NURS 6512: Advanced Health Assessment and Diagnostic Reasoning

NURS 6512: Advanced Health Assessment and Diagnostic Reasoning

Course Introduction  

Welcome to NURS 6512: Advanced Health Assessment and Diagnostic Reasoning

One of the greatest concerns of any health professional is that he or she will overlook some important symptom and misdiagnose a patient. Unfortunately, these types of incidents occur all too frequently. According to one research study, “’Failure to Rescue,’ meaning failure to diagnose and treat in time, was the most common cause of a patient safety incident, with a rate of 155 per 1,000 hospitalized patients” (Health Grades, 2011, p. 2). One of the most significant hedges against such misdiagnoses is careful practice in performing health assessments. When coupled with critical thinking and a broad knowledge of possible ailments, health assessments greatly enhance the likelihood of effectively diagnosing and treating a patient.

In this course, you will focus on recognizing a wide variety of symptoms and what they signify. You will gain experience in developing meaningful health histories and identifying relevant physical conditions while also respecting the unique individual needs, culture, and mores of the patient. You will practice performing assessments, both through case studies and through hands-on experiences. You will also apply critical thinking to making diagnoses and treating patients. Finally, you will focus on the ethics of health assessment.

Course Description

The physical and emotional well-being of patients and families can be complex and multifaceted. Advanced practice nurses need to have the knowledge and ability to provide safe, competent, and comprehensive physical health assessments. Students in this course focus on concepts and skills to assess patients across the lifespan. They learn to use diagnostic reasoning, advanced communication, and physical assessment skills to identify changes in health patterns. Students also will explore preventative health through risk evaluation of healthy individuals as a central theme of clinical practice in addition to the assessment of patients with acute and chronic health problems. The advanced skills of suturing, reading 12 Lead EKGs, and interpreting X-rays will be covered. Course assignments emphasize risk assessment, diagnostic reasoning, and evidence-based assessment across the lifespan.  

Welcome to Advanced Health Assessment, one of our foundation courses for APRN students. In this course, you will learn the importance of gathering an advanced health history, detailed documentation of your patient encounter, and performing the skills of an advanced nurse practitioner in order to provide patient care. No longer are the days of “following Dr’s orders”, you are learning how to be the provider that “writes the orders” based on the assessment of your patient.

In this online program, your advanced health assessment skills will be thoroughly evaluated via several assignments throughout the course. Your readiness to move on to a clinical course is a critical part of passing this course as we move to meeting the course objectives.

As an introduction to the course, we have provided you with two case study samples for your review and self-critique as you prepare to begin the course.

Case Study #1

“Patient JB, 39 yo Caucasian female, is seen by her care provider for a complaint of productive cough, weakness, and “I just haven’t felt good for the past 2 weeks.” The care provider completes an assessment of listening to her lungs by having her take 2 deep breaths and informs her that her lungs are clear and to take OTC cough medication and hydrate well. The next day, JB feels worse and visits a different care provider who at this time, assesses her head, eyes, ears, nose, throat, auscultates her heart sounds and hears a murmur (which she did not know she had), auscultates her lungs by having her to take 4 deep breaths, performs percussion techniques, and tells her there is fluid on her lungs, examines her lower extremities and notices that there is bilateral  2+ pitting edema, and lastly, reviews her vital signs and tells her that her heart rate is 120, respirations are 22, and she has a temp of 101.

Questions:

1.)   Is the health history about the patient’s complaint thorough?

2.)   Which provider’s examination would provide the patient with an accurate diagnosis and treatment plan?

3.)   What diagnoses (we call them differential diagnoses) would be considered, and how would you rule them out to come up with an actual diagnosis?

Case Study #2

HS, an otherwise healthy 45-year-old AA male, had been treated for months with a diagnosis of GERD and gastritis. As the symptoms continued to progress with the current treatment, HS received a second opinion and was diagnosed with colon cancer. HS proceeded with surgery and the surgery went well, the biopsies came back that the margins were clear, and the cancer had been removed. Not long after, HS complained of excruciating pain to the assigned nurse. HS was told to relax because “he’d just had abdominal surgery and it was gas pains and/or bad indigestion.”

Questions:

1.)   What questions would the APRN ask to obtain more details about this patients’ complaint?

2.)   Which body systems would be examined by the APRN to provide HS with an explanation of his pain?

3.)   What other concerns would you have for this patient that had just had surgery?

4.)   Would additional labs and imaging be appropriate? If so, what would you order and why?

These are two scenarios in which your advanced health assessment skills are very important. Missing key findings due to improper assessment can lead to error and potentially patient death.

At Walden University, we strive to prepare our students for the challenges they may encounter as future advanced practice nurses. Our goal in this course is to provide you with the foundation of learning skills that will be used in everyday clinical practice, assist you with knowing the importance of those skills, and guide you to perfecting these skills.

Course Prerequisites

NURS 6521 (can be taken concurrently)

Course Learning Outcomes

By the conclusion of this course, you should be able to:

1. Apply appropriate approach to patient assessment that takes into consideration life circumstance as well as cultural and developmental variations
2. Analyze patient data obtained from health histories as well as functional and comprehensive physical assessments
3. Apply diagnostic reasoning skills when assessing patients
4. Apply assessment findings to underlying pathology or physiologic changes
5. Formulate a differential diagnosis based on the assessment data
6. Evaluate options for a systematic approach to preventative and palliative care
7. Analyze ethical considerations in health assessment
8. Identify concepts, theories, and principles related to advanced health assessment
9. Propose appropriate techniques for skin closure, abscess drainage, and skin biopsies
10. Analyze 12 lead EKGs for atrial arrhythmias, ventricular arrythmias, and heart blocks
11. Analyze chest x-rays for pathological conditions

Overview of Digital Clinical Experiences (DCE) and Lab Components

Throughout this course, you are required to not only complete your standard course assignments and discussions, but you will also complete conversation labs,  DCE Assignments,  and other Lab Components that are either structured as optional or required assignment submissions. Please take the time to review your DCE Assignments and Lab Components for this course that are required submissions. See the attached table for specific DCE Assignments and Lab Components for the course.

Note: You must complete each REQUIRED component prior to accessing the next assignment. 

Note:  Each Shadow Health Assessment may be attempted and reopened as many times as necessary prior to the due date to achieve a total score of 80% or better (Total score includes DCE score and documentation), but you must take all attempts by the Day 7 deadline. You must pass BOTH the Health History and Comprehensive (head-to-toe) Physical Exam of at least a total score of 80% in order to pass the course.

Concept Labs are mandatory pre-requisites for certain weighted assignments, but they have no points assigned.

Course Summary: