N522PE Neurological & Musculoskeletal Assessment Assignment 3

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Assignment 3

Assignment Instructions:

For this 4-5 page assignment, you will conduct a focused health history and physical assessment based upon your Practice Experience work in Shadow Health. Particularly, you will complete a focused assessment on Brian, an adult who is complaining of chest pain. Please submit your summary documentation in MS Word. Use the submission parameters and rubric below to guide you in completion of this written assignment. N522PE Neurological & Musculoskeletal Assessment Assignment 3

Submission Parameters:

For this written assignment, please use the following guidelines and criteria. Also, please refer to the rubric for point allocation and assignment expectations. The expected length of the paper is approximately 4-5 pages, which does not include the cover page and reference page(s).

Introduction (including purpose statement)
Focus of the assessment
1. Describe the focus of this particular assessment on the patient complaining of chest pain
Subjective Component
1. Describe the ROS, PMH, and other relevant data in this section.
Objective Component
1. Describe the physical examination findings including techniques of examination
Documented evidence to support clinical reasoning
1. Describe the list of differential diagnoses
Plan of care
1. Describe the plan of care individualized to findings, life-span stage of development with culturally specific considerations for each focused area of assessment.
Conclusion
References (use primary and/or reliable electronic sources)

In regards to APA format, please use the following as a guide:

Include a cover page and running head (this is not part of the 4-5 pages limit)
Include transitions in your paper (i.e. headings or subheadings)
Use in-text references throughout the paper
Use double space, 12 point Times New Roman font
Apply appropriate spelling, grammar, and organization
Include a reference list (this is not part of the 4-5 pages limit)
Attempt to use primary sources only. That said, you may cite reliable electronic sources (i.e. NCSBN, AANP)

Rubric – N522PE Neurological & Musculoskeletal Assessment Assignment 3

Competency	20	18	16	0	Points Earned
Focus of the Assessment is identified with Special Considerations including Documented Focused Health History	Documentation clearly shows student has completed a focused assessment with identified special considerations including a well-documented focused health history.	Documentation supports the student has completed the focused assessment with minimal identification of special concerns. The focused health history is documented. N522PE Neurological & Musculoskeletal Assessment Assignment 3	Documentation supports the student has completed the focused assessment without identification of special concerns. The focused health history is documented and lacks depth and specificity of weekly topic.	Documentation supports the student attempted to complete the focused assessment without identification of special concerns. The focused health history is briefly documented and lacks depth and specificity of weekly topic.	/20
	20	18	16	0
Documented Physical Examination Findings including Techniques of Examination	Documentation clearly shows student has completed the physical examination and accurately describes the techniques of examination for the week.	Documentation supports the student has completed the physical examination and describes the techniques of examination for the week.	Documentation supports student completed some of the physical examination for the focused assessment of the week. Documentation is accurate but lacks depth.	No evidence that the student is applying read concepts of advanced focused physical assessment. Documentation lacks depth and may lack coherence for understandability of tasks completed in this week.	/20
	20	18	16	0
Documented Evidence to Support Clinical Reasoning with External Course Resources	Discourse clearly shows the student has studied the topic and has given thought to the focused assessed topic and documentation for the week.	Discourse supports the student has studied the topic and has given thought to the focused assessment topic and documentation for the week.	Discourse supports student studied some of the topic for the focused assessment topic this week. Discourse is accurate but lacks depth.	No evidence that that student has read or studied the topic. Discourse lacks depth. May be presented in a rambling manner. Content is inaccurate &/or is unclear.	/20
	20	18	16	0
Individualized Plan of Care Based Upon Clinical Findings	Accurately presents an individualized plan of care based upon clinical findings.	Presents an individualized plan of care based upon clinical findings. Some minor omissions are noted.	Presents a plan of care that is not individualized based upon the clinical findings.	A plan of care is not presented or the plan of care presented lacks demonstration of competency or is irrelevant to the clinical findings.	/20
	5	4	3	0
Developmentally and Culturally Specific	Accurately documents a developmentally and culturally specific assessment and plan of care for the selected patient.	Documents a developmentally and culturally specific assessment and plan of care.	Presents a developmentally and culturally specific assessment or plan of care and one or both are not based upon the selected patient.	A developmentally and culturally specific assessment and plan of care are not presented or based upon the selected patient’s findings.	/5
	5	4	3	0
Demonstration of Compliance with Ethical and Legal Standards of Professional Nursing Practice	Compliance with the ethical and legal standards of professional nursing practice is explicitly stated in the documentation of the focused physical assessment.	Compliance with the ethical and legal standards of professional nursing practice is stated in the documentation.	Compliance with the ethical and legal standards of professional nursing practice is briefly implied in the documentation of the focused physical assessment or inaccuracies are evidenced in the written assessment.	Compliance with the ethical and legal standards of professional nursing practice is not included in the documentation of the focused physical assessment.	/5
	10	9	8	0
Grammar, Spelling, and Punctuation APA Format	APA Format, grammar, punctuation and spelling is accurate with no errors.	APA Format, grammar, punctuation and spelling is accurate with less than two types of errors.	APA Format, grammar, punctuation and spelling is accurate with five or fewer types of errors.	APA Format, grammar, punctuation and spelling is accurate with more than five types of errors.	/10
COMMENTS:				TOTAL:	/100

Discussion 5

This week you have studied neurological and musculoskeletal advanced physical assessment. While a diverse set of advanced physical assessment skills where do you place your greatest level of confidence and what areas need more development. What methods do you use to remember assessment of cranial nerves, mental status, or other important clinical assessments of persons with neurological or musculoskeletal problems? Of these areas of advanced physical assessment what psychomotor skill is most challenging for you to accomplish? Why?

Post a concept to the discussion board that you have had difficulty with and note where you are with resolution of these difficulties. Please describe the clinical issue completely, citing your sources so that your classmates can reference the information and provide additional “clinical pearls”. In other words, please include primary sources and/or reliable electronic sources to support your arguments. N522PE Neurological & Musculoskeletal Assessment Assignment 3

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Discussion Participation Guidelines & Grading Criteria.

Example Discussion 5 Essay

At first when completing the cranial nerve assessment, it took me a while to get back into the swing of things, but suddenly a phrase popped in my head from my undergraduate degree: “Oh, oh, oh, to touch and feel very good velvet. Ah, heaven” to remember the progression of what to assess. However, I still needed to brush up on exactly how to assess each of those nerves as well. Damodaran et. al. (2013) really helped break down each cranial nerve, including the anatomy and the examination. One thing I found interesting is that Damodaran (2013) recommends utilizing a red pen when testing visual fields, because your finger can reduce the sensitivity of the test. The article combined with the pneumonic really helped me understand and grasp the assessment again. The psychomotor skill that I feel is the most challenging is to identify muscle strength, as this is something that I am unable to really assess on Shadow Health. When responding to stroke alerts at my facility, I have noticed a difference in strength on one side, however I feel that I struggle between discerning between grade 3 (active movement against gravity) and grade 4 (active movement against gravity and some resistance). I feel that my lack of experience with patients with unequal strength contributes to this. I will continue to assess as practice makes perfect. Bickley (2017) reviews utilizing +/- after grading a specific muscle to further explain if a patient is less strong or weaker for more detailed documentation. I feel that this is something I will aspire to document once I am more comfortable.

Bickley, L. S. (2017). Bate’s guide to physical examination and history taking (11th ed.). Philadelphia, PA: Wolters Kluwer Health | Lippincott Williams & Wilkins.

Damodaran, O., Rizk, E., Rodriguez, J., & Lee, G. (2013). Cranial nerve assessment: A concise guide to clinical examination. Clinical Anatomy, 27(1), 25–30. https://doi.org/10.1002/ca.22336

319 words

Well done. Describe how you will assess cerebellar function.

9 words

As I searched for mnemonics to help with assessing the cranial nerves, I came across one to help remember which nerves are sensory and which are motor or both. “Some say marry money but my brother says big brains matter more” Cranial nerves 1 and 2 are sensory, 3 and 4 are motor, 5 is both, 6 is motor, 7 is both, 8 is sensory, 9 and 10 are both and 11 and 12 are motor. Sympathetic nervous system is the part that provides the flight or fight response. The parasympathetic nervous system provides the rest and digest response. Cranial nerve 2 is the optic nerve and is a sensory nerve. This allows the eye to blink when an object comes near it, or the pupils to react to light. The third cranial nerve is a parasympathetic or motor nerve. It allows movement of the eye or raise the eyelid (Joyce, Le, & Peterson, 2020).
Joyce, C., Le, P., & Peterson, D. (2020). Neuroanatomy, cranial nerve 3 (oculomotor). Statpearls. https://www.ncbi.nlm.nih.gov/books/NBK537126/#:~:text=The%20oculomotor%20nerve%20(the%20third,tracking%20and%20gaze%20fixation%20(somatic) N522PE Neurological & Musculoskeletal Assessment Assignment 3

188 words

N522PE Neurological & Musculoskeletal Assessment Assignment 3