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NURS 6512 Week 1 Advanced Health Assessment and Diagnostic Reasoning

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NURS 6512 Week 1: Building a Comprehensive Health History

According to the 2011 Gallup poll, nurses are the most trusted professionals in the United States. One skill that contributes to this ranking is nurses’ ability to put patients at ease. Individuals visiting medical centres are apprehensive about their personal information. However, nurses are able to alleviate that fear and allow the patients to confide in them.

The best time to develop an open and supportive relationship between a nurse and a patient is during the initial health history interview. The diagnostic process can go smoothly if a nurse uses appropriate communication skills to foster a bond with the patient. An advanced practice nurse must also consider patient-specific factors to determine what questions they will ask and how.

This week, you will learn about social health determinants such as age, gender, and ethnicity and how they impact your patients’ risk assessments. You will also explore how these determinants influence your interview by working with a patient to build their health history.

Discussion: Building a Health History

Effective communication between the patient and the nurse is essential for constructing a detailed and accurate patient history. A number of factors influence a patient’s health, including age, gender, ethnicity, and environmental situation. As an advanced practice nurse, you must consider these factors when tailoring your interviewing techniques.

For this discussion, you will act as a clinician for a specific patient assigned to you by your instructor.

NURS 6512 Week 2: Functional Assessments and Cultural and Diversity Awareness in Health Assessment

Assessments are a mandatory part of diagnosis. However, they may need to be more useful. Health assessments are only helpful if they result in the necessary care. As a nurse, you must ensure you take into account the impact of the patient’s factors, such as their culture and developmental circumstances.

Discussion: Diversity and Health

Different populations, cultures, and groups have diverse beliefs and practices that influence their health. As a healthcare professional, you must be aware of this fact and consider it when designing your assessment techniques. Ensure you accommodate diversity in your recommendations.

In this discussion, you will explore cultural factors such as socioeconomic, spiritual, and lifestyle factors, which you must consider when building a health history for your patient.

NURS 6512 Week 3: Assessment Tools, Diagnostics, Growth, Measurement, and Nutrition in Adults and Children

Obesity is one of the most common chronic diseases in the United States, and it’s a massive strain on the US healthcare system. The rate of childhood obesity has tripled in the past 30 years, according to the Centers for Disease Control and Prevention, with about 13.7 million adolescents and children considered obese in 2018. When interviewing a patient, it’s essential to include the individual’s body weight and height in your enquiries. This is especially true with paediatrics.

This is because height and weight measurements provide insight into the patient’s overall health and nutritional state. As an advanced practice nurse, ensure you use tools such as the Body Mass Index (BMI) and growth charts to monitor pediatric development and other health-related risks.

To ensure that your assessment is practical and valuable, you should familiarize yourself with test-specific factors that may affect the validity, reliability, and value of these tools. This week, you will explore various assessment tools and diagnostic tests used to derive information about a patient and learn the reliability and validity of each.

Assignment: Assessment Tools and Diagnostic Tests in Adults and Children

Several assessment tools and diagnostic tests can be used to identify a patient’s health condition. Different factors determine the validity and reliability of these tools. As a nurse, you must be aware of these factors to ensure you pick and choose the right tool and test for a specific patient.

Diagnostic tests such as body measurements also provide general information about a child’s nutrition and the health risks surrounding them. Other factors to consider include lifestyle, culture, and family history.

For this assignment, you will explore a number of assessment tools and assess their reliability and validity. You will also consider children of different weight measurements and devise effective ways to gather information on their health.

NURS 6512 Week 4: Assessments of the Skin, Hair, and Nails

Abnormalities in the skin, hair, and nails can be external clues to internal disorders or can actually be disorders themselves. Something as small as a discoloured toenail or a mole can offer meaningful insight into a patient’s health. As a nurse, you must assess your patient’s skin, hair, and nails to gain an incentive on their health condition.

This week, you will explore how to examine skin, hair, and nails and how to assess abnormal findings.

Assignment: Differential Diagnosis for Skin Conditions

Differential diagnosis is a process that involves identifying the cause and type of a patient’s skin condition through elimination. In this process, a medical practitioner identifies a set of physical abnormalities, health assessment findings, vital signs and symptoms and narrows them down to one likely diagnosis.

In this assignment, you will examine several visual representations of skin conditions, describe your observations, and use differential diagnosis to determine which skin condition it might be.

Also Read:

NURS 6512 Discussion: Building a Health History Instructions

NURS 6512 Digital Clinical Experience

NURS 6512 Assessment Tools and Diagnostic Tests in Adults and Children Case

NURS 6512 Lab Assignment: Assessing the Abdomen Sample Paper

Assessment of Nutrition in Children NURS 6512

Diversity and Health Assessments NURS 6512

Comprehensive SOAP Document: Skin Condition Sample Paper

Patient’s Initials: __WP__.                   Age:__ 54 ___                              Gender: Male.

SUBJECTIVE DATA: Graphic#2

Chief Complaint (CC): Painful and itchy blisters on the back and right arm for one week (image #2).

History of Presenting Illness (HPI): A 54-year-old Caucasian male patient presents with blisters and ulcers on his torso extending all the way to his upper right arm. There are multiple blisters that appear shiny in colour. There is also an erythematous region surrounding the blisters. The condition started about a week ago with a painful burning and tingling sensation around the same region before the appearance of the rash. This was accompanied by fever and generalised body weakness. The rash later appeared four days after the initial tingling and burning sensation. The patient said that the condition had no aggravating factors but that it was relieved by taking a cool bath.

Past Medical History: The patient has no known chronic illnesses and has no history of previous admissions. The patient has never undergone any surgical procedures and has no prior history of blood transfusion. The patient has no known drug and food allergies.

Family Social History: There are no known chronic illnesses among close family members. The patient leads a sedentary lifestyle. He is an occasional drinker claiming that he drinks a glass of wine every now and then. He denies any tobacco use or use of any other drugs and substances.

REVIEW OF SYSTEMS

General: complains of generalised body weakness

HEENT: The patient complains of occasional headaches during the one-week period that he has been unwell. He also complains of sensitivity to light

Neck; no lymphadenopathy or goitre

Respiratory: no cough, wheezing, shortness of breath

CVS: no chest pain, dyspnea, orthopnea or oedema.

GIT: no nausea, vomiting, constipation or diarrhea

Skin: no bruising, petechiae or changes in hair.

General Examination: The patient has hotness of body. There are several painful blisters and erythematous regions around his torso and upper arm. There is no significant weight loss and no apparent signs of wasting. There is no jaundice, no pallor, no cyanosis, no clubbing no lymphadenopathy, no oedema and no dehydration.

OBJECTIVE DATA:

Physical examination:

Vitals: The patient has a blood pressure reading of 134/83. His heart rate is 86 beats per minute with a respiratory rate of 16 breaths per minute. His temperature reading is 99.7 F indicating a slight fever. The patient weighs 179 pounds with a height of 5ft. 10 in. The patient’s Body Mass Index (BMI) is 25.7 indicating that the patient is slightly obese which is evident even on examination.

General: Middle-aged man who is alert and oriented to time place and person. The patient is conscious, alert and co-operative. The patient is not in any apparent respiratory distress. He is well groomed and tidy in a hospital gown. He does not seem to be in any apparent pain, though he is constantly scratching his back. The patient has no odour coming from his mouth and he has good oral hygiene. He does not have any tar stains on his fingers or clothes.

Skin: The patient as several shiny blisters and erythematous rash on his torso extending all the way to the arm that are painful and itchy. The blisters appear shiny and fluid-filled. The rash on the other hand is erythematous and maculopapular with ulcerations and scabbing. There are also several regions of hyperpigmentation.

ASSESSMENT.

Differential diagnosis: Herpes Simplex Virus (HSV) Infection, hives, psoriasis and eczema.

1. Herpes Simplex Virus (HSV) is virus that commonly reactivates throughout an individual’s life and results from herpes simplex virus 1 and 2. The blisters commonly observed in this condition may be mistaken for those of shingles (Fathy et al., 2021). However, the blisters in this condition are commonly localized around the oral and genital regions. Shingles when compared to herpes also takes a longer duration of time to resolve.
2. Hives, also commonly referred to as urticaria, is a skin rash often triggered in response to certain foods, medication or other irritants. The condition, according to Greiwe and Bernstein (2019), is normally characterized by the appearance of raised erythematous or skin-coloured welts that tend to be itchy appearing on the surface of the skin. The condition is often a self-diagnosable and self-treatable one that rarely requires any laboratory investigations or imaging. The welts tend to resolve within a few days or weeks. 
3. Psoriasis is described as a condition in which the cells of the skin tend to build up resulting in the formation of scaly and dry patches that tend to be itchy. In severe instances, the rash may involve both the nails and joints (Armstrong & Read, 2020). The skin also tends to be dry, flaky, has bumps and easily peels off. Patients will commonly present with depression, inflamed tendons, stiffness and possessing dents in their nails. Topical ointments, light therapy and medications have been used in the management of psoriasis.
4. Eczema or atopic dermatitis is a condition that causes and individual’s skin assume a dry, erythematous and bumpy appearance that tends to be itchy. The condition disrupts the barrier tendencies of the skin resulting in increased sensitivity and increasing the likelihood of both infections and drying off (Ring et al., 2019). Regularly moisturization of the skin, medication and habits aimed at protecting the skin such as the use of soap with little or no perfumes and dyes are vital in the management of eczema.

Primary Diagnosis: The most likely diagnosis for the graphic provided is shingles. Shingles can be described as a reactivation of the chicken pox virus that commonly results in the appearance of a painful rash. As Fritz et al. (2020) notes, shingles often leads to the appearance of a painful and itchy rash that tends to appear as a collection of several pus-filled blisters on the torso of the affected individual. This painful sensation tends to persist, in some instances, even after the resolution of the rash.

The initial symptoms usually reported include fever and generalized body weakness. The patient may also experience a painful, burning or tingling sensation around certain areas. This is usually followed by the appearance of rashes a few days after the initial presentation of the tingling sensation (Bolton et al., 2021). The patient tends to notice the appearance of erythematous patches, mostly on one side of the body. Blisters, scabs and ulcers follow the initial presenting rash.

In some instances, patients may develop ophthalmic shingles. In this condition, there is appearance of shingle rashes in the region around the eye and above the forehead. This condition is commonly accompanied by a complaint of occasional headaches. Inflammation of the cornea and swelling of the eye may also be evident (Battista et al., 2020). Widespread shingles may be observed in individuals with extremely weakened immune systems. Widespread rashes resembling chicken pox are commonly observed in this condition.

According to Bakker et al. (2021), shingles commonly develops in individuals who have previously had chicken pox that has consequently resolved. The virus responsible for the causation of both chicken pox and shingles can, however, be transmitted to and individual who has never suffered chicken pox or received the chicken pox vaccine. In such instances, the individual develops chicken pox instead. Transmission of shingles occurs during the blister phase of the rash (Laing et al., 2018). Transmission is through direct contact of the rash or inhalation of virus particles that are released into the air.  

In most instances, the condition normally resolves on its own. There are several antiviral drugs that have been employed in the treatment of shingles. Some of these agents include acyclovir, valacyclovir and famciclovir. As Nazarko (2019) notes, the use of these medication during the early stages of appearance of the rash greatly reduces the severity of the condition and reduces the duration of illness. Pain medication to counter the intense pain may also be recommended by the health care practitioner.

Conclusion

In conclusion, both the appearance and the location of the rash confirm the diagnosis of shingles. The rash is localized in the patient torso on the posterior surface and his right arm. The rash is erythematous and comprises of several shiny pus-filled blisters confirming the diagnosis of shingles. As previously noted, the blister phase of the rash is the most infective stage of the condition. Thus, it is paramount to immediately commence the management of the patient’s conditions so as to offer relief to him by reducing both the severity and duration of his condition, while still reducing the risk of him transmitting to others. Antiviral medication and the use of analgesics to manage the pain go a long way in managing the patient’s condition.

References.

Armstrong, A. W., & Read, C. (2020). Pathophysiology, clinical presentation, and treatment of psoriasis: a review. JAMA, 323(19), 1945-1960. https://doi.org/10.1001/jama.2020.4006

Bakker, K. M., Eisenberg, M. C., Woods, R., & Martinez, M. E. (2021). Exploring the seasonal drivers of varicella zoster transmission and reactivation. American Journal of Epidemiology, 190(9), 1814-1820. https://doi.org/10.1093/aje/kwab073

Battista, M., Marchese, A., Bordato, A., Bandello, F., Modorati, G. M., & Miserocchi, E. (2020). Ophthalmic Shingles with Simultaneous Acute Retinal Necrosis in the Opposite Eye. Ocular Immunology and Inflammation, 1-3. https://doi.org/10.1080/09273948.2020.1770298

Bolton, L. L., Faller, N., & Kirsner, R. S. (2021). Herpes Zoster (Shingles) Patient-Centered Wound Outcomes: A Literature Review. Advances in Skin & Wound Care, 34(5), 239-248. https://doi.org/10.1097/01.asw.0000737412.71091.4f

Fathy, R. A., McMahon, D. E., Lee, C., Chamberlin, G. C., Rosenbach, M., Lipoff, J. B., Tyagi, A., Desai, S. R., French, L. E., Lim, H. W., Thiers, B. H., Hruza, G. J., Fasset, M., Fox, L. P., Greenberg, H. L., Blumenthal, K. & Freeman, E. E. (2021). Varicella Zoster and Herpes Simplex Virus Reactivation Post?COVID?19 Vaccination: A Review of 40 Cases in an International Dermatology Registry. Journal of the European Academy of Dermatology and Venereology. https://doi.org/10.1111/jdv.17646

Fritz, D. J., Curtis, M. P., & Kratzer, A. (2020). Shingles. Home Healthcare Now, 38(5), 282-283. https://doi.org/10.1097/nhh.0000000000000905

Greiwe, J., & Bernstein, J. A. (2020). Approach to the Patient with Hives. The Medical clinics of North America, 104(1), 15–24. https://doi.org/10.1016/j.mcna.2019.08.010

Laing, K. J., Ouwendijk, W., Koelle, D. M., & Verjans, G. (2018). Immunobiology of Varicella-Zoster Virus Infection. The Journal Of Infectious Diseases, 218(suppl_2), S68–S74. https://doi.org/10.1093/infdis/jiy403

Nazarko, L. (2019). Diagnosis, treatment and prevention of shingles: the role of the healthcare assistant. British Journal of Healthcare Assistants, 13(1), 20-25. http://dx.doi.org/10.12968/bjha.2019.13.1.20

Ring, J., Zink, A., Arents, B., Seitz, I. A., Mensing, U., Schielein, M. C., Wettemann, N., de Carlo, G., & Fink-Wagner, A. (2019). Atopic eczema: burden of disease and individual suffering – results from a large EU study in adults. Journal of the European Academy of Dermatology and Venereology: JEADV, 33(7), 1331–1340. https://doi.org/10.1111/jdv.15634

NURS 6512 Week 5: Assessment of Head, Neck, Eyes, Ears, Nose, and Throat

Some conditions are subtle, and their symptoms are common. To determine the exact condition a patient with these symptoms is suffering from, you have to use special instruments and tests.

This week, you will learn how to assess your patient’s head, neck, eyes, ears, nose, and throat. You will also gain insight into how to identify proper assessment techniques to get accurate diagnoses.

Assignment: Assessing the Head, Neck, Eyes, Ears, Nose, and Throat

Most ear, nose, and throat conditions are minor. However, minor symptoms can lead to life-threatening conditions. Therefore, you must be keen in your assessment and treatment.

With the right techniques, nurses can differentiate between life-threatening symptoms and benign ones. In this assignment, you will analyze several case studies of abnormal findings. You will then determine what history should be collected from the patient, the physical and diagnostic tests that should be conducted, and form a diagnosis from the information.

NURS 6512 Week 6: Assessment of the Abdomen and Gastrointestinal System

Several conditions affect the Gastrointestinal system and the abdomen. The closeness of these organs in the body makes it quite challenging to make an accurate assessment. This is also fueled by the fact that pain in other organs can also affect the GI system.

This week, you will learn and explore how to assess the abdomen and the GI system.

Assignment: Assessing the Abdomen

There are high chances of misdiagnosis when it comes to abdominal conditions. This makes the process time-consuming and challenging. Through analyzing several case studies, nurses are able to prepare themselves to diagnose these conditions better,

In this assignment, you will assess case studies that describe abnormal findings. You will determine what history should be collected and what exams should be conducted.

NURS 6512 Midterm-Exam

Exam sample questions and help available

NURS 6512 Week 7: Assessment of the Heart, Lungs, and Peripheral Vascular System

Cardiovascular disease (CVD) is the leading cause of death worldwide, with 610,000 annual deaths as of 2017. This disease commonly goes unnoticed until it’s too late. However, with early detection and prevention measures, CVD can be treated. One of the ways to detect CVD is by assessing the heart, lungs, and peripheral vascular system.

This week, you will evaluate abnormal findings in the chest and lungs area. You will also appraise health assessment techniques and diagnoses of the heart, lungs, and peripheral vascular system.

Assignment: Assessing the Heart, Lungs, and Peripheral Vascular System

In order to effectively assess the chest area of a patient, you need to be aware of your patient’s history, abnormal findings, and what diagnostic tests must be conducted to determine the cause and severity of their condition.

For this assignment, you will conduct an exam related to chest pain. You will consider the patient’s symptoms and how they relate to different diagnoses.

NURS 6512 Week 8: Assessment of the Musculoskeletal System

The musculoskeletal system’s complex structure and range of movement pilot physical activities. A healthy musculoskeletal system ensures that your patient lives a life full of mobility. Assessment is one of the basic ways of maintaining the health of this assessment.

This week, you will learn how to examine the musculoskeletal system.

Discussion: Assessing Musculoskeletal Pain

The body constantly sends signals about its health, and one of these signals is pain. Musculoskeletal conditions are one of the leading causes of long-term pain in patients. This system is made up of interconnected levers that provide the body with support and mobility. Due to this interconnectedness, identifying the cause of pain in a musculoskeletal system can be quite challenging. Interpreting this pain requires an assessment process.

In this discussion, you will examine case studies that describe abnormal findings in patients.

Assignment: Practice Assessment-Musculoskeletal System (Optional)

It’s not enough to highlight the symptoms of a musculoskeletal condition. Before formulating a diagnosis, it’s essential to perform a physical examination. This will determine whether your diagnosis is accurate.

In this assignment, you will practice performing a musculoskeletal examination and formulate a diagnosis.

NURS 6512 Week 9: Assessment of Cognition and the Neurologic System

Neurological conditions can lead to symptoms such as memory loss, obsessive cleaning, and avoiding eye contact. When assessing the neurologic system, it’s essential to formulate an accurate diagnosis as early as possible. This prevents continued damage and deterioration in the patient’s health.

This week, you will learn techniques to assess cognition and the neurologic system.

NURS 6512 Week 10: Special Examinations- Breast, Genital, Prostate, and Rectal

For a physical exam to go smoothly, the examiner has to put the patient at ease. This is especially true when dealing with issues concerning breasts, genitals, prostrates, and rectums. When the patient is at ease, the nurses are most likely to gain meaningful and quality information that will help the patient get the best care possible. When dealing with patients with these conditions, you have to find techniques that are non-evasive since these are critical areas.

This week, you will explore how to assess issues with breasts, genitalia, rectum, and prostate.

Assignment: Assessing the Genitalia and Rectum

Issues concerning the genitalia and the rectum are uncomfortable topics to discuss. However, as s nurse, you have to gather adequate patient history when performing a physical exam. Examining case studies of genital and rectal abnormalities helps prepare nurses to assess patients with problems in these areas accurately.

In this assignment, you will analyze a case study with abnormal findings, consider what history should be collected, the diagnostic tests to be conducted, and formulate a diagnosis.

NURS 6512 Week 11: The Ethics Behind Assessment

Throughout this course, you have learnt how to assess health conditions and abnormal findings. We have focused on the procedure of these assessments. This week, you will focus on the ethical and legal considerations surrounding these assessments.

By the end of the week, you should have learnt evidence-based practice guidelines and ethical considerations surrounding health assessments.

Assignment: Ethical Concerns

In your line of work as an advanced practice nurse, you will encounter situations where your patient’s wishes conflict with those of their family, your own evidence, or general evidence. What do you do in these cases?

In this assignment, you will explore evidence-based practice guidelines and ethical considerations of such situations.

NURS 6512 Final Exam

Example Sample Questions and Help Available
NURS – 6512C Advanced Health Assessment & Diagnostic Reasoning 2024 JUNE

NURS 6512 Week 1: Building a Comprehensive Health History

Week 2: Functional Assessments and Cultural and Diversity Awareness in Health Assessment

BUILDING A HEALTH HISTORY: COMMUNICATING EFFECTIVELY TO GATHER APPROPRIATE HEALTH-RELATED INFORMATION

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. 

There may also be significant cultural factors. In 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). 

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

As an advanced practice nurse, you must build a patient health history that takes into account all of the factors that make a patient unique and tailor your communication techniques accordingly. Doing so will not only help you establish rapport with each patient, but it will also enable you to more effectively gather the information needed to assess a patient’s health risks. 

For this first Assignment, you will take on the role of an APRN who is building a health history for a particular patient assigned by your Instructor. You will consider how social determinants of health and specific cultural considerations will influence your interview and communication techniques as you work in partnership with the patient to gather data for an accurate health history.  

Note: You are expected to draw on the resources for both Week 1 and Week 2 when completing your Assignment. 

Resources

Be sure to review the Learning Resources before completing this activity.
Click the weekly resource links to access the resources. 

To prepare:

• Reflect on your experience as an advanced practice nurse and on the information provided in the Week 1 Learning Resources on building a health history and the Week 2 Learning Resources on diversity issues in health assessments. 
• By Day 1 of this week, your Instructor will assign a case study for this Assignment.?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 your assigned patient. 
• Consider how you would build a health history for the patient. What questions would you ask? How might you target your questions based on the patient’s social determinants of health? How would you frame the questions to be sensitive to the patient’s background, lifestyle, and culture? 
• Identify any potential health-related risks, based on the patient’s age, gender, ethnicity, or environmental setting, which should be taken into consideration. 
• What risk assessment instruments would be appropriate to use with this patient? 
• What questions would you ask to assess the patient’s health risks?  
• Select?one?(1) risk assessment instrument discussed in the Learning Resources, or another tool with which you are familiar, related to your selected patient. 
• Develop five (5) targeted questions you would ask the patient to build their health history and to assess their health risks. 
• Think about the challenges associated with communicating with patients from a variety of specific populations. What communication techniques would be most appropriate to use with this patient? What strategies can you as an APRN employ to be sensitive to different cultural factors while gathering the pertinent information?

Assignment: Building a Health History With Cultural and Diversity Awareness  

Include the following: 

• Explain the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with

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