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Module One: Introduction to the Course & Implementing Clinical Reasoning in Practice
Post to the discussion board a planned approach to communicating with someone who speaks another language. What type of questions will you need to ask? Was there any communication issues discussed this week in Shadow Health?
How does communication impact the concept of clinical reasoning in nursing? Please discuss the issues completely, citing your sources so that your classmates can reference the information. Include one insight gained this week from your readings or interaction in Shadow Health.
Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Discussion Participation Guidelines & Grading Criteria.
Write a three-page paper on the use of clinical reasoning in developing and applying advanced health history and physical assessment skills at the graduate level. Consider contemporary nursing literature on the development of clinical reasoning and decision-making.
How does the use of the nursing process enhance critical thinking, clinical reasoning, and clinical judgment in professional nursing practice at the graduate level. Please use the submission parameters and rubric below to guide you when completing this assignment.
For this written assignment, please use the following guidelines and criteria. Also, please refer to the rubric for point allocation and assignment expectations. The expected length of the paper is approximately 3 pages, which does not include the cover page and reference page(s).
I. Introduction (including purpose statement)
II. Clinical Reasoning
III. Nursing Process
IV. Clinical Example
V. Conclusion
VI. References (consider contemporary nursing research studies or reliable electronic sources)
Competency
30
27
25
0
Points
Define, compare and contrast clinical reasoning and decision-making. How is this related to critical thinking and clinical judgment in graduate level nursing practice?Defines, compares, and contrasts clinical reasoning and decision-making with cited references in addition to course readings for Week 1.Module Two: HEENT and Skin Assessment
This week you have studied advanced physical assessment of the eyes, ears, nose, throat, head, neck and skin (HEENT). Describe the classification of rashes. What additional resources for HEENT advanced health assessment skills have you found beneficial in developing your knowledge and psychomotor skills this week? Post a concept to the discussion board that you have had difficulty with and note where you are with resolution of your difficulties.
Please describe the issue completely, citing your sources so that your classmates can reference the information and provide additional “clinical pearls”. In other words, please include primary sources and/or reliable electronic sources to support your arguments.
Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Discussion Participation Guidelines & Grading Criteria.
Skin rashes are temporary disruptions of the skin. Dermatological disorders are classified according to lesion type (Primary), lesion configuration (Secondary), texture, location and distribution, and color.
1. Macules – flat, <10 mm; large macula is called patch (rubella)
2. Papules – elevated, <10 mm (acne)
3. Plaques – elevated/depressed, >10 mm (psoriasis)
4. Nodules – firm papules extending to dermis or subcutaneous tissue (cysts)
5. Vesicles – clear, vesicle, fluid-filled blisters <10 mm (herpes infections)
6. Bullae – clear fluid-filled blister >10 (allergic contact dermatitis)
7. Pustules – pus-filled vesicle (pustular psoriasis)
8. Urticaria – red pruritic wheals or hives (medication allergies)
9. Scale -horny epithelium (seborrheic dermatitis)
10. Crusts /Scabs – (impetigo)
11. Erosions – open skin areas (excoriation)
12. Ulcers – epidermal loss (decubitus)
13. Petechiae – hemorrhage (vasculitis)
14. Purpura – palpable hemorrhage (ecchymoses/bruises)
15. Atrophy – skin thinning (lupus)
16. Scars – fibrotic skin (keloid)
17. Telangiectases – small dilated blood vessels (rosacea)
1. Annular – center-cleared rings (tinea)
2. Target (bull’seye or iris) – rings w/centered duskiness (erythema multiforme)
3. Serpiginous – linear, branched, curving; fungal and parasitic infections (cutaneous larva migrants)
4.Numular – coin-shaped (numular eczema)
5. Herpetiform – grouped papules or vesicles (herpes simplex)
6. Reticulated – lacy, networked (cutis marmorata)
6. Zosteriform – dermatomal clustered lesions (herpes zoster)
1. Verrucous lesions – irregular pebbly rough surface (warts)
2.Lichenification -skin thickening (repeated rubbing)
3. Induration – deep skin thickening (paniniculitis)
4. Umbilical – central indentation; viral (molluscum contagiosum)
5. Xanthomas – yellowish waxy (lipid disorders)
1. Psoriasis – scalp, elbows, kneees, umbilicus, gluteal cleft
2. Lichen planus – wrists, forearms, genitals, Lower legs
3. Vitiligo – patchy isolated; distal extremities and face, peri-orbital and peri-oral
4. Discoid lupus erythomatosus -sun-exposed area, forehead, nose, cochal bowl of the ear
5. Hidradenitis suppurativa – apocrie gland-dense skin areas; axilla, groin, ulcer breasts
1. Red – Erythema
2. Orange – Hypercarotenemia
3. Yellow – Xanthomas
4. Green fingernails – pseudomonas aeruginosa
5. Violet – cutaneous hemorrhage (kaposi sarcoma)
6. Blue, silver and gray – drug/metal deposits ( mini cyclone. Amiodarone); argyria (silver)
7.Black – melanocytes (melanoma), infarction (anthrax)
1. Dermatologist – urticaria wheal
2. Carrier sign – rapid swelling when lesion is stroked (mastocytosis)
3. Nikon sky sign – epidermal shear after lateral pressure (bullous disease)
4. Auzpitz sign – pinpoint bleeding appears after scale removal (psoriasis)
5. Koebner phenomenon – lesions within traumatized areas (lichen planus)
There were several communication techniques that I had to use during the interview process to get a quality relevant answer. Rephrasing the questions oftentimes redirect the answer. The Shadow health is of course limited since it’s a digitized one. Communications would have been easier if it was a real clinician-client interaction.
In our profession, observing nonverbal cues and silence and empathy would garner additional qualifying patient information to our database. Therapeutic communication is not just confined to asking questions to elicit response. Touch, sharing hope and humor and empathy can help build rapport. Sometimes providing information, clarifications and confrontation are needed when there are inconsistencies in the patient history.
But the latter can only be done when trust and comfort have been established. Reflection and stating patient observation will bring patient attention to one’s demeanor without cultivating embarrassment. Self-disclosure can promote the therapeutic relationship by providing framework for respect and hope.
While all of these communication techniques are helpful, cultural competence and sensitivity will further reinforce the positive patient-provider relationship.
I need to increase my databank for illness scripts to be able to maximize the potential for clinical reasoning skills while doing physical and assessment. During the actual diagnostic testing of the eyes, ears, mouth and nose, I found it handy to have an ample background knowledge of the normal and abnormal anatomical concepts of human body systems. It helps to focus on the details that may contribute to the current health concern.
However, my limited exposure to the use of otoscope and ophthalmoscope, I unfortunately had to repeat my examination procedure to make sure that I correctly diagnosed the abnormality that I saw specially in the retinal structure. If it was in the real life situation, it would be comfortable for the patient and detrimental to the trusting relationship that has been established. Realistically, professionals can ask colleagues or a physician if there’s something that was unsure of in terms of abnormal findings.
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PermalinkIn reply to Honey Variacion Brojan N522PE-20A Advanced Physical Assessment Course Papers
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The term “tinea” exclusively refers to dermatophyte infections. Dermatophyte (tinea) infections are common fungal infections of the skin, hair, and nails and are classified according to body site. Dermatophytes are filamentous fungi that metabolize and subsist upon keratin in the skin, hair and nails.
The major clinical subtypes are tinea capitis (scalp), tinea corporis (skin other than bearded area, feet, groin, face, scalp or beard hair), tinea barbae/sycosis/barber’s itch (beard), tinea pedis (foot), tinea cruris (groin, perineum, and perineal areas), tinea manuum (hands) and tinea unguium (nail) also called dermatophyte onychomycosis.
Dermatophytes cause a red skin rash that forms around a normal-looking skin. Tinea infections or dermatophytosis symptoms include ring-shaped rash, itchy skin, red-scaly cracked skin and hair loss. Clinical picture of the rash is a circular or ovoid in appearance with patches and plaques with sharp marginations and raised erythematous scaly edge which may contain vesicles.
The lesions advance centrifugally from a core, leaving a central clearing and mild residual scaling; this appears as a “ring” like pattern thus the term “ringworm.” Tinea infections are spread by skin-to-skin contact, and usually favors warm weather. Treatment includes topical or oral anti fungal.
Tinea capitis – scaly, itchy red circular bald spot; Rounded, patchy hair loss on scalp, leaving broken-off hairs, pustules, and scales on skin; mostly affects children; can be confused with dandruff or cradle cap.
Tinea barbae – scaly, itchy, red spots on the cheeks, chin, and upper neck; spots may be crusted over or filled with pus, and the affected hair might fall out.
Tinea cruris (jock itch) – scaly, itchy, red spots the moist, warm areas of inner sides of skin folds and thighs; mostly affects boys
Tinea pedis(athlete’s foot) – red, swollen, peeling, itchy skin between the toes; common in adolescents
Tines corporis – hyperpigmented in whites, depigmented in dark-skinned people; on chest, abdomen, back of arms forming multiple circular lesions with clear centers; tinea gladiatorum wrestlers
Tinea unguium – infection of the toenails, and sometimes fingernails; thickened, deformed, and discolored nails instead of a rash.
Tinea manuum – slightly raised red, scaly rash in hands
Tinea versicolor or pityriasis versicolor – caused by a slow-growing fungus (Pityrosporum orbiculare) that is a type of yeast. It is a mild infection that can occur on many parts of the body.
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Module Three: Cardiovascular, Peripheral Vascular System & Respiratory Assessment
This week you have studied cardiovascular, peripheral vascular, and respiratory advanced physical assessment. What additional resources for these advanced health assessment skills have you found beneficial in developing your knowledge and psychomotor skills this week?
Post a concept to the discussion board that you have had difficulty with and note where you are with resolution of these difficulties. Please describe the issue completely, citing your sources so that your classmates can reference the information and provide additional “clinical pearls”. In other words, please include primary sources and/or reliable electronic sources to support your arguments.
Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Discussion Participation Guidelines & Grading Criteria.
Assignment Instructions:
For this 4-5 page assignment, you will conduct a focused health history and physical assessment based upon your Practice Experience work in Shadow Health. Particularly, you will complete a focused assessment on Danny, a child who is complaining of a cough. Please submit your summary documentation in MS Word. Use the submission parameters and rubric below to guide you in completion of this written assignment.
For this written assignment, please use the following guidelines and criteria. Also, please refer to the rubric for point allocation and assignment expectations. The expected length of the paper is approximately 4-5 pages, which does not include the cover page and reference page(s).
Competency
20
18
16
0
Points Earned
Focus of the Assessment is identified with Special Considerations including Documented Focused Health HistoryDocumentation clearly shows student has completed a focused assessment with identified special considerations including a well-documented focused health history.Documentation supports the student has completed the focused assessment with minimal identification of special concerns. The focused health history is documented.Documentation supports the student has completed the focused assessment without identification of special concerns. The focused health history is documented and lacks depth and specificity of weekly topic.Documentation supports the student attempted to complete the focused assessment without identification of special concerns. The focused health history is briefly documented and lacks depth and specificity of weekly topic./202018160Documented Physical Examination Findings including Techniques of ExaminationDocumentation clearly shows student has completed the physical examination and accurately describes the techniques of examination for the week.Documentation supports the student has completed the physical examination and describes the techniques of examination for the week.Documentation supports student completed some of the physical examination for the focused assessment of the week. Documentation is accurate but lacks depth.No evidence that the student is applying read concepts of advanced focused physical assessment. Documentation lacks depth and may lack coherence for understandability of tasks completed in this week./202018160Documented Evidence to Support Clinical Reasoning with External Course ResourcesDiscourse clearly shows the student has studied the topic and has given thought to the focused assessed topic and documentation for the week.Discourse supports the student has studied the topic and has given thought to the focused assessment topic and documentation for the week.Discourse supports student studied some of the topic for the focused assessment topic this week. Discourse is accurate but lacks depth.No evidence that that student has read or studied the topic.Compliance with the ethical and legal standards of professional nursing practice is explicitly stated in the documentation of the focused physical assessment.
Compliance with the ethical and legal standards of professional nursing practice is stated in the documentation.Compliance with the ethical and legal standards of professional nursing practice is briefly implied in the documentation of the focused physical assessment or inaccuracies are evidenced in the written assessment.Compliance with the ethical and legal standards of professional nursing practice is not included in the documentation of the focused physical assessment./510980Grammar, Spelling, and Punctuation APA FormatAPA Format, grammar, punctuation and spelling is accurate with no errors.APA Format, grammar, punctuation and spelling is accurate with less than two types of errors.APA Format, grammar, punctuation and spelling is accurate with five or fewer types of errors.APA Format, grammar, punctuation and spelling is accurate with more than five types of errors./10COMMENTS:TOTAL:/100
Module Four: Gastrointestinal, Breast and Axilla Assessment
Module Five: Neurological & Musculoskeletal Assessment
This week you have studied neurological and musculoskeletal advanced physical assessment. While a diverse set of advanced physical assessment skills where do you place your greatest level of confidence and what areas need more development.
What methods do you use to remember assessment of cranial nerves, mental status, or other important clinical assessments of persons with neurological or musculoskeletal problems? Of these areas of advanced physical assessment what psychomotor skill is most challenging for you to accomplish? Why?
Post a concept to the discussion board that you have had difficulty with and note where you are with resolution of these difficulties. Please describe the clinical issue completely, citing your sources so that your classmates can reference the information and provide additional “clinical pearls”. In other words, please include primary sources and/or reliable electronic sources to support your arguments.
Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Discussion Participation Guidelines & Grading Criteria.
For this 4-5 page assignment, you will conduct a focused health history and physical assessment based upon your Practice Experience work in Shadow Health. Particularly, you will complete a focused assessment on Brian, an adult who is complaining of chest pain.
Please submit your summary documentation in MS Word. Use the submission parameters and rubric below to guide you in completion of this written assignment.
Submission Parameters:
For this written assignment, please use the following guidelines and criteria. Also, please refer to the rubric for point allocation and assignment expectations. The expected length of the paper is approximately 4-5 pages, which does not include the cover page and reference page(s).
Competency
20
18
16
0
Points Earned
Focus of the Assessment is identified with Special Considerations including Documented Focused Health HistoryDocumentation clearly shows student has completed a focused assessment with identified special considerations including a well-documented focused health history.Documentation supports the student has completed the focused assessment with minimal identification of special concerns. The focused health historyPlace your order to get best research help