Week 1
discussionEffective communication is vital to constructing an accurate
and detailed patient history. A patient’s health or illness is influenced by
many factors, including age, gender, ethnicity, and environmental setting. As
an advanced practice nurse, you must be aware of these factors and tailor your
communication techniques accordingly. Doing so will not only help you establish
rapport with your patients, but it will also enable you to more effectively
gather the information needed to assess your patients’ health risks.
For this Discussion, you will take on the role of a
clinician who is building a health history for one of the following new
patients:
76-year-old Black/African-American male with disabilities
living in an urban setting
Adolescent Hispanic/Latino boy living in a middle-class
suburb
55-year-old Asian female living in a high-density poverty
housing complex
Pre-school aged white female living in a rural community
16-year-old white pregnant teenager living in an inner-city
neighborhood
To prepare:
With the information presented in Chapter 1 in mind,
consider the following:
How would your communication and interview techniques for
building a health history differ with each patient?
How might you target your questions for building a health
history based on the patient’s age, gender, ethnicity, or environment?
What risk assessment instruments would be appropriate to use
with each patient?
What questions would you ask each patient to assess his or
her health risks?
Select one patient from the list above on which to focus for
this Discussion.
Identify any potential health-related risks based upon the
patient’s age, gender, ethnicity, or environmental setting that should be taken
into consideration.
Select one of the risk assessment instruments presented in
Chapter 1 or Chapter 26 of the course text, or another tool with which you are
familiar, related to your selected patient.
Develop at least five targeted questions you would ask your
selected patient to assess his or her health risks and begin building a health
history.
By Day 3
Post a description of the interview and communication
techniques you would use with your selected patient. Explain why you would use
these techniques. Identify the risk assessment instrument you selected, and
justify why it would be applicable to the selected patient. Provide at least
five targeted questions you would ask the patient.
Note: For this Discussion, you are required to complete your
initial post before you will be able to view and respond to your colleagues’
postings. Begin by clicking on the "Post to Discussion Question" link
and then select "Create Thread" to complete your initial post.
Remember, once you click on Submit, you cannot delete or edit your own posts,
and you cannot post anonymously. Please check your post carefully before
clicking on Submit!
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues on two different
days who selected a different patient than you, using one or more of the
following approaches:
Share additional interview and communication techniques that
could be effective with your colleague’s selected patient.
Suggest additional health-related risks that might be
considered.
Validate an idea with your own experience and additional
research.
Week 2
discussion
Discussion: Diversity and Health Assessments
In May 2012, Alice Randall wrote an article for The New York
Times on the cultural factors that encouraged black women to maintain a weight
above what is considered healthy. Randall explained—from her observations and
her personal experience as a black woman—that many African-American communities
and cultures consider women who are overweight to be more beautiful and
desirable than women at a healthier weight. As she put it, “Many black women
are fat because we want to be” (Randall, 2012).
Randall’s statements sparked a great deal of controversy and
debate; however, they emphasize an underlying reality in the health care field:
different populations, cultures, and groups have diverse beliefs and practices
that impact their health. Nurses and health care professionals should be aware
of this reality and adapt their health assessment techniques and
recommendations to accommodate diversity.
In this Discussion, you will consider different socioeconomic,
spiritual, lifestyle, and other cultural factors that should be taken into
considerations when building a health history for patients with diverse
backgrounds.
Case 1
JC, an at-risk 86-year-old Asian male is physically and
financially dependent on his daughter, a single mother who has little time or
money for her father's health needs. He has a hx of hypertension (HTN),
gastroesophageal reflux disease (GERD), b12 deficiency, and chronic
prostatitis. He currently takes Lisinopril 10mg QD, Prilosec 20mg QD, B12
injections monthly, and Cipro 100mg QD. He comes to you for an annual exam and
states “I came for my annual physical exam, but do not want to be a burden to
my daughter."
Case 2
TJ, a 32-year-old pregnant lesbian, is being seen for an
annual physical exam and has been having vaginal discharge. Her pregnancy has
been without complication thus far. She has been receiving prenatal care from
an obstetrician. She received sperm from a local sperm bank. She is currently
taking prenatal vitamins and takes Tylenol over the counter for aches and pains
on occasion. She a strong family history of diabetes. Gravida 1; Para 0;
Abortions 0.
Case 3
MR, a 23-year-old Native American male comes in to see you
because he has been having anxiety and wants something to help him. He has been
smoking "pot" and says he drinks to help him too. He tells you he is
afraid that he will not get into Heaven if he continues in this lifestyle. He
is not taking any prescriptions medications and denies drug use. He has a positive
family history of diabetes, hypertension, and alcoholism.
To prepare:
Reflect on your experiences as a nurse and on the
information provided in this week’s Learning Resources on diversity issues in
health assessments.
Select one of the three case studies. Reflect on the
provided patient information.
Reflect on the specific socioeconomic, spiritual, lifestyle,
and other cultural factors related to the health of the patient you selected.
Consider how you would build a health history for the
patient. What questions would you ask, and how would you frame them to be
sensitive to the patient’s background, lifestyle, and culture? Develop five
targeted questions you would ask the patient to build his or her health history
and to assess his or her health risks.
Think about the challenges associated with communicating
with patients from a variety of specific populations. What strategies can you
as a nurse employ to be sensitive to different cultural factors while gathering
the pertinent information?
By Day 3
Post an explanation of the specific socioeconomic,
spiritual, lifestyle, and other cultural factors associated with the patient
you selected. Explain the issues that you would need to be sensitive to when
interacting with the patient, and why. Provide at least five targeted questions
you would ask the patient to build his or her health history and to assess his
or her health risks.
Note: For this Discussion, you are required to complete your
initial post before you will be able to view and respond to your colleagues’
postings. Begin by clicking on the "Post to Discussion Question" link
and then select "Create Thread" to complete your initial post.
Remember, once you click on Submit, you cannot delete or edit your own posts,
and you cannot post anonymously. Please check your post carefully before
clicking on Submit!
Read a selection of your colleagues’ responses
By Day 6
Respond on or before Day 6 to at least two of your
colleagues who selected a different patient than you, using one or more of the
following approaches:
Suggest additional socioeconomic, spiritual, lifestyle, and
other cultural factors related to the patient.
Critique your colleague’s targeted questions, and explain
how the patient might interpret these questions. Explain whether any of the
questions would apply to your patient, and why.
Week 3
discussion
Discussion: Assessment Tools and Diagnostic Tests in Adults
and Children
When seeking to identify a patient’s health condition,
advanced practice nurses can use a diverse selection of diagnostic tests and
assessment tools; however, different factors affect the validity and
reliability of the results produced by these tests or tools. Nurses must be
aware of these factors in order to select the most appropriate test or tool and
to accurately interpret the results.
Not only do these diagnostic tests affect adults, body
measurements can provide a general picture of whether a child is receiving
adequate nutrition or is at risk for health issues. These data, however, are
just one aspect to be considered. Lifestyle, family history, and culture-among
other factors-are also relevant. That said, gathering and communicating this
information can be a delicate process.
In this Discussion, you will consider the validity and
reliability of different assessment tools and diagnostic tests. You will
explore issues such as sensitivity, specificity, and positive and negative
predictive values. You will also consider examples of children with various
weight issues. You will explore how you could effectively gather information
and encourage parents and caregivers to be proactive about their children’s
health and weight.
To prepare:
Review this week’s learning resources and consider factors
that impact the validity and reliability of various assessment tools and
diagnostic tests. We will also review examples of pediatric patients and their
families as it relates to BMI.
This week you will be assigned one of the following DB by
your instructor.
Select one of the following assessment tools or diagnostic
tests to explore for the purposes of this Discussion:
Mammogram
Prostate-specific antigen (PSA) test
Body-mass index (BMI) using waist circumference for adults
Select one of the examples on which to focus for this
Discussion. What health issues and risks may be relevant to the child you
selected?
Overweight 5-year-old boy with overweight parents
5-year-old girl of normal weight with obese parents
Severely underweight 12-year-old girl with underweight
parents
Search the Walden Library and credible sources for resources
explaining the tool or test you selected. What is its purpose, how is it
conducted, and what information does it gather?
What does the literature discuss regarding the validity,
reliability, and are there any issues with sensitivity, specificity, predictive
values, ethical dilemmas, and controversies related to the test or tool?
Based on the risks you identified, consider what further
information you would need to gain a full understanding of the child’s health.
Think about how you could gather this information in a sensitive fashion.
Consider how you could encourage parents or caregivers to be
proactive toward the child’s health.
By Day 3
Post a description of how the assessment tool or diagnostic
test you selected is used in health care. Based on your research, evaluate the
test or the tool’s validity and reliability, and explain any issues with
sensitivity, reliability, and predictive values. Include references in
appropriate APA formatting.
OR
Post an explanation of the health issues and risks that are
relevant to the child you selected. Describe additional information you would
need in order to further assess his or her weight-related health. Taking into
account the parents’ and caregivers’ potential sensitivities, list at least
three specific questions you would ask about the child to gather more
information. Provide at least two strategies you could employ to encourage the
parents or caregivers to be proactive about their child’s health and weight.
Note: For this Discussion, you are required to complete your
initial post before you will be able to view and respond to your colleagues’
postings. Begin by clicking on the "Post to Discussion Question" link
and then select "Create Thread" to complete your initial post.
Remember, once you click on Submit, you cannot delete or edit your own posts,
and you cannot post anonymously. Please check your post carefully before
clicking on Submit!
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues who selected a
different tool test, or child health example than you, using one or more of the
following approaches:
Critique your colleague’s evaluation of the validity and
reliability of the tool or test selected.
Suggest alternative or additional tools or tests that should
be considered when gathering information about specific conditions or symptoms.
Based on the risks you identified, consider what further
information you would need to gain a full understanding of the child’s health.
Think about how you could gather this information in a sensitive fashion.
Consider how you could encourage parents or caregivers to be
proactive toward the child’s health.
Suggest additional health risks or issues that could be
relevant to the child.
Critique your colleagues’ questions, and suggest how the parents
or caregivers might interpret these questions. Provide alternate or additional
questions.
Suggest an additional strategy for gathering patient
information or promoting proactivity
Week 5
discussion
Discussion: Assessing the Ears, Nose, and Throat
Most ear, nose, and throat conditions that arise in
non-critical care settings are minor in nature. However, subtle symptoms can
sometimes escalate into life-threatening conditions that require prompt
assessment and treatment. Nurses conducting assessments of the ears, nose, and
throat must be able to identify the small differences between life-threatening
conditions and benign ones. For instance, if a patient with a sore throat and a
runny nose also has inflamed lymph nodes, the inflammation is probably due to
the pathogen causing the sore throat rather than a case of throat cancer. With
this knowledge and a sufficient patient health history, a nurse would not need
to escalate the assessment to a biopsy or an MRI of the lymph nodes, but would
probably perform a simple strep test.
In this Discussion, you consider case studies of abnormal
findings from patients in a clinical setting. You determine what history should
be collected from the patients, what physical exams and diagnostic tests should
be conducted, and formulate a differential diagnosis with several possible
conditions.
Note: By Day 1 of this week, your Instructor will have
assigned you to one of the following specific case studies for this Discussion.
Also, your Discussion post should be in the Episodic/Focused SOAP Note format,
rather than the traditional narrative style Discussion posting format. Refer to
Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the
Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP
notes have specific data included in every patient case.
Case 1: Nose Focused Exam
Richard is a 50-year-old male with nasal congestion,
sneezing, rhinorrhea, and postnasal drainage. Richard has struggled with an
itchy nose, eyes, palate, and ears for 5 days. As you check his ears and throat
for redness and inflammation, you notice him touch his fingers to the bridge of
his nose to press and rub there. He says he's taken Mucinex OTC the past two
nights to help him breathe while he sleeps. When you ask if the Mucinex has
helped at all, he sneers slightly and gestures that the improvement is only
minimal. Richard is alert and oriented. He has pale, boggy nasal mucosa with
clear thin secretions and enlarged nasal turbinates, which obstruct airway flow
but his lungs are clear. His tonsils are not enlarged but his throat is mildly
erythematous.
Case 2: Focused Throat Exam
Lily is a 20-year-old student at the local community
college. When some of her friends and classmates told her about an outbreak of flu-like
symptoms sweeping her campus over the past two weeks, Lily figured she
shouldn't take her three-day sore throat lightly. Your clinic has treated a few
cases similar to Lily's. All the patients reported decreased appetite,
headaches, and pain with swallowing. As Lily recounts these symptoms to you,
you notice that she has a runny nose and a slight hoarseness in her voice but
doesn't sound congested.
Case 3: Focused Ear Exam
Martha brings her 11-year old grandson, James, to your
clinic to have his right ear checked. He has complained to her about a mild
earache for the past two days. His grandmother believes that he feels warm but
did not verify this with a thermometer. James states that the pain was worse
while he was falling asleep and that it was harder for him to hear. When you
begin basic assessments, you notice that James has a prominent tan. When you
ask him how he's been spending his summer, James responds that he's been
spending a lot of time in the pool.
To prepare:
With regard to the case study you were assigned:
Review this week's Learning Resources and consider the
insights they provide.
Consider what history would be necessary to collect from the
patient.
Consider what physical exams and diagnostic tests would be
appropriate to gather more information about the patient's condition. How would
the results be used to make a diagnosis?
Identify at least 10 possible conditions that may be
considered in a differential diagnosis for the patient.
Note: Before you submit your initial post, replace the
subject line (“Week 5 Discussion”) with “Review of Case Study ___,” identifying
the number of the case study you were assigned.
By Day 3
Post an episodic/focused note about the patient in the case
study to which you were assigned using the episodic/focused note template
provided in week 5 resources. Provide evidence from the literature to support
diagnostic tests that would be appropriate for each case. List five different
possible conditions for the patient's differential diagnosis and justify why you
selected each.
Note: For this Discussion, you are required to complete your
initial post before you will be able to view and respond to your colleagues’
postings. Begin by clicking on the "Post to Discussion Question" link
and then select "Create Thread" to complete your initial post.
Remember, once you click on Submit, you cannot delete or edit your own posts,
and you cannot post anonymously. Please check your post carefully before
clicking on Submit!
Read a selection of your colleagues' responses.
By Day 6
Respond to at least two of your colleagues on two different
days who were assigned different case studies than you. Analyze the possible
conditions from your colleagues' differential diagnoses. Determine which of the
conditions you would reject and why. Identify the most likely condition and
justify your reasoning.
Week 7
discussion
Discussion: Assessing the Heart, Lungs, and Peripheral
Vascular System
Take a moment to observe your breathing. Notice the
sensation of your chest expanding as air flows into your lungs. Feel your chest
contract as you exhale. How might this experience be different for someone with
chronic lung disease or someone experiencing an asthma attack?
In order to adequately assess the chest region of a patient,
nurses need to be aware of a patient's history, potential abnormal findings,
and what physical exams and diagnostic tests should be conducted to determine
the causes and severity of abnormalities.
In this Discussion, you will consider how a patient's
initial symptoms can result in very different diagnoses when further assessment
is conducted.
Note: By Day 1 of this week, your Instructor will have
assigned you to one of the following specific case studies for this Discussion.
Also, your Discussion post should be in the Episodic/Focused SOAP Note format,
rather than the traditional narrative style Discussion posting format. Refer to
Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the
Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP
notes have specific data included in every patient case.
To prepare:
With regard to the case study you were assigned:
Review this week's Learning Resources and consider the
insights they provide.
Consider what history would be necessary to collect from the
patient.
Consider what physical exams and diagnostic tests would be
appropriate to gather more information about the patient's condition. How would
the results be used to make a diagnosis?
Identify at least five possible conditions that may be considered
in a differential diagnosis for the patient.
Note: Before you submit your initial post, replace the
subject line ("Discussion - Week 6") with "Review of Case
Study" identifying the number of the case study you were assigned.
By Day 3
Post an episodic/focused note about the patient in the case
study to which you were assigned using the episodic/focused note template
provided in week 5 resources. Provide evidence from the literature to support
diagnostic tests that would be appropriate for each case. List five different
possible conditions for the patient's differential diagnosis and justify why
you selected each.
Note: For this Discussion, you are required to complete your
initial post before you will be able to view and respond to your colleagues’
postings. Begin by clicking on the "Post to Discussion Question" link
and then select "Create Thread" to complete your initial post.
Remember, once you click on Submit, you cannot delete or edit your own posts,
and you cannot post anonymously. Please check your post carefully before
clicking on Submit!
Read a selection of your colleagues' responses.
By Day 6
Respond to at least two of your colleagues on two different
days who were assigned different case studies than you. Analyze the possible
conditions from your colleagues' differential diagnoses. Determine which of the
conditions you would reject and why. Identify the most likely condition, and
justify your reasoning.
Week 8
discussion
Discussion: Assessing Muscoskeletal Pain
The body is constantly sending signals about its health. One
of the most easily recognized signals is pain. Musculoskeletal conditions
comprise one of the leading causes of severe long-term pain in patients. The
musculoskeletal system is an elaborate system of interconnected levers that
provide the body with support and mobility. Because of the interconnectedness
of the musculoskeletal system, identifying the causes of pain can be
challenging. Accurately interpreting the cause of musculoskeletal pain requires
an assessment process informed by patient history and physical exams.
In this Discussion, you will consider case studies that
describe abnormal findings in patients seen in a clinical setting.
Note: By Day 1 of this week, your Instructor will have
assigned you to one of the following specific case studies for this Discussion.
Also, your Discussion post should be in the Episodic/Focused SOAP Note format,
rather than the traditional narrative style Discussion posting format. Refer to
Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the
Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP
notes have specific data included in every patient case.
Case 1: Back Pain
A 42-year-old male reports pain in his lower back for the
past month. The pain sometimes radiates to his left leg. In determining the
cause of the back pain, based on your knowledge of anatomy, what nerve roots
might be involved? How would you test for each of them? What other symptoms
need to be explored? What are your differential diagnoses for acute low back
pain? Consider the possible origins using the Agency for Healthcare Research
and Quality (AHRQ) guidelines as a framework. What physical examination will
you perform? What special maneuvers will you perform?
spine
Case 2: Ankle Pain
A 46-year-old female reports pain in both of her ankles, but
she is more concerned about her right ankle. She was playing soccer over the
weekend and heard a "pop." She is able to bear weight, but it is
uncomfortable. In determining the cause of the ankle pain, based on your
knowledge of anatomy, what foot structures are likely involved? What other
symptoms need to be explored? What are your differential diagnoses for ankle
pain? What physical examination will you perform? What special maneuvers will
you perform? Should you apply the Ottowa ankle rules to determine if you need
additional testing?
ankle
Case 3: Knee Pain
A 15-year-old male reports dull pain in both knees.
Sometimes one or both knees click, and the patient describes a catching
sensation under the patella. In determining the causes of the knee pain, what
additional history do you need? What categories can you use to differentiate
knee pain? What are your specific differential diagnoses for knee pain? What
physical examination will you perform? What anatomic structures are you
assessing as part of the physical examination? What special maneuvers will you
perform?
knee
To prepare:
With regard to the case study you were assigned:
Review this week's Learning Resources, and consider the
insights they provide about the case study.
Consider what history would be necessary to collect from the
patient in the case study you were assigned.
Consider what physical exams and diagnostic tests would be
appropriate to gather more information about the patient's condition. How would
the results be used to make a diagnosis?
Identify at least five possible conditions that may be
considered in a differential diagnosis for the patient.
Note: Before you submit your initial post, replace the
subject line ("Discussion - Week 8") with "Review of Case Study
___." Fill in the blank with the number of the case study you were
assigned.
By Day 3
Post an episodic/focused note about the patient in the case
study to which you were assigned using the episodic/focused note template
provided in week 5 resources. Provide evidence from the literature to support
diagnostic tests that would be appropriate for each case. List five different
possible conditions for the patient's differential diagnosis and justify why
you selected each.
Note: For this Discussion, you are required to complete your
initial post before you will be able to view and respond to your colleagues’
postings. Begin by clicking on the "Post to Discussion Question" link
and then select "Create Thread" to complete your initial post.
Remember, once you click on Submit, you cannot delete or edit your own posts,
and you cannot post anonymously. Please check your post carefully before
clicking on Submit!
Read a selection of your colleagues' responses.
By Day 6
Respond to at least two of your colleagues on 2 different
days who were assigned different case studies than you. Analyze the possible
conditions from your colleagues' differential diagnoses. Determine which of the
conditions you would reject and why. Identify the most likely condition, and
justify your reasoning.
Week 9
discussion
Discussion: Assessing Neurological Symptoms
Imagine not being able to form new memories. This is the
reality patients with anterograde amnesia face. Although this form of amnesia
is rare, it can result from severe brain trauma. Anterograde amnesia
demonstrates just how impactful brain disorders can be to a patient's quality
of living. Accurately assessing neurological symptoms is a complex process that
involves the analysis of many factors.
In this Discussion, you will consider case studies that
describe abnormal findings in patients seen in a clinical setting.
Note: By Day 1 of this week, your Instructor will have
assigned you to one of the following specific case studies for this Discussion.
Also, your Discussion post should be in the Episodic/Focused SOAP Note format,
rather than the traditional narrative style Discussion posting format. Refer to
Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the
Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP
notes have specific data included in every patient case.
Case 1: Headaches
A 20-year-old male complains of experiencing intermittent
headaches. The headaches diffuse all over the head, but the greatest intensity
and pressure occurs above the eyes and spreads through the nose, cheekbones,
and jaw.
Case 2: Numbness and Pain
A 47-year-old obese female complains of pain in her right
wrist, with tingling and numbness in the thumb and index and middle fingers for
the past 2 weeks. She has been frustrated because the pain causes her to drop
her hair-styling tools.
Case 3: Drooping of Face
A 33-year-old female comes to your clinic alarmed about
sudden "drooping" on the right side of the face that began this
morning. She complains of excessive tearing and drooling on her right side as
well.
To prepare:
With regard to the case study you were assigned:
Review this week's Learning Resources, and consider the
insights they provide about the case study.
Consider what history would be necessary to collect from the
patient in the case study you were assigned.
Consider what physical exams and diagnostic tests would be
appropriate to gather more information about the patient's condition. How would
the results be used to make a diagnosis?
Identify at least five possible conditions that may be
considered in a differential diagnosis for the patient.
Note: Before you submit your initial post, replace the
subject line ("Discussion - Week 9") with "Review of Case Study
___." Fill in the blank with the number of the case study you were
assigned.
By Day 3
Post an episodic/focused note about the patient in the case
study to which you were assigned using the episodic/focused note template
provided in week 5 resources. Provide evidence from the literature to support
diagnostic tests that would be appropriate for each case. List five different
possible conditions for the patient's differential diagnosis and justify why
you selected each.
Note: For this Discussion, you are required to complete your
initial post before you will be able to view and respond to your colleagues’
postings. Begin by clicking on the "Post to Discussion Question" link
and then select "Create Thread" to complete your initial post.
Remember, once you click on Submit, you cannot delete or edit your own posts,
and you cannot post anonymously. Please check your post carefully before
clicking on Submit!
Read a selection of your colleagues' responses.
By Day 6
Respond to at least two of your colleagues on two different
days who were assigned different case studies than you. Analyze the possible
conditions from your colleagues' differential diagnoses. Determine which of the
conditions you would reject and why. Identify the most likely condition, and
justify your reasoning.
