NURS 6512 Discussion Assessing Musculoskeletal Pain -

Sample Answer for NURS 6512 Discussion Assessing Musculoskeletal Pain Included After Question

The body is constantly sending signals about its health. One of the most easily recognized signals is pain. Musculoskeletal conditions comprise one of the leading causes of severe long-term pain in patients. The musculoskeletal system is an elaborate system of interconnected levers that provides the body with support and mobility. Because of the interconnectedness of the musculoskeletal system, identifying the causes of pain can be challenging. Accurately interpreting the cause of musculoskeletal pain requires an assessment process informed by patient history and physical exams.

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

To prepare:

By Day 1 of this week, you will be assigned to one of the following specific case studies for this Discussion. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
Your Discussion post should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes have specific data included in every patient case.
Review the following case studies:

Case 1: Back Pain

Photo Credit: University of Virginia. (n.d.). Lumbar Spine Anatomy [Photograph]. Retrieved from http://www.med-ed.virginia.edu/courses/rad/ext/5lumbar/01anatomy.html. Used with permission of University of Virginia.

A 42-year-old male reports pain in his lower back for the past month. The pain sometimes radiates to his left leg. In determining the cause of the back pain, based on your knowledge of anatomy, what nerve roots might be involved? How would you test for each of them? What other symptoms need to be explored? What are your differential diagnoses for acute low back pain? Consider the possible origins using the Agency for Healthcare Research and Quality (AHRQ) guidelines as a framework. What physical examination will you perform? What special maneuvers will you perform?

Case 2: Ankle Pain

Photo Credit: University of Virginia. (n.d.). Lateral view of ankle showing Boehler’s angle [Photograph]. Retrieved from http://www.med-ed.virginia.edu/courses/rad/ext/8ankle/01anatomy.html. Used with permission of University of Virginia.

A 46-year-old female reports pain in both of her ankles, but she is more concerned about her right ankle. She was playing soccer over the weekend and heard a “pop.” She is able to bear weight, but it is uncomfortable. In determining the cause of the ankle pain, based on your knowledge of anatomy, what foot structures are likely involved? What other symptoms need to be explored? What are your differential diagnoses for ankle pain? What physical examination will you perform? What special maneuvers will you perform? Should you apply the Ottawa ankle rules to determine if you need additional testing?

Case 3: Knee Pain

Photo Credit: University of Virginia. (n.d.). Normal Knee Anatomy [Photograph]. Retrieved from http://www.med-ed.virginia.edu/courses/rad/ext/7knee/01anatomy.html. Used with permission of University of Virginia.

A 15-year-old male reports dull pain in both knees. Sometimes one or both knees click, and the patient describes a catching sensation under the patella. In determining the causes of the knee pain, what additional history do you need? What categories can you use to differentiate knee pain? What are your specific differential diagnoses for knee pain? What physical examination will you perform? What anatomic structures are you assessing as part of the physical examination? What special maneuvers will you perform?

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 8”) with “Review of Case Study ___.” Fill in the blank with the number of the case study you were assigned.

By Day 3 of Week 8

Post an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Read a selection of your colleagues’ responses.

By Day 6 of Week 8

Respond to at least two of your colleagues on 2 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.

A Sample Answer For the Assignment: NURS 6512 Discussion Assessing Musculoskeletal Pain

Title: NURS 6512 Discussion Assessing Musculoskeletal Pain

Subjective

Chief Concern (CC): I’ve been having dull pain in both of my knees, and I have also noticed that my knee and sometimes both of them click.”

History of Physical Illness (HPI): 15-year-old male patient presents today with a history of dull pain in both knees. The patient is concerned that one or both knees intermittently click, and he feels something catch below the patella (Walden University, n.d.).

Additional History Needed to Determine Cause of Knee Pain:

As a future APRN, it would be important to know if the patient’s pain is acute or chronic. I would use a mnemonic, such as OLDCARTS, to guide me as I interview the patient (Ball et al., 2019). Questions that I would want to know from the patient would include: Does the clicking sound occur with knee movement? How often does the clicking sound occur? Has the patient sustained any recent injuries? I would be interested to know what makes the pain worse and better. Additionally, I want to know the treatments the patient has used for his knee pain (e.g., rest, ice [or heat], elevate, immobilize, non-steroid inflammatory drugs, or acetaminophen). I would conduct the interview with the parent or caregiver out of the room, and then with the patient’s permission, ask the parent for more information.

Categories to Differentiate Knee Pain:

There are different categories to differentiate knee pain: bones, cartilage, ligaments, muscles, and tendons (National Institute of Arthritis and Musculoskeletal and Skin Diseases [NIAMS], n.d.). Each of these categories has conditions with clinical presentations, such as arthritis (bones and cartilage), chondromalacia and meniscus injury (cartilage), anterior and posterior cruciate ligaments injuries (ligament), tendinitis (tendon), and more (NIAMS).

Medications:

Name, dosage, frequency, indication for taking medication, and last dosage should be noted.
Medications should include prescribed, over the counter, vitamins, minerals, supplements, and complementary alternative medications (Ball et al., 2019).

Past Medical History (PMH):

NURS 6512 Discussion Assessing Musculoskeletal Pain

Recent trauma
Cancer
Connective tissue disorders (e.g., Marfan’s syndrome)
Juvenile Rheumatoid Arthritis
Hemophilia
Osteoporosis
Renal
Neuromuscular disorders
Neurological disorders

Past Surgical History (PSH):

Orthopedic surgeries or procedures, such as arthroplasty

Family History [FH]: (Ball et al., 2019)

Arthritis
Abnormalities of the hips, knees, or feet
Osteogenesis imperfecta
Hypophosphatemia
Hypercalciuria
Marfan’s Syndrome

Social History (SH)

Information needs to be collected regarding the patient’s usage of tobacco products, alcohol, or illicit drugs. It is essential to get a baseline assessment of the patient’s usual activity of daily living. Is the patient involved in organized sports (e.g., soccer, football, baseball, basketball, martial arts)? I would also gather information about the patient’s average diet, including a balanced diet with protein and nutrients to help heal his condition.

Allergies:

Allergies to prescribed medications, over-the-counter medications, vitamins, minerals, and supplements should be noted with the type of reaction and severity.

Immunizations:

Review of current immunizations that should include last T-dap, Influenza, and COVID-19 boosters, and vaccines.

Review of Systems (ROS)

General

Recent fatigue, malaise, fever, chills, night sweats, unusual bruising, unusual bleeding, and unintentional weight loss will need to be asked of the patient.

Cardiovascular:

Inspection, percussion, palpation, and auscultation of the heart are part of all focused episodic exam.

Pulmonary:

Inspection, percussion, palpation, and auscultation of the lungs are also part of a focused episodic exams.

Musculoskeletal:

Inspection, percussion, palpation, and auscultation of both knees will be performed.

Physical Examination Performed (Ball et al., 2019)

Inspect knees for symmetry, concavity, and contour in the flexed and extended positions.
Observe the patient’s lower legs for alignment, specifically the femur and tibial angle should be at or less than 15 degrees to rule out either genu valgum or genu varum.
Palpate popliteal and joint space in the flexed and extended positions.
Test the patient’s range of motion (e.g., flexion-130 degrees, extension-0 to 15 degrees).
Test the patient’s strength during flexion and extension while providing oppositional force against movement.

Anatomic Structures Being Assessed (Ball et al., 2019)

Patella
Meniscus
Anterior and Posterior Cruciate Ligaments
Lateral and Medial Ligaments

Special Maneuvers Performed (Lee et al., 2017; Ball et al., 2019)

Hughston’s Plica Test
Strutter Test
Ballottement test
Bulge test
McMurray Test
Apley Test
Thessaly Test
Anterior and Posterior Drawer Test
Lachman Test
Varus and Valgus Stress Tests

Objective

Vital Signs: (VS) height, weight, body/mass index (BMI), or vital signs

General: patient’s race, patient’s preference for gender identity will be ascertained.

Cardiovascular: The patient’s heart sounds (e.g., nl S1, nl S2, S3, S4), murmurs (e.g., type and location), adventitious sounds, clubbed fingers, capillary refill, jugular vein distension, carotid bruits or thrills, pedal edema would be noted in this section.

Pulmonary: Breath sounds in all areas of the anterior and posterior lungs (e.g., bronchial, bronchovesicular, vesicular, dull, resonant, and hyper-resonant) would be noted.

Musculoskeletal- symmetry, skin condition (e.g., bruising), swelling, pain with range of motion, and effusion around knee should be noted.

Diagnostic Tests:

Radiograph of knees would be indicated this patient if it was determined his condition was secondary to an acute knee injury with the following findings: tenderness at fibula head, patella tenderness that is isolated, and the inability of the patient to flex his knee at a 90-degree angle (Ball et al., 2019). The patient has bilateral knee pain, which decreases the probability of malignancy; however, I would consult with my preceptor regarding ordering X-rays of his knees to rule out bony pathology.
An MRI may be indicated if the patient has an injury to the medial or lateral meniscus and to the anterior or posterior cruciate ligaments (Rastegar et al., 2016). I would consult with my preceptor if the patient had a positive McMurray test before ordering an MRI. Additionally, if the patient’s symptoms did not improve with therapy, I would again consult with my preceptor about ordering an MRI for this patient.
CBC with differential-if indicated depending on the patient’s H&P (Thatayatikom, 2021).
Sedimentation rate-if indicated depending on the patient’s H&P (Thatayatikom, 2021).
Anti-nuclear antibody test- if indicated depending on the patient’s H&P (Thatayatikom, 2021).
Rheumatoid factor- if indicated depending on the patient H&P’s (Thatayatikom, 2021).

Assessment

Differential Diagnosis according to Song et al. (2018); Lee et al. (2017):

Synovial Infrapatellar Plica Syndrome of the knee is associated with anterior knee pain and clicking or popping sounds (Casadei & Kiel, 2021). The authors report that plica, a thick fibrotic band of tissue extending from a synovial joint, most commonly the knee[s] becomes inflamed due to overuse. Bilateral anterior knee pain is common. This patient has clicking sounds with pain around the knees. This diagnosis needs to be supported by more evidence from the history and physical of the patient.
Medial or Lateral Meniscal Tears are associated with knee sounds such as clicking, catching, and locking around the knee (Bhan, 2020). The author reports meniscal tears are common, and MRIs are inevitably required to confirm a diagnosis. This patient has bilateral clicking noise and a sensation of catching to the back of his knees.
Patellar Tendinopathy, commonly referred to as ‘Jumpers Knee’ is caused by small tears to the patella tendon that can be painful (Santana et al., 2021). The authors note this condition is seen with sporting activities that require jumping. The patient is complaining of dull pain in both knees. It is essential to gather more subjective and objective data from this patient and possibly his parents for an accurate working diagnosis.
Patellofemoral pain syndrome is characterized by anterior knee pain reproduced with running, climbing, and squatting (Bump & Lewis, 2021). The authors report patients generally describe an achy pain located around the knee. This diagnosis is part of the differential because the patient is experiencing pain around the knee. However, more information is required to give a presumptive diagnosis.
Anterior Cruciate Ligament Sprain or Tear is considered the most common injury to a knee ligament associated with sporting activities such as football, soccer, and basketball (Evans & Nielson, 2021). The authors state that the injury sustained to the ACL is most commonly a non-contact injury seen with skiers, soccer players, and basketball players from rotational movements. Patients generally complain of a popping sound and the knee giving out (Evans & Nielson). The patient is not complaining of a popping sound but rather a clicking sound with a catching sensation under the patella. This diagnosis is less likely because of the patient’s clinical presentation.
Juvenile Rheumatoid Arthritis (JRA) is diagnosed in patients younger than 16 years of age with joint and soft tissue pain (Thatayatikom, & Modica, 2021). An inflammatory, autoimmune process must be considered, especially if there is a family history of autoimmune disorders.
Osteochondrosis is also known as Osgood Schlatter disease, is a frequent cause of adolescent knee pain (Smith & Varacallo, 2020). The authors state it is caused by repetitive athletic movements seen more often in boys 12 to 14 years of age. They report that patients complain of anterior knee pain caused by microvascular tears and swelling when a piece of the tendon pulls away from the patella (NIAMS, n.d.). This diagnosis is less likely because the patient is complaining of dull bilateral pain to the knees, and he is not complaining of a bony bump to his kneecap, which is common with this disorder.

Primary Diagnosis/Presumptive Diagnosis

Synovial Infrapatellar Plica Syndrome.

Plan

This section is not required for the assignment in this course (NURS 6512) but will be required for future courses.

References

Ball, J.W., Dains, J.E., Flynn, J.A., Solomon, B.S., & Stewart, R.W. (2019). Seidel’s guide to

physical examination: An interprofessional approach, (9^th ed.). Elsevier.

Bhan, K. (2020). Meniscal tears: Current understanding, diagnosis, and management. Cureus,

12(6), e8590. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7359983/

Bump, J.M., & Lewis, L. (2021, May 8). Patellofemoral syndrome. In: StatPearls. StatPearls

Publishing. http://www.ncbi.nlm.nih.gov/books/NBK557657/

Casadei, K., & Kiel, J. (2021, April 19). Plica syndrome. In: StatPearls. StatPearls Publishing.

https://www.ncbi.nlm.nih.gov/books/NBK535362/

Evans, J., & Nielson, J.L. (2021, February 19). Anterior cruciate ligament knee injuries. In:

StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499848/

Lee, P., Nixon, A., Chandratreya, A., & Murray, J.M. (2017). Synovial plica syndrome of the

knee: A commonly overlooked cause of anterior knee pain. Surgery Journal, 3(1), e9-e16. https://doi.org/10.1055/s-0037-1598047

National Institute of Arthritis and Musculoskeletal and Skin Diseases. (n.d.). Knee problems.

https://www.niams.nih.gov/health-topics/knee-problems#tab-symptoms

Rastegar, S., Motififard, M., Nemati, A., Hosseini, N.S., Tahririan, M.A., Rozati, S.A., Sepiani,

M., & Moezi, M. (2016). Where does magnetic resonance imaging stand in the diagnosis of knee injuries? Journal of Research in Medical Sciences: The Official Journal of Isfahan University of Medical Sciences, 21,(52). https://doi.org/10.4103/1735-1995.187256

Santana, J.A., Mabrouk, A., & Sherman, A.L. (2021, March 17). Jumpers Knee. In: StatPearls.

StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK532969/

Smith, J.M., & Varacallo, M. (2020, July 29). Osgood Schlatter disease. In: StatPearls,

StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441995/

Song, S.J., Park., C.H., Liang, H., & Kim, S.J. (2018). Noise around the knee. Clinics in

Orthopedic Surgery, 10(1), 1-8. https://doi.org/10.4055/cios.2018.10.1.1

Thatayatikom, A., & Modica, R., & de Leucio, A. (2021, January). Juvenile idiopathic arthritis.

In: StatPearls, StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK554605/

Walden University. (n.d.). Case 3: Knee pain: Advanced health assessment. www.waldenu.edu.

Case 3: Knee Pain

Click here to ORDER an A++ paper from our MASTERS and DOCTORATE WRITERS: NURS 6512 Discussion Assessing Musculoskeletal Pain

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

To prepare:

By Day 1 of this week, you will be assigned to one of the following specific case studies for this Discussion. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
Your Discussion post should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes have specific data included in every patient case.
Review the following case studies:

Case 1: Back Pain

Case 2: Ankle Pain

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.

By Day 3 of Week 8

Read a selection of your colleagues’ responses.

By Day 6 of Week 8

Submission and Grading Information

Grading Criteria

To access your rubric:

A Sample Answer 2 For the Assignment: NURS 6512 Discussion Assessing Musculoskeletal Pain

Title: NURS 6512 Discussion Assessing Musculoskeletal Pain

S.
CC: “Ankle Pain”
HPI: The patient is a 46-year-old woman experiencing pain in both ankles, although the right one feels more severe. The agony started over the weekend when she was playing soccer and heard a sound in her ankles, which might have been because of joint dislocation during the game. The ankle pain is due to the rapture of the Achilles tendon at the back of the leg. The aching is around the ankle region and it is accompanied by discomfort, despite her manageable weight. The patient has tried using analgesics to relieve the pain.

Medication: Analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) to relieve pain (Foster et al., 2018).

PMH: Manageable weight and positive for avulsion fracture and joint inflammation.

FH: The patient is married to a 55-year-old African American man, whose mother died from arthritis. No history of cardiovascular diseases. The patient lacks a family history of stroke, respiratory disorders, and cardiac illnesses.

SH: Negative for substance use, does not consume alcohol, previously engaged in different physical activities, and has been married for eighteen years.

Allergies: Cold environment, proteins, and animal furs, such as cats’ and dogs’.

Immunization: A double dose of the COVID-19 vaccine.

ROS

General: The patient records mild chills, headache, and fever. No breathing difficulties. Mild joint pain and general body discomfort.

Respiratory: The breathing pathways are clear, no shortness of breath, and no inflammation in the lungs.

Blood cell count: The patient has a healthy blood count, strong red blood cells, and an efficient supply of oxygen to the brain and other body tissues.

Arthritis: The patient has joint pains, mild friction at the ankle, redness of the ankle bone, ruptured Achilles tendon, swollen muscles, and damaged and deformed joints.

Diabetic ulcers: No diabetic wound, the patient reports mild venous, and arterial ulcers.

Obesity: The patient reports a manageable weight, enjoys healthy sleeping patterns, no sleep apnea, and no reported varicose veins and gallstones.

VS: BP 185/104; P 95; R 24; T 97.0; 02 95% Wt 230lbs; Ht 69

General: The patient is in mild pain, uncomfortable, and strains to walk due to agony.

Respiration: The patient breathes eighteen times per minute

Heartbeat is normal

No recorded chest pains

No dyspnea, tachypnea, hypopnea, and hyperpnea

Blood cell count: The hemoglobin count is 15.2 g/dL, white blood cells are 4.7 billion cells per liter, and platelets are 214 billion per liter.

Arthritis: The patient records sufficient synovial fluids, inflammation of the ankle bone, and ruptured Achilles tendon.

Diabetic wound: No cuts on the dermis.

Obesity: Weight is 230lbs and height is 69

Differential diagnoses:

Chest pain: Ruptured tendons lead to the damaging of veins and arteries, resulting in excessive pain (Liu et al., 2020). The rationale for chest pain assessment is to identify damage to the tendons and blood vessels, which leads to excessive agony.

Abdominal pain: The musculoskeletal system consists of the entire bones, and damage to the abdomen can affect the limbs, leading to ankle pain (Dains et al., 2018)

Mobility assessment: Patients with affected legs experience pain in the limb, back, and lower abdomen. Assessment of mobility is important to identify the affected musculoskeletal region impacting the limbs (Ball et al., 2019).

Back pain: The back hosts the spinal cord that anchors the skeletal system. Examining the causes of back pain helps note the damage to the spine, which may affect other anchoring organs (Sullivan, 2019).

Arthritis: Friction in the joints causes pain (Hicks et al., 2020). Testing for arthritis helps identify the underlying causes of joint and ankle ache in the limbs.

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9^th ed.). Elsevier Mosby.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2018). Advanced health assessment and clinical diagnosis in primary care (5^th ed.). Elsevier Mosby.

Foster, N. E., Anema, J. R., Cherkin, D., Chou, R., Cohen, S. P., Gross, D. P., Ferreira, P. H., Fritz, J. M., Koes, B. W., Peul, W., Turner, J. A., Maher, C. G., Buchbinder, R., Hartvigsen, J., Cherkin, D., Foster, N. E., Maher, C. G., Underwood, M., van Tulder, M., . . . Woolf, A. (2018). Prevention and treatment of low back pain: Evidence, challenges, and promising directions. The Lancet, 391(10137), 2368–2383. https://doi.org/10.1016/s0140-6736(18)30489-6

Hicks, C., Levinger, P., Menant, J. C., Lord, S. R., Sachdev, P. S., Brodaty, H., & Sturnieks, D. L. (2020). Reduced strength, poor balance and concern about falls mediate the relationship between knee pain and fall risk in older people. BMC Geriatrics, 20(94). https://doi.org/10.1186/s12877-020-1487-2

Liu, H., Zhang, J., Yu, J., Li, D., Jia, Y., Cheng, Y., Zhang, Q., Liao, X., Liu, Y., Wu, J., Zeng, Z., Cao, Y., Zeng, R., Wan, Z., & Gao, Y. (2020). Prognostic value of serum albumin-to-creatinine ratio in patients with acute myocardial infarction: Results from the retrospective evaluation of acute chest pain study. Medicine, 99(35). https://dx.doi.org/10.1097%2FMD.0000000000022049

Sullivan, D. D. (2019). Guide to clinical documentation (3^rd ed.). F. A. Davis.

Rubric Detail

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Content

Name: NURS_6512_Week_8_Discussion_Rubric

	Excellent	Good	Fair	Poor
Main Posting	Points Range: 45 (45%) – 50 (50%) “Answers all parts of the Discussion question(s) with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.	Points Range: 40 (40%) – 44 (44%) “Responds to the Discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth. Supported by at least three credible sources. Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.	Points Range: 35 (35%) – 39 (39%) “Responds to some of the Discussion question(s). One or two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors.	Points Range: 0 (0%) – 34 (34%) “Does not respond to the Discussion question(s) adequately. Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible sources. Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness	Points Range: 10 (10%) – 10 (10%) Posts main post by Day 3.	Points Range: 0 (0%) – 0 (0%) N/A	Points Range: 0 (0%) – 0 (0%) N/A	Points Range: 0 (0%) – 0 (0%) Does not post main post by Day 3.
First Response	Points Range: 17 (17%) – 18 (18%) “Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.	Points Range: 15 (15%) – 16 (16%) “Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.	Points Range: 13 (13%) – 14 (14%) “Response is on topic and may have some depth. Responses posted in the Discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.	Points Range: 0 (0%) – 12 (12%) “Response may not be on topic and lacks depth. Responses posted in the Discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Second Response	Points Range: 16 (16%) – 17 (17%) “Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.	Points Range: 14 (14%) – 15 (15%) “Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.	Points Range: 12 (12%) – 13 (13%) “Response is on topic and may have some depth. Responses posted in the Discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.	Points Range: 0 (0%) – 11 (11%) “Response may not be on topic and lacks depth. Responses posted in the Discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Participation	Points Range: 5 (5%) – 5 (5%) Meets requirements for participation by posting on three different days.	Points Range: 0 (0%) – 0 (0%) N/A	Points Range: 0 (0%) – 0 (0%) N/A	Points Range: 0 (0%) – 0 (0%) Does not meet requirements for participation by posting on three different days.
Total Points: 100

Excellent

Good

Fair

Poor

Main Posting

Points Range: 45 (45%) – 50 (50%)

“Answers all parts of the Discussion question(s) with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Points Range: 40 (40%) – 44 (44%)

“Responds to the Discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth. Supported by at least three credible sources. Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Points Range: 35 (35%) – 39 (39%)

“Responds to some of the Discussion question(s). One or two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors.

Points Range: 0 (0%) – 34 (34%)

“Does not respond to the Discussion question(s) adequately. Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible sources. Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style.

Main Post: Timeliness

Points Range: 10 (10%) – 10 (10%)

Posts main post by Day 3.

Points Range: 0 (0%) – 0 (0%)

N/A

Points Range: 0 (0%) – 0 (0%)

N/A

Points Range: 0 (0%) – 0 (0%)

Does not post main post by Day 3.

First Response

Points Range: 17 (17%) – 18 (18%)

“Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.

Points Range: 15 (15%) – 16 (16%)

“Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.

Points Range: 13 (13%) – 14 (14%)

“Response is on topic and may have some depth. Responses posted in the Discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

Points Range: 0 (0%) – 12 (12%)

“Response may not be on topic and lacks depth. Responses posted in the Discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.

Second Response

Points Range: 16 (16%) – 17 (17%)

Points Range: 14 (14%) – 15 (15%)

Points Range: 12 (12%) – 13 (13%)

Points Range: 0 (0%) – 11 (11%)

Participation

Points Range: 5 (5%) – 5 (5%)

Meets requirements for participation by posting on three different days.

Points Range: 0 (0%) – 0 (0%)

N/A

Points Range: 0 (0%) – 0 (0%)

N/A

Points Range: 0 (0%) – 0 (0%)

Does not meet requirements for participation by posting on three different days.

Total Points: 100

NURS 6512 Discussion Assessing Musculoskeletal Pain

Lopes Write Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.

Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.

Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?

Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

Your response needs to be a minimum of 150 words (not including your list of references)
There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
Include in-text citations in your response
Do not include quotes—instead summarize and paraphrase the information
Follow APA-7th edition
Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

A minimum of 6 responses per week, on at least 3 days of the week.
Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
Each response needs to be at least 75 words in length (does not include your list of references)
Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
Follow APA 7th edition
Points will be deducted if the above is not followed
Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
Here are some helpful links
Student paper example
Citing Sources
The Writing Center is a great resource