NR305 full course – 2019

NR 305 RN Health Assessment

 

Week 1 Discussion

 

Healthy People Initiative

 

CO1 Utilize prior knowledge of theories and principles of nursing and related disciplines to explain expected client behaviors, while differentiating between normal findings, variations, and abnormalities. (PO 1)

 

CO3 Utilize effective communication when performing a health assessment. (PO 3)

 

The topic this week asks you to apply what you have learned to the following case study.

 

As the school nurse working in a college health clinic, you see many opportunities to promote health. Maria is a 40-year-old Hispanic who is in her second year of nursing school. She complains of a 14-pound weight gain since starting school and is afraid of what this will do to both her appearance and health if the trend continues. After conducting her history, you learn that she is an excellent cook and she and her family love to eat foods that reflect their Hispanic heritage. She is married with two school-age children. She attends class a total of 15 hours per week, plus she must be present for 12 hours of labs and clinical. She maintains the household essentially by herself and does all the shopping, cooking, cleaning, and chauffeuring of the children. She states that she is lucky to get 6 hours of sleep per night, but that is okay with her. She lives 1 hour from campus and commutes each day. Using Healthy People 2020 (Links to an external site.)Links to an external site. and your text as a guide, answer the following questions.

 

What additional information would you like to gather from Maria?

 

What are Maria’s real and potential health risks?

 

Why is Maria’s culture important when obtaining the health assessment?

 

Pick one of Maria’s health risks. What would be one reasonable short-term goal for this risk?

 

What nursing interventions would you incorporate into Maria’s plan of care to assist her with meeting your chosen goal? Please provide rationale for your selections.

 

 

 

NR 305 RN Health Assessment

 

Week 2 Discussion

 

General Survey/Skin/Nutrition

 

CO1 Utilize prior knowledge of theories and principles of nursing and related disciplines to explain expected client behaviors, while differentiating between normal findings, variations, and abnormalities. (PO 1)

 

CO3 Utilize effective communication when performing a health assessment. (PO 3)

 

Your home health agency has received an order from a local hospital to evaluate and treat an elderly woman being discharged from its medical surgical unit.

 

Millie Gardner, an 83-year-old female patient, is being discharged home today to the care of her husband Fred (87 years old) following a 9-day hospitalization for pneumonia, dehydration, and failure to thrive. She has a history of hypertension (HTN), Type II Diabetes, and cerebral vascular accident (CVA) with left-sided weakness. Patient is alert and oriented but does have periods of forgetfulness during the overnight hours. Patient has intermittent incontinence of bowel and bladder and requires assistance with all activities of daily living (ADLs).

 

Medications:

 

Lopressor

 

Lisinopril

 

Plavix

 

Metformin

 

Novolin R per sliding scale *NEW*

 

Multivitamin

 

Colace

 

Zithromax *NEW*

 

Upon arrival you are greeted by Champ, the couple’s rambunctious miniature Doberman pinscher dog. Millie is in her wheelchair staring blankly out the window, and Fred is busy in the kitchen preparing the couple’s lunch.

 

Based on the scenario above, please use the general survey process to describe the areas that you would be observing immediately upon entry to the home.

 

What, if any, concerns related to Millie’s skin and nutritional status do you have?

 

What nursing interventions will you include in the plan of care to address these concerns?

 

What teaching strategies will you use to educate Millie and Fred on the new medications?

 

Using the SBAR, please include the information that you will communicate to the physician’s office at the completion of the visit.

 

 

 

NR 305 RN Health Assessment

 

Week 3 Discussion

 

Assessment of the Neurological System

 

CO1 Utilize prior knowledge of theories and principles of nursing and related disciplines to explain expected client behaviors, while differentiating between normal findings, variations, and abnormalities. (PO 1)

 

CO2 Recognize the influence that developmental stages have on physical, psychosocial, cultural, and spiritual functioning. (PO 1)

 

CO3 Utilize effective communication when performing a health assessment. (PO 3)

 

Randy Adams is a 38-year-old male patient of Dr. Joseph Reynolds who was admitted yesterday morning for 24-hour observation for mild concussion following a motor vehicle accident. Randy lost consciousness during the accident and was very confused when he arrived in the ER after EMS transport. He is an Iraq war veteran and he seemed to think after the accident that this all happened in Iraq. Dr. Reynolds is concerned that Randy has some residual problems from a couple of explosive incidents that occurred while he was in Iraq. The physician is unsure whether Randy’s current symptoms are from the car accident or from prior injuries so he has referred him for consultations to both a neurologist and to a behavioral health specialist.

 

Based on the above please discuss the following.

 

Pathophysiology of concussive injuries and treatment

 

Neurological assessment tools used in your current practice setting (if not presently working, please describe one used during prior employment or schooling)

 

Current best practices associated with post-traumatic stress disorder (PTSD)

 

Nursing interventions you would include in this patient’s plan of care

 

 

 

NR 305 RN Health Assessment

 

Week 4 Discussion

 

Assessment of Cardiac Status

 

CO1 Utilize prior knowledge of theories and principles of nursing and related disciplines to explain expected client behaviors, while differentiating between normal findings, variations, and abnormalities. (PO 1)

 

CO3 Utilize effective communication when performing a health assessment. (PO 3)

 

Esther Jackson is a 56-year-old black female who is 1-day post-op following a left radical mastectomy. During morning rounds, the off-going nurse shares with you during bedside report that the patient has been experiencing increased discomfort in her back throughout the night and has required frequent help with repositioning. She states that the patient was medicated for pain approximately 2 hours ago but is voicing little relief and states that you might want to mention that to the doctor when he rounds later this morning. With the patient appearing to be in no visible distress, you proceed on to the next patient’s room for report.

 

Approximately 1 hour later, you return to Ms. Jackson’s room with her morning pills and find her slumped over the bedside stand in tears. The patient states, “I don’t know what is wrong, I don’t feel right. My back hurts and I’m just so tired. What is wrong with me?” The patient refuses to take her medications at this time stating that she is starting to feel sick to her stomach.

 

Just then the nursing assistant comes into the patient’s room to record Ms. Jackson’s vital signs, you take this opportunity to quickly research the patient’s medication record to determine if she has a medication ordered for nausea. Upon return, the nursing assistant hands you the following vital signs: T 37, R 18, and BP 132/54, but states she couldn’t get the patient’s pulse because “it is all over the place.”

 

Please address the following questions related to the scenario.

 

What do you suspect is the cause of the patient’s symptoms?

 

Describe the course of action that you will take to confirm this suspicion and prevent further decline.

 

What further assessments, lab values, and tests will likely be ordered for this patient and how often? If testing is to be completed more than once, please explain the rationale for doing so.

 

While you are caring for this patient, how will you ensure that the needs of your other patients are being met?

 

 

 

NR 305 RN Health Assessment

 

Week 5 Discussion

 

Assessment of Respiratory Status

 

CO1 Utilize prior knowledge of theories and principles of nursing and related disciplines to explain expected client behaviors, while differentiating between normal findings, variations, and abnormalities. (PO 1)

 

CO3 Utilize effective communication when performing a health assessment. (PO 3)

 

CO4 Identify teaching/learning needs from the health history of an individual. (PO 2)

 

Please review the video above as it will provide you with an opportunity to immerse yourself in the role of a nurse addressing tobacco use during routine patient care. Click to review a transcript (Links to an external site.)Links to an external site. of this recording.

 

While viewing, reflect on what you have learned about tobacco use and the role that nurses and other interdisciplinary team members play in helping to assist tobacco users with quitting. While viewing, it is also important to keep in mind that tobacco users move through stages of change in the process of quitting. They move from pre-contemplation to contemplation, contemplation to preparation; preparation to abstinence; abstinence to maintenance. Every stage requires a different strategy by a nurse.

 

After watching the video, and reflecting on the information presented, address each of the following questions.

 

What are the common symptoms associated with an exacerbation of COPD?

 

What assessment techniques will you use to assess Mary?

 

Identify smoking strategies that would be appropriate for each of the encounters that Mary had with the nurse throughout the video that could have been used to assist Mary in quitting smoking.

 

Find a resource in your community that could assist Mary. Start by searching the Internet for your local health department’s website. What services are available to Mary? Briefly describe the services that the state quit line provides. Does it meet the 4 As? Is it accessible, acceptable, affordable, or available for Mary?

 

What will you do to follow-up on Mary’s smoking cessation process?

 

 

 

 

 

 

 

 

 

NR 305 RN Health Assessment

 

Week 6 Discussion

 

Assessment of the Abdomen and Genitourinary System

 

CO1 Utilize prior knowledge of theories and principles of nursing and related disciplines to explain expected client behaviors, while differentiating between normal findings, variations, and abnormalities. (PO 1)

 

CO2 Recognize the influence that developmental stages have on physical, psychosocial, cultural, and spiritual functioning. (PO 1)

 

CO3 Utilize effective communication when performing a health assessment. (PO 3)

 

Amira is a 27-year-old Syrian refugee who has been residing in a local homeless shelter since her arrival here in the United States 4 weeks ago. She was brought into the emergency room this morning via squad after being found by a shelter employee sitting in a pool of blood on the bathroom floor crying and holding her abdomen. Due to her limited English speaking abilities, she is unable to provide specific details as to her complaints but the shelter employee states that she has recently stopped eating and has not looked well for the past couple of days.

 

Based on the limited information provided, please answer the following questions.

 

How will you prioritize your care of Amira, what assessments will you complete, and in what order? Please provide rationale for choosing this order.

 

Are there any cultural beliefs/practices that must be taken into consideration when planning her care?

 

Considering her symptoms of abdominal pain and bleeding, is it possible that her status as a homeless refugee is a causative or contributing factor to her illness? Please provide rationale for your response.

 

 

 

NR 305 RN Health Assessment

 

Week 7 Discussion

 

Assessment of the Musculoskeletal System and Pain

 

CO1 Utilize prior knowledge of theories and principles of nursing and related disciplines to explain expected client behaviors, while differentiating between normal findings, variations, and abnormalities. (PO 1)

 

CO2 Recognize the influence that developmental stages have on physical, psychosocial, cultural, and spiritual functioning. (PO 1)

 

CO3 Utilize effective communication when performing a health assessment. (PO 3)

 

Fred is an 83-year-old male who is being admitted to the medical-surgical unit status post fall. He is alert and oriented and reports that while visiting a local casino with his wife Margaret earlier this evening, he tripped over a curb and fell landing on his right side. After receiving morphine in the emergency room prior to transfer to your unit, Fred is rating his pain at 6/10. He has multiple bruises from his jawbone to his knee as well as a slight rotation of his right leg.

 

Past medical history includes: myocardial infarction (MI) x 2, peripheral vascular disease (PVD) with bilateral iliac stents, non-insulin-dependent diabetes mellitus (NIDDM), sleep apnea, and degenerative joint disease.

 

Medications include: aspirin, Plavix, Lopressor, Lisinopril, and Metformin.

 

After reviewing the above scenario please answer the following questions.

 

Based on the information provided, how will you prioritize your care, what assessments will you include and in what order? Please provide rationale for your response.

 

Considering this patient’s age, injury, past medical history, and list of current medications, what, if any, concerns do you have related to his potential need for surgery?

 

Should surgery to repair his right femur be required; what type of clearance and pre-op orders would you anticipate receiving related to his diet, meds, lab work, and so on?

 

 

 

NR 305 RN Health Assessment

 

Week 8 Discussion

 

Rapid Assessment of a Client

 

CO1 Utilize prior knowledge of theories and principles of nursing and related disciplines to explain expected client behaviors, while differentiating between normal findings, variations, and abnormalities. (PO 1)

 

CO2 Recognize the influence that developmental stages have on physical, psychosocial, cultural, and spiritual functioning. (PO 1)

 

CO3 Utilize effective communication when performing a health assessment. (PO 3)

 

CO5 Explore the professional responsibilities involved in conducting a comprehensive health assessment and provide appropriate documentation. (PO 6)

 

Please choose one of the patient scenarios below. Next, complete a rapid assessment, and provide a SBAR report to a classmate. Remember to include all concepts of patient safety, standard precautions, and professional standards.

 

You are covering for a coworker who is off the floor for lunch, when you suddenly hear a loud crash coming from a nearby patient room. You quickly run in and discover Mr. Johnson who was admitted yesterday with a diagnosis of cerebral vascular accident (CVA) unconscious on the floor between the bed and the bathroom.

 

You are called to the room of 2-year-old Jonah by his mother who states the child has suddenly started breathing very loudly and does not look right. Upon entering the room you quickly recognize that the child is in respiratory distress as his lips are cyanotic and the use of accessory muscles is evident.

 

You are in the process of admitting Ashley, a 27 year old who is 28 weeks pregnant with her first child, to the obstetric unit for complaints of headache, dizziness, and swelling of her lower extremities when she suddenly begins seizing.

 

 

 

 

 

 

 

 

 

NR 305 RN Health Assessment

 

Week 2 Family Genetic History

 

Family Genetic History Guidelines

 

Purpose

 

This assignment is to help you gain insight regarding the influence of genetics on an individual’s health and risk for disease. You are to obtain a family genetic history on a willing, nonrelated, adult participant. NOTE: failing to complete this assignment using an adult participant other than yourself will result in a 20% penalty deduction being applied.

 

Course Outcomes

 

This assignment enables the student to meet the following Course Outcomes.

 

CO3: Utilize effective communication when performing a health assessment. (PO3)

 

CO5: Explore the professional responsibilities involved in conducting a comprehensive health assessment and providing appropriate documentation. (PO6)

 

Points

 

This assignment is worth a total of 200 points.

 

Due Date

 

The Family Genetic History Assignment is to be submitted at the end of Week 2.

 

Disclaimer

 

When taking a family genetic history on an actual client, it is essential that the information is accurate. Please inform the person you are interviewing that they do not need to disclose information that they wish to keep confidential. If the adult participant decides not to share information, please write, “Does not want to disclose.” If the client fails to disclose answers to several items, you will need to find another client who is willing to share.

 

Directions

 

Refer to the examples in Chapter 4 of your textbook that discuss development of a genogram.

 

Download the required NR 305_Family_Genetic_History_Form (Links to an external site.)Links to an external site.. You will document the adult participant’s family genetic history using this MS Word document.

 

Complete the family genetic history using the information that the adult participant is willing to share with you. The focus of this course is on the normal healthy individual so your paper does not need to contain much medical/nursing detail. Refer to your textbook or the Internet to learn what impact the family’s health history may have on the adult participant’s personal state of wellness both now and in the future. This paper does not require APA formatting, but you are expected to write clearly and use proper grammar and spelling. Developing a pictorial genogram using symbols to identify certain relationships (e.g., divorced, sibling, deceased, etc.), may provide more insight, however, drawing may be difficult to accomplish with MS Word, therefore you are not expected to use symbols, lines, or other drawing elements. Instead, describe the relationships among the various people in the adult participant’s family’s genetic history. Remember, the goal is not to learn how to draw with Word, but to gather information about the family and recognize its significance to the adult participant and that person’s health.

 

You are required to complete the form using the productivity tools required by Chamberlain University, which is Microsoft Office Word 2013 (or later version), or Windows and Office 2011 (or later version) for MAC. You must save the file in the “.docx” format. Do NOT save as Word Pad. A later version of the productivity tool includes Office 365, which is available to Chamberlain students for FREE by downloading from the student portal at http://my.chamberlain.edu (Links to an external site.)Links to an external site.. Click on the envelope at the top of the page.

 

Save the completed form by clicking on Save as and add your last name to the file name, for example, NR 305_Family_Genetic_History_Form_Smith.

 

Submit the completed form to the Family Genetic History form by Sunday, 11:59 p.m. MT at the end of Week 2. Please post questions about this assignment to the weekly Q & A Forums so the entire class may view the answers.

 

Chamberlain College of Nursing values honesty and integrity. All students should be aware of the Academic Integrity policy and follow it in all discussions and assignments.

 

By submitting this assignment, I pledge on my honor that all content contained is my own original work except as quoted and cited appropriately. I have not received any unauthorized assistance on this assignment.

 

 

 

NR 305 RN Health Assessment

 

Week 4 Health History

 

Health History Guidelines

 

Purpose

 

The student will obtain a health history on a willing, nonrelated, adult participant in order to generate written documentation that is clear and accurate. Note: Failing to complete this assignment using an adult participant other than yourself will result in a 20% penalty deduction being applied.

 

Course Outcomes

 

This assignment enables the student to meet the following Course Outcomes.

 

CO #3: Utilize effective communication when performing a health assessment. (PO3)

 

CO #4: Identify teaching/learning needs from the health history of an individual. (PO2)

 

CO #5: Explore the professional responsibilities involved in conducting a comprehensive health assessment and providing appropriate documentation. (PO6)

 

Points

 

This assignment is worth a total of 200 points.

 

Due Date

 

The Health History assignment is to be submitted by Sunday, 11:59 p.m. MT at the end of Week 4. Post questions to the Q & A Forum. Contact your instructor if you need additional assistance.

 

Disclaimer

 

The focus of this assignment is on communicating details within the written client record. When taking a health history on an actual client, it is essential that the information is accurate. Please inform the person you are interviewing that they do not need to disclose information that they wish to keep confidential. If the interviewee decides not to share information, please write, “Does not want to disclose.” If the client fails to disclose answers to several items, you will need to find another client who is willing to share.

 

Directions

 

Find an adult who is not related to you who is willing to let you take a health history.

 

Download the required NR 305 Health History (Links to an external site.)Links to an external site.. You will type your answers directly into this Word document. Your paper does not need to follow APA formatting; however, you are expected to be clear in your communication by using correct medical terminology, grammar, and spelling.

 

You are required to complete the form using the productivity tools required by Chamberlain University, which is Microsoft Office Word 2013 (or later version), or Windows and Office 2011 (or later version) for MAC. You must save the file in the “.docx” format. Do NOT save as Word Pad. A later version of the productivity tool includes Office 365, which is available to Chamberlain students for FREE by downloading from the student portal at http://my.chamberlain.edu (Links to an external site.)Links to an external site.. Click on the envelope at the top of the page.

 

Review the examples in Chapter 4 of your textbook to gain insight into how to document the health history. Remember this is a health history, not a physical examination. Avoid words like frequently, improved, increased, decreased, good, poor, normal, or WNL (within normal limits) as they may have different meanings for different people. Instead, document the specific data that led you to these conclusions, for example, 3x/day instead of frequently, or consuming four servings of vegetables/day instead of increased vegetable servings.

 

Save the file by clicking Save as and adding your last name to the file name, for example, NR 305_Health History_Form_Smith. You must save as a .docx file, but do not save as a “Word Pad” document.

 

Submit the completed form by Sunday, 11:59 p.m. MT at the end of Week 4.

 

Please post questions in the Q & A Forum so the entire class may view the answers.

 

 

 

NR 305 RN Health Assessment