NP 601 Advanced Physical Health Assessment Summer Immersion Course Summer Session Syllabus (Two week course)

NP 601 Advanced Physical Health Assessment Summer Immersion Course Summer Session Syllabus (Two week course) SUMMER SESSION NUMBER AND DATE: NP 601: Advanced Physical Health Assessment Summer Immersion Course COURSE DESCRIPTION NP 601 provides the student advanced practice nurse with the tools to perform a comprehensive health assessment on patients throughout the lifespan. The course builds on knowledge of anatomy, physiology, pathophysiology, and health assessment skills previously attained in undergraduate nursing education. The major focus of this course is to ensure that the student has the ability to perform a high quality health history, review of systems, and head-to-toe comprehensive physical exam, and is able to communicate that information in both written and oral form to members of the multi-disciplinary health care team. COURSE PREREQUISITE AND/OR MINIMAL TECHNICAL SKILLS NP 602, NP 603, and basic physical assessment and interview skills acquired in an undergraduate BSN program. COURSE OBJECTIVES Upon completion of this course, you should be able to do the following: 1. Describe the role of the Advanced Practice Nurse (APN) in advanced physical health assessment process across the lifespan by eliciting a comprehensive health history while incorporating the bio-psychosocial, environmental, cultural, and spiritual factors that enhance or impede an individual s health. 2. Develop competency in physical exam techniques for all body systems. 3. Demonstrate competency in documenting and describing verbally the findings of the comprehensive health history and physical examination in a format appropriate to accurate communication in the multi-disciplinary health care setting. Page 1 of 25

4. Perform integrated physical examination for the adult client without the use of reference material during the exam. 5. Use effective verbal and non-verbal communication skills in the comprehensive health assessment process. To successfully meet the course outcome objectives, the student will log 45 patient contact hours in the Comprehensive Health Assessment Practice Experience (CHAPE) during the second week of this summer immersion course. The focus of the CHAPE will be performing comprehensive health assessment in a real-time clinical setting. COURSE FORMAT This is an accelerated two-week course. During the two weeks, you will complete five classes and the CHAPE as outlined below. Each lesson will have clearly defined learning outcomes, which you will meet with related readings, activities, and/or discussion questions. Essential to the successful completion of the course will be completing the inclass complete physical exam with a passing grade. REQUIRED TEXT Bickley, L. (2013) Bates' guide to physical examination and history taking (11th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN: 978-1-60913-762- 5. There will be required readings and media assignments throughout the course, but the above is the only required text. If you have any questions regarding your course materials, please contact your academic advisor and/or our book vendor EDMAP. You can reach EDMAP by phone at 1-(800)-274-9104 or website at http://www.edmapbookstore.com/storefront/index/stjsp COURSE SCHEDULE Class Period 1: -Overview of the Advanced Health Assessment Process -The Patient History Page 2 of 25

In this class you will do the following: 1. Demonstrate understanding of the role of the NP in the Advanced Health Assessment Process. Explore the difference between comprehensive assessment as an RN and an APN. 2. Describe the role of the NP in collaborative practice as a part of the multidisciplinary provider team. 3. Define the term cultural humility in the context of a comprehensive health assessment. 4. Describe the ethical framework that guides interviewer/client interactions. 5. Demonstrate success at differentiating Subjective and Objective Data 6. Practice eliciting and documenting a Patient History, including a Chief Complaint, History of Present Illness, Past Medical and Surgical History, Family History and Personal Social History. REQUIRED READINGS Bickley Text: Chapter 1, pp. 3-12, and 25 Chapters 2 and 3 National Organization of Nurse Practitioner Faculties (NONPF). (2006). Domains and Core Competencies of Nurse Practitioner Practice. http://www.nonpf.com/associations/10789/files/domainsandcorecomps2006.pdf Spain, M.P., et al. (2004). Educating advanced practice nurses for collaborative practice in the multidisciplinary provider team. Journal of the American Academy of Nurse Practitioners, 6 (11) 535-546. HYPERLINK http://web.ebscohost.com/ehost/detail?vid=1&hid=101&sid=9454e414-05a6-4cd6-8532- 9ba4a1d303ab%40sessionmgr111&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=aph&AN =15395079 ASSESSMENTS: 1. Describe three key points from the Spain article, emphasizing the differences in the RN and NP role. (Group Discussion) 2. Describe a professional experience in which you were aware of cultural differences, which shaped the interview process. Describe three approaches you might use to create a positive and Page 3 of 25

non-biased approach to the interview using the guidelines for ensuring cultural humility outlined in the Bickley text. (Group Discussion) 3. Using the Checklist For A Clear and Accurate Record (p. 40, Bickley) as a guideline, give an example from your own practice experience where inaccurate recording of data had a negative result on patient outcome. (Group Discussion) 4. Complete the Subjective/Objective Interactive Exercise (Group Discussion) CLASSROOM ACTIVITIES: Watch and Learn: Approach to Patient Video: Introduction (2 K). Watch and Learn: Approach to Patient Video: The Successful Clinician (2 K). Watch and Learn: Approach to Patient Video: Preparing for the History Taking Interview and Examination (2 K). Watch and Learn: Approach to Patient Video: The Health History Taking Interview (2 K). WRITTEN ASSIGNMENT: With a class partner, conduct and document a Patient History, including a Chief Complaint, History of Present Illness, Past Medical and Surgical History, Family History and Personal Social History. (Using the outline in the Bickley textbook, pages 6-12). Review the Grading Rubric below, which will guide you as you prepare to demonstrate proficiency in your documentation of the Health History. SUBMITTING ASSIGNMENTS As you complete each assignment in a Class Period, add each assignment on a new page to your word processing document. Complete and submit all the assignments for a Class Period in a single word processing document if requested. For instructions on how to submit your assignments, you can find an icon in your course called Submit an Assignment or by clicking on the following link and fill out the Assignment Submission Form: http://www.sjcme.edu/gps/assignments. Documentation of History (For the purpose of this assignment, no need to include HPI, ROS, or physical exam) Page 4 of 25

Content Excellent (10 pts.) Satisfactory (8.5 pts.) Unsatisfactory (0 pts.) Documentation well done with all areas completely discussed from subjective perspective. Documentation missing some areas Documentation poor, missing key areas. Identifying Data Source of History Chief Complaint Present Illness Medications Allergies Past Med Hx Past Surg Hx Family Hx Social Hx Total Points / 140 Class Period 2: -Practicing, Sequencing and Coordinating the Comprehensive Health Assessment -Beginning the Comprehensive Physical Exam of the Adult Patient In this lesson you will do the following: 1. Elicit a complete Review of Systems (ROS) from a classmate. 2. Demonstrate understanding the meaning of Pertinent Positives and Negatives. 3. Accurately document Subjective Abnormal Data. 4. Demonstrate the components of symptom analysis using The Seven Attributes of a Symptom. Page 5 of 25

5. Begin the practice of sequencing and coordinating the Comprehensive Physical Exam of the Adult Patient 6. Identify the anatomical landmarks of the human body of these systems. 7. Correlate examination techniques of the following body systems using the correct sequence and anatomical landmarks in an adult patient: a. General Survey, Vital Signs, Pain b. Behavior and Mental Status c. Skin, Hair, and Nails d. Lymphatic System e. Head and Neck 8. Use correct terminology to record objective components of the physical examination findings READINGS Bickley Text: Chapter 1, pp. 6-13, Chapters 2 and 3, Seven Attributes of a Symptom found on page 70-71. Bickley Text: Please focus your reading for this unit on the sections of each chapter that detail system anatomical landmarks and general examination techniques as follows. For the most part, this reading assignment, while extensive, is a review of material previously mastered at the undergraduate level. There is a tremendous amount of useful and important information in these chapters, which will become more useful as you gain skills and increasing expertise in performing the physical exam. The goal of this course is to gain proficiency in the exam itself, and to be able to document your findings. As you read, keep this in mind. The only way to become comfortable and proficient in physical exam skills is to practice them. We strongly suggest that you practice your assessment skills for each system at least 10 times on different classmates. You will get even more experience in the upcoming CHAPE next week. This text will be very helpful in your future clinical courses as well, when you begin to focus on the problem-oriented visit. Chapter 4: Beginning the Physical Examination: General Survey, Vital Signs, Pain Chapter 5: Behavior and Mental Status Chapter 6: The Skin, Hair and Nails Chapter 7: The Head and Neck Page 6 of 25

ASSESSMENTS 1. Using the guidelines presented in the Components of the Health History pages 7-12 in the current Bickley text, obtain and document a complete ROS on you class partner. Document Pertinent Positives and Negatives while taking this ROS, using the Components of the Health History in the Bickley text, found under Present Illness. Include a thorough description of each positive finding on the elicited ROS. The Bickley text pages 31-33, the Case of Mrs. N gives an excellent example of this type of write-up for you to use as a guideline. We will complete this exercise in class, with the assignment submitted to APD before the next class. 2. Complete a separate one page document and choose one of the Subjective Abnormal Findings mentioned by your patient in the CC, History of Present Illness, or Review of Systems. Document your understanding of how to use the Seven Attributes for symptom analysis found in the Bickley text. This assignment should be completed in class, with the assignment submitted to APD before the next class. Review the Grading Rubric below which will guide you as you prepare to demonstrate proficiency in your documentation of the Review of Systems and the Seven Attributes of symptom analysis. Grading Rubric for the Comprehensive Review of Systems Content Excellent (100 pts.) Satisfactory (85 pts.) Unsatisfactory (0 pts.) History Questions Appropriate ROS questions in each system area, including documentation of pertinent positives and negatives. Missing some pertinent ROS or questions. Lack of understanding of what history questions are appropriate and pertinent for this system or abnormal finding. Rationale Appropriate rationale for each history question related to an abnormal finding. Missing some depth and rationale for history questions related to an abnormal finding. Lacks understanding and rationale, without explanation of why the questions are pertinent. Page 7 of 25

Grading Rubric for Symptom Analysis Using the Seven Attributes Content Excellent (100 pts.) Satisfactory (75 pts.) Unsatisfactory (0 pts.) Seven Attributes All attributes of the symptoms are evaluated and documented Missing one or two attributes. Lack of understanding of what attributes are and fail to ask appropriate questions. Rationale Appropriate rationale for each question related to an abnormal finding. Missing some depth and rationale for questions related to an abnormal finding. Lacks understanding and rationale, without explanation of why the questions are pertinent. During your CHAPE, you will be practicing physical exam skills in a supervised setting. In this lesson, focus on the areas listed below. View Watch and Learn videos accessible through the website associated with your text, http://thepoint.lww.com/bickley. Approach to the Patient - The Examination Head-to-Toe Assessment - Introduction - Importance of Patient Comfort - General Survey - Vital Signs - The Skin - HEENT - Thyroid Watch and Learn videos on the following two systems can be reached at the sites listed: -Lymphatic System http://www.youtube.com/watch?v=kpj_izfjdtw&list=ple4453033a0df8de6&index=55&feat ure=plpp_video -Thyroid http://www.youtube.com/watch?v=krxoyp5j5lk&feature=related To guide the thoroughness of your practice exams in this lesson and the lessons in the next two Units, I would strongly suggest that you use the grading rubric found in Unit 5. Page 8 of 25

Graded Written Assignment: Submit a write-up of the physical exam on your classmate, focusing on the systems we are studying in this class. Pay attention to the proper sequencing of the exam in your write-up, and please limit to 300-400 words. As you write, be aware of using proper terminology and technical writing skills appropriate to sharing this information in a multi-disciplinary forum. You will find the Recording Your Findings section at the end of each Bickley Chapter very helpful in your documentation for the above assignment. I would suggest using it as your guideline. This assignment will be done in class. Class Period 3: Conducting the Comprehensive Physical Exam of the Adult Patient, Continued In this lesson you will do the following: 1. Practice the sequencing and coordination of the Comprehensive Physical Exam of the Adult Patient 2. Identify the anatomical landmarks of the human body of these systems. 3. Correlate examination techniques of the following body systems using the correct sequence and anatomical landmarks in an adult patient: a. Thorax and Lungs b. Cardiovascular c. Breasts and Axilla d. Abdomen e. Peripheral Vascular f. Male Genitalia and Hernia* g. Female Genitalia* h. Anus Rectum and Prostate* *Note: Genital exam sequencing and techniques to be discussed only, no genital exams will be conducted in classroom setting. 4. Use correct terminology to record objective components of the physical examination findings. Page 9 of 25

REQUIRED READINGS Bickley Text: Please focus your reading for this unit on the sections of each chapter that detail system anatomical landmarks and general examination techniques as follows. For the most part, this reading assignment, while extensive, is a review of material previously mastered at the undergraduate level. Chapter 8: The Thorax and Lungs Chapter 9: The Cardiovascular System Chapter 10: The Breasts and Axillae Chapter 11: The Abdomen Chapter 12: The Peripheral Vascular System Chapter 13: Male Genitalia and Hernia Chapter 14: Female Genitalia Chapter 15: The Anus, Rectum, and Prostate ASSESSMENTS Graded Written Assignment: Submit a write-up of the physical exam on your classmate, focusing on the systems we are studying in this class. Pay attention to the proper sequencing of the exam in your write-up, and please limit to 300-400 words. As you write, be aware of using proper terminology and technical writing skills appropriate to sharing this information in a multi-disciplinary forum. You will find the Recording Your Findings section at the end of each Bickley Chapter very helpful in your documentation for the above assignment. I would suggest using it as your guideline. This assignment will be done in class. Class Period 4: -Conducting the Comprehensive Physical Exam of the Adult Patient, Continued - Assessment of the Pediatric, Geriatric, and Pregnant Patient In this lesson you will do the following: 1. Practice the sequencing and coordination of the Comprehensive Physical Exam of the Adult Patient, focusing only on the systems listed below in this lesson. 2. Identify the anatomical landmarks of the human body of these systems. 3. Correlate examination techniques of the following body systems using the correct sequence and anatomical landmarks in an adult patient: Page 10 of 25

a. Musculoskeletal System b. Nervous 4. Use correct terminology to record objective components of the physical examination findings. You will be focusing on the care of children, adolescents, pregnant women and older adults in your NP clinical courses, and will learn the physical assessment skills in detail at that time. However, it will be useful for you to understand how the approach and sequence of the exam is different from that of the adult patient. The purpose in this lesson is to give you an opportunity to review how the techniques of examination differ in these populations. In this lesson you will do the following: 1. Review techniques of examination for the newborn. 2. Review techniques of examination for the infant. 3. Review techniques of examination for the young and school-aged child. 4. Review techniques of examination for adolescents. 5. Review the techniques of examination for the older adult. 6. Review the techniques of examination for the pregnant woman. REQUIRED READINGS Bickley Text: Please focus your reading for this unit on the sections of each chapter that detail system anatomical landmarks and general examination techniques as follows. For the most part, this reading assignment, while extensive, is a review of material previously mastered at the undergraduate level. Chapter 16: The Musculoskeletal System Chapter 17: The Nervous System Chapter 18: pp. 775, 780-814, pp. 819-856, and pp. 857-860, 862-872 Chapter 20, pages 926-930, 940-953 Chapter 19, pages, 897-900, 903-912 We will return to these chapters later to explore further details and clinical reasoning processes. ACTIVITIES / ASSESSMENTS In class activity: View Watch and Learn videos online at http://thepoint.lww.com/bickley : Page 11 of 25

The Musculoskeletal System The Neurological Exam Additional watch and learn videos: Cranial Nerves: http://www.youtube.com/watch?v=vu8-plsdj-w&feature=relmfu Reflexes: http://www.youtube.com/watch?v=srzz2xbnzne&feature=related Musculoskeletal: http://www.youtube.com/watch?v=17rvkifyylc&feature=related 1. Graded Written Assignment: Complete a write-up of the physical exam on a classmate, focusing on the systems we are studying in this lesson. Pay attention to the proper sequencing of the exam in your writeup, and please limit to 300 words. As you write, be aware of using proper terminology and technical writing skills appropriate to sharing this information in a multi-disciplinary forum. Again, you will find the Recording Your Findings section at the end of each Bickley Chapter very helpful in your documentation for the above assignment. I would suggest using these sections as your guideline for this assignment. This assignment will be done in class. 2. For each pediatric age group above, discuss an approach to the physical exam, which differs, from that of the adult patient. (Classroom Discussion) 3. Discuss what is meant by assessment of the functional status of the older patient. Limit this response to 100 words or less. This assignment will count for 50% of your grade for this lesson. (Classroom Discussion) 4. Discuss one approach to the physical exam of the pregnant woman, which differs, from that of the adult patient. Class Period 5: Performing the Complete Physical Exam on a Classmate In this lesson you will do the following: 1. Perform a comprehensive head-to-toe physical exam on your classmate without the use of notes or a written guideline. READINGS None. Page 12 of 25

Relevant chapters in the Bickley text may be of use when writing up the health history and physical exam findings in the post-residency section of the course. ASSESSMENTS In this graded assignment, you will complete a complete physical examination performed on a classmate. You must receive a grade of 90% or above to successfully complete the assignment. You do not need to include the Health History and Review of Systems done in the previous lesson in this this exam must be performed without the use of a written guideline or notes. For the purpose of this exam the genital, breast, and rectal exams are deferred. This will be an interactive activity done with a faculty member present during the exam. During the exam the faculty member will provide feedback and guidance. This exam should be completed within a one hour time period The grading rubric for this exam is below. You are already aware that there are different routines for doing certain systems. For example, if you prefer to do check all the cranial nerves in one group, or all the deep tendon reflexes grouped together, that is your choice. Page 13 of 25

Physical Examination Grading Rubric Grades for the items checked off for the systems you have chosen are awarded as follows: 0 = Did not do or did not do correctly 1 = Demonstrated 2 = Demonstrated thoroughly with correct technique Use this checklist as you do your video go step-by-step, narrating throughout. Skin assessment is done throughout exam and includes examination for color, temperature, moisture, texture, edema, turgor, bruising, scars, lesions, nevi (c, t, m, t, e, t, b, s, l, n) HEAD AND FACE Inspects skin c, t, m, t, e, t, b, s, l, n Inspect head for size, symmetry, midline position Inspect and palpate head and scalp for: Hair distribution, hair color, hair texture, lesions, masses, tenderness, depressions, or infestations Palpate temporal arteries for tenderness Palpates lymph nodes of the head and neck Preauricular Postauricular Occipital Tonsillar Submandibular Submental Anterior cervical Posterior cervical Supraclavicular CN 5 Motor palpate over the masseter muscle as patient clenches jaw Sensory light touch sensation to forehead, cheeks, chin, nose CN 7 Inspect for facial symmetry with smile, frown, raise eyebrows, puff cheeks, pucker lips EAR Inspect outer ear for shape and position Inspect auditory canal (and TM if otoscope available) Palpate pinnae and tragus for masses and tenderness CN 8 Assess hearing with whisper test, Weber (for lateralization), Rinne (AC> BC) EYE Inspects lashes, brows, and palpebral fissures Inspects sclera and conjunctiva for color, lesions, discharge Assesses gross visual acuity and peripheral/central vision (CN 2) Tests for direct/consensual pupillary response to light (CN 3) Tests for accommodation/convergence (CN 3) Page 14 of 25

Tests for conjugate gaze with EOM (CN 3, 4, 6) Assesses for red reflex and other internal eye structures (if opthalmoscope available) NOSE Inspect nose midline and straight Assesses for nasal patency Palpates frontal and maxillary sinuses THROAT AND MOUTH Inspect lips, teeth, gums, buccal mucosa, palate, tongue, the floor of the mouth (under The tongue), salivary ducts, posterior pharynx, and tonsils (grade, if present) Palpate TMJ for any subluxation, tenderness, or crepitus CN 9 and 10 Soft palate and uvula rise symmetrically with phonation CN 12 Tongue midline without fasiculations NECK Inspects skin c, t, m, t, e, t, b, s, l, n Palpates trachea midline Palpates thyroid gland Palpates carotid artery pulsation Auscultate over the carotid for bruits Test ROM flexion, extension, hyperextension, lateral flexion, rotation CN 11 Shrug shoulders against resistance POSTERIOR CHEST Inspect skin c, t, m, t, e, t, b, s, l, n Inspect for s/s respiratory distress use of accessory muscles, tripod position, nasal flaring, retractions, tachypnea, cyanosis Inspect for obvious deformities and symmetry Palpate symmetrical chest expansion Palpate for symmetrical tactile fremitus Percuss over posterior lung fields (in intercostal spaces) Auscultate posterior lung fields Start above scapula Alternating side-to-side in intercostal spaces Go down into bases of lungs Assess lateral lung fields (get right middle lobe) Auscultate posterior lung fields Egophony Bronchophony Whisper pectoriloquy ANTERIOR CHEST Inspect skin c, t, m, t, e, t, b, l, s, n Inspect for obvious deformities and symmetry Palpate chest expansion and tactile fremitus anteriorly Auscultate lung sounds in anterior lung fields Page 15 of 25

HEART Auscultate in all 5 areas with the bell and diaphragm with the patient sitting Aortic Pulmonic Erb s point Tricuspid Mitral Identify and palpate the PMI Auscultate the apical pulse for a full minute and report findings rate and rhythm Have patient lie down now Inspect for any heaves or lifts Palpate for any thrills over each auscultation point Repeat the cardiac auscultation with patient supine Assess for JVD and for jugular pulsation with HOB up 30-45 degrees ABDOMEN Inspect skin c, m, t, t, t, e, b, s, l,n Inspect abdominal contours and symmetry Auscultate for bruits aorta, renal arteries, iliac arteries, femoral arteries Auscultate for bowel sounds in all 4 quadrants Percuss in all 4 quadrants for tympany, dullness, flatness Palpate for tenderness, masses Palpate liver and spleen Have patient sit up again Percuss for CVA tenderness UPPER EXTREMITIES Inspect and palpate the joints of the hands redness, swelling, deformity, tenderness, nodules, crepitus, symmetry Palpate for capillary refill Assess radial pulses Assess overall warmth, color, skin integrity of upper extremities. Assess for edema. Assess ROM of the fingers (flexion, extension, hyperextension, abduction, adduction, thumb opposition) Assess hand grips 5/5 strength Inspect and palpate the wrists redness, swelling, deformity, tenderness, nodules, crepitus, symmetry Assess ROM of the wrist (flexion, extension, hyperextension, ulnar deviation, radial deviation, rotation) Inspect and palpate the elbows redness, swelling, deformity, tenderness, nodules, crepitus, symmetry Assess ROM of the elbow (flexion, extension, hyperextension) Assess strength of biceps, triceps flex/extend elbow against resistance 5/5 strength Inspect and palpate the shoulders redness, swelling, deformity, tenderness, nodules, crepitus, symmetry Assess ROM of the shoulder (flexion, extension, hyperextension, Page 16 of 25

internal rotation, external rotation, abduction, adduction, circumduction) Assess strength of shoulder girdle abduct/adduct shoulder against resistance 5/5 Assess light touch sensation to upper extremities Assess stereognosis and graphesthesia Assess vibratory sensation at the wrist over proximal ulnar prominence Assess cerebellar coordination with rapid alternating movement Serial finger opposition Hand flip-flop Finger-to-finger Assess DTRs Brachioradialis Biceps Triceps Patellar Achilles Babinski LOWER EXTREMITIES Inspect and palpate the toes redness, swelling, deformity, tenderness, nodules, crepitus, symmetry Assess ROM in toes (flexion, extension, hyperextension, abduction, adduction) Assess capillary refill in toes Assess dorsalis pedis and posterior tibial pulses Assess overall warmth, color, skin integrity of lower extremities. Assess for edema. Inspect and palpate the ankles redness, swelling, deformity, tenderness, nodules, crepitus, symmetry Assess ROM of the ankles (dorsiflexion, plantar flexion, inversion, eversion, rotation) Assess strength at ankles dorsi/plantar flex against resistance 5/5 strength Inspect and palpate the knees redness, swelling, deformity, tenderness, nodules, crepitus, symmetry Assess strength at the knees flex/extend against resistance 5/5 strength Assess strength at the hips abduct/adduct against resistance 5/5 strength Assess for light touch sensation in the lower extremities Assess vibratory sensation over medial malleolus Have patient stand up at this point Inspect and palpate the hip joints redness, swelling, deformity, tenderness, nodules, crepitus, symmetry Assess ROM of hip (flexion, extension, hyperextension, circumduction, abduction, adduction, internal rotation, external rotation) Assess ROM of the knees (flexion, extension, hyperextension) Page 17 of 25

Inspect and palpate the spine expected curvatures, alignment, tenderness Assess ROM of the spine (flexion, extension, hyperextension, lateral flexion, and rotation) Assess for scoliosis while patient in spinal flexion Assess Romberg Assess gait regular and tandem Hop in place hop on one foot (unless concerned about patient safety) SUBTOTAL /200 Yes No Proceeds in systemic, professional manner 10 0 Demonstrates appropriate technique for inspection 10 0 Demonstrates appropriate technique for palpation 10 0 Demonstrates appropriate technique for percussion 10 0 Demonstrates appropriate technique for auscultation 10 0 SUBTOTAL /50 GRADE FOR THIS LESSON /250 = POST-RESIDENCY ASSIGNMENT Accurately document the complete physical exam of your classmate using language and format appropriate to sharing the write-up with a multi-disciplinary team. READINGS Bickley text, Recording Your Findings sections of each chapter for specific systems will be of help in doing this assessment. ACTIVITIES / ASSESSMENTS The student will write up a two-three-page summary of the findings of the complete history and physical exam done in lesson 10. The Case of Mrs. N in our Bickley text (p. 34-35) gives and excellent example to use as a reference for this assignment. Please submit this assignment using the assignment submission form. is due by August 9 th. This assignment Page 18 of 25

PLEASE NOTE: All graded assignments for this post-residency assignment should be grouped together and submitted using the Assignment Submission form accessed from your course homepage or http://www.sjcme.edu/gps/assignments. ONSITE CHAPE DESCRIPTION: The summer onsite CHAPE will provide the student with hands-on experience conducting a comprehensive health assessment with adult volunteer patients in a simulated clinic setting. The experience will be conducted by nurse practitioner faculty members and will prepare the student for the clinical year of the MSN FNP program. Successful completion of the summer CHAPE completes the 45 hour requirement for the NP601 summer immersion course. Attendance is required at all summer CHAPE sessions to meet course requirements. Each day of the summer CHAPE will include the following elements: I. Pre-conference session to include skills labs and NP role development II. Two comprehensive history and examinations on volunteer patients III. Practice performing verbal case presentations with peer and faculty feedback IV. Real time practice of patient history and physical exam documentation V. Post-conference session to include population specific skill development Sample daily schedule: 8:00-9:00 Pre-conference 9:00-9:30 Students set up for exams 9:30-11:00 History taking/interview volunteer patient #1 11:00-11:15 Verbal case synopsis presentation to faculty 11:15-12:30 Physical exam* patient #1 12:30-1:30 Lunch and post-conference patient #1 1:30-3:00 History taking/interview volunteer patient #2 3:00-3:15 Verbal case synopsis presentation to faculty 3:00-4:30 Physical exam* patient #2 4:30-5:00 Post-conference patient #2 *Day One physical exams will be conducted as time allows Assignment submission: Written assignments will be submitted concurrently during the CHAPE experience to the on-site faculty members. NP601 grading rubrics will be applied per course syllabus. Day ONE: Focus of day one will be on history taking. Physical exams will be conducted as time allows. Page 19 of 25

AM session objectives: 1. Elicit, verbally present and document the patient history, including: a. Chief Complaint b. History of Present Illness (HPI) c. Past Medical and Surgical History d. Family History e. Personal Social History PM session objectives: 1. Obtain, verbally present, and document a complete ROS on a patient a. Document Pertinent Positives and Negatives while taking this ROS b. Using the Components of the Health History in the Bickley text as a guidelines, include a thorough description of each positive finding on the elicited ROS. Pre and post-conference discussion foci: 1. Orientation to CHAPE experience and procedures 2. Skills lab: effective patient case verbal presentation skills. 3. Population specific questions and history elements for pediatric population, pregnant females, and elders DAY TWO objectives: 1. Elicit a comprehensive health history and ROS (no chief complaint or HPI included) on each volunteer patient: 2. Practice the sequencing and coordination of the Comprehensive Physical Exam of the Adult Patient a. Identify the anatomical landmarks of the human body of the focus systems. b. Correlate examination techniques of the following body systems using the correct sequence and anatomical landmarks in an adult patient: i. General Survey, Vital Signs, Pain ii. Behavior and Mental Status iii. Skin, Hair, and Nails iv. Lymphatic System v. Head and Neck Page 20 of 25

3. Use correct terminology to verbally present and document subjective history elements and objective components of the physical examination findings. Pre and post-conference discussion foci: 1. Skills lab: use of the otoscope and opthalmascope; documentation of mental status. 2. Population specific examination techniques and unique findings with pediatric patients, pregnant females, elders for systems examined in this session. DAY THREE objectives: 1. Elicit a comprehensive health history, ROS, CC, HPI (if applicable) on each volunteer patient. 2. Practice the sequencing and coordination of the Comprehensive Physical Exam of the Adult Patient a. Identify the anatomical landmarks of the human body of the focus systems. b. Correlate examination techniques of the following body systems using the correct sequence and anatomical landmarks in an adult patient with a focus on the following systems (in addition to Day 2 systems): i. Thorax and Lungs ii. Cardiovascular iii. Breasts and Axilla 3. Use correct terminology to verbally present and document subjective history elements and objective components of the physical examination findings. Pre and post-conference discussion foci: 1. Skills lab: Discrimination of normal and abnormal heart and lung sounds 2. Population specific examination techniques and unique findings with pediatric patients, pregnant females, elders for systems examined in this session. DAY FOUR objectives: 1. Elicit a comprehensive health history, ROS, CC, HPI (if applicable) on each volunteer patient. 2. Practice the sequencing and coordination of the Comprehensive Physical Exam of the Adult Patient a. Identify the anatomical landmarks of the human body of the focus systems. Page 21 of 25

b. Correlate examination techniques of the following body systems using the correct sequence and anatomical landmarks in an adult patient with a focus on these systems in addition to systems from Day 2 and Day 3: i. Abdomen ii. Peripheral Vascular iii. Male Genitalia and Hernia iv. External Female Genitalia Note: the following systems to be discussed in seminar only, no pelvic exams to be performed in volunteer patient experience: a. Female pelvic exam b. Anus Rectum and Prostate 3. Use correct terminology to verbally present and document subjective history elements and objective components of the physical examination findings. Pre and post-conference discussion foci: 1. Skills lab: female and male pelvic exam techniques 2. Population specific examination techniques and unique findings with pediatric patients, pregnant females, elders for systems examined in this session. DAY FIVE objectives: 1. Elicit a comprehensive health history, ROS, CC, HPI (if applicable) on each volunteer patient. 2. Practice the sequencing and coordination of the Comprehensive Physical Exam of the Adult Patient a. Identify the anatomical landmarks of the human body of the focus systems. b. Correlate examination techniques of the following body systems using the correct sequence and anatomical landmarks in an adult patient with a focus on these systems in addition to systems from Days 2,3 and 4: i. Musculoskeletal System ii. Nervous System Page 22 of 25

3. Use correct terminology to record subjective history elements and objective components of the physical examination findings. Pre and post-conference discussion foci: 1. Skills lab: Focusing and abbreviating the physical exam based upon key history elements; e.g. the Trauma Survey 2. Specific examination techniques and unique findings with pediatric patients, pregnant females, elders for systems examined in this session. GRADING BREAKDOWN In Class Written Assignments 25 Class Participation 25 CHAPE and Post-Residency Assignment 25 Class 5: Class Complete Physical Exam 25 RUBRICS Score A B C D Discussion Grading Criteria Responses are on topic, original, and contribute to the quality of the discussion. Responses make frequent, informed references to unit material. Responses are clearly written. Substantial original answers to the questions that furthers the work of the class. Typically in the 100 words range or responses meet length requirements as posted in the classroom. Two or more thoughtful responses per discussion question to classmates that advance the discussion. Responses are on topic, largely original, and contribute to the quality of the discussion. Responses make some informed references to unit material. Responses are generally clearly written. Substantial original answers to the questions that further the work of the class. Typically in the 75-100 words range or responses meet only 80% of the length requirements as posted in the classroom. One response per discussion question to a classmate that is thoughtful and advances the discussion. Responses are on topic, but they lack originality and lack a significant contribution to the quality of the discussion. Responses make vague or summary references to unit material. Responses have several mechanical or stylistic errors. Short posting. Normally in the 50-75 words range or responses meet only 70% of the length requirements as posted in the classroom. Response(s) to others does not advance the discussion. Responses are only partially on topic, lack originality, and lack a significant contribution to the quality of the discussion. Responses make little or no references to unit material. Responses have several mechanical or stylistic errors. Minimal posting. Normally in the 25-50 words range or responses meet only 60% of the length requirements as posted in the classroom. No responses to classmates. If there are two questions, student did not respond to one. Page 23 of 25

Grade A B C D Written Assignment Content, Focus, Use of Analysis and Critical Writing Style, Grammar, APA Format Text/Research Thinking 50% 30% 20% Response successfully Response exhibits strong Sentences are clear, concise, and direct; answers the assignment higher-order critical thinking tone is appropriate. Grammatical skills question(s); thoroughly uses and analysis (e.g., are strong with almost no errors per the text and other literature. evaluation). page. Correct use of APA format when Response answers the assignment question(s) with only minor digressions; sufficiently uses the text and other literature. Response answers the assignment question(s) with some digression; sufficiently uses the text and other literature. Response answers the assignment question(s) but digresses significantly; insufficiently uses the text and other literature. Response generally exhibits higher-order critical thinking and analysis (e.g., true analysis). Response exhibits limited higher-order critical thinking and analysis (e.g., application of information). Response exhibits simplistic or reductive thinking and analysis but does demonstrate comprehension. assigned. Sentences are generally clear, concise, and direct; tone is appropriate. Grammatical skills are competent with very few errors per page. Correct use of APA format when assigned. Sentences are occasionally wordy or ambiguous; tone is too informal. Grammatical skills are adequate with few errors per page. Adequate use of APA format when assigned. Sentences are generally wordy and/or ambiguous; tone is too informal. Grammatical skills are inadequate, clarity and meaning are impaired, numerous errors per page. Inadequate use of APA format when assigned. COURSE POLICIES AND PROCEDURES Current information regarding College policies affecting your course can be found on the Resources/Policy section of the course homepage. On this page, you will find vital information, including the following: Current Student Handbook, outlining course-specific policies Access to support resources, including advising and online tutorial services Student Success Guides SUBMITTING ASSIGNMENTS As you complete each assignment in a Class Period, add each assignment on a new page to your word processing document. Complete and submit all the assignments for a Class Period in a single word processing document. For instructions on how to submit your assignments, you can find an icon in your course called Submit an Assignment or by clicking on the following link and fill out the Assignment Submission Form: http://www.sjcme.edu/gps/assignments. Page 24 of 25

How Do I Access Disabilities Services? Anyone who would like information or needs access to accommodations or services related to disabilities should contact the college s Accommodations Office. Please contact your Academic Advisor or refer to the Student Handbook for more information. Saint Joseph s College developed this course for the exclusive use of students enrolled in the College s Division of Graduate and Professional Studies. Copyright 2013 by Saint Joseph s College Online - All Rights Reserved Page 25 of 25