THE UNIVERSITY OF TEXAS AT TYLER College of Nursing Health Assessment NURS 3310
1 THE UNIVERSITY OF TEXAS AT TYLER College of Nursing Health Assessment NURS 3310 Fall 2011 Didactic Faculty Belinda Deal, PhD, RN, CEN Office: BRB 2350 Office: 903‐566‐7120 Email: [email protected] Office hours posted on BBd and office door Skills lab Team Doug Raymond, MSN, MA ,RN Office: BRB: 2420 Office 903‐565‐5715 Email: [email protected] Jennie Pierce, MSN, CNS, RN Office BRB 2135 Office : 903‐565‐5710 [email protected] Sandra Savage, BSN, RN TBA Carol Rizer, RN, CRNA TBA Longview campus: Lisa Herterich, MSN, RN LUC: 230/Ext.8230 Email: [email protected] Kathleen Hudson, MSN, MBA, RN LUC: 224/Ext.8224 Email: [email protected] Katherine Strout, MSN, RN LUC: 229/Ext. 8229 Email: [email protected] Palestine campus: Virginia Buell, MSN,RN, ACNP, CCRN PAL: 111/Ext. 2305 Email: [email protected] Joni Edmond, MSN, RN PAL 109/Ext: 2313 Email: [email protected] Kara Jones, MSN, RN PAL: 124/Ext.2303 Email: [email protected] The content of this syllabus/WEB site is subject to change at the discretion of the faculty leaders according to current learning needs. Approved by FO: 10/02 2 Master Schedule Week 1 Monday 8-22 Classroom Content First lecture Course Overview Chapter 4 The Interview, The Complete Health Hx Chapters 8 ,9 & 11 Assessment Techniques, General Survey, Measurement, Vital Signs, Nutrition ATI Vital Signs Skills Module online Pretest and Post test Complete by: 8-28 midnight NO LECTURE No lecture but lab does meet Thorax and Lungs Chapter 18 Cultural Assessment on BBD DUE on BBD 9-11 Sun midnight 2 8-29 3 4 9-5 LABOR DAY 9-12 5 9-19 EXAM 1 6 9-26 Heart and Neck Vessels Peripheral Vascular and Lymphatics Chapters19 & 20 View Cardiovascular and peripheral vascular Video/DVD before lab Peer Check-0ff View See Me Video and write reflection 7 10-3 Instructor Check-Off Head to Toe Practicum at local nursing home. 8 10-10 9 10-17 Abdomen, Anus, rectum, and prostate, Male Genitalia Assessment Chapters 21,24, & 25 Health History Assignment due beginning of Lecture EXAM 2 Following modules DUE 10-16 Sunday midnight 1. ATI Physical Assessment Skills Module of the Adult 2. ATI Completion Learning System RN Communication Practice test and Final (20 + 20 questions) 3. ATI Nurse Logic 5 modules completion Head, Eyes, Ears, Nose, Mouth and Throat Chapters 13, 14, 15, & 16 10 10-24 11 10-27 10-31 12 11-7 Musculoskeletal Chapter 22 Skin, Hair, and Nails Chapter 12 100 B/Ps DUE beginning of Lab Discussion of clinical patients Grand Rounds EBP Journal Article DUE in Lab View Medicine of Compassion Video and write reflection in syllabus Sim Man Focused Assessment case studies View Musculoskeletal Video before lab Discussion of clinical patients Skin module in lab 13 11-14 Breasts, Axillae, Female Genitalia Assessment Chapters 17 & 26 Domestic Violence, Chapter 7 GRAND ROUNDS Final PowerPoint presentation for Grand Rounds posted on BBD by Sunday 11-13 midnight 14 11-21 Pediatric assessment "Putting It All Together" 15 16 17 11-28 12-5 12-12 Neurological System and Mental Status Chapter 23 and 6 LAST DAY TO WITHDRAW FROM A COURSE EXAM 3 EXAM 4 Review Final Exam 9-11 ON TUESDAY Laboratory Content: Medicine of Compassion DVD & reflection, Review of Systems activity, Symptom analysis activity Mastery skill: Vital Signs Vital Signs Video in lab, Check out BP cuffs, Begin 100 BPs Vital Signs Check off Sim man activities View Respiratory Video before lab Head to Toe video Begin Head to Toe Mastery Skills: Skin, Neuromuscular & Pulmonary Breath sounds competency in lab on Sim man Practice on Sim man breath sounds Head to Toe Mastery Skills: Cardiovascular & Gastrointestinal Heart sounds competency in lab and practice Sim man Check offs on Sim man Continue to practice Instructor Check-Off Head to Toe Practicum at local nursing home. Discussion of clinical patients Head, Eyes, Ears, Nose, Mouth and Throat View Videos/DVD before lab, Advanced Assessment Techniques View Video/DVD before lab Discussion of clinical patients Neurological Lab with cranial nerve, reflex assessment in syllabus Thanksgiving/ no lab Grand Rounds Have a wonderful Break!!! Be sure all lab equipment and books are returned. 3 NURS 3310 Health Assessment Section .040 Course Description and Objectives Semester Credit Hours: 1Theory/2Laboratory: 3 credit hours. Prerequisites Courses Admission to the nursing program, NURS 3303, NURS 3205, NURS 3307 or concurrent enrollment. Note: NURS 3310: Health Assessment is a pre-requisite or co-requisite of NURS 3603: Nursing Competencies. If a student is failing or drops NURS 3310: Health Assessment, the student must also drop NURS 3603: Nursing Competencies. Link to online catalog: http://www.uttyler.edu/catalog/ Link to course descriptions: http://www.uttyler.edu/catalog/ Course Description Concepts related to health assessment of patients are presented. Emphasis is on development of nursing skills to perform a holistic health assessment of the patient across the life span, including a health history and comprehensive physical examination. Levels of physical, cognitive and social functioning are analyzed and interpreted. Students practice health assessment skills in laboratory and selected settings. Course Learning Objectives NURS 3310 Health Assessment Upon successful completion of the course the student will: 1. Utilize assessment skills, findings and diagnostic reasoning to identify actual and potential problems for the patient. 2. Integrate knowledge from physical and behavioral sciences, current literature findings, and use critical thinking when assessing patients. 3. Perform a comprehensive health exam by means of interviewing and physical assessment exam at a screening level. 4. Incorporate the concept of caring in developing nurse-patient relationships. 5. Demonstrate professional values according to moral, ethical, and legal principles during health assessment of the patient. 6. Demonstrate sensitivity for patient education, socio-cultural differences, patient comfort, and privacy in interactions with patients. Approved by Academic Affairs 10/99 The following University policies:/absence for religious observance, absence for university-supported trips, services to students with disabilities, grade replacement, state-mandated course drop policy, and Social Security and Privacy may be found as a pdf at: http://www.uttyler.edu/academicaffairs/syllabuspolicies.pdf Required Texts Jarvis, C. (2012). Physical examination and health assessment (6th ed.). Philadelphia: W.B.Saunders. ISBN: 9781437701517 Mosby’s Nursing Video Skills: Physical Examination and Health Assessment. (DVD) ISBN 978-0-323-04962-7 2nd (2012) Note: these are (shrink wrapped) packaged together: ISBN for package: 9781437756852 4 College of Nursing: BSN/MSN Guide for Nursing Students www.uttyler.edu/nursing/nursing.htm (Go to handbook at the end of the page) Required Scantrons to be used for examinations: Look for the correct form which includes F-17355-PAR-L (there are 2 of the same color so make sure to look at the form) On the line with your name, IT MUST HAVE SPACE FOR 4 LETTERS. There is an alternate red scantron that has space for two letters which is NOT acceptable. NOTE: no extra writing such as information for the exam is to be written on the scantron Other helpful but not required learning resources available online and possibly the bookstore: 1. Nursing Made Insanely Easy and Pharmacology Made Insanely Easy (Helpful books with lots of illustrations to help with concepts) www.icanpublishing.com 2. Mosby’s Assessment Memory Notecards by Zerwekh, Joann. Available online. (also available: Pharmacology Notecards) 3. Health Assessment Made Incredibly Visual! ISBN-10: 1-58255-985-6 http://www.lww.com/product/?978-1-58255-985-8| 4. Laminated charts by QuickStudy: http://www.barcharts.com/default.asp?page=charts&pg=quickstudy&ca=MEDICAL Medical Terms: Basics (medical terminology) http://www.barcharts.com/default.asp?page=chart_details&gid=2&pid=538-6 ISBN 538-6 Pocket Nursing http://www.barcharts.com/default.asp?page=chart_details&gid=2&pid=493-2 ISBN 761-3 5. iauscultate iphone app ($5) http://itunes.apple.com/us/app/iauscultate/id329328071?mt=8 Supplies: Watch with second hand, Stethoscope, Lab coat (thigh-length) with nametag and UT Tyler patch. Disability Statement "If you have a disability, including a learning disability, for which you request disability support services/accommodation(s), please contact Ida MacDonald in the Disability Support Services office so that the appropriate arrangements may be made. In accordance with federal law, a student requesting disability support services/accommodation(s) must provide appropriate documentation of his/her disability to the Disability Support Services counselor. For more information, call or visit the Student Services Center located in the University Center, Room 282. The telephone number is 566-7079 (TDD 565-5579)." Additional information may also be obtained at the following UT Tyler Web address: http://www.uttyler.edu/disabilityservices. 5 Grading Policy Completion of NURS 3310: Health Assessment is based on satisfactory attainment of didactic and clinical criteria. Any student who fails to meet the course objectives and expectations in either the classroom or clinical area must repeat the entire courses and may not progress to the next level. The simple average of the 5 exam grades (including exams 1,2,3,4, and the final), before weighted calculation is performed, must be 75% or above to pass the course. Grades will not be rounded when calculating the average (74.5 -74.9 is not rounded to 75). Students with an exam average of 75 or higher will have course grades calculated based on the weighted calculation of the exams and other required course work. Graded Assignments Four Exams (15 % each) Comprehensive Final Exam Health History Assignment Grand rounds presentation Daily Grade 60% 20% 5% 10% 5% Lab/Clinical Assignments Completion of these assignments is mandatory Mastery Skills: 1. Vital signs check off Pass/Fail 2. 100 Blood Pressures Pass/Fail 3. Head to Toe Practicum Pass/Fail 4. Lab breath sounds competency Pass/Fail 5. Lab heart sounds competency Pass/Fail 6. Lab written assignments Pass/Fail 7. Focused Sim man assessments Pass/Fail 100% Letter grades will be assigned on the following scale: A 90-100 B 80-89 C 75-79 D 60-74 F Below 60 Approved Faculty Organization: Fall 1999, implemented Spring 2000 Additional Grading Criteria for assignments is included on Blackboard website. Daily Grade: will consist of the following 5 assignments which are completed by due date on Master Schedule. 1. ATI Vital Signs Module Pre and posttest grade 1% 2. ATI Nurse Logic, all 5 modules (100 for completing, 0 for not completing). 1% 3. Completion of Cultural Assessment tool on BBD(100 for completing, 0 for not completing). 1% 4. ATI Learning System RN: Communication practice test and final (total of 40 questions) (100 for completing, 0 for not completing) 1% 5. ATI Adult Physical Assessment Module pre and posttest grade. 1% The Learning Portfolio, an optional activity can be completed which will allow you to receive ONE point in the overall course grade after the exam average is 75 and all other weighted points are applied. This point may make the difference between rounding up for the next highest grade. For example: 79.5 and 89.5 and above are rounded up to the next number, meaning B for 79.5 or an A for 89.5. Score of 89.4 and lower are NOT rounded up; if you successfully complete the optional activity, you will have one point that can be applied, and if your final course grade was 88.5 to 89.4, the one point would mean the score is rounded up to a 90 (same situation with a C rounded to a B with 78.5 to 79.4). The completed optional activity (The Learning Portfolio) is turned in to your lab instructor who communicates successful completion with the course coordinator for application in the final course grade if needed. 6 The Learning Portfolio describes and illustrates the meaning of the whole learning experience for health assessment. Components for the Learning Portfolio include assignments that are completed in the course. The only additional part is a one page summary. Required supporting documents: 1. Copy of ATI Vital Signs Module Post Test 2. Health History and Grading Criteria or grading comments if online feedback is given 3. Copy of Reflections from: 1. Compassion in Medicine video, 2. See Me Video, 3. Nursing Home Experience 4. Drawing of Head to Toe Exam 5. Head to Toe Grading Criteria 6. Head to Toe Documentation record 7. 100 Blood Pressure record 8. Grand Rounds Power point slides and Grading Criteria or grading comments if online feedback is given 9. Copy of ATI Physical Assessment of the Adult Module Post Test 10. One page summary of what you’ve learned: What have you learned about health assessment? What have you learned about how to apply the content of this course? What have you learned about how you learn and how you could learn more effectively? How have you changed in some important way after taking this course? The Portfolio should be placed in a simple folder with brads and turned in after the Grand Rounds Presentation is graded and turned back in. Deadline is one day before the final exam to your lab instructor. Grade Replacement Policy If you are repeating this course for a grade replacement, you must file an intent to receive grade forgiveness with the registrar by the census date. Failure to file an intent to use grade forgiveness will result in both the original and repeated grade being used to calculate your overall grade point average. A student will receive grade forgiveness (grade replacement) for only three (undergraduate student) repeats during his/her career at UT Tyler. (2006-08 Catalog) Paper/Assignment Re-grading Policy Student assignments will not be re-graded. At the instructor’s discretion, a draft may be written for review. Examination and Examination Review Policy 1. Attendance for exams is mandatory 2. If absence for an exam is necessary, the student is responsible for notifying the faculty prior to the exam with an acceptable reason. 3. Students will be allowed entry to the classroom after an exam has been started ONLY with faculty discretion. 4. Exams will be distributed at the time class is scheduled to begin. 5. All hats/caps must be removed during exam time. All personal items such as purses, books, backpacks, notebooks, and briefcases must be left in the front of the room during testing. 6. Silence will be enforced during the exam time. In order to avoid distraction during the exam, no one will be permitted to leave the room during the exam. 7. Make-up exams will only be given at the discretion of the faculty member and may be in a different format than the original exam. 8. Students will not share calculators during exams. Students will not bring their own calculators, cell phones, or any communicating devices into an examination 9. Exam reviews will be conducted at the discretion of the faculty. Test review may be scheduled with the faculty during office hours and within 10 school days from the return of the exam grades. Additional group reviews will be done in lab. 10. Any student achieving an examination grade less than 75%, must schedule an appointment with the faculty within10 school days from the return of the exam grades. 7 Academic Integrity 1. Students are expected to assume full responsibility for the content and integrity of all academic work submitted as homework and examinations. 2. Students are advised to review the UT Tyler Academic Dishonesty Policy and Academic Integrity Policy in the Current College of Nursing Student Handbook and Academic Integrity Policy for UT Tyler students at www.uttyler.edu; click on current students, then Vice-President for Student Affairs, then Student Guide for Conduct and Discipline at UT Tyler. These policies are fully endorsed and enforced by all faculty members within the College of Nursing. 3. Plagiarism, cheating, and collusion are unacceptable and if found violating any of these standards the student will be disciplined accordingly (See BSN/MSN Nursing Student Guide for definitions). 4. The College of Nursing reserves the right to dismiss students from the program for any infraction of a legal, moral, social, or safety nature, pursuant to the procedures detailed in the Regent’s Rules. Student Dress Code for the University of Texas, College of Nursing: A. General It is the philosophy of the College of Nursing that the student has a responsibility to be neatly groomed and modestly dressed. Appearances should promote good health, safety and general well-being of the student. Clothing should avoid brevity and/or design that are offensive to the dignity and rights of others. School officials have the right and responsibility to counsel with the student or take any other corrective action. Types of clothing (other than those specified in this document) may be worn at the direction of the nursing instructor for special events. B. Classroom Casual or every day business wear is recommended. This includes but is not limited to the following: Slacks or skirt; sweater, blouse, and shirt. Jeans as well as conservative shorts (mid-thigh or longer) may be worn, but avoid overly frayed or soiled. Shoes must be worn. See items to be avoided below. C. Professional Presentations, Ceremonies/ Graduation Business or dressy day social: suit, dress, dressy separates, jacket, ties, nice fabrics. Dress shoes. Avoid denim, jeans, t-shirt or other casual clothes. For workshops/seminars attended by students, business attire will be worn. D. Items to be Avoided in all School-related Functions (including but not limited to) Overly frayed, worn or soiled garments. Costume look, transparent blouses, bare midriff shirts, tank tops, spaghetti straps, muscle shirts, overtly sexual, gang colors or logos, facial or body piercing, obscene slogans or pictures, bedroom wear, short-shorts, short skirts, or clothing that may be offensive to others. E. Laboratory The school clinical laboratory setting is designed to simulate the health care clinical area. Students will wear clean white lab coats with name tag and UT Tyler school patch on the front left uniform jacket. Classroom attire will be worn under the lab coat. F. Pre or Post-clinical Experiences in the Health Care Setting Students may be required to attend conferences or visit the clinical areas as part of their course requirements. Students should wear lab coat with name tag and UTT school patch. The following items will be avoided in the clinical areas: jeans, shorts,sandals, jogging/athletic suits, t-shirts, ball-caps, etc. G. Clinical Experience 1. When attending any clinical experience students are required to wear the standardized student uniform and white uniform jacket with name badge and school patch. Street clothes will be worn in appropriate clinical settings as directed by the clinical faculty with the white uniform jacket, nametag and school patch (see items above to be avoided in clinical areas). Students are to remember that whenever they are visiting a clinical agency or any clinical site, they represent UT Tyler and the College of Nursing and are expected to be professional in appearance and behavior at all times. 8 2. When student uniforms are required for clinical experiences, as specified by the course, the following guidelines must be adhered to: a) School patch on the front left of the uniform jacket and the top of the standardized uniform. b) The UTT name badge will be worn in all clinical setting. Name tag must be worn above the waist, so name and title are clearly visible. c) White or neutral nylon hose are worn with dress/skirt; nylon hose, knee-highs or white socks with pants. Socks must cover ankle. d) Clean, white clinical shoes or white leather athletic shoes should be worn (shoes may be mostly white and if stripes or logos are on shoes, these must be minimal and light colored). No canvas shoes or athletic shoes with colored stripes or large logos. e) Jewelry: wedding or engagement rings only; single stud earrings and only 1 in each lobe (no dangling or hoops); no rings or studs in the nose, tongue, lip or any other facial or body piercing (other body piercing must be covered or removed); and, no necklaces or bracelets (only Medic Alert). Must have a watch with a second hand. f) Make-up, hair, and grooming should be conservative. Hair shoulder length or longer must be pulled neatly back in a ponytail or bun. Hair clips, bands, etc. shall be functional, not decorative (no bows). Mustaches and beards will be neatly groomed, clean and trimmed. g) Tattoos must be covered and not visible. h) Nails are to be clean and neatly trimmed to no more than fingertip length, with clear or no polish. No artificial nails in OR or L & D. i) No perfume, after-shave or other strong scents since this causes nausea and /or difficulty in breathing for many patients. j) Gum chewing is not allowed k) Any question concerning adherence to the dress code should be directed toward the clinical instructor. 3. Failure to comply with the above requirements may result in an unexcused clinical absence and/or negative clinical evaluation. 4. If the dress code rules are broken and a change of clothes in not available, the student may be removed from the school-related function for the remainder of the day. Appropriate disciplinary action will be taken for repeated violations of this code. Course Information A. General 1. If lecture outlines are used, they will be posted on Blackboard a minimum of two (2) working days prior to class and will be removed at midnight prior class, 2. The clinical portion of the course syllabus, handouts, and any other required course materials will be placed on blackboard. 3. All submitted written material (papers, assignments, examinations, etc.) are the property of the College of Nursing. They will be maintained in an archived file in the College of Nursing. 4. The BSN/MSN Nursing Student Guide is available on the CON website http://www.uttyler.edu/nursing/ . The student must sign the statement indicating they have accessed the guide and return the signed Student Guide Affirmation Form to the program secretary for placement in the student file. (Responsibility of Level 1 faculty to include in syllabus) 5. There is NO ATI exam association with this course (only ATI Skills modules). 6. All nursing students are required to use their student email accounts for all correspondence (Approved FO: 2/03) Important phone numbers Tyler Campus College of Nursing Main number: 903-566-7320 Palestine Campus 903.727.2300 Longview Campus 903.663.8222 University Police 903.566.7300 Emergencies: 911 9 Laboratory Portion of Course B. Unsafe Clinical Practice 1. Any act of omission or commission, which may result in harm to the patient, is considered unsafe clinical practice, and may result in removal from the clinical setting, disciplinary action according to the discretion of the course faculty, a negative clinical evaluation, a course failure, and/or dismissal from the program. 2. During the clinical practicum, unsafe clinical practice is defined as any one of the following: When the student: a. Commits repetitive and/or a single, serious medication error. b. Violates or threatens the physical, psychological, microbiological, chemical, or thermal safety of the patient. c. Violates previously mastered principles/learning objectives in carrying our nursing care skills and/or delegated medical functions. d. Assumes inappropriate independence in action or decisions. e. Does not adhere to current CDC guidelines for infection control. f. Fails to recognize own limitations, incompetence, and/or legal responsibilities. g. Fails to accept moral and legal responsibility for his/her own actions thereby violating professional integrity as expressed in the Code of Ethics for Nurses. h. Arrives at clinical settings in an impaired condition as determined by the clinical instructor. 3. Failure to comply with any of the above requirements may result in an unexcused clinical and/or negative clinical evaluation. Policy Revision and approval: Spring 2006 Skills Laboratory Attendance is mandatory. Notification prior to lab of tardiness or absence is necessary. Student must leave a message on the instructor's voice message, including the telephone number where he/she may be contacted. Student must make up the missed work 1. Lab Rules a. Obtain lab assignment. b. Observe demonstration as appropriate. c. Set up privacy screens or pull drapes as necessary. d. Obtain exam gown and drape sheet as appropriate. e. Perform lab exercise on a different lab partner each class. f. Turn in documentation as directed g. Clean lab area. Replace table papers or make bed, etc. 2. Laboratory Equipment Check-out a. Certain assessment equipment may be checked-out through Skill Lab Coordinator. b. All supplies must be returned to the Skills Lab Coordinator. Failure to return equipment will result in failure of the course. 10 Mastery Skills will be evaluated by the lab instructor through student demonstration in the learning laboratory. A passing grade is achieved when the student can successfully demonstrate competency for that skill. If the student is unsuccessful remediation will be provided followed by re-demonstrate of the skill. If the student is unable to successfully perform any of the mastery skills during the semester, a clinical failure will result. NURS 3310 Mastery Skill Grading Criteria Check off with Lab Instructor, must accurately determine Vital Signs temperature, pulse, respiration, and blood pressure in a Temperature, pulse, patient (lab classmate) or simulation mannequin. May respirations and blood repeat at instructor’s discretion. pressure (manual reading) 100 Blood Pressures Student will complete 100 manual blood pressures. One AssignmentsmenuBBD person’s blood pressure may be repeated on different occasions up to 5 times. Students must turn in 100 Blood Pressure Sheet, on due date. Perform an practice assessment on a classmate with a peer Head to Toe Practicum Assignments menu BBD evaluating. Do another check off on selected Nursing Home patient with instructor check off. See expanded grading criteria on BBd. Lab breath sounds and Student must correctly identify specified heart sounds and heart sounds competency breath sounds. Must retest until sounds are correctly identified. Lab Focused assessment Student must correctly identify problems presented as case studies using simulation mannequins. Lab assignments Satisfactorily complete written laboratory assignments in the Written assignments Student Lab Manual corresponding with content selected weeks. Satisfactory completion of the written laboratory assignments includes work that is legible, correct, complete (with no blanks), and completed by the end of the lab period. Summary of Requirements Requirement Grading Criteria Exams X5 Simple Average of 75% MUST BE MET TO PASS THE COURSE Then items are weighted Four exams (15% each) Final Exam (20%) with percentages Health History (5%) Completed on acquaintance/family member. Grand Rounds Presentation Grand Rounds Resources on patient from N3603 clinical or (10%) comparison if student is not enrolled in N3603. Student must present Grand Rounds Daily Grade (5%) 5 assignments @ 1% each Skills in Lab: Pass/Fail Vital Signs Demonstrates competency on peer or vital sim mannequin. 100 Blood Pressures Demonstrates competency. Various acquaintances Head to Toe Practicum Demonstrates competency on Nursing home patient. Lab competency for breath Demonstrates competency while listening to audio. and heart sounds and focused assess 11 Pint out this page and complete each week in lab: Minute Paper: Take 1-2 minutes to complete these thoughts: Name: Date: Lab Topic: WK 1 The most important concept I learned in today’s lab was: What concept or concepts remain unclear from the information presented today in lab or lecture this week? In your own words, how would you describe the relationship between the health history and the review of systems? _______________________________________________________________________________________ Name: Date: Lab Topic: WK 2 The most important concept I learned in today’s lab was: What concept or concepts remain unclear from the information presented today in lab or lecture this week? In your own words, how would you explain the significance of a low blood pressure or hypotension? ________________________________________________________________________________________ Name: Date: Lab Topic: WK 4 The most important concept I learned in today’s lab was: What concept or concepts remain unclear from the information presented today in lab or lecture this week? In your own words, how would you explain the cause of wheezing? ________________________________________________________________________________________ Name: Date: Lab Topic: WK 6 The most important concept I learned in today’s lab was: What concept or concepts remain unclear from the information presented today in lab or lecture this week? In your own words, how would you describe the relationship between heart murmurs and heart valve stenosis? 12 Name: Date: Lab Topic: WK 9 The most important concept I learned in today’s lab was: What concept or concepts remain unclear from the information presented today in lab or lecture this week? In your own words, how would you describe the relationship between cataracts and the red reflex? ________________________________________________________________________________________ Name: Date: Lab Topic: WK 10 The most important concept I learned in today’s lab was: What concept or concepts remain unclear from the information presented today in lab or lecture this week? In your own words, how would you describe the relationship between peripheral neuropathy and the monofilament assessment? ________________________________________________________________________________________ Name: Date: Lab Topic: WK 12 The most important concept I learned in today’s lab was: What concept or concepts remain unclear from the information presented today in lab or lecture this week? In your own words, how would you describe the relationship between a decreased pulse and skin changes with peripheral arterial disease? 13 Overview of Units Because patients’ conditions can change rapidly, with life and death in the balance, nurses need to be able to grasp changes in the patient’s condition and integrate their knowledge and skills quickly and confidently. p. 29 from Educating Nurses: A Call for Radical Transformation (2010) Unit 1: Chapter 4 The Interview and Chapter 5 The Complete Health History Unit 2: Chapter 8 Assessment Techniques and the Clinical Setting; Chapter 9 General Survey, Measurement, Vital Signs; Chapter 11 Nutritional Assessment Unit 3: Chapter 18 Thorax and Lungs Unit 4: Chapter 19 Heart and Neck Vessels, Chapter 20 Peripheral Vascular System and Lymphatics Unit 5: Chapter 21 Abdomen; Chapter 24 Male Genitourinary System; Chapter 25 Anus, Rectum, and Prostate Unit 6: Chapter 13 Head, Face, Neck and Regional Lymphatics; Chapter 14 Eyes; Chapter 15 Ears; Chapter 16 Nose, Mouth, and Throat Unit 7: Chapter 23 Neurologic System, Chapter 6 Mental Status Assessment Unit 8: Chapter 22 Musculoskeletal System, Chapter 12 Skin, Hair, and Nails Unit 9: Chapter 17 Breasts and Regional Lymphatics, Chapter 26 Female Genitourinary System, Chapter 7 Domestic Violence Assessment Unit 10: Pediatric Assessment, Putting it All Together (Jeopardy Game) Unit 11: Grand Rounds Presentation Unit 12: Head to toe Assessment Unit 13: Reflective Videos Learning Objectives: After completing the Vital Signs Skills module on the ATI website and the health assessment lab for vital signs, the student will be able to: Describe the appropriate procedure for measuring a temperature Describe the appropriate procedure for assessing a normal pulse Describe the appropriate procedure for assessing a blood pressure Discuss normal and abnormal variations of vital signs. Describe pain assessment Discuss Oxygen saturation as an additional measure of vital signs Discuss the standards of care for blood pressure measurement based on evidence based practice online. Additional Evidence Based Practice information on difference between the bell and diaphragm for auscultating BPs: 1. http://www.guideline.gov/summary/summary.aspx?doc_id=6527&nbr=4093&ss=6&xl=999 Phase 1 (systolic) and phase 5 (diastolic) Korotkoff sounds are best heard using the bell of the stethoscope over the palpated brachial artery in the antecubital fossa, although some studies have shown that there is little difference when using the bell or the diaphragm. The key to good measurement is the use of a high-quality stethoscope with short tubing, because inexpensive models may lack good tonal transmission properties required for accurate auscultatory measurement. 2. Bell or diaphragm in the measurement of blood pressure? [J Hypertens. 2005] Kantola I, Vesalainen R, Kangassalo K, Kariluoto A. RESULTS: No statistically significant difference was seen between the bell side and the diaphragm side of the acoustic stethoscope, either in systolic blood pressure (SBP; mean +/- SD 129.5 +/- 21.7 and 129.4 +/- 20.8 mmHg, respectively) or diastolic blood pressure CONCLUSIONS: Both sides of the acoustic stethoscope give similar results in the measurement of office blood pressure and either side can be used in the reliable measurement of blood pressure. 14 Unit 1: Chapter 3 The Interview and Chapter 4 The Complete Health History Theory Objectives 1 Distinguish between subjective and objective data 2 Discuss the concept of health promotion related to health assessment 3. State the purpose of a complete health history 4. Identify the different types of health histories based on individual patient situations 5. Apply principles of therapeutic communication 6. Compare techniques that enhance and block effective communication. 7. Discuss individual patient needs (development, cultural, acuity) that require modified communication 8. Delineate types of data that belong under each of the following sections of the health history: a. Biographic data b. Reason for seeking care/Chief complaint c. Present health status/ History of present illness d. Past health history e. Family history f. Review of Systems g. Functional Assessment 9. Describe the eight characteristics included in the analysis of a symptom. 10. Discuss assessment of depressed patient who is at risk for suicide 11. Conduct a health history, assess environmental exposure, inform patients using clinical prevention activities like immunizations, cancer screening, and basic genetic health screening. 12. Collect data in a systematic and ongoing process (From Scope and Standards of Nursing Practice, Standard 1, Assessment) a. Document relevant data in a retrievable format b. Apply principles of infection control c. Apply principles of patient confidentiality d. Ensure accurate identification of the patient 13. Complete a Cultural Assessment. 14. Develop an awareness of patients as well as healthcare professionals’ spiritual Beliefs and values and how those beliefs and values impact health care. Laboratory Objectives 1. Demonstrate use of open-ended, close-ended, and directive questioning. 2. Draw a genogram for own family that includes three generations. 3. Accurately record the review of systems with a lab partner. 4. Describe the 8 health variables for a patient with low back pain. Suggested pre lab activity: Read/review selected chapters prior to lecture and lab. Lab activity: View and discuss appropriate and inappropriate interviewing techniques and therapeutic communication (links on BBD) Present Health History or Symptom Analysis (page 15 syllabus) Review of systems assignment on partner/will be graded by instructor (page 17-18 syllabus) Draw genogram including three generations View Medicine of Compassion and write reflection 15 Present Health History or Symptom Analysis Eight Critical Characteristics See text p. 77 (p. 50-51 6th ed) BH is a 32-year old male who presents with a complaint of back pain. He tells you he first noticed the pain two days ago after he helped move a heavy couch. He says the pain is severe and he says it is sharp, comes and goes, and radiates down his left leg. He has difficulty walking when the pain hits. The pain is unrelieved by OTC analgesics. He states, “The pain seems to be in the lower back area. It is worse when bending over at work and is better when lying down.” He also says he thinks he pulled a muscle when he helped a neighbor move. Complete the history of present illness for his chief complaint (CC) of back pain. Are there other questions you need to ask to complete the database? History of Present Illness or Present health status CC: The 8 Health variables: 1. Body location 2. Quality (character) 3. Quantity (severity) 4. Timing Onset Duration Frequency 5. Setting 6. Aggravating & alleviating factors 7. Associated factors 8. Client’s perception of the symptoms 16 View Medicine of Compassion DVD (long version) and write reflection 1. How did you feel while watching the video? 2. Can you describe similar experiences like in the video from personal situations? 3. What did you learn from watching the video and how might it influence your future nursing practice? 17 Review of Systems Assignment: peer interviewed Begin this assignment in lab. Complete and turn in the next lab Review of Systems: see textbook p. 80-82 (p. 54-59 6th ed) Note: do NOT include objective information or assessments you observe, this is subjective and only what the patient says. Student Examiner Name _______________________ Patient (initials only)_______ General overall health status: 1. 2. 3. Any weight loss or gain______________ and Weight_____ Height_____ BMI Skin: 1. 2. Hair and Nails: 1. 3. 2. 3. Health Promotion: Head: 1. 2. 3. Eyes: 1. 2. 3. 2. 3. Health Promotion: Ears: 1. Health Promotion: Nose and Sinuses: 1. 2. 3. Mouth and Throat: 1. 2. 3. Health Promotion: Neck: 1. 2. 3. Breast: 1. 2. 3. Health Promotion: (include for male as well) Axilla: 1. 2. 3. Respiratory System 1. 2. 3. Health Promotion: Cardiovascular: 1. 2. 3. Health Promotion: Peripheral Vascular: 1. Health Promotion 2. 3. 18 Gastrointestinal: 1. 2. 3. 2. 3. Health Promotion Urinary System: 1. Health Promotion Male Genital System/ Health Promotion or Female Genital System: 1. 2. 3. . Health Promotion Sexual Health (defer if personal relationship) Musculoskeletal: 1. 2. 3. Health Promotion Neurologic: 1. 2. 3. Health Promotion Hematologic: 1. 2. 3. . Endocrine: 1. 2. 3. Note: you may write across like: Breast: Denies lump, nipple discharge, or rash. Health Promotion: Has not had mammogram and does not perform self breast exam. Or you may list the items downward like: Skin: 1. States color change redness in face from neck up 2. Mole left side of face on cheek 3. Denies rash or lesions Health Promotion Always wears sunscreen and usually wears a hat when outdoors. Also, begin to identify someone you know, friend or family, who has or has had a problem you could analyze. It could be someone with a chronic problem like arthritis, migraine headaches, for example. It might be a one-time problem that happened in the past, like a grandfather who had a heart attack or stroke and for the analysis of the symptom, you use that instance for the data but all other information is current time or situation. It is important to find someone with a real problem and not something minor like a young adult with a broken toe or sinus infection. Also some diseases don’t have clear symptoms, like hypertension (the silent killer) or diabetes so if they choose that, they’ll need to identify some symptom like symptoms of low blood sugar of they have a headache with hypertension. 19 Unit 2: Chapter 8 Assessment Techniques and the Clinical Setting; Chapter 9 General Survey, Measurement, Vital Signs; Chapter 11 Nutritional Assessment Assessment Techniques, General Survey, Measurement, Nutrition 1. Describe the use of inspection, palpation, auscultation, and percussion as a physical assessment technique. 2. Differentiate between parts of the hand used for palpation techniques. 3. Differentiate between light, deep, and bimanual palpation 4. Discuss appropriate infection control measures used to prevent spread of infection. 5. Discuss developmental considerations in performing a physical assessment. 6. Discuss various tools used in a physical assessment (This objective accomplished during EENT advanced practice lab) 7. Discuss the purpose of a general survey 8. List the information considered in each of the four general areas of general survey 9. Discuss developmental considerations in a general survey 10. Discuss how to evaluate a client’s weight and height 11. Determine appropriate documentation. 12. Based on patient data, determine priority of assessment 13. Discuss subjective information related to a nutritional assessment. 14. Discuss unique developmental considerations when performing a nutritional assessment 15. Discuss components of a nutritional assessment 16. Discuss common nutritional variations 17. Describe variations for BMI 18. Discuss ways to ensure accurate identification of patients Suggested pre lab activity: Read/review selected chapters prior to lecture and lab. Lab Activity: Complete a brief general survey and begin applying principles of vital signs assessments. Complete ATI Vital Signs module and bring stethoscope to lab for Vital signs demonstrations and check off 20 Lab Written Assignment for Content: Assessment Techniques, General Survey, Measurement and Vital Signs Date ________________ Examiner ____________________________________ General Survey of Patient See text p.148‐150 (p. 127‐129 6th ed) (Initials of the client) _________ is a ______ year old _____ who appears or/ doesn’t appear stated age. She is ________________ (Level of consciousness) and _________(oriented), ___________ (cooperative, hostile, crying) with no acute signs of distress (acute pain or respiratory distress) or/ with acute distress. Measurement and Vital Signs 1. Weight ______ Height ______ BMI ______ 2. Vital Signs Temperature _____ Pulse ______ Resp ______ BP ________/_________ 21 Unit 3: Chapter 18 Thorax and Lungs Theory Objectives 1. Identify landmarks for a respiratory assessment. 2. Relate the relevant subjective information in an assessment of the respiratory system. 3. Discuss health promotion practices that are pertinent to the respiratory system. 4. Identify equipment appropriate to the examination of the respiratory system. 5. Describe appropriate inspection, palpation, auscultation, percussion and positioning techniques used in the examination of the respiratory system. 6. Discuss the developmental considerations associated with the respiratory assessment 7. Compare abnormal findings in a thorax and lung assessment. 8. Discuss characteristics of normal breath sounds. 9. Describe adventitious breath sounds. 10. Compare respiratory disease assessment findings. 11. Recognize respiratory distress signs and symptoms. The following objectives may be included in each lecture: From Scope and Standards of Nursing practice, Standard 1, Assessment Collect data in a systematic and ongoing process Document relevant data in a retrievable format Apply principles of infection control Apply principles of patient confidentiality Ensure accurate identification of the patient Laboratory Objectives 1. Begin Head to Toe Mastery Skills: Skin, Neuromuscular & Pulmonary 2. Listen and recognize normal and abnormal (wheezing, crackles) breath sounds in lab by testing. Suggested pre lab activity: Pre-class/lab Learning Assignments include reading/reviewing corresponding chapters in the text prior to class. View corresponding video/DVD for that system. Portions of this content will be evaluated on a unit exam and the final exam. Lab activity: Check-off competency of Mastery Skill: Posterior & Anterior breath sounds, technique & position with stethoscope/ Skin, Neuromuscular & Pulmonary Breath sounds competency in lab Crackles: Sim man ____________ Respiratory rate_____ Wheezes: Sim man ____________ Respiratory rate_____ Normal breath sounds: Sim man ____________ Respiratory rate_____ Assess the oxygen saturation with the pulse oximter: O2 sat_________% p. 150 6th ed 22 Unit 4: Chapter 19 Heart and Neck Vessels, Chapter 20 Peripheral Vascular System and Lymphatics Theory Objectives 1. Recall the anatomy and physiology of the heart and peripheral vascular system. 2. Relate the relevant subjective information in an assessment of the heart and peripheral vascular system 3. Discuss health promotion practices that are pertinent to the heart and peripheral vascular system 4. Identify equipment appropriate to the examination of the heart and peripheral vascular system 5. Describe appropriate inspection, palpation, auscultation, and positioning techniques used in the examination of the heart and peripheral vascular system 6. Describe expected findings, minor variations, variations related to age, race, gender that may be found on examination of the heart and peripheral vascular system 7. Cite risk factors associated with heart disease, peripheral vascular disease and stroke. 8. Describe normal and abnormal findings of heart sounds. 9. Recognize normal and abnormal findings of the heart and peripheral vascular system 10. Determine appropriate documentation. 11. Based on patient data, determine priority of assessment 12. Compare venous and arterial disease of the peripheral blood vessels Laboratory Objectives 1. Demonstrate Head to Toe Mastery Skills: Cardiovascular & Gastrointestinal 2. Demonstrate proper technique for performing the Allen test and using the Doppler to assess an arterial pulse. 3. Listen and recognize normal and abnormal heart sounds (murmur and extra heart sound or gallop) in lab by testing. Suggested pre lab activity: Pre-class/lab Learning Assignments include reading/reviewing corresponding chapters in the text prior to class. View corresponding video/DVD for that system. Portions of this content will be evaluated on a unit exam and the final exam. Lab activity: over 2 labs Check off Head to Toe Mastery Skills: Cardiovascular & Gastrointestinal Draw diagram to help you remember Head to Toe Assessment Heart Sounds Competency in lab S1 S2 : Sim man ____________ Heart rate_____ Gallop or extra heart sound: Sim man ____________ Heart rate_____ Murmur: Sim man ____________ Heart rate_____ Assess a peripheral pulse with the Doppler: example documentation: R dorsalis pedis pulse heard by Doppler p. 516 6th ed __________________________________________________________________________________ 23 Questions for the reflection after See Me video SEE ME Video 1. How did I feel while watching the video? 2. How are the situations in the video like something I have experienced? 3. What did you learn from watching the video and how might it influence your future nursing practice? 24 Unit 5: Chapter 21 Abdomen; Chapter 24 Male Genitourinary System; Chapter 25 Anus, Rectum, and Prostate Theory Objectives 1. Recall anatomy and physiology of the abdomen, and identify the organs in the 4 quadrants. 2. Relate the relevant subjective information in an assessment of the abdomen. 3. Discuss health promotion practices that are pertinent to the abdomen. 4. Identify equipment appropriate to the examination of the abdomen. 5. Describe appropriate inspection, palpation, auscultation, percussion, and positioning techniques used in the examination of the abdomen. 6. Describe expected findings, minor variations, variations related to age, race, gender that may be found on examination of the abdomen. 7. Identify common causes of abdominal distention. 8. Recall anatomy and physiology of the male genitalia. 9. Relate the relevant subjective information in an assessment of the male genitalia and urinary system. 10. Discuss health promotion practices that are pertinent to the male genitalia. 11. Identify equipment appropriate to the examination of the male genitalia. 12. Describe appropriate inspection, palpation, and positioning techniques used in the examination of the male genitalia. 13. Describe expected findings, minor variations, variations related to age, race, gender that may be found on examination of the male genitalia. 14. Identify male genital lesions and abnormalities of the scrotum. 15. Identify abnormalities of the penis 16. Recall anatomy and physiology of the anus, rectum, and prostate. 17. Relate the relevant subjective information in an assessment of the anus, rectum, and prostate. 18. Discuss health promotion practices that are pertinent to the anus, rectum, and prostate. 19. Identify equipment appropriate to the examination of the anus, rectum, and prostate. 20. Describe appropriate inspection, palpation, and positioning techniques used in the examination of the anus, rectum, and prostate. 21. Describe expected findings, minor variations, variations related to age, race, gender that may be found on examination of the anus, rectum, and prostate. 22. Identify abnormalities of the rectum 23. Identify abnormalities of the prostate gland 24. Determine appropriate documentation. 25. Based on patient data, determine priority of assessment Note: omit physical exam of male genitalia and rectum. Suggested pre lab activity: Pre-class/lab Learning Assignments include reading/reviewing corresponding chapters in the text prior to class. View corresponding video/DVD for that system. Portions of this content will be evaluated on a unit exam and the final exam. Lab this week: instructor check off at nursing home 25 Unit 6: Chapter 13 Head, Face, Neck and Regional Lymphatics; Chapter 14 Eyes; Chapter 15 Ears; Chapter 16 Nose, Mouth, and Throat Theory Objectives Upon completion of this unit, the student should be able to: 1. Recall anatomy and physiology of the head and neck assessment and lymphatic system 2. Relate the relevant subjective information in an assessment of the head and neck assessment and lymphatic system 3. Identify equipment appropriate to the examination of the head and neck assessment and lymphatic system 4. Describe appropriate inspection, palpation, of the head and neck assessment and lymphatic system 5. Describe expected findings, minor variations, variations related to age, race, gender that may be found on examination of the head and neck assessment and lymphatic system 6. Identify the structures and landmarks of the neck. 7. Identify abnormal findings associated with the exam of the head and neck. 8. Identify developmental considerations in the head and neck exam. 9. Recall anatomy and physiology of the eyes. 10. Relate the relevant subjective information in an assessment of the eyes. 11. Discuss health promotion practices that are pertinent to the eyes. 12. Identify equipment appropriate to the examination of the eyes. 13. Describe appropriate inspection, palpation, and positioning techniques used in the examination of the eyes. 14. Describe expected findings, minor variations, variations related to age, race, gender that may be found on examination of the eyes. 15. Understand abnormalities of the eyes 16. Recall anatomy and physiology of the ears. 17. Relate the relevant subjective information in an assessment of the ears. 18. Discuss health promotion practices that are pertinent to the ears. 19. Identify equipment appropriate to the examination of the ears. 20. Describe appropriate inspection, palpation, and positioning techniques used in the examination of the ears. 21. Describe expected findings, minor variations, variations related to age, race, gender that may be found on examination of the ears. 22. Compare abnormalities of the ear including the tympanic membrane 23. Identify expected and abnormal findings of tuning fork tests. 24. Recall anatomy and physiology of the nose, mouth, and throat. 25. Relate the relevant subjective information in an assessment of the nose, mouth, and throat. 26. Discuss health promotion practices that are pertinent to the nose, mouth, and throat. 27. Identify equipment appropriate to the examination of the nose, mouth, and throat. 28. Describe appropriate inspection, palpation, and positioning techniques used in the examination of the nose, mouth, and throat. 29. Describe expected findings, minor variations, variations related to age, race, gender that may be found on examination of the nose, mouth, and throat. 30. Compare abnormalities of the nose, mouth, and throat. 31. Determine appropriate documentation. 32. Based on patient data, determine priority of assessment Pre-class/lab Learning Assignments include reading/reviewing corresponding chapters in the text prior to class. View corresponding video/DVD for that system. Portions of this content will be evaluated on a unit exam and the final exam. 26 Lab activity: Turn in this page or have instructor check Examiner Name _______________________ Advanced Assessment Techniques 1. Otoscope Text reference p. 138 (p. 119 6th ed) Attach otoscope head Turn on Select largest speculum that fits comfortably in the ear Look in the ear of a peer (text reference p. 352‐3) (331‐333 6th ed) Pull pinna up and back Visualize pearly gray tympanic membrane ****Bonus**** identify cone of light and bony landmarks Chapter 15 Ears Document the following for Testing hearing acuity: Whispered voice test:_____________________________________ 2. Ophthalmoscope Text reference p. 138 (p. 120 6th ed) Attach ophthalmoscope head Turn on Text reference p. 317 follow instructions (p. 297‐298 6th ed) Visualize red reflex of a peer and discuss why it is significant? ****Bonus**** identify retinal background, yellow optic disc, and retinal blood vessels (the only place in the body you can see blood vessels!!) Chapter 14 Eye Document the following for the physical examination of the eye: p. 287‐8 6th ed 1. Test visual acuity: a. Snellen eye chart: R Eye__________ L Eye ________ Both eyes______ b. Pocket/Rosenbaum chart for near vision: Both eyes __________ 2. Inspect extraocular muscle function: a. Corneal light reflex ___________ b. Cover test __________________ c. Diagnostic positions test or EOMs or Six cardinal fields of gaze _________________ 27 NURSING HOME (NH) EXPERIENCE Reflection 1. How did I feel about going to the nursing home? 2. What did you learn from this experience? 3. How might I use this NH experience to guide my future nursing practice? 4. How was this different from practicing on a peer? 28 Unit 7: Chapter 23 Neurologic System, Chapter 6 Mental Status Assessment Neurological System and Mental Status Theory Objectives 1. Recall anatomy and physiology of the neurologic system. 2. Relate the relevant subjective information in an assessment of the neurologic system. 3. Discuss health promotion practices that are pertinent to the neurologic system. 4. Identify equipment appropriate to the examination of the neurologic system. 5. Describe appropriate inspection, palpation, percussion, and positioning techniques used in the examination of the neurologic system. 6. Describe expected findings, minor variations, variations related to age, race, gender that may be found on examination of the neurologic system. 7. Identify expected and unexpected findings associated with the cranial nerves. 8. Describe exams that assess cerebellar function 9. Describe exams that assess sensory function 10. Describe the different deep tendon reflexes including normal and abnormal responses 11. Discuss abnormalities of the neurologic system 11. Determine appropriate documentation. 12. Based on patient data, determine priority of assessment 13. Compare normal and abnormal findings related to the Glasgow Coma Scale 14. Compare neurological disease assessment findings. 15. Describe the following components of a mental status exam: appearance, behavior, cognition, and thought processes. 16. Discuss developmental considerations of the mental status examination. 17. Discuss measures and tests of cognitive functioning including memory. 18. Discuss examples of abnormalities of thought content 19. Relate the relevant subjective information in an assessment of the mental status exam 20. Describe the characteristics of major depression and potential safety issues. 21. Describe abnormalities of mood and affect 22. Describe delirium and dementia 23. Determine appropriate documentation. 24. Based on patient data, determine priority of assessment Suggested pre lab activity: Pre-class/lab Learning Assignments include reading/reviewing corresponding chapters in the text prior to class. View corresponding video/DVD for that system. Portions of this content will be evaluated on a unit exam and the final exam. 29 Lab activities: Turn in to instructor 1. Complete a Mini-Cog exam: Repeat after me these three words: 1. 2. 3. Draw a clock face then draw the hands of the clock to read 11:10 Now repeat the three words 2. Demonstrate knowledge of the neurologic system by assessing cranial nerves, cerebellar function, sensory system, motor system, and deep tendon reflexes. 3. Use your text book Chapter 23 and document the following: 4. Cranial Nerves: describe the expected findings when tested a. I _______________________________________________ b. II ______________________________________________ c. III, IV, VI_________________________________________ d. V_______________________________________________ e. VII______________________________________________ f. VIII_____________________________________________ g. IX, X____________________________________________ h. XI______________________________________________ i. XII______________________________________________ 5. Cerebellar function: describe the expected findings when tested a. Gait ____________________________________________ b. Romberg test ____________________________________ c. Rapid alternating movements _______________________ d. Finger to finger test _______________________________ e. Finger to nose test ________________________________ f. Heel to shin test ___________________________________ 6. Sensory system: describe the expected findings when tested a. Pain __________________________________________ b. Light touch_______________________________________ c. Vibration_________________________________________ d. Position sense or proprioception or kinesthesia___________ e. Stereognosis______________________________________ f. Graphesthesia_____________________________________ g. Monofilament: perform assessment of a peer’s foot using monofilament ______________________________________________________ 7. Test the following reflexes and describe the expected reaction (0 to 4+) 2+ is normal or expected a. Biceps ____________ b. Triceps_____________ c. Brachoradialis________ d. Patellar_____________ e. Achilles____________ f. Plantar/Babinski_______ (neg or pos) 30 Laboratory Activity coordinating with week of Exam 3 Sim Man activities and view Compassion in Action DVD and write reflection 4. How did I feel while watching the video? 5. Can you describe similar experiences like in the video from your clinical experience so far? 6. What did you learn from watching the video and how might it influence your future nursing practice? 31 Student Sim Man Lab Examiner Name _______________________ 1. Mr. Jones is 76 and has been short of breath for the past week. He woke up in the night with SOB and comes to the ER, he was put on O2, a cardiac monitor, and an IV was started. He has peripheral edema and dyspnea on exertion. Take his vital signs and based on the history and vital signs, What do you think is going on? What would a nurse do? Adult 1 Pulse Heart sounds Resp rate Lung sounds BP 2. Mrs. Smith had a colon resection with a 10 cm incision midline in her abdomen this morning. Based on the history and her vital signs, What do you think is going on? What would a nurse do? Adult 2 Pulse Heart sounds Resp rate Lung sounds BP160/100 3. Alex is a 12 year old boy that just got back from visiting his grandmother who has 2 inside dogs. He is short of breath, based on his history and vital signs, What do you think is going on? What would a nurse do? Adolescent Pulse Heart sounds Resp rate Lung sounds 4. Baby Michelle (1 year old) is being checked for a well baby exam. Based on the history and vital signs, What do you think is going on? What would a nurse do? Baby Heart rate sounds Resp rate Breath sounds NOTE: these case studies may be updated by the lab instructor or varied. 32 Unit 8: Chapter 22 Musculoskeletal System, Chapter 12 Skin, Hair, and Nails Theory Objectives 1. Recall anatomy and physiology of the musculoskeletal system. 2. Relate the relevant subjective information in an assessment of the musculoskeletal system. 3. Discuss health promotion practices that are pertinent to the musculoskeletal system. 4. Identify equipment appropriate to the examination of the musculoskeletal system. 5. Describe appropriate inspection, palpation, specific exams, and positioning techniques used in the examination of the musculoskeletal system 6. Describe expected findings, minor variations, variations related to age, race, gender that may be found on examination of the musculoskeletal system. 7. Identify abnormalities of the bones, joints, spine, and ligaments and muscles (rheumatoid arthritis, carpal tunnel syndrome, osteoporosis, and osteoarthritis) 8. Determine appropriate documentation. 9. Based on patient data, determine priority of assessment Skin, Hair and Nails and Nutritional Assessment Theory Objectives Upon completion of this unit, the student should be able to: 1. Describe significant differences between skin in the developmental stages. 2. Describe the differences between basal cell carcinoma and melanoma. 3. Discuss subjective information collected for a skin, hair, and nail assessment. 4. Discuss health promotion practices that are pertinent to the skin. 5. Describe the techniques for inspection and palpation of the skin. 6. Describe the techniques for inspection and palpation of the hair. 7. Describe the technique for inspection and palpation of the nails. 8. Differentiate between common shapes and configurations of lesions. 9. Identify common skin lesions. 10. Identify abnormal conditions of hair. 11. Identify abnormal conditions of the nails. 12. Based on patient data, determine priority of assessment Lab Assignment Suggested pre lab activity: Pre-class/lab Learning Assignments include reading/reviewing corresponding chapters in the text prior to class. View corresponding video/DVD for that system. Portions of this content will be evaluated on a unit exam and the final exam. Lab activity: View Wound module, see next page 33 Student guide for NDQI Skin modules Wound types and skin injuries often misclassified as pressure ulcers include: Skin Tears Venous Ulcers Arterial Ulcers Diabetic Ulcers Perineal (Incontinence Associated) Dermatitis Skin Tears A wound resulting from: separation of the epidermis from the dermis OR separation of both epidermis and dermis from underlying tissue Risk Factors Older age Immobility Dependence in ADLs Compromised nutrition or hydration status Past history of _____________ Causes : Unknown, Wheelchair/geriatric chair Bumping into objects Transfers and falls Tape removal/adhesive dressing _____________ Location: Arms and hands, Lower extremities and other body areas Associated Skin Characteristics Thin skin due to loss of the subcutaneous fatty layer Less elastic skin Surrounding purpura or ecchymosis in aged Associated Wound Characteristics: Epidermal flap may cover or partially cover the wound or be lost Classification System: Skin tears are categorized using the Payne‐Martin Classification System for Skin Tears o Category I to III according to the amount of tissue loss and epidermal flap loss Epidermal stripping may be classified as a type of skin tear that is found in the _____________ population. Risk Factors: Neonatal prematurity – epidermal stripping is more common in neonates born before 27 weeks gestation Associated Skin Characteristics: Thin skin as subcutaneous fat layer may not be fully _____________ Causes : _____________ removal/adhesive dressing removal 34 Arterial Ulcers A wound caused by impaired arterial _____________ to the lower leg and foot. Impairment in blood flow results in tissue ischemia, necrosis and loss. Location: Toes, foot, malleolus Associated Skin Characteristics _____________ skin temperature Thin, shiny skin _____________ skin hair Painful o Pain may increase when the leg is elevated o Pain may decrease or be relieved when the leg is in a dependent position Decreased pulse strength in extremity Associated Wound Characteristics _____________ exudate _____________ wound bed; necrotic tissue may cover the wound Well defined wound margins Classification System: Arterial ulcers are usually classified as partial thickness or full thickness wound Venous Ulcers A wound caused by a decrease in blood flow _____________ from the lower extremities to the heart Risk Factors Older age Previous history of venous disease or thrombophlebitis Female Pregnancy Obesity Occupation that involves standing for a long period Location Between the knee and the ankle Usually between the _____________ and ankle in the area covered by a sock Associated Skin Characteristics Hyperpigmentation of lower calf and ankle skin from hemosiderin staining Firm/hardened skin Dry scaly skin; may be itchy Edema Associated Wound Characteristics Often shallow Irregular margins 35 Drainage Classification System : Venous ulcers are usually classified as partial thickness or full thickness wounds Diabetic Ulcers: An ulcer that occurs in persons with diabetes. Contributing causes: Sensory, motor, and autonomic _____________ Peripheral vascular disease with poor microvascular circulation Repetitive trauma, unperceived pressure, or friction/shear Poor control of _____________ levels Location: Usually on metatarsal head, top of toes, and foot Associated Skin Characteristics Dry, cracked skin Warm skin Decreased sensation (neuropathy) Charcot's foot Associated Wound Characteristics Regular wound margins Callus around wound Perineal (Incontinence Associated) Dermatitis A skin irritation that occurs from urinary or fecal _____________ Can lead to inflammation, erosion, and/or secondary infection. Location Buttocks, perineum, and upper thighs Diaper dermatitis is a type of perineal (incontinence associated) dermatitis commonly found in the diaper wearing infant/pediatric population. Similar to adult perineal (incontinence associated) dermatitis, fungal/yeast infections may occur in diaper dermatitis. The test is comprised of 8 pictures of wounds. What is a Pressure Ulcer? A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. Pressure ‐ Pressure is the force that is applied vertically or perpendicular to the surface of the skin. Pressure compresses underlying tissue and small blood vessels hindering blood flow and nutrient supply. Tissues become ischemic and are damaged or die. Shear ‐ Shear occurs when one layer of tissue slides horizontally over another, deforming adipose and muscle tissue, and disrupting blood flow (e.g. when the head of the bed is raised > 30 degrees). Pressure Ulcer Locations: Bony prominences Occiput Ear 36 Scapula Spinous Process Shoulder Elbow Iliac Crest Sacrum/Coccyx Ischial Tuberosity Trochanter Knee Malleolus Heel Toe * Pressure Ulcer Staging Significance The rising number of pressure ulcers in hospitalized patients has captured national attention and driven initiatives to reduce hospital acquired pressure ulcer occurrence. The Centers for Medicare and Medicaid Services (CMS) has determined that they will no longer pay for the treatment of Stage III and IV pressure ulcers that develop during a patient's hospital stay. * Differentiating between a community acquired pressure ulcer (one that developed before hospital admission) and a hospital acquired pressure ulcer (one that developed after hospital admission) is essential to appropriate reimbursement of treatment costs Pressure Ulcer Locations Any Skin Surface Subjected to Excess Pressure Examples include skin surfaces under: * Oxygen tubing * Drainage tubing * Casts * Cervical collars * Other medical devices Common Pressure Ulcer Locations in Neonates and Children Occiput, Scapula, Chest, Sacrum/Coccyx, Buttocks, Heels Pressure Ulcer Staging: Pressure Ulcers are ________ (classified) to reflect the level of tissue injury or damage. * Category/Stage I * Category/Stage II * Category/Stage III * Category/Stage IV * Unstageable/Unclassified * Suspected Deep Tissue Injury Ulcer stage at the time of assessment may appear less than the stage documented in the patient’s record if the ulcer has started to heal. The pressure ulcer should be staged according to the maximum anatomic depth of tissue damage. 37 Healing ulcers should not be reverse staged. * A Stage IV pressure ulcer cannot become a Stage III, Stage II or Stage I pressure ulcer, etc. Descriptions of the pressure ulcer stages that follow include the terms Partial Thickness and Full Thickness. A partial thickness wound involves only the epidermis and dermis. A full thickness wound involves the epidermis and dermis and extends into deeper tissues (subcutaneous fat, muscle, etc.). Category/Stage I Pressure Ulcer Intact skin with non‐blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area. Category/Stage II Pressure Ulcer Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. Stage II pressure ulcers may also present as an intact or open/ruptured serum‐filled or serosangineous‐filled blister. Category/Stage III Pressure Ulcer Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Some slough may be present. Stage III pressure ulcers may include undermining and tunneling. Category/Stage IV Pressure Ulcer Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present. These ulcers often include undermining and tunneling. Unstageable/Unclassified Pressure Ulcer Full thickness tissue loss in which the base of the ulcer is completely covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed. Suspected Deep Tissue Injury Purple or maroon localized area of discolored intact skin or blood‐filled blister due to damage of underlying soft tissue from pressure and/or shear Pressure Ulcers on Mucous Membranes can develop on mucous membranes from pressure exerted by a medical device in use at the location of the ulcer. The staging system for pressure ulcers of the skin cannot be used to stage mucosal pressure ulcers because the histology of mucous membrane tissue is different than skin. * Nonblanchable erythema cannot be seen in mucous membranes * It is difficult to distinguish between partial thickness and full thickness tissue loss as tissue layers are thin * Exposed muscle would seldom be seen * Bone is not present in mucous membrane tissue Healing and Closed/Healed Pressure Ulcers/Wound healing occurs in phases ‐ * Inflammation * Proliferation * Maturation Pressure Ulcer Staging Test 12 questions https://www.nursingquality.org/NDNQIPRESSUREULCERTRAINING/Module2/Default.aspx reference site 38 Unit 9: Chapter 17 Breasts and Regional Lymphatics, Chapter 26 Female Genitourinary System, Chapter 7 Domestic Violence Assessment TheoryandLabObjectives 1. Recall anatomy and physiology of the female genitalia. 2. Relate the relevant subjective information in an assessment of the female genitalia. 3. Discuss health promotion practices that are pertinent to the female genitalia. 4. Discuss expected findings and procedures for the pelvic exam. 5. Describe appropriate inspection, palpation, and positioning techniques used in the examination of the female genitalia. 6. Describe expected findings, minor variations, variations related to age, race, gender that may be found on examination of the female genitalia. 7. Compare abnormalities of external female genitalia. 8. Compare abnormalities of female pelvic musculature. 9. Identify risk factors for cervical and ovarian cancer 10. Identify signs and symptoms and patient education regarding sexually transmitted diseases 11. Compare abnormalities of the cervix and vulvovaginal inflammations. 12. Recall anatomy and physiology of the breasts and regional lymphatics. 13. Relate the relevant subjective information in an assessment of the breasts and regional lymphatics. 14. Discuss health promotion practices that are pertinent to the breasts and regional lymphatics. 15. Identify equipment appropriate to the examination of the breasts and regional lymphatics. 16. Describe appropriate inspection, palpation, and positioning techniques used in the examination of the breasts and regional lymphatics. 17. Describe expected findings, minor variations, variations related to age, race, gender, and pregnancy that may be found on examination of the breasts and regional lymphatics. 18. Identify risk factors and signs of breast cancer. 19. Compare disorders occurring during lactation. 20. Discuss abnormal findings related to a breast exam 21. Discuss breast cancer and other abnormalities of the male breast. 22. Determine appropriate documentation. 23. Based on patient data, determine priority of assessment Domestic Violence Objectives 1. Recognize health care professional’s role as mandatory reporters of domestic violence. 2. Explain the aspects of assessment and history taking for suspected domestic violence. 3. Compare assessment findings consistent with domestic violence. 4. Recognize the difference between physical abuse, physical neglect, unintentional neglect, psychological abuse, and psychological neglect 5. Recognize causes for patterned injury Unit 10: Pediatric Assessment Pediatric Objectives 1. Describe the aspects of a thorough pediatric history, including differences for developmental levels. 2. Describe the components of a thorough pediatric physical assessment, noting the differences between infants, young children and adolescents. 3. Recognize significance of APGAR scores. 39 Unit 11: Head to Toe Assessment Objectives 1. Engage in community-based activity (nursing home head to toe assessment experience) to promote collaboration and advocacy. 2. Use simulation activities in the laboratory setting to analyze physical assessment data. 3. Engage in caring and healing techniques that promote a therapeutic nurse-patient relationship. 4. Conduct a comprehensive, focused physical assessment using developmentally and culturally appropriate approaches. Unit 12: Grand Rounds Presentation Objectives 1. Apply evidence-based practice article results to a case study or comparison. 2. Use electronic database search strategies to obtain references for case study. 3. Use an oral/visual presentation (Grand Rounds Presentation) to disseminate case study. Unit 13: Reflective Videos Objectives 1. After viewing “See Me” that illustrates age bias and then going to the nursing home to perform a head to toe assessment, students will reflect on their actions and values to promote ongoing selfassessment and commitment to excellence in practice. 2. Participate in a values clarification exercise by watching the videos “The Medicine of Compassion” and “Compassion in Action” and write a reflective paper that describes how watching the video will change the student’s practice. 3. Recognize the impact of attitudes, values, and expectations on the care of frail older adults and other vulnerable populations. 40 Student Affirmation Form _____I agree to protect the privacy of faculty, peers, patients, and family members of patients by not inappropriately disclosing confidential information about faculty, peers, patients or their family members that is disclosed to me in my capacity as a University of Texas at Tyler nursing student. In addition, I agree not to inappropriately disclose confidential information about any agency or institution that is disclosed to me in my capacity as a University of Texas at Tyler nursing student. I will adhere to HIPAA guidelines. _____I have/will read the syllabus of this nursing course I am taking this semester, and I understand the criteria established for grading my course work. I understand that my average on exams must be 75 or higher in order to attain a passing grade for the course. ____ I agree that I will conduct myself in a manner that exhibits professional values and in accordance with the American Nurses Association (ANA) Code of Ethics for Nurses, the Texas Nurse Practice Act and UTT’s Student Academic Dishonesty Policy. ____ I will maintain and uphold the academic integrity policy of the College of Nursing and will not condone or participate in any activities of academic dishonesty including, but not limited to, plagiarism, cheating, stealing, or copying another’s assigned work. ____ I will not recreate any items or portions of any exam for my own use, or for use by others during my enrollment in the College of Nursing ____ I will not accept or access any unauthorized information related to any exam administered during my enrollment in the College of Nursing. ____ I will sign only my own papers and other documents and will not sign any other student's name to anything, including class rolls. ____ I will not allow any other student access to any of my paperwork for the purpose of copying. _ Student’s Signature _____________________________________ Student’s Printed Name Approved: University of Texas System-Spring 1996 Faculty Organization-Spring 1996 Faculty Organization: December 8, 2000 Revised: Fall 2000; May 2004, Summer 2005 Date NURS 3310 Course 41 AUDIO/VIDEO-RECORDING AGREEMENT I have been given permission to record the following class, NURS _3310_____. I understand that, the recordings are for my personal studies only. I realize that lectures recorded may not be shared with other people without the written consent of the faculty member. I also understand that recorded lectures may not be used in any way against the faculty member, other lecturer, or students whose classroom comments are recorded as part of the class activity. I am aware that the information contained in the recorded lectures is protected under federal copyright laws and may not be published or quoted without the expressed consent of the lecturer and without giving proper identity and credit to the lecturer. I agree to abide by these guidelines with regard to any lectures I record while enrolled as a student at The University of Texas at Tyler. Due to the confidential nature of some course content, I agree to provide written documentation of the erasure of any recordings made during the current semester. Failure to return this written documentation to the faculty by the date of the final examination will result in a grade of “I” (Incomplete). _____________________________________ Print Name ________________ Date ____________________________________ Signature of Student NURS ___3310__________ Course Number I have erased all recordings made during this current semester in NURS __3310_______. (sign this at the end of the course) ____________________________________ Signature of Student (Revised with permission from TCU Approved FO: 10/06) _________________ Date
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