NKU MSN610 Full Course Latest 2019 November

MSN610 Diagnostic Reasoning and Advanced Physical Assessment

Module 1 Discussion

Complete both of the Discussion Topics and Submit by the Due Date.

1)  Obtaining a comprehensive health history can be difficult in a variety of situations. In this discussion, choose one type of patient scenarios and describe how you would approach interview and obtain the history. Each student must reply to at least one other student in discussion of the scenario.

A) The Angry Patient who has been waiting a long time for an appointment and is disgusted with health care in general.

B) The Internet Patient who obtains all his health information from the Internet and has self -diagnosed his problem.

C) The Unfocused Patient with a 3 inch health record she has brought with her to get a second opinion.

D) The Terminal Patient who has end-stage uterine metastatic cancer who has refused treatment.

Instructions:

      A.  Make your initial post by 11:59pm EST Wednesday of Week 1.

       B. Respond to one other classmate posts by 23:59 EST Saturday of Week 1.

2.  There are both a comprehensive history and physical exam and a focused history and physical exam. Discuss the circumstances and components for each type of history/exam. This discussion DOES NOT require another student response.

 

MSN610 Diagnostic Reasoning and Advanced Physical Assessment

Module 2 Discussion

Case Study 2A

C.C. M.A. is a 6 year old female who presents for a sick episodic visit who is accompanied with her mother for sore throat, fever and rash.

HPI:  Her mother states M.A.. has been sick for about 4 days which started with a headache. Then she developed a sore throat and runny nose. M.A.. now appears feverish and doesn’t feel like eating much.

She normally attends pre-school, but mom has kept her home yesterday and today since she felt feverish. Now, this morning, she has this rash. The rash is “a little itchy”. Mom denies changing laundry detergents, foods, soaps and there has been no known exposure to anyone else with a rash or illness.

M.A. has never had a rash previously.

PMH: Growth percentiles within normal limits on previous visits

Immunizations Record:

DPT given at:       2 mos      4mos     6 mos     18 mos        5 yr

OPV given at:       2 mos      4 mos                    18 mos        5 yr

MMR: given at:                                 13 mos                         5 yr

Hib given at:       2 mos     4 mos      6 mos    18 mos

FH:

Relationship Mortality     Age        Health Problems    Relationship   Mortality       Age      Health Problems

Mother           Alive            27              None                      Father              Alive                 27                      None

MGM              Alive             51              HTN/DM               MGF   Alive                 48                      HLN

PGM               Alive              45              None       PGF                  Alive                  52                   Prostate CA

SH: Lives with mother but spends every other weekend with father who lives in a suburban area 15 miles away. Mother is an elementary school teacher and Father is an social worker. Parents have been divorced for 2 years. M.A. is doing well in the first grade without social or behavioral problems.

Meds: Children’s Tylenol 1 dose last pm                  Allergies: None

ROS:

General: Mom denies weight loss, fatigue until the last 3 days, generally eats well

Skin: Mom denies birthmarks, scars, no previous rashes

HEENT: Denies dizziness, head trauma, vision trouble, does not wear glasses, has about 3 colds/year, denies swallowing problems, nasal congestion, Admits to sore throat, difficulty swallowing,  but drinking fluids as normal

Neck: Denies lumps, pain, stiffness

Resp: Denies dyspnea or pain, admits to rare non-productive cough for 48 hours

Cardiac: Denies chest pain, irregular heart rate, or edema

Gastrointestinal: Denies nausea, vomiting, diarrhea or abdominal pain

 

MSN610 Diagnostic Reasoning and Advanced Physical Assessment

Module 3 Discussion

Diagnostic Reasoning and Advanced Physical Assessment

MODULE 3 CASE STUDY

BJ is a 10 yr old female of Hispanic origin who presents to your exam room with an adult Hispanic male that identifies himself as her uncle. He states that BJ has hurt her Right arm after falling down the steps the day before. He states she did NOT loss consciousness or injury her head. The providers asks BJ, “How did you fall down the steps?” BJ looks down and softly states, “I just tripped and feel:. Both speak with broken English.

PMI: No hospitalization or Surgeries. Immunization History is unknown.

Medications: None                                                       Allergies: None

FH: Parents Living Mother age 24  Father age 30, No Siblings

SH: Both parents work cleaning in the hotel industry. BJ is “home schooled” by her aunt.

ROS:

General: NEG weight loss or gain NEG  fatigue, NEG fever

HEENT: NEG for headache,  congestion, nasal drainage,  vision problems,  throat pain

Cardiac: NEG for chest pain, palpitations, swelling, loss of consciousness

Resp:  NEG Dyspnea, Neg for cough, wheezing, NEG PND

GI: NEG Nausea, Neg for Vomiting, Diarrhea, dysphagia, pain, anorexia

MS: + R Shoulder Joint pain, +Joint Swelling, + for falls

HEME:  + for bruising  NEG for bleeding, Neg night sweats

ENDO: Neg for thirst, heat or cold intolerance

NEURO: NEG dizziness, Neg for confusion, numbness, aphasia

PSYCH: NEG for memory loss, Neg for nervousness, suicidal ideation

 

MSN610 Diagnostic Reasoning and Advanced Physical Assessment

Module 4 Discussion

Diagnostic Reasoning and Advanced Physical Assessment

Module 4 Case Study

K.H. is a 16 year old male who presents to your exam room with recurrent episodes of dyspnea. His mother is with him and reports he has been in his usual good health until this past fall football season ( 4 months ago), when she noticed him wheezing after activities. Usually the wheezing would resolve spontaneously after a couple of minutes of rest. When you ask K.H. how often he feels SOB, he states it has gotten worse and now even walking up a flight of steps causes wheezing and coughing. He also admits to increased fatigue with decreased exercise tolerance.

PMH: Croup as an infant. Recurrent URIs as a child. Immunizations are Up To Date.

Surgical History includes PE tubes at age 3 for chronic OTM (Otitis Media)

Medications: None                                                                      Allergies: Amoxicillin (hives)

SH: Breast fed x 6 month. Normal Developmental Milestones. Currently in grade 10 at local high school. Active in sports (football, baseball) Grades: As and Bs. + Smoking 3-4 cigs per day x 1 year. Neg for ETOH (alcohol)

Denies illegal drugs. Lives at home with both parents and sister

FH: Mother living @ age 36 with Hypertension and Hypothyroidism – Asthma, – Pneumonia – Smoking

       Father living @ age 40 with GERDS -Asthma -Pneumonia + Smoking 1 ppd x 10 years

       Siblings: 1 Sister age 13 with recurrent URIs

 

MSN610 Diagnostic Reasoning and Advanced Physical Assessment

Module 5 Discussion

Case Study 5

CC: J.D. is a 32 year old male presents to your office for a complete physical exam as a new patient. He c/o intermittent episodes of diarrhea, abdominal discomfort, bloating and occasional constipation.

HPI: J.D. states he often eats a meal and within 10 minutes, he feels bloated and “gassy”. He frequently has periods of nausea, urgent watery diarrhea. This is embarrassing for him as he is not always near a bathroom. This has become progressively worse over the last years and occurs almost daily. He first realized he was having bowel problems when he was in high school when he played on the football team. Diarrhea always seemed to get worse on game day. He denies vomiting or laxative use.

PMH: No hospitalizations or surgeries. His childhood immunizations were all completed and he had a tetanus booster 5 years ago. Only health problem has been his abdominal bloating and “bowel problems”. He was treated for strep throat and a sinus infection 5 years ago with Amoxicillin.

FH:         Relationship                       Mortality             Age                       Health Problems

               Mother                               Alive                     54                          None

               Father                                 Alive                     56                          Arthritis

               MGM                                   Alive                     70                          HTN, Rheumatoid Arthritis, HLN

               PGM                                    Alive                     66                          Breast CA, Pacemaker

               PGF                                      Alive                     67                          None

               MGF                                     Deceased            65                          CVA

SH:         He is a graduate student at the university studying Psychology. He lives in an apartment with his girlfriend.

He drank heavily in high school, but may have 1 glass of wine weekly. Denies smoking cigs/marijuana or IV drug use.  He exercises regularly but his diet is “awful” and depends on how hectic his schedule is. He is currently working full time as a bank teller.

Meds: None                                                                                                  Allergies: None

ROS:

General: Fair appetite with no weight loss, Denies fatigue, fever, chills, blood transfusion

Skin: Denies rashes, lesions, scars

HEENT: Denies dizziness, headaches, head trauma, vision or hearing difficulties, Sees dentist annually, Denies allergies, nasal congestion, sinus problems, dysphagia

Neck: Denies lumps, pain, stiffness

Cardiac:  Denies chest pain, dyspnea on exertion, palpitations

Resp:  Denies dyspnea, cough, wheezing

Gastrointestinal:  See HPI

Genitourinary: Denies dysuria, frequency, hematuria, penile discharge, heterosexual but libido is low as he frequently just does not feel well.

Musculoskeletal: Denies joint pain, swelling, arthritis, myalgia

Endocrine: Denies skin or hair changes, temperature intolerances, excessive thirst or urination

Neurological: Denies weakness, seizures,

Psychological: Denies depression, but admits he sometimes gets “anxious” with graduate school and work.

Nutritional: Admits he eats 1 meal/day usually in the evening when “life has quieted down”. This meal consists of some meat/potato. Salads causes bloating. Snacks can cause cramping and diarrhea in the afternoon-so I just don’t eat. Milk products do not seem to bother him.

Physical Exam:

Vital Signs:   Temperature 98        Pulse: 76 b/min      Resp:  16/mi     BP: 120/80     HT: 5’11  WT: 174   BMI: _____

General Appearance:  Well developed, well nourished, appropriately groomed and appears his stated age

Skin: Smooth, soft, w/o lesions, rashes, scars. Tattoo of an eagle on his chest.

HEENT: Normocephalic with evenly distributed hair. No redness or lesions of his eyes, extraocular movements (EOM) intact.

Ophthalmic Exam: Red reflex intact bilaterally. Optic Disc is round creamy yellow with clear margins. Retinal vessels are bright red without exudate, edema, and wool spots. Macula is positive for foveal light reflex.

 

MSN610 Diagnostic Reasoning and Advanced Physical Assessment

Module 6 Discussion

Case Study 6

CC: 85 year old female presents to your exam room with “memory loss”

HPI: J.B. is brought in with her son who states his mom is forgetting to pay her bills over the last 4 months and “gets lost” in her own home. J.B. admits she sometimes gets “forgetful”. Her previous PCP retired 6 months ago and they have no medical records with them.

PMH: Total Abdominal Hysterectomy 20 years ago. G3P2 1 Miscarriage. No other surgeries or hospitalizations. Treated for HTN, A-fib

Medications: HCTZ 25 mg daily                                                 Allergies: None

                         Digoxin 0.25 mg daily

                         Coumadin 1 mg daily

                         Multivitamin daily

FH:         Relationship        Mortality             Age        Health Problems

               Mother                Deceased            54           Diabetes Mellitus II

               Father                  Deceased            75           CAD

               Daughter             Deceased            20           MVA

               Son                       Alive                     45           None

ROS:

General: Denies weight loss, fatigue until the last 3 days, generally eats well

Skin: Denies  birthmarks, scars, no previous rashes

HEENT: Denies dizziness, head trauma, vision trouble, does wear glasses, Had cataract surgery in L eye , denies swallowing problems, nasal congestion, 

Neck: Denies lumps, pain, stiffness

Resp: Denies dyspnea or pain, cough, wheezing

Cardiac: Denies chest pain, or edema of extremities, Has had an irregular heart rhythm “for years”

Gastrointestinal: Denies nausea, vomiting, diarrhea or abdominal pain

Genitourinary:  Denies hematuria, dysuria, or odor

Musculoskeletal: Denies back pains, Admits to knee pain with difficulty walking

Neurological:  Denies seizures, limb weakness, headaches, loss of consciousness

Psychological: Denies depression/anxiety. No suicidal/homicidal ideations.

She likes to color and work on puzzles but sometimes “I loose pieces” that makes me angry.

 

MSN610 Diagnostic Reasoning and Advanced Physical Assessment

Module 1 Assignment  

Differential Diagnoses Table

Complete and Submit the Differential Diagnoses Table for Module 1 using information from Stern, S., Cifu, A., and Altkorn, D., (2015). Symptom to Diagnosis. 3rd edition to complete the table.

Read  pages 179-183, 341-342, and  Chapters 18 (Fatigue) and 32 (Unintentional Weight Loss). Chapters 18 and 32 can be associated with generalized symptoms i.e. Fever.

This assignment is designed to assist you in the development of differential diagnoses based on the signs/symptoms,and physical findings of specific disease entities. You will also begin examining the commonly used laboratory, radiological and other diagnostic studies to identify the diagnosis (rule in) and/or exclude the diagnosis (rule out).

Within the table there are identified diagnoses listed that may be associated with a chief complaint. You are to complete each column for each disease entity.

The Epidemiology Data includes the population you would see this diagnosis occur i.e. pediatrics, adult females/males, elderly, etc. Condense this information as you would in the “Illness Script” described in the Medical Media software.

List the  subjective data:  that is what a patient may tell you. Also, list the physical findings of that disorder. This is the objective data that you would discover on exam. Then list 3 other differential diagnosis that may present with the same chief complaint to begin grouping pattern recognition.

USE BULLET POINTS. This is not a narrative

Finally, list any diagnostic testing you would use to finalize the diagnosis and the references used to complete the table. All citations should be in APA format. References should be listed at the bottom of the table. For Module 3  Use ONLY peer review articles for references as Stern does not cover Mental Health in his textbook.

 

MSN610 Diagnostic Reasoning and Advanced Physical Assessment

Module 2 Assignment

Differential Diagnoses Table

Within the table there are identified diagnoses listed that may be associated with a chief complaint. This assignment will focus on additional diagnoses within the Skin, HEENT and Neck body systems.

Read Chapters 14 (Dizziness), 20 (Headache), 29 (Rash) and 30 (Sore Throat) within Stern, Cifu & Altkorn to complete your table.  Use Bullet Points !!

Complete the table and submit to your faculty by the due date.

You are to submit the table within CANVAS for each module. This table is to be used as a collective tool throughout the course and may be used to help study for your credentialing exam.

 

 

Chief Complaint	Differential Diagnoses	Epidemiology	Other Differential Diagnoses to Consider (List 3 and consider the Do Not Miss Diagnoses)	Signs and Symptoms List 5  Subjective Data Points (Presentation & Symptom Analysis)	Physical Findings  List 5 Objective Key Features (Highest LR+ or High Specificity)	Diagnostic Tests List 1-3 most specific  to this disease entity
MODULE 1:  GENERAL	Multisystem Disorders
Fever	Influenza
Module 2: Dermatological,	HEENT & Neck Disorder
Rash	Cellulitis
	Benign Positional Vertigo

 

 

 

 

 

MSN610 Diagnostic Reasoning and Advanced Physical Assessment

Module 3 Assignment

Within the table there are identified diagnoses listed that may be associated with a chief complaint for mental health, substance abuse or seen in the pediatric population. You are to utilize other resources to list the signs/symptoms and physical findings of that disorder. Also include in what patient population this disorder may be seen.

READ Chapter 11 (Dementia/Delirium) in Stern, Cifu, and Altkorn.

You will also need to perform a journal search for a peer-reviewed article for each of these diagnoses. WEB MD is NOT acceptable. Document the reference article used beneath the table.

You are to submit the table within CANVAS for each module by the due date. This table is to be used as a collective tool throughout the course and may be used to help study for your credentialing exam.  Remember: BULLET Points Only.

Module 3: Mental,	Substance Abuse &	Pediatric Disorders
Forgetfulness	Attention Deficit Disorder
	Chemical Dependency
	Concussion Syndrome
Headache	Migraine

 

MSN610 Diagnostic Reasoning and Advanced Physical Assessment

Module 4 Assignment

Within the table, there are identified diagnoses listed that may be associated with a chief complaint for the cardiovascular and respiratory systems .

Read Chapters 9 (Chest Pain), 15 (Dyspnea), 17 (Edema), 31 (Syncope) and 33 (Wheezing) from Stern, CIFU and Altkorn (2015) to assist in the completion of your table.

Finally, list any diagnostic testing you would use to finalize the diagnosis and the references used to complete the table.

You are to submit the table within CANVAS for each module by the due date. This table is to be used as a collective tool throughout the course and may be used to help study for your credentialing exam.

Each diagnosis is worth 1.0 points (.20 points for each column)

Module 4:	Cardiovascular & Resp	Disorders
Edema	Venous Insufficiency
	Deep Vein Thrombosis
Dyspnea	Community Acquired Pneumonia
	Congestive Heart Failure
Palpitations	Sick Sinus Syndrome

 

MSN610 Diagnostic Reasoning and Advanced Physical Assessment

Module 5 Assignment

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