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NURS 6512 Discussion: Building a Health History and Example Solution Provided

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. As an advanced practice nurse, you must be aware of these factors and tailor your communication techniques accordingly. Doing so will not only help you establish rapport with your patients, but it will also enable you to more effectively gather the information needed to assess your patients’ health risks.

For this Discussion, you will take on the role of a clinician who is building a health history for a particular new patient assigned by your Instructor.

Photo Credit: Getty Images/Caiaimage

To prepare for NURS 6512 Discussion: Building a Health History:

With the information presented in Chapter 1 of Ball et al. in mind, consider the following:

• By Day 1 of this week, you will be assigned a new patient profile by your Instructor for this Discussion. Note: Please see the “Course Announcements” section of the classroom for your new patient profile assignment. Patient Profile to Use: 40-year-old black recent immigrant from Africa without health insurance
• How would your communication and interview techniques for building a health history differ with each patient?
• How might you target your questions for building a health history based on the patient’s social determinants of health?
• What risk assessment instruments would be appropriate to use with each patient, or what questions would you ask each patient to assess his or her health risks?
• Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration.
• Select one of the risk assessment instruments presented in Chapter 1 or Chapter 5 of the Seidel’s Guide to Physical Examination text, or another tool with which you are familiar, related to your selected patient.
• Develop at least five targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history.

By Day 3 of Week 1

Post a summary of the interview and a description of the communication techniques you would use with your assigned patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Read a selection of your colleagues’ responses.

By Day 6 of Week 1

Respond to at least two of your colleagues on 2 different days who selected a different patient than you, using one or more of the following approaches:

• Share additional interview and communication techniques that could be effective with your colleague’s selected patient.
• Suggest additional health-related risks that might be considered.
• Validate an idea with your own experience and additional research.

Also read:

Diversity and Health Assessments NURS 6512

NURS6512 Week 7: Assessment of the Heart, Lungs, and Peripheral Vascular System

NURS 6512 Week 5 Focused Exam Cough Danny Rivera

Resource List

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

• Chapter 1, “The History and Interviewing Process”

This chapter explains the process of developing relationships with patients in order to build an effective health history. The authors offer suggestions for adapting the creation of a health history according to age, gender, and disability.

• Chapter 5, “Recording Information”

This chapter provides rationale and methods for maintaining clear and accurate records. The authors also explore the legal aspects of patient records.

Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.

• Chapter 2, “The Comprehensive History and Physical Exam” (pp. 19–29)

Deckx, L., van den Akker, M., Daniels, L., De Jonge, E. T., Bulens, P., Tjan-Heijnen, V. C. G., … Buntinx, F. (2015). Geriatric screening tools are of limited value to predict decline in functional status and quality of life: Results of a cohort study. BMC Family Practice, 16, 1–12.  https://doi-org.ezp.waldenulibrary.org/10.1186/s12875-015-0241- x 

Wu, R. R., & Orlando, L. A. (2015). Implementation of health risk assessments with family health history: Barriers and benefits. Postgraduate Medical Journal, (1079), 508–513. 

Jardim, T. V., Sousa, A. L. L., Povoa, T. I. R., Barroso, W. K. S., Chinem, B., Jardim, L., … Jardim, P. C. B. V. (2015). The natural history of cardiovascular risk factors in health professionals: 20-year follow-up. BMC Public Health, 15(1111), 1–7. https://doi-org.ezp.waldenulibrary.org/10.1186/s12889-015-2477-8 

NURS 6512 Discussion: Building a Health History Example 1 – Healthcare Challenges for a Homeless African American

The patient, a 46-year-old African American male residing in a homeless shelter, presents with a complex background that profoundly impacts his health management. Socioeconomically, his homelessness highlights a severe lack of stability, greatly complicating his access to consistent healthcare and necessary medications, such as Norvasc for hypertension. The instability and stress associated with his living situation may hinder regular follow-up care, thereby exacerbating his chronic conditions (Bensken et al., 2021). This socioeconomic backdrop is crucial in understanding the barriers he faces toward achieving optimal health outcomes, necessitating targeted interventions that address these specific challenges.

Furthermore, the patient’s decision to quit drinking could reflect a significant spiritual or personal shift, possibly driven by cultural or religious beliefs that emphasize transformation and redemption as components of recovery. However, he continues to smoke cigarettes, a lifestyle choice that likely serves as a coping mechanism to manage stress. This behavior could also be influenced by cultural norms surrounding masculinity and stress management prevalent in his community (Bensken et al., 2021). As an African American, he faces additional challenges like healthcare disparities and potential stigmatization in medical settings, which can influence his healthcare engagement and treatment adherence. Recognizing these intertwined cultural, lifestyle, and socioeconomic factors is essential for providing culturally competent care that effectively addresses his comprehensive health needs.

Addressing Healthcare Barriers in Marginalized Populations

When interacting with a 46-year-old African American male patient currently residing in a homeless shelter, it is imperative to be cognizant of several sensitive issues that directly impact his health and well-being. Firstly, his homelessness introduces significant challenges, including erratic access to healthcare services, medication, and stable living conditions. This precarious living situation can lead to heightened stress and exacerbate health conditions like hypertension, which he is currently facing. 

Understanding and acknowledging the logistical and emotional hurdles he encounters daily is crucial in providing realistic and empathetic medical guidance (Bantham et al., 2021). Considering these socioeconomic barriers allows healthcare providers to tailor their recommendations to the patient’s specific circumstances, thereby enhancing the effectiveness of the treatment plan and adherence to it.

Additionally, the patient’s history of alcohol dependency and recent cessation is a critical aspect of his health profile. This background requires a compassionate approach that supports his current efforts to abstain from alcohol without passing judgment. Also, being sensitive to his continued use of cigarettes to manage stress involves recognizing this as a coping mechanism rather than merely a harmful habit. Engaging in open conversations about his smoking and exploring alternative stress-relief techniques could foster a more trusting patient-provider relationship (Bantham et al., 2021). Furthermore, as an African American, he may have experienced biases in healthcare settings, which could affect his engagement and trust in medical advice. Addressing these potential experiences respectfully and ensuring that communication is clear, respectful, and culturally competent are fundamental to providing care that not only treats but also empowers the patient.

Effective Communication Strategies for Sensitive Patient Care

Effective communication with a patient facing multiple health and social challenges requires tailored techniques to ensure sensitivity and improve treatment outcomes. Employing patient-centered communication is paramount. This approach involves active listening, asking open-ended questions to encourage the patient to share his experiences and feelings, and responding in a way that validates these expressions (Kwame & Petrucka, 2021). Such interactions are crucial for building trust and rapport, especially given his current unstable living conditions and previous healthcare experiences. Focusing on the patient’s perspectives and needs enhances their sense of respect and understanding, which in turn increases their engagement and compliance with medical recommendations.

Additionally, motivational interviewing is a critical technique in this context. This method focuses on empathetic engagement, highlighting discrepancies between the patient’s health goals and behaviors and reinforcing his autonomy in making health-related decisions. This approach is particularly effective for discussing sensitive issues such as smoking and its cessation, as it encourages the patient to consider the benefits of change without feeling judged.

Furthermore, simplifying medical information by avoiding jargon and ensuring that explanations are clear and relatable is essential for his understanding and active participation in his health care plan (Kwame & Petrucka, 2021). Acknowledging and incorporating cultural sensitivities into all interactions, understanding his background, and respecting his coping mechanisms, like smoking, can lead to more personalized and effective healthcare strategies. These communication strategies facilitate a better healthcare experience and empower the patient to take more significant control over his health, reflecting a respectful acknowledgment of his circumstances and cultural identity.

Targeted Health History Interview for Comprehensive Risk Assessment

1. Can you describe your current daily diet and fluid intake?

This question aims to understand his nutritional status, which is crucial for managing hypertension and overall health. Nutritional deficiencies or imbalances can significantly impact chronic health conditions.

2. Have you experienced any symptoms like chest pain, dizziness, or unusual fatigue recently?

These symptoms are relevant to his known hypertension and potential cardiac issues. Clarifying these symptoms can help evaluate his condition’s severity and any immediate risks.

3. What medications are you currently taking, and how often do you take them?

Given his previous prescription for Norvasc and his current lack of access, this question checks for medication adherence and understanding, which are critical for the effective management of hypertension.

4. Can you tell me about your smoking habits, including how much and how often you smoke?

Smoking is a significant risk factor for many health issues, including cardiovascular disease. Understanding his smoking habits will help in discussing potential interventions and support for cessation.

5. What kinds of support do you have from friends, family, or community services?

This question assesses his social support network, which can influence his ability to manage health conditions and access healthcare services. Social support is essential for overall well-being and can impact his recovery and health management.

Framingham Score for Cardiovascular Assessment

For the 46-year-old African American male patient currently residing in a homeless shelter and dealing with hypertension and a history of alcohol dependence, the appropriate risk assessment instrument would be the Framingham Heart Study Risk Score. This tool estimates the 10-year cardiovascular risk based on factors such as age, gender, cholesterol levels, blood pressure, diabetes, and smoking status.

Given his known history of hypertension and smoking, these are critical factors that contribute significantly to cardiovascular risk. The Framingham Risk Score would provide a quantitative measure of his risk of developing cardiovascular diseases over the next decade, which is crucial for early intervention and management (Iadecola & Parikh, 2020). Utilizing this tool would allow healthcare providers to prioritize interventions that could significantly impact his cardiovascular health, such as smoking cessation, blood pressure management, and lifestyle modifications.

Additionally, considering his socioeconomic challenges and lifestyle factors, integrating the Framingham Risk Score with a comprehensive assessment of his social determinants of health is essential. This dual approach ensures that interventions are medically appropriate and contextually relevant to his living conditions and available resources (Iadecola & Parikh, 2020). For instance, the patient’s ability to adhere to a prescribed medication regimen or to make lifestyle changes is likely influenced by his living situation in a homeless shelter.

Therefore, using the Framingham Risk Score provides a foundation for understanding his medical risks, while a broader assessment of his social circumstances helps in tailoring the interventions to be realistic and effective (Iadecola & Parikh, 2020). This approach maximizes the potential for positive health outcomes by addressing his immediate medical needs and the underlying social factors impacting his health.

NURS 6512 Discussion: Building a Health History References

Bantham, A., Ross, S. E. T., Sebastião, E., & Hall, G. (2021). Overcoming barriers to physical activity in underserved populations. Progress in Cardiovascular Diseases, 64, 64-71. https://doi.org/10.1016/j.pcad.2020.11.002

Bensken, W. P., Krieger, N. I., Berg, K. A., Einstadter, D., Dalton, J. E., & Perzynski, A. T. (2021). Health status and chronic disease burden of the homeless population: an analysis of two decades of multi-institutional electronic medical records. Journal of Health Care for the Poor and Underserved, 32(3), 1619. https://doi.org/10.1353%2Fhpu.2021.0153

Iadecola, C., & Parikh, N. S. (2020). Framingham general cardiovascular risk score and cognitive impairment: the power of foresight. Journal of the American College of Cardiology, 75(20), 2535-2537. https://doi.org/10.1016/j.jacc.2020.03.061

Kwame, A., & Petrucka, P. M. (2021). A literature-based study of patient-centered care and communication in nurse-patient interactions: barriers, facilitators, and the way forward. BMC Nursing, 20(1), 158.  https://doi.org/10.1186/s12912-021-00684-2

NURS 6512 Discussion: Building a Health History Example Solution 2

The scenario I was given for this week is an 80-year-old white male with angina who lives on a farm 80 miles from a healthcare center. 

According to the National Institute on Aging (NIA), 25% of seniors aged 65 to 70 have hearing loss, while 50% of those over 75 have debilitating hearing loss. Talking clearly and slowly, looking at the patient directly, and reducing background noise are all ways of dealing with hearing loss (National Institute on Aging, n.d.-b). 

Background noise could distract patients from listening to what you are trying to communicate with the patient. Sit facing the patient, employ active listening techniques, ask open-ended questions that might elicit a more thorough response, inquire about their functional status, and, if possible, request medical records from another provider before the appointment so that you can gather additional information that the patient may not provide to obtain an accurate medical history via interview (National Institute on Aging, n.d.-a).

When there is excellent communication between the practitioner and the patient, health assessment questions can be answered to the best of one’s ability. For the patient to grasp what you are asking or saying, the National Institute on Aging (n.d.-b) advises avoiding medical terms and adopting straightforward language and expressions. 

The cardiovascular risk calculator from the ACC/AHA is the risk assessment tool I selected to employ for this patient. The patient’s angina complaint was why I decided on this tool. To ascertain the likelihood of a stroke, heart attack, or death from cardiovascular illness within the next ten years, persons should have a cardiovascular risk assessment (UpToDate, n.d.). To use this tool efficiently, this patient would require simple laboratory tests to determine his total cholesterol and HDL cholesterol. His medical history for diabetes, the drugs he is on now, his social history for smoking, and his current medications would all need to be evaluated by the healthcare professional (UpToDate, n.d.). 

Age, race, and gender of the patient are all potential health hazards that should be taken into account. According to the Centers for Disease Control and Prevention, approximately 1 in every 4 American male fatalities are attributable to heart disease in 2021, and 7.7% of white males, or 1 in 13, had coronary artery disease. Diabetes history, a poor diet, being overweight, being inactive physically, and drinking too much alcohol are all potential risk factors for heart disease (Centers for Disease Control and Prevention, 2021). When beginning new drug management, this information should be carefully reviewed and may be obtained during the patient interview. 

A few questions I would ask the patient are:  

• What medications are you now taking? Can I see them, please? 
• What do you consume in the morning? Lunch? Dinner?
• Do you have any dietary or medicine allergies? What responses did you get? 
• Do you find it easy to stand up and move around or feel out of breath?
• Do you experience breathing issues while lying on your back? 
• Any issues using the restroom? 
• Are there any aches or weakened muscles?
• How does this pain feel when it is present? Does it extend to your arm, neck, or jaw? 
• Does it hurt or feel like someone is stabbing you? 
• How long does this discomfort linger before it stops? 
• Is there anything you do that affects it positively or negatively?
• Do you consume alcohol, illegal substances, or smoke?
• What procedures have you previously undergone? 
• How do you feel today?
• Do you get enough rest at night?

NURS 6512 Discussion: Building a Health History References 

Ball, J., Dains, J., Flynn, J., Soloman, B., & Stewart, R. (2021). Seidel’s guide to physical examination 9th edition 2018 (9th ed.). Elsevier. https://evolve.elsevier.com/cs/product/9780323545068#:~:text=Seidel’s%20Guide%20to%20Physical%20Examination

Centers for Disease Control and Prevention. (2021, February 3). Men and heart disease. https://www.cdc.gov/heartdisease/men.htm

National Institute on Aging. (n.d.-a). Obtaining an Older Patient’s Medical History. https://www.nia.nih.gov/health/obtaining-older-patients-medical-history

National Institute on Aging. (n.d.-b). Tips for improving communication with older patients. https://www.nia.nih.gov/health/tips-improving-communication-older-patients#: %7E:text=Talk%20slowly%20and%20clearly%20in,or%20pick%20up%20visual %20clues.  

UpToDate. (n.d.). Calculator: Cardiovascular risk assessment in adults (10-year, ACC/AHA 2013) (patient education). https://www.uptodate.com/contents/calculator-cardiovascularrisk-assessment-in-adults-10-year-acc-aha-2013-patient-education 

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

DIVERSITY AND HEALTH ASSESSMENTS

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; however, they emphasize an underlying reality in the healthcare field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and healthcare professionals should be aware of this reality and adapt their health assessment techniques and recommendations to accommodate diversity.

In this Discussion, you will consider different socioeconomic, spiritual, lifestyle, and other cultural factors that should be taken into considerations when building a health history for patients with diverse backgrounds. Your Instructor will assign a case study to you for this Discussion.

To prepare:

• Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments.
• By Day 1 of this week, you will be assigned a case study by your Instructor. 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 the patient assigned to you.
• Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.
• Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information?

BY DAY 3 OF WEEK 2

Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!   

Required Readings

• Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2023). Seidel’s guide to physical examination: An interprofessional approach (10th ed.). St. Louis, MO: Elsevier Mosby.
  • Chapter 1, “Cultural Competency”
    This chapter highlights the importance of cultural awareness when conducting health assessments. The authors explore the impact of culture on health beliefs and practices.

• Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
  Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.
  • Chapter 2, “Evidenced-Based Clinical Practice Guidelines”
• Centers for Disease Control and Prevention. (2020, October 21). Cultural competence in health and human services
• . Retrieved from https://npin.cdc.gov/pages/cultural-competence
  This website discusses cultural competence as defined by the Centers for Disease Control and Prevention (CDC). Understanding the difference between cultural competence, awareness, and sensitivity can be obtained on this website.
• United States Department of Human & Health Services. Office of Minority Health. (n.d.). A physician’s practical guide to culturally competent care. Retrieved June 10, 2019, from https://cccm.thinkculturalhealth.hhs.gov/
  From the Office of Minority Health, this website offers CME and CEU credit and equips healthcare professionals with awareness, knowledge, and skills to better treat the increasingly diverse U.S. population they serve.
• Coleman, D. E. (2019). Evidence based nursing practice: The challenges of health care and cultural diversity. Journal of Hospital Librarianship, 19(4), 330–338. https://doi.org/10.1080/15323269.2019.1661734
• Young, S., & Guo, K. L. (2016). Cultural diversity training. The Health Care Manager, 35(2), 94–102. https://doi.org/10.1097/hcm.0000000000000100

NURS 6512 Week 3: Assessment of Nutrition in Children

Week 3: Assignment 1 Case Study Assignment: Assessment of Nutrition in Children

When seeking to identify a patient’s health condition, advanced practice nurses can use a diverse selection of diagnostic tests and assessment tools; however, different factors affect the validity and reliability of the results produced by these tests or tools. Nurses must be aware of these factors in order to select the most appropriate test or tool and to accurately interpret the results.

Not only do these diagnostic tests affect adults, body measurements can provide a general picture of whether a child is receiving adequate nutrition or is at risk for health issues. These data, however, are just one aspect to be considered. Lifestyle, family history, and culture—among other factors—are also relevant. That said, gathering and communicating this information can be a delicate process.

For this Assignment, you will  consider examples of children with various weight issues. You will explore how you could effectively gather information and encourage parents and caregivers to be proactive about their children’s health and weight.

To Prepare:

• Review this week’s Learning Resources and consider factors that impact the validity and reliability of various assessment tools and diagnostic tests. You also will review examples of pediatric patients and their families as it relates to BMI.
  • Based on the risks you might identify consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this information in a sensitive fashion.
  • Consider how you could encourage parents or caregivers to be proactive toward the child’s health.

THE ASSIGNMENT

Assignment (3–4 pages, not including title and reference pages):

Assignment: Child Health Case:

Include the following:

• An explanation of the health issues and risks that are relevant to the child you were assigned.
• Describe additional information you would need in order to further assess his or her weight-related health.
• Identify and describe any risks and consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this information in a sensitive fashion.
• Taking into account the parents’ and caregivers’ potential sensitivities, list at least three specific questions you would ask about the child to gather more information.
• Provide at least two strategies you could employ to encourage the parents or caregivers to be proactive about their child’s health and weight.

Required Readings

• Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2023). Seidel’s guide to physical examination: An interprofessional approach (10th ed.). St. Louis, MO: Elsevier Mosby.
  • Chapter 3, “Examination Techniques and Equipment”
    This chapter explains the physical examination techniques of inspection, palpation, percussion, and auscultation. This chapter also explores special issues and equipment relevant to the physical exam process.
  • Chapter 8, “Growth and Nutrition”
    In this chapter, the authors explain examinations for growth, gestational age, and pubertal development. The authors also differentiate growth among the organ systems.

• Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Student checklist: Health history guide 
• Download Student checklist: Health history guide. In Seidel’s guide to physical examination (9th ed.). St. Louis, MO: Elsevier Mosby.
  Credit Line:  Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearan

NURS 6512 FINAL EXAM SAMPLE QUESTIONS

1. Costovertebral angle tenderness should be assessed whenever you suspect the patient may have: – Polynephritis
2. In older adults, overflow fecal incontinence is commonly due to: -Fecal impaction
3. A 1 month old boy has been vomiting for 2 weeks. How is this symptom of GERD and pyloric stenosis further differentiated in this child’s assessment? – The infant has regurgitation with pyloric stenosis
4. Auscultation of borborygmi is associated with: – Gastroenteritis, early intestinal obstruction, or hunger
5. When auscultating the abdomen, which finding would indicate collateral circulation between the portal and systemic venous systems? – Venous hum
6. Conversion of fat-soluble wastes to water-soluble material for renal excretion is a function of the: – Liver
7. The major function of the large intestine is: -Water absorption
8. Which structure is located in the hypogastric region of the abdomen? –Ileum, bladder, and pregnant uterus
9. A 45 year old man relates a several week history of severe intermittent abdominal burning sensations. He relates that the pain is relieved with small amounts of food. Before starting the physical examination, you review his laboratory work, anticipating a (n): -Positive Helicobacter pylori result
10. You are caring for a patient with trigeminal neuralgia. During the assessment, the patient would describe the pain as: – Burning or shocklike
11. Your 85 year old patient is complaining of right knee pain. She has a history of osteoarthritis for which she is given anti-inflammatory medication. To assess her right knee pain, you should ask her if: – The pain gets better when she sits
12. A 5 year old is complaining of nondescriptive “belly pain.” Your next action should be to ask him to: – Point to the area of pain
13. The perception of pain: – Is variable and is affected by emotions, and cultural background
14. Patients presenting with ascites, jaundice, cutaneous spider veins, and nonpalpable liver exhibit signs of: – Cirrhosis
15. A patient presents to the emergency department after a motor vehicle accident. The patient sustained blunt trauma to the abdomen and complains of pain in the upper left quadrant that radiates to the left shoulder. What organ is most likely injured? – Spleen
16. Imaging studies reveal that a patient has dilation of the renal pelvis from an obstruction in the ureter, what condition will be documented in this patient’s health record? – Hydronephrosis
17. Visible intestinal peristalsis may indicate: – Intestinal obstruction
18. Infants born weighing less than 1500g are at higher risk for: – Necrotizing enterocolitis
19. Which of the following factors is not known to affect patient compliance with his or her treatment regimen? – The patient’s age and social status
20. One of the most important aspects to consider in the orthopedic screening examination is: – Symmetry
21. The sequence of the physical examination should be individualized to: – Minimize the number of times the patient has to change positions to conserve the patient’s energy
22. As you greet the patient, which examination technique is first implemented? – Inspection
23. Which of the following is most likely to enhance examiner reliability? – The examiner attempts to qualify data
24. A 7 year old boy is brought to your office with a chief complaint of possible fracture to his left third finger. He jammed it while playing basketball 2 days ago. The mother states that she really does not think it is broken because he can move it. What is your best response? – This is common misconception, and the finger may be broken. An x-ray is indicated.
25. A patient presenting for the first time with typical low back pain should receive which of the following diagnostic tests? – None of the above. X-ray is not indicated because lumbar pain is usually musculoskeletal etiology.
26. Skeletal changes in older adults are the result of: -Increased bone resorption
27. A positive straight leg raise test usually indicates: – Lumbar nerve root irritation
28. What technique is performed at every infant examination during the first year of life to detect hip dislocation? – Barlow-Ortolani maneuvers
29. Expected normal findings during inspection of spinal alignment include: – Convex lumbar curve
30. Temporalis and masseter muscles are evaluated by: – Having the patient clench his or her teeth
31. When palpating joints, crepitus may be caused when: – Irregular bony surfaces rub together
32. A 3 year old is brought to the clinic complaining of a painful right elbow. He is holding the right arm slightly flexed and pronated and refuses to move it. the mother states that symptoms started right after his older brother had been swinging him around by his arms. This presentation supports a diagnosis of: – Radial head subluxation
33. Light skin and thin body habitus are risk factors for: – Osteoporosis
34. Risk factors for sports-related injuries include: – Failure to warm up before activity
35. Injuries to long bones and joints are more likely to result in fractures than in sprains until: – Adolescence
36. Ligaments are stronger than bone until: – Adolescence
37. The family history for a patient with joint pain should include information about siblings with: -Genetic disorders
38. The Thomas test is used to detect: – Flexion contractures of the hip
39. A goniometer is used to assess: – Range of motion
40. During a football game, a player was struck on the lateral side of the left leg while his feet were firmly planted. He is complaining of left knee pain. To examine the left knee you should initially perform the ­­­­­­­­­­­­­­­­________ test. – Valgus stress
41. You note that a child has a positive Gower Sign. You know that this indicates generalized: – Muscle weakness
42. The dowager hump is: – The hallmark of osteoporosis
43. What temporary disorder may be experienced by pregnant women during the third trimester because of fluid retention? –Carpal tunnel syndrome
44. A common finding in markedly obese and pregnant women is: – Lordosis
45. A 45-year-old laborer presents with low back pain, stating that the pain comes from the right buttock and shoots down and across the right anterior thigh, down the shin to the ankle. Which examination finding is considered more indicative of nerve root compression?A 45 year old laborer presents with low back pain, stating that the pain comes from the right buttock and shoots down and across the right anterior thigh, down the shin to the ankle. Which examination finding is considered more indicative of nerve root compression? – Positive straight leg raise result
46. Mrs. Bower is a 57 year old patient who comes in for an office visit. Which of the following disorders is known to be hereditary? – Huntington chorea
47. Testing of cranial nerve ­­­­________ is not routinely performed unless a problem is suspected. – I
48. The patient is able to rapidly touch each finger to his thumb in rapid sequence. What does this finding mean? – The patient has appropriate cerebellar function
49. Which question asked by the examiner may hellp to determine prevention strategies for seizures that a patient is experiencing? – “Are there any factors or activities that seem to start the seizures?”
50. A patient has a complaint of dizziness. The patient makes the following statement: “I sometimes feel as if the whole room is spinning.” What type of neurologic dysfunction should the examiner suspect? – Inner ear dysfunction affecting the acoustic nerve
51. The examiner asks the patient to close her eyes, then places a vibrating tuning fork on the patient’s ankle and asks her to indicate what is felt. What is being assessed? – Peripheral nerve sensory function
52. Which of the following findings should an examiner consider a normal finding if associated with pregnancy? – Acroparesthesia
53. Jack is a 52 year old obese man with a history of poorly controlled diabetes. He also smokes. Based on the above data, the examiner should recognize that Jack has several risk factors for: – Cerebrovascular accident
54. Mrs. Jones is a 24 year old patient who presents to your office 2 days postpartum. She complains that she is experiencing foot drop. Which of the following problems should the examiner consider? – Lumbosacral plexopathy
55. The examiner is assessing deep tendon reflex response in a 12 year old boy. The response is an expected reflex response. Which of the following scores should be documented? – 2+
56. A 68 year old patient presents to your office for follow-up. He tells you, “I have a hard time finding the right words when I am talking;” he also is experiencing numbness. On examination, you note postural instability. This symptom may be: – A late symptom of Parkinson’s disease
57. Motor maturation proceeds in an orderly progression from: – Head to toe
58. The thalamus is the major integration center for perception of: – Pain
59. The examiner should be concerned about neurologic competence if a social smile cannot be elicited by the time a child is ________old. – 3 months
60. Normal changes of the aging brain include: – Diminished perception of touch. — this is by process of elimination/educated guess. I could not find direct information addressing this in Seidel
61. When interviewing a 70 year old female clinic patient, she tells you that she takes ginkgo biloba and St. John’s Wort. You make a short note to check for results of the: -Mini-mental state examination
62. The area of body surface innervated by a particular spinal nerve is called a: – Dermatome
63. If a patient cannot shrug the shoulders against resistance, which cranial nerve (CN) requires further evaluation? – CN XI, spinal accessory

NURS 6512 Lab Assignment: Differential Diagnosis for Skin Conditions (SOAP Note for differential diagnosis)

Sample Paper

Skin Condition Picture # 5

Patient Initials: ___AB_____   Age: _____23__   Gender: ___M____

SUBJECTIVE DATA:

Chief Complaint (CC): Painful rash and joint pain

History of Present Illness (HPI): During the day, AB a 23-year-old lady was presented to the clinic with an onset of painful plague like rashes and pain her joints that started two weeks ago. She added that the rashes started on her knees and later to her elbows and scalps. She further reported the rashes are itchy and sore and complained her joints have painful for the past three weeks. The condition makes her annoyed and worsens as the days go by. More importantly, she added she takes painkillers (Ibuprofen 400mg three times a day) to relieve the pain as well change her laundry detergent with no improvement on her condition.

Onset – Rashes three days

Location – Knee

Duration – Three weeks ago

Character- gradual

Associated symptoms – none

Relieving factors – Painkillers

Treatment – None

Severity – 6/10

Medications: 

Takes Ibuprofen 400mg three times a day as prescribed in her local pharmacy.

Multivitamin for women I tablet daily

Allergies: Denies drug or food allergies.

Past Medical History (PMH):

Frequent Tonsillitis

Past Surgical History (PSH):

Tonsillectomy 2006

Caesarian section 2014

Sexual/Reproductive History: 

In a monogamous relationship

Menarche 9 years and 8 months

Gravida 1, Parity 0

She experiences regular menstruation

Denies any history of sexually transmitted diseases

She is on Nexplanon contraception for 3 years now

She has her last pap smear in 2018 and results were normal

Social History:

Denies smoking and ETOH intake or substance abuse. She maintains a balanced diet and exercises when she can.

Immunization History:

AB is immunization is up to date according to the World Health Organization. She had a flu vaccine towards the end of last year and her Tdap in 2017 does not fulfill the standards for pneumonia immunization.

Lifestyle: 

AB has been working as a receptionist in a local insurance company for the last three months now. AB lives with her elder sister after she had broken up with her boyfriend two years ago. However, she is looking for her own apartment since they have had some differences with her sister. Her sister’s apartment is quite confined after she delivered a baby some months ago as she uses AB’s room as her child’s newborn nursery. As such, she is forced to sleep on the couch with her child. In addition, she helps in nursing her sister and stays late in the night helping with the baby. Luckily, AB has her own health insurance policy and she usually has regular health examination, takes a balanced diet and goes to the gym thrice in a week. More importantly, she agrees the family support is tense due to the newborn and barely have friends to visit her.

Family History

According to AB reports, her father is 47 years of age, and her 43 years old. She is a second born in a family of 4. Both her maternal grandmother mother and paternal grandfather aged 65 and 68 years old respectively have a history of psoriasis and eczema as well as psoriasis arthritis and psoriasis respectively. His father although separated with her mum now, he has a history of multiple allergies and psoriasis. In addition, her mother was diagnosed with breast cancer in 2013 and she is currently in remission. Her two younger brothers were recently diagnosed with an unknown fungal infection.  

Review of Systems: 

General: Denies having fever, chills, fatigue, night sweats, or significant weight changes

HEENT:

Head/face: No hair loss or head injury, denies headache,

Eyes: Round pupils and reactive to light, Moist mucus Membranes

Ears: Denies having any hearing problems. No tinnitus, no drainage

Nose: No epistasis, nasal congestion, denies having allergies and nasal drainage.

Mouth/Throat/ Neck: Denies sore throat, supple neck, no stiffness, no thyromegaly, no

Lymphadenopathy, no toothache. She had the last dental exam on 20th August 2018.

Musculoskeletal: Positive for diffuse joint pain.No cyanosis, no edema or clubbing. No tenderness on her scapular. Positive dorsalis and radial pulses (2+). Denies any history for gout, arthritis fractures or trauma.  

Psychiatric: AB is experiencing social problems, increased stress and sleep problems. However, denies having anxiety depression or suicidal thoughts in the past.

Skin: Polycyclic and pinkish orange-colored plaques approximately 1 cm in size present on her knees, elbows, and scalp, sore and pruritic. No pigment change noticed.

Allergic/Immunologic: Denies any history of drug or food allergies. No known seasonal allergies or immunological condition.

OBJECTIVE DATA:

Physical Exam:

Vital signs: SpO2: 98% tympanic;Ht: 5’7”, Wt: 131lbs, BMI: 23.8, BP 112/68 right arm, sitting, regular adult cuff; Pain severity 6/10; Respiratory Rate- 17, non-labored.

General: AAOx4.Appears neat with a well-kempt hair. Maintains eye contact, fluent in speech and

cooperative.

HEENT: PERRLA, EOMI, normal head traumatic and cephalic, dry oral mucosa, pure oropharynx. Identical pupils, no nasal deviation.

Musculoskeletal: Positivemild swelling on the wrist, knee, and ankle joints bilaterally with pain present. Symmetric muscle development

Skin:  Pinkish orange-colored, hoary, polycyclic plaques approximately 1cm in size with discrete borders present on the scalp, elbows, and knees. Sore and a bit painful to palpation. Thick acrylic nails present, limiting nail assessment

Lab Tests and Results:

 A complete blood count (CBC) – white blood cells counts (WBC) – 8,500 cells/mcL

Diagnostics:                                                                   

• Skin biopsy
  • Positive for psoriasis.
  • Negative for fungal infection

ASSESSMENT:

Primary Diagnosis: Psoriasis

Differential Diagnoses:

1. Nummular eczema
2. Lichen Planus
3. Mycosis Fungoides
4. Allergic contact dermatitis
5. Duhring’s disease

            Based on the clinical manifestation presented characterized by rashes and joints paints, it is evident the patient is suffering from psoriasis. Psoriasis is a common condition characterized by dry, raised and red skin lesions covered with silvery scales anywhere in the body such as genitals and on soft tissue. Moreover, plaques or lesions might be itchy and painful (Langley et.al., 2014). Anyone can develop psoriasis. However, family history is one of the most significant risk factors. AB’s family has a history of Psoriasis condition. According to the client, both her maternal grandmother and paternal grandfather suffered from psoriasis and eczema as well as psoriasis arthritis and psoriasis respectively putting her at higher risk of developing the condition. In addition, life stressors can impact significantly on the immune system. As such, high-stress levels increase the risk of psoriasis (Di Meglio & Nestle, 2017). The descriptions of the rashes and their location point out towards the diagnosis of psoriasis. Upon diagnosis of psoriasis, the patient complains of joint pains suggesting she might be suffering from psoriasis arthritis (Ball, Dains, Flynn, Solomon, & Stewart, 2015).

            However, despite the lesions/plagues being pinkish orange, all the other differential diagnosis was ruled through skin biopsies. More importantly, Mycosis Fungoides and Lichen Planus are caused by fungi and the skin biopsy results were negative for fungal infection and lichen planus plaques are white (Napolitano et.al.,2016). In addition, the patient does not have any allergies to foods and drugs or immunization disorder hence she could not be diagnosed with allergic contact dermatitis. Furthermore, the patient could not be diagnosed with nummular eczema are allergic related, but the patient does not have any allergic or immunization disorder and the plaques are associated with extensive scratching

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

Napolitano, M., Caso, F., Scarpa, R., Megna, M., Patrì, A., Balato, N., & Costa, L. (2016). Psoriatic arthritis and psoriasis: differential diagnosis. Clinical rheumatology, 35(8), 1893-1901.

Di Meglio, P., & Nestle, F. O. (2017). Immunopathogenesis of Psoriasis. In Clinical and Basic Immunodermatology (pp. 373-395). Springer, Cham.

Langley, R. G., Elewski, B. E., Lebwohl, M., Reich, K., Griffiths, C. E., Papp, K., … & Rivas, E. (2014). Secukinumab in plaque psoriasis—results of two phases 3 trials. New England Journal of Medicine, 371(4), 326-338.

NURS 6512 Week 1 Advanced Health Assessment and Diagnostic Reasoning

Are you looking for guidance on how to complete the assignments, ihuman assessments and exams in this class? Look no further. We have a team of dedicated professionals ready to walk you through this course, delivering meticulous results. Chat with us now for more detail.

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