NURS 6512: Advanced Health Assessment and Diagnostic Reasoning

The first week is devoted to compiling a thorough medical history.
According to a Gallup study conducted in 2011, nurses are considered to be the most trustworthy professionals in the United States. When it comes to nursing abilities, the ability to put patients at rest is one of the most coveted. When patients enter a healthcare setting, they are often cautious about disclosing sensitive personal health information about themselves. Patients' reluctance to provide information can be alleviated by compassionate nurses, who can also encourage them to be forthright.

The initial health history interview can be a fantastic chance for patients and nurses to establish supportive relationships that will last a lifetime. Patients can benefit from the use of a number of communication skills and interview tactics, which nurses can apply to build strong ties with them and efficiently ease the diagnostic process. APRNs must take into consideration a variety of patient-specific circumstances when conducting interviews, which may influence the questions they ask, the manner in which they ask those questions, and their overall assessment of the patient's health.

It is your responsibility this week to think about how social determinants of health such as the patient's age, gender, race, ethnicity, and environmental circumstance influence the health and risk assessment of those whom you serve. Working in cooperation with a patient, you will evaluate how socioeconomic determinants of health influence your interview and communication approaches as you gather data for the purpose of building a complete medical record.

Objectives for Learning
Students will be able to:

• Study communication tactics used to acquire patients' health histories in light of socioeconomic determinants of health to determine how well they are working.
• Examine the possibility of health problems.
• Apply concepts, theories, and principles linked to patient interviewing, diagnostic reasoning, and recording patient information in order to improve patient care and outcomes.
• Learn more about learning resources here.
• Readings that are required (Click to enlarge/reduce the image)

Assignment: Acknowledgement of Completion of Course
This required work serves as an acknowledgement that you have read and comprehended the course guidelines.

Submit your assignment by the third day of Week 1.

Information about submitting work and receiving a grade
Please submit your assignment by the third day of Week 1.
To complete this assignment, click on the URL provided below and answer the questions that are presented there.

 Week 1's homework NURS 6512 assignment

Building a Health History is the topic of discussion.
The ability to communicate effectively is essential for compiling an accurate and thorough patient history. The health or disease of a patient is influenced by a variety of factors, including their age, gender, ethnicity, and the environment in which they live. It is your responsibility as an advanced practice nurse to be aware of these considerations and to modify your communication tactics accordingly. Not only will this assist you in developing a relationship with your patients, but it will also enable you to more effectively obtain the information necessary to analyze the health risks associated with your patients' conditions.

To prepare for this Discussion, you will assume the position of a physician who is compiling information about the health of a certain new patient allocated to you by your Instructor.

Featured image courtesy of Sam Edwards / Caiaimage / Getty Images

To get ready, do the following:

Assuming that you are familiar with the information offered in Chapter 1 of Ball et al., examine the following:

Your Instructor will assign you a fresh patient profile for this Discussion on Day 1 of this week, so that you can begin discussing it on Day 1. For more information about your new patient profile assignment, please read the "Course Announcements" area of the classroom. Note:
Which aspects of your communication and interview procedures would you use to compile a patient's health history would be different for each patient?
What questions should you ask to compile a patient's health history based on their socioeconomic determinants of health? How can you tailor your inquiries to be more effective?
Is it appropriate to utilize different risk assessment instruments with different patients? If so, what questions would you ask each patient in order to assess his or her health risks?
Determine whether there are any potential health-related concerns associated with the patient's age, gender, ethnicity, or environmental context that should be taken into account during the examination.
Consider using one of the risk assessment measures offered in Chapter 1 or Chapter 5 of the Seidel's Guide to Physical Examination manual, or another tool with which you are familiar, to assess the risk associated with your patient's condition.
Prepare at least five specific questions that you would ask your chosen patient in order to assess his or her health risks and begin compiling a health history of the patient.
By the third day of Week 1,
Post a summary of the interview as well as a description of the communication tactics that you would use with your allocated patient in your response. Explain why you would utilize these methods in your presentation. Identify the risk assessment instrument you choose and explain why you believe it would be appropriate for the patient you have picked. Provide at least five targeted questions that you would ask the patient if you were in his or her shoes.

Please keep in mind that you must complete your initial post before you will be able to access and comment to the postings of your fellow participants in this Discussion. In order to complete your first post, start by clicking on the link that says "Post to Discussion Question." Then select "Create Thread" to finish your post. Remember that after you click on Submit, you will no longer be able to delete or alter your own posts, and you will no longer be able to post anonymously. Make sure to double-check your post before hitting the "Submit" button.

Take a look at some of the replies from your coworkers.

Week 1 has reached its sixth day.
Use one or more of the following techniques to respond to at least two of your coworkers on two different days who chose a different patient than you.

Share any additional interview and communication tactics that you think would be beneficial with your colleague's chosen patient with the group.
Please provide any additional health-related dangers that should be taken into consideration.
Validate a notion by drawing on your own personal experience and conducting extra research.
Information about submitting work and receiving a grade
Criteria for determining a grade
To gain access to your rubric, follow these steps:

Rubric for the First Week of Discussion

To participate in this discussion, you must post by Day 3 of Week 1 and respond by Day 6 of Week 1 by the following dates:

Discussion from Week 1

What Can You Expect From Module 2?

Photo courtesy of [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images. Image source:

As you progress through Module 2, you'll learn about the importance of functional evaluations, cultural diversity, and sensitivity when conducting health exams. Also covered are numerous assessment methods and diagnostic tests that are used to obtain information about patients' ailments. You will look at how valid and reliable they are, as well as their impact on patients' health when conducting health assessments.

In the coming week, you will focus on functional assessments and how they relate to diversity and sensitivity.

Shadow Health registration is now open.
In this course, you will participate in digital clinical encounters through the use of the online simulation platform Shadow Health during the duration of the course. By examining standardized digital patients, the Shadow Health digital clinical experience provides a dynamic, immersive experience that is intended to improve nursing skills and clinical reasoning in participants. You will be asked to engage in health histories, focused tests, and a full assessment through the use of Shadow Health.

In Modules 2 and 3, you will be required to complete four different components of the Shadow Health evaluation. These are:

Examination of the patient's medical history (Week 3 & 4)

The focus of this week's examination was cough in a pediatric patient who had presented with cough on week 5.
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.

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.

 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 1  NURS 6512 Sample

Discussion: Week # 1: Building a Comprehensive Health History
During a health history assessment, it is essential to remember that each patient is unique, and the communication and interview techniques may differ. Most important, it is vital to conduct a comprehensive and accurate health history that would assist health care providers in making correct diagnose and develop appropriate treatment plans (Ball et al., 2017). Building a health history often begins with developing a positive relationship with the patient via effective communication. Moreover, one should then apply appropriate interview and communication techniques while considering the age, gender, ethnicity, or environment of the patient. In this discussion, I have chosen the case study of a 55-year-old Asian female patient who lives in a highly dense poverty housing complex.
For this 55-year-old Asian patient, the first to do when building a health history is to develop a positive and trusting relationship by ensuring that the patient is comfortable physically and emotionally, which can be achieved through maintaining good eye contact and listening to the patient carefully and in a respectable way. Again, one would also utilize open-ended questions to assist in collecting more information, then narrow down the data to specific ones once one gathers enough information (Ball et al., 2017). For the 55-year-old Asian patient, there are several health-related risks based upon the patient’s age, gender, ethnicity, or environment setting that must be considered during health risk assessment.
Considering the environment in which the patient lives, she might be at risk for malnutrition, physical abuse (because women of her age are prone to sexual and physical abuse- gender and age), behavioral and psychosocial health risks (because she lives in a high-density housing complex- environment). These risks could be verbally, physically, or financially perpetuated abuse. Again, this patient may be depressed because of her low socioeconomic status, considering her neighborhood. Therefore, the goal of health risk assessments (HRA) for this patient is to assess the level of risk for acquiring certain illnesses to enable healthcare providers to create healthcare plans to prevent illnesses and promote health (Lemke et al., 2020).

Moreover, various risks assessment instruments can be used to evaluate the potential health-related risks the patient may face. One of the risk assessments instruments that can be used is the Hurt, Insult, Threaten, and Scream (HITS) (Ball et al., 2017). Further, The My Own Health Report (MOHR) is also a helpful tool, useful in assessing behavioral and mental health risks like sleep, stress, and anxiety. This tool is more patient-centered, thus can help the patients to identify risk factors they might be facing and how they might change to prevent the risks (Krist et al., 2016).
Targeted questions include the following:

• When was the last time you visited your primary care physician or Ob/Gyn doctor for a check-up?
• Are there medications you are currently taking?
• Generally, how would you rate your overall health status (poor, fair, good, excellent)?
• Are you or have you ever smoked, drink alcohol or utilize any recreational drugs?
• How frequent do you get anxious or depressed?
• Can you describe your diet over the past seven days?
• Do you have any health issue that you would like us to discuss?

References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2017). Seidel's Guide to Physical Examination-E-Book: An Interprofessional Approach. Elsevier Health Sciences.
Krist, A. H., Glasgow, R. E., Heurtin-Roberts, S., Sabo, R. T., Roby, D. H., Gorin, S. N. S., ... & MOHR Study Group. (2016). The impact of behavioral and mental health risk assessments on goal setting in primary care. Translational behavioral medicine, 6(2), 212-219.
Lemke, A. A., Thompson, J., Hulick, P. J., Sereika, A. W., Johnson, C., Oshman, L., & Dunnenberger, H. M. (2020). Primary care physician experiences utilizing a family health history tool with electronic health record–integrated clinical decision support: an implementation process assessment. Journal of community genetics, 11(3), 339-350.