Revised as of _8/1/2010__. Page 1 of 12
Course Number: NURS 520
Course Title: Health Assessment for Advanced
Practice Nurs...
2
based on history, assessment findings and diagnostic lab/procedure results.
6. Recognize patterns of behavior, signs and...
3
3. Midterm 100 points
4. Final examination 100 points
5. Standardized patient 100 points
Total points 450 points
E. Prep...
4
Examination Policies:
1. Students are expected to take exams as scheduled. If they cannot be present for
the exam due to...
5
<73% D
H. Clinical Facilities
The DCOM clinic, simulation lab, and the nursing lab will be utilized.
V. Methods of Instr...
6
unauthorized notes during an examination, obtaining information during an examination
from another student, assisting ot...
7
quality nurses, at multiple levels of nursing education, through superior academic
programs at the undergraduate and gra...
8
Week 9
Oct. 15
MIDTERM
Week 10
Oct. 22
Satterfield
Neurological
Mental Health
Rhoads Ch. 4 & 16
Dains Ch. 28-32
DCOM Cli...
9
Evaluation Tools:
Complete H & P Guidelines / Evaluation tool
History guideline for a complete H&P with no focused probl...
10
Physical Examination Guidelines: The Minimum Data Set
You will use this abbreviated, minimum data set guide for the Com...
11
 Inspect breasts (3 positions) 1
 Palpate axillae 1
 Palpate breast (express nipples) 1
 Provide life stage appropr...
12
Rectum
 Inspect and palpate N/A
 Digital exam N/A
 Test stool for occult blood N/A
Total = ____/50 points for object...
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Fall 10 Syllabus - LMU

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Fall 10 Syllabus - LMU

  1. 1. Revised as of _8/1/2010__. Page 1 of 12 Course Number: NURS 520 Course Title: Health Assessment for Advanced Practice Nursing Course Term and Year: Fall 2010 Course Section: NURS 520-00 Meeting Time and Place: Fridays: 8:30- 11:20 AM, Harrogate Course Credit Hours: 3 credit hours (2 credits lecture, 1 credit lab) FACULTY CONTACT INFORMATION: COURSE COORDINATOR: Jennifer Savage, RN, FNP-BC; jennifer.savage@lmunet.edu Home: (865) 497-3834 Cell: (865) 603-1513 Kim Satterfield, RN, APN-BC; kimberly.satterfield@lmunet.edu Cell: (865) 765-2846 Kim Ferguson, RN, APN-BC, DNP; kimberly.ferguson@lmunet.edu Caylor School of Nursing, Suite# 312 (423) 869-6822 I. Course Description: This course focuses on the development of advanced health assessment skills needed for the provision of primary care and nurse anesthesia to clients across the lifespan with consideration of cultural and rural health needs. Diagnostic reasoning is used to interpret data obtained from the history, physical examination, and diagnostic procedures to generate a comprehensive health assessment and problem list. Additional domains of interest include: family processes, transcultural issues, nutrition, genetic variations, growth and development, spirituality, and health promotion. Prerequisite: Admission to the MSN Program/ Also will have reviewed health assessment skills and will have competency in performing basic physical examination II. Course Objectives: After successful completion of Nursing 520, the student will be able to: 1. Perform comprehensive and/or focused advanced health histories sensitive to individuals’ adaptative needs in the following four modes: physiologic, self concept, role function, and interdependence. 2. Perform a comprehensive and/or focused physical exam using advanced assessment skills. 3. Order, perform and interpret selected diagnostic tests and procedures such as laboratory tests, Microscopy, and others. 4. Distinguish between adaptive/maladaptive findings that require additional assessment and/or follow-up (such as further diagnostic studies, laboratory, radiology, or consultation). 5. Utilize diagnostic reasoning to develop problem list and differential diagnoses
  2. 2. 2 based on history, assessment findings and diagnostic lab/procedure results. 6. Recognize patterns of behavior, signs and/or symptoms, which may be associated with ethnic, genetic or cultural variations across the lifespan from neonatal to geriatrics. 7. Communicate findings from a comprehensive (or focused) history and physical exam through verbal report and/or written documentation. 8. Incorporate health promotion and health education strategies in the nurse/patient interaction and in the plan of care. 9. Analyze the impact of economic constraints on the ability of the patient to obtain needed diagnostics or follow-up. III. Texts/Materials for the Course: Dains, J., Baumann, L., & Scheibel, P. (2007). Advanced health assessment and clinical diagnosis in primary care. St. Louis: Mosby Elsevier. Rhoads, J. (2005). Advanced health assessment and diagnostic reasoning. Philadelphia: Lippincott, Williams & Wilkins. Jarvis, C. (2008). Physical examination & assessment: Pocket companion. Philadelphia: Elsevier. Online Physical Exam Teaching Assistant and Pediatric Teaching Assistant: Available at library site: http://opeta.medinfo.ufl.edu/index.html IV. Course Requirements, Assessment (Learning Outcomes) and Evaluation Methods: A. Attendance requirements: Attendance is mandatory. Any lecture/lab/clinical absence will result in a 2% reduction of the final course grade for each recorded absence. Students must be present for the entire class in order not to be recorded as absent. B. Written Requirements: Tests and examinations; 1. Midterm and final 2. Five (5) unscheduled quizzes 3. Ten (10) symptom history and physical examination write-ups 4. Simulated clinical situation history and physical, oral presentation 5. Complete history and physical C. Campus lab/Clinical Requirements Application of advanced assessment skills in the DCOM clinic, the nursing lab, and the simulation lab D. Methods of Evaluation 1. Five (5) 10-point quizzes 50 points 2. Ten (10) history and physical examination write-ups 100 points
  3. 3. 3 3. Midterm 100 points 4. Final examination 100 points 5. Standardized patient 100 points Total points 450 points E. Preparation Before Class Students will be expected to review the appropriate Bates’ physical examination video and Online Physical Exam Teaching Assistant available online thru the library before attending each class. This will provide a review of basic physical assessment before studying advanced techniques History and Physical Exam: Each student will perform a complete history and physical and submit the write-up. The purpose of this assignment is to document basic history and physical examination techniques before studying and applying advanced physical assessment techniques. The performance of the physical exam will be video recorded allowing the faculty to review the physical assessment. The student will be expected to articulate what physical exam technique they are performing while they perform the exam. A write-up of this history and physical will be submitted the date of the examination. This exercise is to affirm each student’s competency in basic assessment skills. 15 minutes will be allotted for the completion of the physical examination. The videos will be available for review by the faculty. Chapter quizzes: Five unannounced quizzes will be given at the beginning of class. The material covered in the quiz will be from the required readings covering the body system to be covered during this class period. System specific history and physical exam: Students will be divided into groups and will be given system specific chief complaints for application of advanced assessment techniques. The symptom specific history and physical will be performed and a written submission of the examination will be submitted the day of the exam. Each student will also practice timed written submissions of SOAP notes as well as performance of oral presentations throughout the semester. Midterm and Final examinations: A combination of multiple choice and short answer questions Standardized patient: Each student will perform a history and physical on a standardized patient scenario. The student will also provide an oral presentation of the case to faculty on the day of the exercise as well as a timed written note of the encounter. This will be video recorded. Simulated patient: Students will participate in a simulated patient case scenario as part of a team. This exercise is provided to give direct faculty feedback to the student and for integration of learning in Advanced Assessment.
  4. 4. 4 Examination Policies: 1. Students are expected to take exams as scheduled. If they cannot be present for the exam due to illness or other unavoidable and unforeseen circumstances, students must contact faculty by phone prior to the scheduled exam time. If the faculty person is unavailable by phone, the student should contact the nursing office by calling 1-800-325-0900 and asking to speak to the nursing secretary. Failure to notify appropriate faculty will result in a grade of zero for the examination. 2. Faculty will schedule a make-up exam. If a student does not make up the exam on the scheduled date and time, the student will receive a grade of zero on the exam. 3. Electronic devices and personal belongings must be put away during exams. The use of simple calculators with no other functions may be allowed. Faculty will require that multi-function devices be put away during exams. 4. Hats may not be worn during exams. 5. Editorial corrections will be announced before the exam begins. If any corrections or needed clarifications are found after the exam has started, the faculty will interrupt, announce the correction, and write it on the board. 6. A student who has a question during the exam should raise his/her hand and stay seated. 7. Exams are timed. The time for the exam to end and the time for the class to resume will be written on the board. A student who is late must turn in his/her exam at the scheduled time. 8. When finished, the student may leave the room and return at the time class is scheduled to resume. Students may not re-enter the room during the exam time. F. Incomplete policy Students are expected to complete all requirements as assigned during the semester. Incompletes are only given in extreme circumstances as deemed by the faculty. If the request for an “I” is approved, the work must be completed within the first six weeks of the following semester; otherwise the grade automatically becomes “F”. The grade of “I” is calculated in the grade point average with zero points. G. College of Nursing Grading Scale The LMU grading system is based on a four-point scale. A grade of “B” or above is required in order to be successful in this course and to receive graduate credit at LMU. There is no rounding of grades in the MSN program. The grading scale is as follows: % Grade 93-100 A 89-92 B+ 83-88 B 79-82 C+ 73-78 C
  5. 5. 5 <73% D H. Clinical Facilities The DCOM clinic, simulation lab, and the nursing lab will be utilized. V. Methods of Instruction: Lecture, video and audio presentations will be utilized. Information Literacy/Technological Resources: Blackboard will be utilized to post announcements and individual course grades. VI. University Policies: Students with Disabilities Policy: Any student with a disability should bring documentation for the disability to the ADA Compliance Officer in the Office of Student Services [which is presently located on the third floor of the Student Center]. When the documentation has been reviewed, a form will be completed stating the reasonable accommodations to be granted to the student with a disability. All students with disabilities (learning or physical) should contact the Office of the Vice President for Student Services and Enrollment Management at (423) 869-6393. Discrimination, Scholastic Dishonesty, Cheating, and Plagiarism Policies can be found in the student handbook: Lincoln Memorial University is committed to maintaining study and work environments that are free from discriminatory harassment based on sex, race, color, national origin, religion, pregnancy, age, military status, disability or any other protected discriminatory factor. Sexual or other discriminatory harassment of its students is strictly prohibited, whether by non-employees, (such as contractor or vendors), other students, or by its employees, and LMU will take immediate and appropriate action to prevent and to correct behavior that violates this policy. Likewise, students are strictly prohibited from engaging in harassing behavior directed at LMU’s employees, its visitors, vendors and contractors. All students must comply with this policy and take appropriate measures to create an atmosphere free of harassment and discrimination. Appropriate disciplinary action, up to and including, as appropriate, suspension, expulsion and termination from employment or being banned from LMU properties, will be taken against individuals who violate this policy. http://www.lmunet.edu/campuslife/sthandbook/handbook.pdf. Scholastic Dishonesty: It is the aim of the faculty of LMU to foster a spirit of complete honesty and a high standard of integrity. The attempt of any student to present work as his/her own that he/she has not honestly performed is regarded by the faculty ad the administration as a very serious offense and renders the offender liable to several consequences and possible suspension Cheating: LMU prohibits dishonesty of any kind on examinations or written assignments. This includes unauthorized possession of examination questions, the use of
  6. 6. 6 unauthorized notes during an examination, obtaining information during an examination from another student, assisting others to cheat, altering grade records, or entering any campus office without permission. Violations will subject the student to disciplinary action. Plagiarism: LMU prohibits offering the work of another as one’s own without proper acknowledgement. Any student who fails to give credit for quotations or essentially identical material taken from books, magazines, encyclopedias, web sources or other reference works, or from themes, reports, or other writing of a fellow student has committed plagiarism. LMU’s Inclement Weather Policy: Local radio and television stations will be contacted and every effort made to have morning or daytime cancellations posted/announced by 6:00 A.M., along with a recorded announcement on the LMU main campus telephone number (423) 869-3611. You may also check the university’s website for class cancellation notices: they will be posted at the following link to LMU’s website: http://www.lmunet.edu/curstudents/weather.html. VII. LINCOLN MEMORIAL UNIVERSITY MISSION STATEMENT: Lincoln Memorial University is a values-based learning community dedicated to providing educational experiences in the liberal arts and professional studies. The University strives to give students a foundation for a more productive life by upholding the principles of Abraham Lincoln’s life: a dedication to individual liberty, responsibility, and improvement; a respect for citizenship; recognition of the intrinsic value of high moral and ethical standards; and a belief in a personal God. The University is committed to teaching, research, and service. The University’s curriculum and commitment to quality instruction at every level are based on the beliefs that graduates must be able to communicate clearly and effectively in an era of rapidly and continuously expanding communication technology, must have an appreciable depth of learning in a field of knowledge, must appreciate and understand the various ways by which we come to know ourselves and the world around us, and must be able to exercise informed judgments. The University believes that one of the major cornerstones of meaningful existence is service to humanity. By making educational and research opportunities available to students where they live and through various recreational and cultural events open to the community, Lincoln Memorial University seeks to advance life in the Cumberland Gap area and throughout the region through its teaching, research, and service mission. Reaffirmed by the Board of Trustees May5, 2006 Can be found at the following link to LMU’s website: http://www.lmunet.edu/about/mission.html. Caylor School of Nursing Mission Statement: In conjunction with the University’s mission, the Faculty of the Caylor School of Nursing strives to instill responsibility and high moral/ethical standards in the preparation of
  7. 7. 7 quality nurses, at multiple levels of nursing education, through superior academic programs at the undergraduate and graduate level. Specifically, the mission of the Faculty is to prepare nurses with the ASN degree, the RN to BSN degree, and the MSN degree, to assist individuals, families, communities, and society as they adapt to changes in physiological needs, role function, self-concept, and interdependent relationships during health and illness. The Caylor School of Nursing seeks to respond to the needs of nursing education and healthcare in the surrounding communities by preparing nurses at multiple levels and by providing continuing education/professional development opportunities that are rooted in knowledge, research, and other scholarly activities. VIII. Course Outline/Assignments/Units of Instruction or Clinic Schedule: Date/ Instructor Topic Readings Media/lab/practicum Experience Exams/ Due Dates Week 1 Aug. 20 Savage Course Overview; Interviewing and Health History strategies Physical examination strategies; Oral Presentations; Documentation Cultural Competency Rhoads, Chapter 1, 2, 3, & 4 Dains, Ch. 1 Supplemental Reading on Oral Presentation: http://meded.ucsd.edu/clinicalmed /oral.htm Cultural competency pretest DCOM Clinic Orientation 10-11:20 Obtain Health History for Complete Physical Exam to be Recorded Next Week Demonstration or video of full physical exam Week 2 Aug. 27 Video Physical Exams See Jarvis/ Syllabus for overview of complete physicalexam guidelines DCOM clinic 8:30-11:20 (Times will be assigned) Complete PE recorded Health history and Well Physical exam write up due Week 3 Sept. 3 Savage Eye, Ear, Nose, Sinus, Mouth, Throat Rhoads Ch 6, 7, &, 8 Dains Ch.2-7 DCOM clinic Write-up due Week 4 Sept. 10 Ferguson Respiratory Rhoads Ch 9 Dains Ch. 11,12,& 35 Nursing Lab SIM Lab Write-up due Week 5 Sept. 17 Savage Cardiovascular Rhoads Ch 10 Dains Ch. 9&10 Nursing Lab SAM Model Write-up due Week 6 Sept. 24 West Knoxville Savage Dermatology Rhoads Ch 5 Dains Ch. 8 Classroom in West Knox Practice Virtual Derm Clinic Write-up due Week 7 Oct. 1 Ferguson Gastrointestinal Endocrine Rhoads Ch. 11 & 14 Dains Ch.13-16 DCOM Clinic Standardized Patient 9:30-12:30 Write-up due Week 8 Oct. 8 Satterfield Musculoskeletal Rhoads Ch. 15 Dains Ch. 26 & 27 DCOM clinic Write Up Due
  8. 8. 8 Week 9 Oct. 15 MIDTERM Week 10 Oct. 22 Satterfield Neurological Mental Health Rhoads Ch. 4 & 16 Dains Ch. 28-32 DCOM Clinic Write-up due Week 11 Oct. 29 West Knoxville Satterfield Male/ Female GU and Breast Exam Rhoads Ch. 12 & 13 Dains Ch. 17-25 Practice with Mannequins (Prostate, Breast, And Female Genitalia) Write-up due Week 12 Fri, Nov. 5 Male Patient Model See Week 11 DCOM Clinic Write-up due Sat., Nov. 6 Peds Day Readings to be announced DCOM Clinic Write-up due Week 13 Nov. 12 Female Patient Model See Week 11 DCOM Clinic Write-up due Week 14 Nov. 19 Standardized patients DCOM Clinic Pt. Scenario, SOAP note,& Oral Presentation Week 15 Nov. 26 Thanksgiving Break No Class Week 16 Dec. 3 West Knoxville Ferguson Diagnostic studies Readings to be announced Week 17 Dec. 10 Final Exam IX. Laptops: It is advisable that students bring a laptop to class. PowerPoint notes will be available on Blackboard before class so that students may take notes during class and follow the lecture. Student File: A file will be available at the end of clinic sessions for students to submit their written work. The student is responsible to be certain that each assignment is placed in the appropriate file.
  9. 9. 9 Evaluation Tools: Complete H & P Guidelines / Evaluation tool History guideline for a complete H&P with no focused problem or chief complaint 1) Biographical Data a) Demographic data (age, sex, ethnicity, plus anything else pertinent) b) Reliability a) Reason for visit (brief, in client’s own words—in quotes) 2) Present Health Status a) Health perception b) Health maintenance activities c) Health habits (exercise, diet, sleep routine) b) Stressors & coping strategies 3) Past Health History a) Allergies (food, environment, drugs) b) Childhood illnesses—Sequelae? c) Immunizations d) Chronic illnesses c) Hospitalizations/Surgeries—any updates? d) Accidents/trauma e) Last physical examination—result? f) OB history if pertinent g) Routine Medications: all meds, including herbal and OTC---dose, frequency, date started, and compliance/noncompliance with medication regime 4) Family History a) Complete H&P's require a genogram in addition to a summary statement 5) Psychosocial History a) Family/support systems b) Living situation/environment c) Occupation d) Sexual activity e) Finances 6) Review of Systems a) Review all systems in a complete health history
  10. 10. 10 Physical Examination Guidelines: The Minimum Data Set You will use this abbreviated, minimum data set guide for the Complete Health Assessment Competency (2nd week of Class) and for any complete examinations that you perform if other guidelines are not provided. The N/A in the “points” column only applies to the 2nd week assessment evaluation. Please note: this is a minimum data set. An advanced practice nurse must expand upon the history and related physical exam whenever there is a patient symptom/complaint or a positive finding. Your textbook guidelines for focused exams will be helpful in such cases. System / Category Points possible Points earned Comments Specific Maneuver Survey/General Appearance  Weight .25  Height .25  Vital Signs .25  Blood Pressure .25 Skin, Hair and Nails  Inspect and palpate hair .5  Inspect and palpate skin 1.0  Inspect and palpate nails .5 Eyes  Inspect external / internal structures 1  Test visual acuity 1  Inspect function EOMs 1  Constriction &consensualresponse 1  Fundoscopic exam 3 Ears  Inspect External Ear 1  Otoscopic Examination 1  Answers questions to normal voice 1 Nose, mouth and Throat  Inspect nose and nasal cavity 1  Palpate sinuses and check patency 1  Inspect mouth and oropharynx 1 Neck  Inspect and palpate for range of motion 1  Inspect and palpate for lymph node 1  Inspect and palpate trachea / thyroid 1 Thorax  Percuss posterior and anterior chest 1  Check for CVA tenderness 1  Auscultate posteriorand anterior chest 1 Breasts & Regional Lymphatics
  11. 11. 11  Inspect breasts (3 positions) 1  Palpate axillae 1  Palpate breast (express nipples) 1  Provide life stage appropriate health teaching including demonstration & review of BSE 1 Heart & Neck vessels  Inspect neck & precordium with tangential light 1  Palpate & auscultate carotid arteries 1  Palpate precordium for PMI 1  Auscultate for rate, rhythm identification of S1 and S2, extra heart sounds,murmurs. 2  Palpate all other pulses 1 Abdomen  Auscultate 4 quadrants 1  Percuss abdomen/liver 1  Light, medium, and deep palpation of abdomen 2  Palpate femoral arteries 1  Palpate lymph nodes 1  Palpate for hernias (raise head & cough) 1 Musculoskeletal System  Observe for symmetry 1  Inspect and palpate joints & tissue of upper and lower extremities 1  Range and motion of trunk 1 Neurological System Assessment of sensory system  Light touch/point location/vibration 1  Pain – sharp, dull 1  Deep tendon reflexes (Biceps, triceps, brachioradialis, patellar, achilles) 2 Assessment of the Motor System  Inspect and palpate muscles for size and tone 1  Assess strength 1 Assessment of cerebellar function:  Romberg with pronator drift test 1  Gait (regular & heel-toe walking ) 1 Mental Status exam See minimental N/A Genitalia – Female  Inspect and palpate N/A  Pap smear N/A Genitalia – Male  Inspect and palpate N/A  Digital exam of prostate N/A
  12. 12. 12 Rectum  Inspect and palpate N/A  Digital exam N/A  Test stool for occult blood N/A Total = ____/50 points for objective exam Pass/Fail (< 42 = FAIL) X. Important Dates in the Academic Calendar Fall 2010 Classes begin August 17 Last day to complete registration/add classes without late fee August 25 Labor Day (no classes, residence halls remain open) September 6 DCOM White Coat Ceremony September 25 Last day to drop course without "WD" October 6 Homecoming (classes held as scheduled) October 14-16 Mid-term October 11-15 Fall Break October 18-19 Last day to drop course without "F" October 22 Early registration begins October 25 Thanksgiving holiday (no classes) November 25- 26 Classes end December 3 Final exams December 6- 10 Commencement (11 a.m.) December 11 XI. THE INSTRUCTOR RESERVES THE RIGHT TO REVISE, ALTER AND/OR AMEND THIS SYLLABUS, AS NECESSARY. STUDENTS WILL BE NOTIFIED IN WRITING AND/OR BY EMAIL OF ANY SUCH REVISIONS, ALTERATIONS AND/OR AMENDMENTS.

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