible with their assignments, i.e. our prices are affordable and services premium.

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NURS6003 Transition to Graduate Study Week 6 Discussion
Using the Walden Library
Where can you find evidence to inform your thoughts and scholarly writing? Throughout your degree program, you will use research literature to explore ideas, guide your thinking, and gain new insights. As you search the research literature, it is important to use resources that are peer-reviewed and from scholarly journals. You may already have some favorite online resources and databases that you use or have found useful in the past. For this Discussion, you explore databases available through the Walden Library.
To Prepare:
Review the information presented in the Learning Resources for using the Walden Library, searching the databases, and evaluating online resources.
Begin searching for a peer-reviewed article that pertains to your practice area and interests you.
By Day 3 of Week 6
Post the following:
Using proper APA formatting, cite the peer-reviewed article you selected that pertains to your practice area and is of particular interest to you and identify the database that you used to search for the article. Explain any difficulties you experienced while searching for this article. Would this database be useful to your colleagues? Explain why or why not. Would you recommend this database? Explain why or why not
By Day 6 of Week 6
Respond to at least two of your colleagues’ posts by offering suggestions/strategies for working with this database from your own experience, or offering ideas for using alternative resources.
Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.

Patients are frequently uncomfortable discussing with healthcare professional’s issues that involve the genitalia and rectum; however, gathering an adequate history and properly conducting a physical exam are vital. Examining case studies of genital and rectal abnormalities can help prepare advanced practice nurses to accurately assess patients with problems in these areas.
In this Lab Assignment, you will analyze an Episodic note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.
To Prepare
Review the Episodic note case study your instructor provides you for this week’s Assignment. Please see the “Course Announcements” section of the classroom for your Episodic note case study.
Based on the Episodic note case study:
Review this week’s Learning Resources, and consider the insights they provide about the case study. Refer to Chapter 3 of the Sullivan resource to guide you as you complete your Lab Assignment.
Search the Walden library or the Internet for evidence-based resources to support your answers to the questions provided.
Consider what history would be necessary to collect from the patient in the case study.
Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
The Lab Assignment
Using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature.
Analyze the subjective portion of the note. List additional information that should be included in the documentation.
Analyze the objective portion of the note. List additional information that should be included in the documentation.
Is the assessment supported by the subjective and objective information? Why or why not?
Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis?
Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.

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

Name: NURS_6512_Week_10_Assignment_Rubric

	Excellent	Good	Fair	Poor
With regard to the SOAP note case study provided and using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature: ·   Analyze the subjective portion of the note. List additional information that should be included in the documentation.	10 (10%) – 12 (12%) The response clearly, accurately, and thoroughly analyzes the subjective portion of the SOAP note and lists detailed additional information to be included in the documentation.	7 (7%) – 9 (9%) The response accurately analyzes the subjective portion of the SOAP note and lists additional information to be included in the documentation.	4 (4%) – 6 (6%) The response vaguely analyzes the subjective portion of the SOAP note and vaguely and/or inaccurately lists additional information to be included in the documentation.	0 (0%) – 3 (3%) The response inaccurately analyzes the subjective portion of the SOAP note, with inaccurate and/or missing additional information included in the documentation.
·   Analyze the objective portion of the note. List additional information that should be included in the documentation.	10 (10%) – 12 (12%) The response clearly, accurately, and thoroughly analyzes the objective portion of the SOAP note and lists detailed additional information to be included in the documentation.	7 (7%) – 9 (9%) The response accurately analyzes the objective portion of the SOAP note and lists additional information to be included in the documentation.	4 (4%) – 6 (6%) The response vaguely analyzes the objective portion of the SOAP note and vaguely and/or inaccurately lists additional information to be included in the documentation.	0 (0%) – 3 (3%) The response inaccurately analyzes the objective portion of the SOAP note, with inaccurate and/or missing additional information included in the documentation.
·  Is the assessment supported by the subjective and objective information? Why or why not?	14 (14%) – 16 (16%) The response clearly and accurately identifies whether or not the assessment is supported by the subjective and/or objective information, with a thorough and detailed explanation.	11 (11%) – 13 (13%) The response accurately identifies whether or not the assessment is supported by the subjective and/or objective information, with a clear explanation.	8 (8%) – 10 (10%) The response vaguely identifies whether or not the assessment is supported by the subjective and/or objective information, with a vague explanation.	0 (0%) – 7 (7%) The response inaccurately identifies whether or not the assessment is supported by the subjective and/or objective information, with an inaccurate or missing explanation.
·   What diagnostic tests would be appropriate for this case, and how would the results be used to make a diagnosis?	18 (18%) – 20 (20%) The response thoroughly and accurately describes appropriate diagnostic tests for the case and explains clearly, thoroughly, and accurately how the test results would be used to make a diagnosis.	15 (15%) – 17 (17%) The response accurately describes appropriate diagnostic tests for the case and explains how the test results would be used to make a diagnosis.	12 (12%) – 14 (14%) The response vaguely and/or with some inaccuracy describes appropriate diagnostic tests for the case and vaguely and/or with some inaccuracy explains how the test results would be used to make a diagnosis.	0 (0%) – 11 (11%) The response inaccurately describes appropriate diagnostic tests for the case, with an inaccurate or missing explanation of how the test results would be used to make a diagnosis.
·   Would you reject or accept the current diagnosis? Why or why not? ·   Identify three possible conditions that may be considered as a differenial diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.	23 (23%) – 25 (25%) The response states clearly whether to accept or reject the current diagnosis, with a thorough, accurate, and detailed explanation of sound reasoning. The response clearly, thoroughly, and accurately identifies three conditions as a differential diagnosis, with reasoning that is explained clearly, accurately, and thoroughly using three or more different references from current evidence-based literature.	20 (20%) – 22 (22%) The response states whether to accept or reject the current diagnosis, with an accurate explanation of sound reasoning. The response accurately identifies three conditions as a differential diagnosis, with reasoning that is explained using three different references from current evidence-based literature.	17 (17%) – 19 (19%) The response states whether to accept or reject the current diagnosis, with a vague explanation of the reasoning. The response identifies two to three conditions as a differential diagnosis, with reasoning that is explained vaguely and/or inaccurately using three or fewer references from current evidence-based literature.	0 (0%) – 16 (16%) The response inaccurately states or is missing a statement of whether to accept or reject the current diagnosis, with an explanation that is inaccurate and/or missing. The response identifies three or fewer conditions as a differential diagnosis, with reasoning that is missing or explained inaccurately using two or fewer references from current evidence-based literature.
Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.	5 (5%) – 5 (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.	4 (4%) – 4 (4%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.	3 (3%) – 3 (3%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic.	0 (0%) – 2 (2%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided.
Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation	5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors.	4 (4%) – 4 (4%) Contains a few (1 or 2) grammar, spelling, and punctuation errors.	3 (3%) – 3 (3%) Contains several (3 or 4) grammar, spelling, and punctuation errors.	0 (0%) – 2 (2%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list.	5 (5%) – 5 (5%) Uses correct APA format with no errors.	4 (4%) – 4 (4%) Contains a few (1 or 2) APA format errors.	3 (3%) – 3 (3%) Contains several (3 or 4) APA format errors.	0 (0%) – 2 (2%) Contains many (≥ 5) APA format errors.
Total Points: 100

ADDITIONAL INSTRUCTIONS FOR THE CLASS

SCORE A+ WITH HELP FROM OUR PROFESSIONAL WRITERS – NURS6512 Week 10 Assignment

We will process your orders through multiple stages and checks to ensure that what we are delivering to you, in the end, is something that is precise as you envisioned it. All of our essay writing service products are 100% original, ensuring that there is no plagiarism in them. The sources are well-researched and cited so it is interesting. Our goal is to help as many students as possible with their assignments, i.e. our prices are affordable and services premium. NURS6512 Week 10 Assignment

• Discussion Questions (DQ)

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

• Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

• APA Format and Writing Quality

Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.

• Use of Direct Quotes

I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source. NURS6512 Week 10 Assignment

• LopesWrite Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for tips on improving your paper and SI score.

• Late Policy

The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading. NURS6512 Week 10 Assignment

• Communication

Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours. NURS6512 Week 10 Assignment

• Guarantee

  

• Zero Plagiarism
• On-time delivery
• A-Grade Papers
• Free Revision
• 24/7 Support
• 100% Confidentiality
• Professional Writers

• Services Offered

• Custom paper writing
• Question and answers
• Essay paper writing
• Editing and proofreading
• Plagiarism removal services
• Multiple answer questions

We will process your orders through multiple stages and checks to ensure that what we are delivering to you, in the end, is something that is precise as you envisioned it. All of our essay writing service products are 100% original, ensuring that there is no plagiarism in them. The sources are well-researched and cited so it is interesting. Our goal is to help as many students as possible with their assignments, i.e. our prices are affordable and services premium.

Looking for a Similar Assignment? Order a custom-written, plagiarism-free paper

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 three to 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.

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

To Prepare

• Review this week’s Learning Resources and consider the insights they provide related to ears, nose, and throat.
• Review the Shadow Health Resources provided in this week’s Learning Resources specifically the tutorial to guide you through the documentation and interpretation within the Shadow Health platform. Review the examples also provided.
• Review the DCE (Shadow Health) Documentation Template for Focused Exam: Cough found in this week’s Learning Resources and use this template to complete your Documentation Notes for this DCE Assignment.
• Access and login to Shadow Health using the link in the left-hand navigation of the Blackboard classroom.
• Review the Week 5 Focused Exam: Cough Rubric provided in the Assignment submission area for details on completing the Assignment in Shadow Health.
• Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?

Focused Exam: Cough Assignment:

Complete the following in Shadow Health:

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

NURS 6512  Week 5 DCE Assignment 2 Rubric Details

Student Documentation

Subjective Daniel who preferred to be called “Danny” Rivera is 8 years old male Spanish whose country of origin is Puerto Rico. Chief Complaint: Danny stated, “my abuela brought me here because I’ve been feeling sick” “I have been coughing a lot, and I feel kind of tired”. History of present condition: Cough which started about 5 days ago. Patient stated that cough is “gurgle and watery”, and the color of cough is “gross, slimy stuff”. As per patient, he takes cough medicine given by his mom in the morning, and the color of the medicine is purple. He stated that the medicine helps the cough a little and he does not remember what it is called. Patient stated, “most times I sleep for about 8 hours”, and said, “I haven’t been able to sleep much because of my cough”. Patient reported having running nose and does not have seasonal allergy. Color of the nasal drainage is clear, watery and thin. Reported pain in the right ear and rated it 3 on a scale of 0-10. Denied pain on the left ear. Patient’s father and grandfather smoke around him.

Objective

Vital signs: B/P 120/76, pulse 100, respiration 28, Temp. 37.2C (99.0F), oxygen saturation 98%, spirometry FVC: 3.91 L FEV1 3.15 L (FEV1/FVC: 80.5%) Increase respiration at 28, mild tachycardia at 100 bpm. Appearance: stable, seated on the examination table calm and able to make full complete sentences. Redness observed in the nostrils. Breathe sounds clear upon auscultation, alert and oriented x3. Head full of hair and clean, neck smooth and jugular vein non-distended.

Assessment

Cough, Fatigue, Sore throat, Rhinitis, Allergies.

Plan

Order lab work for the throat culture to R/O strep. Cough medicine to be given at night. Encourage fluid intake. Educate family about administration of medication. Encourage family members not to smoke in the house. Follow up with your primary physician.

Documentation / Electronic Health Record

Document: Vitals

Document: Provider Notes

Document: Provider Notes

Student Documentation Model Documentation

Subjective

Daniel who preferred to be called “Danny” Rivera is 8 years old male Spanish whose country of origin is Puerto Rico.

Medical History: No surgery, no prior hospitalization, had pneumonia last year and was treated at urgent care clinic.

Allergies: No known allergies.

Chief Complaint: Danny stated, “my abuela brought me here because I’ve been feeling sick” “I have been coughing a lot, and I feel kind of tired”. He is in 3rd grade.

History of present condition: Cough which started about 5 days ago. Patient stated that cough is “gurgle and watery”, and the color of cough is “gross, slimy stuff”. As per patient, he takes cough medicine given by his mom in the morning, and the color of the medicine is purple. He stated that the medicine helps the cough a little and he does not remember what it is called. Patient stated, “most times I sleep for about 8 hours”, and said, “I haven’t been able to sleep much because of my cough”. Patient reported having running nose and does not have seasonal allergy. Nasal Cavity color is erythema, color of the nasal drainage is clear, watery and thin. Reported pain in the right ear and rated it 3 on a scale of 0-10. Denied pain on the left ear. Patient’s father and grandfather smoke around him.

Family History: Mother has type 2 diabetes, HTN, hypercholesterolemia, spinal stenosis, , obesity.

Father: Is a smoker, HTN, hypercholesterolemia, asthma as a child.

Maternal grand-mother: Type diabetes, HTN.

Maternal grand-father: Smoker, eczema

Paternal grand-mother: died in a car accident at age 52 years old.

Paternal grand-father: No known history.

Social history:

School attendance record: Danny has been out of school for two weeks last year due to pneumonia. He lives with his parents and grand-mother. Grand-mother takes care of him while his parents go to work. He speaks English and family use Spanish in conjunction with English.

N/A

Objective

Vital signs: B/P 120/76, pulse 100, respiration 28, Temp. 37.2C (99.0F), oxygen saturation 98%, spirometry FVC: 3.91 L

FEV1 3.15 L (FEV1/FVC: 80.5%). Weight: 90 lbs., Ht. 4′ 2”.

Increase respiration at 28, mild tachycardia at 100 bpm. Appearance: stable, seated on the examination table calm and able to make full complete sentences. Redness observed in the nostrils. Breathe sounds clear upon auscultation, alert and oriented x3. Head full of hair and clean, neck smooth and jugular vein non-distended.

N/A

Assessment

Cough, Fatigue, Sore throat, Rhinitis, Allergies.

N/A

Plan

Order lab work for the throat culture to R/O strep. Cough medicine to be given at night. Encourage fluid intake. educate family about administration of medication. Encourage family member not to smoke in the house.

Follow up with your primary physician.

WEEK 5 Shadow Health DCE Focused Exam-Cough Documentation

Name: Danny

Section:

Week 5

Shadow Health Digital Clinical Experience Focused Exam: Cough Documentation

SUBJECTIVE DATA: Include what the patient tells you, but organize the information.

Daniel who preferred to be called “Danny” Rivera is 8 years old Spanish male whose country of origin is Puerto Rico.

Chief Complaint (CC): Cou

History of Present Illness (HPI):

Medications:

Allergies:

Past Medical History (PMH):

Past Surgical History (PSH):

Sexual/Reproductive History:

Personal/Social History:

Immunization History:

Significant Family History (Include history of parents, Grandparents, siblings, and children):

Review of Systems: From head-to-toe, include each system that covers the Chief Complaint, History of Present Illness, and History). Remember that the information you include in this section is based on what the patient tells you. You will only need to cover systems pertinent to your CC, HPI (N/A, UNKNOWN is not acceptable, make up the information if you need to). To ensure that you include all essentials in your case, refer to Chapter 2 of the Sullivan text.

General: Include any recent weight changes, weakness, fatigue, or fever, but do not restate HPI data here.

HEENT:

Respiratory:

Cardiovascular/Peripheral Vascular:

Psychiatric:

Neurological:

Lymphatics:

OBJECTIVE DATA: From head-to-toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History unless you are doing a total H&P. Do not use WNL or normal. You must describe what you see.

Physical Exam:

Vital signs: Include vital signs, ht, wt., temperature, and BMI and pulse oximetry

General: Include general state of health, posture, motor activity, and gait. This may also include dress, grooming, hygiene, odors of body or breath, facial expression, manner, level of conscience, and affect and reactions to people and things.

HEENT:

Respiratory: Always include this in your PE.

Cardiology: Always include the heart in your PE.

Lymphatics:

Psychiatric:

Diagnostics/Labs (Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses.)

ASSESSMENT: List your priority diagnosis(es). For each priority diagnosis, list at least 3 differential diagnoses, each of which must be supported with evidence and guidelines. For holistic care, you need to include previous diagnoses and indicate whether these are controlled or not controlled.

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

Content

Name: NURS_6512_Week_5_DCE_Assignment_2_Rubric

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

	Excellent	Good	Fair	Poor
Student DCE score (DCE percentages will be calculated automatically by Shadow Health after the assignment is completed.) Note: DCE Score – Do not round up on the DCE score.	Points: Points Range: 56 (56%) – 60 (60%) DCE score>93 Feedback:	Points: Points Range: 51 (51%) – 55 (55%) DCE Score 86-92 Feedback:	Points: Points Range: 46 (46%) – 50 (50%) DCE Score 80-85 Feedback:	Points: Points Range: 0 (0%) – 45 (45%) DCE Score <79 No DCE completed. Feedback:
Subjective Documentation in Provider Notes Subjective narrative documentation in Provider Notes is detailed and organized and includes: Chief Complaint (CC), HPI, Current Medications, Allergies, Past Medical History, Family History, Social History and Review of Systems (ROS) ROS: covers all body systems that may help you formulate a list of differential diagnoses. You should list each system as follows: General: Head: EENT: etc. You should list these in bullet format and document the systems in order from head to toe.	Points: Points Range: 16 (16%) – 20 (20%) Documentation is detailed and organized with all pertinent information noted in professional language. Documentation includes all pertinent documentation to include Chief Complaint (CC), HPI, Current Medications, Allergies, Past Medical History, Family History, Social History and Review of Systems (ROS). Feedback:	Points: Points Range: 11 (11%) – 15 (15%) Documentation with sufficient details, some organization and some pertinent information noted in professional language. Documentation provides some of the Chief Complaint (CC), HPI, Current Medications, Allergies, Past Medical History, Family History, Social History and Review of Systems (ROS). Feedback:	Points: Points Range: 6 (6%) – 10 (10%) Documentation with inadequate details and/or organization; and inadequate pertinent information noted in professional language. Limited or/minimum documentation provided to analyze students critical thinking abilities for the Chief Complaint (CC), HPI, Current Medications, Allergies, Past Medical History, Family History, Social History and Review of Systems (ROS). Feedback:	Points: Points Range: 0 (0%) – 5 (5%) Documentation lacks any details and/or organization; and does not provide pertinent information noted in professional language. No information is provided for the Chief Complaint (CC), HPI, Current Medications, Allergies, Past Medical History, Family History, Social History and Review of Systems (ROS). or No documentation provided. Feedback:
Objective Documentation in Provider Notes – this is to be completed in Shadow Health Physical exam: Document in a systematic order starting from head-to-toe, include what you see, hear, and feel when doing your physical exam using medical terminology/jargon. Document all normal and abnormal exam findings. Do not use “WNL” or “normal”. You only need to examine the systems that are pertinent to the CC, HPI, and History. Diagnostic result – Include any pertinent labs, x-rays, or diagnostic test that would be appropriate to support the differential diagnoses mentioned Differential Diagnoses (list a minimum of 3 differential diagnoses). Your primary or presumptive diagnosis should be at the top of the list (#1).	Points: Points Range: 16 (16%) – 20 (20%) Documentation detailed and organized with all abnormal and pertinent normal assessment information described in professional language. Each system assessed is clearly documented with measurable details of the exam. Feedback:	Points: Points Range: 11 (11%) – 15 (15%) Documentation with sufficient details and some organization; some abnormal and some normal assessment information described in mostly professional language. Each system assessed is somewhat clearly documented with measurable details of the exam. Feedback:	Points: Points Range: 6 (6%) – 10 (10%) Documentation with inadequate details and/or organization; inadequate identification of abnormal and pertinent normal assessment information described; inadequate use of professional language. Each system assessed is minimally or is not clearly documented with measurable details of the exam. Feedback:	Points: Points Range: 0 (0%) – 5 (5%) Documentation with no details and/or organization; no identification of abnormal and pertinent normal assessment information described; no use of professional language. None of the systems are assessed, no documentation of details of the exam. or No documentation provided. Feedback:

Show Descriptions Show Feedback

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

Levels of Achievement: Excellent 56 (56%) – 60 (60%) DCE score>93 Good 51 (51%) – 55 (55%) DCE Score 86-92 Fair 46 (46%) – 50 (50%) DCE Score 80-85 Poor 0 (0%) – 45 (45%) DCE Score <79 No DCE completed. Feedback:

Subjective Documentation in Provider Notes Subjective narrative documentation in Provider Notes is detailed and organized and includes: Chief Complaint (CC), HPI, Current Medications, Allergies, Past Medical History, Family History, Social History and Review of Systems (ROS) ROS: covers all body systems that may help you formulate a list of differential diagnoses. You should list each system as follows: General: Head: EENT: etc. You should list these in bullet format and document the systems in order from head to toe.–

Levels of Achievement: Excellent 16 (16%) – 20 (20%) Documentation is detailed and organized with all pertinent information noted in professional language. Documentation includes all pertinent documentation to include Chief Complaint (CC), HPI, Current Medications, Allergies, Past Medical History, Family History, Social History and Review of Systems (ROS). Good 11 (11%) – 15 (15%) Documentation with sufficient details, some organization and some pertinent information noted in professional language. Documentation provides some of the Chief Complaint (CC), HPI, Current Medications, Allergies, Past Medical History, Family History, Social History and Review of Systems (ROS). Fair 6 (6%) – 10 (10%) Documentation with inadequate details and/or organization; and inadequate pertinent information noted in professional language. Limited or/minimum documentation provided to analyze students critical thinking abilities for the Chief Complaint (CC), HPI, Current Medications, Allergies, Past Medical History, Family History, Social History and Review of Systems (ROS). Poor 0 (0%) – 5 (5%) Documentation lacks any details and/or organization; and does not provide pertinent information noted in professional language. No information is provided for the Chief Complaint (CC), HPI, Current Medications, Allergies, Past Medical History, Family History, Social History and Review of Systems (ROS). or No documentation provided. Feedback:

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

Levels of Achievement: Excellent 16 (16%) – 20 (20%) Documentation detailed and organized with all abnormal and pertinent normal assessment information described in professional language. Each system assessed is clearly documented with measurable details of the exam. Good 11 (11%) – 15 (15%) Documentation with sufficient details and some organization; some abnormal and some normal assessment information described in mostly professional language. Each system assessed is somewhat clearly documented with measurable details of the exam. Fair 6 (6%) – 10 (10%) Documentation with inadequate details and/or organization; inadequate identification of abnormal and pertinent normal assessment information described; inadequate use of professional language. Each system assessed is minimally or is not clearly documented with measurable details of the exam. Poor 0 (0%) – 5 (5%) Documentation with no details and/or organization; no identification of abnormal and pertinent normal assessment information described; no use of professional language. None of the systems are assessed, no documentation of details of the exam. or No documentation provided. Feedback:

Total Points: 100

Name: NURS_6512_Week_5_DCE_Assignment_2_Rubric

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

ADDITIONAL INSTRUCTIONS FOR THE CLASS

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• Discussion Questions (DQ)

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

• Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week. NURS6512 Week 5 Assignment Digital Clinical Experience Focused Exam Cough

• APA Format and Writing Quality

Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.

• Use of Direct Quotes

I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source.

• LopesWrite Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for tips on improving your paper and SI score.

• Late Policy

The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

• Communication

Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours. NURS6512 Week 5 Assignment Digital Clinical Experience Focused Exam Cough

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Assignment 2: Digital Clinical Experience (DCE): Health History Assessment

In Week 3, you began your DCE: Health History Assessment. For this week, you will complete this Health History Assessment in your simulation tool, Shadow Health and finalize for submission.

To Prepare

• Review this week’s Learning Resources as well as the Taking a Health History media program in Week 3, and consider how you might incorporate these strategies. Download and review the Student Checklist: Health History Guide and the History Subjective Data Checklist, provided in this week’s Learning Resources, to guide you through the necessary components of the assessment.
• Review the DCE (Shadow Health) Documentation Template for Health History found in this week’s Learning Resources and use this template to complete your Documentation Notes for this DCE Assignment.
• Access and login to Shadow Health using the link in the left-hand navigation of the Blackboard classroom.
• Review the Shadow Health Student Orientation media program and the Useful Tips and Tricks document provided in the week’s Learning Resources to guide you through Shadow Health.
• Review the Week 4 DCE Health History Assessment Rubric, provided in the Assignment submission area, for details on completing the Assignment.

Note: There are 2 parts to this assignment – the lab pass and the documentation. You must achieve a total score of 80% in order to pass this assignment. Carefully review the rubric and video presentation in order to fully understand the requirements of this assignment.

DCE Health History Assessment:

Complete the following in Shadow Health:

Orientation

• DCE Orientation (15 minutes)
• Conversation Concept Lab (50 minutes)

Health History

• Health History of Tina Jones (180 minutes)

Note: Each Shadow Health Assessment may be attempted and reopened as many times as necessary prior to the due date to achieve a total of 80% or better (this includes your DCE and your Documentation Notes), but you must take all attempts by the Week 4 Day 7 deadline.

Submission and Grading Information

By Day 7 of Week 4

• Complete your Health Assessment DCE assignments in Shadow Health via the Shadow Health link in Blackboard.
• Once you complete your assignment in Shadow Health, you will need to download your lab pass and upload it to the corresponding assignment in Blackboard for your faculty review. 
• (Note: Please save your lab pass as “LastName_FirstName_AssignmentName”.) You can find instructions for downloading your lab pass here: /orders/link.shadowhealth.com/download-lab-pass
• Once you submit your Documentation Notes to Shadow Health, make sure to copy and paste the same Documentation Notes into your Assignment submission link below.
• Download, sign, date, and submit your Student Acknowledgement Form found in the Learning Resources for this week.
• Note: You must pass this assignment with a minimum score of 80%  in order to pass the class. Once submitted, there are not any opportunities to revise or repeat this assignment. 

Grading Criteria

To access your rubric:
Week 4 Assignment 2 DCE Rubric

Submit Your Assignment by Day 7 of Week 4

To submit your Lab Pass:
Week 4 Lab Pass

To submit this required part of the Assignment:
Week 4 Documentation Notes for Assignment 2

To Submit your Student Acknowledgement Form:
Submit your Week 4 Assignment 2 DCE Student Acknowledgement Form

Module 3: Approach to System-Focused Advanced Health Assessments

What’s Happening in This Module?

Module 3: Approach to System-Focused Advanced Health Assessments is a 7-week module that spans Weeks 4–10. In this module, you explore advanced health assessments using a system-focused approach. Assessments such as skin, hair, and nails as well as head, neck eyes, ears, nose, and throat (HEENT) help you to begin considering abnormalities as you move forward in your assessments. You continue the module by assessing the abdomen and gastrointestinal system and move to other systems—such as heart, lungs, vascular, musculoskeletal, neurologic—before finishing with other special examinations.

What do I have to do?	When do I have to do it?
Review your Learning Resources.	Days 1–7, Weeks 4, 5, 6, 7, 8, 9, and 10
DCE: Health History Assessment	Complete and submit your DCE: Health History Assessment by Day 7 of Week 4.
Lab Assignment: Differential Diagnosis for Skin Conditions	Submit your Lab Assignment by Day 7 of Week 4.
Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat	Submit your Case Study Assignment by Day 6 of Week 5.
DCE: Focused Exam: Cough	Complete and submit your DCE: Focused Exam: Cough by Day 7 of Week 5.
Lab Assignment: Assessing the Abdomen	Submit your Lab Assignment by Day 7 of Week 6.
Midterm Exam	Complete by Day 7 of Week 6.
DCE: Focused Exam: Chest Pain	Complete and submit your DCE: Focused Exam: Chest Pain by Day 6 of Week 7.
Discussion: Assessing Musculoskeletal Pain	Post by Day 3 of Week 8 and respond to your colleagues by Day 6 of Week 8.
Case Study Assignment: Assessing Neurological Symptoms	Submit your Case Study Assignment by Day 6 of Week 9.
DCE: Comprehensive (Head-to-Toe) Physical Assessment	Complete and submit your DCE: Comprehensive Physical Assessment by Day 7 of Week 9.
Lab Assignment: Assessing the Genitalia and Rectum	Submit your Lab Assignment by Day 7 of Week 10.

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

Something as small and simple as a mole or a discolored toenail can offer meaningful clues about a patient’s health. Abnormalities in skin, hair, and nails can provide non-invasive external clues to internal disorders or even prove to be disorders themselves. Being able to evaluate such abnormalities of the skin, hair, and nails is a diagnostic benefit for any nurse conducting health assessments.

This week, you will explore how to assess the skin, hair, and nails, as well as how to evaluate abnormal skin findings.

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

Learning Resources

Required Readings

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 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.

Chapter 1, “Punch Biopsy”

Chapter 2, “Skin Biopsy”

Chapter 10, “Nail Removal”

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

Chapter 16, “Skin Tag (Acrochordon) Removal”

Chapter 22, “Suture Insertion”

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.

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.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Skin, hair, and nails: Student checklist. In Seidel’s guide to physical examination (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). Skin, hair, and nails: 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.

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

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

VisualDx. (n.d.). Clinical decision support. Retrieved June 11, 2019, from http://www.skinsight.com/info/for_professionals

This interactive website allows you to explore skin conditions according to age, gender, and area of the body.

Clothier, A. (2014). Assessing and managing skin tears in older people. Nurse Prescribing, 12(6), 278–282.

Document: Skin Conditions (Word document)

This document contains five images of different skin conditions. You will use this information in this week’s Discussion.

Document: Comprehensive SOAP Exemplar (Word document)

Document: 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:

Frey, C. [Chris Frey]. (2015, September 4). Student orientation [Video file]. Retrieved from /orders/www.youtube.com/watch?v=Rfd_8pTJBkY

Document: Shadow Health Support and Orientation Resources (PDF)

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

Document: Shadow Health. (2014). Useful tips and tricks (Version 2) (PDF)

Document: Shadow Health Nursing Documentation Tutorial (Word document)

Document: Student Acknowledgement Form (Word document)

Note: You will sign and date this form each time you complete your DCE Assignment in Shadow Health to acknowledge your commitment to Walden University’s Code of Conduct.

Document: DCE (Shadow Health) Documentation Template for Health History (Word document)

Use this template to complete your Assignment 2 for this week.

Optional Resources

LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.

Chapter 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 /orders/web.archive.org/web/20170215015223/http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/absorbable_suture_chart.pdf

Ethicon, Inc. (2006). Dermabond topical skin adhesive application technique. Retrieved from /orders/web.archive.org/web/20150921174121/http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/db_application_poster.pdf

Ethicon, Inc. (2001). Ethicon needle sales types. Retrieved from /orders/web.archive.org/web/20150921171922/http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/needle_template.pdf

Ethicon, Inc. (n.d.-b). Ethicon sutures. Retrieved from /orders/web.archive.org/web/20150921202525/http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/suture_chart_ethicon.pdf

Ethicon, Inc. (2002). How to care for your wound after it’s treated with Dermabond topical skin adhesive. Retrieved from /orders/web.archive.org/web/20150926002534/http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/db_wound_care.pdf

Ethicon, Inc. (2005). Knot tying manual. Retrieved from /orders/web.archive.org/web/20160915214422/http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/knot_tying_manual.pdf

Ethicon, Inc. (n.d.-c). Wound closure manual. Retrieved from http://www.uphs.upenn.edu/surgery/Education/facilities/measey/Wound_Closure_Manual.pdf

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Week 4 Soap Note Sample Paper

NURS 6512 Week 4 Soap Note – Lab Assignment: Differential Diagnosis for Skin Conditions

SOAP Note

Student’s Name:

Institutional Affiliation:

Comprehensive SOAP NOTE

Patient Initials: ___N/A____              Age: ___N/A____                              Gender: ___N/A____

SUBJECTIVE DATA:

Chief Complaint (CC): #3

History of Present Illness (HPI):   A Caucasian male whose age is unknown presents with non-scaly annual papules distributed along his nape. The papules have undiluted borders and appear reddish in color.

Medications:  No medical history provided.

Allergies: No known allergies.

Past Medical History (PMH): Past medical history not provided.

Past Surgical History (PSH): No surgical history provided.

Sexual/Reproductive History: Not provided. Ask about his sexuality, the number of sexual partners, pregnancy, and whether the patient has a history of sexually transmitted infections.

Personal/Social History: Not provided. Enquire on his hobbies, place of work, traveling history, and whether he smokes or use any recreational drugs.

Immunization History: Not provided. Collect the patient immunization details.

Significant Family History: Not provided. Inquire if there are family members with any skin complications. Inquire about other family’s medical conditions that might contribute to skin infections.

Review of Systems:

General:  Not reported. Inquire for symptoms of fatigue, fever, sweating, or any significant weight changes.

HEENT: Not reported. Inquire about any vision or hearing changes, any chewing or swallowing difficulty, and any nasal complications.

Neck: Red lesions distributed on the back of the neck.

Breasts:  No reported complications. Ask if the patient has a history of lesions, masses, or rashes.

Respiratory:  No reported complications.

CV: No reported complications.

GI: No reported complications.

GU:  No reported complications. Ask if the patient has had any lesions or rashes on his genital areas.

MS: No reported complications.

Psych: No reported complications.

Neuro: No reported complications.

Integument/Heme/Lymph:  Red lesions at the back of the neck.  Ask if the lesions are present in other parts of the body.

Endocrine: No endocrine symptoms reported.

Allergic/Immunologic: No known allergies.

OBJECTIVE DATA

Physical Exam:

Check for the patient’s vital signs. Vital signs include blood pressure, temperature, heart rate, and body mass index.

General: Check for the patient’s appearance and signs of fatigue and discomfort.

HEENT: Investigate the eyes, ears, and nose for any abnormalities.

Neck: Non-scaly annual papules at the back of the neck. Palpate the lesions to determine the texture and warmness.

Chest/Lungs: Check the chest for the presence or rashes or lesions.

Heart/Peripheral Vascular: N/A

ABD:  Check the abdomen for the presence of rashes or lesions

Genital/Rectal:  Investigate the genitalia for the presence of rashes.

Musculoskeletal: N/A

Neuro: N/A

Skin/Lymph Nodes:  Non-scaly annual lesions at the back of the neck. Check whether there are further lesions on other skin regions.

ASSESSMENT:

Diagnostics:

Lab:

Various laboratory procedures can be used to guide the diagnosis. The following are some of the recommended procedures.

Dermoscopy. The procedure uses a skin surface microscope known as a dermatoscope to magnify the lesion (Colyar, 2015). The process aims at providing a more detailed investigation of the lesion to make a diagnosis and determine the skin lesions that require a biopsy (Colyar, 2015).

Diascopy. The process involves pressing a glass or plastic slide on the lesion and noting any color changes (Colyar, 2015). The procedure determines whether determining the type of lesions. For example, whether it is hemorrhagic or not (Colyar, 2015).

Punch Biopsy.  This involves collecting a cylindrically shaped tissue sample (Colyar, 2015). The medical practitioner first cleans the skin and administers local anesthesia. The practitioner then stretches the skin and rotates a biopsy instrument while exerting downward pressure (Colyar, 2015). The procedure obtains a specimen that is then sent for culture to identify the bacteria or virus, causing the condition (Colyar, 2015).

Differential Diagnosis (DDx):

Tinea corporis. This is a skin condition that causes red, itchy, and circular rashes on the skin (Halder & Nootheti, 2014). Symptoms include itchy ring-shaped lesions that appear commonly on the arms and legs (Halder & Nootheti, 2014). However, the rashes may also appear on any part of the body. The rings may also overlap and appear red in color (Halder & Nootheti, 2014). Common causes of tinea corporis are skin to skin contact with an infected person or an animal (Halder & Nootheti, 2014).

Pityriasis rosea. This is a form of skin rash that starts as an oval spot on the back or the chest that then spreads to the other body parts (Halder & Nootheti, 2014). It commonly affects individuals between ages 10-35 and may clear on its own after around ten weeks (Halder & Nootheti, 2014). Symptoms of the condition are large and slightly raised red patches, fatigue, fever, and itching (Halder & Nootheti, 2014). The causes of pityriasis rosea are not clearly known, but some viruses are suspected of causing the infection (Halder & Nootheti, 2014).

Lupus. This is an autoimmune infection that occurs when the immune system attacks the body’s tissues and organs (Halder & Nootheti, 2014). Lupus causes an inflammation that may affect the skin, lungs, brain, kidneys, or joints (Halder & Nootheti, 2014). Lupus can be difficult to diagnose since it affects various body parts, and the symptoms vary from the type of lupus (Halder & Nootheti, 2014). Some symptoms of Lupus include red skin lesions that appear in areas exposed to the Sun., butterfly-shaped rashes in various body parts, fever, fatigue, chest pain, dry eyes, and headaches (Halder & Nootheti, 2014).

Guttate psoriasis. This is a form of a skin condition that appears as a red small itchy lesion (Dains, Baumann, & Scheibel, 2015). It is a form of an autoimmune disease that might occur more than once in a lifetime (Dains et al., 2015). Gutate psoriasis usually occurs on the face, ears, scalp, neck, legs, and arms (Dains et al., 2015). Guttate psoriasis is usually caused by bacterial infections, especially streptococcus (Dains et al., 2015). In some cases, genetic factors can play a role if there are several family members with the condition (Dains et al., 2015).

Patient’ problem/diagnosis:

Granuloma annulare. This a skin condition that causes circular reddish lesions. It is usually triggered by skin injuries or particular drugs (Halder & Nootheti, 2014). The condition may disappear on its own after approximately two years without treatment (Halder & Nootheti, 2014). However, treatment can help speed up healing. The symptoms of granuloma annulare depend on the type of infection (Halder & Nootheti, 2014). For example, localized granuloma annulare causes skin-colored lesions that occur on the feet, wrists, and hands (Halder & Nootheti, 2014). Generalized granuloma annulare causes red lesions on areas such as the neck, legs, and arms (Halder & Nootheti, 2014). The lesions in granuloma annulare are usually annular bumps that might spread to various parts of the body (Halder & Nootheti, 2014).

 Discussion:

Making a diagnosis for skin conditions can be difficult since the symptoms are often similar to those of other conditions. In the case of this discussion, it is particularly difficult because the patient was not physically present, and the diagnosis depended on an image interpretation.  The selected primary diagnosis for this discussion was granuloma annulare because the patient had symptoms of non-scaly annual papules distributed along his nape. The symptoms are similar to what shows in cases of granuloma annulare.  However, it is also possible for the patient to have conditions such as tinea corporis, pityriasis rosea, and lupus because the conditions also manifest red circular lesions in some cases. Therefore, further lab assessment and physical exams may be needed for an accurate diagnosis.

References

Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2015). Advanced Health Assessment & Clinical Diagnosis in Primary Care-E-Book. Elsevier Health Sciences.

Halder, R. M., & Nootheti, P. K. (2014). Ethnic skin disorders overview. Journal of the American Academy of Dermatology, 48(6), S143-S148.

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