This document discusses an advanced health assessment course that focuses on building health histories, assessing risks, and using diagnostic tools and tests. It provides several case studies of patients from diverse backgrounds and asks students to consider how they would tailor their communication and questions to take into account each patient's demographic factors and effectively evaluate their health risks. Students are asked to select a case study patient and propose targeted questions and the most appropriate risk assessment tools to evaluate that patient.

1. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning
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ReasoningWeek 1 discussionBuilding a Health HistoryEffective 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.ORDER COMPREHENSIVE SOLUTION PAPERS
ON NURS 6512 – Advanced Health Assessment and Diagnostic ReasoningFor 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 settingAdolescent Hispanic/Latino boy living in a middle-class suburb55-year-
old Asian female living in a high-density poverty housing complexPre-school aged white
female living in a rural community16-year-old white pregnant teenager living in an inner-
city neighborhoodTo 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 3Post 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.Read a selection of your
colleagues’ responses.By Day 6Respond to at least two of your colleagues on two different

2. 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 – NURS 6512 – Advanced Health Assessment and Diagnostic
Reasoning DQ1Assessment Tools and Diagnostic TestsWhen 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.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.To prepare:Review this week’s Learning Resources, and consider
the factors that impact the validity and reliability of various assessment tools and diagnostic
tests.Select one of the following assessment tools or diagnostic tests to explore for the
purposes of this Discussion:MammogramPhysical tests for sore throat (inspecting the
throat, palpating the head and neck lymph nodes, listening to breath sounds)Prostate-
specific antigen (PSA) testDix-Hallpike testBody-mass index (BMI) using waist
circumference for adultsSearch 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?Examine the literature and resources you located for
information about the validity and reliability of the test or tool you selected. What issues
with sensitivity, specificity, and predictive values are related to the test or tool?Are there
any controversies or issues related to any of these tests or tools?Consider any ethical
dilemmas that could arise by using these tests or tools.By Day 3Post 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.Read a selection of your colleagues’ responses.By Day 6Respond to at least one
of your colleagues who selected a different tool or test 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.DQ2Diversity and Health AssessmentsIn 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

3. 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 1Subjective DataCC: “I came for my
annual physical exam, but do not want to be a burden to my daughter.”History of Present
Illness (HPI): At-risk 86-year-old Asian male – who is physically and financially dependent
on his daughter, a single mother who has little time or money for her father’s health
needs.PMH: hypertension (HTN), gastroesophageal reflux disease (GERD), b12 deficiency
and chronic prostatitisPSH: S/P cholecystectomyDrug Hx:Current Meds: Lisinopril 10mg
daily, Prilosec 20mg daily, B12 injections monthly, and cipro 100mg daily.Review of
Systems (ROS)General: + weight loss of 25 lbs over the past year; no recent fatigue, fever or
chills.Head, eyes, ears, nose & throat (HEENT): no changes in vision or hearing, no difficulty
chewing or swallowing.Neck: no pain or injuryRespiratory:CV:GI:GU: no urinary hesitancy
or change in urine streamIntegument: multiple bruises on his upper arms and
back.MS/Neuro: + falls x 2 within the last 6 months; no syncopal episodes or
dizzinessPsych:Objective DataPE: B/P 188/96; Pulse 89; RR 16; Temp 99.0; Ht 5,6; wt 110;
BMI 17.8HEENT: Atraumatic, normocephalic, PERRLA, EOMI, arcus senilus bilaterally,
conjunctiva and sclera clear, nares patent, ornasopharynx clear, edentulous.Lungs: CTA
AP&LCor: S1S2 without rub or gallopAbd: benign, normoactive bowel sounds x 4Ext: no
cyanosis, clubbing or edemaIntegument: multiple bruises in different stages of healing – on
his upper arms and back.Neuro: No obvious deformities, CN grossly intact II-XIICase
2Subjective DataCC: “I am here for my annual physical exam and have been having vaginal
discharge.”History of Present Illness (HPI): 32-year-old pregnant lesbian – 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.Drug Hx:Current Medications:
prenatal vitamins and takes Tylenol over the counter for aches and pains on occasionFamily
Hx: She a strong family history of diabetes. Gravida 1; Para 0; Abortions 0.Review of
Systems (ROS)General: no fatigue, fever or chills.Head, eyes, ears, nose & throat
(HEENT):Neck: no pain or injuryRespiratory:CV:GI:GU:Integument: multiple piercings, and
tattoos. Old scars related to “cutting”.Neuro: no syncopal episodes or dizziness, no change in
memory or thinking patterns; no twitches or abnormal movementsObjective DataPE: B/P
128/76; Pulse 83; RR 16; Temp 99.0; Ht 5,6; wt 128; BMI 20.98HEENT: Atraumatic,
normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, ornasopharynx
clear, good dentition. Piercing in her right nostril and lower lip.Lungs: CTA AP&LCor: S1S2
without rub or gallopAbd: benign, normoactive bowel sounds x 4GU: external genitalia
intact, no lesions or masses. White copious discharge with an amine odor; no cervical
motion tenderness; adenxa intact.Ext: no cyanosis, clubbing or edemaIntegument: intact
without lesions masses or rashes.Neuro: No obvious deficits and CN grossly intact II-XIICase
3Subjective DataCC: “Annual physical exam”History of Present Illness (HPI): 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.Drug
Hx:Current medication – deniedAllergies: no allergies to food or medications.Family

4. history: is very positive for diabetes, hypertension, and alcoholism.Review of Systems
(ROS)General: no recent weight gains of losses, fatigue, fever or chills.Head, eyes, ears, nose
& throat (HEENT):Neck:Respiratory:CV: no chest discomfort or
palpitationsGI:GU:Integument: history of eczema – not activeMS/Neuro: no syncopal
episodes or dizziness, no change in memory or thinking patterns; no twitches or abnormal
movementsPsych:Objective DataPE: B/P 158/90; Pulse 88; RR 18; Temp 99.2; Ht 5,7; wt
208; BMI 32.6General: 23 year old male appears well developed and well nourished. He is
anxious – pacing in the room and fidgeting, but in no acute distress.HEENT: Atraumatic,
normocephalic, PERRLA, EOMI, sclera with mild icterus, nares patent, ornasopharynx clear,
poor dentition – multiple carries.Lungs: CTA AP&LCor: S1S2, +II/VI holosystolic murmur;
without rub or gallopAbd: benign, normoactive bowel sounds x 4; Hepatomegaly 2cm below
the costal margin.Ext: no cyanosis, clubbing or edemaIntegument: intact without lesions
masses or rashes.Neuro: No obvious deficits and CN grossly intact II-XIITo 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 3Post 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.Read a selection of your colleagues’ responses.By Day
6Respond on or before Day 6 to at leastone 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 – NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Health
Assessment of Children’s WeightBody 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.For this Discussion, you will 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:Consider the following examples of pediatric patients and their
families:Overweight 5-year-old boy with overweight parentsSlightly overweight 10-year-

5. old girl with parents of normal weight5-year-old girl of normal weight with obese
parentsSlightly underweight 8-year-old boy with parents of normal weightSeverely
underweight 12-year-old girl with underweight parentsSelect one of the examples on which
to focus for this Discussion. What health issues and risks may be relevant to the child you
selected?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 3Post 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.Read a selection of your colleagues’
responses.By Day 6Respond to at least two of your colleagues on 2 different days who
selected a different example than you, using one or more of the following
approaches: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 4
discussion NURS 6512 – Advanced Health Assessment and Diagnostic
Reasoning Differential Diagnosis for Skin ConditionsProperly 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 Discussion, 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.Note: Your Discussion post should be in
the SOAP (Subjective, Objective, Assessment, and Plan) note format, rather than the
traditional narrative style Discussion posting format. 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.To
prepare:Review the Skin Conditions document provided in this week’s Learning Resources,
and select two conditions to closely examine for this Discussion.Consider the abnormal
physical characteristics you observe in the graphics 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.By Day 3Post a description of
the two graphics you selected (identify each graphic by number). Use clinical terminologies
to explain the physical characteristics featured in each graphic. Formulate a differential
diagnosis of three to five possible conditions for each. Determine which is most likely to be
the correct diagnosis, and explain your reasoning.Read a selection of your colleagues’

6. responses.By Day 6Respond to at least two of your colleagues on two different days. Make
sure that you respond to colleagues who selected at least one graphic that is different from
the ones you selected. For each, address all of the following:Critique your colleague’s clinical
description of the physical characteristics of each.Suggest an additional possible condition
for each graphic, and explain your reasoning.Provide an alternative correct diagnosis, and
explain your reasoning.Validate an idea with your own experience and additional
research.Week 5 discussion – NURS 6512 – Advanced Health Assessment and Diagnostic
Reasoning Assessing the Ears, Nose, and ThroatMost 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 case studies to
review for this Discussion. Also, your Discussion post should be in the SOAP Note format,
rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of
the Sullivan text and the Comprehensive SOAP Template in the Week 4 Learning Resources
for guidance. Remember that not all comprehensive SOAP data are included in every patient
case.Case 1: Nose Focused ExamRichard 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 ExamLily 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 ExamMartha
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

7. 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 3Post a description of
the health history you would need to collect from the patient in the case study to which you
were assigned. Explain what physical exams and diagnostic tests would be appropriate and
how the results would be used to make a diagnosis. List five different possible conditions
for the patient’s differential diagnosis and justify why you selected each.Read a selection of
your colleagues’ responses.By Day 6Respond 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 6 discussionAssessing the Heart, Lungs, and Peripheral Vascular
SystemTake 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
video case studies in this week’s Learning Resources titled Advanced health assessment and
diagnostic reasoning. Also, your Discussion post should be in the SOAP Note format, rather
than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the
Sullivan text and the Comprehensive SOAP Template in the Week 4 Learning Resources for
guidance. Remember that not all comprehensive SOAP data are 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 3Post a description of

8. the health history you would need to collect from the patient in the case study you were
assigned. Explain what physical exams and diagnostic tests would be appropriate and how
the results would be used to make a diagnosis. List five different possible conditions for the
patient’s differential diagnosis, and justify why you selected each.Read a selection of your
colleagues’ responses.By Day 6Respond 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 – NURS 6512 – Advanced Health Assessment and Diagnostic
Reasoning Assessing the AbdomenA woman went to the emergency room for severe
abdominal cramping. She was diagnosed with diverticulitis; however, as a precaution, the
doctor ordered a CAT scan. The CAT scan revealed a growth on the pancreas, which turned
out to be pancreatic cancer—the real cause of the cramping.Because of a high potential for
misdiagnosis, determining the precise cause of abdominal pain can be time-consuming and
challenging. By analyzing case studies of abnormal abdominal findings, nurses can prepare
themselves to better diagnose conditions in the abdomen.In this Discussion, you will
consider case studies that describe 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.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 SOAP Note format, rather than the
traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text
and the Comprehensive SOAP Template in the Week 4 Learning Resources for guidance.
Remember that not all comprehensive SOAP data are included in every patient case.Case 1:
Abdominal PainA 12-year-old female complains of malaise with abdominal pain pointing to
the right lower quadrant. The patient has been vomiting and feeling nauseated for several
days. The abdominal pain has been insidious and now is more pronounced. Both parents
are with the child and are concerned because she has not been eating and has had a fever
for the past 3 evenings.Case 2: Gastrointestinal PainA 50-year-old male complains of
burning pain starting at the abdomen and rising to the middle of his chest. He describes the
pain as a gnawing feeling that begins after meals, especially when lying down.Case 3:
Nausea and VomitingA 20-year-old female complains of nausea and has vomited three times
over the past 48 hours. The patient also experienced a low-grade fever this morning. She
states that she recently ate shellfish at a new restaurant with two friends who are suffering
from similar symptoms.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 (“Week 7 Discussion”) with “Review of Case Study ___.” Fill in the blank with the

9. number of the case study you were assigned.By Day 3Post a description of the health
history you would need to collect from the patient in the case study to which you were
assigned. Explain which physical exams and diagnostic tests would be appropriate and how
the results would be used to make a diagnosis. List five different possible conditions for the
patient’s differential diagnosis, and justify why you selected each.Read a selection of your
colleagues’ responses.By Day 6Respond 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 – NURS 6512 – Advanced Health Assessment and Diagnostic
Reasoning Assessing Muscoskeletal PainThe 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 SOAP Note format, rather than the traditional narrative
style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the
Comprehensive SOAP Template in the Week 4 Learning Resources for guidance. Remember
that not all comprehensive SOAP data are included in every patient case.Case 1: Back PainA
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?Note: Please view the Week 8 Discussion area to
view the image for Case Study 1.Case 2: Ankle PainA 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?Note: Please view the Week 8 Discussion area to view the
image for Case Study 2.Case 3: Knee PainA 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

10. 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?Note: Please view the Week 8 Discussion area to view the image for Case
Study 3.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 3Post a description of the health history you
would need to collect from the patient in the case study to which you were assigned. Explain
what physical exams and diagnostic tests would be appropriate and how the results would
be used to make a diagnosis. List five different possible conditions for the patient’s
differential diagnosis, and justify why you selected each. Include how the patient X-ray
helped you to refine the differential diagnosis.Read a selection of your colleagues’
responses.By Day 6Respond 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 –
NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Assessing
Neurological SymptomsImagine 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 SOAP Note format, rather than the traditional narrative style Discussion posting format.
Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in the Week 4
Learning Resources for guidance. Remember that not all comprehensive SOAP data are
included in every patient case.Case 1: HeadachesA 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 PainA 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 FaceA 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

11. 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 3Post a description of the health history you would need to
collect from the patient in the case study to which you were assigned. Explain what physical
exams and diagnostic tests would be appropriate and how the results would be used to
make a diagnosis. List five different possible conditions for the patient’s differential
diagnosis, and justify why you selected each.Read a selection of your colleagues’
responses.By Day 6Respond 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 10
discussionAssessing the Genitalia and RectumPatients are frequently uncomfortable
discussing with health care professionals 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
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 SOAP Note format, rather than the traditional narrative style Discussion
posting format. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP
Template in the Week 4 Learning Resources for guidance. Remember that not all
comprehensive SOAP data are included in every patient case.Case 1: Rectal BleedingA 62-
year-old male construction worker reports to your clinic after experiencing rectal bleeding
for over 1 month. He has noticed small amounts of blood after every bowel movement. He
had a colonoscopy 2 years ago with normal results. The patient has no fever, chills, dysuria,
abnormal urinary frequency, or abdominal pain. The patient reports occasional rectal
itching and pain. He states he has no noticeable sores on his rectal area and no family
history of colorectal cancer.Case 2: DysuriaA 55-year-old African-American male reports to
your clinic complaining of frequent and painful urination for the past 2 months. The patient
is sexually active and has been in a monogamous relationship for the past 3 years. He
reports no penile discharge, fever, chills, abdominal pain, or back pain. His father is
deceased and passed away of colon cancer. His father had a history of benign prostatic
hypertrophy (BPH). The patient considers himself as a healthy male. He works for a large
American corporation, has a relatively healthy diet, and exercises 4 to 5 times per
week.Case 3: GenitaliaA 21-year-old college student reports to your clinic with external
bumps on her genital area. The bumps are painless and feel rough. The patient is sexually
active and has had more than one partner over the past year. Her initial sexual contact

12. occurred at age 18. The patient reports no abnormal vaginal discharge. She is unsure how
long the bumps have been there but noticed them about a week ago. Her last Pap smear
exam was 3 years ago, and no dysplasia was found; the exam results were normal. She had
one sexually transmitted infection (chlamydia) about 2 years ago. She completed the
treatment for chlamydia as prescribed.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 (“Week 10 Discussion”) with “Review of Case Study ___.” Fill in
the blank with the number of the case study you were assigned.By Day 3Post a description
of the health history you would need to collect from the patient in the case study to which
you were assigned. Explain what physical exams and diagnostic tests would be appropriate
and how the results would be used to make a diagnosis. List five different possible
conditions for the patient’s differential diagnosis, and justify why you selected each.Read a
selection of your colleagues’ responses.By Day 6Respond 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 11 discussion – NURS 6512 – Advanced Health Assessment and Diagnostic
Reasoning Ethical ConcernsAs 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 Discussion, you will explore evidence-based practice
guidelines and ethical considerations for specific scenarios.Scenario 1:The parents of a 5-
year-old boy have accompanied their son for his required physical examination before
starting kindergarten. His parents are opposed to him receiving any vaccines.Scenario 2:A
49-year-old woman with advanced stage cancer has been admitted to the emergency room
with cardiac arrest. Her husband and one of her children accompanied the
ambulance.Scenario 3:A 27-year-old man with Crohn’s disease has been admitted to the
emergency room with an extreme flare-up of his condition. He explains that he has not been
able to afford his medications for the last few months and is concerned about the costs he
may incur for treatment.Scenario 4: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.Scenario 5:A 17-year-old boy has come in for a check-up after a head injury
during a football game. He has indicated that he would like to be able to play in the next
game, which is in 3 days.Scenario 6:A 12-year-old girl has come in for a routine check-up
and has not yet received the HPV vaccine. Her family is very religious and believes that the
vaccine would encourage premarital sexual activity.Scenario 7:A 57-year-old man who was
diagnosed with motor neuron disease 2 years ago is experiencing a rapid decline in his

13. 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.To prepare:Select three scenarios, 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.By Day 3Post the explanation of the health assessment information required for a
diagnosis of your selected patients (include the scenario numbers). Explain how you would
respond to the scenario as an advanced practice nurse using evidence-based practice
guidelines and applying ethical considerations. Justify your responses.Read a selection of
your colleagues’ responses.By Day 6Respond to at least two of your colleagues on two
different days who selected different scenarios than you, using one or more of the following
approaches:Suggest additional health assessment information that would be necessary to
collect from the patientCritique your colleague’s response, and explain alternative
approaches to the situation.Validate an idea with your own experience and additional
research. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning