The physical and emotional well-being of patients and families can be complex and multifaceted. Advanced practice nurses need to have the knowledge and ability to provide safe, competent, and comprehensive physical health assessments. Students in this course focus on concepts and skills to assess patients across the lifespan. They learn to use diagnostic reasoning, advanced communication, and physical assessment skills to identify changes in health patterns. Students also will explore preventative health through risk evaluation of healthy individuals as a central theme of clinical practice in addition to the assessment of patients with acute and chronic health problems. The advanced skills of suturing, reading 12 Lead EKGs, and interpreting X-rays will be covered. Course assignments emphasize risk assessment, diagnostic reasoning, and evidence-based assessment across the lifespan.  

Welcome to Advanced Health Assessment, one of our foundation courses for APRN students. In this course, you will learn the importance of gathering an advanced health history, detailed documentation of your patient encounter, and performing the skills of an advanced nurse practitioner in order to provide patient care. No longer are the days of “following Dr’s orders”, you are learning how to be the provider that “writes the orders” based on the assessment of your patient.

In this online program, your advanced health assessment skills will be thoroughly evaluated via several assignments throughout the course. Your readiness to move on to a clinical course is a critical part of passing this course as we move to meeting the course objectives.

As an introduction to the course, we have provided you with two case study samples for your review and self-critique as you prepare to begin the course.

Case Study #1

“Patient JB, 39 yo Caucasian female, is seen by her care provider for a complaint of productive cough, weakness, and “I just haven’t felt good for the past 2 weeks.” The care provider completes an assessment of listening to her lungs by having her take 2 deep breaths and informs her that her lungs are clear and to take OTC cough medication and hydrate well. The next day, JB feels worse and visits a different care provider who at this time, assesses her head, eyes, ears, nose, throat, auscultates her heart sounds and hears a murmur (which she did not know she had), auscultates her lungs by having her to take 4 deep breaths, performs percussion techniques, and tells her there is fluid on her lungs, examines her lower extremities and notices that there is bilateral  2+ pitting edema, and lastly, reviews her vital signs and tells her that her heart rate is 120, respirations are 22, and she has a temp of 101.

Questions:

1.)   Is the health history about the patient’s complaint thorough?

2.)   Which provider’s examination would provide the patient with an accurate diagnosis and treatment plan?

3.)   What diagnoses (we call them differential diagnoses) would be considered, and how would you rule them out to come up with an actual diagnosis?

Case Study #2

HS, an otherwise healthy 45-year-old AA male, had been treated for months with a diagnosis of GERD and gastritis. As the symptoms continued to progress with the current treatment, HS received a second opinion and was diagnosed with colon cancer. HS proceeded with surgery and the surgery went well, the biopsies came back that the margins were clear, and the cancer had been removed. Not long after, HS complained of excruciating pain to the assigned nurse. HS was told to relax because “he’d just had abdominal surgery and it was gas pains and/or bad indigestion.”

Questions:

1.)   What questions would the APRN ask to obtain more details about this patients’ complaint?

2.)   Which body systems would be examined by the APRN to provide HS with an explanation of his pain?

3.)   What other concerns would you have for this patient that had just had surgery?

4.)   Would additional labs and imaging be appropriate? If so, what would you order and why?