nure 212course syllabus

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TRINITAS SCHOOL OF NURSING

NURE 212

HEALTH AND PHYSICAL ASSESSMENT

COURSE DESCRIPTION: NURE 212 builds upon the foundation of LPN education and introduces the student to holistic health assessment and physical examination. The course aims to develop the student’s abilities in gathering data to determine client’s health status, practices and goals as influenced by his/her own culture. Starting with assessment of normal health parameters, the student will learn to differentiate between what is within and out of acceptable limits. Within the context of care of the perioperative or gerontological client, the student will learn and use physical assessment techniques of inspection, palpation, percussion and auscultation as well as other forms of data collection, such as, client interview, chart review, and analysis of laboratory and diagnostic results. The roles of the RN and the LPN in physical assessment/data collection will be discussed. The student will practice physical assessment skills and participate in laboratory experiences using scenarios involving a patient simulator in the Skills laboratory and in the application of concepts in acute health care settings. Students will also review and perform basic clinical nursing skills.

Theory Hours: 2 hours/week Clinical Hours: 6 hours/week Credits: 4 credits Duration: 15 weeks FACULTY: Ariel Almacen, APN, PsyD, MSN, FNP, CCRN, CEN, RN, C M. E. Kelley, MSN, MEd, RN, CNE PRE-REQUISITES: Proof of current LPN license

Satisfactory completion of NJ Basic Skills Test/Course or waiver G.P.A. 2.3 BIO 105, BIO 106, BIO 108,CHE 105 or CHE 113/114 ENG 101, ENG 102, PSY 101, PSY 205, SOC 101, HUMANITIES ELECTIVES (6 credits) One year employment as an LPN in a health care setting

CO-REQUISITES: NURE 211 THE STUDENT IS RESPONSIBLE FOR ALL INFORMATION CONTAINED IN THE STUDENT HANDBOOK Copyright 2006-2007. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic,

mechanical, photocopying, recording or otherwise, without the prior permission of Trinitas School of Nursing.

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COURSE OBJECTIVES FOR NURE 212 Upon completion of this course, the student will:

1. Perform a comprehensive health and physical assessment of a client/individual. 2. Demonstrate the use of effective and culturally-sensitive communication techniques in history taking and interviews with clients. 3. Utilize the nursing process and critical thinking in determining client’s health status. 4. Integrate knowledge of anatomy and physiology in the physical assessment process and interpretation of findings. 5. Document assessment findings and health history accurately using available resources. 6. Demonstrate psychomotor ability in performing basic clinical nursing skills 7. Utilize available technological resources in the libraries, and the skills and computer laboratories.

All students enrolled in Trinitas School of Nursing NURE/NREL courses will be required to adhere to zero tolerance of: Academic Misconduct, Academic Dishonesty, Professional Misconduct and Illegal Activities The commitment to a Zero Tolerance policy fosters and upholds academic and professional integrity. It creates a safe, secure, and healthy environment to learn and work. Therefore, Zero Tolerance involving the above behaviors is subject to disciplinary processes up to and including dismissal from Trinitas School of Nursing. EFFECTIVE JANUARY 2006: If a student exits the program or if the sequence is not maintained, an application for re-entry is required. The student must submit the application to the Dean and a minimum GPA of 2.5 is required. There is no

guarantee of re-entry into the Nursing Program. To stay active, a student not registered for courses at UCC must submit a no- fee application form each semester.

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CLINICAL EXPERIENCE: Most of the clinical/lab experiences will be within the Skills Laboratory where students will practice and perform health and physical assessments. The universal patient simulator and other computerized manikins will also be utilized. If available, the instructor may use a clinical setting at Trinitas Hospital e.g. the perioperative or gerontological units for health and physical assessment of an actual client with a health deviation.

Course Requirements: Completion of examinations and quizzes with a grade of ‘75’ or higher

Health/physical assessment on-line exercises/quizzes accessed through http://evolve.elsevier.com and are due as indicated on the course calendar. Username and password will be provided by the instructor.

Demonstration of a cephalocaudal physical examination Submission of a comprehensive written history and physical examination of an adult Satisfactory demonstration of the following procedures: IV therapy/IV Piggyback Tracheostomy care and suctioning Colostomy care Foley catheter insertion Wound dressing See the Student Handbook for general information on nursing course requirements Grading System:

1) 2 Unit exams – 15% each = 30% total 2) 4 Quizzes – 5% 3) Lab Practical on psychomotor performance of cephalocaudal physical examination – 20% 4) Written health history and physical examination of an adult individual – 20% 5) Written final examination – 25% A grade of “C+” (2.5) or better in this course is required in order to continue in the nursing sequence

Teaching Methods/Materials: Lecture, seminar discussion, assigned readings, clinical psychomotor practice, on-line assignments, audio-visual and computer-assisted instruction, writing assignment

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REQUIRED TEXTS: Jarvis, C. (2004). Physical examination and health assessment 4th ed. Philadelphia: Saunders/Elsevier. Jarvis, C. (2004). Student Manual of Physical Assessment 4th ed. Philadelphia: Saunders/Elsevier Pagana, K. & Pagana, T. (2002). Mosby’s manual of diagnostic and laboratory tests 2nd ed. St. Louis: Mosby. RECOMMENDED TEXTS: Leonard, P. (2003). Quick and easy medical terminology 4th ed. Philadelphia: Saunders. Venes, D. (ed) (2001). Taber’s Cyclopedic Medical Dictionary 19th ed. Philadelphia: F.A. Davis

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NURE 212 BEHAVIORAL OBJECTIVES CONTENT LEARNING ACTIVITIES

UNIT I Overview of Health Assessment Given information in class, laboratory, required readings, and planned learning experiences, the student will be able to:

1. Discuss the role of assessment as the starting point of clinical reasoning.

2. Identify the purpose of data collection and physical assessment.

3. Describe the use of diagnostic reasoning in clinical judgment.

4. Discuss the use of the nursing process in clinical judgment.

5. Discuss the expanded concept of health and relate it to the process of data collection.

6. Describe the types of databases used in different clinical situations

7. Consider growth and development stage when evaluating health data.

8. Describe expected physical, psychosocial, cognitive, and behavioral milestones of a patient based on developmental stage.

9. Discuss the basic characteristics of culture and its role as a potential source of conflict between nurse and client within the health assessment process.

10. Identify the components of the health belief system and their influence on health practices and illness perception/expression.

Unit I Overview of Health Assessment

A. Assessment of the whole person 1. Critical thinking in health

assessment 2. Diagnostic reasoning in clinical

judgment 3. Nursing process in clinical

judgment B. Expanding the concept of health

1. Comprehensive assessment factors

2. Types of databases a. complete b. episodic c. follow-up database d. emergency database

C. Assessment throughout the life cycle 1. Developmental tasks and

health promotion across the life span

a. developmental stages

b. developmental screening tests

2. Hereditary influences D. Transcultural considerations in

assessment 1. Religious beliefs and practices 2. Health-related beliefs and

practices 3. Transcultural expression of

illness

Unit I Required Readings: Jarvis, C. (2004). Physical examination and health assessment 4th ed. Philadelphia: Saunders. Chapters 1, 2, 3 Student Activities:

1. Participate in discussions on the role of assessment as a point of entry in the ongoing process of nursing care.

2. Using a professional journal article as a basis for identifying health problems, describe the type of data collection indicated: complete, episodic, follow-up, or emergency

3. Discuss demographics of your town and develop a list of appropriate transcultural considerations for the ethnic groups in your area.

4. Complete open-book quizzes at the end of each chapter (non-graded)

5. Complete on-line assignment and submit by the designated date on course calendar.

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TRINITAS SCHOOL OF NURSING NURE 212

BEHAVIORAL OBJECTIVES CONTENT LEARNING ACTIVITIES

UNIT II The Interview

1. State facilitators and blockers of effective communication.

2. Demonstrate ability to establish the parameters for a health interview

3. Use the specified communication techniques appropriately to gather data.

4. State the ten traps of interviewing. 5. Discuss the meaning of common

nonverbal modes of communication. 6. Modify communication techniques

according to client’s developmental stage, special needs or cultural practices.

7. Discuss working with and without an interpreter in order to overcome communication barriers.

8. Explain the aspects of assessment and history taking for suspected abuse.

9. Recognize health care professional’s role as mandatory reporters of abuse.

10. Discuss the health effects of violence. 11. Describe the use of the Abuse

Assessment Screen (AAS) when one is screening for intimate partner violence.

UNIT II The Interview

A. Therapeutic communication 1. The process of communication 2. Techniques of communication 3. Stages of therapeutic

communication a. initial interview b. working phase c. termination phase

4. Effective interviewing skills 5. Developmental considerations

a. children and adolescents

b. the older adult c. clients with special

needs 6. Overcoming communication

barriers B. Cross-cultural communication

1. The professional relationship 2. Functional use of space 3. Nonverbal cross-cultural

communication C. Domestic violence assessment

1. Health effects of violence 2. Screening for intimate partner

violence a. assessment b. history c. physical exam d. documentation

UNIT II Required Readings: Jarvis, 4th edition Chapters 4, 5 Student Activities:

1. Paired students will role play an interview between nurse and client based on an identified problem/concern that the client wants to discuss. At the completion of the interview, the student/client will give feedback to the student/interviewer. Both students should identify facilitators and barriers. Video or audio recorders may be used with the permission of students involved in the role play. Use the performance checklist as a basis for the critique.

2. Identify local resources available for domestic violence as well as for elder abuse/neglect.

3. Discuss “red flags” of abuse and neglect that may be found during an assessment.

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UNIT III The Complete Health History

1. State the purpose of the complete health history

2. List categories of information contained in a health history

3. Describe the data that must be gathered for each category of a health history.

4. Describe the eight characteristics that should be addressed for each symptom identified

5. Relate the developmental considerations to be addressed during a health history for a child or older adult.

6. Define the behaviors that are considered in assessment of a person’s mental status.

7. Describe developmental considerations of a mental status examination.

8. Define nutritional status 9. State the purpose of nutritional

assessment. 10. Describe the role of culture and

values in a client’s nutritional intake. 11. Identify the components of a

nutritional assessment. 12. Use anthropometric measures and

laboratory data to assess nutritional status of clients.

13. Use nutritional assessment in the provision of care.

UNIT III The Complete Health History

A. The health history 1. Biographical data 2. Source of history 3. History of present illness 4. Past health 5. Family history 6. Review of systems 7. Functional assessment 8. Perception of health

B. Developmental considerations 1. Children and adolescents 2. The older adult

C. Mental Status Assessment 1. Defining mental status

a. developmental considerations

b. components of mental status examination

2. Objective data a. appearance b. behavior c. cognitive functions d. thought processes

and perceptions e. developmental

considerations 3. Abnormal findings

a. nursing diagnoses

UNIT III Required Readings: Jarvis, 4th edition Chapters 6, 7, 8 Student Activities:

1. Using the School’s or the hospital’s health history form and working in pairs, obtain a health history from each other.

2. Identify interviewing techniques that were most or least helpful.

3. Search the Internet for available mental status assessment instruments and assess instrument for completeness

4. Using the form provided in the text, complete a MiniMental State Examination on an assigned partner.

5. Complete a mental status assessment on an assigned client. Document the results of the assessment and formulate associated nursing diagnoses.

6. Complete a nutritional assessment of a person from a different culture and describe the nutritional implications of the cultural values of the person.

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UNIT III continued

D. Nutritional status Assessment 1. Define nutritional status

a. developmental considerations

b. transcultural considerations

c. dietary practices of selected cultures

d. purposes and components of nutritional assessment

2. Subjective data – health history questions for specific populations

3. Objective data – clinical signs and anthropometric measures

4. Laboratory studies – biocultural variations; serial assessment

E. Effective documentation of findings

1. Review of systems 2. Comprehensive history

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UNIT IV BEGINNING THE PHYSICAL EXAMINATION PROCESS

1. Describe the use of inspection, palpation, auscultation and percussion as physical examination techniques.

2. Differentiate between light, deep, and bimanual palpation.

3. Discuss appropriate infection control measures to prevent spread of infection during physical assessment.

4. State developmental considerations in preparing clients for physical examination.

5. List information considered in each of the four areas of a general survey.

6. Discuss relevant developmental considerations in relation to a general survey.

7. Describe correct procedures for assessing vital signs.

8. Differentiate the different types of pain 9. Describe initial pain assessment. 10. Compare available pain assessment

tools 11. Discuss the physical changes that

may occur because of poorly controlled pain.

12. Describe developmental, transcultural, and gender considerations regarding pain.

UNIT IV BEGINNING THE PHYSICAL EXAMINATION PROCESS

A. Cultivating your senses - Physical examination techniques

1. Inspection 2. Palpation 3. Percussion 4. Auscultation

B. The clinical setting 1. Equipment 2. Safe environment 3. Approaching the client

C. Developmental considerations across the life span.

D. General survey 1. Physical appearance 2. Body structure 3. Mobility 4. Behavior

E. Measurement – height and weight F. Vital signs G. Additional techniques H. Developmental considerations

1. Infants and children 2. The aging adult

F. Transcultural considerations G. Application and critical thinking H. Abnormal findings I. Pain Assessment – the 5th vital sign

1. Neuroanatomic pathway 2. Nociception 3. Sources of pain

Required Readings: Jarvis 4th edition Chapters 9, 10, 11 Student Activities:

1. Working in pairs, students will practice the techniques used in physical examination.

2. Practice handling an otoscope and ophthalmoscope.

3. Practice listening to heart and lung sounds using SimMan and on each other.

4. Write a general survey description of a “client”.

5. Participate in a seminar discussion of personal pain experiences and how it was managed.

6. Use different pain assessment tools to rate pain.

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UNIT IV BEGINNING THE PHYSICAL EXAMINATION PROCESS CONTINUED

4. Types of pain a. infants b. aging adult

5. Gender differences 6. Subjective data

a. initial pain assessment

b. pain assessment tools

7. Objective data 8. Documentation

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NURE 212

BEHAVIORAL OBJECTIVES CONTENT LEARNING ACTIVITIES UNIT V PHYSICAL EXAMINATION

1. Demonstrate techniques used during a physical examination

2. State adjustments which may be necessary to accommodate cultural, spiritual, or developmental considerations

3. Describe equipment used in performing examination and observations

4. List techniques to promote physical and psychological comfort during a physical examination.

5. Describe proper positioning for the client.

6. Identify differences in assessing children, young adults, and older adults.

7. Complete a physical assessment of each body system in a systematic manner.

8. Identify normal and abnormal findings across the life span

9. Document findings in a concise, descriptive manner using appropriate terminology.

10. Discuss how assessment findings influence the nursing process.

11. Describe methods to incorporate health teaching into the physical assessment.

UNIT V PHYSICAL EXAMINATION

A. Body systems examination

1. Skin, hair and nails 2. Head and neck, lymphatics 3. Eyes 4. Ears 5. Nose, mouth, throat 6. Breasts and regional

lymphatics 7. Thorax and lungs 8. Head and neck vessels 9. Peripheral vascular system

and lymphatic system 10. Neurological system 11. Male/Female genitalia 12. Anus, rectum, and prostate

B. Integration of physical assessment

1. Use of critical thinking to determine client health status and recommendation for health promotion

2. Incorporation of health teaching into the physical assessment

3. Documentation

Required readings: Jarvis, 4th edition Chapters 12 – 28 Student Activities:

1. Working in groups of three, one to follow the checklist and textbook, one to perform the examination, and one to act as client, perform a physical examination of assigned body system. Each student will rotate roles to allow each to be an examiner.

2. Document data obtained using the selected History and Physical Assessment Form.

3. View assigned Bates’ Physical Assessment video tapes.

4. Complete a comprehensive health assessment project.

5. Complete and submit assigned on-line exercises.

nure 212course syllabus

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