Week 9 Discussion: Assessing Neurological Symptoms

Imagine not being able to form new memories. This is the reality patients with anterograde amnesia face. Although this form of amnesia is rare, it can result from severe brain trauma. Anterograde amnesia demonstrates just how impactful brain disorders can be to a patient’s quality of living. Accurately assessing neurological symptoms is a complex process that involves the analysis of many factors.

In this Discussion, you will consider case studies that describe abnormal findings in patients seen in a clinical setting. Week 9 Discussion: Assessing Neurological Symptoms.

Note: By Day 1 of this week, your Instructor will have assigned you to one of the following specific case studies for this Discussion. Also, your Discussion post should be in the SOAP Note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in the Week 4 Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case. Week 9 Discussion: Assessing Neurological Symptoms.

Case 1: Headaches

A 20-year-old male complains of experiencing intermittent headaches. The headaches diffuse all over the head, but the greatest intensity and pressure occurs above the eyes and spreads through the nose, cheekbones, and jaw.

Case 2: Numbness and Pain

A 47-year-old obese female complains of pain in her right wrist, with tingling and numbness in the thumb and index and middle fingers for the past 2 weeks. She has been frustrated because the pain causes her to drop her hair-styling tools.

Case 3: Drooping of Face

A 33-year-old female comes to your clinic alarmed about sudden “drooping” on the right side of the face that began this morning. She complains of excessive tearing and drooling on her right side as well.

To prepare Week 9 Discussion: Assessing Neurological Symptoms:

With regard to the case study you were assigned:

Review this week’s Learning Resources, and consider the insights they provide about the case study.
Consider what history would be necessary to collect from the patient in the case study you were assigned.
Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

Note: Before you submit your initial post, replace the subject line (“Discussion – Week 9”) with “Review of Case Study ___.” Fill in the blank with the number of the case study you were assigned. Week 9 Discussion: Assessing Neurological Symptoms.

By Day 3

Post a description of the health history you would need to collect from the patient in the case study to which you were assigned. Explain what physical exams and diagnostic tests would be appropriate and how the results would be used to make a diagnosis. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.

Read a selection of your colleagues’ responses. Week 9 Discussion: Assessing Neurological Symptoms.

By Day 6

Respond to at least two of your colleagues on two different days who were assigned different case studies than you. Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition, and justify your reasoning. Week 9 Discussion: Assessing Neurological Symptoms.

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NURS 6512 Week 9 Quiz

Question 1

A woman brings her husband to the emergency department and states that he is having a stroke. You are the student NP on the hospitalist service and are sent down first to obtain the history and physical. You develop a differential diagnosis and know that the initial gold standard radiology test to further evaluate is:

Question 2

You are examining a patient in the emergency department who has recently sustained head trauma. In order to initially assess this patient s neurologic status, you would:

Question 3

While interviewing a patient, you ask him to explain the Lion and the Mouse in order to assess:

Question 4

Which area of the brain is responsible for perceiving sounds and for determining their source?

Question 5

You are initially evaluating the equilibrium of Ms. Q. You ask her to stand with her feet together and arms at her sides. She loses her balance. Ms. Q. has a positive:

Question 6

An older adult is administered the Set Test and scores a 14. The nurse interprets this score as indicative of:

Question 7

To assess spinal levels L2, L3, and L4, which deep tendon reflex should be tested?

Question 8

The examiner should be concerned about neurologic competence if a social smile cannot be elicited by the time a child is _____ old.

Question 9

Environmental hazards and cognitive function are data needed for the personal and social history section of a neurologic assessment for:

Question 10

When you ask the patient to tell you the meaning of a proverb or metaphor, you are assessing which of the following?

Question 11

Appropriateness of logic, sequence, cohesion, and relevance to topics are markers for assessment of:

Question 12

Facial muscle or tongue weakness may result in:

Question 13

If a patient cannot shrug the shoulders against resistance, which cranial nerve (CN) requires further evaluation?

Question 14

The finger-to-nose test allows assessment of:

Question 15

Visible or palpable extension of the elbow is caused by reflex contraction of which muscle?

Question 16

The major portion of brain growth and myelinization occurs between ____ year(s) of age.

Question 17

At what age should the infant begin to transfer objects from hand to hand?

Question 18

An acute polyneuropathy that commonly follows a nonspecific infection occurring 10 to 14 days earlier and that primarily affects the motor and autonomic peripheral nerves in an ascending pattern is:

Question 19

The Mini-Mental State Examination:

Question 20

You have asked a patient to close his eyes and identify an object placed in his hand. You are evaluating:

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NURS 6512 Advanced Health Assessment and Diagnostic Reasoning DQs Week 10 Discussion: Assessing the Genitalia and Rectum

Patients are frequently uncomfortable discussing with health care professionals issues that involve the genitalia and rectum; however, gathering an adequate history and properly conducting a physical exam are vital. Examining case studies of genital and rectal abnormalities can help prepare advanced practice nurses to accurately assess patients with problems in these areas.

In this Discussion, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.

Case 1: Rectal Bleeding

A 62-year-old male construction worker reports to your clinic after experiencing rectal bleeding for over 1 month. He has noticed small amounts of blood after every bowel movement. He had a colonoscopy 2 years ago with normal results. The patient has no fever, chills, dysuria, abnormal urinary frequency, or abdominal pain. The patient reports occasional rectal itching and pain. He states he has no noticeable sores on his rectal area and no family history of colorectal cancer.

Case 2: Dysuria

A 55-year-old African-American male reports to your clinic complaining of frequent and painful urination for the past 2 months. The patient is sexually active and has been in a monogamous relationship for the past 3 years. He reports no penile discharge, fever, chills, abdominal pain, or back pain. His father is deceased and passed away of colon cancer. His father had a history of benign prostatic hypertrophy (BPH). The patient considers himself as a healthy male. He works for a large American corporation, has a relatively healthy diet, and exercises 4 to 5 times per week.

Case 3: Genitalia

A 21-year-old college student reports to your clinic with external bumps on her genital area. The bumps are painless and feel rough. The patient is sexually active and has had more than one partner over the past year. Her initial sexual contact occurred at age 18. The patient reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She had one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed.

To prepare:

With regard to the case study you were assigned:

Review this week’s Learning Resources, and consider the insights they provide about the case study.
Consider what history would be necessary to collect from the patient in the case study you were assigned.
Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

Note: Before you submit your initial post, replace the subject line (“Week 10 Discussion”) with “Review of Case Study ___.” Fill in the blank with the number of the case study you were assigned.

By Day 3

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who were assigned different case studies than you. Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject, and why. Identify the most likely condition, and justify your reasoning. NURS 6512 Advanced Health Assessment and Diagnostic Reasoning DQs

NURS 6512 Week 10 Quiz

Question 1

Prostate examination findings of a hard, irregular, painless nodule with obliteration of the median sulcus are signs of:

Question 2

Bimanual examination of the uterus includes:

Question 3

Which of the following is a normal component of vaginal discharge seen on a wet mount?

Question 4

The tail of Spence extends:

Question 5

When should girls be taught to perform breast self-examination?

Question 6

The form of gynecologic cancer that is increased in obese women is:

Question 7

Small, pale yellow, raised, and rounded areas are visualized on the surface of the cervix. You should:

Question 8

A 70-year-old man has a prostate-specific antigen (PSA) value of 6 and a negative digital rectal examination (DRE). These findings indicate:

Question 9

Initial digital approach to the rectal examination should be:

Question 10

The most emergent cause of testicular pain in a young male is:

Question 11

The risk of ovarian cancer is increased by a history of:

Question 12

A mother brings her 8-year-old daughter to the clinic because the child says it hurts to urinate after she fell while riding her bicycle. Upon inspection, you find posterior vulvar and gross perineum bruising. These findings are consistent with:

Question 13

The mother of a newborn boy tells you that her baby s breasts are swollen and sometimes look as if they are leaking milk. It is most appropriate to tell her that the:

Question 14

Your patient s chief complaint is repeated pencil-like stools. Further examination should include:

Question 15

The female patient should ideally be in which position for the pelvic examination?

Question 16

While examining an 18-year-old man, you note that the penis and testicles are more darkly pigmented than the body skin. You should consider this finding to be:

Question 17

When examining a small child, in which position should he be placed to help push the testicles into the scrotum?

Question 18

A 23-year-old female presents with severe right lower quadrant tenderness. All of the following should be considered in the differential except:

Question 19

What is the initial diagnostic radiology test that should be ordered if you suspect a ruptured ovarian cyst?

Question 20

A 17-year-old male was brought into the emergency room with testicular/scrotal pain. The differential diagnosis should include all except:

NURS 6512 Advanced Health Assessment and Diagnostic Reasoning DQs

NURS 6512 Week 11 Discussion: Ethical Concerns

As an advanced practice nurse, you will run into situations where a patient’s wishes about his or her health conflict with evidence, your own experience, or a family’s wishes. This may create an ethical dilemma. What do you do when these situations occur?

In this Discussion, you will explore evidence-based practice guidelines and ethical considerations for specific scenarios.

Scenario 1:

The parents of a 5-year-old boy have accompanied their son for his required physical examination before starting kindergarten. His parents are opposed to him receiving any vaccines.

Scenario 2:

A 49-year-old woman with advanced stage cancer has been admitted to the emergency room with cardiac arrest. Her husband and one of her children accompanied the ambulance.

Scenario 3:

A 27-year-old man with Crohn’s disease has been admitted to the emergency room with an extreme flare-up of his condition. He explains that he has not been able to afford his medications for the last few months and is concerned about the costs he may incur for treatment.

Scenario 4:

A single mother has accompanied her two daughters, aged 15 and 13, to a women’s health clinic and has requested that the girls receive a pelvic examination and be put on birth control. The girls have consented to the exam but seem unsettled.

Scenario 5:

A 17-year-old boy has come in for a check-up after a head injury during a football game. He has indicated that he would like to be able to play in the next game, which is in 3 days.

Scenario 6:

A 12-year-old girl has come in for a routine check-up and has not yet received the HPV vaccine. Her family is very religious and believes that the vaccine would encourage premarital sexual activity.

Scenario 7:

A 57-year-old man who was diagnosed with motor neuron disease 2 years ago is experiencing a rapid decline in his condition. He prefers to be admitted to the in-patient unit at a hospice to receive end-of-life care, but his wife wants him to remain at home.

To prepare:

Select three scenarios, and reflect on the material presented throughout this course.
What necessary information would need to be obtained about the patient through health assessments and diagnostic tests?
Consider how you would respond as an advanced practice nurse. Review evidence-based practice guidelines and ethical considerations applicable to the scenarios you selected.

By Day 3

Post the explanation of the health assessment information required for a diagnosis of your selected patients (include the scenario numbers). Explain how you would respond to the scenario as an advanced practice nurse using evidence-based practice guidelines and applying ethical considerations. Justify your responses.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who selected different scenarios than you, using one or more of the following approaches:

Suggest additional health assessment information that would be necessary to collect from the patient
Critique your colleague’s response, and explain alternative approaches to the situation.
Validate an idea with your own experience and additional research.

NURS 6512 Week 11 Quiz

Question 1

When interviewing a disabled patient, it is best to speak to:

Question 2

Which of the following is most likely to enhance examiner reliability?

Question 3

Throughout the history and physical examination, the clinician should:

Question 4

At your first meeting with a patient, it is usually best to say:

Question 5

Which of the following is true regarding the relationship between the examiner and the patient?

Question 6

When conducting a geriatric assessment, basic activities of daily living (ADLs) include:

Question 7

Your 15-year-old patient is athletic and thin. Radiography of an ankle injury reveals a stress fracture. You should question this patient about her:

Question 8

The reliability of health-related findings and observations is the responsibility of the:

Question 9

The cranial nerves are usually assessed while the patient is in which position?

Question 10

The best way to ease the apprehension of a 3-year-old child before a physical examination is to:

Question 11

When you attempt to move a 10-month-old child from his mother s lap to the examination table, he screams loudly. Your best action is to:

Question 12

Palpation of epitrochlear nodes is part of the:.

Question 13

Which medical condition would exclude one from sports participation?

Question 14

The greatest risk for potential health problems occurs in which age group?

Question 15

Functional assessment is most important during the examination of a(n):

Question 16

When conveying bad or distasteful news to the patient and family, it is best to:

Question 17

The checkout station for preparticipation physical evaluation (PPE) is critical because at this point:

Question 18

To promote your examination time with a cooperative child, your approach to the examination should be to:

Question 19

Which of the following data are not part of your general inspection?

Question 20

Part of the screening orthopedic component of the examination includes evaluating the person while:

Week 9 Discussion: Assessing Neurological Symptoms