Course Number: NURS 520Course Title: Health Assessment for Advanced Practice NursingCourse Term and Year: Fall 2010<br />Course Section:NURS 520-00<br />Meeting Time and Place:Fridays: 8:30- 11:20 AM, Harrogate<br />Course Credit Hours:3 credit hours (2 credits lecture, 1 credit lab)<br />Faculty Contact Information: Course Coordinator: Jennifer Savage, RN, FNP-BC; firstname.lastname@example.orgHome: (865) 497-3834 Cell: (865) 603-1513 Kim Satterfield, RN, APN-BC; email@example.com Cell: (865) 765-2846Kim Ferguson, RN, APN-BC, DNP; firstname.lastname@example.orgCaylor School of Nursing, Suite# 312 (423) 869-6822<br />I.Course Description: <br />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.<br />Prerequisite: Admission to the MSN Program/ Also will have reviewed health assessment skills and will have competency in performing basic physical examination<br /> <br /> Course Objectives: <br />After successful completion of Nursing 520, the student will be able to: <br />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. <br />Perform a comprehensive and/or focused physical exam using advanced assessment skills.<br />Order, perform and interpret selected diagnostic tests and procedures such as laboratory tests, Microscopy, and others.<br />Distinguish between adaptive/maladaptive findings that require additional assessment and/or follow-up (such as further diagnostic studies, laboratory, radiology, or consultation). <br />Utilize diagnostic reasoning to develop problem list and differential diagnoses based on history, assessment findings and diagnostic lab/procedure results.<br />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.<br />Communicate findings from a comprehensive (or focused) history and physical exam through verbal report and/or written documentation.<br />Incorporate health promotion and health education strategies in the nurse/patient interaction and in the plan of care. <br />
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:<br />Dains, J., Baumann, L., & Scheibel, P. (2007). Advanced health assessment and <br />clinical diagnosis in primary care. St. Louis: Mosby Elsevier.<br />Rhoads, J. (2005). Advanced health assessment and diagnostic reasoning. Philadelphia: Lippincott, Williams & Wilkins.<br />Jarvis, C. (2008). Physical examination & assessment: Pocket companion. Philadelphia: Elsevier.<br />Online Physical Exam Teaching Assistant and Pediatric Teaching Assistant: <br />Available at library site: http://opeta.medinfo.ufl.edu/index.html <br />IV.Course Requirements, Assessment (Learning Outcomes) and Evaluation Methods: <br />Attendance requirements:<br />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.<br />Written Requirements:<br />Tests and examinations;<br />Midterm and final<br />Five (5) unscheduled quizzes<br />Ten (10) symptom history and physical examination write-ups<br />Simulated clinical situation history and physical, oral presentation<br />Complete history and physical<br />Campus lab/Clinical Requirements<br />Application of advanced assessment skills in the DCOM clinic, the nursing lab, and the simulation lab<br />Methods of Evaluation<br />1. Five (5) 10-point quizzes50 points<br />2. Ten (10) history and<br /> physical examination write-ups 100 points<br />3. Midterm 100 points<br />4. Final examination 100 points<br />5. Standardized patient 100 points<br />Total points 450 points<br />Preparation Before Class<br /> 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<br />History and Physical Exam: <br />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. <br />Chapter quizzes: <br />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.<br />System specific history and physical exam:<br />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.<br />Midterm and Final examinations:<br />A combination of multiple choice and short answer questions<br />Standardized patient:<br />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.<br />Simulated patient:<br />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.<br />Examination Policies:<br />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. <br />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. <br />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. <br />4. Hats may not be worn during exams.<br />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. <br />6.A student who has a question during the exam should raise his/her hand and stay seated. <br />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. <br />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. <br />F. Incomplete policy<br />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.<br />G. College of Nursing Grading Scale<br />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:<br />%Grade <br />93-100A<br />89-92B+<br />83-88B <br />79-82C+<br />73-78C<br /><73%D<br />H. Clinical Facilities<br />The DCOM clinic, simulation lab, and the nursing lab will be utilized.<br />V.Methods of Instruction: <br />Lecture, video and audio presentations will be utilized.<br />Information Literacy/Technological Resources: <br />Blackboard will be utilized to post announcements and individual course grades.<br />University Policies: <br />Students with Disabilities Policy: <br />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. <br />Discrimination, Scholastic Dishonesty, Cheating, and Plagiarism Policies can be found in the student handbook: <br />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.<br />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<br />Cheating: LMU prohibits dishonesty of any kind on examinations or written assignments. This includes unauthorized possession of examination questions, the use of 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.<br />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.<br />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.<br />Lincoln Memorial University Mission Statement:<br />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. <br />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.<br />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<br />Can be found at the following link to LMU’s website: http://www.lmunet.edu/about/mission.html.<br />Caylor School of Nursing Mission Statement:<br />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 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. <br />Course Outline/Assignments/Units of Instruction or Clinic Schedule: <br />Date/InstructorTopic ReadingsMedia/lab/practicumExperienceExams/Due DatesWeek 1 Aug. 20SavageCourse Overview; Interviewing and Health History strategiesPhysical examination strategies; Oral Presentations; DocumentationCultural CompetencyRhoads, Chapter 1, 2, 3, & 4Dains, Ch. 1Supplemental Reading on Oral Presentation: http://meded.ucsd.edu/clinicalmed/oral.htm Cultural competency pretestDCOM Clinic Orientation10-11:20Obtain Health History for Complete Physical Exam to be Recorded Next WeekDemonstration or video of full physical examWeek 2Aug. 27Video Physical Exams See Jarvis/ Syllabus for overview of complete physical exam guidelinesDCOM clinic 8:30-11:20 (Times will be assigned)Complete PE recorded Health history and Well Physical exam write up dueWeek 3Sept. 3SavageEye, Ear, Nose, Sinus, Mouth, ThroatRhoads Ch 6, 7, &, 8Dains Ch.2-7DCOM clinicWrite-up dueWeek 4Sept. 10FergusonRespiratoryRhoads Ch 9Dains Ch. 11,12,& 35Nursing Lab SIM LabWrite-up dueWeek 5Sept. 17 SavageCardiovascularRhoads Ch 10Dains Ch. 9&10Nursing LabSAM Model Write-up due Week 6Sept. 24 West KnoxvilleSavageDermatologyRhoads Ch 5Dains Ch. 8Classroom in West Knox PracticeVirtual Derm ClinicWrite-up dueWeek 7Oct. 1FergusonGastrointestinalEndocrineRhoads Ch. 11 & 14DainsCh.13-16DCOM ClinicStandardized Patient9:30-12:30Write-up dueWeek 8Oct. 8SatterfieldMusculoskeletalRhoads Ch. 15Dains Ch. 26 & 27DCOM clinicWrite Up DueWeek 9Oct. 15MIDTERMWeek 10Oct. 22SatterfieldNeurological Mental HealthRhoads Ch. 4 & 16Dains Ch. 28-32DCOM ClinicWrite-up dueWeek 11Oct. 29West KnoxvilleSatterfieldMale/ Female GU and Breast ExamRhoads Ch. 12 & 13Dains Ch. 17-25Practice with Mannequins (Prostate, Breast, And Female Genitalia)Write-up due Week 12Fri, Nov. 5 Male Patient ModelSee Week 11 DCOM ClinicWrite-up dueSat., Nov. 6Peds DayReadings to be announcedDCOM ClinicWrite-up dueWeek 13Nov. 12Female Patient ModelSee Week 11DCOM ClinicWrite-up dueWeek 14Nov. 19Standardizedpatients DCOM ClinicPt. Scenario, SOAP note, & Oral PresentationWeek 15Nov. 26Thanksgiving BreakNo ClassWeek 16Dec. 3West KnoxvilleFergusonDiagnostic studiesReadings to be announcedWeek 17Dec. 10Final Exam<br />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.<br />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.<br />Evaluation Tools:<br />Complete H & P Guidelines / Evaluation tool<br />History guideline for a complete H&P with no focused problem or chief complaint<br />1) Biographical Data <br />a) Demographic data (age, sex, ethnicity, plus anything else pertinent)<br />b) Reliability<br />Reason for visit (brief, in client’s own words—in quotes)<br />2) Present Health Status <br />a) Health perception<br />b) Health maintenance activities<br />c) Health habits (exercise, diet, sleep routine)<br />Stressors & coping strategies<br />3) Past Health History <br />a) Allergies (food, environment, drugs)<br />b) Childhood illnesses—Sequelae?<br />c) Immunizations<br />d) Chronic illnesses<br />Hospitalizations/Surgeries—any updates?<br />Accidents/trauma<br />Last physical examination—result?<br />OB history if pertinent<br />Routine Medications: all meds, including herbal and OTC---dose, frequency, date started, and compliance/noncompliance with medication regime<br />4) Family History <br />a) Complete H&P's require a genogram in addition to a summary statement <br />5) Psychosocial History<br />a) Family/support systems<br />b) Living situation/environment<br />c) Occupation<br />d) Sexual activity<br />e) Finances<br />6) Review of Systems<br />a) Review all systems in a complete health history<br />Physical Examination Guidelines: The Minimum Data Set<br />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. <br />System / Category Points possiblePoints earnedComments Specific ManeuverSurvey/General AppearanceWeight .25Height .25Vital Signs .25Blood Pressure .25Skin, Hair and Nails Inspect and palpate hair.5Inspect and palpate skin1.0Inspect and palpate nails .5EyesInspect external / internal structures1Test visual acuity 1Inspect function EOMs1Constriction &consensual response1Fundoscopic exam3EarsInspect External Ear1Otoscopic Examination1Answers questions to normal voice1Nose, mouth and ThroatInspect nose and nasal cavity1Palpate sinuses and check patency1Inspect mouth and oropharynx1NeckInspect and palpate for range of motion1Inspect and palpate for lymph node1Inspect and palpate trachea / thyroid 1Thorax Percuss posterior and anterior chest1Check for CVA tenderness1Auscultate posterior and anterior chest 1Breasts & Regional LymphaticsInspect breasts (3 positions)1Palpate axillae1Palpate breast (express nipples)1Provide life stage appropriate health teaching including demonstration & review of BSE 1Heart & Neck vesselsInspect neck & precordium with tangential light 1Palpate & auscultate carotid arteries1Palpate precordium for PMI1Auscultate for rate, rhythm identification of S1 and S2, extra heart sounds, murmurs.2Palpate all other pulses1AbdomenAuscultate 4 quadrants 1Percuss abdomen/liver 1Light, medium, and deep palpation of abdomen 2Palpate femoral arteries1Palpate lymph nodes1Palpate for hernias (raise head & cough)1Musculoskeletal System Observe for symmetry1Inspect and palpate joints & tissue of upper and lower extremities1Range and motion of trunk 1Neurological System Assessment of sensory systemLight touch/point location/vibration1Pain – sharp, dull1Deep tendon reflexes (Biceps, triceps, brachioradialis, patellar, achilles)2 Assessment of the Motor SystemInspect and palpate muscles for size and tone1Assess strength1 Assessment of cerebellar function:Romberg with pronator drift test1Gait (regular & heel-toe walking )1Mental Status exam See minimental N/AGenitalia – FemaleInspect and palpateN/APap smearN/AGenitalia – MaleInspect and palpateN/ADigital exam of prostateN/ARectumInspect and palpateN/ADigital examN/ATest stool for occult bloodN/A<br />Total = ____/50 points for objective exam Pass/Fail (< 42 = FAIL)<br />Important Dates in the Academic Calendar Fall 2010<br />Classes beginAugust 17Last day to complete registration/add classes without late feeAugust 25Labor Day (no classes, residence halls remain open)September 6DCOM White Coat CeremonySeptember 25Last day to drop course without "WD"October 6Homecoming (classes held as scheduled)October 14-16Mid-termOctober 11-15Fall BreakOctober 18-19Last day to drop course without "F"October 22Early registration beginsOctober 25Thanksgiving holiday (no classes)November 25-26Classes endDecember 3Final examsDecember 6-10Commencement (11 a.m.)December 11<br />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. <br />