NURS 3421 Health Assessment

 

COURSE DESCRIPTION:  Basic technical aspects of anatomy, pathophysiology, bedside assessment skills, laboratory tests and diagnostic tests are emphasized.  The emphasis on caring is displayed through themes of assessment of the whole person: cultural, spiritual, familial, and environmental considerations, patient dignity and health promotion.  Emphasis will be placed on communication of specific health assessment findings and acquiring health assessment knowledge and skills based on scientific rationale.  Prerequisites: NURS 3424, NURS 3922.

 

CREDIT:  4 Credit hours (2 hrs. class/wk and 6 hrs. lab/wk)

 

PROGRAM LEVEL:  I

 

TEXTBOOKS:

 

Bickley, L. & Szilagyi, P., (2009). Bates Guide to Physical Examination and History Taking, 10th Edition. Philadelphia: Lippincot Williams & Wilkins.

 

ATI Fundamentals for Nursing Version 6.0

 

REQUIRED EQUIPMENT

Blood pressure cuff

Stethoscope

Penlight

Clear plastic ruler (6 inches)

Course Coordinator:  Associate Professor, Dorothy Flagg Diaz RN, WNC-NP, MSN, JD

           

Office Hours:              by appointment

                        Office: Rm 113 Telephone 210-826-7595

 Email:  dorothy.diaz@wbusa.wbu.edu

 

Class Schedule: Lecture:      Monday 1300 – 1510

                        Skills Lab:  Monday 1500 - 1700

      Tuesday  1200 - 1710

 

COURSE OBJECTIVES: 

 

Upon completion of this course, the student should be able to:

  1. Use interviewing skills to obtain a nursing health history and entry level nursing physical assessment.
  2. Apply concepts of history-taking, interviewing and physical assessment of the adult client and to distinguish between abnormal findings and normal variations.
  3. Utilize critical thinking and reasoning skills and reflection to identify functional health patterns and develop a basic nursing plan of care for clients in collaboration with the client and the interdisciplinary health care team.
  4. Describe clinically relevant laboratory and diagnostic tests.
  5. Apply concepts of developmental, cultural, and spiritual assessment.  Identify holistic concerns when assessing the client.
  6. Demonstrate and document a bedside nursing interview, general survey, and head to toe assessment and document findings.

 

EVALUATION AND GRADING:  A point system is used to determine the grade in Health Assessment.

 

            A = 90-100

            B = 80-90

            C = 75-80                                                         75 or greater required to pass course

            D = 70-74

            F = 69 and below

 

Grading Rubric:

 

Knowledge

Test One          50 Questions                 10%

Test Two          50 Questions                 10%    

Test Three        50 Questions                 10%

Test Four          50 Questions                 10%

Final Exam        100 Questions               20%

Skills & Attitude

Health History paper                                                                 10%

Complete Physical Exam Performance & documentation             15%

Weekly workshop assignments completion & attendance             15%

                                                            --------

Total                                                     100%

 

The lab portion of the class is on a pass/fail basis and must be passed to pass the course. Students will be required to demonstrate accurate assessments in each system:  the skin, hair, and nails; the lymphatic system; the head, neck, ears and eyes; the lungs and respiratory system; the heart and peripheral vascular system; the breasts, axillae, abdomen, and gastrointestinal system; the female and male genitalia; the musculoskeletal system; the neurological system and age related differences.  Maintain professional behavior, scholastic integrity and complete all assigned paperwork.  The final course average must be a 75 or better to pass.

 

All students will be assigned a Skills Lab partner for this Term. You will perform physical examinations on each other throughout the term.   Weekly Unit assignments and demonstration of assessment skills are your responsibility. You must be prepared, display professional behavior and perform skills successfully, with minimal prompting, to pass the course. Written workshop assignments are  required weekly and are 15% of the course grade.  Your complete physical exam performance and write-up constitutes 15% of your course grade.

 

Absence from class/lab will jeopardize you and your lab partner’s ability to pass. Please be accountable to one another.   

 

Class Attendance

 

  1. The student must attend classes for which he/she is enrolled.
  2. A student enrolled at Wayland Baptist University should make every effort to attend all class meetings.  All absences must be explained to the satisfaction of the instructor, who will decide whether the omitted work may be made up.
  3. A student who misses twenty percent or more of the regularly scheduled class meetings will receive a grade of “F” for that class.
  4. When a student reaches a number of absences considered by the instructor to be excessive for this course content, the instructor will so advise the student and file an Unsatisfactory Progress Report at the San Antonio Campus.
  5. The instructor will count three tardies as one absence.
  6. If an instructor fails to appear or fails to send notification of late arrival within the first fifteen minutes of a class period, the student may leave without incurring an absence.

 

University Policy precludes exclusion of qualified disabled persons from participation in, or is denied the benefits of, or is subject to discrimination under any educational program or activity in the University. Students should inform their instructor of any documented disabilities in the first class meeting.

 

Testing

 

A test blueprint will be prepared by the faculty and made available to the student before the exam.  The blueprint will provide the student with the generalized subject content, the number of questions in that subject area and the type of question.  The type of question will be categorized by the areas of the nursing process: assessment, planning, implementation and evaluation and by cognitive level, knowledge, analysis, application, and comprehension.  In the event a faculty must change a test date, students will be notified before the scheduled exam.  If the student must miss an exam, they must notify the faculty prior to the exam and schedule a date for the make-up exam within one week of the date of the exam. 

 

Make-up Tests

 

Occasionally a student will miss a test that is scheduled for a class.  A student should contact his/her instructor to arrange the make-up test.  The staff at the IH 35 location will administer the make-up test; both the instructor and the individual student will contact the office to schedule the test.  Tests begin at either 9:00 a.m. or 1:00 p.m. on Tuesday, Wednesdays, or Thursday and completed before the office closes at 5:00 p.m. Missed exams must be taken within one week of the date of the exam. Failure to do so will result in course failure.

 

Course Outline*

 

Unit 1: Foundations of Physical Examination, History Taking & Documentation

Unit 2: Mental Health, Skin, Hair, Nails and Head & Neck

Unit 3: The Thorax and Lungs, Breasts & Axillae

Unit 4: Heart and Peripheral Vascular System

Unit 5: Abdomen

Unit 6: Musculoskeletal System

Unit 7: Nervous System

Unit 8:  Elder assessment

Unit 9: Genital, anus, rectum

 

Course Schedule

Week 1

May 25, 26

Bates Chapters 1-4

Week 2

June 1, 2

Bates Chapters 5 Test 1

Week 3

June 8, 9

Bates Chapters 6, 7 Health History write up

Week 4

June 15, 16

Bates Chapters , 8, 10 Test 2 (MH, Skin, Head & Neck)

Week 5

June 22, 23

Bates 9, 12

Week 6

June 29, 30

Bates Chapter 11 Test 3 (CV, Lungs, Brst)

Week 7

July 6, 7

Bates Chapters 16 & 17

Week 8

July 13, 14

Bates Chapters 13, 14, 15 Test 4 (Abd, MS & Neuro)

Week 9

July 20, 21

Bates Chapter 20

Week 10

July 27, 28

Complete PE & write up

Week 11

August 3, 4

ATI exam, Final exam

 

* All contents and schedules for this course are subject to change during the term. Their Instructor will inform students of changes as soon as possible.

 

Unit 1:  Foundations of Physical Examination & History Taking

 

Unit Objectives

Student Assignments

Learning Activities
  1. Describe the purpose and application of a Health Assessment
  2. List the components of the Health Assessment
  3. Review proper interviewing techniques and sequence.
  4. Review interviewing to obtain a health history
  5. Discuss the techniques of inspection, palpation, percussion and auscultation necessary for a physical assessment
  6. Describe the equipment necessary for a physical assessment
  7. Review concepts of general and physical assessment
  8. Describe the process of conducting a mental health and mental status assessment
  9. Describe the process for conducting a pain assessment
  10. Review the process for conducting a sleep assessment and describe some of the problems and conditions a patient may be experiencing
  11.  Review general survey, physical exam and vital signs

Bates Guide to Physical Examination and History Taking, 10th Edition

 

Chapter 1 - 4, pp 3-113,

 

ATI Chapter 12,13, 14, pp 92-121

ATI Chapter 27 pp 233-242

ATI Chapter 28 243-255

Lecture and Discussion

 

Skills Lab:  Perform a comprehensive health history, using interviewing techniques.

 

 

This lab requires a Written Comprehensive Health History Due June 8.

 

 

 

 

 

 

 

 

 

REGIONAL EXAMINATIONS

 

Unit 2:  Mental Health, Skin, Hair, Nails and Head & Neck

 

Unit Objectives

Student Assignments

Learning activities
  1. Describe and perform a mental health exam
  2. Describe and perform an examination of the skin, hair and nails
  3. Discuss common problems and conditions of the skin, hair, and nails
  4. Describe the age-related variations in client’s hair, nails, and skin
  5. Perform an examination of the head and neck; axillary and breast; arm; and groin to common problems and conditions of the lymphatic system
  6. Discuss age-related variations of the lymphatic system
  7. Describe and perform an examination of the head, neck and thyroid.
  8. Describe common problems and conditions related to areas of the head and neck
  9. Discuss age-related variations of the head and neck
  10. Describe and perform an examination of the Nose, Paranasal Sinuses, Mouth, and Oropharynx
  11. Describe common problems and conditions of the Nose, Paranasal Sinuses, Mouth and Oropharynx
  12. Discuss the age-related variations with the Nose, Paranasal Sinuses, Mouth, and Oropharynx
  13. Describe and perform an examination of the Ears and Auditory System
  14. Describe common problems and conditions of the Ear and Auditory System
  15. Discuss age-related variations of the Ear and Auditory System
  16. Describe and perform an examination of the Eyes and the Visual System
  17. Describe common problems and conditions of the Eye and the Visual System
  18. Discuss age-related variations of the Eye and the Visual System

 

Read Bates,

Chapter 5, 6, 7

 

ATI Chapter on Mental Exam ATI Chapter 30 pp 256-265

ATI Chapter 31, 32, 33 pp 166- 293

Lecture and discussion

 

Skills Lab:  Perform an assessment of the Mental Health, Skin, Hair and Nails, the lymphatic system, the head and neck, ears and eyes

 

 

Document finding on lab worksheet


Unit 3:  Thorax and Lungs / Respiratory System & Breast & Axilla

 

Unit Objectives

Student Assignments

Student Activities
  1. Review the anatomy and physiology of the respiratory system
  2. Describe the content obtained when performing a health history
  3. Describe and perform an examination of the lungs and respiratory system
  4. Discuss age-related variations of the lungs and respiratory system
  5. Describe common problems and conditions of the respiratory system
  1. Describe the anatomy and physiology of the female and male breast and the abdomen and gastrointestinal system
  2. Describe the content obtained when performing a health history of the breast and abdomen 
  3. Describe the technique and perform an examination of the breasts and axillae

Read Bates,

Chapter 8

Chapter 10

 

ATI Chapter 35 pp 301-308

ATI Chapter on Breast assessment

Lecture and Discussion

 

Skills Lab:  Perform an assessment of the respiratory system to include anterior and posterior chest,  Verbalize BSE &  an assessment of the breasts & perform axillae exam.  Perform  assessment of the breast[on anatomical models if available]

 

 

Document finding on lab worksheet

 

Unit 4:  Heart and Peripheral Vascular System

 

Unit Objectives

Student Assignments

Learning Activities
  1. Review the anatomy and physiology of the heart, the cardiac cycle, electrical conduction, and the peripheral vascular system
  2. Describe the content obtained when performing a health history for the heart and peripheral vascular system
  3. Describe and perform an examination of the cardiac system and peripheral vascular system
  4. Discuss age-related variations of the cardiac and peripheral vascular system
  5. Describe common problems and conditions of the cardiac and peripheral vascular system

Read Bates

 Chapters 9 & 12

 

ATI Chapter 36 pp 309-317

Lecture and discussion

 

Skills lab:  Perform an examination of the cardiac and peripheral vascular system

 

Document finding on lab worksheet

 

                          Unit 5:  Abdomen and Gastrointestinal System

 

Unit Objectives

Student Assignments

Learning Activities

1.        Describe and perform an examination of the abdomen

2.        Discuss age-related variations of the abdomen and gastrointestinal system

3.        Describe common problems and conditions associated with the abdomen, gastrointestinal tract, and urinary system

Read Bates,

Chapter 11

 

ATI Chapter on Abdomen

Lecture and discussion

 

Skills Lab:  Perform an assessment on the abdomen

 

Document finding on lab worksheet

 

Unit 6:  Musculoskeletal System

 

Unit Objectives

Student Assignments

Learning Activities
  1. Review the anatomy and physiology of the musculoskeletal system
  2. Describe the content obtained when conducting a health history of the musculoskeletal system
  3. Describe and perform an examination of the musculoskeletal system
  4. Discuss age-related variations of the musculoskeletal system
  5. Describe common problems and conditions of the musculoskeletal system

Read Bates,

 

 Chapter 16

 

ATI Chapter 38, pp 326-333

Lecture and Discussion

 

Skills Lab:  Practice performing an examination of the musculoskeletal system

 

Document finding on lab worksheet

 

Unit 7:  Neurologic System

 

Unit Objectives

Student Assignments

Learning Activities
  1. Describe the anatomy and physiology of the neurologic system
  2. Describe the content obtained when conducting a health history of the neurologic system
  3. Describe and perform an examination of the neurologic system
  4. Describe age-related variations of the neurologic system
  5. Describe common problems and conditions of the neurologic system

Read Bates,

Chapter 17

 

ATI Chapter 39 pp 334-345

Lecture and discussion

 

Skills Lab:  Practice and perform an examination of the neurologic system

 

Know Cranial nerves

And MMSE

 

Document finding on lab worksheet

 

Unit 8: Focus on Elder Examinations

Unit Objectives

Student Assignments

Learning Activities

1. Describe the anatomy and       physiology differences of the Older Adult.

 

2.  Identify assessment approaches and special areas of concern when assessing symptoms in the older adult.

 

3. Define the “Sixth Vital Sign” and its implications.

 

 

Bates

Chapter 20

Lecture & discussion

Skills Lab: Review & practice focused &/or full examination as needed

 

 

Unit 9 Genital, anus & rectal assessment

Unit Objectives

Student Assignments

Learning Activities
  1. Review the anatomy and physiology of the external and internal genitalia, the menstrual cycle, menopause, and the bony pelvis
  2. Discuss the content obtained when performing a health history for a female patient including a reproductive history
  3. Describe the content obtained when performing a health history for a male patient
  4. Review the anatomy and physiology of the testes, ducts, glands and external genitalia
  5. Describe an examination of the female genitalia and male genitalia
  6. Discuss age-related variations of the female and male genitalia
  7. Discuss common problems and conditions of the female and male genitalia
  8. Describe the anatomy and physiology of the anus, rectum, and prostate
  9. Describe the content obtained when conducting a health history related to the anus, rectum, and prostate
  10. Describe and perform an assessment of the anus, rectum, and prostate
  11. Describe age-related variations of the anus, rectum, and prostate
  12. Describe common problems and conditions of the anus, rectum and prostate

Read Bates,

Chapter 13,14,15

 

ATI Chapter 40 pp 346-355

Lecture and Discussion

 

Skills Lab:  Practice performing assessments of the female and male genitalia and assessment of the anus, rectum and prostate  [on anatomical models if available]

 

Document finding on lab worksheet