NURS 6512 Essay Assignments

WEEK 1 : Health History

Doctors and hospitals use a medical history of a patient to review his/her health history. It’s a very important part of their workflow to ensure they’re providing the best care and treatment. A patient’s medical history may include details about past diseases, illnesses running in the family, previous diagnoses, medical abstract, therapies, allergies, and medication. Yes, this is not the whole picture but with the help of a detailed medical history, doctors can see health patterns of patients over time at a glance.NURS 6512 Essay Assignments

Many hospitals rely on paper-based forms for this task. Others use online forms while some also use PDF forms. So, here’s a collection of PDF form templates that you can use as a starting point. There are a plethora of questions to be asked but what’s nice about using a template is the freedom to customize it. To top it all off, you get to start with beautiful and well-designed PDF templates, for free.

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Privacy is also a key point to consider. The Health Insurance Portability and Accountability Act of 1996 (or HIPAA) is a United States legislation that provides data privacy and security provisions for safeguarding medical information. The good news? JotForm is HIPBATH-compliant and that’s a huge plus for anyone in the healthcare industry. So, aside from these PDF templates that were pre-fill and designed for you, you also enjoy the advantages of using a platform that’s HIPBATH-compliant.

The Global Health Histories project was established within the WHO headquarters in late 2004 and expanded into the regional offices from 2009 on wards. An official WHO activity, its mission is based on the principle that understanding the history of health, especially during the last 60 years, helps the global public health community to respond to the challenges of today and help shape a healthier future for everyone, especially those most in need.

Forming an important part of the project, the Global Health Histories Seminars are organized with WHO partners around the world, at WHO headquarters, regional and country offices, as well as with WHO member states and university partners around the world. Since 2005, the seminars have been generously supported by the Welcome Trust.

Seminars bring together panelists from diverse backgrounds to discuss and debate topical issues in global health, based on a deeply inter-disciplinary examination of the recent past. There have now been well over 120 seminars, with a tremendous array of topics covered. The seminars provide access to significant amounts of useful data and ideas for effective policy engagement, staff training, and public health education and engagement about the uses and expansion of healthcare. Where possible each event is broadcast live, so that audiences can listen to the talks, view the speakers’ PowerPoint presentations and, if they wish, even pose questions to the presenters and other discussants.

WEEK 3 : Advanced Health Assessment and Diagnostic Reasoning

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

Effective communication is vital to constructing an accurate and detailed patient history. A patient’s health or illness is influenced by many factors, including age, gender, ethnicity, and environmental setting. As an advanced practice nurse, you must be aware of these factors and tailor your communication techniques accordingly. Doing so will not only help you establish rapport with your patients, but it will also enable you to more effectively gather the information needed to assess your patients’ health risks.NURS 6512 Essay Assignments

For this Discussion, you will take on the role of a clinician who is building a health history for a particular new patient assigned by your Instructor.

To prepare:

With the information presented in Chapter 1 of Ball et al. in mind, consider the following:

  • By Day 1 of this week, you will be assigned a new patient profile by your Instructor for this Discussion. Note: Please see the “Course Announcements” section of the classroom for your new patient profile assignment.
  • How would your communication and interview techniques for building a health history differ with each patient?
  • How might you target your questions for building a health history based on the patient’s social determinants of health?
  • What risk assessment instruments would be appropriate to use with each patient, or what questions would you ask each patient to assess his or her health risks?
  • Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration.
  • Select one of the risk assessment instruments presented in Chapter 1 or Chapter 5 of the Sidelines Guide to Physical Examination text, or another tool with which you are familiar, related to your selected patient.
  • Develop at least five targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history.

By Day 3 of Week 1

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

In order to critically reflect upon problem solving skills in health assessment, the motivations and processes entailed in Egan’s skilled helper approach and clinical reasoning will be identified. This will be followed by an evaluation of their contrasting motivations and comparisons of their initial inquiry positions. It will be identified how these positions inform the collection of patient history data. Subsequent to this, appropriate applications of the approaches will be discussed followed by a dissemination of the influence of both upon humanistic nursing processes. It will be identified that both the skilled helper and clinical reasoning approaches encourage reflective practice, which in turn informs health assessment processes.

Egan’s (1997) skilled helper approach is implemented across counselling and health care professions in order to facilitate the patient’s identification of problems. Furthermore, the approach is designed to enable the patient to identify and implement self-identified coping strategies in order to deal with the identified problem. There are two primary motivations behind skilled-helper approach implementation. These are to enable the patient to live effectively and to maximise opportunities, and to enable patient’s ability to manage their own health (Manning, 2000).

The approach is broadly composed of three interactive stages (Egan, 1997). Firstly, the patient is led through the generation of history data, until enough has been collected so that both the nurse and patient are able to fully conceptualise the current problem. The client and nurse identify major cognitive and behavioural features that may have led to the current scenario. The second stage entails the detailing of the client’s preferred scenario; the nurse assists the patient in identification of an ideal future position, and develops patient courage and confidence in order to pursue the ideal scenario. Lastly, the nurse and patient brainstorm specific actions that would realistically lead to the desired solution. The result is a formulation of specific goals and strategies that the patient will work to achieve.

Clinical reasoning; or problem based learning (Barrows & Pickell, 1991) employs two knowledge types in order to identify and diagnose patient problems. The authors propose that effective clinical reasoning uses both content and process knowledge in order to achieve diagnosis and health assessment. Content knowledge refers to what knowledge the nurse practitioner has achieved through training and practice. The second form, process knowledge, relates to how the content knowledge is used in health assessment. The approach employs the scientific inductive method in order to achieve a health assessment and diagnosis.NURS 6512 Essay Assignments

The nurse interacts with the patient over a series of steps to achieve the health assessment. Similarly to Egan (1997), the nurse develops an initial concept through a primary discussion with the patient regarding their problem concept (Barrows & Pickell, 1991). The problem concept and primary perceptions are used to generate multiple hypotheses of possible diagnoses for the patient’s condition. A focused patient history is conducted in order to discount hypotheses. Critical deductive skills and physical examination are also employed to falsify or support inferred hypotheses. New hypotheses are generated with the assimilation of further information or when the current line of enquiry becomes unproductive. Inquiries should occur in conjunction with an understanding of the pathophysiological mechanism that is operative in the patient’s condition. Inquiry continues until a single remaining hypothesis is supported.

The skilled helper and clinical reasoning approaches differ in their motivations. Egan’s (1997) skilled helper model aims to enable the patient to identify problems within their current situation while clinical reasoning (Barrows & Pickell, 1991) aims to use the patient concept to motivate a line of enquiry which will result in the clinician making a diagnosis. While the skilled helper model relies upon facilitation of patient concepts, clinical reasoning approaches incorporate physical examination (Seidel, Dains & Benedict, 1994). Despite this, both approaches begin with a similar concept. Formulations of the skilled helper and clinical reasoning approaches both begin with a generation of patient history data. Acquisition of the contextual data relating to the impact of the patient’s background upon the current problem concept, in conjunction with personal and family history (Epstein, Perkins, Cookson, Watt, & Rakhit, 2008) allows for the formulation of further inquiries in both health assessment approaches.

As Egan’s (1997) skilled helper model facilitates the client’s management of their own problem concepts, it is arguably a more fruitful strategy within community based mental health nursing (Hannigan, 1997). When the patient presents with minor ailments requiring diagnosis and short term treatment, clinical reasoning is potentially a more effective approach to employ (Jones, 2006). However, both approaches share in the benefit of facilitating a patient-centred approach to health assessment and treatment management. For example, a rating study of student nurses’ interviewing skills found that the utilisation of both approaches facilitated humanistic inquiry strategies (Arthur, 1999). This benefits nurse-patient communication processes, ensuring a positive experience of health assessment and care provision for the patient (McCabe, 2004).

Both approaches benefit from the opportunity to engage the nurse in reflective practice. By structuring the health assessment process, the approaches enable nurse practitioners to evaluate successive stages. This provides a structure to reflect upon the successes and limitations of their health assessment behaviours (Schon, 1991). For example, the interactive nature of both processes can be utilised by nurses to adjust health assessment practice in line with self-evaluation strategies. Furthermore, Egan’s (1997) skilled helper approach benefits reflective practice by equipping nurses to utilise the approach upon their own health assessment processes (Kuiper & Pesut, 2004). Concurrently, clinical reasoning skills facilitate skills of critical judgement and limitation identification (Higgs & Jones, 2000).NURS 6512 Essay Assignments

Egan’s skilled helper approach aims to facilitate patients’ self-management of problem concepts, while clinical reasoning uses the patient’s problem concept in order to inform inductive inquiries. These inquiries result in a diagnosis presented by the clinician. Both approaches begin inquiries with the patient’s formulation of the problem concept which motivates further inquiry. Egan’s skilled helper approach is more appropriate within the context of mental health nursing, while clinical reasoning is useful in the diagnosis and treatment of minor ailments. Both approaches facilitate communication styles that support humanistic nursing processes. Furthermore, both approaches enable reflective nursing practice, informing the health assessment process.

WEEK 4 : Differential Diagnosis for Skin Conditions

Properly identifying the cause and type of a patient’s skin condition involves a process of elimination known as differential diagnosis. Using this process, a health professional can take a given set of physical abnormalities, vital signs, health assessment findings, and patient descriptions of symptoms, and incrementally narrow them down until one diagnosis is determined as the most likely cause.

In this Discussion, you will examine several visual representations of various skin conditions, describe your observations, and use the techniques of differential diagnosis to determine the most likely condition.

Note: Your Discussion post should be in the SOAP (Subjective, Objective, Assessment, and Plan) note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in this week’s Learning Resources for guidance.Remember that not all comprehensive SOAP data are included in every patient case.

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To prepare:

·        Review the Skin Conditions document provided in this week’s Learning Resources, and select two conditions to closely examine for this Discussion.

·        Consider the abnormal physical characteristics you observe in the graphics you selected. How would you describe the characteristics using clinical terminologies?

·        Explore different conditions that could be the cause of the skin abnormalities in the graphics you selected.

·        Consider which of the conditions is most likely to be the correct diagnosis, and why.

Post a 1 page paper APA format Your Discussion post should be in the SOAP (Subjective, Objective, Assessment, and Plan) note format,

1.     a description of the two graphics you selected (identify each graphic by number). (see sample skin conditions attached)

2.      Use clinical terminologies to explain the physical characteristics featured in each graphic.NURS 6512 Essay Assignments

3.      Formulate a differential diagnosis of three to five possible conditions for each.

4.      Determine which is most likely to be the correct diagnosis, and explain your reasoning.

Differential Diagnosis for Skin Conditions
Properly identifying the cause and type of a patient’s skin condition involves a process of elimination known as differential diagnosis. Using this process, a health professional can take a given set of physical abnormalities, vital signs, health assessment findings, and patient descriptions of symptoms, and incrementally narrow them down until one diagnosis is determined as the most likely cause.

In this Discussion, you will examine several visual representations of various skin conditions, describe your observations, and use the techniques of differential diagnosis to determine the most likely condition.

Note: Your Discussion post should be in the SOAP (Subjective, Objective, Assessment, and Plan) note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in this week’s Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case.

To prepare:
•Review the Skin Conditions document provided in this week’s Learning Resources, and select two conditions to closely examine for this Discussion.
•Consider the abnormal physical characteristics you observe in the graphics you selected. How would you describe the characteristics using clinical terminologies?
•Explore different conditions that could be the cause of the skin abnormalities in the graphics you selected.
•Consider which of the conditions is most likely to be the correct diagnosis, and why.

Post on or before Day 3 a description of the two graphics you selected (identify each graphic by number). Use clinical terminologies to explain the physical characteristics featured in each graphic. Formulate a differential diagnosis of three to five possible conditions for each. Determine which is most likely to be the correct diagnosis, and explain your reasoning.
Resources can not be any older than 5 years and they must be scholarly resources

WEEK 5 :Advanced Health Assessment

Assessment is one of the first steps in becoming a nurse. From the time we enter nursing school we are taught to assess. Whether we are formulating a nursing care plan or rendering bedside care to a patient, assessment skills are, in my opinion, one of the most important foundation skills to master in the profession of nursing.
“Assessment is the collection of data about an individual’s health state (Jarvis, 2008)”. This statement seems so simple, but in reality what I learned during the course of the semester was that assessment is not limited to just the physical being, but also includes culture, values, family and support networks, as well as the ability of the patient to care for self. These factors must be assessed in order to follow a holistic model of care (Jarvis, 2008).
Although this task seemed insurmountable initially, I realized that the way in which I typically assess patients could provide a more holistic approach by integrating some of the techniques I learned in this class. I normally have conversations with my patients while I assess them, and I found that if I asked them about their lives as I went about the physical aspect of the exam, I could learn much about how they were feeling and what support systems they had available to them.NURS 6512 Essay Assignments
While it is important to take into account the whole picture of the patient when assessing their health, it is paramount to have assessment skills refined to the highest level because in the hospital, the nurse is the only health care professional who is continually available at the bedside (Jarvis, 2008). I find this idea to be true to my practice. As much as I enjoy learning about the people I care for and what makes them “tick”, that information is of little use to me if I am unable to render appropriate care which is based on my initial physical assessment of the patient.
I felt that this class helped to reinforce and strengthen skills I had previously learned, such as heart and lung sounds, and expanded my knowledge of areas I less frequently assessed, like the hair and nails. I found the textbook in this class to be exceptionally useful for my learning, most notably because of the sheer volume of pictures to refer to, and I have kept this text for my collection. I think the skills I learned over the course of the semester will help me when I continue my education because this class touched on areas that I do not normally assess at length while in the surgical setting, such as the eyes and ears. Additionally, I have all my focused exam videos to look back on if I should need them in the future.

Advanced health assessment (AHA) is required in Masters of Science in Nursing and Doctor of Nursing Practice programs. Finding preceptors for student clinical experiences is becoming more challenging due to recent increases in numbers of schools with competing programs, and productivity requirements for preceptors. Additionally, faculty noted that students were overwhelmingly weak on history taking and differential diagnosis when leaving the AHA course; often, this trend followed students through their population focused courses. With these issues in mind, we decided to look for other ways to provide students with the experience of getting thorough histories, doing physical exams, determining differential diagnoses and coming up with diagnostics. This presentation describes the use of simulation to achieve these goals.

Methods:

I-Human is a subscription website that provides hundreds of cases reflecting multiple populations appropriate for all levels of student learning. We piloted i-Human in our existing course requiring 52 hours of clinical with preceptors to see how the students used the program, their responses and how best to use it as a learning tool. Once we were sure it would achieve our learning goals, we approached the faculty and proposed changing the course from clinical to didactic. The course has about 100 students every semester and at least 10 faculty. Thus, we had plenty of feedback from our pilot to help us make decisions for subsequent courses. We analyzed the student’s individual work on each case, as well as the results from the class as a whole.

Results:

The pilot showed students improved their history taking skills, critical thinking and differential diagnosis skills when using i-Human. We believe this is because the expert who wrote the case provided detailed feedback on all aspects of the “visit” including history taking, physical exam and differential diagnosis. Students were able to write a SOAP note and compare it to that of the expert, enhancing their ability to practice recording patient data. Faculty and students both appreciated the feedback on the cases, which was provided in visual charts and spreadsheet format to pinpoint the student’s strengths and challenges.

The revised didactic online course requires students to practice their history and physicals on willing family and friends and come to two on campus clinical lab days to refine skills with faculty. They also practice mock OSCEs in a group situation to prepare for day two, when students do an individual OSCE to demonstrate their history and physical skills. During the debrief of the mock OSCEs, students practiced differential diagnosis and presentation skills with faculty. They then submit a SOAP note on the OSCE case to be graded. NURS 6512 Essay Assignments

Conclusion:

The feasibility of using simulation to replace clinical preceptors was proven to be acceptable to students and faculty. Simulation seems to be superior in some respects, namely, developing thorough history taking and improving critical thinking abilities regarding differential diagnosis. Students were also able to achieve very good OSCE scores despite having had no clinical experience with preceptors.

WEEK 6: Assessing the Abdomen /Gastrointestinal System

It is important to begin the assessment by obtaining a thorough history of abdominal or gastrointestinal complaints. You will need to elicit information about any complaints of gastrointestinal disease or disorders. Gastrointestinal disease can have various signs and symptoms, including change in appetite, weight gain or loss, dysphagia, intolerance to certain foods, nausea and vomiting, change in bowel habits, and abdominal pain (Jarvis, 2016).

Physical examination techniques should be used in an organized manner from least disturbing or invasive to most invasive to the patient (Jarvis, 2016). Inspection is first, as it is non-invasive. Auscultation is performed following inspection; the abdomen should be auscultated before percussion or palpation to prevent production of false bowel sounds.

It is also important to assess abdominal pain and other gastrointestinal symptoms, such as distention, nausea, and vomiting. After eliciting information about any experienced signs or symptoms of gastrointestinal disease, ask about your patients past abdominal or gastrointestinal history, medications, and nutritional status. The patient history is extremely important in assessing abdominal pain. Pain may be chronic or acute and related to inflammation, infection, allergy, or food intolerance. It can also result from trauma or obstruction. There are also a few physical exam techniques that can be used to assess acute abdominal pain. These are the iliopsoas muscle test, obturator test, and Blumberg test (Porter & Kaplan, 2016; Wilson & Giddens, 2017).

WEEK 8 :Assessing the Skin, Hair, Nails

SKIN, HAIR AND NAILS
Skin pink, warm, dry and elastic.  No lesions or excoriations noted.  Old appendectomy scar right lower abdomen 4 inches long, thin, and white.  Sprinkling of freckles noted across cheeks and nose.  Hair brown, shoulder length, clean, shiny.  Normal distribution of hair on scalp and perineum.  Hair has been removed form legs, axillae.  Nails form 160 degree angle at base, are hard, smooth, and immobile.  Nailbeds pink without clubbing.  Cuticles smooth, no detachment of nailplate.  Hands well-manicured with clear enamel.

HEAD AND NECK
Head symmetrically round, hard, and smooth without lesions or bumps.  Face oval, smooth, and symmetrical.  Temporal artery elastic and nontender.  Temporomandibular joint palpated with full range of motion without tenderness.  Neck symmetric with centered head position and no bulging masses.  C7 is visible and palpable with neck flexion.  Has smooth, controlled, full range of motion of neck.  Thyroid gland nonvisible but palpable when swallowing.  Trachea in midline.  Lymph nodes nonpalpable.NURS 6512 Essay Assignments

EYE AND EAR
Acuity by Snellen chart O.D. 20/20, O.S. 20/20.  Visual fields full by confrontation.  Extraocular movements smooth and symmetric with no nystagmus.  Evelids in normal position with no abnormal widening or ptosis.  No redness, discharge, or crusting noted on lid margins.  Conjunctiva and sclera appear moist and smooth.  Sclera white with no lesions or redness.  No swelling or redness over lacrimal gland.  Cornea is transparent, smooth, and moist with no opacities, lens is free of opacities.  Irises are round, flat, and evenly colored.  Pupils are equal in size and reactive to light and accommodation.  Pupils converge evenly.
Ears are equal in size bilaterally.  Auricles are aligned with the corner of each eye.  Skin smooth, no lumps, lesions, nodules.  No discharge.  Non tender on palpation.  Small amount of moist yellow cerumen in external canal.  Whisper test : patient repeats 2 syllable word.

MOUTH, THROAT, NOSE, AND SINUS
Lips pink, smooth, and moist without lesions.  Buccal mucosa pink, moist, and without exudates.  Stensen/s ducts visible with no redness or swelling.  32 white to yellowish teeth present.  Gums pink without redness or swelling.  Protrudes geographic tongue in midline with no tremors.  Equal bilateral strength in tongue.  Ventral surface of tongue smooth and shiny pink with small visible veins present.  Frenulum in midline.  Soft palate smooth and pink.  Tonsillar pillars pink and symmetric.
Nose somewhat large but smooth and symmetric.  Able to sniff through each nostril. Nasal septum slightly deviated to the left, but does not obstruct airflow.  Inferior and middle turbinates dark pink, moist, and free of lesions.  No purulent drainage noted.  Frontal and maxillary sinuses  are nontender to palpation and percussion.

THORAX AND LUNG
Respirations 18/minute, relaxed and even.  Anteroposterior less than transverse diameter.
Chest expansion symmetric.  No retraction or bulging of interspaces.  No pain or tenderness on palpation.  Tactile fremitus symmetric.  Percussion tones resonant over all lung fields.  Vesicular breath sounds auscultated over lung fields.  No adventitious sounds present.

BREASTS AND LYMPHACIC
Bilateral breasts moderate in size, pendulant, and symmetric.  Breast skin pale, pink with light brown areola.  Nipples everted bilaterally.  Free movement of breasts with position changes of arms and hands.  No dimpling, retraction, lesions, or inflammation noted.  Axillae free of rashes or inflammation.
No masses or tenderness noted on palpation.  Bilateral mammary ridge present.  No discharge noted from nipples.  Axillary ( central, posterior, or anterior) and lateral arm lymph nodes nonpalpable.  Demonstrates appropriate technique for BSE.

HEART AND NECK VESSELS
Carotid pulse equal bilaterally, 2+, elastic.  No bruits auscultated over carotids.  Jugular venous pulsation disappears when upright.  Apical  impulse palpated in the fifth ICS at the left MCL.  Apical pulse- 70 beats/minute, regular rhythm, S1 heard best at the apex, S2 heard best at the base.

ABDOMEN
Skin of abdomen is free of striae, scars, lesions, or rashes.  Umbilicus is midline and recessed with no bulging.  Abdomen is flat and symmetric with no bulges or lumps.  No bulges noted when patient raises head.  No peristaltic movements seen.  Soft clicks and gurgles heard at a rate of 15 per minute.   Percussion reveals generalized tympany over all four quadrants.  No tenderness or guarding                                 in any quadrant with light palpation.  Umbilicus and surrounding area free of masses, swelling, and bulges.NURS 6512 Essay Assignments

MALE GENITALIA
pubic hair growth pattern is normal for adult male: pubic hair and base of penis are free of excoriation and infestation.  Circumcised penis is free of rashes, lesions, and lumps and is soft, flaccid and nontender on palpation.  Glans is rounded, and free of lesions; urinary meatus is centrally located on glans; no discharge is palpated from urinary meatus.  No masses or swelling noted in scrotum and left side hangs slightly lower than right side.  Skin is free of lesions and appears rugated and darkly pigmented.  Two descended testicles palpated.  No swelling, tenderness,or masses palpated along the testicle.  No bulges or masses palpated in inguinal or femoral canal.

WEEK 9:Assessment of Cognition and the Neurologic System

The Cognitive Neurology Unit (CNU) is an outpatient multi specialty clinic devoted to the evaluation and treatment of people who have difficulties in concentration, memory, perception, and language, as well as emotional consequences resulting from an injury or disease affecting the nervous system, concerns about aging and cognition, learning disabilities and attention deficit disorder, and other neurodevelopmental disorders (e.g., autism spectrum disorders). Our staff has expertise in cognitive neurology, neuropsychiatry, neuropsychology, neurorehabilitation and social work.

A neurologist is a specific type of medical doctor, who is trained in diagnosing and treating disorders of the brain and nervous system. Such disorders include conditions that can affect the central nervous system (including the brain and spinal cord), the peripheral nervous system, and the autonomic nervous system. Neurologists may want to assess a person’s ability to walk, coordinate movements, and other actions such as hand-eye coordination. They will examine one’s brain functions for injury, diseases, or developmental problems.

Neurologists may treat individuals who experience a stroke as well as individuals with epilepsy, Parkinson’s disease, and hundreds of other neurological issues. Neuropsychology is the study of the relationship between the brain and behavior.A neuropsychologist, for example, may assess a person’s ability to learn and recall information, to attend to their environment, concentrate and focus, as well as their emotional well-being. Neuropsychologists administer a battery of psychological tests that measure problem-solving skills, reasoning and conceptualization abilities, sensory-motor abilities, learning, memory, receptive and expressive language, perceptual-motor skills, and cognitive abilities, to examine an individual’s overall functioning.

From the information gathered during the evaluation, a neuropsychologist uses the individual’s pattern of strengths and weaknesses to assess brain functioning. From this complex and detailed set of measurements, a variety of inferences can be drawn relating directly to the functioning of an individual’s brain and their overt behaviors. Neuropsychologists help assess and monitor the recovery of function of individuals who experience traumatic brain injury, examine the ability of an individual with a disorder that affects reasoning abilities, or help discriminate between disorders such as Attention-Deficit/Hyperactivity Disorder and Tourette’s Syndrome.NURS 6512 Essay Assignments

What is the difference between a neurological assessment & a neuropsychological assessment?

A neurological assessment is a series of questions and tests that provide crucial information about the nervous system and any related abnormalities. The neurological assessment, which is performed by a neurologist, is divided into several components, each focusing on a different part of the nervous system. A neurologist may assess a person’s mental status, sensory system, motor system, cranial nerves, or reflexes as well as any other areas related to the nervous system. Often diagnostic tests, such as EEGs, x-rays, CT scans, or MRI scans of the head or spine may be given to obtain information about brain functioning. This information is used to determine appropriate medical treatment. A neurologist sometimes recommends neuropsychological evaluations to assess cognition or emotional status.
A neuropsychological assessment provides a profile of an individual’s strengths and weaknesses that is used to develop intervention strategies to capitalize on strengths and build on areas of weakness. A person’s performance on a variety of tasks is compared to that of same age peers. Areas of brain functioning such as attention, memory, visual-motor and sensory abilities, ability to regulate behaviors and emotions, solve complex problems, and monitor and adjust one’s behavior as needed are some of the areas that are evaluated.

Standardized, objective, and reliable measures of diverse aspects of human cognition and behavior allow for a complete picture of an individual’s higher cortical functioning. This picture of current brain/cognitive functioning is used to guide intervention planning. Interventions can include learning strategies that utilize strengths, remediation of specific skills, strategies to improve areas of weakness, therapy to improve emotional or behavioral functioning, or collaboration with other professionals such as speech/language pathologists, occupational or physical therapists, audiologists, or neurologists.

What are executive functions?

Over the last ten years there has been increased interest in “executive functions” and their role in behavior and emotional functioning. The term executive function (EF) is an “umbrella term” which encompasses a set of several abilities which primarily reside in the frontal lobes of the brain. Planning, problem-solving, self-monitoring, organization, divided attention, shifting or mental flexibility, and initiation of behaviors are often included under the term executive functions.

Attention and working memory are also sometimes listed as executive functions. EFs develop throughout childhood, adolescence, and even into young adulthood. The development of executive functions is considered to be important because they are necessary for purposeful, planned, organized behaviors such as goal-setting and attainment. There are a variety of reasons that an individual may have difficulty with executive functions.NURS 6512 Essay Assignments

Some individuals with ADD/ADHD have problems with executive functions. Individuals with Asperger’s Syndrome, autism, Tourette’s Syndrome, bipolar disorder, schizophrenia, traumatic brain injuries, emotional problems, and other developmental or genetic disorders may struggle with executive functions as well. Impairments in executive functions can cut across many areas and affect academic performance, social interactions, and vocational performance.

WEEK 10: Assessing the Genitalia and Rectum

Patients are frequently uncomfortable discussing with health care professional’s issues that involve the genitalia and rectum; however, gathering an adequate history and properly conducting a physical exam is vital. Examining case studies of genital and rectal abnormalities can help prepare advanced practice nurses to accurately assess patients with problems in these areas.

In this assignment, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.

In this assignment, you will analyze a SOAP note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.

The pelvic exam can feel invasive to patients, so it is important to do everything possible to make patients feel comfortable and empowered, rather than vulnerable. Clinicians should be aware of how they are communicating, both verbally and nonverbally, and should give their patients control whenever possible. There are many ways to do this, from how the exam table is positioned to how the patient is engaged throughout the exam. As many as 1 in 5 patients may have experienced sexual trauma; therefore, it is important to avoid triggering those patients, but it’s not always possible to know who they are. The exam in this video demonstrates neutral language and techniques that can be employed with all patients to create the best experience possible.

It’s important to keep the patient covered wherever possible and to minimize extraneous contact. A clinician should be careful to tuck fingers that aren’t being used to examine the patient to avoid accidental contact with the clitoris or anus.

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Before performing the pelvic examination, examiners should find out how knowledgeable the patients are about the exam and their own bodies, and establish the expectation that the patients can communicate questions or concerns throughout the exam. While it is always important to avoid extremely clinical language, certain colloquial words can cross the line from caring to overly intimate during this exam. It is helpful to avoid the words “touch” and “feel,” which can feel sexualized in this context; instead, the words “assess,” “check,” “inspect,” or “examine” should be used. The words “bed” and “sheet” should be avoided, and “table” and “drape” should be used instead. Also, a clinician should use the word “footrests” rather than “stirrups” to avoid connoting horses. It’s a good idea to avoid telling patients to “relax,” because it’s a hard order for a patient to follow when anxious. Asking patients to “soften” or “release” specific muscles can be more useful, and having a patient do a Kegel exercise or Valsalva maneuver can serve as a specific relaxation technique.NURS 6512 Essay Assignments

Best practice dictates avoiding assumptions about patients’ gender, as patients with female anatomy may identify as another gender (e.g., transgender or gender queer). This video depicts the approach to a patient whose history has revealed no specific complaints or risk factors related to gynecological health.

The pelvic exam consists of three parts: the visual and manual exam of the external genitalia, a speculum exam, and a bimanual exam. This video covers the introduction to the pelvic exam and the external genitalia exam. To avoid missing potential findings, the external pelvic exam should be performed in a systematic approach consisting of two main components: a visual inspection of the vulva (Figure 1), and internal palpation and assessment of glands and tone.

WEEK 11 : Ethical Concerns in Health Assessment

There are many different sources for rules of ethical conduct in health care work. Legislation is the most obvious and binding one. In addition there are different kinds of ethical guidelines from professional associations, academic organizations and individual institutions. At the most practical level, there are rules and procedures of different workplaces and working teams. And surely workers’ personal moral stances cannot be disregarded either.

These different sources can sometimes be contradictory in complex or sensitive situations. Therefore, some skills of ethical assessment are very valuable for everyone working in health care. When difficulties in ethical matters occur, an optimal way of addressing them is a thorough discussion in the work community or team. If there is no consensus to be found, the matter should be handed over to upper level decision makers or to some external authority like a national ethical board or similar committee.

If the ethical codes or guidelines available are not helpful in solving the problem, the solution may be found by applying the most basic principles used in the ethical guidelines. They are typically as follows: 1) respecting the patient’s  or client’s autonomy, integrity and dignity; 2) respecting the patient’s or client’s rights and confidentiality; and 3) seeking to improve the patient’s or client’s condition if possible.

Healthcare Briefings spoke with a number of experts in medical ethics and got their opinions about the top ethical issues facing healthcare today–plus insights on how managers are dealing with them.

1.  Avoiding conflicts of interest. Doctors and nurses are often prime targets of promotions from pharmaceutical, medical device and equipment manufacturers. That’s why more hospitals are banning free-meal presentations, pens, notepads and other logo items, said Kirk Hanson, MBA, professor and executive director of the Markkula Center for Applied Ethics at Santa Clara University in California’s Silicon Valley. “Recent studies show that physicians’ behavior is even influenced by trivial freebies,” he said. Among these is a July 2007 report in Obstetrics & Gynecology that found, “Even small gifts produce in their recipients a disproportionately powerful willingness to reciprocate in some manner.”NURS 6512 Essay Assignments

The industry has made some efforts at self-regulation, including the Pharmaceutical Research and Manufacturers of America, which published an updated code of conduct for interactions with healthcare professionals in January 2009, and the Council of Medical Specialty Societies which announced their own voluntary ethics code in April 2010, seeking to limit the influence of for-profit enterprises.  Despite these measures, new research in the June 2010 issue of Archives of Surgery shows many physicians don’t mind accepting free samples from drug companies or collaborating with medical device manufacturers. The same perception applies to meals and travel expenses. Of the 590 doctors and medical students who replied to the survey, 72.2 percent said that industry-sponsored lunches were appropriate.

While encouraging their clinicians to turn down giveaways and any compensation that might influence their decision-making, hospital management teams are also scrutinizing whether their trustees and boards of directors should be allowed to maintain financial ties to the institution or health system, such as selling their own goods or services. And amid healthcare reform’s emphasis on containing costs, hospitals and practices are taking a closer look at their purchasing employees’ favoritism for certain suppliers. “Very few hospitals have ethical guidelines to govern the behavior of their purchasing professionals,” Hanson said.

2. Balancing profit with serving patients and providing charity care. “Nurses are a scarce resource. So is cash. Healthcare organizations must balance the books to keep their doors open ― ‘No margin, no mission,’” said Nancy Berlinger, Ph.D., M.Div., deputy director and research scholar at The Hastings Center, a national nonpartisan bioethics institution.

Healthcare organizations need to take a long, hard look at how they make ethical decisions involving their business operations, she explained. Berlinger, who also teaches healthcare ethics at Yale University School of Nursing in New Haven, Conn., gave an example: “Should organizations invest scarce resources in profit-making areas that are likely to serve a relatively small number of patients, or in areas that will provide basic care to a larger number of patients?”

Many questions like this cannot be solved definitively, but they can be anticipated and managed, according to Berlinger.

“It is crucial for healthcare institutions to support good care through ethically sound policy, clear and fair processes, and ongoing ethics education for patient care providers at all levels, and through access to a clinical ethics consultation service that can consult with clinicians on difficult cases.”

3. Wrestling with equal treatment vs. VIP treatment for donors and other influential people. Elite care for VIP patients such as financial donors, trustees’ family members, and other influential people in the community can take many forms. It may result in shorter waiting times or longer physician consultations, or it could mean that “the hospital administrator drops by to make sure they don’t have any problems and that their care is first-class,” said Hanson, a specialist in healthcare organizational ethics.NURS 6512 Essay Assignments

While ensuring the privacy of celebrities enters into the equation, “The question is whether consistently the hospital treats people who are wealthy, or who are donors, differently than the general public,” Hanson explained. Individual cases should be monitored and policies put in place to clarify expectations.

4. Managing pediatric and geriatric patients who may not have decision-making capacity. In questionable situations, providers need to determine whether the patient understands his or her medical condition, “the benefits and burdens” of the treatment options, and “what would happen if the patient elected no treatment at all,” said Bruce White, D.O., JD, director of the Alden March Bioethics Institute at Albany Medical College in Albany, N.Y. The patient also should be able to rationalize in selecting one choice over another. If a patient can’t give informed consent to a medical provider, then the responsibility falls to his or her legally authorized representative. That person is supposed to decide based on the patient’s known preferences or best interest.

5. Addressing nurses’ moral distress about providing care with minimal benefit.  This distress, according to White, is “the anguish that bedside nurses feel upon providing care for some patients when there’s minimal medical benefit or quality of life.” Some nurses tend to patients on life support for years. “They’re asking themselves, ‘Why am I doing this?’” said White, who’s also director of the Ethics Consultant Group in Nashville, which provides services to hospitals and healthcare organizations. Caught in the crossfire, nurses may feel they’re hurting people rather than helping people. And it bothers them that others go without care due to lack of funding. “We’re robbing Peter to pay Paul, and the nurses at the bedside know that,” he said.

Examples like the Terry Schiavo case in Florida – in which the patient was kept alive and cared for in a vegetative state for 15 years, including a long, publicized legal battle involving family members with opposing points of view – showed how difficult these cases can be for everyone involved.NURS 6512 Essay Assignments

Berlinger emphasized the importance of helping nurses and other staff members deal with these kinds of issues.

“Care near the end of life should be a particular focus of an ethically sound organization,” she said, “as most cases referred for ethics consultations involve patients with life-threatening conditions, impaired capacity to make treatment decisions, or both. Institutional investment in advance care planning, which helps patients to identify and document their treatment preferences in ways that can guide care if they are unable to make decisions in the future, is one step institutions can take to prevent crises.”

General methods for ethical problem-solving

White pointed out that the Joint Commission requires each accredited hospital to have an “ethics mechanism” that helps staff deal with ethical dilemmas. This mechanism is generally an ethics committee. Ethics committee members or consultants should be available around the clock to assist employees, patients and families, and can be called on to help resolve a perceived conflict between the parties. These consultants need to be well grounded in the hospital’s policies and should have additional ethics training.NURS 6512 Essay Assignments