NRP571 Advanced Health Assessment IIand Clinical Procedures
Week 1 Assignment
Reflection: i-Human Patients – Carolyn Cross
Assignment Content
Read one of the recommended evidence-based practice academic articles provided at the end of the Carolyn Cross case or locate an academic article from the University Library that relates to the conditions presented in the Carolyn Cross case to improve your clinical skills.
Write a 500-word summary of the article as it relates to your patient encounter with Carolyn Cross.
Include the following in your summary:
Rationale for the questions you asked during the history examination
Rationale for the physical exam that was conducted on the patient
Summary of what the article was trying to validate
Critique of your overall case evaluation (now that the diagnosis has been revealed) and examination of areas of opportunity identified in the article to improve your clinical skills
NRP571 Advanced Health Assessment IIand Clinical Procedures
Week 2 Assignment 1
Signature Assignment Episodic SOAP Note Pt. 1 Craig Harris
Assignment Content
This week focused on the male genitourinary system and how to collect a proper history. It is time to practice your documentation skills by completing an episodic SOAP note for Craig Harris.
Review the Craig Harris Scenario.
Use the SOAP Note Template and the SOAP Note Structure Guide to develop your documentation needed to complete your SOAP note.
The assessment and plan sections will not be graded but should be completed to ensure documentation of a complete SOAP note. You will also use this information to complete your E&M coding for the visit. Make sure to:
Document all relevant information using appropriate terminology.
List the appropriate ICD-10 codes and E&M codes using the diagnoses provided.
Submit your assignment.
Resources
Center for Writing Excellence
Reference and Citation Generator
Grammar and Writing Guides
NRP571 Advanced Health Assessment IIand Clinical Procedures
Week 2 Assignment
Wk 2 - Signature Assignment: Episodic SOAP Note Pt. 2: Craig Harris
Assignment Content
Now that you have completed your SOAP note for Craig Harris, it is time for reflection. This reflection is your opportunity to review what you learned about the patient, the process, and the outcomes in preparation for future patient encounters. The reflection must include a discussion about an evidence-based practice to improve the quality of care the patient receives.
Write a 700-word reflection providing rationale for your completed SOAP note. Consider the interview information provided in the patient scenario as you:
List 5 open-ended questions you would ask using descriptive language familiar to the patient during the HPI exam relevant to the chief complaint, including all pertinent and positive negatives. Provide a rationale for each question you ask by explaining why it is appropriate and how it aligns to the chief complaint.
Provide a minimum of 3 rationales for the physical exam components performed.
Locate and review a current evidence-based article that discusses evidence-based guidelines or new research relating to each diagnosis. Provide a brief summary of the article(s) in your reflection.
Identify a minimum of 2 barriers to quality health care the patient can potentially experience per the information provided in the interview (e.g., cultural, linguistic, economic, previous conditions, etc.).
As the FNP, explain how you can address these barriers to improve the quality of care the patient receives. Use a minimum of 2 peer reviewed articles to support your answers.
Cite your references according to APA guidelines.
Submit your assignment.
NRP571 Advanced Health Assessment IIand Clinical Procedures
Week 3 Assignment
Reflection: i-Human Patients: Buddy Theodore Jr.
Read one of the recommended evidence-based practice academic articles provided at the end of the Buddy Theodore Jr. case or locate an academic article from the University Library that relates to the conditions presented in the Buddy Theodore Jr. case to improve your clinical skills.
Write a 500-word summary of the article as it relates to your patient encounter with Buddy Theodore Jr.
Include the following in your summary:
Rationale for the questions you asked during the history examination
Rationale for the physical exam that was conducted on the patient
Summary of what the article was trying to validate
Critique of your overall case evaluation (now that the diagnosis has been revealed) and examination of areas of opportunity identified in the article to improve your clinical skills
Resources
Center for Writing Excellence
Reference and Citation Generator
Grammar and Writing Guides
NRP571 Advanced Health Assessment IIand Clinical Procedures
Week 4 Assignment 1
Signature Assignment: Pediatric Comprehensive SOAP Note Pt. 1: B.P.
Assignment Content
This week you have gained insight about the pediatric assessment, as you have compared the head to toe examination of the infant, child, and adult.
Now it is time to apply your documentation skills by writing a comprehensive SOAP note focused on a 7-year-old well child check with parental concerns of short stature.
Review the B.P Scenario.
Use the SOAP Note Template and the SOAP Note Structure Guide to develop your documentation needed to complete your SOAP note. Make sure to review the The 10 charts in Set 2: Clinical charts with 3rd and 97th percentiles from the National Center for Health Statistics and reference the appropriate chart within the SOAP note.
The assessment and plan sections will not be graded but should be completed to ensure documentation of a complete SOAP note. You will also use this information to complete your E&M coding for the visit. Make sure to:
Document all relevant information using appropriate terminology.
List the appropriate ICD-10 codes and E&M codes using the diagnoses provided.
NRP571 Advanced Health Assessment IIand Clinical Procedures
Week 4 Assignment 2
Assignment Content
Now that you have completed your SOAP note for B.P., it is time for reflection. This reflection is your opportunity to review what you learned about the patient, the process, and the outcomes in preparation for future patient encounters. The reflection must include a discussion about an evidence-based practice to improve the quality of care the patient receives.
Write a 700-word reflection providing rationale for your completed SOAP note. Consider the interview information provided in the patient scenario as you:
List 5 open-ended questions you would ask using descriptive language familiar to the patient during the HPI exam relevant to the chief complaint, including all pertinent and positive negatives. Provide a rationale for each question you ask by explaining why it is appropriate and how it aligns to the chief complaint.
Provide a minimum of 3 rationales for the physical exam components performed.
Locate and review a current evidence-based article that discusses evidence-based guidelines or new research relating to each diagnosis. Provide a brief summary of the article(s) in your reflection.
Identify a minimum of 2 barriers to quality health care the patient can potentially experience per the information provided in the interview (e.g., cultural, linguistic, economic, previous conditions, etc.).
As the FNP, explain how you can address these barriers to improve the quality of care the patient receives. Use a minimum of 2 peer reviewed articles to support your answers.
Format?your references according to APA guidelines.
Submit your assignment.
Resources
Center for Writing Excellence
Reference and Citation Generator
Grammar and Writing Guides
NRP571 Advanced Health Assessment IIand Clinical Procedures
Week 6 Assignment 1
Clinical Procedures Case Studies
Complete the case studies by answering the questions beneath each scenario.
Case Study 1
A 35-year-old Hispanic female presents to the office. She complains of severe pain in her left 1st metatarsal (big toe) on the medial corner of her nail bed. She reports that the pain has gradually worsened over the last week and she can now barely walk. She has tried soaking her foot in Epsom salts and putting antibiotic cream on her toe, none of which have helped. On physical exam her toe is swollen and erythematous with tenderness. She also has purulent drainage present.
PMHx: none
SHx: married with two children
Allergies: none
1. What is your diagnosis (include staging)?
2. What is the treatment plan?
3. What post-procedure instruction should she receive?
Case Study 2
A 47-year-old male presents to the clinic. He has a 3-inch laceration on his right forearm and reports that he was replacing a bedroom window when the window broke, cutting his right arm. He reports that “it bled quite a bit.” He wrapped it in a shirt and came directly to the clinic. He does not know when he had his last Td shot, but he thinks it was at least 12 years ago.
On physical examination you observe a 3-inch laceration extending through the dermis layer of skin not affecting tendons or ligaments and determine if sutures are warranted.
PMHx: asthma
SHx: married with no children
Allergies: none
VS: T 98 BP 134/60 HR 78 R 18 02 sat 98%
1. What sequence of steps would you take to treat this patient?
2. What would be your post-procedure instructions to the patient?
3. Should he receive a Td immunization today?
Case Study 3
A 45-year-old male was in his garage grinding a piece of metal when he experienced sudden pain in his right eye. He went inside and flushed his eye with water, but he still felt like there was something in the eye.
On physical examination, his visual acuity in both eyes is 20/20. There is no obvious foreign body seen in the eye; however, the conjunctiva is injected. You consider that he may have a corneal abrasion.
PMHx: none
SHx: divorced with no children
Allergies: sulfa
VS: T 98 BP 136/60 HR 70 R 12 02 sat 97%
1. Describe the process involved with assessing a patient for a corneal abrasion.
2. What would your treatment be if this patient was positive for a corneal abrasion?
3. How would your treatment differ if there was a change in visual acuity?
NRP571 Advanced Health Assessment IIand Clinical Procedures
Week 7 Assignment
Diagnostic Testing Case Studies
Complete the case studies by answering the questions associated with each scenario.
Case Study 1
A 25-year-old male experienced a FOOSH (fall on outstretched hand – see images below) while riding his bicycle. He comes in for evaluation of the wrist injury. Initial X-ray suggests that there are no visible fractures. You note on physical exam that he has tenderness at the scaphoid fossa.
PMHx: None
Medications: Advil 200mg q8h PRN pain
SH: Single, non-smoker, denies alcohol or drug use
VS: T: 98.6 BP 145/60 HR 55 R 12 o2 sats 95%
Gen: Well developed male in no acute distress. Lungs CTA with no wheezes, rales, or rhonchi, Heart S1 S1 audibly heard with no murmurs or extra heart sounds. Right wrist with mild edema and slight decreased ROM due to pain. Tenderness noted at the scaphoid fossa.
1. What diagnosis must you always consider with this assessment finding?
2. What will be your treatment at this time? Is there further testing to be ordered?
3. Are there any potential consequences of not treating this? If so, what?
Case Study 2
A 24-year-old female runner just returned three days ago from traveling in Guatemala. She is finishing medication for a UTI. She was running and felt a pop in her right calf but was able to continue her run and iced her leg when she got home. This morning, she woke up with ecchymosis, slight swelling to the upper right ankle, and slight pain with some positions like squatting and climbing stairs.
PMHx: None
Medications: Ciprofloxin 250 mg TID x 3 days, Chloroquine
SH: Single, non-smoker, denies alcohol or drug use
VS: T: 98.6 BP 154/90 HR 78 R 14 o2 sats 99%
Pain scale 6/10
Gen: Well developed female in pain. Lungs CTA with no wheezes, rales, or rhonchi, Heart S1 S1 audibly heard with no murmurs or extra heart sounds. Right posterior ankle with purple ecchymosis, mild edema, and decreased ROM due to pain. Tenderness noted at the Achilles tendon insertion site. Slight positive Thompson's test and knee flexion sign appears negative.
1. What diagnosis should you consider?
2. What imaging studies should you order?
3. What treatment will you start now?
Case Study 3
A 32-year-old white female is concerned with increasing migraines and vision disturbances with vertigo over the past three months. She denies any head injuries or LOC, has never had migraines before, and usually headaches resolve with just rest. For current headaches, she needs to go to sleep and take OTC analgesics which sometimes help. She does not have a headache at this visit. She reports having a similar incident that lasted 5 weeks 2 years ago while in Colorado visiting family. No test was done then, and she never found out what caused it.
PMHx: None
Medications: Excedrin Migraine
SH: Single, non-smoker, denies alcohol or drug use
VS: T: 98.6 BP 118/72 HR 90 R 16 o2 sats 100%
Pain scale 1/10
Gen: Pleasant WF NAD
HEENT:PERRLA, Fundoscopy no papilladema, cup:disc ratio 2:1 no AV nicking.
Neuro: CN II-XII grossly intact, Romberg was positive.
MS: FROM all extremities, DTR's 2 + with positive Babinski right foot.
You are referring to a neurologist and they have requested imagining before seeing her.
1. What imaging is appropriate for this patient?
2. What questions do you need to ask before ordering MRI with contrast?
3. How would you describe an MRI during patient education?
Case Study 4
A 44-year-old well-known Caucasian female patient presents to the clinic. She has experienced increased shortness of breath over the past 3 days. She has a well-documented history of asthma which is normally controlled by her asthma medications. The patient tells you she recently had a cold and this has triggered her shortness of breath.
PMHx: asthma, hypothyroidism
Meds: synthroid 137mcg qd, proventil inhaler 2 puffs qid prn
SHx: single
Allergies: NKDA
VS: T 97.7 BP 122/60 HR 88 R 12 02 sat 90%
Gen: well-developed female in NAD
Lungs: clear BS throughout with diminished in both bases with expiratory wheezes heard in both lungs
1. What is the likely diagnosis?
2. What test would be appropriate for this patient?
3. How might the information obtained from testing be helpful to the practitioner?
Case Study 5
A 50-year-old Hispanic male presents to the clinic as a new patient with a concern about increased shortness of breath over the last 6 months when climbing stairs. He also reports a productive cough. He has just relocated to southern California and “thinks this may be allergies.”
PMHx: previous health care minimal in Mexico
Meds: no Rx; his wife gave him some OTC Claritin
SHx: married, smokes 2 packs/day x 30 years
Allergies: NKDA
VS: T 98 BP 126/80 HR 84 RR 24 O2 Sat 90%
Gen: well-developed male in NAD
Lungs: clear bilaterally, but diminished BS throughout, no rales, rhonchi, or wheezing, however, slightly increased expiratory phase (I:E ratio 1:3)
1. What is in your differential diagnosis?
2. What test would be appropriate in this patient?
3. How might the information obtained from testing be helpful to the nurse practitioner?
