NUR 820/830/850 ADVANCED PHYSICAL ASSESSMENT

Transcription

1 MICHIGAN STATE UNIVERSITY COLLEGE OF NURSING NUR 820/830/850 ADVANCED PHYSICAL ASSESSMENT COURSE SYLLABUS Fall 2002 NUR 820 Kate Lein, RN, CS, MS Family Nurse Practitioner Office: 517/ A Life Sciences kate.lein@ht.msu.edu NUR 830 Linda J. Keilman, RN, CS, MSN Gerontological Nurse Practitioner Office: 517/ A126 Life Sciences keilman@msu.edu College Toll Free #: East Lansing: Wednesday from 5-8:50 pm; B 109A Life Sciences Grand Rapids: Thursday 6 9:50 pm Credits: 2 MSU is an Affirmative Action/Equal Opportunity Institution

2 TABLE OF CONTENTS Course Description...3 Course Objectives...3 Instructional Methods...5 Required Textbooks...5 Required Assessment Equipment...5 Media Laboratory Information...6 Evaluation...6 Procedures for Performance Evaluation...7 Clinic Experiences..8 PREPARATION FOR 1 st DAY OF CLASS! 8 Clinic Experiences Log East Lansing Schedule Grand Rapids Schedule Page 2 of 14

3 COURSE OVERVIEW Course Description NUR 820/830/850 focuses on the advanced assessment component of the nursing process in order to describe the health status of a healthy patient. The emphasis of the course is on the development of advanced health history and physical assessment skills across the lifespan. Advanced assessment involves the collection of comprehensive subjective and objective data for practice as a family, adult or gerontological advanced practice nurse. The student s use of interviewing techniques, communication, interpersonal skills and psychomotor skills will be refined. The impact of the cultural diversity of patients and ethical issues related to the assessment process are discussed. Interpretation of data for the purpose of differentiating normal from variations from normal, recognizing actual and potential health problems, and determining nursing and medical diagnosis are introduced. The problem-oriented system of organizing and recording data is covered. Course Objectives At the completion of the course, the student will be able to: Exit Behavior 1: Analyze and demonstrate communication skills needed for professional interaction with patients. Objective a. Objective b. Objective c. Objective d. Objective e. Objective f. Apply patient-centered interviewing skills. Describe ways a patient and interviewer can communicate feelings nonverbally. Integrate appropriate interviewing responses to facilitate effective nurse-patient communication. Discuss the influence diversity may have in the nurse-patient relationship. Critique and analyze interviewer responses. Identify difficult patient situations that may occur during the interview. Evaluate the interviewer s own personal impact on the patient and the patient s impact on her/him. Exit Behavior 2: Apply the assessment component of the nursing process to a healthy patient. Objective a. Objective b. Define the principles of history taking. Identify ethical issues involved in collecting a history and conducting a physical examination. Page 3 of 14

4 Objective c. Objective d. Objective e. Objective f. Objective g. Elicit an entire health history from a healthy patient. Conduct an organized, efficient and complete physical examination of all body systems on a healthy patient. Differentiate normal findings from variations from normal findings on the physical examination. Conduct a physical exam appropriate for a presenting problem. Demonstrate special assessment techniques for select problems. Exit Behavior 3: Document the health assessment of any patient using the problem oriented system. Objective a. Objective b. Use accurate, precise terminology to describe the findings of the history and physical examination. Use a problem oriented format. Exit Behavior 4: Apply special assessments/techniques to specific populations (obstetric, pediatric, elderly). Objective a. Objective b. Describe assessments that are specific to select populations. Complete specialty assessments specific to adult, gerontology or family focus as assigned. Exit Behavior 5: Apply routine specialty assessment skills related to specific problems/concerns. Objective a. Objective b. Practice and integrate physical assessment skills for select patients. Correctly perform and document special exams and techniques. Page 4 of 14

5 INSTRUCTIONAL METHODS Videotaping Each student will videotape patient centered interviewing and history-taking. The videotapes provide an opportunity for the student to incorporate communication strategies and to evaluate the taped interaction for the appropriateness and effectiveness of the communication. Feedback will be provided via peer review. Resources/Media Media materials are available in the Media Laboratory (B127B Life Sciences). Media assignments are in the syllabus. These materials are designed to assist in preparing the students for the clinical practicum and quizzes through independent study. Readings, videos, slides, and workbook assignments are to be completed prior to scheduled lab for that content area. Laboratory Experience A mandatory 4 hour per week laboratory experience during weeks 1-9 will provide students with the opportunity to practice their physical examination skills with faculty supervision. 2 hours per week is to be arranged by student for continued clinical application and practice (with peers, family, friends, etc). If you are unable to attend any session for emergency reason, you must make prior arrangements with Kate Lein (East Lansing; pager ) or Pam Nethery (Grand Rapids). Required Textbooks Barkauskas, V.H., Baumann, L.C., & Darling-Fisher, C. (2002) Health and Physical Assessment (3 rd ed.). St. Louis: Mosby. Student Workbook & Lab Manual that accompanies Barkauskas text. Smith, R.C. (2002). Patient-Centered Interviewing: An Evidenced-Based Method (2 nd ed.). Philadelphia: Lippincott, Williams & Wilkins. Required Assessment Equipment Stethoscope 2 clear plastic rulers, 5-6 inches long Penlight Lab coat Watch with second hand or second function Name tag:, R.N. MSU Graduate Student Family OR Gerontology OR Adult Page 5 of 14

6 Media Laboratory Assistant (campus) The laboratory assistant (Marla ) is responsible for the overall organization and operation of the Media laboratory. This includes such activities as monitoring use of the equipment, checking audiovisual material in and out of the storage area, handling equipment maintenance and malfunction, and scheduling the showing of videotapes. The laboratory assistant is not available to answer questions regarding content of the modules or the performance of learning activities. Use of the Media laboratory (campus) Campus learners will have to stagger use of the Media Laboratory to prevent long waiting periods to obtain audiovisual materials. Times can be scheduled for group viewing of videotapes. This should be arranged by the students with the media laboratory assistant. Media lab hours will be made available the 1 st week of class. Media for Off Campus Sites Information will be provided through outreach staff and local MSU faculty. Details will be discussed at first meeting time. Equipment Each student will be issued an equipment bag that he/she will be responsible for. The equipment bag will be issued at the beginning of each semester and must be returned by the end of finals week in order to receiving a final grade. 2 videotapes will be provided. Students will need access to a video camera and VCR once during the semester. Page 6 of 14 EVALUATION The overall grading system in this course is Pass/Fail with 80% as the minimum performance for a passing grade. The following components of the evaluation methods are mandatory and must be achieved in order to pass the course: 1. Performance Testing a. Physical examination of body systems b. Written documentation of findings c. Participation in supervised practice session of male and female genitalia d. Performance and documentation of final history taking and physical examination. Students have 30 minutes to complete the history and 45 minutes to complete the physical examination. Any skills not completed at the end of the time will be considered unfinished for grading purposes. The examination is audio taped. Satisfactory written documentation of the final health history, physical exam and summary will include clinical impression in POR format on appropriate forms according to criteria identified on performance evaluation guide.

7 2. Video taped Interview and Health History a. Satisfactory performance and documentation according to criteria in course packet. b. Peer review/evaluation of health-history tape. 3. Written Quizzes Five quizzes will be based on information from assigned readings and workbook exercises. 4. Clinical Experiences will be held during weeks 13 16; further information forthcoming. 5. Specialty Clinical Assignments are due no later than week 15 (East Lansing =December 4; Grand Rapids = December 5). Retesting Policy ONE opportunity for retesting of skills performances (within 14 calendar days of failed performance) will be allowed after the student has attended a supervised practice session. This does not include the final performance evaluation. Missed quizzes will be completed within 7 days of the quiz date and may be essay-type. Practice and make-up are scheduled in collaboration with the course coordinator and clinical faculty. Final examination - No retesting will be allowed for any portion of the final examination. Procedures for Performance Evaluations 1. Appointments will be scheduled with faculty. 2. You will perform the exam on a course partner. 3. Wear a laboratory coat and name pin and bring the appropriate equipment needed to conduct the examination. 4. Bring your complete testing packet for every performance evaluation in a 3-ring binder with your name on the outside. 5. Conduct the examination in the assigned room with faculty supervision within the time allotted. Students are to verbalize findings while doing the examination. 6. Verbalize summary of the exam findings. 7. The learner will clean and rearrange the examining room. Page 7 of 14

8 8. The learner will: a. Write an abbreviated description of findings in the appropriate area on the history and physical examination recording form. b. Return the completed documentation sheet(s), and history and physical examination recording form to your faculty preceptor as directed. 9. The faculty preceptor will review the documentation sheet and physical form and give written feedback. Procedure for Final Performance Evaluation of H & P (see final testing packet) Clinical Experiences Log This log has been created to help the student, faculty and preceptors understand how best time spent in a clinical setting can be utilized. Please take the log with you to each clinical experience during weeks Accurate completion, with preceptor signature, is expected. At the end of your clinical experience time, make one (1) copy of the form and turn in to your clinical faculty by December 12 (East Lansing) and December 13 (Grand Rapids). **** PREPARATION FOR 1 st DAY OF CLASS **** Please read PRIOR to the 1 st week of class o Smith, chapters 1-5 o Barkauskas, chapters 1-3 o Student Workbook, chapters 1-3 East Lansing students report to B-109A Life Sciences Building at 5:00 pm on Wednesday August 28 th. Grand Rapids students will receive instructions prior to the beginning of class. On the 1 st day of class you will check out your blue canvas equipment bag. This is the bag you will bring to class every week. Bring the Smith Patient-Centered Interviewing book with you to class. For every subsequent week you will bring your NUR 820/830/850 Course Packet Page 8 of 14

9 NUR 820/830/850 CLINIC EXPERIENCES LOG (Fall 2002) Student Name: The Clinic Experiences Log should be taken with you to your clinical sites and filled out appropriately. The Log will help all interested participants in the clinic experience (student, faculty, preceptor) understand what skill or technique has been observed. Preceptors must sign each activity. I. ASSESSMENT & HISTORY ACTIVITY DATE PRECEPTOR SIGNATURE Patient Centered Interview Affective Status Cognition Depression Screening Falls/Balance/Gait Functional Health Maintenance Review Medication Review Menopause Mini Mental Status Examination 24 Hour Nutrition Recall Review of Acute & Chronic Medical Problems Review of Systems Sexuality Social Support Spiritual Other (specify) II. PHYSICAL EXAMINATION Abdomen Abnormal Heart Sounds (rubs, murmurs) Adolescent Screening Breast Bruits Cardiovascular Digital Rectal Exam (DRE) Female Genitalia HEENT Hearing Male Genitalia Mobility & Gait Musculoskeletal Page 9 of 14

10 Neurological Orthostatic Blood Pressures Prenatal examination Prostate Skin Thyroid Visual Acuity (Snellen Chart) Vital Signs Weight Well baby Well child Other (specify) ACTIVITY DATE PRECEPTOR SIGNATURE Overall Comments: Areas of Strength: Areas for Improvement: Page 10 of 14

11 NUR 820 / 830/ 850 East Lansing Schedule WEEK DATE READINGS & MEDIA CONTENT & DUE DATES 1 8/28 B-109A LSB Smith, chapters 1-5 Barkauskas, chapters 1 & 3 2 9/4 Smith, chapters 6 7 Barkauskas, chapters 8 9, 19 Media: Bates HEENT, cranial nerves & sensory system; Smith video 3 9/11 Text Ch Media: External eye, middle ear slides - Orientation to course - Equipment distribution - Interviewing skills - Review IPPA - Documentation - Intro to HEENT - General Survey - HEENT Quiz #1 - Patient Centered Interviewing Video DUE - Practice HEENT - Mental Status 4 9/18 - Check off HEENT - Thorax, Upper Extremities & Integumentary system 5 9/25 Text, Ch. 10, 14-16, 18 Media: Bates thorax, lungs, cv, breast, axillae, upper extremities (musculoskeletal) - Thorax, Breasts, Upper Extremities & Integumentary system Quiz #2 - Check off Thorax, Upper Extremities & Integumentary system 6 10/2 Text, Chapter 17 & review chapter 18; (aging & functional limitations) Media: Bates tape on Abd. & Assessing the elderly - Quiz #3 Abdomen & Lower Extremities - Practice Health History on peers 7 10/9 Text, chapter 4, 5, 6, 7 - Health History Video DUE - Check off Abdomen & Lower Extremities Page 11 of 14

12 WEEK DATE READINGS & MEDIA CONTENT & DUE DATES 8 10/16 Text: ch Media: Male genitalia and rectal exam, female genitalia, anus and rectum; Putting It All Together 9 10/23 Text (family students), Chapter 24 & 25 - Quiz Genitalia - Check off Male Genitalia - Quiz Specialty Check off Female Genitalia 10 10/30 Family, adult & gerontology assignments TBA - Final H & P 11 11/6 - Final H & P 12 11/13 - Final H & P 13 11/20 - Clinical Experiences START (arranged individually) 14 11/27 HAPPY THANKSGIVING! 15 12/4 Family, Adult & Gerontology Assignments DUE! - Clinical Experiences 16 12/11 12/12 Clinical Documentation DUE! Clinical Experience Log DUE! - Clinical Experiences Page 12 of 14

13 NUR 820 / 830/ 850 Grand Rapids Schedule WEEK DATE READINGS & MEDIA CONTENT & DUE DATES 1 8/29 Smith, chapters 1-5 Barkauskas, chapters 1 & 3 2 9/5 Smith, chapters 6 7 Barkauskas, chapters 8 9, 19 Media: Bates HEENT, cranial nerves & sensory system; Smith video 3 9/12 Text Ch Media: External eye, middle ear slides - Orientation to course - Equipment distribution - Interviewing skills - Review IPPA - Documentation - Intro to HEENT - General Survey - HEENT Quiz #1 - Patient Centered Interviewing Video DUE - Practice HEENT - Mental Status 4 9/19 - Check off HEENT - Thorax, Upper Extremities & Integumentary system 5 9/26 Text, Ch. 10, 14-16, 18 Media: Bates thorax, lungs, cv, breast, axillae, upper extremities (musculoskeletal) - Thorax, Breasts, Upper Extremities & Integumentary system Quiz #2 - Check off Thorax, Upper Extremities & Integumentary system 6 10/3 Text, Chapter 17 & review chapter 18; (aging & functional limitations) Media: Bates tape on Abd. & Assessing the elderly - Quiz #3 Abdomen & Lower Extremities - Practice Health History on peers 7 10/10 Text, chapter 4, 5, 6, 7 - Health History Video DUE - Check off Abdomen & Lower Extremities Page 13 of 14

14 WEEK DATE READINGS & MEDIA CONTENT & DUE DATES 8 10/17 Text: ch Media: Male genitalia and rectal exam, female genitalia, anus and rectum; Putting It All Together 9 10/24 Text (family students), Chapter 24 & 25 - Quiz Genitalia - Check off Female Genitalia - Quiz Specialty Check off Male Genitalia 10 10/31 Family, adult & gerontology assignments TBA - Final H & P 11 11/7 - Final H & P 12 11/14 - Final H & P 13 11/21 - Clinical Experiences START (arranged individually) 14 11/28 HAPPY THANKSGIVING! 15 12/5 Family, Adult & Gerontology Assignments DUE! - Clinical Experiences 16 12/12 12/13 Clinical Documentation DUE! Clinical Experiences Log DUE! - Clinical Experiences Page 14 of 14