NURS 6512 Advanced Health Assessment and Diagnostic Reasoning Discussions

NURS 6512 Advanced Health Assessment and Diagnostic Reasoning Discussions

NURS 6512 Advanced Health Assessment and Diagnostic Reasoning Discussions
NURS 6512 Week 1 Discussion: Building a Health History
Effective communication is vital to constructing an accurate and detailed patient history. A patient’s health or illness is influenced by many factors, including age, gender, ethnicity, and environmental setting. As an advanced practice nurse, you must be aware of these factors and tailor your communication techniques accordingly. Doing so will not only help you establish rapport with your patients, but it will also enable you to more effectively gather the information needed to assess your patients’ health risks.
For this Discussion, you will take on the role of a clinician who is building a health history for one of the following new patients:

76-year-old Black/African-American male with disabilities living in an urban setting
Adolescent Hispanic/Latino boy living in a middle-class suburb
55-year-old Asian female living in a high-density poverty housing complex
Pre-school aged white female living in a rural community
16-year-old white pregnant teenager living in an inner-city neighborhood

To prepare:

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With the information presented in Chapter 1 in mind, consider the following:
How would your communication and interview techniques for building a health history differ with each patient?
How might you target your questions for building a health history based on the patient’s age, gender, ethnicity, or environment?
What risk assessment instruments would be appropriate to use with each patient?
What questions would you ask each patient to assess his or her health risks?
Select one patient from the list above on which to focus for this Discussion.
Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration.
Select one of the risk assessment instruments presented in Chapter 1 or Chapter 26 of the course text, or another tool with which you are familiar, related to your selected patient.
Develop at least five targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history.

By Day 3

Post a description of the interview and communication techniques you would use with your selected patient. Explain why you would use these techniques.Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.
Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who selected a different patient than you, using one or more of the following approaches:
Share additional interview and communication techniques that could be effective with your colleague’s selected patient.
Suggest additional health-related risks that might be considered.
Validate an idea with your own experience and additional research.

NURS 6512 Advanced Health Assessment and Diagnostic Reasoning Discussions
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NURS 6512 Week 1 Quiz
Question 1
Drawing of stick figures is most useful to:
Question 2
Mr. F. is speaking with you, the health care provider, about his respiratory problem. Mr. F. says, I ve had this cough for 3 days, and it s getting worse. You reply, Tell me more about your cough. Mr. F. states, I wish I could tell you more. That s why I m here. You tell me what s wrong! Which caregiver response would be most appropriate for enhancing communication?
Question 3
During the course of the interview you should:
Question 4
Which of the following formats would be used for visits that address problems not yet identified in the problem-oriented medical record (POMR)?
Question 5
Constitutional symptoms in the ROS refer to:
Question 6
A detailed description of the symptoms related to the chief complaint is presented in the:
Question 7
Which of the following is not a characteristic of the plan portion of the problem-oriented medical record?
Question 8
When recording assessments during the construction of the problem-oriented medical record, the examiner should:
Question 9
Mrs. G. reports an increase in her alcohol intake over the past 5 years. To screen her for problem drinking, you would use the:
Question 10
During a history-taking session, Mr. B. appears to be avoiding certain questions. He keeps looking out the window. What should the caregiver do?
Question 11
Mary Jane has brought in her 16-year-old son, Kyle. She states that he has been sleeping more, doesn t hang around his friends, and recently his girlfriend broke up with him. Your most immediate question is to ask Kyle:
Question 12
You are collecting a history from an 11-year-old girl. Her mother is sitting next to her in the examination room. When collecting history from older children or adolescents, they should be:
Question 13
J.M. has been seen in your clinic for 5 years. She presents today with signs and symptoms of acute sinusitis. The type of history that is warranted is a(n) _____ history.
Question 14
A tool used to screen adolescents for alcoholism is the:
Question 15
Ms. S. reports that she is concerned about her loss of appetite. During the history, you learn that her last child recently moved out of her house to go to college. Rather than infer the cause of Ms. S. s loss of appetite, it would be better to:
Question 16
Subjective and symptomatic data are:
Question 17
Which of the following is an effective adjunct to document location of findings during recording of physical examinations?
Question 18
When taking a history, you should:
Question 19
Which question would be considered a leading question?
Question 20
Which of the following is considered an IADL but not an ADL?
NURS 6512 Week 2 Discussion
NURS 6512 DQ1 Assessment Tools and Diagnostic Tests
When seeking to identify a patient’s health condition, advanced practice nurses can use a diverse selection of diagnostic tests and assessment tools; however, different factors affect the validity and reliability of the results produced by these tests or tools. Nurses must be aware of these factors in order to select the most appropriate test or tool and to accurately interpret the results.
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:
Mammogram
Physical tests for sore throat (inspecting the throat, palpating the head and neck lymph nodes, listening to breath sounds)
Prostate-specific antigen (PSA) test
Dix-Hallpike test
Body-mass index (BMI) using waist circumference for adults
Search the Walden Library and credible sources for resources explaining the tool or test you selected. What is its purpose, how is it conducted, and what information does it gather?
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 3

Post a description of how the assessment tool or diagnostic test you selected is used in health care. Based on your research, evaluate the test or the tool’s validity and reliability, and explain any issues with sensitivity, reliability, and predictive values. Include references in appropriate APA formatting.
Read a selection of your colleagues’ responses.

By Day 6
Respond 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.

NURS 6512 Advanced Health Assessment and Diagnostic Reasoning Discussions
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NURS 6512 DQ2: Diversity and Health Assessments
In May 2012, Alice Randall wrote an article for The New York Times on the cultural factors that encouraged black women to maintain a weight above what is considered healthy. Randall explained—from her observations and her personal experience as a black woman—that many African-American communities and cultures consider women who are overweight to be more beautiful and desirable than women at a healthier weight. As she put it, “Many black women are fat because we want to be” (Randall, 2012).
Randall’s statements sparked a great deal of controversy and debate; however, they emphasize an underlying reality in the health care field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and health care professionals should be aware of this reality and adapt their health assessment techniques and recommendations to accommodate diversity.
In this Discussion, you will consider different socioeconomic, spiritual, lifestyle, and other cultural factors that should be taken into considerations when building a health history for patients with diverse backgrounds.
Case 1
Subjective Data
CC: “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 prostatitis
PSH: S/P cholecystectomy
Drug 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 injury
Respiratory:
CV:
GI:
GU: no urinary hesitancy or change in urine stream
Integument: multiple bruises on his upper arms and back.
MS/Neuro: + falls x 2 within the last 6 months; no syncopal episodes or dizziness
Psych:
Objective Data
PE: B/P 188/96; Pulse 89; RR 16; Temp 99.0; Ht 5,6; wt 110; BMI 17.8
HEENT: Atraumatic, normocephalic, PERRLA, EOMI, arcus senilus bilaterally, conjunctiva and sclera clear, nares patent, ornasopharynx clear, edentulous.
Lungs: CTA AP&L
Cor: S1S2 without rub or gallop
Abd: benign, normoactive bowel sounds x 4
Ext: no cyanosis, clubbing or edema
Integument: multiple bruises in different stages of healing – on his upper arms and back.
Neuro: No obvious deformities, CN grossly intact II-XII
Case 2
Subjective Data
CC: “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 occasion
Family 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 injury
Respiratory:
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 movements
Objective Data
PE: B/P 128/76; Pulse 83; RR 16; Temp 99.0; Ht 5,6; wt 128; BMI 20.98
HEENT: 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&L
Cor: S1S2 without rub or gallop
Abd: benign, normoactive bowel sounds x 4
GU: 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 edema
Integument: intact without lesions masses or rashes.
Neuro: No obvious deficits and CN grossly intact II-XII
Case 3
Subjective Data
CC: “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 – denied
Allergies: no allergies to food or medications.
Family 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 palpitations
GI:
GU:
Integument: history of eczema – not active
MS/Neuro: no syncopal episodes or dizziness, no change in memory or thinking patterns; no twitches or abnormal movements
Psych:
Objective Data
PE: B/P 158/90; Pulse 88; RR 18; Temp 99.2; Ht 5,7; wt 208; BMI 32.6
General: 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&L
Cor: S1S2, +II/VI holosystolic murmur; without rub or gallop
Abd: benign, normoactive bowel sounds x 4; Hepatomegaly 2cm below the costal margin.
Ext: no cyanosis, clubbing or edema
Integument: intact without lesions masses or rashes.
Neuro: No obvious deficits and CN grossly intact II-XII
To prepare:

Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments.
Select one of the three case studies. Reflect on the provided patient information.
Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient you selected.
Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.
Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information?

By Day 3

Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you selected. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.
Read a selection of your colleagues’ responses.

By Day 6
Respond 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.

NURS 6512 Advanced Health Assessment and Diagnostic Reasoning Discussions
NURS 6512 Week 2 Quiz
Question 1
When percussing, a dull tone is expected to be heard over:
Question 2
Which technique should be used to stabilize the stethoscope during auscultation?
Question 3
The degree of percussion tone is determined by the density of the medium through which the sound waves travel. Which statement is true regarding the relationship between density of the medium and percussion tone?
Question 4
Which of the following describes a physical, not a cultural, differentiator?
Question 5
Your new patient is a 40-year-old Middle Eastern man with the complaint of new abdominal pain. You are concerned about violating a cultural prohibition when you prepare to do his rectal examination. The best tactic would be to:
Question 6
Which statement is true regarding the impoverished?
Question 7
To perform a deep tendon reflex measurement, you should:
Question 8
In terms of cultural communication differences, Americans are more likely to _____ than are other groups of patients.
Question 9
Underestimation of blood pressure will occur if the blood pressure cuff s bladder:
Question 10
Guidelines for Standard Precautions indicate that mask and eye protection or a face mask should be worn while performing:
Question 11
A patient in the emergency department has a concussion to the head. You suspect the patient may also have a retinal hemorrhage. You are using the ophthalmoscope to examine the retina of this patient. Which aperture of the ophthalmoscope is most appropriate for this patient?
Question 12
A nonambulatory 80-year-old male patient tells the female nurse that he feels like he is having drainage from his rectum. Which initial nursing action is appropriate?
Question 13
For a woman with a small vaginal opening, the examiner should use a _____ speculum.
Question 14
Which statement is true regarding the relationship of physical characteristics and culture?
Question 15
You are performing a vaginal examination for a patient with a history of spina bifida. As you insert the metal speculum, the patient suddenly feels nauseated and is sweating, and her skin turns blotchy. What is your most immediate reaction to this situation?
Question 16
The infant should be placed in which position to have his or her height or length measured?
Question 17
Which question has the most potential for exploring a patient s cultural beliefs related to a health problem?
Question 18
Expected normal percussion tones include:
Question 19
A naturalistic or holistic approach to health care often assumes:
Question 20
Because of common cultural food preferences, avoidance of monosodium glutamate (MSG) is likely to be most problematic for the hypertensive patient of which group?
NURS 6512 Week 3 Discussion: Health Assessment of Children’s Weight
Body measurements can provide a general picture of whether a child is receiving adequate nutrition or is at risk for health issues. These data, however, are just one aspect to be considered. Lifestyle, family history, and culture—among other factors—are also relevant. That said, gathering and communicating this information can be a delicate process.
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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 parents
Slightly overweight 10-year-old girl with parents of normal weight
5-year-old girl of normal weight with obese parents
Slightly underweight 8-year-old boy with parents of normal weight
Severely underweight 12-year-old girl with underweight parents
Select one of the examples on which to focus for this Discussion. What health issues and risks may be relevant to the child you selected?
Based on the risks you identified, consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this information in a sensitive fashion.
Consider how you could encourage parents or caregivers to be proactive toward the child’s health.

By Day 3

Post 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 6
Respond 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.

NURS 6512 Advanced Health Assessment and Diagnostic Reasoning Discussions
NURS 6512 Week 3 Quiz
Question 1
Milestone achievements are data most likely to appear in the history of:
Question 2
In clinical practice, the Ballard Assessment Tool is used to assess a newborn’s:
Question 3
At what age does peak height growth velocity occur in boys?
Question 4
Which breast Tanner stage corresponds to a secondary areola mound development above the breast?
Question 5
Gender-specific skeletal differences first occur during:
Question 6
A detailed description of the symptoms related to the chief complaint is presented in the:
Question 7
Subjective and symptomatic data are:
Question 8
Which of the following is an example of a problem requiring recording on the patient s problem list?
Question 9
Deficiency of which micronutrient is implicated in osteoporosis?
Question 10
When recording assessments during the construction of the problem-oriented medical record, the examiner should:
Question 11
In children 3 to 18 years of age, the formula age + 5 g should be used to determine _____ needs.
Question 12
Which medication is frequently associated with weight gain?
Question 13
Which of the following is an effective adjunct to document location of findings during recording of physical examinations?
Question 14
A major risk factor for developing an eating disorder is having:
Question 15
Which of the following formats would be used for visits that address problems not yet identified in the problem-oriented medical record (POMR)?
Question 16
An anorexia patient is different from the bulimic patient because of the following characteristics:
Question 17
You are advising a patient concerning his targeted low-density lipoprotein cholesterol (LDL-C) level. The patient currently smokes and has medication-controlled hypertension. You should tell this patient that he should modify his diet and exercise in order to meet the target LDL-C of <_____ mg/dL.
Question 18
The patient s perceived disabilities and functional limitations are recorded in the:
Question 19
During the course of the interview you should:
Question 20
Which B vitamin is deficient in patients with pernicious anemia?
NURS 6512 Week 4 Discussion: Differential Diagnosis for Skin Conditions
Properly 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.
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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?