Posted: January 19th, 2023

NURS 6512 Discussions and Assignments: Advanced Health Assessment and Diagnostic Reasoning

NURS 6512 Discussions and Assignments: Advanced Health Assessment and Diagnostic Reasoning
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.

Building a Health History

The primary purpose of building health history is to gather subjective information from the patient or the patient’s family so that the patient and the healthcare team can develop a collaborative plan that will ensure effective delivery of healthcare (Ball, Dains, Solomon, & Stewart, 2015). In the case of the adolescent Hispanic boy living in a middle-class suburb, the interview would involve first setting an accommodating environment that can help enhance the patient conform in answering the questions NURS 6512 Discussions and Assignments: Advanced Health Assessment and Diagnostic Reasoning. The interview will begin by presenting a proper self-introduction and the reason for the expected interaction to ensure that the patient is aware of the reason for the interview. Besides, the interview would entail covering a health history checklist by obtaining biographical data such as age from the patient. The interaction will also include obtaining information on the reason seeking care, past health history, family health history, functional assessment, and cultural assessment. The interview questions would also be structured in both open-ended and close-ended format.

Moreover, the establishment of the health history requires the employment of proper communication techniques. One of the first techniques that would be used during the communication with the patient is the avoidance of medical jargon. Ideally, it is highly unlikely that the adolescent Hispanic boy would have a grasp of medical-technical terms, and using hard jargon can result in confusion. Besides, active listening is another technique that would be used during the interview. This skill entails not only hearing what is being said but also processing and interpreting the words that are being spoken by the patient (Choudhary & Gupta, 2015). Empathy is another communication technique that will be practiced when building the health history. By expressing empathy, the patient will be more comfortable in answering questions hence ensuring that no relevant information is hidden. Building a rapport is another communication technique that would ensure that no information is withheld during the interview NURS 6512 Discussions and Assignments: Advanced Health Assessment and Diagnostic Reasoning.

The development of the health history also involves conducting a comprehensive risk assessment. As such, the most applicable risk assessment strategy that would be employed in the case of the patient is identifying mental healthcare risks through the profound evaluation of family health history. Poor mental healthcare among teenagers is one of the major public health concerns not only in the United States but also across the globe. Mental disorders in adolescents are becoming relatively common as at least one in every five youth aged between 9 and 17 are diagnosed with a mental health issue (López, et al., 2017). Since the subject in context is an adolescent, he is also at high risk of possessing or developing a mental health disorder. As such, this risk assessment technique would help in the identification of the possibility of occurrence of the risk and also the development of a proper healthcare plan for the mitigation of the risk NURS 6512 Discussions and Assignments: Advanced Health Assessment and Diagnostic Reasoning.

The following are the questions that would be asked to the patient in the assessment of his healthcare risks;

  1. What is the reason for seeking care today?
  2. What are some of the past healthcare issues you have been diagnosed with and treated?
  3. Have you been diagnosed or treated for Emotional or psychiatric problems before?
  4. Does your family have any cases of mental health disorders?
  5. Does your family have a record of any significant illness such as heart disease, cancer, diabetes, or hypertension?
  6. Do you engage in any activities and leisure?

 

References

Ball, J. W., Dains, J. E., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s Guide to Physical Examination. Elsevier Health Sciences.

Choudhary, A., & Gupta, V. (2015). Teaching communications skills to medical students: Introducing the fine art of medical practice. International Journal of Applied and Basic Medical Research, 5(Suppl 1), S41.

López, C. M., Andrews III, A. R., Chisolm, A. M., De Arellano, M. A., Saunders, B., & Kilpatrick, D. (2017). Racial/ethnic differences in trauma exposure and mental health disorders in adolescents. Cultural diversity and ethnic minority psychology, 23(3),.NURS 6512 Discussions and Assignments: Advanced Health Assessment and Diagnostic Reasoning

By Day 6 of Week 1

Respond to at least two of your colleagues on 2 different days who selected a different patient than you, using one or more of the following approaches:

You make some good points about including functional and cultural assessments when obtaining your patient’s health history.  I agree with keeping the interview questions structured and open-ended, allowing the patient to provide data in their own words without being nudged in any particular direction. Furthermore, effective communication skills cannot be emphasized enough, especially when treating younger patients and adolescents.  If developed during formative years, effective communication skills, a core competency for practitioners, can help students and future practitioners alike (Choudhary & Gupta, 2015).  However, clinical communication skills with the pediatric and adolescent populations specifically, pose a distinct challenge for health care providers, as research in this area is complex and limited, (Frost et al., 2015).

I agree with your techniques of avoiding medical jargon, actively listening, and expressing empathy.  I would add to the questionnaire more focused inquiries regarding this patient’s mental health status. For example, is the home environment chaotic, has the teen experienced any physical/verbal abuse, bullying at school, history of substance use, does he or his friend drink at parties, use cannabis in any form (vape, smoke, edibles.)  Here in California cannabis is legalized and this has resulted in the trickle-down effect of substance use becoming common ground even in middle schools, unfortunately.  Vaping is prevalent in the middle and high school populations and as providers, it’s important we ask questions in such a manner that the patient is reassured we’re not judging and we are genuinely concerned for their overall well-being.  This is where patient-specific communication skills apply NURS 6512 Discussions and Assignments: Advanced Health Assessment and Diagnostic Reasoning.

Including questions on signs or symptoms of anxiety & depression may also be useful.  Perhaps you can ask about this patient’s sleep pattern, eating habits, racing thoughts, thoughts of suicide, history of self-harm behaviors…etc. Self-harm is a crucial part of the mental health assessment, as it is one of the major reasons for admission to an adolescent inpatient psychiatric facility and a major risk factor for suicidal ideation and suicide attempts (Boylan et al., 2019).  I would definitely add the risk assessment tool of the Well-Being Index (WBI) to assess the health of the whole child. This is a reliable tool to assess the adolescent, along with perceptions of school climate to foster their overall well-being by assessing four symptom areas: depression, anxiety, rule-breaking, and substance use (Luthar et al., 2020).

I’m sure that as providers if we were to ask such questions, the adolescent patient would gradually begin to open up and share details he would otherwise keep from his family for fear of repercussion or judgment.

References

Boylan, K., Chahal, J., Courtney, D. B., Sharp, C., & Bennett, K. (2019). An evaluation of clinical practice guidelines for self-harm in adolescents: The role of borderline personality pathology. Personality Disorders: Theory, Research, and Treatment10(6), 500-510. https://doi.org/10.1037/per0000349

Choudhary, A., & Gupta, V. (2015). Teaching communications skills to medical students: Introducing the fine art of medical practice. International Journal of Applied and Basic Medical Research5(4), 41. https://doi.org/10.4103/2229-516x.162273

Frost, K., Metcalf, E., Brooks, R., Kinnersley, P., Greenwood, S., & Powell, C. (2015). Teaching pediatric communication skills to medical students. Advances in Medical Education and Practice, 35. https://doi.org/10.2147/amep.s68413

Luthar, S. S., Ebbert, A. M., & Kumar, N. L. (2020). The well-being index (WBI) for schools: A brief measure of adolescents’ mental health. Psychological Assessment32(10), 903-914. https://doi.org/10.1037/pas0000913

response 2

Thank you for such a detailed post. Your approach in communication techniques with this teenager is professional and definitely empathic and establishing trust is very important. Adolescence is a critical developmental period associated with increased vulnerability for depressive symptoms and gender differences in depression generally emergence during adolescence (Lorenzo-Blanco et al., 2012). Although the reasons and details of the visit are not indicated, it would be important to inquire about thoughts of wanting to hurt himself or anyone else.  (Caplan, 2019) reports that the rate of self-reported mental illness for Latinos are similar to or slightly less than those of the population as a whole, which is a very large population NURS 6512 Discussions and Assignments: Advanced Health Assessment and Diagnostic Reasoning. I found it interesting that as of 2019, the Hispanic population in the United States is over 60.47 million (2021).

I worked on an inpatient acute child/adolescent behavioral unit for over 3yrs and I have found that being compassionate, yet open and asking teenagers directly, what their thoughts and feelings are about self-harm, suicide, etc has not only opened the space for trust, but for truth-building. I have witnessed how the approach of the health providers can both, be helpful and therapeutic, as well as observing how a teen will shut-down due to a lack of trust. Again, I enjoyed reading your post and your selection of questions were great.

References

Caplan, S. (2019). Intersection of cultural and religious beliefs about mental health: Latinos in the faith-based setting. Hispanic Health Care International17(1), 4–10. https://doi.org/10.1177/1540415319828265

Hispanic population by state 2021. (2021). worldpopulationreview.com. https://worldpopulationreview.com/state-rankings/hispanic-population-by-state

Lorenzo-Blanco, E. I., Unger, J. B., Baezconde-Garbanati, L., Ritt-Olson, A., & Soto, D. (2012). Acculturation, enculturation, and symptoms of depression in hispanic youth: The roles of gender, hispanic cultural values, and family functioning. Journal of Youth and Adolescence41(10), 1350–1365. https://doi.org/10.1007/s10964-012-9774-7

Week 1: Building a Comprehensive Health History

According to a 2011 Gallup poll, nurses are ranked as the most trusted professionals in the United States. One of the most admired nursing skills is the ability to put patients at ease. When patients enter into a healthcare setting, they are often apprehensive about sharing personal health information. Caring nurses can alleviate the hesitance of patients and encourage them to be forthcoming with this information NURS 6512 Discussions and Assignments: Advanced Health Assessment and Diagnostic Reasoning.

The initial health history interview can be an excellent opportunity to develop supportive relationships between patients and nurses. Nurses may employ a variety of communication skills and interview techniques to foster strong bonds with patients and to effectively facilitate the diagnostic process. In conducting interviews, advanced practice nurses must also take into account a range of patient-specific factors that may impact the questions they ask, how they ask those questions, and their complete assessment of the patient’s health.

This week, you will consider how social determinants of health such as age, gender, ethnicity, and environmental situation impact the health and risk assessment of the patients you serve. You will also consider how social determinants of health influence your interview and communication techniques as you work in partnership with a patient to gather data to build an accurate health history.

Learning Objectives

Students will:

  • Analyze communication techniques used to obtain patients’ health histories based upon social determinants of health
  • Analyze health-related risk
  • Apply concepts, theories, and principles related to patient interviewing, diagnostic reasoning, and recording patient information NURS 6512 Discussions and Assignments: Advanced Health Assessment and Diagnostic Reasoning
  • Learning Resources
Required Readings (click to expand/reduce)
Required Media (click to expand/reduce)
Assignment: Course Acknowledgement

This mandatory assignment is an acknowledgement that you fully understand the course guidelines.

By Day 3 of Week 1

Submit your Assignment.

Submission and Grading Information

Submit Your Assignment by Day 3 of Week 1.

To complete this assignment, follow the link below and answer the questions provided.

Week 1 Assignment

Discussion: Building a Health History

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

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.

Photo Credit: Sam Edwards / Caiaimage / Getty Images

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 Seidel’s 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 NURS 6512 Discussions and Assignments: Advanced Health Assessment and Diagnostic Reasoning.
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.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Read a selection of your colleagues’ responses.

By Day 6 of Week 1

Respond to at least two of your colleagues on 2 different days who selected a different patient than you, using one or more of the following approaches:

  • Share additional interview and communication techniques that could be effective with your colleague’s selected patient.
  • Suggest additional health-related risks that might be considered.
  • Validate an idea with your own experience and additional research.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 1 Discussion Rubric

Post by Day 3 of Week 1 and Respond by Day 6 of Week 1

To Participate in this Discussion:

Week 1 Discussion NURS 6512 Discussions and Assignments: Advanced Health Assessment and Diagnostic Reasoning

What’s Coming Up in Module 2?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

In Module 2, you explore the impact of functional assessments, diversity, and sensitivity in conducting health assessments. You also examine various assessment tools and diagnostic tests used to gather information about patients’ conditions and examine their validity, reliability, and impact in conducting health assessments.

Next week, you will specifically examine functional assessments as they relate to diversity and sensitivity

Registration for Shadow Health

Throughout this course, you will participate in digital clinical experiences using the online simulation tool Shadow Health. The Shadow Health digital clinical experience provides a dynamic, immersive experience designed to improve nursing skills and clinical reasoning through the examination of digital standardized patients. Using Shadow Health you will participate in health histories, focused exams, and a comprehensive assessment.

There will be four Shadow Health assessment components that you will need to complete in Module’s 2 and 3:

  • Health History Assessment (Week 3 & 4)
  • Focused Exam: Cough (Week 5) for a pediatric patient presenting with cough
  • Focused Exam: Chest Pain (Week 7) for an adult patient presenting with chest pain
  • Comprehensive (Head-to-Toe) Physical Assessment (Week 9)

Before you can participate in these simulations, you will need to register for a Shadow Health account. To do this:

  • Go to the Walden Bookstore and purchase access to Shadow Health and the required texts.
  • Once Shadow Health has been purchased, an access code will be emailed to you from the bookstore.
  • Review this video explaining how to register in Shadow Health: https://vimeo.com/275921826/c12d50ee6e
  • Use the Shadow Health link located in the navigation menu on the left in the Blackboard course.
  • Follow the prompts to register in Shadow Health. You will need the access code provided from the bookstore to register. Once registered, Shadow Health should always be accessed via the link in Blackboard.
  • Use only Google Chrome when accessing Shadow Health and make sure all other programs are turned off on your computer. Other browsers do not work well and will not allow the Shadow Health speech to text function to work.
  •  Once registered, complete the Shadow Health Orientation in the Shadow Health website/program and review the videos designed to assist with navigating and completing assignments.
  • Read the Shadow Health Nursing Documentation Tutorial located in the Week 1 Learning Resources.

Note: As nurses you typically use the word assessment to mean completing the physical exam. However, in the SOAP Note format, assessment means diagnosis so start getting in the habit of calling the physical exam exactly that NURS 6512 Discussions and Assignments: Advanced Health Assessment and Diagnostic Reasoning.

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Week 2 Case Studies

In Week 2, your Instructor will assign you a case study related to your Discussion by Day 1 of the week. Please make sure to review the “Course Announcements” area of the course to verify your assigned case study. Please plan ahead to ensure you have time to review your case study and your Learning Resources so that you can complete your Discussions and Assignments on time.

Photo Credit: Getty Images/iStockphoto

Practicum – Upcoming Deadline

In the Nurse Practitioner programs of study (FNP, AGACNP, AGPCNP, and PMHNP) you are required to take several practicum courses. If you plan on taking a practicum course within the next two terms, you will need to submit your application via Meditrek .

For information on the practicum application process and deadlines, please visit the Field Experience: College of Nursing: Application Process – Graduate web page.

Please take the time to review the Appropriate Preceptors and Field Sites for your courses.

Please take the time to review the practicum manuals, FAQs, Webinars and any required forms on the Field Experience: College of Nursing: Student Resources and Manuals web page.

  • Field Experience: College of Nursing Quick Answers
  • Field Experience: MSN Nurse Practitioner Practicum Manual
  • Student Practicum Resources: NP Student Orientation
  • Week 2: Functional Assessments and Cultural and Diversity Awareness in Health Assessment

 

Diversity is not about how we differ. Diversity is about embracing one another’s uniqueness.

—Ola Joseph

 

Countless assessments can be conducted on patients, but they may not be useful. In order to ensure that health assessments result in the necessary care, health assessments should take into account the impact of factors such as cultures and developmental circumstances.

Learning Objectives

Students will:

  • Analyze diversity considerations in health assessments
  • Apply concepts, theories, and principles related to examination techniques, functional assessments, and cultural and diversity awareness in health assessment NURS 6512 Discussions and Assignments: Advanced Health Assessment and Diagnostic Reasoning
  • Learning Resources
Required Readings (click to expand/reduce)
Required Media (click to expand/reduce)
Discussion: Diversity and Health Assessments

May 2012, Alice Randall wrote an article for The New York Times on the cultural factors that encouraged black women to maintain a weight above what is considered healthy. Randall explained—from her observations and her personal experience as a black woman—that many African-American communities and cultures consider women who are overweight to be more beautiful and desirable than women at a healthier weight. As she put it, “Many black women are fat because we want to be” (Randall, 2012).

Photo Credit: Getty Images

Randall’s statements sparked a great deal of controversy and debate; however, they emphasize an underlying reality in the healthcare field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and healthcare professionals should be aware of this reality and adapt their health assessment techniques and recommendations to accommodate diversity.

In this Discussion, you will consider different socioeconomic, spiritual, lifestyle, and other cultural factors that should be taken into considerations when building a health history for patients with diverse backgrounds. Your Instructor will assign a case study to you for this Discussion NURS 6512 Discussions and Assignments: Advanced Health Assessment and Diagnostic Reasoning.

To prepare:

  • Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments.
  • By Day 1 of this week, you will be assigned a case study by your Instructor. Note: Please see the “Course Announcements” section of the classroom for your case study assignment.
  • Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient assigned to you.
  • Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.
  • Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information?
By Day 3 of Week 2

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

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Read a selection of your colleagues’ responses.

By Day 6 of Week 2

Respond on or before Day 6 on 2 different days to at least two of your colleagues who were assigned a different patient than you. Critique your colleague’s targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to your patient, and why NURS 6512 Discussions and Assignments: Advanced Health Assessment and Diagnostic Reasoning.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 2 Discussion Rubric

Post by Day 3 of Week 2 and Respond by Day 6 of Week 2

To Participate in this Discussion:

Week 2 Discussion

What’s Coming Up in Week 3?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

Next week, you examine assessment techniques, health risks and concerns, and recommendations for care related to patient growth, weight, and nutrition. You will also begin your first DCE: Health History Assessment which will be due in Week 4. Plan your time accordingly.

Overview of Digital Clinical Experiences (DCE) and Lab Components

Throughout this course, you are required to not only complete your standard course assignments and discussions, but you will also complete DCE and Lab Components that are either structured as optional or required assignment submissions. Please take the time to review your DCEand Lab Components for this course that are required submissions. See the table below and the attached table for specific DCE and Lab Components for the course.

Note: Each Shadow Health Assessment may be attempted and reopened as many times as necessary prior to the due date to achieve a total score of 80% or better, but you must take all attempts by the Day 7 deadline. You must pass BOTH the Health History and Comprehensive (head-to-toe) Physical Exam of at least a total score of 80% in order to pass the course.

 

Week Digital Clinical Experiences Lab Components
Module 1:  Comprehensive Health History
Week 1: Building a Comprehensive Health History
Module 2: Functional Assessments and Assessment Tools
Week 2: Functional Assessments and Cultural and Diversity Awareness in Health Assessment
Week 3: Assessment Tools, Diagnostics, Growth, Measurement, and Nutrition in Adults and Children DCE: Health History Assessment (assigned in Week 3, due in Week 4) Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children
Module 3: Approach to System Focused Advanced Health Assessments
Week 4: Assessment of the Skin, Hair, and Nails DCE: Health History Assessment Lab Assignment: Differential Diagnosis for Skin Conditions (SOAP Note for differential diagnosis)
Week 5: Assessment of Head, Neck, Eyes, Ears, Nose, and Throat DCE: Focused Exam: Cough Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat (Episodic SOAP Note)
Week 6: Assessment of the Abdomen and Gastrointestinal System Lab Assignment: Assessing the Abdomen (Analyze SOAP Note)
Week 7: Assessment of the Heart, Lungs, and Peripheral Vascular System DCE: Focused Exam: Chest Pain
Week 8: Assessment of the Musculoskeletal System Discussion: Assessing Musculoskeletal Pain (Episodic SOAP Note)
Week 9: Assessment of Cognition and the Neurologic System DCE: Comprehensive (head-to-toe) Physical Assessment Case Study Assignment: Assessing Neurological Symptoms (Episodic SOAP Note)
Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal Lab Assignment: Assessing the Genitalia and Rectum (analyze SOAP Note)
Module 4: Ethics in Assessment
Week 11: The Ethics Behind Assessment Lab Assignment: Ethical Concerns

 

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