Module 1: Assignment PDF

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Syllabus Course Number : MSN 610 Course Name: Diagnostic Reasoning and Advanced Physical Assessment

Credit Hours: 3 Semester and Year: Summer 2nd 7 week session 2020 Course Description: This course is designed to assist the student in the development of advanced skills in the

assessment of physical, cognitive, nutritional domains with the integration of appropriate test data and diagnostic reasonings. The synthesis of the physical assessment and diagnostic testing is designed to ensure the delivery of safe, quality care to diverse populations in a variety of settings. Prerequisites: Admission to MSN program & BIO 669 Pathophysiology Lead Faculty: Kathy J. Noyes, DNP, APRN, FNP-BC, ACNP-BC [email protected]

Mary Ann Michael, MSN, CNP, PNP-BC

[email protected]

Office Phone: Via E-Mail Office : Rm 497D in Health Innovations Center, Northern Kentucky University, Highland Heights, KY Meetings: By Appointment online Course Faculty: Assigned by Sections Student Learning Outcomes: Upon completion of this course the student will be able to: 1) 2) 3) 4) 5)

Demonstrate a complete physical assessment using a virtual patient Develop differential diagnosis as it applies to pathophysiological processes and assessment Document a complete history and physical of a patient in designated specialty areas Utilize appropriate health screening measures and anticipatory guidance for clients across the life span Describe the techniques of and rationale for commonly used laboratory, radiological and other diagnostic studies 6) Interpret subjective and objective data to formulate a diagnostic conclusion

Required Course Materials Rhoads, J. and Peterson, S.W., (2018) Advanced Health Assessment and Diagnostic Reasoning. 4th Edition. Jones & Bartlett. ISBN 9781284105377 Stern, S., Cifu, A., Altkorn, D. (2015). Symptom to Diagnosis: An Evidence-Based Guide. 4th Ed. McGraw-Hill Education. ISBN 978-0-07-180344-1 pg. 1

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I-Human Software purchased via PayPal on-line Medical Media Software purchased via PayPal on-line http://labtestonline.org (free reference for diagnostic labs associated with a condition/disease) Introduction to in vitro Diagnostic Testing https://dx.advamed.org/sites/dx.advamed.org/files/resource/advameddx-policy-primer-on-diagnostics-june2011.pdf (Links to an external site.) Required Equipment: Equipment needed for skills practice: (Improvising is NOT acceptable). You will use these pieces of equipment your entire careers. ALL EQUIPMENT IS REQUIRED FOR FINAL EXAM. *High Quality Stethoscope * Reflex Hammer * Tongue Blades * Handheld Eye Chart * Thermometer

* otoscope/ophthalmoscope * Tuning Fork * Cotton Swabs * BP Cuff (either aneroid or digital)

Suggested Resources: Domino, F.J., Baldor, R.A., Golding J., & Stephens, M.B. (2020). 5 Minute Clinical Consult. 28 th edition. Wolters Kluwer. ISBN: 9781975136413 Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th edition American Academy of Pediatrics Fishbach, F.& Fisbach, M.,(2018) Fishback’s Manual of Laboratory and Diagnostic Tests. Wolters Kluwer. ISBN: 9781496377128 Bickly, Lynn (2017). Bates Guide to Physical Examination & History Taking. 12 ed. Wolters Kluwer. ISBN: 9781469893419 Huether, S.E. & McCance, K.L. (2017). Understanding Pathophysiology. 6th ed. Elsevier Publisher Methods of Instruction: Teaching strategies will include, but not limited to, textbook readings, group discussion of case studies, review of various diagnostic tests needed to confirm a final diagnosis among a list of differential diagnoses, submission of history and physical findings utilizing virtual patients (via I-Human) and a video submission of a comprehensive history and physical on a live patient. Assessment skills should be practiced with consenting adolescents or adults, (13 years old and above) i.e. spouses, friends, relatives. All information/data obtained for this course should remain HIPPA compliant. Practice and Assignments SHOULD NOT be performed on actual patients within your job setting. pg. 2

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All work is to be completed individually by each student unless permission from faculty is given or work is designated as a group assignment. Group work is not acceptable and may result in failure of the course. Faculty reserves the right to make changes as necessary to this course syllabus. Students will be notified in writing of any changes in a timely fashion. It is the student’s responsibility to check the Course Announcements daily. Course Assignments: Students will be required to submit assignments by the due date and time stated. Assignments submitted late but within 24 hours of time due can receive up to half credit if the assignments meets the other criteria. ANY ASSIGNMENT SUBMITTED AFTER 24 HOURS OF TIME DUE WILL BE GIVEN A ZERO UNLESS THERE IS SUBSTANTIAL EVIDENCE OF AN EMERGENY CAUSING THE DELAY. Assignments will include: Quizzes: There will be 3 quizzes during the course every 2 weeks. These quizzes will evaluate the critical knowledge acquired within those modules. Each quiz will consist of 25 questions. Each answer is worth 1.0 points for a total of 25 points per test. Case Study Discussions: The Discussion posts will constitute class participation. There will be 6 case discussions with one case study presented within each of the 6 modules. These discussions will focus on the synthesis of patient data and diagnostic reasoning. The cases will have specific questions that must be answered by every student with at least 1 other student reply/comment to be posted regarding that case. You must post your initial answers by Wednesday night at 11:59 pm and a reply post by Sunday night at 11:59 pm. You must cite your references in APA format, 7th edition for each entry. Each case discussion is worth up to 20 points. There will be 10 pts for the initial post and 10 pts for the reply post. The reply post MUST ADD SUBSTANCE TO THE INITIAL POST. Weekly Discussion Board Grading Criteria Discussion Board Grading Rubric Points

Quality

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10 points if all of the following items are present Demonstrates thorough preparation, synthesis and informed opinion, addresses the topic thoroughly, comments/asks questions that contribute to group learning. Submits

5.0 points if any of the following items are present Demonstrates some preparedness and generally addresses topic; comments/asks questions; outside materials may lack appropriateness , Uses 1 Reference only

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0 points

Student Points Comments

Demonstrates inadequate preparation, marginal or offtopic posts, lacks synthesis of information, minimal or no contribution to group learning. Rarely supports the efforts, ideas or work of others

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Discussion Board Response Submission

appropriate outside materials into the discussion. 2 References Required in APA 7th edition format 10.0 points if all of the items are present -Student meets the deadlines for posting evidence- based responses outlined by course requirements -Always listens to and supports the work of others. 1 Reference required in APA format

Does not use APA format

No APA Reference are provided.

5.0 point if any of the following apply -Student posts responses within 24 hours of the due date/time -Usually listens to and supports the work of others but does not add new information to the post -No Reference presented

0 points if any of the following apply -Student posts is past the 24 hours deadline -Does not respond to others. No references presented

Students Total Grade

I-Human Case Submissions: I -Human is a virtual software program that will allow you to practice your interviewing and physical assessment skills as you obtain a focused or comprehensive history and physical findings on a virtual patient. Each of the I-Human cases will require a History, Physical Exam, Differential and Definitive diagnoses that you must establish. The H & P MUST be written up in the EMR found within IHuman. Each weekly EMR will be awarded 50 points. Faculty will provide feedback on your documentation. This program is in a learning platform so that you will be able to check your progress, identify the correct answers, learn why other answers are incorrect, and document your H & P in an electronic record format. You must register for this software program. The registration link will be announced before your first assignment is due. This software program works best using Chrome or Fire Fox as browsers. Do Not use I-pad Pro as this program does not work effectively. For all of the modules, you will have a “practice “and “submitted “cases used for your History and Physical Assessments. History & Physical Assignments: There will be weekly “submitted” cases within I-Human. They include both the History and Physical, but you will be graded on the History, Physical Exam and Differential Diagnoses, Ranking the Diagnosis and identification of the Must Not Miss skill sections, within I-Human for the submitted cases. I-Human is graded internally within the program. You will earn points as you work your way through the various components. You do NOT have to submit the I-Human cases to CANVAS. The faculty will go into the pg. 4

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software to retrieve your grade. Faculty will convert the percentage score within I-Human to the exact points earned (Ex: % score /165 points) I-Human Grading Rubric for Modules 1-6 Physical Exam You will have the opportunity to score 165 points for each physical exam for a total of 990 total points. Score within I-Human Points 90-100 % 149-165 points 89-85 % 140-148 points 84- 80 % 132-139 points 79 or less% < 132 The more you practice the higher your cumulative scores will become. There are mechanisms of “hints” built into each case. You MUST view the I-Human tutorial videos and the practice case as often as needed to become proficient with using the software. You may pause any of the cases to be able to research the presenting objective data. You may leave the cases and return to finish them prior to their completion. These exercises are designed to develop critical thinking and clinical reasoning skills. INITIALLY, DO NOT EXPECT TO MAKE PERFECT SCORES. This is a learning process. Your perception must now become that of a PROVIDER not a bedside nurse. Be sure to use resources for advanced practice nurses or physicians. Basic nursing references will NOT provide the correct information. Use evidence-based, peer reviewed references. Although, I-Human will provide a variety of normal and abnormal findings, it is IMPERATIVE that you practice on live humans also. It will be important to be able to use your instruments correctly to demonstrate your skill level for the final physical exam. Your “patients” should be voluntary friends, family, neighbors, etc. that are willing to let you examine them. Practice writing up your findings. There is an H & P assessment form provided, that you may use for practice found within the modules. Voice Thread Submission Assignments: To allow for faculty feedback on how well you are doing with practicing your hands-on skills, there will be 3 voice thread submissions located within Modules 2, 4 and 5. You will be creating a video recording demonstrating a specific component of the physical exam on a volunteer patient. The recording must be less than 10 minutes in length, or you will fail the assignment. You may use the grading rubric to be sure you have covered all the body area components discussed in that module. These assignments will be preparation for your comprehensive history and physical final exam. Each voice thread submission will be worth 25 points. Written History Assignments: Within I-Human for Modules 1 & 3 you will be required to complete a written comprehensive HISTORY on a designed patient and Submit these via CANVAS. These assignments are worth 80 points. The Grading Rubric for the Comprehensive History & Physical Exam will be used to grade the written Histories. Final Comprehensive Exam: The final exam will consist of a written comprehensive history and a taped video recording of each student demonstrating a comprehensive examination on a live adult patient. The documentation of this complete history and physical exam must be submitted with the video on the template provided. This video will be viewed by the instructors only and must be HIPPA compliant to maintain the privacy of the volunteer “patient”. The video/ exam must be a thorough demonstration of examining each body systems reviewed during this course. The video must be less than 25 minutes in length and MUST BE PERFORMED IN A PROFESSIONAL EXAM ROOM SETTING WITH PROFESSIONAL ATTIRE OR YOU WILL pg. 5

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AUTOMATICALLY FAIL THIS EXAM. There will be 10 points deduced if the video is more than 25 min. . This Exam is due the 7th week of the course and can be found in Module 7. You will be graded with the same H & P rubric listed below. YOU MUST PASS THE FINAL EXAM WITH AN 80% TO PASS THE COURSE. Other requirements for the Final Exam include: 1) At the beginning of the video, every student must show a close up picture ID of themselves into the camera. Do NOT expose any personal data, i.e. Social Security number, Date of Birth or address. Please cover any personal data with finger or tape. We only want to see your picture and name. 2) At the beginning of the video, every student must scan the room in which they will be performing the examination. You must have all the assessment equipment needed to complete the examination. 3) There cannot be any documents, textbooks, picture, posters, or grading rubrics in the "exam room". There can be a single white sheet of paper to be used by the patient to perform the mini-cog test. Students must show the single, blank sheet of paper. 4) The examiner student should wear a mask and gloves to perform the exam. The "patient" can also wear a mask and gloves, but must remove the mask to allow for the oral/mouth examination. 5) The examiner/student must demonstrate and discuss the components of the exam and verbally explain the findings. Beware not to turn your back towards the camera, as you will obstruct the viewing of your assessment. If we can not see what you are assessing, we can not grade it. 6) The room must be quiet, well-lit and free of distractions i.e. TV, radio, other children, pets, etc. 7) The examiner must take all of the vital signs at the beginning of the assessment. 8) The patient should be clothed in shorts and tee shirts to allow for viewing each required body system. The breast and genitourinary exams are EXCLUDED from the assessment. 9) You do not need to record the patient history, however, you must write up the patient's history on the template we have been using throughout the course and submit via CANVAS 10) The Voice Thread video will automatically upload into CANVAS. If you can not submit your video via Voice Thread, you have the option to upload your video to U Tube, but send your instructor notice that is what you have done. You MUST label your video with your name so your instructor(s) can find it.

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GRADING RUBRIC for COMPREHENSIVE HISTORY & PHYSICAL EXAM: There will be points for your documentation and points for your exam demonstration. Grading Rubric for Comprehensive History Activity SUBJECTIVE DATA Completes Demographic Data Chief Complaint History of Present Illness Past Medical History Active Health Problems

Points Doc 2 2 2 2

Resolved Health Problems Previous Hospitalizations Surgical History Gender/Sexual Orientation Allergies

2 2 2 2 2

Medications Social History

2

Living Arrangements Occupation

2 2

Environmental Safety Smoking Alcohol Use Other Unprescribed Drugs

2 2 2 2

Diet Family History Anticipatory Guidance

2 16 2

Immunizations Review of Systems General Health Skin, Hair, Nails

2 2 2

HEENT Neck

2 2

Cardiovascular Pulmonary Abdominal/GI

2 2 2

Genitourinary/Gyn/Breast Musculoskeletal

2

Neurological Endo/Lymph Nodes

2 2

Hematology Psychological

Comments

2

2 2

Possible History Total: 80 points

The following physical exam grading rubric will Include points for the demonstration,

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documentation And explanation of the exam to the patient/faculty. OBJECTIVE DATA

Vital Signs: T, HR, BP, Resp Handwashing General Appearance Skin (Inspection/Palpation (turgor) Head (Inspection/Palpation) TMJ Ears (Inspection/Palpation of outer ear) Weber & Rinne Test

Ears (Inspection with Otoscope) Whisper Test Eyes (Inspection External Eye, EOM, Peripheral Fields) Pupil Reactivity/ Accommodation Eyes Exam (Ophthalmoscope/Fundoscopic) Visual Acuity Nose (Inspection/Palpation of external nose/ sinuses and inspection of nasal cavity) Nasal Patency Throat (Inspection of palates, buccal areas, dentition, pharynx) Neck (Palpation of Thyroid, Auscultation of Carotids) Cervical Lymph Nodes (4 areas) JVD Heart (Palpation of PMI, Auscultation of heart sounds Lungs (Inspection for Symmetry, Palpation for Tactile Fremitus, Auscultation of lung sounds) Abdomen (Inspection for abnormalities/scars, Auscultation for bowel sounds and bruits, Light & Deep Palpation for masses, Percussion)

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Doc Demo Exp. 4 4 2 4 4 2 4 2 4 2 4 2 4 2 2 2 2 2 4 2 4 2 6 6 4 2 4 2 4 2 4 2

4 4 4 4 4 2 2 4 4 6 4 4 4 4

4 2 4 4 4 2 8 4 2 2 4 4 6 6 6 6

4 4 4 8 2 4 6

6

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Musculoskeletal Sensory (Sharp/Dull Sensations of face & extremities, Proprioception Sensation) Motor (Gait, ROM for Neck, shoulders, elbows, wrists, hips, knees, ankles, spine) Peripheral Vascular (Inspection of extremities, Capillary Refill) Palpation of radial, posterior tibialis, dorsal pedis, carotid pulses Neurological Romberg and Pronator Drift Cranial Nerves (CN 1) Cranial Nerve (CN II) Cranial Nerve (CN III) Cranial Nerve (CN IV) Cranial Nerve (CN V) Cranial Nerve (CN VI) Cranial Nerve (CN VII) Cranial Nerve (CN VIII) Cranial Nerve (CN IX) Cranial Nerve (CN X) Cranial Nerve (CN XI) Cranial Nerve (CN XII) Deep Tendon Reflexes (Biceps, Brachioradialis, Triceps, Patellar, Achilles Mental Status (Date, Time, Place,Mini-Cog) Differential Diagnosis/Assessment Summary Plan Appropriate Organization of PE Possible Total PE points:

4 2

4

18 9 (2 ea) 2 2 8 4

18

4 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 10 5

4

4 4 8

2 8

2 2 2 2 2 2 2 2 2 2 2 2 10

4

8 4

480 points

Score:

Comments:

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Differential Diagnoses Table: The Differential Diagnoses Table is designed for you to identify specific signs/symptoms (Subjective Data), the physical findings (Objective Data), the diagnostic testing you would order to rule in (confirm) or rule out a definitive diagnosis for a specific disorder. There will be several disorders listed and due for each module associated with a chief complaint. You are to complete each column for each disease entity. Information obtained for the table MUST be referenced using APA format 7th Edition. This table can be useful for future courses and to assist in studying for credentialing exams. Test questions regarding the Differential Diagnoses may be included on your written tests. Focus on the Subjective and Objective Findings and the Diagnostic Testing. Synthesize the informati...